Clinical Neuroscience

[The 6th National Congress of Hungarian Chapter of International League against Epilepsy]

JUNE 20, 2002

Clinical Neuroscience - 2002;55(05-06)

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Clinical Neuroscience

[Electrophysiological investigations in Parkinson’s diseae]

SZIRMAI Imre, GERTRÚD Tamás, TAKÁTS Annamária, PÁLVÖLGYI László, KAMONDI Anita

[Objective - Post-movement beta synchronization is an increase in EEG beta power after movement termination. Its characteristics in movement disorders are not well described. Tremor dominant Parkinson’s disease shows unique clinical, anatomical and biochemical features. In our study we examined the relation between the laterality of tremor and size of post-movement beta synchronisation in tremor dominant Parkinson’s disease. Methods - In a self-paced movement paradigm we measured movement duration and analyzed EEG power changes at movement-reactive beta frequencies. Results - Movement duration was significantly longer in Parkinson-patients than in controls (0.49±0.170 s, 0.35±0.087 s, p=0.013, Mann-Whitney test). There was no difference between the two hands in the control group (0.36±0.078s, 0.34±0.099 s, p=0.207, Wilcoxon-test), while Parkinson patients performed longer movement with their left hand (0.52±0.195 s, 0.46±0.148 s, p=0.049, Wilcoxon), unrelated to the side of tremor. In controls, post-movement beta synchronisation contralateral to the movement was not significantly different after right and left hand movement (108.1±68.21% and 92.1±23.43%, p=0.78 Wilcoxon). In Parkinson patients post-movement beta synchronisation was significantly smaller contralateral to the tremulous hand movement (36.9±47.79%, 104.7±91.42%, p=0.012, Wilcoxon-test). The post-movement beta synchronisation showed anterior shifting in Parkinson-patients. Conclusions - In tremor dominant Parkinson’s disease the asymmetric decrease of post-move beta synchronisation is related to the laterality of tremor rather than bradykinesia. Analysis of this phenomena might provide further insight to the pathophysiology of Parkinson’s disease.]

Clinical Neuroscience

[In remembrance of Kálmán Sántha, on his 45th death anniversary]

SZIRMAI Imre

Clinical Neuroscience

[MR examination of thoracic herniation of the spinal cord]

KENÉZ József, BARSI Péter, VÁRALLYAY György, BOBEST Mátyás, VERES Róbert

[Transdural herniation of the spinal cord is thought to be previously extremely rare and very often misdiagnosed. Possible reasons may be iatrogenic and traumatic or in about one third of cases it may be unknown, where the probable origin might be a congenital dural defect. The pathology may show characteristic and misleading MR patterns of the thoracic spine, emphasising the importance of these patterns. This anomaly can lead to progressive Brown-Sequard syndrome. Surgical intervention, consisting the repair of the dural defect may result in improvement or even complete regression of the neurologic deficits.]

Clinical Neuroscience

[Neurologic complications of aortic dissection]

MÉSZÁROS István, MÓROCZ József, SZLÁVI József, SCHMIDT János, NAGY László, KATÓ Csaba, TORNÓCI László

[Introduction - Beside the damages of the cardiovascular system the lesions of the the nervous system are the most common complications of aortic dissection. This is usually an early event, therefore the dissection of the aorta may manifest itself as an acute primary neurologic disease. The aim of this study is to describe the frequency and distribution of acute neurologic symptoms occurring in aortic dissection and the distribution of their clinico-pathologic features and to establish correlations between these and the acute inhospital mortality as well as to discuss available diagnostic and therapeutic possibilities. Patients and methods - The study was based of 95 cases of acute dissection of aorta (with additional three later events of redissection), observed in a longitudinal study over a period of 29.5 years, in a population of 106 000 (in Western Hungary). Results - Of the 95 patients 20 (21%) died before admission. Neurological complications were observed in 30 of the 75 patients admitted to hospital (40%). Symptoms involving the central nervous system were found in 24 patients, affecting the spinal cord in two and the peripheral nervous system in four cases. The dissection of the aorta was diagnosed in vivo only in 22 out of the 75 patients who died in hospital (29%). 53 patients (71%) without correct diagnosis received supportive therapy only. The average survival time of the 21 patients with proximal dissection of aorta was 48.5 hours. The survival time of 23 patients with the same type of dissection involving the vessels of the aortic arch was 22.2 hours. This difference in survival time was significant (p=0.0152). 20 of 23 patients (87%) in this group showed signs of neurologic damage confirming earlier experience that neurological complications can seriously worsen the otherwise already catastrophic prognosis of aortic dissection. Conclusions - The study brought compelling evidence for the need for early diagnosis and rapid transfer of patients to appropriate cardiac surgery centers for definitive diagnosis and therapy.]

