Clinical Neuroscience

[Informations for the candidates of the title of ”Doctor of the Hungarian Academy of Science”]

VÉCSEI László

OCTOBER 20, 2002

Clinical Neuroscience - 2002;55(09-10)

COMMENTS

0 comments

Further articles in this publication

Clinical Neuroscience

[Anxiety in epilepsy - based on two case reports]

BARAN Brigitta, FARKAS Márta, RAJNA Péter

[There are a great number of psychopathological symptoms which manifest themselves in 70-75% of epileptic patients but most of them remain unrecognised and untreated. These symptoms may affect the patients’ quality of life more negatively than the epileptic seizures themselves. Anxiety is one of the most frequently occurring interictal psychopathological symptom. A number of specialists agree that chronic epilepsy causes the amplification of endogenic seizure suppressing mechanisms which hinder the epileptic seizures and are responsible for the development of interictal psychopathological symptoms. However the physiological effects of the interictal psychopathological conditions (e.g. anxiety) have epileptogenic effect as well. There is a high chance that the conditions of epilepsy and anxiety will mutually create a destructive vicious circle and it will be illustrated by our two case reports. In our experience, before modifying the pharmacotherapy of a patient suffering from chronic epilepsy with increased frequency of seizures, the anxiety level should be defined; and if it is high it should be treated first. From our perspective, the so-called ”rational bitherapy” is very effective when a high potential antiepileptic drug is combined with an anxiety reducing method. The latter can be drug related or consists only of psychotherapy. We need more controlled clinical research to prove that inside epilepsy there are risk groups as well as conditions of high risk when the connection between anxiety and epilepsy is more than evident. The described cases seem to indicate that the existence of periictal anxiety can be a risk factor in developing later interictal anxiety.]

Clinical Neuroscience

[Dezsõ Miskolczy, the founder of modern neurology in Hungary]

PÁSZTOR Emil

Clinical Neuroscience

[The antinociceptive effect of kynurenic acid]

KÉKESI Gabriella, HORVÁTH Gyöngyi

[It is well known that glutamate receptors have significant role in the pain transmission. The activation of N-methyl-Daspartate receptors causes persistent pain, therefore the antagonists acting on these receptors cause antinociception in chronic pain states. As the synthetic N-methyl-D-aspartate receptor antagonists have several side effects, they are not used generally in the clinical therapy. The tryptophan metabolite kynurenic acid is an endogenous antagonist of N-methyl-D-aspartate receptors. Although some data proved its neuroprotective effect, only a few studies suggest the antinociceptive potential of kynurenic acid. The goal of this review to summarise the possible role of kynurenic acid in the pain therapy based on the results of animal studies. Data available concerning this subject demonstrated that kynurenic acid is not an appropriate agent for antinociception neither in single nor in continuous administration because of its side-effect resulting in motor deficiency. On the other hand the combination of low doses of kynurenic acid and endomorphin-1 provides effective antinociception without side-effects on inflammatory pain test, thus may offer a new treatment modality in human pain therapy.]

Clinical Neuroscience

[Kennedy’s syndrome - bulbo-spinal muscular atrophy]

SZABÓ Antal, MECHLER Ferenc

[Kennedy syndrome is a late-onset, bulbar-spinal type of muscular atrophy, with X-linked recessive inheritance. The characteristic features of the disease become prominent in the 4-5th decades: proximal muscle wasting and weakness, bulbar signs, fasciculations in skeletal muscles, subtle signs of endocrine dysfunction, such as gynaecomastia or testicular atrophy. The electrophysiological examinations are the keypoint to the diagnosis. Electroneurography shows normal conduction velocity in peripheral nerves, but the sensory nerves usually show axonal degeneration, which causes only very mild or subclinical neurological deficits. Electromyography shows chronic anterior horn cell degeneration in skeletal muscles. Molecular genetic diagnosis was introduced in 1991, when an abnormal expansion of CAG repeat was found in the first exon of the androgen receptor gene on chromosome X with a frequency of 100% in the affected population. Since the progression is very slow and these patients can expect a normal life span, it is essential to distinguish this syndrome from other, often more severe diseases, such as ALS. There is no proven therapy for Kennedy's disease yet. This is the first case of Kennedy's disease published in Hungary.]

