Clinical Neuroscience

[THE USE OF STALEVO IN HUNGARY. AN OBSERVATIONAL STUDY]

KLIVÉNYI Péter, VÉCSEI László

JANUARY 22, 2008

Clinical Neuroscience - 2008;61(01-02)

[The triple combination of levodopa, DDCI and entacapone (Stalevo) is used to treat motor complication in Parkinsonian patients with fluctuation. An observational investigation has been conducted in Hungary to study the effects of Stalevo on the “wearing off” phenomenon and on the quality of life in patients, who are to be treated with. The introduction of Stalevo to the treatment resulted in no changes in the number of patients taking selegiline, amantadine and dopamin agonists, while the number of patients taking anticholinergic drugs were slightly increased. This treatment significantly decreased the average Hoehn-Yahr stadium, as well as the non-motor symptoms, without any remarkable side effect. Stalevo also improved the quality of life, detected by the EQ-5D questionare and the visual analoge scale.]

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[Complex regional pain syndrome]

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Clinical Neuroscience

[MANAGEMENT AFTER DBS IMPLANTATION]

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[Deep brain stimulation is a widely used technique for the treatment of movement disorders. This method is a breakthrough in treatment of drug-resistant idiopathic Parkinson’s disease, essential tremor and dystonia. The aim of the present paper is to give an inside overview of the postoperative management like fine tuning of the stimulation and balancing the antiparkinsonian medication. We also discuss the advantage of the use of the (Access Therapy) patient controller. After reviewing the stimulation-related side-effects and their management, the contraindicated medical procedures are discussed.]

Clinical Neuroscience

[Occlusive hydrocephalus caused by a fourth ventricle arachnoid cyst (in English language)]

SZŰCS Anna, VÁRADY Péter, PESTALITY Péter, FABÓ Dániel, LALIT Narula, KENÉZ József

[The case history of a woman with occlusive hydrocephalus caused by a fourth ventricle cyst is presented. She had slowly progressive complaints and symptoms - concentration and memory disturbances, low-tempered mood, then slight dizziness, loss of appetite and progressive headache - transitorily misinterpreted for signs of depression. She had been treated by psychotherapy and antidepressants for months. Since she did not improve she was referred to a psychiatric hospital. The rapidly progressing neurological syndrome with worsening headache, gait disturbance and vomiting was finally identified and it turned out to be caused by a fourth ventricle CSF blockage of unknown aetiology. An acute neurosurgical intervention was indicated. It revealed a huge fourth ventricle cyst, undetectable on MRI, occupying the whole ventricle. The resection of its walls resulted in complete recovery. We conclude that since unspecific mental complaints and symptoms suggesting depression may be misleading, their organic origin has to be excluded.]

Clinical Neuroscience

[Péter Rajna : Aging brain - aging mind - ageless (?) soul]

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Clinical Neuroscience

[COMBINED USE OF PATTERN ELECTRORETINOGRAPHY AND PATTERN VISUAL EVOKED POTENTIALS IN THE NEUROOPHTHALMOLOGICAL DIAGNOSIS]

BENEDEK Krisztina, PÁLFFY Andrea, BENCSIK Krisztina, FEJES Imre, RAJDA Cecília, TUBOLY Gábor, LISZLI Péter

[Objective - To survey the role of pattern electroretinography (PERG) and pattern visual evoked potentials (VEPs) in the process of clinical evaluation of neuro-ophthalmological cases. The study is illustrated with the electrophysiological findings of 231 patients sent to our laboratory in 2005 because of the suspicion of damage in the optic pathway. Methods - The RETIport program of the ROLAND equipment (Wiesbaden - Germany) was used to record PERGs and VEPs. The recordings were done according to the recommendations of the International Society for Clinical Electrophysiology of Vision. Results - The combined application of PERG and VEP provided useful data on the retino-cortical conduction time and hence demyelinisation. The comparison of the N35/P50 and P50/N90 amplitudes of the PERG recordings greatly promoted the diagnostic procedure. Conclusions - The combined application of PERG and VEP methods is recommended in the assessment of optic nerve function of neuro-ophthalmological patients.]

