Clinical Neuroscience

[Practical informations about Qutenza patch]

KISS Gábor

NOVEMBER 20, 2012

Clinical Neuroscience - 2012;65(11-12)

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Clinical Neuroscience

[Vinpocetin in neurological diseases]

SZAPÁRY László, KÉSMÁRKY Gábor, TÓTH Kálmán, MISNYOVSZKY Melinda, TÓTH Tímea, BALOGH Ágnes, NAGY Krisztián, NÉMETH György, FEHÉR Gergely

[Introduction - Stroke is the third leading cause of death worldwide (following cardiovascular and cancer mortality) and associated with serious disability for the vast majority of patients. There is no salvage therapy for irreversibly damaged brain areas, improving the circulation of the surrounding hypoperfused territories may be associated with benefitial clinical states. Cerebral hypoperfusion may play a role in the pathogenesis of other kind of neurological diseases, improvement of global circulation may have a preventive effect on these conditions. Aims - The aim of our study was to review the experimental and clinical articles focusing on the role of vinpocetin in different neurological conditions. Results - Vinpocetin appears to have several different mechanisms of action that allow for its antiinflammatory, antioxidant, vasodilating, antiepileptic and neuroprotective activities in experimental conditions. On the other hand, several meta-analysis of the existing studies in acute stroke examining short and long term fatality rates with vinpocetin was unable to assess efficacy. In chronic cerebrovascular patients, vinpocetin improves impaired hemorheological variables, has significant vasodilating properties, improves endothelial dysfunction, neuroimaging studies showed selective increase in cerebral blood flow and cerebral metabolic rate, all of which are potentially beneficial in cerebrovascular disease and may improve cognitive functions. Summary - Based on the above mentioned results vinpocetin plays an important role both in basic research and in clinical management of different neurological diseases.]

Clinical Neuroscience

[Rivaroxaban in prevention of stroke in patients with atrial fibrillation]

SIMONYI Gábor, MEDVEGY Mihály

[Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group.]

Clinical Neuroscience

[Clinical significance of the cardiovascular effects of fingolimod treatment in multiple sclerosis]

SZÉPLAKI Gábor, MERKELY Béla

[Fingolimod is a sphingosine-1 phosphate receptor modulator, which is effective in the treatment of severe relapsingremitting form of multiple sclerosis. Once daily oral use of fingolimod decreased the annualized relapse rate, inflammatory brain lesion activity and the rate of brain atrophy compared both to placebo and intramuscular administered interferon beta-1a. The drug targets the cardiovascular system as well via sphingosine- 1 phosphate receptors. After initiation of fingolimod therapy transient sinus bradycardia and slowing of the atrioventricular conduction develops. The onset of the effect is as early as 1 hour post administration, while heart rate and conduction normalized in 24 hours in most of the cases. According to the clinical trials symptomatic bradycardia developed in 0.5% of the cases, responding to the appropriate therapy. The incidence of Mobitz I type II atrioventricular blocks and blocks with 2:1 atrioventricular conduction was 0.2% and 0.1%, respectively. All of these cardiovascular events showed regression during observation and no higher degree atrioventricular blocks were detected at the approved therapeutic dose. Following the first dose effect, fingolimod had a moderate hypertensive effect on long-term. For the safety of fingolimod treatment detailed cardiovascular risk stratification of all patients, adequate patient monitoring after the first dose and competency in treating the possible side effects is necessary. In patients with increased cardiovascular risks, treatment should be considered only if anticipated benefits outweigh potential risks and extended monitoring is required.]

