Background: Therapeutic plasma exchange (TPE) is an extracorporeal blood purification technique that is designed to remove substances with a large molecular weight. The TPE procedure includes removal ...of antibodies, alloantibodies, immune complexes, monoclonal protein, toxins or cytokines, and involves the replenishment of a specific plasma factor. The aim of the study was to describe the clinical response to TPE in various neurological patients, and to assess the clinical response to this therapy.
Methods: The study was retrospective. We analyzed the medical records of 77 patients who were treated at the Department of Neurology, University Clinical Center (UCC) Tuzla from 2011 to 2016.
Results: 83 therapeutic plasma exchanges were performed in the 77 patients. There was a slight predominance of male patients (54.5%), with an average age of 51±15.9 years. The most common underlying neurological diseases were Guillain-Barré syndrome (GBS) (37.7%), then chronic inflammatory demyelinating polyneuropathy (CIDP) (23.4%), multiple sclerosis (MS) (11.7%) and myasthenia gravis (10.4%). Less frequent neurological diseases that were encountered were paraneoplastic polyneuropathies (5.2%), neuromyelitis optica (also known as Devic's disease) (3.9%), motor neuron disease (3.9%), polymyositis (2.6%) and multifocal motor neuropathy (1.2%).
Conclusions: Six years experience of therapeutic plasma exchange in neurological patients in our department have shown that, following evidence-based guidelines for plasmapheresis, the procedure was most effective in patients with GBS, CIDP and myasthenia gravis.
- Multifocal motor neuropathy (MMN) is a chronic demyelinating neuropathy mainly characterized by multifocal distribution; affecting only motor nerve fibers of two or more peripheral nerves, with the ...absence of symptoms and signs of upper motor neuron; chronic, sometimes cascading progressive course; demyelination with partial block of motor conduction; immune-mediated pathogenesis and good response to intravenous immunoglobulin treatment (IVIG). The diagnosis of MMN is based on clinical, laboratory and electrophysiological characteristics. Steroids are ineffective in MMN and may lead to worsening of the disease. Similarly, therapeutic plasma exchange is negligibly effective in this neuropathy. However, more than 80% of patients with MMN experience improvement after IVIG. We present our three cases of MMN with positive response to IVIG.
The aim of this study was to analyze one year outcome of the acute stroke patients with sleep apnea in order to gender and age.
It was analyzed 110 patients with acute stroke and sleep apnea. Among ...them 65(59%) were men. Average age of all participant was 65.13±9.27 years. The same number and gender distribution of participants with stroke and without apnea were in control group. Evaluation of sleep apnea has been done with: "The Sleep Disorders Questionnaire", "Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome" and "The Epworth Sleepiness Scale".
One year after stroke onset survived 91 (82.7%) out of 110 patients with apnea. Average age of survived patients was 63.66±8.78 years. Among them 52(80%) were men. In control group, without apnea survived 104 (94.5%) patients with average age of 65.00±8.62 years. Among them 62 (95.4%) were men. In men with apnea there is significantly lower survival range in order to patients without apnea (X(2)=8.22, p=0.004). In women there is no difference. Survival of both gender in patients with apnea (22; 64.7%) was the lowest in group older than 70 years of age. Sex ratio (men : women) was 15 (68.2%):7(58.3%). Survival in both gender in patients without apnea was the same in group older than 70 years of age: 27 (81.2%) out of 33. Average age of patients who died with apnea was significantly higher in order to patients without (t=1.97, p=0.03).
One year after stroke, significantly more patients survived without (94.5%) than with apnea (82.7%) (p=0.01). In order to sex survived range was significantly (p=0.004) lover in men with apnea than without but in women there is no difference. Survival range of both gender in patients with apnea was the lowest in group older than 70 years (p=0.03).
The aim of this study was to analyze: frequency of balance disorder (vertigo and disequilibrium), frequency of abnormalities in auditory evoked potentials (AEP) and magnetic resonance imaging (MRI) ...changes of the brain in multiple sclerosis (MS) patients with balance disorder, relation of patient's disability status to balance disorder and relation of the changes in MRI of the brainstem to AEP abnormalities. It was analyzed 60 patients with relapsing-remitting form of MS. Two groups of patients were made consecutively under Expanded Disability Status Scale score (EDSS): A (EDSS < or =4,5) and B (EDSS > or =5,0). The study was retrospective-prospective. After the neurological exam AEP and MRI of the brain have been done. Balance disorder has been verified as initial symptom in 29 (48,4%) and out of them disequilibrium experienced 24 (83,4%) patients. During the relapses balance disorder experienced 48 (80%) patients and in 37 (77,1%) it was disequilibrium. Among them 33 (68,7%) were with lower EDSS (< or =4,5) and 15 (31,3%) with higher EDSS score (> or =5). There is no correlation between disability status and vertigo which means that vertigo is not more frequent in more disabled patients and vice-versa. The AEP were pathological in 57 (95%) patients. Of all 29 patients with vertigo AEP were pathological in 28 (96,5%) while in 31 patients without vertigo pathological AEP were in 29 (93,5%) but it is not statistical significant. The most frequent characteristic of AEP changes were prolonged inter-peak latency III-V waves (48 patients or 80%). The plaque in brainstem visualized by MRI was found in 41 (71,8%) of patients (38 or 92,6% of them had pathological AEP and in three patients AEP were normal). In group of patients with pathological AEP, 38 (66,6%) of them had plaque in brainstem. In other three patients with normal AEP it was visualized plaque in brainstem. In the group of 29 patients with balance disorder, 20 (68,9%) had plaque in brainstem as well as 21 (67,7%) out of 31 patients without balance disorder had plaque in the brainstem. This difference is not statistical significant. It is concluded that the vertigo (including disequilibrium) is relatively often (48,4%) initial symptom of MS. Vertigo is not more frequent in patients with higher EDSS score and vice-versa. Pathological AEP are frequent neurophysiologic finding in both (95%) patients with (96,5%) and without (93,5%) vertigo. The most often pathological characteristic of AEP are prolonged interpeak latency of III-V waves (78,5%), as well as abnormalities of V and than IV wave. MS plaques in brainstem visualized by MRI technique are frequent in both groups of patients with and without pathological finding of the AEP.
