Lege Artis Medicinae

[Tarnabod – Living on the Edge of Society]


FEBRUARY 20, 2010

Lege Artis Medicinae - 2010;20(02)



Further articles in this publication

Lege Artis Medicinae

[Death as a Challenge A Discussion with Criminalist Mihály Filó]

NAGY Zsuzsanna

Lege Artis Medicinae

[Gambling Passion of Dostoevsky’s Heroes]


Lege Artis Medicinae

[Our Monthly Contest – Physicians in Literature]


Lege Artis Medicinae

[Halfway on a physician’s life course]


Lege Artis Medicinae

[Dangers of the use of performance enhancement drugs and food supplements]


[The history of humankind is full of stories related to performance enhancement drug abuse. For the purpose of improving explosive power and long-term physical performance central nervous system stimulating drugs and supplements, such as: amphetamine and cocaine have been used. Androgenic anabolic steroids are used for increasing skeletal muscle mass. The abuse of performance enhancer drugs is seriously deteriorating the human health, and have several negative side effects. Number of food-supplements - available in the market, often contain traces of steroids. So called designer steroids are extremely dangerous. In the near future it will be possible to enhance physical performance through genetic interventions.]

All articles in the issue

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Clinical Neuroscience

Cholinesterase inhibitors and memantine for the treatment of Alzheimer and non-Alzheimer dementias


In aging societies, the morbidity and mortality of dementia is increasing at a significant rate, thereby imposing burden on healthcare, economy and the society as well. Patients’ and caregivers’ quality of life and life expectancy are greatly determined by the early diagnosis and the initiation of available symptomatic treatments. Cholinesterase inhibitors and memantine have been the cornerstones of Alzheimer’s therapy for approximately two decades and over the years, more and more experience has been gained on their use in non-Alzheimer’s dementias too. The aim of our work was to provide a comprehensive summary about the use of cholinesterase inhibitors and memantine for the treatment of Alzheimer’s and non-Alzheimers’s dementias.

Clinical Neuroscience

[Consensus statement of the Hungarian Clinical Neurogenic Society about the therapy of adult SMA patients]

BOCZÁN Judit, KLIVÉNYI Péter, KÁLMÁN Bernadette, SZÉLL Márta, KARCAGI Veronika, ZÁDORI Dénes, MOLNÁR Mária Judit

[Background – Spinal muscular atrophy (SMA) is an autosomal recessive, progressive neuromuscular disorder resulting in a loss of lower motoneurons. Recently, new disease-modifying treatments (two drugs for splicing modification of SMN2 and one for SMN1 gene replacement) have become available. Purpose – The new drugs change the progression of SMA with neonatal and childhood onset. Increasing amount of data are available about the effects of these drugs in adult patients with SMA. In this article, we summarize the available data of new SMA therapies in adult patients. Methods – Members of the Executive Committee of the Hungarian Clinical Neurogenetic Society surveyed the literature for palliative treatments, randomized controlled trials, and retrospective and prospective studies using disease modifying therapies in adult patients with SMA. Patients – We evaluated the outcomes of studies focused on treatments of adult patients mainly with SMA II and III. In this paper, we present our consensus statement in nine points covering palliative care, technical, medical and safety considerations, patient selection, and long-term monitoring of adult patients with SMA. This consensus statement aims to support the most efficient management of adult patients with SMA, and provides information about treatment efficacy and safety to be considered during personalized therapy. It also highlights open questions needed to be answered in future. Using this recommendation in clinical practice can result in optimization of therapy.]

Clinical Neuroscience

[Tracing trace elements in mental functions]

