Clinical Neuroscience

[Natalizumab therapy, 2013]


JULY 30, 2014

Clinical Neuroscience - 2014;67(07-08)

[Multiple sclerosis (MS) is the most common chronic disease of the central nervous system in young adults. No curative therapy is known. Currently, six drugs are available that can reduce the activity of MS. The first-line drugs can completely reduce the activity of the disease in nearly two-thirds of the patients. In the remainder, who suffer from breakthrough disease, the condition of the patient worsens, and secondline therapies must be used. The second-line drug natalizumab exhibits almost double efficacy of the first-line drugs, but also have less favourable adverse effects. As a severe side-effect for instance, natalizumab carries the risk of the development of progressive multifocal leucoencephalopathy (PML), caused by a polyoma virus, the JC virus. There are three major risk factors for PML: an anti-JCV antibody status, a long duration of natalizumab treatment and prior immunosuppressant therapy. The lowest-risk group (1:14 286) comprises of patients who are anti-JCV antibody-negative, in whom the prior immunosuppressant use and duration of natalizumab therapy do not influence the risk of PML. With no prior immunosuppressant treatment, the incidence of PML increases to 1 in 192 patients after 2 years among those who are anti-JCV antibody-positive. These data may lead the physician to decide to discontinue natalizumab treatment. The half-life of natalizumab is three months; during this time other therapies can not be administered and the patients encounter the rebound effect: as the patients receiving natalizumab therapy displayed a high disease activity before treatment, the rebound effect can lead to relapses. After the termination of natalizumab secondline disease-modifying therapy with fingolimod may be introduce; no PML cases occur in response to fingolimod treatment. In the large majority of patients taking natalizumab who do not develop PML, this drug is highly effective and can prevent the progression of MS. The benefit of therapy and the risk of PML must be considered on an individual basis, with regard to the disease activity, the progression and the MRI activity, before natalizumab therapy is implemented.]



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[Long-term safety and effectiveness of natalizumab redosing and treatment in the STRATA MS Study]


Clinical Neuroscience

[Depression in Parkinson’s disease]

RIHMER Zoltán, GONDA Xénia, DÖME Péter

[The prevalence of major and minor depression in Parkinson’s disease is around 30-40% but, unfortunately, depression remains frequently underrecognized and often undertreated. However, recognition and appropriate treatment of depression in patients with Parkinson’s disease is essential for improving the cross-sectional picture and longitudinal course. This review focuses on the epidemiology, pathophysiology and different treatment modalities of depression in Parkinson’s disease.]

Clinical Neuroscience

[Ars Neurologiae]

JANKA Zoltán

Clinical Neuroscience

[The impact of levodopa-carbidopa intestinal gel on health-related quality of life in Parkinson’s disease]

KOVÁCS Norbert, ASCHERMANN Zsuzsanna, ÁCS Péter, BOSNYÁK Edit, DELI Gabriella, JANSZKY József, KOMOLY Sámuel

[Background - The levodopa/carbidopa intestinal gel (LCIG) therapy can improve the severe fluctuations associated with advanced Parkinson’s disease (PD). Our aim was to assess the improvement in the health related quality of life of PD patients treated with LCIG at University of Pécs. Methods - Eight PD patients were evaluated (age: 68.1±4.4 years, disease duration: 14,5±6,2 years, duration of fluctuations: 8.9±3.1 years). Before the initiation of LCIG treatment and 6 and 12 months later, the health-related quality of life (PDQ-39 and EQ-5D-5L), severity of PDrelated symptoms (MDS-UPDRS, Hoehn-Yahr Scale, Clinical Global Improvement - Severity) and major non-motor symptoms (PD Sleep Scale 2nd version: PDSS-2, Epworth Scale and Beck Depression Inventory: BDI) were assessed. Results - Health-related quality life improved after LCIG treatment measured by both EQ-5D-5L (from 0.257 to 0.662, p=0.009) and PDQ-39 (from 34 to 26 points, p=0.038). Meanwhile PD-related symptoms (MDS-UPDRS total score: from 105 points to 68 points, p<0.05) sleep quality (PDSS-2: from 25 to 22 points, p<0.05), daytime sleepiness (Epworth: from 12 to 7 points, p<0.05) and depression (BDI: from 20 to 15 points, p<0.05) also improved. Median ON time improved form 4.5 hours to 10.0 hours; whereas, the OFF time decreased from 4.5 to 0.5 hours (p<0.05). Conclusion - Both the quality of life and the clinical features of PD can be improved by LCIG treatment in advanced PD.]

Clinical Neuroscience

[Examining the diagnostic accuracy of a new migraine screener]

CSÉPÁNY Éva, BOZSIK György, KELLERMANN István, HAJNAL Boglárka, SCHEIDL Erika, PALÁSTI Ágnes, TÓTH Marianna, GYÜRE Tamás, ERTSEY Csaba

[Background - Migraine affects more than 10% of the Hungarian population, causes significant disability and severely affects patients’ generic and condition-specific quality of life. Despite these facts, a significant proportion of patients is not diagnosed and not treated adequately. Headache centres can provide care for only a fraction of all patients. The task of primary care providers would be greatly simplified by a reliable self-administered migraine screening questionnaire. Objective - To develop a short and reliable questionnaire as a migraine screening tool. Methods - Outpatients at the Headache Service, Department of Neurology, Semmelweis University completed a self-administered questionnaire which contained 9 yes/no questions about their headaches’ characteristics. The number of ’yes’ answers (the patients’ total score) was evaluated in connection with the diagnosis based on the International Headache Society criteria. We calculated the sensitivity, specificity, positive and negative predictive value as well as the misclassification rate for each total score value and used these to establish the final cutoff value of the questionnaire. 306 patients (242 females, mean age 39.1±13.3 years) were enrolled. The diagnosis was migraine in 244. Results - Completing the questionnaire did not pose any difficulty for the patients. At a cutoff value of 5 points the questionnaire’s sensitivity was 0.96 and specificity was 0.61. The positive predictive value was 0.91 and the negative predictive value was 0.81. The misclassification rate was 0.11. Discussion - Our results show that the questionnaire may help the diagnosis of migraine. In order to use it in medical practice, its further evaluation is necessary on a large representative sample of the Hungarian population.]

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[Family planning is an exceptionally important question in multiple sclerosis, as women of childbearing age are the ones most often affected. Although it is proven that pregnancy does not worsen the long-term prognosis of relapsing-remitting multiple sclerosis, many patients are still doubtful about having children. This question is further complicated by the fact that patients – and often even doctors – are not sufficiently informed about how the ever-increasing number of available disease-modifying treatments affect pregnancies. Breastfeeding is an even less clear topic. Patients usually look to their neurologists first for answers concerning these matters. It falls to the neurologist to rationally evaluate the risks and benefits of contraception, pregnancy, assisted reproduction, childbirth, breastfeeding and disease modifying treatments, to inform patients about these, and then together come to a decision about the best possible therapeutic approach, taking the patients’ individual family plans into consideration. Here we present a review of relevant literature adhering to international guidelines on the topics of conception, pregnancy and breastfeeding, with a special focus on the applicability of approved disease modifying treatments during pregnancy and breastfeeding. The goal of this article is to provide clinicians involved in the care of MS patients with up-to-date information that they can utilize in their day-to-day clinical practice. ]

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Clinical Neuroscience

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Clinical Neuroscience

Evaluation of body image perception in multiple sclerosis patients without neurological deficit

SENGUL S Hakan, SENGUL Yildizhan, TAK Zeynel Abidin Ali, KOCAK Müge, TUNC Abdulkadir

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