Clinical Neuroscience

[Topographic pattern of spike-waves in absence seizures]

CLEMENS Béla1

MAY 20, 1996

Clinical Neuroscience - 1996;49(05-06)

[Topography of generalized ictal spike-wave patterns (absence seizures) have been investigated by voltage mapping analysis. The 31 patients investigated in this study belonged to a wide variezy of epileptic syndromes with absence seizures. Previously described different topographic patterns of the spike and the wave components have been confirmed in this study.]

AFFILIATIONS

  1. Hajdú-Bihar Megyei Kenézy Gyula Kórház, Idegosztály, Debrecen

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Clinical Neuroscience

[Somatic defects and pain manifested at adults' drawings of a man]

GRYNAEUS Tamás

[The outhor observed that “draw-a-man tests” of mentally retarded or demented adult patients may truly reflect their somatic defects or painful disorders. Drawings of mentally intact patients could also exhibit their somatic illness if it causes pain or the compensating mechanisms are insufficient. A brief discussion is given on the possible mechanisms, in connection with the body-schema.]

Clinical Neuroscience

[The effect os levodopa in Parkinson's disease ]

MECHLER Ferenc, DIÓSZEGHY Péter, GLAUB Theodóra, HIDASI Eszter, JOSE Rosa

[The effect of carbidopa/levodopa on clinical signs and laboratory data was studied in 21 patients with Parkinson's disease during a follow-up period of 7-12 months. The Columbia and Webster scales were used for analysis. The improvement was significant already in the first weeks of the treatment. The drug did not influence the laboratory data and the side effects were found to be insignificant. The changes due to the drug were analysed by electrophysiological methods. Certain peak amplitudes and the area of visually evoked responses increased significantly during the treatment suggesting facilitation in the function of visual pathways. On stimulating the motor system by transcranial and spinal magnetic stimulation, the motor latencies and the duration of silent period showed normalization. ]

Clinical Neuroscience

[The prognostic relevance of apoptosis in medulloblastoma]

SCHUBERT EO Thomas, CERVOS-NAVARRO Jorge

[Apoptosis is known to be a phenomenon of prognostic significance in certain neoplasms. Several previous studies have indicated that the prognosis of desmoplastic medulloblastoma is better than that of classical medulloblastoma. We studied 5 desmoplastic and 5 classical medulloblastomas by in situ end labelling of DNA strand breaks to see whether there is any difference in amount or pattern of apoptosis in these subtypes, correlating to the different prognostic behaviour. We found no significant difference neither in amount nor in pattern of apoptosis between the two subtypes. Our results indicate that apoptosis may not be a relevant variable in the prognosis of medulloblastoma.]

Clinical Neuroscience

[Thrombolytic therapy in acute ischemic stroke (preliminary report)]

HAFFNER Zsolt, HORVÁTH Erzsébet, HORVÁTH Éva, PAPP Gabriella, EGERVÁRI Ágnes, LIPÓTH Sarolta, CSÁNYI Attila, TUKA Andrea

[Intravenous stretiokinase infusion therapy was performed on four patients in acute occulsive cerebrovascular disease (hemorrhage was rxcluded by CT scan). The thrombolytic therapy was started not later than six hours after the onset of the first symptoms. Kabikinase (1 250 000 IU) was administered in intravenous infudion during two hours. After thrombolysis no prolonged anticoagulant therapy was applied. Improvement of the neurological symptoms was impressive and convincing: in two cases immadiate. Ino one case we could be observed during the treatment (2 hours) nor after it. The possibility of thromolytic therapy in acute occulsiv stroke should be take into consideration. So far as we are aware this is the first time that thromolysis is occulsive stroke according to a protocol like this has been used in Hungary.]

Clinical Neuroscience

[Glaucomatous optic nerve disease]

ÁGNES Boros, JOHN Bryan Fenton, IVAN Bodis-Wollner

[Glaucomatous optic nerve disease (GOND) is the axonal neuropathy of the optic nerve and this diagnosis should enter the differential diagnosis of patients complaining of progressive diminution of vision. A positive family history is one of the major risk factors. Current theories regard the elevation of intractor pressure only a risk factor of GOND, not as its cause. The pathophysiology of ganglion cell dam- age in GOND in some respect parallels processes in other neurodegenerative disease. Current therapy aims at reducing the intraocular pressure and new forms of therapy, to prevent neuronal death are being developed. ]

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Clinical Neuroscience

Effects of valproate, carbamazepine and levetiracetam on Tp-e interval, Tp-e/QT and Tp-e/QTc ratio

