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Clinical Neuroscience

MARCH 30, 2020

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


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

JANUARY 30, 2020

[Correction of the physiological artefacts at pre-surgical clinical functional MR]

KISS Máté, GÁL Andor Viktor, KOZÁK Lajos Rudolf, MARTOS János, NAGY Zoltán

[Introduction/aim of the study - Pre-surgical functional MRI (fMRI) is an important modality of examinations before brain surgery. There are several artefacts (e.g. motion, susceptibility) which may hinder the evaluation of fMRI data. Physiological artefacts (breathing, pulsation) also affect the sensitivity and specificity of anatomical localization. The aim of this study is to demonstrate the efficiency of physiological artefact identification and removal methods for presurgical evaluation. Materials and methods - Siemens Magnetom Verio 3T MRI scanner was used to collect data. The physiological parameters (breathing, pulse) were recorded with the MRI system’s built-in devices. Data from fourteen patients - with primary brain tumour - were evaluated with SPM12 utilizing the RETROICOR/RVHR tool to detect and decrease the effect of physiological artefacts. We compared the statistical maps obtained with and without the physiological correction using the Jaccard similarity coefficient, and ROI analyses. Results - Significant differences were found in the mean ROI values (p<0.0016) and the extensions of eloquent activations (p<0.0013), when using the physiological correction (RETORICOR/RVHR) based on convolution method. On the other hand, no significant differences were found between the ROIs’ standard deviations (F=0.28). The RETROICOR/ RVHR method helps to define the precise localisation of eloquent areas (p<0.009). The number of irrelevant (non-significant) voxels were increased (p<0.001). Conclusions - Minimising of physiological artefacts in fMRI data calculations, the (RETROICOR/RVHR) method based on convolution has been successfully adapted. This algorithm could be helpful before neurosurgical intervention. The activity pattern became more reliable. ]

Hypertension and nephrology

JUNE 20, 2019

[Hyperuricemia in hypertension. Domestic experience based on the data of the Hungarian Hypertonia Register 2011., 2013., 2015. Part II.]


[Asymptomatic hyperuricemia is frequent in hypertension and its prevalence is increasing. Authors studied the incidence of serum uric acid levels and its correlation with age, risk factors, anthropological, metabolic characteristics, blood pressure, blood pressure target, organ damage, age-related co-morbidity in 47,372 hypertensive patients (22,688 males, 24,694 women). In the second part of their analysis the prevalence of hyperuricemia was 13.8% in hypertensive men and 21.6% in women. The age, BMI, waist diameter, systolic and diastolic blood pressure and onset of hypertension, serum cholesterol, triglyceride, blood glucose and serum creatinine were slightly higher, but serum HDL cholesterol and eGFR were slightly lower in hyperuricemic hypertensive patients, independently of their gender. Among hypertension mediated organ damage ischemic and left ventricular hypertensive ECG alterations, mild chronic kidney disease and proteinuria, among hypertension associated diseases diabetes associated ischemic heart disease, chronic kidney disease associated diabetes and both ischemic and chronic kidney disease associated diabetes were significantly more frequent in hyperuricemic hypertensive patients.]

Hypertension and nephrology

FEBRUARY 20, 2019

[Hypertension and atrial fibrillation. Part 3. Screening of atrial fibrillation with active involvement of patients. New telemedicine devices]


[In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regaining increasing role. The author provides a detailed description of a number of reliable, validated - working on smart phones or without her solutions - equipment with pulse or ECG recording and the irvalue in every day clinical practice. They promote closer physician - patient cooperation and signal the future of prevention and care of atrial fibrillation. In the early detection of atrial fibrillation, new devices and methods with smart phone applications for patients’ self-control a regain in gin creasing role.]

Hypertension and nephrology

DECEMBER 10, 2018

[Hypertension and atrial fibrillation. Part 2. Basic methods of screening atrial fibrillation]


[Early detection of PF, especially short-term “paroxysmal aritmia”, is very important primarily in older individuals (over 65 ys), especially those with heart disease, hypertension or diabetes. Two methods are known for the early detection of PF: In one (regular screening) making 12-lead ECG examination for individuals over the age of 65 at fix times. The other (opportunistic screening) means that every person over the age of 65, whenever he or she percieves any complains, the physician will experience the pulse of the patient and in case of arrhythmia the EKG is made.]

Clinical Neuroscience

MARCH 30, 2018

A rare aetiology of stroke; myxomatous aneurysm caused by atrial myxoma

ACAR Erkan, OZDEMIR Zeynep, SELCUK Hakan Hatem, ÇOBAN Eda, SOYSAL Aysun

Atrial myxoma is a rare cause of stroke. In this report we present the case of a 52-year-old female patient who went to hospital suffering from a headache. Her neurological examination was normal except for a positive Babinski sign on the left. In the superolateral of the right, a Sylvian fissure consistent with a thrombosed aneurysm was detected using computerised tomography (CT). Diffusion MRI showed an acute infarction on the right MCA area. Transthorasic Echocardiography and ECG were normal. A -16×4 mm-sized fusiform perpendicular aneurysm on the M2 segment Sylvian curve of right MCA and a -6×4 mm-sized dissecting aneurysm on P3 segment of the left posterior cerebral artery (PCA) were observed in cerebral angiography. Transesophageal echocardiography (TEE) demonsrated a large mass with a suspected size of 2×2×1.5 cm on the left atrium. The mass was resected and on the eighth day after the operation, she had a temporary vision loss and hyperintensity on the T1 sequence was interpreted as laminary necrosis suspected on Cranial MRI. In follow up, she was stable with 300mg acetylsalicylic acid treatment. The main treatment is surgical resection in stroke caused by atrial myxoma.

