Clinical Neuroscience

[THE USE OF INTRAVENOUS IMMUNGLOBULIN IN THE TREATMENT OF AUTOIMMUNE NEUROMUSCULAR DISEASES]

MOLNÁR Mária Judit

MARCH 30, 2006

Clinical Neuroscience - 2006;59(03-04)

[Intravenous immunglobulin given in autoimmune neuromuscular disorders modulates the immune system by complex actions, including, 1. the modification of the expression and function of Fc receptors, 2. interference with the activation of the complement and the cytokine network, 3. neutralisation of antiidiotypic antibodies, 4. effects on the activation, differentiation and effector functions of the T and B cells. Controlled trials have shown that intravenous immunglobulin is effective as first-line therapy in patients with Guillain-Barré syndrome and multifocal motor neuropathy. In case of steroid resistance or coexisting diabetes mellitus, intravenous immunglobulin can be the first line therapy in chronic inflammatory demyelinating polyneuropathy as well. As an alternative therapy it can be a second-line choice in dermatomyositis, myasthenia gravis, Lambert-Eaton myasthenic syndrome, and stiff person syndrome. While it has a remarkably good safety record for long term administration the following side effects have been observed: headache, skin rash, thromboembolic events and renal tubular necrosis. In some disorders, the appropriate dose and frequency of infusions that maintain a satisfactory therapeutic response is well defined on the basis of data of evidencebased medicine, whereas in others it still remains to be defined. For the analysis of pharmacoeconomical aspects and the mechanism(s) of response differences in the same disease categories, further studies are necessary.]

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Clinical Neuroscience

[SPECTRAL EEG-CHARACTERISTICS OF SUBCORTICAL ISCHEMIC BRAIN LESION - A CASE STUDY]

MOLNÁR Márk, CSUHAJ Roland, HORVÁTH Szabolcs, VASTAGH Ildikó, GAÁL Zsófia Anna, CZIGLER Balázs, BÁLINT Andrea, NAGY Zoltán

[Introduction - Although the EEG-changes caused by ischemic stroke are well known, data of the literature are rather ambiguous. The EEGfindings recorded in a patient with a unilateral subcortical ischemic lesion are evaluated with special emphasis related to the effect of the dynamics caused by eyes opening. Participants and methods - Data recorded from a patient (54 years old male with a completed stroke involving the frontal and parietal subcortical region in the left side) were compared to those of a control group (12 healthy age matched subjects). Absolute and relative frequency spectra, theta/beta quotients, the interaction index characterizing the effect of eyes opening and the symmetry index were calculated from the EEG recorded in eyes closed and eyes open conditions. Data of the patient were compared to those recorded in the control group on the basis of 95% confidance intervals. Results - Irrespective of the recording conditions the predominance of slow activity and the increase of theta/beta quotients were found in the absolute frequency spectra. The increase of beta1 and beta2 frequency bands following eyes opening on the side of the lesion were found to be less obvious than that seen on the intact side and that observed in the control group. With respect to the interaction index related to the side differences caused by eyes opening the change of the beta2 frequency band was found to be the most conspicuous. The symmetry index underscored the predominance of slow (delta, theta, alpha1) frequencies on the lesion side, and that of the fast (beta1, beta2) frequencies on the intact side in both recording conditions. Conclusions - Localized lesion of the white matter without cortical damage can cause the predominance of slow activity and decrease of the fast frequency bands on the side of the lesion which can be shown by the absolute frequency spectra and is revealed by the symmetry index. The lack of functional reactivity of the fast frequencies in the side of the lesion can clearly be seen in the change of relative spectra following eyes opening and on the basis of the calculation of the interaction index reflecting the dynamics of side differences.]

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[ULTRASONOGRAPHIC EXPRESSIONS OF THE FOETAL FACE MAY REFLECT FOETAL MOOD - MIMICRY IS PART OF FOETAL ETHOLOGY]

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[The author studied foetal faces and changes in features in the coronal plane during routine prenatal ultrasound scans. Based on known behaviour of children and adults, deductions can be made about foetal mood alterations. During the four years of the study the author noted five main facial expression changes that might be reflections of foetal mood. Foetal expressions and fine lineaments may indicate adequate maturity of the central nervous system as well as satisfactory oxygen supply. Ethologically, facial mimicry is an inherited behavioural pattern.]

Clinical Neuroscience

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