Clinical Neuroscience

[Identification of gliomas by morphological and immunocytochemical analysis in cell cultures]

FAZEKAS Ilona, KEREKES Edit, HEGEDŰS Balázs, NYÁRY István

[Introduction - The morphology and immunocytochemical properties of 250 different monolayer cultures derived from various human brain tumor specimens were investigated on purpose to support and complement the neuropatholgical diagnosis. In this study analyses of 124 glioma cases are presented. Methods - The tumor samples were mechanically dissociated and seeded on glass coverslips. After the formation of the monolayer cultures were fixed and stained by May-Grünwald- Giemsa method for the morphological examination. Semi-quantitative immunocytochemical labeling included several different types of mono- and polyclonal primary antibodies using avidin-biotin visualization system. In nine cases of the glioblastomas the sufficient proliferation made possible to establish cell lines from the primary cultures. Results - The glial origin of the tumors was identified in 124 cases based upon the presence of glial fibrillary acidic protein. A negative correlation between the intensity of glial fibrillary acidic protein immunostaining and the grade of tumor malignancy was found. During long-term cultivation of the higher grade gliomas the incidence and intensity of glial fibrillary acidic protein labeled cells was decreasing. Both the vimentin and the neuron specific enolase labeling were in general stronger than the glial fibrillary acidic protein and almost all the cells were stained. The incidence of Ki-67 positive cells increased with the grade of malignancy. Concerning the tumor classification our immunocytochemical results correlated with the routine histopathological examination. Conclusions - On the basis of these results we conclude that monolayer cultures obtained from tumor specimens can support and complement the correct diagnosis of the various human brain tumors.]

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[The role of sleep in the relational memory processes ]

CSÁBI Eszter, ZÁMBÓ Ágnes, PROKECZ Lídia

[A growing body of evidence suggests that sleep plays an essential role in the consolidation of different memory systems, but less is known about the beneficial effect of sleep on relational memory processes and the recognition of emotional facial expressions, however, it is a fundamental cognitive skill in human everyday life. Thus, the study aims to investigate the effect of timing of learning and the role of sleep in relational memory processes. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. 84 young adults (average age: 22.36 (SD: 3.22), 21 male/63 female) participated in our study, divided into two groups: evening group and morning group indicating the time of learning. We used the face-name task to measure relational memory and facial expression recognition. There were two sessions for both groups: the immediate testing phase and the delayed retesting phase, separated by 24 hours. Our results suggest that the timing of learning and sleep plays an important role in the stabilizing process of memory representation to resist against forgetting.]

Clinical Neuroscience

Neuroscience highlights: Main cell types underlying memory and spatial navigation

KRABOTH Zoltán, KÁLMÁN Bernadette

Interest in the hippocampal formation and its role in navigation and memory arose in the second part of the 20th century, at least in part due to the curious case of Henry G. Molaison, who underwent brain surgery for intractable epilepsy. The temporal association observed between the removal of his entorhinal cortex along with a significant part of hippocampus and the developing severe memory deficit inspired scientists to focus on these regions. The subsequent discovery of the so-called place cells in the hippocampus launched the description of many other functional cell types and neuronal networks throughout the Papez-circuit that has a key role in memory processes and spatial information coding (speed, head direction, border, grid, object-vector etc). Each of these cell types has its own unique characteristics, and together they form the so-called “Brain GPS”. The aim of this short survey is to highlight for practicing neurologists the types of cells and neuronal networks that represent the anatomical substrates and physiological correlates of pathological entities affecting the limbic system, especially in the temporal lobe. For that purpose, we survey early discoveries along with the most relevant neuroscience observations from the recent literature. By this brief survey, we highlight main cell types in the hippocampal formation, and describe their roles in spatial navigation and memory processes. In recent decades, an array of new and functionally unique neuron types has been recognized in the hippocampal formation, but likely more remain to be discovered. For a better understanding of the heterogeneous presentations of neurological disorders affecting this anatomical region, insights into the constantly evolving neuroscience behind may be helpful. The public health consequences of diseases that affect memory and spatial navigation are high, and grow as the population ages, prompting scientist to focus on further exploring this brain region.

