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Clinical Neuroscience

JANUARY 30, 2016

[A visual based proto-consciousness model of human thinking]

SZŐKE Henrik, HEGYI Gabriella, CSÁSZÁR Noémi, VAS József Pál, KAPÓCS Gábor, BÓKKON István

[Background and objectives – Here we present our results of many years of research on the visual (pictorial) representation model expanded with some new ideas in a simplified form. Our goal is to make available our new pictorial model for a broader scientific community and to point to its possible importance in the future. Method – Own scientific publications, selective literature analysis and preliminary experiments. Results – Our several scientific publications and preliminary experiments were presented outlining our new molecular visual representation model as brain might be able to generate internal images by regulated biophotons in early V1 retinotopic visual regions. We also proposed that some of symptoms and characteristics of autism and savantism may suggest that visual (pictorial) thinking might be a possible cognitive model in the case of healthy people as well. Our model can present a uniform molecular basis for many visual related phenomena. Conclusions – It is possible that a so-called visual proto-consciousness might be developed in evolution, which is directly related to the retinotopic visual areas, and which has a different cognitive ability from verbal abilities. If our model can be exactly proved it presents a common molecular basis for various visual phenomena such as visual perception and imagination, phosphenes ect. and might open new ways in several fields of science such as visual prosthesis for the blind, artificial intelligence, visual neuroscience, cognitive and autism research.]

Clinical Neuroscience

MARCH 30, 2016

[Systemic thrombolysis and endovascular intervention in postpartum stroke]

BERECZKI Dániel Jr., NÉMETH Beatrix, MAY Zsolt, SZAKÁCS ZOLTÁN, GUBUCZ István, SZIKORA István, SZILÁGYI Géza

[Introduction - There are no previously published cases about intravenously applied recombinant tissue plasminogen activator in acute ischemic stroke during puerperium. Case presentation - We report a 40-year-old woman with postpartum acute ischemic stroke caused by multiple cervical artery dissections treated by systemic thrombolysis and endovascular intervention. Discussion - There are only limited data regarding thrombolytic treatment in acute stroke during pregnancy and puerperium. Current acute stroke treatment guidelines - while considering pregnancy as a relative exclusion criterion - do not deal with the postpartum state. Conclusion - As the condition is rare, randomized controlled trials are not feasible, therefore further reports on similar cases could eventually help us suggest guidelines or at least propose recommendations for the acute thrombolytic treatment of strokes occurring in pregnancy and puerperium.]

Clinical Neuroscience

MARCH 30, 2016

[Antecedents to the commencement and history of the West- Pannonic neurological forum]

GARZULY Ferenc, GRUBITS János, NIKL János

[Introduction - Numerous professional groups and sections for the medical specialities have been organized since 1953 in the West-Transdanubian region of Hungary, but such association of neurologists had not occured. Establishing the West-Pannonic Neurological Forum - The lack of regional collaboration among neurologists was related to several factors, among which the most important factor was the lack of a regional medical university, which could coordinate the professional activities. This severe gap necessitated in 1998 the organization of a professional group, that has become a driver for case-consulting conferences and different postgraduate trainings for the physicians specialized in neurology, neurosurgery and neurorehabilitation in counties of Győr-Moson-Sopron, Vas, Veszprém and Zala. The functioning of the Forum - Meetings are organized twice a year for physicians and paramedical staff (nurses, hospital attendants, physiotherapists) on Thursdays afternoons in different towns of the region, in two sections. The lectures are followed by a buffet, after which everyone can get home before too late. Ocasionally guest-lecturers are invited to present scientific topics from Hungarian universities or abroad. However, the main form of the presentations is defined as case discussion. Conclusions - The numbers of platform and other presentations in the physicians’s section have exceeded half a thousand, while in the paramedical section reached the threehundreds. At the 38. meeting of the Forum in January of this year, the number of participants was more than twohundreds, reflecting that both physicians and their coworkers are greatly interested in this form of interactions.]

Clinical Neuroscience

MARCH 30, 2016

Cerebral amyloid angiopathy related inflammation: is susceptibility weighted imaging the clue for diagnosis?

