Clinical Neuroscience

[Temperature sensitivity of some nerve conduction parameters in diabetic polyneuropathy]


MAY 25, 2014

Clinical Neuroscience - 2014;67(05-06)

[Background - We tested whether in diabetic polyneuropathy the temperature dependence of the median nerve conduction parameters reflects the severity of neuropathy. Methods - We validated an electrophysiological score against clinical signs of polyneuropathy. Electroneurography was performed at temperatures from 20-40 °C in diabetic patients with mild, moderate and severe neuropathy and controls. Results - The electrophysiological score reflected the clinical severity of polyneuropathy. At room temperature there were significant differences among groups in almost all parameters. In thermal sensitivity studies were significant differences in distal and proximal motor and sensory areas and in sensory conduction velocities. These four parameters normalized to 1 °C change in temperature also significantly differed among the four groups and were largest in controls and smallest in severe polyneuropathy. Conclusions - The use of an integral parameter - areas are essentially amplitudes integrated over time - increases the probability of detecting decreased thermal sensitivity of peripheral nerves in diabetes.]



Further articles in this publication

Clinical Neuroscience

[LADA type diabetes, celiac diasease, cerebellar ataxia and stiff person syndrome. A rare association of autoimmune disorders]

SOÓS Zsuzsanna, SALAMON Mónika, ERDEI Katalin, KASZÁS Nóra, FOLYOVICH András, SZŰCS Anna, BARCS Gábor, ARÁNYI Zsuzsanna, SKALICZKI József, VADASDI Károly, WINKLER Gábor

[Celiac disease - in its typical form - is a chronic immunemediated enteropathy with typical clinical symptoms that develops against gliadin content of cereal grains, and is often associated with other autoimmune diseases. In cases of atypical manifestation classic symptoms may be absent or mild, and extra-intestinal symptoms or associated syndromes dominate clinical picture. The authors present a longitudinal follow-up of such a case. A 63-years old woman was diagnosed with epilepsy at the age of 19, and with progressive limb ataxia at the age of 36, which was initially thought to be caused by cerebellar atrophy, later probably by stiff person syndrome. At the age 59, her diabetes mellitus manifested with type 2 diabetic phenotype, but based on GAD positivity later was reclassified as type 1 diabetes. Only the last check-up discovered the celiac disease, retrospectively explaining the entire disease course and neurological symptoms. By presenting this case, the authors would like to draw attention to the fact that one should think of the possibility of celiac disease when cerebellar ataxia, progressive neurological symptoms and diabetes are present at the same time. An early diagnosis may help to delay the progression of disease and help better treatment.]

Clinical Neuroscience


SZOK Délia

Clinical Neuroscience

[Analysis of patients applying for emergency treatment with vertigo related symptoms]

VARGA Csaba, NAGY Ferenc, DRUBITS Katalin, LELOVICS Zsuzsanna, VARGA Győrfi Krisztina, OLÁH Tibor

[Objective - Analyzing the medical record data of patients with the main symptom of vertigo in “Kaposi Mór” Hospital’s Emergency Department. Method - Retrospective evaluation of patients’s medical history with vertigo related diagnoses according to BNO classification. Results - In the year of 2010, 18 000 patients were presented to ED. In 471 cases the symptoms were vertigo related which makes up 3% of the total. Almost half, 46% of these patients were brought in by ambulance medical car. The ratio of women was twice as high as of the men. One fifth, 19% of patients with vertigo gained admission to the ward and 81% of them were discharged in 24 hours. According to the interviews, 4 types of vertigo have been identified: “whirling style” vertigo in 37% of the cases, dizziness in 33% of the cases, presyncope in 12% and „light headedness” in 9%. The remaining 9% couldn’t be classified. Conclusion - Vertigo is common presenting symptom in emergency department, however it rarely indicates severe condition. The diagnostic value of vertigo classification based on history and brain CT result in identifying the severity of the background condition is questionable. We found that in recognizing the cases which need prompt intervention, thorough neurological examination and the clarification of the vertigo’s circumstances proved to be helpful.]

Clinical Neuroscience

[The Comprehensive Headache-related Quality of life Questionnaire shows significant improvement after withdrawal treatment in medication overuse headache: a pilot study]


[Background and purpose - Medication overuse headache (MOH) is a common form of disabling headache presenting in as much as 30% of the patients seen in headache subspecialty practice. Quality of life (QOL) is frequently used as a secondary endpoint in headache trials. In MOH, previous trials of QOL focused mostly on generic QOL. We report the results of a pilot study that examined the feasibility of using a new QOL questionnaire, the 23-item Comprehensive Headache-related Quality of life Questionnaire (CHQQ), as an indicator of treatment response in MOH. Patients and methods - Fifteen patients (13 women and two men; mean age: 39.7±12.5 years) suffering from MOH were enrolled in a complex treatment programme consisting of acute medication withdrawal, preventive pharmacological treatment, structured advice and lifestyle intervention. The clinical data were collected using a detailed headache diary. CHQQ was completed before and after the treatment programme. Results - MOH patients had low QOL values at baseline which was comparable to the QOL of episodic migraine patients. The treatment programme resulted in significant reductions of the number of headache days and attacks, headache severity and analgesic consumption. The dimensions and total score of CHQQ showed a significant increase after the treatment period. Seventeen of CHQQ’s 23 individual items also improved significantly. Conclusion - In this study the new headache-specific quality of life instrument CHQQ was able to demonstrate significant improvements after adequate treatment of MOH. This result indicates that the CHQQ may be an adequate tool for assessing quality of life in headache treatment trials.]

