Clinical Neuroscience

[Pregnancy vomiting in the light of Pavlovian reflexology]

KLIMES Károly1, TARJÁN György1

MAY 09, 1953

Clinical Neuroscience - 1953;6(02)

[Vomiting during pregnancy has long been a well-known, almost physiologically accepted complication of pregnancy. The old textbooks divided the phenomenon of increased vomiting in pregnancy (hyperemesis gravidarum) into toxic, reflex and psychogenic causes. In addition to the minor error of scientific arbitrariness, there was a much greater therapeutic error, in that the doctor's therapeutic activity, which was almost entirely subjective, oscillated between excessive prescriptions and the trivialisation of vomiting. On many occasions, however, what started out as harmless vomiting in pregnancy became more and more severe, the patient became dehydrated as a result of the increasing vomiting and the picture became increasingly toxic. It is also important to note that severe toxic vomiting was an indication for abortion, and therefore the precise assessment of the vomiting condition was not only a medical but also a socio-political and even moral task.]

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  1. Budapesti Orvostudományi Egyetem Elme- és Idegkórtani Klinikája és I. sz Nőgyógyászati Klinikája

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[The mechanism of formation of electrical activity in nerve tissue and its significance for cognition of function]

LISSÁK Kálmán

[The discovery and practical application of the doctrine of modern electricity is a major milestone in the cultural history of mankind. Of general interest and particular importance in the history of electricity are bioelectric currents, because the discovery of "animal electricity" was the basis of the doctrine of modern electricity. Galvani's work, De viribus electricitatis in motu muscularis commentarius, published in 1791, not only marks the beginning of the science of electrophysiology, but the ensuing debate led Volta to discover the existence of current electricity, Galvanic current, and the morphology of the electric organs of the electric ray, already known in antiquity, helped him to formulate the Volta column. ]

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[Prevention and treatment of amentiformis images resulting from stacked electroshock treatment]

ZSOMBÓK György

[During cumulative electroconvulsive therapy, amentiform restlessness may occur before and after the stupor phase; in individuals with signs of mild hyperthyroidism, with usually very marked sympathicotonic signs. The clinical observations outlined above suggest that the reduction in the body's mobilisable fluid, partly due to the increase in sympathicotonia and prolonged, intense capillary permeability following ES treatment, is a significant factor in its induction. The immediate resolution of confusion by i.v. administration of ergotamine tartrate or its hydrated derivative (DHE45), and the sustained sedation by combined injections of Sevenal+ergotamine tartrate have been shown to be effective. Prophylactic, regularly monitored tea drinking during treatment can reduce complications and, with immediate combined sedation in the presence of a mentiform condition, corrigorate fluid dysfunction and completely eliminate mortality. ]

Clinical Neuroscience

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[Family planning in multiple sclerosis: conception, pregnancy, breastfeeding]

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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. ]

Clinical Neuroscience

Extraskeletal, intradural, non-metastatic Ewing’s sarcoma. Case report

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Intracranial localization of Ewing’s sarcoma is considerably very rare. Herein, we present clinical and neuroimaging findings regarding a 4-year-old boy with intracranial Ewing’s sarcoma. He was born prematurely, suffered intraventricular haemorrhage, posthaemorrhagic hydrocephalus developed, and a ventriculoperitoneal shunt was inserted in the newborn period. The patient endured re­gular follow ups, no signs of shunt malfunction nor increased intracranial pressure were observed. The last neuroima­ging examination was performed at 8 months of age. Upon reaching the age of 4 years, repeated vomiting and focal seizures began, and symptoms of increased intracranial pressure were detected. A brain MRI depicted a left frontoparietal space-occupying lesion infiltrating the superior sagittal sinus. The patient underwent a craniotomy resulting in the total excision of the tumour. The histological examination of the tissue revealed a small round blue cell tumour. The diagnosis was confirmed by the detection of EWSR1 gene translocation with FISH (fluorescent in situ hybridization). No additional metastases were detected during the staging examinations. The patient was treated in accordance to the EuroEwing 99 protocol. Today, ten years onward, the patient is tumour and seizure free and has a reasonably high quality of life.

Clinical Neuroscience

[The questions of the treatment of Parkinson’s disease]

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[Despite the continuous development of diagnosis and treatment of patients with Parkinson’s disease and the arrival of new therapeutic options in recent years the treatment and care of people with Parkinson’s disease especially in the advanced stage remains a major challenge for neurologists specialized in movement disorders. The treatment of Parkinson’s disease is adversely affected by several factors: the disease progresses relentlessly, the symptoms and rate of progression, other concomitant non-motor symptoms, and the appearance of complications caused by treatment show great heterogeneity. Based on all these factors it is difficult to develop and apply a uniform routine therapeutic guideline. This summary seeks to shed light on aspects of the treatment of Parkinson’s disease particularly in advanced-stage cases drawing on data from a professional college recommendation and the literature.]

Clinical Neuroscience

[Systemic thrombolysis and endovascular intervention in postpartum stroke]

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[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]

Clinical Neuroscience

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[Purpose - Natalizumab is the first evidence based monoclonal antibody, which was launched for treatment in relapsing remitting multiple sclerosis in Hungary in 2010. Standardized follow-up is required to use it. Our aim was to evaluate the efficacy and to monitor the safety of natalizumab treatment by using an electronic database established for MS registry. Clinical activity was measured by annual relapse rates, functional status of patients measured by EDSS and MFSC. Radiological activity was evaluated by standard MRI protocol. Data, results of MS patients and side effects of natalizumab treatment were recorded in iMed software. Results - 31 patients started the natalizumab treatment after 6.5±5.8 years from the onset of MS. The efficacy of treatment was evaluated after a mean of 67 (min: 14 max: 128) infusions in December 2016. The drop-out rate was low, due to the presence of neutralising antibodies in one case, pregnancy in two cases and development of malignant disease in one case which was not related to the natalizumab treatment. The treatment was well tolerated with excellent compliance without serious side effects. The annual relapse rate reduced from a mean of 1.7 to 0.03 (p<0.000001) in the first 12 months of treatment compared to the pretreatment 12 month activity, and it stayed at low level during the whole follow up. EDSS was stable or improved with an exception of two cases. In 23 subjects (77%) lack of new/enlarging T2 lesions and lack of gadolineum-enhancing lesions on MRI were observed. 18 patients (60%) had no evidence of disease activity (NEDA-3). PASAT test improved in most of the cases. Conclusion - The natalizumab therapy was very effective in all cases including those patients who had active disease under the previous immunomodulatory treatment.]