Clinical Neuroscience

[The role of transcranial magnetic stimulation in clinical diagnosis: motor evoked potential (MEP)]

ARÁNYI Zsuzsanna, SIMÓ Magdolna

[Transcranial magnetic stimulation allows painless, non-invasive stimulation, neurophysiological evaluation of nervous structure covered by bone or difficult to access for other reasons. In the clinical setting the technique is mainly used for the investigation of the corticospinal tract (motor evoked potential: MEP). Based upon our experience with patients examined over the course of four years, we have attempted to highlight the clinical situations, where diagnostic help is provided by this technique. MEP in general has proved to be a sensitive and reliable examination. Its significance is apparent mainly in situations where clinical signs of corticospinal tract dysfunction are not evident, or they are masked by lower motoneurone involvement, and where neuroimaging techniques are not informative. The demonstration of subclinical corticospinal lesion is often essential to establish the diagnosis in multiple sclerosis and amyotrophic lateral sclerosis. The technique however received little attention so far with respect to its role in the diagnosis of various spinal cord disorders, and in the demonstration of intact corticospinal function in case of weakness, psychogenic in origin. We have endeavoured to provide further evidence in support of this, and thereby advocating a wider clinical application of the technique.]

All articles in the issue

Related contents

Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

[Decisional collisions between evidence and experience based medicine in care of people with epilepsy]

RAJNA Péter

[Background – Based on the literature and his long-term clinical practice the author stresses the main collisions of evidence and experience based medicine in the care of people with epilepsy. Purpose – To see, what are the professional decisions of high responsibility in the epilepsy-care, in whose the relevant clinical research is still lacking or does not give a satisfactory basis. Methods – Following the structure of the Hungarian Guideline the author points the critical situations and decisions. He explains also the causes of the dilemmas: the lack or uncertainty of evidences or the difficulty of scientific investigation of the situation. Results – There are some priorities of experience based medicine in the following areas: definition of epilepsy, classification of seizures, etiology – including genetic background –, role of precipitating and provoking factors. These are able to influence the complex diagnosis. In the pharmacotherapy the choice of the first drug and the optimal algorithm as well as the tasks during the care are also depends on personal experiences sometimes contradictory to the official recommendations. Same can occur in the choice of the non-pharmacological treatments and rehabilitation. Discussion and conclusion – Personal professional experiences (and interests of patients) must be obligatory accessories of evidence based attitude, but for achieving the optimal results, in some situations they replace the official recommendations. Therefore it is very important that the problematic patients do meet experts having necessary experiences and also professional responsibility to help in these decisions. ]

Journal of Nursing Theory and Practice

[The decaying health status of nurses]

NÉMETH Anikó, BETLEHEM József, LAMPEK Kinga

[Aim of the study: Investigating the changes in health status, medicine usage and frequency of taking sick-leaves among nurses. Sample and methods: Two cross-sectional studies were conducted in six Hungarian teaching hospitals in 2003 and in 2010 involving full time worker inpatient care nurses who were asked to complete a questionnaire developed by the researchers. Results: The self evaluated health status of nurses worsened since the first survey. Significantly more nurses suffered from chronic diseases and more of them are taking medicines regularly than in 2003. The biggest increment was measured in the rate of people with digestive and musculoskeletal disorders, with allergies, varicose veins and migraine. The number of days on sick-leave decreased significantly and there are more nurses who do not take sick-days when they are sick. Sleep disturbances, head and back aches also occur more often. Conclusions: Based on our data the nurse population is getting older and nurses suffer from numerous chronic diseases.]

