Epilepsy is the most common neurological complication in pregnancy. Women
with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are
treated by neurologists ...at tertiary centers according to the place of residence. We prospectively
followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors
responsible for their delivery outcomes and development of their babies. Healthy pregnant women
had a higher level of education and economic status, but pregnant women with epilepsy took folic acid
in a higher proportion than controls, possibly due to timely preconception counseling. Complications
during pregnancy depended on the number of antiepileptic drugs and epilepsy control. We noticed
some behavioral and cognitive aspects in children exposed in utero to valproic acid, which required
follow up. The rate of congenital malformations was not increased. In conclusion, women with epilepsy
should receive preconception counseling about the risk for pregnancy, but also about the possibilities
to minimize that risk. We have introduced a model of integrative management of pregnancy
and epilepsy based on close collaboration among different clinical experts in Croatia, in order to
provide prompt counseling and timely intervention.
Antiepileptic drugs (AED) as transplacental agents are known to have adverse effects on fetal development. Genotoxicity of AEDs is still not fully understood. The aim of present study was to ...investigate the transplacental genotoxicity of valproate on animal model and in 21 mothers and their newborns receiving AED. In both studies, in vivo micronucleus (MN) assay was used. Pregnant dams were exposed to Na-valproate (100
mg/kg) on gestational days 12–14. Dams and pups receiving Na-valproate showed a significantly increased MN frequency (5.17
±
1.17/1000; 5.20
±
1.48/1000) compared to the control (1.0
±
0.58/1000; 1.67
±
1.03/1000). In mother/newborn study a significant increase of MN frequency was detected in newborns of mothers taking AEDs (3.09
±
0.49/10,000) compared to the referent newborns (1.56
±
0.22/10,000). The results of this study suggest that AEDs may act as transplacental genotoxins. Launching the mother/newborn cohorts for genotoxicological monitoring may give a significant new insight in health effects of AEDs.
Summary
AIM OF THE STUDY: We have done a study investigating the value of some less frequently considered Blink reflex parameters for establishing the diagnosis of idiopathic trigeminal neuralgia. ...PATIENTS: The study was done on 50 patients suffering from idiopathic trigeminal neuralgia, diagnosed according to the guidelines of the International Classification of Headache Disorders, with no other apparent illness. METHODS: We have stimulated the supraorbital nerve at the forehead (foramen n. supraorbitalis) and recorded the reflex response on both mm. orbiculares oculi. Incidence of following findings was determined: (1) occurrence of ipsilateral R3 component, (2) prolonged duration (>25 ms) of R2 when stimulating the affected side and (3) occurrence of R1 component during the stimulation of contralateral supraorbital nerve. We have compared these findings to those of 50 healthy subjects from the control group (Chi-square,
p
< 0.05). Sensitivity, specificity and diagnostic value for individual parameters were determined. RESULTS AND CONCLUSION: All three parameters tested proved to have a significantly higher incidence in the group of subjects. The occurrence of R3 component on the affected side showed the highest diagnostic value. Significance: We believe these findings could electrophysiologically reinforce the clinically established diagnosis of idiopathic trigeminal neuralgia.
Creutzfeldt-Jakob disease is the most common form of human prion diseases. A 57-year-old woman was transferred to our Department from a local hospital, where she had been treated for two weeks due to ...consciousness disorders and convulsive epileptic attacks that progressed to refractory status epilepticus. Electroencephalography showed diffuse spike-wave complex discharges and development of nonconvulsive status epilepticus. The causes of metabolic encephalopathy and paraneoplastic syndrome were ruled out. A combination of clinical features and findings of diagnostic procedures including electroencephalography, biomarkers in the cerebrospinal fluid and magnetic resonance imaging suggested with great probability that the patient was affected with sporadic Creutzfeldt-Jakob disease.
Summary The etiology of epilepsy still represents an open subject of discussions and research. Contrary to the majority of diseases for which drugs are developed following the origin of disease, ...epilepsy is treated symptomatically because it is perceived to have diverse causes. Recent results of oncological, neurological, developmental and biochemical studies suggest that the reproductive dysfunction in men and women, as a side effect related with antiepileptic therapy, points to the single origin of this disease. It seems that contrary to the present definition of estrogen as a compound affecting seizure susceptibility, based on causal chains: of increased estrogen levels (alcohol intake) and seizure, fact that all antiepileptic drugs are aromatase inhibitors or have estrogen binding properties, described cases of seizures in epileptic patients taking quinine as preventive therapy against malaria, impact of photic activation and sleep on estrogen level, it can be assumed that estrogen plays the leading role in the mutual origin of different types of epilepsy.
The use of cytogenetic assays in the surveillance of populations occupationally exposed to genotoxic carcinogens originates from the assumption that chromosomal alterations might be causally involved ...in early stages of carcinogenesis. Historical cohort studies have since 1990s consistently reported an association between the level of chromosomal aberrations (CA) in peripheral lymphocytes of healthy subjects and the risk of cancer. Only in few cases, have these results been transformed into a regulatory tool for improving occupational safety. The cytogenetic surveillance program adopted for more than two decades in the Republic of Croatia is one of these few examples. Croatian workers exposed to genotoxic agents were systematically screened for CA, to identify occupational settings needing a priority intervention. Significant increases of mean CA frequency were observed in groups exposed to ionizing radiation, chemical agents, and mixed exposures when compared with a group of unexposed referents. CA data on 736 men and 584 women, monitored between 1987 and 2000, have been associated with cancer incidence. Although the small size of the cohort did not allow for reaching statistical significance, the medium tertile of the CA frequency distribution was associated with a doubling of cancer incidence rate ratio (IRR
=
2.40; 95% CI 0.85–6.77) when compared with the lowest tertile. For chromosome-type CA, IRR was non-significantly increased for both the medium (IRR 1.53, 95% CI 0.58–3.99) and high categories (IRR 1.69; 95% CI 0.61–4.72). Recommendations for future strategies comprise the inclusion of predictive biomarkers in surveillance programs, the definition of a regulatory framework, and their possible use for the identification of individual risk profiles.
Multiple sclerosis is an autoimmune inflammatory demyelinating disease of the central nervous system, characterized by multifocal inflammatory destruction of myelin, axonal damage and loss of ...oligodendrocytes. The disease is carried through two stages: inflammatory and degenerative. The most common form of disease in approximately 85% of the cases is RRMS (relapsing-remitting form). The treatment of MS is devided into: treatment of the acute phase of illness, prevention of new relapses and disease progression, and symptomatic treatment. Most of the changes in treatment of multiple sclerosis and most of the news in recent years concerning new drugs are used in the treatment of progression of the disease and prevention of disease relapses. Some of these drugs are registrated in most Europian countries and USA, and others are in various stages of research.
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