Clinical Neuroscience

[Aspirin and clopidogrel resistance: possible mechanisms and clinical relevance. Part I: Concept of resistance]

VADÁSZ Dávid, SZTRIHA K László, SAS Katalin, VÉCSEI László

[Aspirin and clopidogrel are well established as antiplatelet medication in the treatment of atherothrombotic vascular disease. However, despite treatment, a substantial number of patients experience recurrent ischemic episodes, referred to as aspirin or clopidogrel treatment failure. Various laboratory techniques are available with which to evaluate the effectiveness of antiplatelet drugs. Interestingly, the agreement between the results of the different tests may be poor. The term aspirin or clopidogrel resistance denotes those conditions in which an inadequate inhibitory efficacy of the given antiplatelet agent is detected by an in vitro assay of platelet function. It has been estimated that on average some 30% of patients treated with aspirin, and 20% on clopidogrel, do not achieve an appropriate level of efficacy as concerns platelet activity.]

Clinical Neuroscience

[The role of immobilization stress and sertindole on the expression of APP, MAPK-1 and β-actin genes in rat brain]

KÁLMÁN János, PÁKÁSKI Magdolna, SZŰCS Szabina, KÁLMÁN Sára, FAZEKAS Örsike, SÁNTHA Petra, SZABÓ Gyula, JANKA Zoltán

[Stress, depending on its level and quality, may cause adaptive and maladaptive alterations in brain functioning. As one of its multiple effects, elevated blood cortisol levels decrease the synthesis of the neuroprotective BDNF, thus leading to hippocampal atrophy and synapse loss, and rendering it a possible cause for the Alzheimer’s disease (AD) related neuropathological and cognitive changes. As a result of the stress response, intraneuronal alterations - also affecting the metabolism of β-actin - can develop. These have a role in the regulation of memory formation (LTP), but in pathological conditions (AD) they could lead to the accumulation of Hirano bodies (actin-cofilin rods). According to the dementia treatment guidelines, the behavioural and psychological symptoms of AD can be treated with certain antipsychotics. Therefore, the aim of our study was to examine the effects of sertindole (currently not used in the standard management of AD) on the transcription of some AD associated genes (amyloid precursor protein [APP], mitogen activated protein kinase-1 [MAPK-1], β-actin) in the brain of rats exposed to chronic immobilization stress (CIS). Male Wistar rats were exposed to CIS for three weeks. The four groups were: control (n=16), CIS (n=10), 10 mg/kg sertindole (n=5) and 10 mg/kg sertindole + CIS (n=4). Following transcardial perfusion, the relative levels of hippocampal and cortical mRNA of the previously mentioned genes were measured with real-time PCR. CIS induced hippocampal β-actin (p<0.01), MAPK-1 and APP (p<0.05) mRNA overexpression. The simultaneous administration of sertindole suppressed this increase in β-actin, MAPK-1 and APP expression (p<0.05). Ours is the first report about CIS induced β-actin gene overexpression. This finding, in accordance with the similar results in APP and MAPK-1 expression, underlines the significance of cytoskeletal alterations in AD pathogenesis. The gene expression reducing effect of sertindole suggests that antipsychotic drugs may have a neuroprotective effect.]

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NAGY-GÁL Anetta

[Purpose: Establishing a balance between theoretical and practical training is essential in the training of college nursing students. The aim was to assess the students’ experiences of clinical practice and the problems they indicate in the component, which plays an important role in preparing the training for professional competencies. The study sample consisted of 3rd and 4th grade students (N=96) participating in nursing training at the Faculty of Health Sciences of Semmelweis University. The method of data collection was based on the completion of a quantitative online questionnaire, which also included qualitative elements in the form of three open-ended questions. Among the statements measured on the Likert scale, the balance of theory-practice, the role of participants in education, and the time spent on practical tasks received lower average ranks from both grades. Logistic regression is suitable for estimating the probability of a positive/negative impression of a practice as a combined effect of several explanatory variables. Compared to the results of a previous (2009) study, the problems with field clinical training remain unresolved.]

