Clinical Neuroscience

[Hungarian Spine Association]

JANUARY 20, 1994

Clinical Neuroscience - 1994;47(01-02)

[Scientific activities of the Hungarian Spine Association in 1993. Further plans, ongoing scientific programmes.]

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Clinical Neuroscience

The changing face of neuroscience

LORD WALTON of Detchant

This paper is based upon three lectures one given in Australia in a symposiom in honour of Professor James Lance on his retirement, another delivered to the Russian Academy of Medical Sciences on 26 January 1993 and published in the procceedings of that annual symposium of the Academy. It is reproduced here with permission.

Clinical Neuroscience

The treatment of cluster headache

KARL Ekbom

Cluster headache attacks occur in series, lasting for weeks or months, that are separated by remission periods. However, in less than 15 %, patients suffer from a chronic syndrome, that is regular attacks for one year or longer. The spontaneous course of cluster headache may cause some problems when evaluating clinical trials. For instance, it may be difficult to decide whether an observed improvement is due to effects of the trial drug or to a spontaneous remission. Most studies published hitherto have used an open treatment app- roach – using a concomitant treatment – which is understandable, because the placebo effect has been regarded as being small in cluster headache. In fact, there are in the previous literature only few well-designed, randomised, double-blind clinical trials.

Clinical Neuroscience

[Visual P300 and early components in chronic schizophrenic patients (clinical, neurocognitive and biochemical correlates)]

BARTKÓ György, KUNDRA Olga, BOLLA Mariann, ZÁDOR György, SÁNTA Zsuzsa, HORVÁTH Szabolcs, ARATÓ Mihály

[P300 and early components of the visual event related potentials were compared in 26 chronic schizophrenic patients and 20 healthy subjects. The correlation between visual evoked response and clinical, neurocognitive, biochemical variables was analysed in schizophrenic group. Event related potentials in response to rare visual stimuli were recorded from central and occipital sites and 20 electrophysiological parameters were determined. Reaction time and proportion of correct recognition were also detected. The schizophrenic patients showed significant reduction is P300 amplitude. Differences in other components between groups were also demonstrated. The seven most important parameters were evaluated by discriminant analysis. The prolonged negative components latency and delayed reaction time suggest that the stimulus classification process is slower in schizophrenics, Using canonical correlation analysis three factors were found to be significant. The data showed that electrophysiological abnormality was highly correlated with chronicity of the illness, severe psychopathological features and cognitive deficit but was uncorrelated with negative symptoms and serum dopamine-beta-hydroxylase activity. These findings are compatible with other studies suggesting visual P300 has the characteristic of a state marker in schizophrenia.]

Clinical Neuroscience

[Intracerebral hemorrhages and their neurosurgical management in early infancy]

PARAICZ Ervin, KÓNYA Eszter

[The number of spontaneous intracerebral hemorrhages over early infancy has increased in the last years in Hungary. As possible cause maybe the lack of Vitamin K prophylaxis in our 19 cases. With regard to management mostly the semiinvasive treatment was succesful, the external drainage of the hemorrhage and CSF. Craniotomy was indicated only in 3 patients. The functional result was good in the majority of cases.]

Clinical Neuroscience

[Provocative myasthenia gravis and myasthenic syndromes]

SZOBOR Albert, KLEIN Magda

[Myasthenia gravis as a disease entity has long been known. With the inclusion of the paraneoplastic myasthenia syndrome, a wider area was encompassed by the disease, which became still wider by the description of different myasthenic syndromes in childhood. Recently quite a few provocative factors became known which can cause myasthenia gravis or some similar syndromes. One such-prominent-factor is D-penicillamine a drug widely used in rheumatology practice. A great number of cases were studied involving the provocative factors: D-penicillamine, the infectious diseases, drugs and other possible causes. After provocative factors myasthenia gravis disease, myasthenic syndrome with different clinical course and transitive myasthenic reaction with spontaneous remission may develop. The ability to distinguist between these conditions is important from both the therapeutic and prognostic points of view. Mild not known, or not recognized myasthenia gravis can in some cases be diagnosed by careful neurological examination and diagnostic tests. ]

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Fluoxetine use is associated with improved survival of patients with COVID-19 pneumonia: A retrospective case-control study

NÉMETH Klára Zsófia, SZÛCS Anna , VITRAI József , JUHÁSZ Dóra , NÉMETH Pál János , HOLLÓ András

We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

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

Electrophysiological investigation for autonomic dysfunction in patients with myasthenia gravis: A prospective study

NALBANTOGLU Mecbure, AKALIN Ali Mehmet, GUNDUZ Aysegul, KIZILTAN Meral

Myasthenia gravis (MG) is an autoimmune disorder of neuromuscular transmission. Autonomic dysfunction is not a commonly known association with MG. We conducted this study to evaluate autonomic functions in MG & subgroups and to investigate the effects of acetylcholinesterase inhibitors. This study comprised 30 autoimmune MG patients and 30 healthy volunteers. Autonomic tests including sympathetic skin response (SSR) and R-R interval variation analysis (RRIV) was carried out. The tests were performed two times for patients who were under acetylcholinesterase inhibitors during the current assessment. The RRIV rise during hyperventilation was better (p=0.006) and Valsalva ratio (p=0.039) was lower in control group. The SSR amplitudes were lower thereafter drug intake (p=0.030). As much as time went by after drug administration prolonged SSR latencies were obtained (p=0.043).Valsalva ratio was lower in the AchR antibody negative group (p=0.033). The findings showed that both ocular/generalized MG patients have a subclinical parasympathetic abnormality prominent in the AchR antibody negative group and pyridostigmine has a peripheral sympathetic cholinergic noncumulative effect.

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[LAM 30: 1990–2020. Facing the mirror: Three decades of LAM, the Hungarian medicine and health care system]

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Clinical Neuroscience

[The connection between the socioeconomic status and stroke in Budapest]

VASTAGH Ildikó, SZŐCS Ildikó, OBERFRANK Ferenc, AJTAY András, BERECZKI Dániel

[The well-known gap bet­ween stroke mortality of Eastern and Western Euro­pean countries may reflect the effect of socioeconomic diffe­rences. Such a gap may be present between neighborhoods of different wealth within one city. We set forth to compare age distribution, incidence, case fatality, mortality, and risk factor profile of stroke patients of the poorest (District 8) and wealthiest (District 12) districts of Budapest. We synthesize the results of our former comparative epidemiological investigations focusing on the association of socioeconomic background and features of stroke in two districts of the capital city of Hungary. The “Budapest District 8–12 project” pointed out the younger age of stroke patients of the poorer district, and established that the prevalence of smoking, alcohol-consumption, and untreated hypertension is also higher in District 8. The “Six Years in Two Districts” project involving 4779 patients with a 10-year follow-up revealed higher incidence, case fatality and mortality of stroke in the less wealthy district. The younger patients of the poorer region show higher risk-factor prevalence, die younger and their fatality grows faster during long-term follow-up. The higher prevalence of risk factors and the higher fatality of the younger age groups in the socioeconomically deprived district reflect the higher vulnerability of the population in District 8. The missing link between poverty and stroke outcome seems to be lifestyle risk-factors and lack of adherence to primary preventive efforts. Public health campaigns on stroke prevention should focus on the young generation of socioeconomi­cally deprived neighborhoods. ]