JANKA Zoltán

[Trace elements are found in the living organism in small (trace) amounts and are mainly essential for living functions. Essential trace elements are in humans the chromium (Cr), cobalt (Co), copper (Cu), fluorine (F), iodine (I), iron (Fe), manganese (Mn), molybdenum (Mo), selenium (Se), zinc (Zn), and questionably the boron (B) and vanadium (V). According to the biopsychosocial concept, mental functions have biological underpinnings, therefore the impairment of certain neurochemical processes due to shortage of trace elements may have mental consequences. Scientific investigations indicate the putative role of trace element deficiency in psychiatric disorders such in depression (Zn, Cr, Se, Fe, Co, I), premenstrual dysphoria (Cr), schizophrenia (Zn, Se), cognitive deterioration/de­mentia (B, Zn, Fe, Mn, Co, V), mental retardation (I, Mo, Cu), binge-eating (Cr), autism (Zn, Mn, Cu, Co) and attention deficit hyperactivity disorder (Fe). At the same time, the excess quantity (chronic exposure, genetic error) of certain trace elements (Cu, Mn, Co, Cr, Fe, V) can also lead to mental disturbances (depression, anxiety, psychosis, cognitive dysfunction, insomnia). Lithium (Li), being efficacious in the treatment of bipolar mood disorder, is not declared officially as a trace element. Due to nutrition (drinking water, food) the serum Li level is about a thousand times less than that used in therapy. However, Li level in the red cells is lower as the membrane sodium-Li countertransport results in a Li efflux. Nevertheless, the possibility that Li is a trace element has emerged as studies indicate its potential efficacy in such a low concentration, since certain geographic regions show an inverse correlation between the Li level of drinking water and the suicide rate in that area. ]

Clinical Neuroscience

Neurological disorders in liver transplantation

YUKSEL Hatice , AYDIN Osman, ARI Derya , OTER Volkan , AKDOGAN Meral , BIROL BOSTANCI Erdal

Liver transplantation is the only curative treatment in patients with end-stage liver failure. It has been associated with neurological disorders more frequently than other solid organ transplantations. We aimed to detect neurological disorders in liver transplantation patients and determine those that affect mortality. One hundred eighty-five patients, 105 with and 80 without neurological disorders, were included in this study. The follow-up was categorized into three periods: preoperative, early postoperative and late postoperative. We analyzed all medical records, including demographic, laboratory, radiological, and clinical data. Neurological disorders were observed in 52 (28.1%) patients in the preoperative period, in 45 (24.3%) in the early postoperative, and in 42 (22.7%) in the late postoperative period. Hepatic encephalopathy in the preoperative and altered mental state in the post­operative period were the most common neurological disorders. Both hepatic encephalopathy (37.5%) and altered mental state (57.7%) caused high mortality (p=0.019 and 0.001) and were determined as indepen­dent risk factors for mortality. Living donor transplantation caused less frequent mental deterioration (p=0.049). The mortality rate (53.8%) was high in patients with seizures (p=0.019). While mortality was 28.6% in Wilson’s disease patients with neurological disorders, no death was observed in patients without neurological disorders. We identified a wide variety of neurological disorders in liver transplantation patients. We also demonstrated that serious neurological disorders, including hepatic encephalopathy and seizures, are associated with high morbidity and mortality. Therefore, in order to avoid poor outcomes, hepatic encephalopathy should be considered as a prioritization criterion for liver transplantation.

Clinical Neuroscience

[Rehabilitation results after severe traumatic brain injury ]

DÉNES Zoltán, MASÁT Orsolya

[To assess the rehabilitation outcome after severe traumatic brain injury. Retrospective evaluation of the rehabilitation process and prospective follow-up five years after discharge. Patients – Patients treated in 2013 at the Traumatic Brain Injury Unit, National Institute for Medical Rehabilitation were included in the study (n = 232). Ninety-nine of 232 patients were treated with severe traumatic brain injury. Data were available for 66/99 patients (67%). Fifty patients (13 women and 37 men) were successfully contacted for follow-up (51%), three patients deceased. The mean age of the patients was 42 years (range: 22-72). The majority of them (36/50) was injured in traffic accidents. The mean duration of coma and post-traumatic amnesia were 19 (1-90) and 45 days (5-150), respectively. Patients were admitted for rehabilitation on the 44th (11-111) day after the injury and were rehabilitated for 95 days (10-335). Thirty-eight patients became independent at daily living activity during the rehabilitation period, and none during the follow-up. Two patients needed moderate and one a little help for the daily life. After successful rehabilitation 4 patients continued their higher education, 24 patients worked (six in sheltered, six in the original, 12 in other workplaces). Twenty-two patients did not have permanent jobs, two of whom were retired. The majority of the patients were successfully reintegrated into society. More than half of the patients returned to work or continued their studies. These successes were greatly facilitated by the 40 years of experience and the multidisciplinary team working in the National Institute for Medical Rehabilitation. ]