Clinical Neuroscience

[Operation - rehabilitation - employment]

MÉSZÁROS Gabriella, FEHÉR Miklós, BORBÉLY Csaba

SEPTEMBER 30, 2016

Clinical Neuroscience - 2016;69(09-10)


[In this article we would like to bring the attention to the importance of early rehabilitation, coordinated operation of different subdivisions of rehabilitation and the expanding opportunities after medical care through following a 38- year-old female patient's case who was operated 6 years ago with anaplasticus oligodendroglioma. We find it important that the experts working on the field of health care, social services or labour should be aware of the possibilities of rehabilitation of their patients from the capability assessment, through its development until their placement in integrated labour market. It is important, that even during the medical care both the client and their relatives receive proper information.]



Further articles in this publication

Clinical Neuroscience

Adult attachment and parental bonding in irritable bowel syndrome and in panic disorder - Implications for psychotherapy

PÉNZES István, CZEGLÉDI Edit, SZALAI Dömötör Tamás, CSALA Irén, TÚRY Ferenc

Background and purpose - Attachment theory provides an integrative perspective about the interplay between cognitive, affective, behavioral and interpersonal processes and is relevant for understanding irritable bowel syndrome (IBS) and panic disorder (PD). The aim of the present study was to examine the adult attachment style and parental bonding of IBS and PD patients. Methods - In a cross-sectional questionnaire-based study, 65 PD and 65 IBS patients with clinical diagnosis participated. Measures were Attachment Style Questionnaire, Experiences in Close Relationships Scale - Revised, and Parental Bonding Instrument. Results - The frequencies of insecure attachment (80.0% vs. 63.1%) and paternal neglect (35.4% vs. 16.9%) were higher in IBS than in PD (χ2 (1)=4.571, p=0.033, and χ2 (3)=7.831, p=0.050, respectively). The frequency of secure attachment was significantly higher for optimal paternal bonding than with suboptimal paternal bonding (75.0% vs. 21.9%, χ2 (1)=19.408, p<0.001). According to the results of multiple binary logistic analysis, optimal paternal bonding predicted secure attachment after adjusting for the background variables (OR=9.26, p=0.001). Conclusion - A high frequency of insecure attachment was present in both groups, especially in IBS. With regard to maternal bonding, IBS and PD groups showed similar patterns, while an apparent difference was observed for paternal bonding. These highlighted the developmental similarities of these two, symptomatically different disorders. While optimal maternal bonding did not predict adult attachment security, paternal bonding did thus replete with therapeutic implications. Attachment functions, like responsiveness, attunement and affection modulation were apparent in the psychotherapist-patient relationship as well.

Clinical Neuroscience

Cerebral vasomotor reactivity in fibromyalgia patients and its relationship to central neuropathic pain

GULER Sibel, KURTOGLU S. Hakan, KEHAYA Sezgin, PAMUK Nuri, CELIK Yahya

Background - Cerebral vasomotor reactivity, defined as the cerebral vasculature response to hypoxia, is not wellunderstood in fibromyalgia (FM) patients. This study investigated the difference in the cerebrovascular reactivity (i.e., responsiveness to hypercapnia was evaluated by use of breath- holding index) to the breath-holding index (BHI) between patients with fibromyalgia and a group of normal controls. Methods - The study included 40 FM patients and 40 healthy subjects. Cerebrovascular reactivity was evaluated using the BHI, which is a nonaggressive, well-tolerated, real-time, reproducible screening method to study cerebral haemodynamics. Insonation depth and basal velocity were symmetrical and not significantly different between the two groups (p>0.05). All patients completed the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), visual analogue scale (VAS), and the somatization subscale of the SCL-90-R symptom checklist. Results - The BHI ranged from 0.30 to 2.20 (mean 1.11±0.45) in the FM patients and 1.10 to 2.80 (mean 1.90±0.35) in the control group (p<0.001). Disease duration and right BHIaverage and left BHIaverage values exhibited a significant negative correlation (r=-0.877; p<0.001, r=-0.842; p<0.001, respectively). As pain and fatigue scores increased, the right BHIaverage and left BHIaverage values decreased (r=-0.431; p=0.005, r=-0.544; p<0.001, r=-0.341; p=0.031, r=-0.644; p<0.001, respectively). Conclusions - BHI values showed that cerebrovascular reactivity in FM patients decreased in comparison to healthy individuals. BHI decreased as disease duration and severity increased. Cerebrovascular reactivity decreased in FM patients, and this phenomenon should be accepted as an abnormality. Additionally, this outcome may have been the result of a mechanism responsible for central neuropathic pain.

