Clinical Neuroscience

[ Lectori salutem! A new class is introduced]

PETŐ Zoltán

JANUARY 20, 1994

Clinical Neuroscience - 1994;47(01-02)

[Principles of our thinking. The most important tasks. The purpose of our activity. Our structure and team.]

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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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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.

Lege Artis Medicinae

[A short chronicle of three decades ]

KAPRONCZAY Katalin

[Hungarian professional periodicals started quite late in European context. Their publish­ing, editing and editorial philosophy were equally influenced by specific historical and political situations. Certain breaking points of history resulted in termina­tion of professional journals (War of In­de­pendence 1848-1849, First and Se­cond World Wars), however there were pe­riods, which instigated the progress of sciences and founding of new scientific journals. Both trends were apparent in years after the fall of former Hungarian regime in 1990. The structure of book and journal publishing has changed substantially, some publishers fell “victim” others started successfully as well. The latters include the then-established publishing house Literatura Medica and its own scientific journal, Lege Artis Me­di­cinae (according to its subtitle: New Hun­garian Medical Herald) issued first in 1990. Its appearance enhanced significantly the medical press market. Its scientific publications compete with articles of the well-established domestic medical journals however its philosophy set brand-new trends on the market. Concerning the medical community, it takes on its problems and provides a forum for them. These problems are emerging questions in health care, economy and prevention, in close interrelation with system of public health institutions, infrastructure and situation of those providing individual health services. In all of them, Lege Artis Medicinae follows consequently the ideas of traditional social medicine.]

Lege Artis Medicinae

[Second game, 37th move and Fourth game 78th move]

VOKÓ Zoltán

[What has Go to do with making clinical decisions? One of the greatest intellectual challenges of bedside medicine is making decisions under uncertainty. Besides the psychological traps of traditionally intuitive and heuristic medical decision making, lack of information, scarce resources and characteristics of doctor-patient relationship contribute equally to this uncertainty. Formal, mathematical model based analysis of decisions used widely in developing clinical guidelines and in health technology assessment provides a good tool in theoretical terms to avoid pitfalls of intuitive decision making. Nevertheless it can be hardly used in individual situations and most physicians dislike it as well. This method, however, has its own limitations, especially while tailoring individual decisions, under inclusion of potential lack of input data used for calculations, or its large imprecision, and the low capability of the current mathematical models to represent the full complexity and variability of processes in complex systems. Nevertheless, clinical decision support systems can be helpful in the individual decision making of physicians if they are well integrated in the health information systems, and do not break down the physicians’ autonomy of making decisions. Classical decision support systems are knowledge based and rely on system of rules and problem specific algorithms. They are utilized widely from health administration to image processing. The current information revolution created the so-called artificial intelligence by machine learning methods, i.e. machines can learn indeed. This new generation of artificial intelligence is not based on particular system of rules but on neuronal networks teaching themselves by huge databases and general learning algorithms. This type of artificial intelligence outperforms humans already in certain fields like chess, Go, or aerial combat. Its development is full of challenges and threats, while it presents a technological breakthrough, which cannot be stopped and will transform our world. Its development and application has already started also in the healthcare. Health professionals must participate in this development to steer it into the right direction. Lee Sedol, 18-times Go world champion retired three years after his historical defeat from AlphaGo artificial intelligence, be­cause “Even if I become the No. 1, there is an entity that cannot be defeated”. It is our great luck that we do not need to compete or defeat it, we must ensure instead that it would be safe and trustworthy, and in collaboration with humans this entity would make healthcare more effective and efficient. ]

Clinical Neuroscience

Neuroscience highlights: The mirror inside our brain

KRABÓTH Zoltán, KÁLMÁN Bernadette

Over the second half of the 19th century, numerous theories arose concerning mechanisms involved in understanding of action, imitative learning, language development and theory of mind. These explorations gained new momentum with the discovery of the so called “mirror neurons”. Rizzolatti’s work inspired large groups of scientists seeking explanation in a new and hitherto unexplored area of how we perceive and understand the actions and intentions of others, how we learn through imitation to help our own survival, and what mechanisms have helped us to develop a unique human trait, language. Numerous studies have addressed these questions over the years, gathering information about mirror neurons themselves, their subtypes, the different brain areas involved in the mirror neuron system, their role in the above mentioned mechanisms, and the varying consequences of their dysfunction in human life. In this short review, we summarize the most important theories and discoveries that argue for the existence of the mirror neuron system, and its essential function in normal human life or some pathological conditions.

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.