Clinical Neuroscience

[Hungarian Society of Neurologists and Mental Physicians SZOTE neurological round table]

MARCH 20, 1996

Clinical Neuroscience - 1996;49(03-04)

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Clinical Neuroscience

Clinical perspectives of the new, reversible and selective MAO-A inhibitors

VOLZ H P, GLEITER C H, MÖLLER H J

The classical monoamine oxidase inhibitors are used with great care due to their potency to induce severe side effects caused by tyramine interactions from food. With the advent of reversible and selective inhibitors of monoamine oxidase type A their interaction potential was considerably reduced. The first compounds are brofaromine and moclobemide, the latter already, registered for five years in Europe. The paper reviews the essential pharmacological properties of both compounds and gives a survey of the relevant clinical trials. Their efficacy in major depression is established. Regarding therapy resistant depressions, a certain advantage of brofaromine seems to exist. Promising trials in social phobia and panic attacks have been performed with both drugs.

Clinical Neuroscience

[Use of subdural stips in presurgical evaluation of epileptic patients]

HALÁSZ Péter, PAPP László, VAJDA János, SÓLYOM András, CZIRJÁK Sándor

[The subdural strip-electrode technique was introduced in the eighties in the USA. An account is given here of the first Hungarian experience with this method using implantates developed by us. The properties of the electrodes and the use of the technique are described under chronic and intraoperative conditions. In 8 patients the strips were used to localize the pacemaker zone of the seizures in those cases where the scalp EEG and neuroimaging data were discordant. Two temporal, 4 frontal and 2 parietal lobe epileptic patients were studied. Sixty-six seizures were recorded and on 15 occasions the strips were used for intraoperative corticography. The chronically implanted electrodes provided safe conditions for recording and by means of these we obtained additional information in all the cases studied thereby contributing to the indication of surgery or in the rejection of a surgical solution. The mobility and flexibility of the strips make them an ideal tool for corticography. With the strips the invasivity of presurgical evaluation was reduced.]

Clinical Neuroscience

[Dysfunctional personality attitudes and depression amng adolescents suffering from migraine-type headache]

CSORBA János, FARKAS Viktor, MIHÁDÁK Katalin

[Authors compared a clinical sample of adolescent migraine patients (n=28) aequal in age mean sex ratio with a group of healthy control adolescents (n=68) to demonstrate some differential psychological characteristics of adolescents suffering from migraine. The Dysfunctional Attitude Scale (Burns) and Beck's Depression Inventory were used. The patient sample achieved an increased scores on Approval, Entitlement and Omnipotence scales as well as the group showed a greater total means of the DAS scale, but an unexpectedly lower level of Depressivity has been proved in the clinical sample. Both DAS variables and BDI characterize the two groups better, than clinical features, but besides sufficient sensitivity only moderate specificity was managed to achieve on classification by means of discriminant analysis. Migraneous adolescents do not suffer from depressivity, only gradual differences between the two samples have been found.]

Clinical Neuroscience

[Multiple aspects study of short term memory performance in two diagnostic groups of epileptic patients]

BARCS Gábor, VITRAI József, HALÁSZ Péter

[The short term verbal and the visuo-spatial memory performance of 37 temporal lobe, 30 idiopathic generalized epileptic patients, and 24 normal control individuals were studied by interactive computerized tests. The short term visuo-spatial memory performance of epileptic patients was basically determined by the Raven IQ and strongly influenced by the seizure frequency and sustained attention while the verbal memory performance seemed to be independent of these parameters. The verbal memory performance of temporal lobe epileptic patients on carbamazepine monotherapy was lower compared to the idiopathic generalized epileptic patients on valproate monotherapy and to the normal controls. The difference between the performance of temporal lobe epileptic patients and normal controls was statistically significant. The memory performance in the group of temporal lobe epileptics proved to be independent of the laterality of the affected side. Concerning the short term visuo-spatial memory, after the factors having influence on the memory were ruled out, there was no difference between the controls and patients. Memory performance was not influenced by the duration of the illness nor by the type of antiepileptics used. In a treatment resistant group of idiopathic generalized epileptic patients, without considering other factors having influences on the memory, the visuo-spatial memory performance was even lower than the performance of the temporal lobe epileptic patients.]

