Clinical Neuroscience

[Stroke prevention - A population screening day in district XII of Budapest]

FOLYOVICH András, BAKOS Mária, KÁNTOR Zita, HERTELENDY Anna, HORVÁTH Eszter, ZSIGA Katalin, LAKATOS Henriette, VADASDI Károly

MARCH 30, 2012

Clinical Neuroscience - 2012;65(03-04)

[Along with advances in the treatment of acute stroke, new efforts have been made to enhance efficiency of the prevention of cerebrovascular diseases. Population screening is a way to contact high-risk patients, and there is an increasing international and national experience with the procedure. However, efforts are associated with high costs, so an efficient method, complying with local features, should be selected from the various methods. A stroke prevention day was organized in Szent János Hospital, localized in district XII, and data were analyzed. Taking advantage of the potentials of a large hospital, a comprehensive risk assessment - within the capacity of health care workers - was performed. Program and contact information of the screening day was published in the local newspaper of the district. Data of 48 residents of the district were analyzed. In addition to neurologists, a radiologist, a cardiologist and an ophtalmologist, as well as health care workers were involved in the project. A data sheet was filled in for all participants, including known risk factors, BMI, blood pressure and serum cholesterol levels. All participants had duplex sonography of the cervical vessels, cardiac evaluation and ophtalmic examination. Data were analyzed anonymously, and - if participants approved - postcode and educational level were also recorded. Among the 48 individuals screened, 35 were female and 13 were male. Average age was 62.86 (±8.57) years, and participants were typically of higher educational level. 5 individuals had no known risk factors, most of them had 2-3 risk factors, and multiple risk factors were not uncommon. Individuals with six and seven risk factors were also found. 20 of 27 patients with known hypertension had target blood pressure levels. By duplex sonography, 36 individuals had mild, 4 had significant atherosclerosis. There was no significant carotid stenosis or occlusion. Based on ophtalmic evaluation, 26 patients had signs of vascular disease (mainly hypertensive fundus changes). Cardiac evaluation detected 14 patients with cardiovascular risk. The high standard of primary care in the district was reflected by the fact that all the 6 highrisk individuals were already taken care of by general practitioners (GP-s). One of the leading conclusions from the evaluation of the data is that local press, family ties and local communities play a major role in recruiting people for a screening day. In order to increase efficiency and cost-efficacy of the program, GP-s should also be involved in the planning process, because efficiency may be increased by pre-selecting high-risk individuals.]

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Clinical Neuroscience

[The comparative analysis of arterial wall thickness and arterial wall stiffness in smoking and non-smoking students]

LÉRÁNT Brigitta, CHRISTINA Straesser, OLÁH László, KARDOS László, CSIBA László

[Aim - Our aim was to detect the adverse effects of smoking on arterial wall thickness and arterial wall stiffness in young, healthy university students. Question - Does only a few years of smoking result in measurable vascular alterations in healthy young people? Methods - We measured the intima-media thickness (IMT) on both common carotids by means of carotid ultrasound, then we examined the stiffnessparameters of the blood vessels (pulse wave velocity, PWV; augmentation index, Aix) with the help of arteriograph. Subjects - We recruited 25 smoking and 25 non-smoking young volunteers aged 19-33 for our examinations. Exclusion citeria included any known diseases, abnormally high cholesterol levels, BMI value exceeding 30 kg/m2. Only regular smokers were allowed to participate in the smoking group (at least for six months, minimum five cigarettes a day). Results - In case of smokers morphological, hemodinamic and stiffnessparameters showed significantly higher values compared to non-smokers. Mean bilateral IMT was 0.52±0.034 mm in case of smokers, while in non-smokers we measured 0.46±0.036 mm (this difference is significant: p<0.01). PWV and heart rate also showed significantly higher values in smoking group (PWV: p<0.01; heart rate: p<0.05). Unadjusted to age, gender and smoking status there was a significant correlation between IMT and PWV (0.1 mm thicker IMT - 0.6354 m/s faster PWV). Gender differences were found in vascular changes caused by smoking. Conclusion - The adverse effects of smoking on arterial wall thickness and arterial wall stiffness can be seen even at a young age, only after a few years of smoking. Both higher IMT and higher PWV sensitively predict vascular damages.]

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[PhD thesis New non-invasive transcranial stimulation techniques in neuroplasticity research]

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[Botulinum neurotoxin-A therapy in migraine]

TAJTI János, SZOK Délia, TUKA Bernadett, CSÁTI Anett, KURIS Anikó, MAJLÁTH Zsófia, LUKÁCS Melinda, VÉCSEI László

[Although migraine is a common, paroxysmal, highly disabling disorder, the primary cause and the pathomechanism of migraine attacks are enigmatic. Experimental results suggest that activation of the trigeminovascular system is crucial in its pathogenesis. This activation leads to the release of vasoactive neuropeptides (calcitonin gene-related peptide - CGRP, and substance P - SP) and to neurogenic inflammation, and peripheral and central sensitisation are expressed. Botulinum neurotoxin-A (BoNT-A), a potent toxin produced by Clostridium botulinum, affects the nervous system through specific cleavage of the soluble NSF-attachment protein receptor complex (SNARE), like synaptosomal-associated protein of 25 kDa (SNAP-25). The result of this multistage process is blockade of the presynaptic release of pain neurotransmitters such as CGRP, SP and glutamate. A pooled analysis of the data from two programmes of Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT 1 and 2) with BoNT-A in chronic migraine demonstrated significant benefit of BoNT-A over placebo with regard to the numbers of headache days and migraine episodes. BoNT-A diminished the frequency of acute headache pain medication intake, and resulted in reductions in headache impact and improvements in scores on the Migraine-Specific Quality of Life Questionnaire. The treatments with BoNT-A proved safe and were well tolerated.]