Clinical Neuroscience

[Dissections of the supraaortic arteries]

CSEH Tamás, SZUKITS Sándor, SZAPÁRY László

[Dissection of the cervical and intracranial vasculature is a rare but important cause of ischaemic stroke especially in young adults. In the majority of cases it affects the extracranial vessels, mostly the internal carotid artery. It might be categorized as spontaneous or traumatic, causing diverse clinical symptoms. Dissection might lead to ipsilateral stroke mainly by artery-to-artery embolisation. Due to its relative rarity compared to the classic ischaemic stroke of the elderly, there are much less clinically relevant information for the clinician to rely on. Several large, randomised, multicentered, prospective studies and some smaller, retrospective analyses have been published recently concerning the genetic background, epidemiology, acute care and secondary prevention of supraaortic arterial dissection which helps the neurologist to provide evidence-based care for his patient. Our aim is to give a short, up-to-date overview of arterial dissections with two case reports.]

Clinical Neuroscience

[Functional magnetic resonance imaging studies in pain research]

ÉDES Andrea Edit, JUHÁSZ Gabriella

[Functional imaging studies opened a new way to understand the neural activity underlying pain perception and the pathomechanism of chronic pain syndromes. In the last twenty years several results of functional magnetic resonance imaging (fMRI) studies have been published about examining the different aspects of complex pain experience. The aim of these studies is to understand the functioning of the pain control system, the so-called pain matrix, activated by acute nociceptive stimulus. Another important field of pain research is the investigation of neuronal processes underlying chronic pain, since the pathomechanism of this is still unclear. Our review aims to provide insight into the methods of pain research using fMRI and the achievements of the last few years.]

Clinical Neuroscience

Frequency and types of headaches in patients with metabolic syndrome

DEMIRYÜREK Enes Bekir, EMRE Ufuk, KORUCU Osman, BARUT Özen Banu, TASCILAR Nida Fatma, ATASOY Tugrul Hüseyin, DEMIRYÜREK Esra, YAYLACI Selcuk, GENC Bilal Ahmet

Background - Metabolic Syndrome (MetS) and headaches are common public health problems in whole world. The relationship between headaches and the MetS isn’t understood clearly. Purpose - The aim of this study is to determine the prevalence and types of headaches, and evaluate the relationship between headache characteristics and clinical and laboratory parameters analyzed in patients diagnosed with MetS. Materials and methods - Of the patients diagnosed with MetS in Endocrinology outpatient clinics between July 2011 and July 2012, 202 patients were included in the study. Hemoglobin, fasting blood glucose (FBG), total cholesterol, triglyceride, HDL and LDL cholesterol, thyroid function tests and HbA1c values of all patients were recorded. Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were applied to all patients. The headache severity was assessed by Visual Analog Scale (VAS). Results - The prevalence of headache in patients with MetS was found to be 61.4%. The incidence of headache was higher in female patients (F: 86.4%, M: 13.6%). The distribution of the subtypes of headaches was as follows: Episodic Tension-Type Headaches (ETTH) 24.8%, Episodic Migraine 14.4%, Chronic Tension-Type Headaches (CTTH) 11.3%, Episodic Tension-Type Headaches (ETTH) and Episodic Migraine 7.9%, and other types of headaches (Cervicogenic Headache and Cluster Headache) 3%. No statistically significant relationship was found between headache and non-headache groups in terms of body mass index, waist circumference, and the laboratory parameters (p>0.05). The mean BDI and BAI scores were higher in the headache group (p<0.001 and p<0.001). No significant difference was found between the mean MIDAS scores in the subtypes of headaches (p=0.35). In the headache group, there was a significant relationship only between triglyceride levels and attack frequency, duration and severity. Conclusion - Prevalence of headache in patients with MetS was 61.4%. The incidence of subtypes of headaches was similar to those in the general population. A relationship was found between triglyceride levels and attack frequency and severity. The result may be important to draw attention to the evaluation of triglyceride levels for reducing the frequency and severity of attacks in patients with headaches.