CSÉCSEI Péter, KOMOLY Sámuel, SZAPÁRY László, BARSI Péter

Background - Cerebral amyloid angiopathy-related inflammation (CAA-ri) is characterized by various neurological symptoms such as gradually developing confusion, progressive cognitive decline, seizure or headaches; T2 hyperintensities on magnetic resonance imaging (MRI); and neuropathological evidence of cerebral amyloid angiopathy (CAA) and associated vascular or perivascular inflammation. Although histological confirmation is necessary for accurate diagnosis, in case of typical clinical features and neuroimaging, the diagnosis can be established without biopsy. Case summary - We present the case of a 57-year-old man with a history of hypertension who presented to the emer¬gency department 3-week history of progressive headache and a gradually developing altered mental status. On examination, he was found to have left sided weakness and decreased pscyhomotility. Routine clinical work-up (lab investigations, CT, cerebrospinal fluid analysis) did not show obvious diagnosis, so we performed an MRI. It raised the suspicion of CAA-ri which diagnosis was verified by neuroradiological evaluation. High dose steroid treatment was initiated. The patient rapidly responded to treatment, his focal neurological signs resolved. Control MRI after 1.5 months showed multiple haemorrhagic laesions in the field of previous inflammation which posteriorly supported the previous supposed work-diagnosis. Conclusions - Although histopathology is the gold standard for the diagnosis of cerebral amyloid angiopathy, the typical clinical presentation, good response to steroids and accurate neuroradiological criteria make biopsy unnecessary to diagnose CAA-ri.

Clinical Neuroscience

NOVEMBER 20, 2015

[Mentalizing deficit in neurological disorders: a review article]

HEROLD Róbert, VARGA Eszter, MIKE Andrea, TÉNYI Tamás, SIMON Mária, HAJNAL András, FEKETE Sándor, ILLÉS Zsolt

[Introduction – Mentalization is the ability to attribute mental states (intentions, desires, thoughts, emotions) to others, and hence to predict their behaviour. This ability fundamentally determines our participation in social relationships and adaptation to society. A significant proportion of the disorders of the central nervous system (CNS) affects those brain structures and neurotransmitter systems that play a role in the mentalizing processes. Accordingly, a number of CNS disorders may be associated with mentalizing deficits, which may affect the outcome of these diseases. Here, we review recent research on mentalizing abilities in neurological diseases. Methods – An internet database search was performed to identify publications on the subject. Results – Sixty-two publications in English corresponded to the search criteria. These publications reported impaired mentalization in several neurological disorders (e.g. epilepsy, Parkinson’s disease, multiple sclerosis, dementias, traumatic brain injury). Discussion – The results indicate that a number of neurological disorders associate with mentalizing deficit. This deficit is often present in the early stages of the diseases and has a prognostic value, which in turn emphasizes the importance of the early detection and adequate rehabilitation.]

Clinical Neuroscience

JANUARY 30, 2016

Unanswered questions in the transcranial magnetic stimulation treatment of patients with depression

MORVAI Szabolcs, NAGY Attila, KOVÁCS Attila, MÓRÉ Csaba, BERECZ Roland, FRECSKA Ede

According to the WHO fact sheet depression is a common mental disorder affecting 350 million people of all ages worldwide. Transcranial Magnetic Stimulation (TMS) is a technique which allows the investigator to stimulate and study cortical functions in healthy subjects and patients suffering from various mental and neurological disorders. In the early 1990s, studies revealed that it is possible to evoke long term mood changes in healthy volunteers by rapid rate repetitive, TMS (rTMS) over the frontal cortex. Subsequent studies involving depressed patients found frontal cortical rTMS administered daily to be clinically effective. In the past two decades, numerous trials examined the therapeutic potential of rTMS application in the treatment of mood disorders with constantly evolving treatment protocols. The aim of this paper is to review the literature of the past two decades, focusing on trials addressing the efficacy and safety of rTMS in depressed patients. Our primary goal is to evaluate the results in order to direct future studies which may help investigators in the development of treatment protocols suitable in hospital settings. The time is not far when TMS devices will be used routinely by practitioners primarily for therapeutic purpose rather than clinical research. To our knowledge, a widely accepted “gold standard" that would offer the highest efficacy, with the best tolerability has not been established yet. In order to approach this goal, the most important factors to be addressed by further studies are: localization, frequency, intensity, concurrent medication, maintenance treatments, number of pulses, trains, unilateral, or bilateral mode of application.