Clinical Neuroscience

[Advanced Parkinson’s disease characteristics in clinical practice: Results from the OBSERVE-PD study and sub-analysis of the Hungarian data]

TAKÁTS Annamária, ASCHERMANN Zsuzsanna, VÉCSEI László, KLIVÉNYI Péter, DÉZSI Lívia, ZÁDORI Dénes, VALIKOVICS Attila, VARANNAI Lajos, ONUK Koray, KINCZEL Beatrix, KOVÁCS Norbert

[The majority of patients with advanced Parkinson’s disease are treated at specialized movement disorder centers. Currently, there is no clear consensus on how to define the stages of Parkinson’s disease; the proportion of Parkinson’s patients with advanced Parkinson’s disease, the referral process, and the clinical features used to characterize advanced Parkinson’s disease are not well delineated. The primary objective of this observational study was to evaluate the proportion of Parkinson’s patients identified as advanced patients according to physician’s judgment in all participating movement disorder centers across the study. Here we evaluate the Hungarian subset of the participating patients. The study was conducted in a cross-sectional, non-interventional, multi-country, multi-center format in 18 countries. Data were collected during a single patient visit. Current Parkinson’s disease status was assessed with Unified Parkinson’s Disease Rating Scale (UPDRS) parts II, III, IV, and V (modified Hoehn and Yahr staging). Non-motor symptoms were assessed using the PD Non-motor Symptoms Scale (NMSS); quality of life was assessed with the PD 8-item Quality-of-Life Questionnaire (PDQ-8). Parkinson’s disease was classified as advanced versus non-advanced based on physician assessment and on questions developed by the Delphi method. Overall, 2627 patients with Parkinson’s disease from 126 sites were documented. In Hungary, 100 patients with Parkinson’s disease were documented in four movement disorder centers, and, according to the physician assessment, 50% of these patients had advanced Parkinson’s disease. Their mean scores showed significantly higher impairment in those with, versus without advanced Parkinson’s disease: UPDRS II (14.1 vs. 9.2), UPDRS IV Q32 (1.1 vs. 0.0) and Q39 (1.1 vs. 0.5), UPDRS V (2.8 vs. 2.0) and PDQ-8 (29.1 vs. 18.9). Physicians in Hungarian movement disorder centers assessed that half of the Parkinson’s patients had advanced disease, with worse motor and non-motor symptom severity and worse QoL than those without advanced Parkinson’s disease. Despite being classified as eligible for invasive/device-aided treatment, that treatment had not been initiated in 25% of these patients.]

Clinical Neuroscience

[Zonisamide: one of the first-line antiepileptic drugs in focal epilepsy ]

JANSZKY József, HORVÁTH Réka, KOMOLY Sámuel

[Chronic administration of antiepileptic drugs without history of unprovoked epileptic seizures are not recommended for epilepsy prophylaxis. Conversely, if the patient suffered the first unprovoked seizure, then the presence of epileptiform discharges on the EEG, focal neurological signs, and the presence of epileptogenic lesion on the MRI are risk factors for a second seizure (such as for the development of epilepsy). Without these risk factors, the chance of a second seizure is about 25-30%, while the presence of these risk factors (for example signs of previous stroke, neurotrauma, or encephalitis on the MRI) can predict >70% seizure recurrence. Thus the International League Against Epilepsy (ILAE) re-defined the term ’epilepsy’ which can be diagnosed even after the first seizure, if the risk of seizure recurrence is high. According to this definition, we can start antiepileptic drug therapy after a single unprovoked seizure. There are four antiepileptic drugs which has the highest evidence (level „A”) as first-line initial monotherapy for treating newly diagnosed epilepsy. These are: carbamazepine, phenytoin, levetiracetam, and zonisamide (ZNS). The present review focuses on the ZNS. Beacuse ZNS can be administrated once a day, it is an optimal drug for maintaining patient’s compliance and for those patients who have a high risk for developing a non-compliance (for example teenagers and young adults). Due to the low interaction potential, ZNS treatment is safe and effective in treating epilepsy of elderly people. ZNS is an ideal drug in epilepsy accompanied by obesity, because ZNS has a weight loss effect, especially in obese patients.]

Clinical Neuroscience

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.