Clinical Neuroscience


KOVÁCS Norbert, BALÁS István, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, DÓCZI Tamás, KOMOLY Sámuel

JANUARY 22, 2008

Clinical Neuroscience - 2008;61(01-02)

[Deep brain stimulation is a widely used technique for the treatment of movement disorders. This method is a breakthrough in treatment of drug-resistant idiopathic Parkinson’s disease, essential tremor and dystonia. The aim of the present paper is to give an inside overview of the postoperative management like fine tuning of the stimulation and balancing the antiparkinsonian medication. We also discuss the advantage of the use of the (Access Therapy) patient controller. After reviewing the stimulation-related side-effects and their management, the contraindicated medical procedures are discussed.]



Further articles in this publication

Clinical Neuroscience

[Functional magnetic resonance imaging in neurology (in English language)]


[The present contribution discusses the clinical use of functional MRI (fMRI) and its role in the most common neurological diseases. FMRI was found a reliable and reproducible examination tool resulting in a wide distribution of fMRI methods in presurgical evaluation of epilepsy in determining the relationship of eloquent areas and the epileptic focus. Preliminary data suggest that fMRI using memory paradigms can predict the postoperative memory decline in epilepsy surgery by determining whether a reorganization of memory functions took place. Speech-activated fMRI became the most used tool in determining hemispheric dominance. Visual and senso-motor cortex can also be routinely investigated by fMRI which helps in decision on epilepsy surgery. FMRI combined with EEG is a new diagnostic tool in epilepsy and sleep disorders. FMRI can identify the penumbra after stroke and can provide an additional information on metabolic state of the threatened brain tissue. FMRI has a predictive role in poststroke recovery. In relapsing-remitting MS an adaptive reorganization can be demonstrated by fMRI affecting the visual, motor, and memory systems, despite preserved functional performance. Much more extensive reorganization can be demonstrated in secondary progressive MS. These findings suggest that the different stages of MS are related to different stages of the reorganization and MS becomes progressive when there is no more reserve capacity in the brain for reorganization. FMRI offers the capability of detecting early functional hemodynamic alterations in Alzheimer’s disease before morphological changes. FMRI can be a valuable tool to test and monitor treatment efficacy in AD. FMRI can also provide information about the mechanisms of different therapeutic approaches in Parkinson disorder including drug treatment and deep brain stimulation.]

Clinical Neuroscience

[Complex regional pain syndrome]


[Complex regional pain syndrome is one of the frequently topics to be discussed during International Congresses. Three books have been published recently by the IASP Press (1994., 2001., 2005.) The aim of my publications is to draw the attention to this syndrome frequently unrecognized, and to summarize an interesting case report.]

Clinical Neuroscience


KOVÁCS Gábor Géza, KŐVÁRI Viktor, NAGY Zoltán

[Background - Dementia is an increasing problem of the society. The underlying cause of dementia may be difficult to diagnose during life. Only neuropathological examination gives definite diagnosis. Differences in the reported frequency may be related to factors such as the age or gender of subjects with dementia. Materials and methods - In our neuropathology-based study we examined 156 consecutive subjects clinically diagnosed with dementia during a 3-year period. Using histopathological criteria we calculated the frequencies of various disorders causing dementia. We studied the effect of age and gender on these frequencies. Results - Alzheimer’s disease was the most frequent pathologic finding (57.7%) followed by vascular dementia (43%); diffuse Lewy body disease (15.4%); argyrophilic grain dementia (12.1%), various forms of frontotemporal dementia (5.7%); and other (4.5%). The latter comprise prion disease, alcoholic encephalopathy, and hippocampal sclerosis. Mixed pathology was common: concomitant Alzheimer’s disease was present in 41.6% of diffuse Lewy body disease cases and in 49.2% of vascular dementia patients. Pure disease forms are rare: Alzheimer’s disease: 26.3%, vascular dementia: 17.3%, diffuse Lewy body disease: 5.1%, argyrophilic grain dementia: 2.5%. Females were overrepresented among those with Alzheimer’s disease with age at death above 75 years (p <0.02), while males were overrepresented in patients below 75 years with vascular dementia (p <0.05). Conclusions - Our study indicates that the frequency of neurodegenerative dementias is high in the examined patients, but vascular pathology frequently influences the clinical course.]