Clinical Neuroscience

[Organization of National Neurofibromatosis Register and fields of its application]

HORVÁTH András, FARKAS Viktor, LANGMÁR Zoltán, BACH Rezső, NAGY Zsolt B

[Background and purpose - The neurofibromatosis is a rare genetic disease with increased tumor growing ability and different special symptoms (Riccardi-criteria). The National NF Register has been organized by NF Hungary in 2011. The idea was initiated by hungarian neurofibromatosis experts. Methods - The register contains data about the therapists, the hospitals and the patients. The data are recorded by retrospective method and followed in time, so the register can track progress. Furthermore the register has valid nutrition, physical activity and psychological data, so the users are able to make comparisons with the clinical information. Results - 225 persons are registerd in the system on NF Hungary and 37 patients belong to the NF National Register. The number of the patients, who are member of the register, is always increasing. From the 37 persons 22 are females (60%) and 15 males (40%), 18 adults (48%) and 19 underagedes (52%). Conclusion - NF Register is a very useful system to do research and to draw public health and popolazione conclusions. The register enhances the morbidity details (time of manifestation, progressione, prognostical factors, prognosis), thereby could improve the cooperation and the coverage of the patients. The system is open for the patients as well, so it can give information to the patients about new scientific results, new medical methods and current availavable medications.]

All articles in the issue

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Clinical Neuroscience

[Diabetes, dementia, depression, distress]

SZATMÁRI Szabolcs, ORBÁN-KIS Károly, MIHÁLY István, LÁZÁR Alpár Sándor

[The number of people living with diabetes continues to rise. Therefore neurologists or other health care practitioners may be increasingly faced with comorbid neuropsychiatric disorders commonly presented by diabetic patients. More recently there has been an increasing research interest not only in the interactions between diabetes and the nervous system, the fine structure and functional changes of the brain, but also in the cognitive aspects of antidiabetic treatments. Patients with both types of diabetes mellitus may show signs of cognitive decline, and depression. Comorbid insomnia, anxiety, and distress may also occur. The bi-directional relationships between all these phenomena as well as their connection with diabetes can lead to further health and quality of life deterioration. Therefore it is important that all practitioners involved in the care of diabetic patients recognize the presence of comorbid neuropsychiatric disturbances early on during the healthcare process. Identifying higher risk patients and early screening could improve the prognosis of diabetes and may prevent complications.]

Hypertension and nephrology

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SZEGEDI János, KISS István

[Hypertension and diabetes mellitus are endemics which affect large crowds; they play an important role in the morbidity and mortality of the population. Both diseases are cardiovascular risk factors, their co-occurrence increases the coronary risk. According to forecasts, there will be 60% increase in the number of hypertensive patients by 2025; it will affect 29% of the world’s adult population, 1.56 billion people. The number of patients with diabetes increases in all countries; 552 million diabetic patients should be expected by 2030. The simultaneous occurrence of both diseases may be a coincidence, but there is also causal relationship between the two diseases (diabetic nephropathy, metabolic syndrome). The two diseases often occur in endocrine diseases, and in connection with medicinal therapy (steroids, etc.). The simultaneous occurrence of these two diseases determines the therapeutic strategy. During the prevention and treatment of both diseases, the change in lifestyle has an important role (obesity, salt intake, physical activity).]

Lege Artis Medicinae


NAGY András

[In the diabetic heart the efficacy of haemodynamic agents is limited due to vascular stiffness. Metabolic drugs such as trimetazidine switch energy production from fatty acid oxidation typical to diabetes to the more efficient glycolysis. The improved energy production increases contractility. Three studies have been conducted with trimetazidine in patients with comorbid diabetes and coronary artery disease. In these, trimetazidine improved left ventricular function without modifying heart rate or blood pressure. Markers of glycaemic control also improved. Trimetazidine also reduced the levels of circulating endothelin-1. In conclusion, trimetazidine is a safe and effective drug that improves both myocardial function and glycaemic control in patients with coexisting diabetes and coronary artery disease.]

Journal of Nursing Theory and Practice

[Causes of leg problems in chronic kidney failure, and opportunities for prevention]


[In patients with chronic kidney failure, especially diabetic haemodialysis patients, the risk of lower-limb complications increases. Through the early recognition of changes in the leg, the definition of risk factors and timely intervention, the prevalence of ulcers and amputations can be reduced. The author aims, through a review of the specialist literature, to provide skills for the recognition of lower-limb complications occurring in chronic kidney patients, and to summarise the most common factors leading to amputation, and the opportunities for prevention. It gives guidance for the definition of risk factors, briefly describes the procedure for assessing the condition of the leg, and the basic principles and options relating to patient education. ]

Journal of Nursing Theory and Practice

[Patients with type-1 and type-2 diabetes mellitus in the program of peritoneal dialysis]


[Aim of the research: To evaluate the efficacy of the treatment and incidence of complications in diabetes type 1 and 2 patients treated with peritoneal dialysis. Research and sampling methods: During a retrospective study with 85 diabetic PD patients (19 type 1 patients and 66 type 2 patients) was compared data of 22 years with regard to the following parameters: Glucose metabolism, body weight, changes in residual urine clearance values, distribution of quantity and glucose content of the solutions used, incidence of infections, and average duration in PD programme before transferring to haemodialysis. Results: All patients, irrespective of their type of diabetes: spend the same time in PD on average, gained body weight during PD. Diabetes type 1 patients: had a lower residual urine clearance, had HbA1c values decreasing during PD, reported peritonitis less frequently, had a higher incidence of catheter-related infections. Diabetes type 2 patients: had a better glucose metabolism, had a higher body weight from the beginning of therapy, required PD solution with higher glucose concentration. Conclusions: Diabetes patients, irrespective of the type of diabetes, can successfully be treated with PD, but require more attention because of their underlying disease and associated complications. ]