Clinical Neuroscience

[Neurology Editors: Imre Szirmai]

BERECZKI Dániel

Clinical Neuroscience

[One year follow-up after stroke. A preliminary feasibility study in Josephtown of Budapest]

SZŐCS Ildikó, SZATMÁRI Szabolcs, FEKETE Klára, ORBÁN-KIS Károly, VASTAGH Ildikó, FOLYOVICH András, AJTAY András, BERECZKI Dániel

[Stroke is a major public health issue in Hungary with considerable regional differences in mortality. We have limited information to explain such regional differences. To assess these differences, we would need comparative followup studies optimally carried out by personal contact with the patient or the carer. According to several epidemiological studies, follow-up can be carried out with significantly lower cost and similar efficiency by telephone contact or regular mail. In this pilot study we intend to assess: 1. the efficacy of telephone follow-up one year after stroke in this geographical region 2. whether the efficacy of follow-up can be further increased with questionnaires sent out by regular mail 3. whether telephone and mail-based assessment is sufficient to perform a larger population based study. We included 135 patients hospitalized consecutively for acute cerebrovascular disease (stroke or TIA) by the Department of Neurology, Semmelweis University in January and February of 2008. Based on residence, patients were divided into three groups: those living in the least wealthy district of Budapest (i.e. District-8); those living in other districts of the city; and those living in suburban areas. One year after the hospital treatment follow-up was possible by telephone in 76%. Further 12 patients could be contacted by questionnaire sent out by regular mail. Efficacy of follow-up was altogether 84%. Even in this small group of patients, we have found a tendency for more severe strokes (p=0.06) and higher acute case fatality (32% vs. 5%, p=0.029) in residents of District-8 of Budapest compared to those residing in more wealthy districts of the city and in suburban areas. Survival rate one year after stroke or TIA was only 39% in those living in District-8, 66% in those living in other districts and 75% in suburban dwellers (p=0.006). Telephone and mail-based questionnaires are insufficient for follow-up in these regions even when applied in combination. These preliminary data raise the possibility that the socio-economical conditions might influence stroke severity and outcome in the population. A larger study to address this issue would require more accurate definition of patient-groups and more efficient follow-up methods.]

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Clinical Neuroscience

[Prevalence of stroke/cardiovascular risk factors in rural Hungary - A cross-sectional descriptive study (in English language)]

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[A multi-faceted survey was conducted in 1992-94 to ascertain the somatic, mental and socio-economic conditions of the residents of a village in eastern Hungary. Here we report data on prevalence of somatic disorders from the survey. Objectives - a) To collect and compare prevalence of known cardiovascular disease, including stroke risk factors, in a specific population (a Hungarian village); b) to test a computer-based mass screening device ("Cerberus") designed to identify individuals in the test population at high risk for stroke; c) to compare results obtained with Cerberus with known stroke risk/cardiovascular disease factors and traditional medical records. Methods - A cross-sectional survey (546 subjects) was conducted in Csengersima in the early 1990s, using the Cerberus screening system, which includes: 1. a questionnaire addressing the risk factors for stroke/cardiovascular disease; 2. amplifiers to record the pulse waves of cerebral (rheoencephalography) and peripheral arteries, electrocardiogram and electroencephalogram. Additionally, subjects were measured for carotid stenosis by Doppler ultrasound and 12-lead electrocardiogram; they were also screened for blood cholesterol, glucose, and triglyceride levels. Findings - Prevalence of the following stroke risk factors was identified: overweight, 63.25%; sclerotic brain arteries by rheoencephalogram, 54.29%; heart disease, 37.92%; pathologic carotid flow, 34.24%; smoking, 30.55%; high blood cholesterol, 28.70%; hypertension, 27.83%; high triglyceride, 24.35%; abnormality of electrocardiogram, 20%; high glucose, 15.95%; symptoms of transient ischemic attack, 16.07%; alcohol abuse, 6.74%; and diabetes, 4.53%. Conclusion - The study demonstrates a possible model for primary cardiovascular disease/stroke prevention. The simple, noninvasive test uses the bioimpedance method of measurement. This method offers a standardizable, costeffective, practical technique for mass screenings by identifying the population at high risk for cardiovascular disturbances, especially cerebrovascular disease. In this model, the rheoencephalogram can detect cerebrovascular arteriosclerosis in the susceptibility/presymptomatic phase, earlier than the Doppler ultrasound technique. The method also provides a model for storing analog physiological signals in a computer-based medical record and the first steps of turning it into an expert system also tested.]

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