Clinical Neuroscience

[Occlusive hydrocephalus caused by a fourth ventricle arachnoid cyst (in English language)]

SZŰCS Anna, VÁRADY Péter, PESTALITY Péter, FABÓ Dániel, LALIT Narula, KENÉZ József

[The case history of a woman with occlusive hydrocephalus caused by a fourth ventricle cyst is presented. She had slowly progressive complaints and symptoms - concentration and memory disturbances, low-tempered mood, then slight dizziness, loss of appetite and progressive headache - transitorily misinterpreted for signs of depression. She had been treated by psychotherapy and antidepressants for months. Since she did not improve she was referred to a psychiatric hospital. The rapidly progressing neurological syndrome with worsening headache, gait disturbance and vomiting was finally identified and it turned out to be caused by a fourth ventricle CSF blockage of unknown aetiology. An acute neurosurgical intervention was indicated. It revealed a huge fourth ventricle cyst, undetectable on MRI, occupying the whole ventricle. The resection of its walls resulted in complete recovery. We conclude that since unspecific mental complaints and symptoms suggesting depression may be misleading, their organic origin has to be excluded.]

Clinical Neuroscience

[Péter Rajna : Aging brain - aging mind - ageless (?) soul]

KOPP Mária

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Related contents

Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]


[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Clinical Neuroscience

[Selection of the optimal device-aided therapy in Parkinson’s disease]

KOVÁCS Norbert, ASCHERMANN Zsuzsanna, JUHÁSZ Annamária, HARMAT Márk, PINTÉR Dávid, JANSZKY József

[For the treatment of advanced Parkinson’s disease the deep brain stimulation (DBS) and the levodopa/carbidopa intestinal gel (LCIG) therapies are available in Hungary. Although they may have similar impact on the health-related quality of life and disabilities associated with the disease, they have different indications, and inclusion- and exclusion criteria. Consequently, the patient population treated with DBS and LCIG may be different. In the present review, the authors try to help the process of selection of the optimal device-aided therapy for the patients with advanced Parkinson’s disease. ]

Hungarian Radiology

[Comparison of different gastrointestinal contrast materials for MR examination, an experimental model]

BABOS Magor, PALKÓ András, KARDOS Lilla, CSERNAY László

[PURPOSE - Evaluation of different gastrointestinal endoluminal contrast materials by using an experimental model. MATERIALS AND METHODS - Authors constructed a plastic container holding six plastic cups, thus making possible to evaluate different compounds and concentrations, simultaneously. The signal intensity of more than 15 different materials (commonly used contrast materials, fruit juices, cocoa, iron containing solutions) was measured by T1 and T2 weighted spin echo sequences in a 1T MR unit. The results were compared in tables and demonstrated by figures. RESULTS - The plastic container and cups made it possible to evaluate the contrast materials by MR examination. The fruit juices containing metallic components had high signal intensity on T1 weighted images, while on the T2 weighted images showed moderate to high signal intensity except the rosehip syrup and a special blackcurrant extract, which were of low signal intensity. Cocoa drink had low to moderate signal intensity on both the T1 and T2 weighted images. The signal intensity of the iron(III)-desferrioxamin solution increased on the T1 weighted images and decreased on the T2 weighted images in direct proportion to its iron concentration. CONCLUSION - The described in vitro model is an appropriate and risk-free solution for selecting the proper endoluminal contrast material, its concentration, and the best measuring sequences for defining the optimal in vivo MR bowel examination protocol. On the base of the experimental results rosehip syrup, blackcurrant extract, iron(III)- desferrioxamin and cocoa drink were selected for further in vitro and in vivo examinations.]

Clinical Neuroscience

[Childhood sporadic type of hemiplegic migraine with arteria cerebri media hypoperfusion]

NAGY Csaba, BAJZIK Gábor, SKOBRÁK Andrea, CSORBA Eszter, LAJTAI Anikó, BALOGH Gábor, NAGY Ferenc, VAJDA Zsolt

[Hemiplegic migraine is a rare subtype of migraine that is associated with reversible motor weakness in the aura phase. This is an uncommon form of migraine usually starting in childhood. The purpose of this case report is to highlight the differential diagnostic difficulty of the first attack. We describe a case, where the fluctuating unilateral motor weakness and aphasia suggested that the patient had ischaemic stroke. Nevertheless the brain MRI and MR angiography, the measured 5-hydroxyindole acetic acid (5-HIAA) concentration changes and the spontaneously improving clinical status proved the diagnosis of hemiplegic migraine. The MRI and MR angiography was very beneficial in establishing the correct diagnosis in this case. To distinguish between the familiar and sporadic type of hemiplegic migraine further genetic tests can be carried out.]

Clinical Neuroscience



[Despite the levodopa is used for the treatment of Parkinson’s disease for a long time, recently many questions raised about its clinical use. New issues emerged based on the clinical trials, on latest neuroimaging data and on better understanding the pathomechanism of motor complications. These observations have changed the routine clinical use of levodopa. In this review we summarize the evidences and practical implications of levodopa therapy.]