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Clinical Neuroscience

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[Background - Bilateral pallidal deep brain stimulation (DBS) is an established treatment option for primary generalized and segmental dystonia. In the present study we evaluated the results of our dystonia patients treated by DBS. Methods - The surgical results of forty consecutive dystonia patients underwent DBS implantation were analyzed (age: 43.7±17.7 years; sex: 22 men; etiology: 24 primary and 16 secondary dystonia; topography: 24 generalized, 12 segmental and four hemidystonia; disease duration: 16.1±9.3 years). Severity of dystonia measured by Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) and health-related quality of life measured by EQ-5D scale were obtained preoperatively and compared to the scores obtained at postoperative six months and subsequent yearly follow-ups. The average follow-up lasted 2.5 years (median, 0.5-8 years). In all cases the BFMDRS scores were re-evaluated by a rater blinded to the treatment. Treatment responsiveness was defined as an at least 25% improvement on the BFMDRS scores. Non-parametric Mann-Whitney, McNemar and Kruskal-Wallis tests were applied to test statistical significance. Results - Severity of dystonia improved from 31 to 10 points (median, 68% improvement, p<0.01) in the primary dystonia group, whereas in secondary dystonia these changes were statistically insignificant (improvement from 40 to 31.5 points, 21.2%, p>0.05). However, the health-related quality of life significantly improved in both groups (primary dystonia: 0.378 vs. 0.788 and secondary dystonia: 0.110 vs. 0.388, p<0.01). Significantly more patients in the primary dystonia group responded to DBS treatment than those in the secondary dystonia group (83.3% vs. 37.5%, p<0.01). Conclusion - Our results are in accordance with previously published international findings demonstrating that DBS is a highly effective and long-lasting treatment option for primary dystonia. DBS is considerably less efficient in secondary dystonia; however, it still has a high impact on the quality of life presumably due to its pain-relieving effect.]

Clinical Neuroscience

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[Kidney transplantation provides the best outcomes, concerning morbidity, mortality and health related quality of life for patients with end stage renal disease. Health related quality of life is increasingly recognized as an important outcome measure in patients with different chronic medical conditions, including chronic kidney disease. Sleep disorders, such as insomnia, sleep apnea syndrome and restless legs syndrome are common in patients with chronic kidney disease. The prevalence of insomnia and restless legs syndrome is similar in kidney transplanted patients to the prevalence observed in the general population. On the other hand, the prevalence of sleep apnea is considerably higher, about 30%. The association between sleep disorders and impaired health related quality of life has been relatively well documented in dialysis patients but only scarce information has been published about the kidney transplanted population. In this paper we summarize published data about sleep disorders and also about their association with health related quality of life in the kidney transplanted population.]

Lege Artis Medicinae

[PHYSICAL AND PSYCHOLOGICAL CONDITION OF HEALTH CARE WORKERS DEALING WITH THE SERIOUSLY ILL]

HEGEDÛS Katalin, RISKÓ Ágnes, MÉSZÁROS Eszter

[INTRODUCTION - Health care professionals undertaking treatment/nursing of the seriously ill are equally overburdened emotionally, intellectually and physically. This condition might have several, sometimes irreversible negative consequences: avowed difficulties within the communication with patients, families and colleagues, various harms of accumulating, unprocessed stress, severe physical and psychological symptoms of mental burn-out which is very frequent and failures and difficulties of the private life. In our survey we aimed to gain a realistic image of the physical and psychological condition and quality of life of professionals working in Hungarian clinical care in order to provide with indelayable help. METHODS - The basis of the survey was a version of the Hungarostudy 2002 questionnaire, modified for health care professionals. In our sample there were 200 health care professionals dealing with seriously ill and in the control groups 1356 non health care professionals, and 227 health care professionals, choosen from the Hungarostudy survey. In all three groups the proportion of gender, age and education were the same. The results were analysed by the SPSS 10.0 statistical program and the relationship analysis was completed by ANOVA test. RESULTS - The analysis of the answers of those attending in our questionnaire survey - compared to those working in other health care field and to the control group of non health care workers - proves that the ratio of exhaustion and stress-dependent physical and psychological symptoms are prominently, in many cases significantly higher among health care workers dealing with the seriously ill, addiction is more frequent and social net is more unfavourable. These data are even worse for nurses than for doctors and other graduates. CONCLUSION - In treating difficult cases we can start to help with special education that should be general both in gradual and postgradual training.]