Clinical Neuroscience

SEPTEMBER 30, 2014

[P-wave dispersion doesn’t increase in patients with epilepsy]

SENOL Güney Mehmet, ÖZMEN Namik, YASAR Halit, TEKELI Hakan, ÖZDAG Fatih, SARACOGLU Mehmet

[Aim - Epileptic seizures have occasionally been associated with cardiac conditions as atrioventricular blocks, long QT syndrome etc. P-wave dispersion (PWD), which is the difference between the longest (P max) and shortest P-wave duration (P min), is considered as a forerunner of atrial fibrillation. In this study, we investigated P-wave dispersion (PWD) in epileptic patients; based on the hypothesis that microthromboembolism may occur in atrial fibrillation. Methods - Seventy five patients with mixed types of epilepsy and 50 age and sex matched healthy individuals were included into the study. P max, P min and PWD values were calculated for each subject from an ECG. Results - The mean age of subjects in the epilepsy group and control group were similar (p>0.05). P max in patients with epilepsy was 125.1±0.7 ms, P min was 67.3±10.3 ms, and PWD was 57.6±8.3 ms while these values in the control group were 116.8±11.0 ms, 66.5±5.5 ms and 46.8±7.1 ms, respectively. There were no statistically significant difference between two groups (p>0.05). Conclusions - PWD does not increase in patients with mixed types of epilepsy. Therefore we believe that microthromboembolism duo to atrial fibrillation can’t cause epileptic seizures in patients with no structural heart disease.]

Hypertension and nephrology

DECEMBER 22, 2011

[The advantages of a fixed combination of lisinopril with amlodipine in patients with primary hypertension]


[Background: The aim of the study was to examine the effect of amlodipine, lisinopril and a fixed low-dose combination of amlodipine + lisinopril on the performance of the daily profile, blood pressure variability and heart rate variability in patients with PH stage I-II, 1-2 degrees. The diagnosis of PH was made in accordance with the classification of JNC USA in 2003, ESH, ESH 2007 on the basis of careful clinical and instrumental investigations. Methods: The study included 75 PH patients who were divided into three groups depending on the medication received. The first group included 23 patients treated with lisinopril, the second included 27 patients treated with amlodipine, and the third included 25 patients receiving a fixed combination of amlodipine + lisinopril. Drugs were administered once daily with dose titration for lisinopril effective for 10 to 20 mg (mean 15.6±2.2 mg), for amlodipine 5 to 10 mg (mean 7.8±1.1 mg), and Lisonorm administered in a standard fixed dose (lisinopril 10 mg, amlodipine 5 mg), once in the morning. Controlled treatment lasted for 12 weeks. The study used daily blood pressure monitoring and ECG Holter monitoring methods. Results: A comparison of side effects found that combined therapy significantly reduced the number of adverse reactions. For all three groups, treatment resulted in a significant decrease in the average daily, daytime and night-time BP values and in the variability of systolic and diastolic BP. With combined therapy, these changes were more significant. Conclusion: These positive changes appear to be due to the fact that combination therapy can affect several parts of the pathogenetic development of hypertension, compared with the effects of monotherapy, with superior results. In the combination therapy, lisinopril levelled the sympathetic stimulation of amlodipine by blocking the activity of the sympathoadrenal and renin-angiotensin-aldosterone system.]

LAM Extra for General Practicioners

DECEMBER 15, 2011



[The recognition of ECG artefacts is becoming increasingly important for physicians working in the field of internal medicine. At the same time, however, very little information about artefacts is published in either articles or textbooks. The authors provide a summary of the generation, types and recognition of ECG artefacts. The aim of the article is to draw the attention of clinicians to the dangers of this increasingly common phenomenon. Unrecognised artefacts can often prompt further (unnecessary) investigations and may result in establishing wrong diagnosis as well as erroneous treatment decisions.]

Lege Artis Medicinae

SEPTEMBER 20, 2002

[QT dispersion - the surface ECG marker of arrhythmic risk]

KUN Csaba, CZURIGA István, LŐRINCZ István

[During the past decade numerous publications have reported the pathophysiological and clinical value of QT dispersion. Increased QT dispersion was observed to be associated with proarrhythmic drug effects, prediction of mortality in heart failure and risk assessment after acute myocardial infarction. Based on the results of the repolarization process research and other significant clinical studies, the meaning and the usefulness of QT dispersion seems to be challenged. The original concept of portraying QT dispersion as a direct measure of regional heterogeneity of myocardial refractoriness is seriously flawed. At the same time, disproving this concept is not a good reason for stating that QT dispersion does not exist. The measurement of QT dispersion seems to be an approximate expression of repolarization abnormalities and should not be taken as a gold standard for a noninvasive estimate of repolarization abnormalities. However, we presently have no decent and widely available alternative to address repolarization abnormalities in standard 12-lead ECG. The authors present the pathophysiological meaning of QT dispersion, the controversies of automatic and manual methodology and the possible clinical relevances based on the most recent studies.]