Clinical Neuroscience

[World of agression]

RAJNA Péter, HÁRDI István

JANUARY 30, 2011

Clinical Neuroscience - 2011;64(01-02)

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Clinical Neuroscience

[Some thoughts about the presumed death of classical neurology and the neurology to come]

ERTSEY Csaba

[In my opinion Hungarian medicine, and not just neurology, is in a critical state. This is the consequence of various factors, such as the overemphasizing of medicine’s economic aspects, the malfunctions of patient care caused by inadequate source allocation, and the misinterpretation of the doctors’ role by the society. The vastly increased knowledge base and the huge amount of information we can gather about our patients are an unparalleled chance, rather than a deathly wound, for neurology as a discipline. The challenge the future’s neurology has to face is high-quality patient care, which necessitates dedicating the necessary time for patients, rationally using our ever-increasing diagnostic arsenal, and continuously updating our knowledge about the therapeutic possibilities.]

Clinical Neuroscience

[EEG investigations in cognitive impairments]

SZIRMAI Imre, KAMONDI Anita

[The EEG is an indicator of all physiological and neuropsychological activity. The α rhythm was considered as a key phenomenon in research of human mentation from the discovery of EEG. Two methods are known for the estimation of cognitive deficit by the use of quantitative EEG (QEEG). The first is based on the hypothesis, that the mean values of the normal EEG from healthy volunters can be used as reference, and deviation from the normal values of EEG parameters may suggest disease. This kind of “neurometry” was elaborated by R. E. John. The second method asseses event related (ER) transients evoked by somatosensory and mental stimuli. Quantity and localization of signals may refer to the functional state of the cortex. These reactions depend strongly on the test-paradigms. Recognition of the attention-intention cycle disclosed the psysiological mechanism of ERD (event related desynchronisation) and ERS (event related synchronisation). In contrast with the classical “stimulus-reaction” model, both perception and voluntary movement are iniciated by the brain itself, and not by the environment. Human behavior and conscious actions depend on the intention. QEEG analysis proved that the attention and intention localize in segregate areas of the brain. Both “static” and “dinamic” neurometric methods are able to differenciate the EEG records of demented patients from healthy controls, furthermore some dementias from each other. We conclude that with the help of sofisticated methods of QEEG analysis minimal functional deficit of the electrogenesis can be recognized, which could be helpful in the differential diagnosis Notwithstanding the EEG can not explain the evolution neither the normal or the diseased mental processes. The only “instrument” which is able to approach the human mind is the human cogitation itself with the aids of appropriate tests. The QEEG can be conclusive in the analysis of particular processes of mental activity, such as timing, state of activation, hierarchical organisation of cortical territories and mechanism of electrogenesis.]

Clinical Neuroscience

[ULCERATIVE CARPAL TUNNEL SYNDROME]

KAMONDI Anita, TEIXEIRA Jose Maria, SZIRMAI Imre

[The carpal tunnel syndrome is the most frequent compression- induced neuropathy. A severe but rare clinical manifestation of this disorder associates with ulceration, acral osteolysis and mutilation of the terminal phalanges of the second and third fingers. Recognition of this disorder is difficult, because various dermatological and internal diseases might lead to acral ulcerative lesions, and these patients are seldom referred to neurological and/or electrodiagnostic examination. In this article, we present three cases of this rare clinical form of carpal tunnel syndrome and discuss the electrodiagnostic findings. The early diagnosis is important since decompression of the median nerve in due time might prevent mutilation and could significantly improve the patients’ quality of life.]

Clinical Neuroscience

[Tolosa-Hunt syndrome]

PÉTERFI Anna, ZÁDORI Péter, SÜTŐ Gábor, HORVÁTH Gyula, KOPA János

[Both men and women are affected by the rare disease called Tolosa-Hunt syndrome. We don’t know exactly what causes it to evolve. It is usually put into the categories of either idiopathic inflammation or pseudotumor. Its patological feature is a non-specific inflammatory process with fibroblastic, lymphocytic, plasmocytic infiltration, which can be found, for the most part, in the wall of the sinus cavernosus. Granulocytic and giant-cell infiltrations have been described too. The possibility of autoimmune disease has also come up. In our current study we describe the case of a female patient who recovered with the help of a steroid therapy. Through examining her, we also found immunological alterations, which should urge us to thoroughly examine the further observations of this kind.]

Clinical Neuroscience

[Paroxysmal kinesigenic dyskinesia]

VADÁSZ Dávid, KLIVÉNYI Péter, VÉCSEI László

[Paroxysmal kinesigenic dyskinesia (PKD) is a rare neurological disease and the diagnosis is based on case history and clinical features. Despite of simply diagnostic criteria, the recognition of the disease is sometimes delayed. The involuntary movements in PKD lead to anxiety, social isolation, trauma and worsens the quality of life. To establish the diagnosis many other paroxysmal syndromes have to be excluded. The disease responds to antiepileptic therapy well. The genetic background of the familiar cases is not known. Here we present a 19 year-old patient with PKD and review the current literature. Our patient’s events were triggered by sudden movements and last several seconds. His physical and neurological examinations were normal and responded well to carbamazepine therapy.]

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Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella, BALÁS István, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József, ASCHERMANN Zsuzsanna, NAGY Ferenc, BOSNYÁK Edit, KOVÁCS Norbert

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

Lege Artis Medicinae

[Health care administration between World War I and II]

KAPRONCZAY Károly

Lege Artis Medicinae

[Accident prevention and first aid knowledge among kindergarten children’s parents]

BÁNFAI Bálint, RADNAI Balázs, MARTON József, PÉK Emese, DEUTSCH Krisztina, BETLEHEM József

[INTRODUCTION - Based on statistics, accidents from various mechanisms are among the most common causes of death all over the world. Children are mostly affected in this situations. Our aim was to examine the first aid and accident prevention knowledge and attitude of the parents. PATIENTS AND METHODS - In this study parents of 3-7 years old children were involved in six kindergarten located in Hungary. A self-fill-in questionnaire was used to collect data. In the investigation 307 parents (N=307) were included. Out of them 234 respondents filled out the questionnaire correctly. The statistical analysis was made with SPSS 20.0 statistical software. For analyses deescriptive statistics, Chisquare- test and ANOVA were used. RESULTS - Three-quarters of the children have suffered at least one accident earlier (74.3%). Most of the accidents occured at home (88.5%). 174 parents attended first aid course earlier (74.4%), the previous knowledge is based mainly on the driving license (81.6%). Based on the answers it is important to teach children first aid (70.5%) and prevention (89.7%) knowledge in the kindergarten. There were only 10 parents, who answered all the situation questions correctly (4.3%). Between the subjective judgment of the financial status and the correct answers we found a significant correlation (p=0.03). The previously accomplished first aid training (p<0.05) and the educational attainment (p=0,029) had a positive impact on the results. CONCLUSION - The level of first aid knowledge of parents is lower than expected. Participate in first aid courses the level of knowledge could increase. It would be important, because some of the accidents can be prevented by acquiring proper knowledge.]

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[The Illness of Franz Kafka and his Perception of the World ]

GERLINGER Lilla

Clinical Oncology

[News from the World]