The aim of this study was to analyze one year survival outcome of the patients with sleep apnea in acute stroke in order to type and localisation of lesion. Patients and Methods: It was analyzed 110 ...patients with acute stroke (AS) and verified sleep apnea, treated at Department of Neurology, University Clinical Center Tuzla in the period December 2009 thorough may 2010. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. Average age was 65.13±9.27 years and it was 65 (59%) men. Number of participants with no apnea in control group was the same as well as sex distribution, with average age 64±8.69 years. Results: One year after acute stroke survived 78 (84.8%) patients out of 92 with apnea and ischemic stroke (IS). Otherwise, 13 (72.2%) patients survived out of 18 with hemorrhagic stroke (HS). Without apnea 88 (95.7%) patients who survived had IS and 16 (88.9%) HS. Survival of patients with IS and without apnea is significantly better than in patients with IS and apnea (X2=5.46, p=0.02). Survival of patients with HS with/without apnea is not significantly different. Majority (51/87.9%) of 58 patients with apnea who survived had lesions at two or more locations. Otherwise, 12 (100%) patients out of 12 without apnea who survived had lesion in frontal lobe. Survival of patients with/without apnea is not statisticaly different in order to location of lesion. Concerning the side of stroke 23 (85.5%) patients with apnea who survived had lesion(s) in left hemisphere but this difference is not significant. Patients without apnea 48 (96%) had lesion(s) at both sides. Conclusion: Survival of patients without apnea in ischemic stroke is significantly better than in patients with apnea. Survival in patients with/without apnea in hemorrhagic stroke has no statistical difference. Localization and side of lesion do not have influence on survival.
The objective of the study was to analyze the doppler sonography findings of vertebrobasilar circulation (VB) in patients with Parkinson's disease. 40 patients were analyzed (25 men's and 15 women) ...with Parkinson's disease, average age was 61.9 years (SD=11.43), treated at the Clinic for Neurology in Tuzla. Device for doppler sonography was Multidop x 4. Doppler sonography findings of VB circulation were analyzed in order to computerized tomography (CT) findings of the brain (with or without ischemic lacunar lesions) and in order to presence of postural disturbances as one of dominant Parkinson's disease symptoms during actual hospitalization. Our results suggest that vertebrobasilar insufficiency is more frequent in patients with Parkinson's disease (no matter of type) and postural disturbances as a dominant symptom comparing to group of Parkinson's disease patients without postural disturbances. These results implicate the importance of doppler sonography findings of vertebrobasilar circulation in patients with Parkinson's disease and possibility of considering role of vertebrobasilar insufficiency in development of postural disturbances.
Abstract Objectives To determine epidemiological rates of multiple sclerosis (MS) in western Herzegovina. Patients and methods We analysed data from 81 MS patients (49 females, 32 males) on the ...prevalence day, 31 December 2003. Patient information was obtained from a search of all available medical records from the period 1994–2003 in the investigated area. Results Crude prevalence of MS was 27/100,000 (95% confidence interval (CI) 20–34). Prevalence was highest in the mountainous municipality of Posušje (56/100,000) and lowest in the coastal municipality of Neum (0 incidence). The annual incidence of MS was 1.6/100,000 (95% CI 0–3.3). The female/male ratio of MS was 1.5. The mean age of the patients on prevalence day was 40.0 ± 11.6 years, and the mean age at disease onset was 31.0 ± 7.1 years. Eight (10%) of the patients had a first-degree relative with MS. The primary progressive (PP) disease course was observed only in females. Visual symptoms were the initial symptom of MS in 6 (7%) of the patients. Conclusions Western Herzegovina is an area of moderate risk for MS, and the distribution of MS in western Herzegovina is heterogeneous. PP-MS occurred only in females, and involvement of the visual pathways as the initial symptom of MS was low.
The aim of the study was to analyze the usefulness and side effects of treatment with interferon beta 1B (Betaferon) in patients with the relapsing-remitting form of multiple sclerosis (RRMS). The ...study included 32 RRMS patients that had completed two-year therapy with interferon beta 1B or were still receiving this therapy. Every six months, patients were clinically evaluated and scored by the Expanded Disability Status Scale (EDSS). Two-year therapy was completed by 11 (34.3%) of 32 RRMS patients. Relapse was verified in 4 (36.36%) patients. The mean EDSS score was 2.45 +/- 1.03 at the beginning of therapy and 2.54 +/- 0.98 after two-year therapy; the difference was not statistically significant. In 2 (6.25%) patients on therapy for 18 months there was no relapse, and the mean EDSS was 1.75 +/- 0.35 (both at therapy introduction and at 18 months). Five (15.62%) patients were on therapy for one year. The mean EDSS was 1.6 +/- 1.08 at the beginning of therapy and 1.5 +/- 0.70 at one year. One patient experienced relapse. Two patients were on therapy for six months. They had no relapses with the same EDSS at six months as at therapy introduction (2.0). At the beginning of 2008, another 12 patients started therapy with interferon beta 1B. In conclusion, our experience with two-year interferon beta-1B therapy for RRMS is favorable, with a relatively low rate of relapses (36.36%) and without significant worsening on EDSS. The medication side effects were mild and transient.
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