Clinical Neuroscience

[I. Scientific Forum of the SOTE Department of Psychiatry]

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.

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[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.]

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[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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[What happens to vertiginous population after emission from the Emergency Department?]

MAIHOUB Stefani, MOLNÁR András, CSIKÓS András, KANIZSAI Péter, TAMÁS László, SZIRMAI Ágnes

[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]

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[Affective temperaments (cyclothymic, hypertymic, depressive, anxious, irritable) are stable parts of personality and after adolescent only their minor changes are detectable. Their connections with psychopathology is well-described; depressive temperament plays role in major depression, cyclothymic temperament in bipolar II disorder, while hyperthymic temperament in bipolar I disorder. Moreover, scientific data of the last decade suggest, that affective temperaments are also associated with somatic diseases. Cyclothymic temperament is supposed to have the closest connection with hypertension. The prevalence of hypertension is higher parallel with the presence of dominant cyclothymic affective temperament and in this condition the frequency of cardiovascular complications in hypertensive patients was also described to be higher. In chronic hypertensive patients cyclothymic temperament score is positively associated with systolic blood pressure and in women with the earlier development of hypertension. The background of these associations is probably based on the more prevalent presence of common risk factors (smoking, obesity, alcoholism) with more pronounced cyclothymic temperament. The scientific importance of the research of the associations of personality traits including affective temperaments with somatic disorders can help in the identification of higher risk patient subgroups.]