All articles in the issue

Related contents

Journal of Nursing Theory and Practice

[The Importance of Teamwork and Patient Education in the Rehabilitation of Stroke Patients]

HORVÁTH Orsolya, STERLIK Krisztina

[The aim of the study: Stroke is an increasing problem in public health. Every year in Hungary tens of thousands of people survive stroke and continue their life bearing all the negative consequences of this disease. Well organized and early rehabilitation treatment, based on the patients’ clinical condition, improves not only their life expectancy, but also quality of life and helps to restore the self- sufficient living as well. The majority of the stroke patients live with numerous of cerebrovascular risk factors, highlighting the special importance of personalized education to prevent the recurrent stroke. Material and Methods: The aim of our investigation was to examine the efficiency of the neuro-rehabilitation teamwork and personalized patient-education among stroke patients took part inpatient rehabilitation of the Teaching Hospital and Rehabilitation Center of Sopron (2016-2017). We measured the change in ability of self- sufficient living with the FIM scale and the Bartel index, while we analyzed the presence of the modifiable cerebrovascular risk-factors with the assistance of a questionnaire was completed by the patient or the relatives (2016-2017). Results: During our research we also evaluated the knowledge of patients about their condition. According to our results the modifiable risk-factors occured cumulatively among our patients and despite the education that stroke patients received during the acute period in the hospital, there still occured a general lack of knowledge regarding their disease. Conclusions: Based on our results the complex rehabilitation therapy started at its earliest possible following the acute period was the most successful method of treatment. During the acute period, the dissemination of written educational materials and information sheets help the recovery phase until the start of the complex rehabilitation therapy. ]

Clinical Neuroscience

[Exploration of quality of life goals in rehabilitation of persons after spinal cord injury]

TÓTH Katalin, PUTZ Miklós, KULLMANN Lajos

[Background and purpose - Surveyed references indicate improvement of rehabilitation outcomes if based on exploration of personal rehabilitation goals or quality of life goals. Purpose of our study is mapping of quality of life goals of persons entering rehabilitation by structured interviews, and study of applicability of the method. Methods - Structured interviews have been performed with persons consecutively admitted for their first rehabilitation intervention, meeting inclusion criteria. World Health Organization’s quality of life measure brief version and disability module served as guideline for the interviews. For study any negative effect on rehabilitation of our approach we have compared rehabilitation outcomes of consecutively admitted persons immediately before starting our study (58) and those with closed rehabilitation intervention (53). For this purpose the Functional Independence Measure was used. Finally content analysis of the interviews has been performed. Results - In 24 cases complications and psychological instability have prevented the inclusion, seven persons did not agree into participation in the study. Of the 71 interview participants the rehabilitation of 53 persons concluded. Their rehabilitation outcomes are better as of the control group significant difference has been measured in the social functions domain. Quality of life of included persons decreased during the rehabilitation process insignificantly, the autonomy domain showed insignificant improvement, the inclusion domain did not change. Content analysis revealed the outstanding role of the family among quality of life goals. Conclusions - Reported results indicate that exploration of quality of life goals of persons in early phase of rehabilitation after spinal cord injury is feasible. The selected quality of life measure may well support the interviews.]

