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Clinical Neuroscience

MARCH 30, 2020

[Intracranial EEG monitoring methods]

TÓTH Márton, JANSZKY József

[Resective surgery is considered to be the best option towards achieving seizure-free state in drug-resistant epilepsy. Intracranial EEG (iEEG) is necessary if the seizure-onset zone is localized near to an eloquent cortical area, or if the results of presurgical examinations are discordant, or if an extratemporal epilepsy patient is MRI-negative. Nowadays, 3 kinds of electrodes are used: (1) foramen ovale (FO) electrodes; (2) subdural strip or grid electrodes (SDG); (3) deep electrodes (stereo-electroencephalographia, SEEG). The usage of FO electrode is limited to bitemporal cases. SDG and SEEG have a distinct philosophical approach, different advantages and disadvantages. SDG is appropriate for localizing seizure-onset zones on hemispherial or interhemispherial surfaces; it is preferable if the seizure-onset zone is near to an eloquent cortical area. SEEG is excellent in exploration of deeper cortical structures (depths of cortical sulci, amygdala, hippocampus), although a very precise planning is required because of the low spatial sampling. The chance for seizure-freedom is relatively high performing both methods (SDG: 55%, SEEG: 64%), beside a tolerable rate of complications.]

Hypertension and nephrology

FEBRUARY 20, 2019

[Sexual problems in CKD – a narrative review]

TÖRÖK Marietta, JÖRGEN Hegbrant, GIOVANNI Strippoli

[Sexual dysfunction is highly prevalent in patients with CKD, especially those receiving dialysis. Given the high prevalence of sexual problems in CKD patients, there has been growing interest in finding effective treatments for sexual dysfunction. PDE5i and zinc have been found promising interventions for treating sexual dysfunction in men with CKD in a systematic review of RCTs, but the evidence supporting their routine use in CKD patients is limited. In the Collaborative Depression and Sexual Dysfunction (CDS) Study, over a cohort of 1611 men in hemodialysis, 83% reported erectile dysfunction and 47% reported severe erectile dysfunction, with depression strongly correlated to this problem. Similarly, sexual dysfunction was highly prevalent in women undergoing hemodialysis. Of the 659 respondents, 555 (84%) reported sexual dysfunction and more than half of sexually active women reported sexual dysfunction, associated with age, depressive symptoms, menopause, low serum albumin, and diuretic therapy.]

Clinical Neuroscience

SEPTEMBER 23, 2011

[The role of neuronavigation in the preoperative invasive evaluation and surgical treatment of drug resistant epilepsies]

ERÕSS Loránd

[For localizing the epileptogenic zone in cases of focal epilepsies detailed clinical investigations, imaging studies and electrophysiological methods are in use. In lesional epilepsies the intrapreoperatíve localization of the lesion and it’s location to the eloquent cortex is essential for the neurosurgeon. The development in image guided neurosurgery lead us to use neuronavigation systems to localize intracerebral lesions or functionally eloquent cortical areas or subcortical pathways during surgery. Neuronavigation brought changes in preoperatíve evaluation and in resective surgery in epilepsy as well. In this article we describe the basics of neuronavigation and enhance the advantages of the technique in epilepsy surgery during the presurgical evaluation with invasive electrodes, in resective surgery and DBS for epilepsy.]

Clinical Neuroscience

JULY 30, 2007

[FUNCTIONAL MRI AT 1 TESLA. BASIC PARADIGMS AND CLINICAL APPLICATION]

SCHWARCZ Attila, AUER Tibor, KOMOLY Sámuel, DÓCZI Tamás, JANSZKY József

[AIM OF THE STUDY - To perform functional MRI experiments at low magnetic field, and to set up routine protocol to help the planning of neurosurgical operations and the examination of epilepsy patients. METHODS - An optimized 2D EPI sequence was applied to yield functional MR images in basic paradigms such as finger tapping and internal word generation. Further, activation was induced also by a task involving mental navigation based on the retrieval of individually familiar visuo-spatial knowledge. RESULTS - Low resolution (matrix of 64×64) functional MR images satisfactorily visualized moto-sensor strip and speech centers. In the mental navigation task bilateral activation of formatio hippocampalis was observed. Determination of motor area was also performed in an epilepsy patient whose seizure focus had been found in the area of pre- and postcentral gyrus. The dislocation of the motor cortex was demonstrated. CONCLUSION - Functional MR images with fine quality can be obtained in basic paradigms even at low magnetic field if MR imaging parameters and paradigms are optimized.]

Clinical Neuroscience

NOVEMBER 30, 2006

[BIOMECHANICS OF INTRACRANIAL ANEURYSMS]

FARKAS István, NYÁRY István, RAFFAI Gábor, ZILAHY G, MONOS Emil

[Introduction - Viscoelastic parameters of circumferential and meridional strips of ruptured and silent aneurysms were investigated (considered clinical and histological data either) in order to advance the prediction of risk of aneurysm rupture. Method - In our clinical practice, aneurysms managed by microsurgery aneurysm clipping were removed. Meridional and circumferential strips were cut. Strips were investigated by an uniaxial biomechanical instrument: distending force was recorded as the length of the strips was increased in steps. Normal stress-relaxation patterns were detected. The shape of strain curves well overlapped with the Standard Linear Solid Model curve, as had been expected. The viscosity, serial and parallel elastic moduli of the model were then computed. Results - Linear correlation was demonstrated amongst peek distending force detected and aneurysm strip thickness. Steric inhomogenity was detected at the meridional and circumferential strips. Strain-stress behaviour of ruptured and silent aneurysm specimen showed significant difference. Values of strips originated from patients suffered from hypertension as well as strips originated from aneurysms had been histologically found inflamed were higher. Discussion - Results of these observations are going to be used to set three dimensional computer model in cooperation with IT team of Budapest University of Technology and Economics to advance rupture risk prediction.]