Clinical Neuroscience

[Intracranial respiratory epithelial cysts: report of two cases]

VARGA Zs, VAJTAI I, BODOSI M, VÖRÖS E

[The authors report two cases of leptomeningeal cysts with unusual histologic features. Both cysts originated in the subarachnoid space of the left Sylvian fissure, being solitary in one case and multiocular in the other. Symptoms in both cases were referable to intracranial space occupation. Both lesions were resected surgically. Microscopically, the cyst walls were predominantly lined with pseudostratified and ciliated columnar or non-keratinizing squamous epithelium reminiscent of various segments of the respiratory mucosa. Ependymal covering was present only focally. The cellular elements displayed a characteristic immunophenotype and there was evidence for mucin production. Intracranial respiratory epithelial cysts are distinctly rare. While a dysontogenic origin is presumed for such cysts are distinctly rare. While a dysontogenic origin is persumed for such cysts along the spinal cord, intracranial occurrences are most plausibly interpreted as a result of metaplastic transformation of the meningeal anlage induced by cyst expansion. ]

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Cases of inborn errors of metabolism diagnosed in children with autism

CAKAR Emel Nafiye, YILMAZBAS Pınar

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

JARABIN András János, KLIVÉNYI Péter, TISZLAVICZ László, MOLNÁR Anna Fiona, GION Katalin, FÖLDESI Imre, KISS Geza Jozsef, ROVÓ László, BELLA Zsolt

Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

Alexithymia is associated with cognitive impairment in patients with Parkinson’s disease

SENGUL Yildizhan, KOCAK Müge, CORAKCI Zeynep, SENGUL Serdar Hakan, USTUN Ismet

Cognitive dysfunction (CD) is a common non-motor symptom of Parkinson’s disease (PD). Alexithy­mia is a still poorly understood neuropsychiatric feature of PD. Cognitive impairment (especially visuospatial dysfunction and executive dysfunction) and alexithymia share com­mon pathology of neuroanatomical structures. We hypo­thesized that there must be a correlation between CD and alexithymia levels considering this relationship of neuroanatomy. Objective – The aim of this study was to evaluate the association between alexithymia and neurocognitive function in patients with PD. Thirty-five patients with PD were included in this study. The Toronto Alexithymia Scale–20 (TAS-20), Geriatric Depression Inventory (GDI) and a detailed neuropsychological evaluation were performed. Higher TAS-20 scores were negatively correlated with Wechsler Adult Intelligence Scale (WAIS) similarities test score (r =-0.71, p value 0.02), clock drawing test (CDT) scores (r=-0.72, p=0.02) and verbal fluency (VF) (r=-0.77, p<0.01). Difficulty identifying feelings subscale score was negatively correlated with CDT scores (r=-0.74, p=0.02), VF scores (r=-0.66, p=0.04), visual memory immediate recall (r=-0.74, p=0.01). VF scores were also correlated with difficulty describing feelings (DDF) scores (r=-0.66, p=0.04). There was a reverse relationship bet­ween WAIS similarities and DDF scores (r=-0.70, p=0.02), and externally oriented-thinking (r=-0.77,p<0.01). Executive function Z score was correlated with the mean TAS-20 score (r=-62, p=0.03) and DDF subscale score (r=-0.70, p=0.01) Alexithymia was found to be associated with poorer performance on visuospatial and executive function test results. We also found that alexithymia was significantly correlated with depressive symptoms. Presence of alexithymia should therefore warn the clinicians for co-existing CD.

Clinical Neuroscience

[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Evaluation of the effectiveness of transforaminal epidural steroid injection in far lateral lumbar disc herniations

EVRAN Sevket, KATAR Salim

Far lateral lumbar disc herniations (FLDH) consist approximately 0.7-12% of all lumbar disc herniations. Compared to the more common central and paramedian lumbar disc herniations, they cause more severe and persistent radicular pain due to direct compression of the nerve root and dorsal root ganglion. In patients who do not respond to conservative treatments such as medical treatment and physical therapy, and have not developed neurological deficits, it is difficult to decide on surgical treatment because of the nerve root damage and spinal instability risk due to disruption of facet joint integrity. In this study, we aimed to evaluate the effect of transforaminal epidural steroid injection (TFESI) on the improvement of both pain control and functional capacity in patients with FLDH. A total of 37 patients who had radicular pain caused by far lateral disc herniation which is visible in their lumbar magnetic resonance imaging (MRI) scan, had no neurological deficit and did not respond to conservative treatment, were included the study. TFESI was applied to patients by preganglionic approach. Pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores of the patients were compared with the 3rd week, 3rd month and 6th month scores after the procedure. The mean initial VAS score was 8.63 ± 0.55, while it was 3.84 ± 1.66, 5.09 ± 0.85, 4.56 ± 1.66 at the 3rd week, 3rd month and 6th month controls, respectively. This decrease in the VAS score was found statistically significant (p = 0.001). ODI score with baseline mean value of 52.38 ± 6.84 was found to be 18.56 ± 4.95 at the 3rd week, 37.41 ± 14.1 at the 3rd month and 34.88 ± 14.33 at the 6th month. This downtrend of pa­tient’s ODI scores was found statistically significant (p = 0.001). This study has demonstrated that TFESI is an effective method for gaining increased functional capacity and pain control in the treatment of patients who are not suitable for surgical treatment with radicular complaints due to far lateral lumbar disc hernia.