Clinical Neuroscience

[Importance of hydrocephalus following severe brain injury during postacute rehabilitation]

DÉNES Zoltán, LANTOS Ágnes, SZÉL István, THOMKA Magdolna, VASS Mátyás, BARSI Péter

[Objectives - We report our experiences with hydrocephalus in early rehabilitation over a seven-year period. Method - Retrospective study in Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation, between 1 January 2002 and 31 December 2008. Results - At our institute in the last seven years, we treated 83 patients with secondary and six patients with primary hydrocephalus. The majority of hydrocephalus was of post traumatic origin (52) and remaining 23 following stroke (SAH, AVM, ICH) or brain operation (tumour - seven, and one cranioplasty), and all these patients had undergone ventricular shunt implantation. Mean age of patients was 36 (14-80) years. Hydrocephalus was diagnosed in our rehabilitation unit in 20 of 83 cases and the other patients were shunted before transfer to our unit. The median time point of shunting was 70 (range: 20-270) days after trauma, brain surgery or stroke. Post-operative complications were seen in 12 of 89 patients: six infections and six shunt failure and revision was necessary in 14%. In PTH cases, the post-operative improvement was seen in 40 of 52 patients being shunted and corresponded to FIM scores. At the other 31 cases, with non-traumatic origin, only two patients remain unchanged. Conclusions - Hydrocephalus is considered to be a frequent and important complication after severe brain damage. The incidence of hydrocephalus treated with shunt implantation in our neuro-rehabilitation unit was 4.4%. The postoperative improvement was 77%. Posttraumatic hydrocephalus concerns 5.2% of patients with severe TBI during last seven years in our institution. Diagnosis of posttraumatic hydrocephalus was established in 24%, and complication after shunt implantation (14%) was also recognized in the post-acute rehabilitation unit. It is strongly recommended for the team working at such type of units to obtain clinical practice. Teamwork, good cooperation between acute and postacutecare is necessary for successful rehabilitation of these patients.]

Clinical Neuroscience


DÉNES Zoltán, FEHÉR Miklós, VÁRKONYI Andrea

[Objective - Examination of the effect of local botulinus toxin treatment on spastic upper limb, on patients with different brain injury. Patients and method - Prospective study in Traumatic Brain Injury Rehabilitation Unit of the National Institute for Medical Rehabilitation in the year 2003 and 2004. Thirteen patients (eight with stroke and five with traumatic brain injury) were treated locally on the spastic upper limb with 100 units botulinus A toxin. Results - Spasticity decreased one or two level on Modified Ashworth Scale, and in nine cases the good result were observed still at the end of 3rd month. No local or other complication was detected. Conclusions - Local treatment with botulinus toxin is an effective and safe method to decrease spasticity on upper limb in patients with different brain injury.]

Lege Artis Medicinae

[What does the „whole”-ness of patients with diabetes mellitus mean?]


[Diabetes mellitus is a chronic, progressive disease, characterized by elevated levels of blood glucose, can lead to many complications and can increase the overall risk of early disability and dying prematurely. The newest guidelines on management of patients with diabetes mellitus give a full description of diagnostic criteria, prevention, lifestyle and pharmacological treatment, complications, age-related characteristics. However, in everyday care of patients with diabetes mellitus little attention is paid to severity of anatomical and functional impairment related to disease, how and in what extent those limit everyday activities, restricts filling the social role, the importance of interrelationship of a human being and environment, to personal factors. The aims of this publication is: to present how diabetes mellitus influences the entirety, the “whole”-ness of a human; to show tools of objective estimation of impairments and changes of functionality; to call attention to importance of development of residual abilities, of shaping supportive environment, of assessment of needs, of positive influences of personal characteristics; to demonstrate how all these measures improve quality of life and compliance of patient with diabetes mellitus. The holistic approach of “human’s whole-ness” can contribute to success of preventive, curative and rehabilitative measures in patients with diabetes mellitus.]