Lege Artis Medicinae

[CHANGES IN SENSITIVITY OF NOSOCOMIAL GRAM-NEGATIVE PATHOGENS TO MEROPENEM AND ITS COMPARATIVE AGENTS DURING A FOUR-YEAR PERIOD (2000-2004) - ANALYSIS OF DATA FROM TWO PROSPECTIVE MULTICENTER STUDIES IN HUNGARY]

KONKOLY Thege Marianne, BÁN Éva

[INTRODUCTION - The clinical significance of Gram-negative infections has not diminished in recent years. The number of resistant and multiresistant isolates has increased among Gramnegatives similarly to Gram-positive bacteria. Moreover, panresistant strains (i.e. resistant to all available agents active against Gram-negatives) have emerged. A prospective, multicenter study carried out in 2000 was repeated in 2004 in order to have up to date knowledge of resistance situation of Gram-negative aerobic bacteria and Bacteroides fragilis. In addition, the local data of 2004 were compared to MYSTIC (Meropenem Yearly Susceptibility Test Information) database of year 2004. MATERIALS AND METHODS - The in vitro study protocol-guided was carried out in 20 microbiology laboratories from April 1 to November 15, 2004. Study strains were isolated from relevant samples taken in medical, surgical, haematology, infectious disease wards and intensive care units. The sensitivity of 2099 aerobic Gram-negative and 97 B. fragilis isolates to meropenem and its comparator agents with excellent Gram-negative and/or antianaerob activity was tested according to NCCLS (National Committee for Clinical Laboratory Standards). RESULTS - Meropenem and imipenem have almost retained their 100% activity against Enterobacteriaceae, Acinetobacter and B. fragilis. A very small number of carbapenem nonsusceptible isolates emerged among Enterobacter, Proteus and Acinetobacter strains. Meropenem and especially imipenem sensitivity of Pseudomonas aeruginosa decreased significantly over the 4-year interval (76% vs 67%). The difference between the meropenem and imipenem sensitivity of P. aeruginosa proved significant (<0.001) and a similar difference was found in MYSTIC Programme. The isolation frequency of extended spectrum β-lactamase (ESBL) producing Escherichia coli and Klebsiella strains was relatively low (4.1% and 8.5%, respectively) in Hungary comparing to that in other European countries. Only the carbapenems inhibited consistently the ESBLproducing strains whereas ceftazidime, cefepime and piperacillin/tazobactam were ineffective versus these strains. The rate of cefepime sensitive strains declined significantly in case of Enterobacter (82%), Citrobacter (90%), Acinetobacter (31%) and P. aeruginosa (69%), whereas it did not change among Serratia and Proteus strains. The activity of ceftazidim has decreased, as well: 61% of Enterobacter, 74% of Citrobacter, 15% of Acinetobacter and 78% of P. aeuginosa isolates were sensitive to it. A trend over time toward greater resistance was noted for piperacillin/tazobactam, however, it remained the most active in vitro agent against P. aeruginosa (83%). This rate is better than that was found in MYSTIC. There was not a clear trend in changes of sensitivity to aminoglycosides in Gram-negatives. A significant decrease in gentamicin and tobramycin sensitivity of E. coli and Klebsiella was noted (<90%), and in gentamicin, tobramycin and amikacin sensitivity of P. aeruginosa (57%, 65%, and 79%, respectively). Ciprofloxacin sensitivity also declined over the years: E. coli 85%, Proteus 83%, Acinetobacter 16%, P. aeruginosa 68%. Aztreonam and polymyxin sensitivity were examined only in case of P. aeruginosa because these two agents may be the drugs of choice in infections caused by multior panresistant strains: all isolates were susceptible to polymyxin, and 84% of them to aztreonam. However, panresistant isolates were not sensitive to aztreonam. Ampicillin/sulbactam may be a possible alternative drug in serious infections caused by multiresistant Acinetobacter: 83% of isolates showed sensitivity to it. Carbapenems, piperacillin/tazobactam and metronidazole were active against B. fragilis in 100%, amoxicillin/clavulanic acid resistance occurred scarcely, whereas clindamycin sensitivity was only 79%. CONCLUSIONS - There is no single antibacterial agent which would be effective against >90% of most frequently occurring Gram-negative aerobic bacteria in Hungary. The high increase in resistance rates over a relatively short 4-year period will result in serious challenges in the therapy. At the same time the Hungarian sensitivity rates are better than those reported by MYSTIC Programme.]

Clinical Neuroscience

[8th Hungarian Congress on Alzheimer Abstracts]