YASAR Altun, ERDOGAN Yasar

Aim - To evaluate P-wave dispersion before and after antiepileptic drug (AED) treatment as well as to investigate the risk of ventricular repolarization using the Tpeak-Tend (Tp-e) interval and Tp-e/QT ratio in patients with epileptic disorder. Methods - A total of 63 patients receiving AED therapy and 35 healthy adults were included. ECG recordings were obtained before and 3 months after anti-epileptic treatment among patients with epilepsy. For both groups, Tp-e and Tp-e/QT ratio were measured using a 12-lead ECG device. Results - Tp-e interval, Tpe/QT and Tp-e/QTc ratios were found to be higher in the patient group than in the control group (p<0.05, for all), while QTmax ratio was significantly lower in the patient group. After 3 months of AED therapy, significant increases in QT max, QTc max, QTcd, Tp-e, Tp-e/QT, and Tp-e/QTc were found among the patients (p<0.05). When the arrhythmic effects of the drugs before and after treatment were compared, especially in the valproic acid group, there were significant increases in Tp-e interval, Tp-e/QT and Tp-e/QTc values after three months of treatment (p<0.05). Carbamazepine and levetiracetam groups were not statistically significant in terms of pre- and post-treatment values. Conclusions - It was concluded that an arrhythmogenic environment may be associated with the disease, and patients who received AED monotherapy may need to be followed up more closely for arrhythmia.

Clinical Neuroscience

Management of bone metabolism in epilepsy

UÇAN TOKUÇ Ezgi Firdevs , FATMA Genç, ABIDIN Erdal, YASEMIN Biçer Gömceli

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

Clinical Neuroscience

[Personalised epilepsy treatment]

ALTMANN Anna

[Epilepsy is one of the most common chronic neurological disease in childhood. Patients with epilepsy – even with so-called benign epilepsy – need medication for years. During this time, children go through a very big change, not only gaining weight and height, but also changing hormonal and metabolic processes. Maturation processes in different brain areas also take place at different rates depending on age. All of these should be considered when preparing a therapeutic plan. In everyday practice after the diagnosis of epilepsy, the applied drug is most often selected based on the shape and type of seizure. However, a number of other factors need to be considered when designing a therapeutic strategy: 1. efficacy (form of epilepsy, type of seizure), 2. age, gender, 3. pharmacological properties of the drug, 4. adverse drug reaction profile, 5. lifestyle (community), figure (skinny, corpulent, obese), 6. other comorbidities (nutrition, behavioral and learning problems, circulatory disorders, kidney or liver disease), 7. expected interactions with other drugs already used, 8. genetics, 9. other aspects (drug registration and prescription rules). The purpose of this article is to help to decide which antiepileptic drugs are expected to have the least side effects in a particular child with different comorbidities and which medications should be avoided if possible.]

Lege Artis Medicinae

[Epilepsy in coronavirus pandemic]

SZŰCS Anna, HALÁSZ Péter, NARULA Lalit

[We aim to review the impact of COVID-19 pandemic on epilepsy and epilepsy-care. While the virus has no specific link with epilepsy, it may affect the nervous system both directly and indirectly, leading to seizures in several ways. The hyper-coagulable state occurring with the infection may cause strokes leading to seizures. The infection may first manifest in the form of disturbances of consciousness and behaviour, seizures, and even status epilepticus. The interactions of antiviral/antiepileptic drugs need to be taken into account during treatment. The hypercoagulable state induced by COVID-2 infection may cause stroke, which leads to seizures. The infection can occur also as an impaired consciousness of non-epileptic origin. Interactions of antiviral/antiepileptic drugs have also to be taken into account. The pandemic itself as well as quarantines and social distancing may cause anxiety and insomnia, challenge continuous antiepileptic supply; each one carrying the risk of seizing. Young epilepsy patients with learning disabilities and mental health issues are most vulnerable, justifying their hyper-protection. The danger of infection has highlighted the role of telemedicine. Internet-based video communication may ensure full care for chro­nic patients. Those methods favour bes­­ted patients with higher education. Epilepsy does not increase directly the risk of infection, but its comorbidities may worsen the course of the disease. Brain lesions and hypoxia, stress, insomnia and fever joining the infection increase seizure susceptibility. Because the danger of infection ma­de telemedicine an essential tool of pa­tient care, education and better computer supply for those in need is crucial. ]

Clinical Neuroscience

[The role of zonisamide in the treatment of women with epilepsy]

JUHOS Vera

[The antiepileptic drugs can effect fertility, development of gynecological diseases and occurence of sexual problems. They can cause a number of “cosmetic” problem and also influence the selection of safe contraceptive method. Many antiepileptic drugs can cause congenital malformations or affect the new-born child’s psychomotor and cognitive development, therefore during pregnancy should be treated with extreme caution in women with epilepsy. Most types of epilepsies accompany the patient through their whole life. Women spend almost the third of their lives after menopause and - due to the formation of associated diseases as well - this period is also special. According to the 2013 recommendation of International League Epilepsy (ILAE), zonisamide is one of the first-line antiepileptic drugs in focal epilepsy. In my review I discuss women’s epilepsy in the viewpoint of the application of zonisamid. ]