Clinical Neuroscience

MARCH 30, 2016

The electrophysiological changes after 1 hz RTMS in ALS patients. A pilot study

MAJOR Zsigmond Zoltán, VACARAS Vitalie, MARIS Emilia, CRISAN Ioana, FLOREA Bogdan, MAJOR Andrea Kinga, MURESANU Fior Dafin

Motor neuron diseases are disabling poor prognostic conditions, with no successful treatment. Repetitive transcranial magnetic stimulation might offer a temporary functional improvement. Objective - We intended to evaluate the extent of the functional improvement using electrophysiological and clinical tests. Methods - Patients with motor neuron disease (amyotrophic lateral sclerosis) were included. Muscle strength and respiratory function assessment represents the clinical approach, and central motor conduction time, motor unit number estimation, blink reflex and H-reflex stands for electrophysiology. Two tests were performed using the whole battery prior and after low frequency repetitive transcranial magnetic stimulation, using 1 Hz stimulation frequency for five consecutive days, 20 minutes daily, at 80% of the individual resting motor threshold. Results - Central motor conduction time, muscle strength and pulmonary function showed no statistically significant differences, but a tendency towards improvement. Motor unit number estimation, blink reflex and H-reflex showed a significantly better outcome after the five day repetitive transcranial magnetic stimulation treatment. Conclusion - Low frequency repetitive transcranial magnetic stimulation influences beneficially electrophysiological parameters in amyotrophic lateral sclerosis, but with little clinical impact; further studies are needed to validate the extent of the effect.

Lege Artis Medicinae

APRIL 18, 2020

[About general practitioners in Hungary - without political roadblocks]

BALÁZS Péter

[A brief introduction about the primary care’s evolution is rather improving the clear sight since it supports our right judgement and helps to draw right consequences. Thus, we are able to realise more precisely our strategic aims, actual domestic problems, and the forced pathways indicated by the prevailing trends and the action radius of our reform endeavours. The present study shows hidden risks encoded in human resources, specialists’ services and shed light into the grey zone of remuneration. Indeed, the trends are alarming, the spaces are narrow for actions nevertheless we can escape our century old legacy by innovative solutions. While re-thinking totally the whole system nevertheless maintaining all immanent principles we can just in the short run revitalise our ailing primary health care. ]

Clinical Neuroscience

MARCH 30, 2020

[New applications of conventional EEG analysis ]

CLEMENS Béla, PUSKÁS Szilvia

[Neurophysiological research suggests that the so-called “standard” EEG analysis has been confronted with new diagnostic challenges. The findings mainly concern the occurrence, the neurophysiological and clinical significance of epileptiform EEG discharges in several neurological and psychiatric disorders. In addition to well-known interictal and ictal discharges, a growing number of recently recognized epileptiform phenomena have been described. The first reports suggested that they might be relevant for the comprehensive description of epileptic dysfunction and might contribute to diagnosis and treatment as well. However, considerable improvement of present-day “standard” EEG technique is necessary to give an appropriate answer to most challenges. Reliable registration and quantitative assessment of well-known epileptiform transients require extended electrode coverage of the head (high-density EEG) and long-term recordings including waking and sleep states to estimate frequency and dyna­mics of targeted activities. Computer-based automatic event detection is preferable to spare time and cost of the evaluation. The authors review recent progress concerning epidemiology, neurophysiology and clinical impact of well-known epileptiform transients and candidate epileptiform activities in neurological and psychiatric conditions. However, recent results need confirmation in large patient populations; therefore, research should not be restricted to a few central laboratories.]

Clinical Neuroscience

MARCH 30, 2020

Evaluation of anxiety, depression and marital relationships in patients with migraine

DEMIR Fıgen Ulku, BOZKURT Oya

Aim - The aim of this study was to evaluate the frequency and characteristics of attacks in patients with migraine, to determine the effects of anxiety or depressive symptoms, and to evaluate the marital relationships of patients with migraine. Method - Thirty patients who were admitted to the neurology outpatient clinic of our hospital between July 2018 and October 2018 and were diagnosed with migraine according to the 2013 International Headache Society (IHS) diagnostic criteria were included in this cross-sectional study. Age, sex, headache frequency and severity, depressive traits, marital satisfaction and anxiety status were examined. We used the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Maudsley Marital Questionnaire (MMQ) and Visual Analogue Scale (VAS) for measuring relevant parameters. Results - The mean severity of migraine pain according to VAS scale was 6.93 ± 1.41 and the mean number of migraine attacks was 4.50 ± 4.24. The mean BDI score of the patients was 12.66 ± 8.98, the mean MMQ-M score was 19.80 ± 12.52, the mean MMQ-S score was 13.20 ± 9.53, the mean STAI-state score was 39.93 ± 10.87 and the mean STAI-trait score was 45.73 ± 8.96. No significant correlation was found between age, number of migraine attacks, migraine duration, migraine headache intensity, and BDI, STAI and MMQ scores (p>0.05). But there was a positive correlation between MMQ-S and scores obtained from the BDI and STAI-state scales (p<0.05). Conclusion - In this study more than half of the migraine patients had mild, moderate or severe depression. A positive correlation was found between sexual dissatisfaction and scale scores of depression and anxiety.