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[Neuropsychological rehabilitation following acquired brain injury]

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[Neuropsychological rehabilitation or rehabilitation neuropsychology is a field within applied neuropsychology. It originally diverges from applied clinical and functional neuropsychology, although it could not be entirely differed from them. The unique nature of this area over the complexity is given by its process-controlled and system-approach aspects. In Hungary the number of neurorehabilitation centres and departments requiring neurocognitive rehabilitation has been continually increasing. Nevertheless, the number is still low; accordingly in our country this field is relatively young and isn’t well known. Authors of this review would like to draw attention to the importance of rehabilitation of patients with acquired brain injury and improvement of their quality of life with the theoretical and practical knowledge, as well as the necessity of future alterations and challenges emphasizing the need of a significant change of this narrow domain. ]

Clinical Neuroscience

[Hungarian adaptation of a short eating disorder questionnaire (SCOFF)]

DUKAY-SZABÓ Szilvia, SIMON Dávid, VARGA Márta, SZABÓ Pál, TÚRY Ferenc, RATHNER Günther

[Aim - Eating disorders are becoming an increasingly relevant health issue, therefore the fast and accurate screening of people at risk is of great practical importance. The aim of SCOFF questionnaire is to assess this risk and the extent to which a person is affected, by using five simple yes or no questions. The objective of our study was to assess the validity of the Hungarian version of the test Methods - 777 medical students (210 men, 567 women, mean age 22.3±2.33 years) participated in the survey. The online questionnaire contained anthropometric data, the Eating Behaviour Severity Scale and, beside the SCOFF, the Eating Disorder Inventory (EDI). Results - The SCOFF is excellent at screening clinical eating disorders. Its sensitivity was 100% and specificity 85.1%. It is less efficient at detecting subclinical cases, but it does not show worse results than EDI. According to the data SCOFF is better at identifying more serious cases. Applying on the same sample SCOFF had higher sensitivity and lower specificity than EDI. Discussion - SCOFF is suitable for primary screening of eating disorders with a non-diagnostic purpose, taken two “yes” answers out of five as the critical margin, specified by the authors.]

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[Cardiovascular prevention 2021 – Guidelines of European Society of Cardiology 2021. Cardiovascular prevention at individual level]

VÁLYI Péter, KÉKES Ede

[In August 2021, the European Society of Cardiology (ESC) published its practical guidelines for cardiovascular prevention. In Part 1 of our publication, we discussed cardiovascular risk factors, risk assessment, cardiovascular risk assessment in presumably healthy individuals of different ages, people with proven atherosclerotic cardiovascular disease, people with diabetes mellitus, and factors influencing risk. In Part 2, conditions that influence cardiovascular risk were detailed. In the current Part 3 of this publication, we review personalised cardiovascular prevention, non-pharmaceutical and pharmaceutical treatment of specific risk factors, emerging treatment options, and par­ticipation in cardiovascular rehabilita­tion and prevention programmes based on ESC guidelines.]

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[Practical aspects of anticoagulant treatment during the COVID-19 pandemic]

KOMÓCSI András

[Coronavirus infection has a multiple im­pact on the coagulation system and anti­coagulant therapies. Patients admitted with COVID-19 have un­usually high incidence of coagulation ab­normalities. The incidence of atrial fibrillation (AF) seems also to be more frequent among COVID-19 out- and especially in-patients. Among COVID-19 patients receiving oral anticoagulant therapy, for minimizing the risk of bleeding or thromboembolic complications there should also be considered the renal and hepatic functions and drug-drug interactions of oral anticoagulant and COVID-19 therapy. In case of direct anticoagulants, in addition to the benefits of better safety, more favorable treatment ad­he­rence, and fixed dosing, the use of this class of drugs does not require laboratory mo­nitoring of efficacy, which may be of exp­licit benefit in terms of social distancing and health network burdens. This study reviews the possible interactions of drugs used for viral infection and anticoagulation, and in addition to the issues of coagulopathy associated with COVID-19, we discuss also the concerning difficulties of continued anticoagulant therapy related to the social distancing measures.]