The aim was to determine differences of blink reflex in clinically definite multiple sclerosis (CDMS) and clinically isolated syndrome (CIS) in patients presented with symptoms and signs of brainstem ...impairment. The study included 20 patients diagnosed with CDMS, 20 with CIS, and 20 healthy controls. We recorded latencies of early (R1) and late component ipsilaterally (R2) and contralaterally (R2'), and occurrence of irritative component (R3). We analyzed data on sex, age, signs of brainstem impairment and magnetic resonance imaging (MRI) findings for the presence of brainstem demyelinating lesions. There was no statistically significant difference between patient groups according to sex, age, symptoms of brainstem involvement and MRI findings. There was no statistically significant difference in R1 component latencies and R2 latencies on the right side. Latencies of R2 on the left and R2' on the right were statistically longer in CDMS group. There was no difference in the appearance of R3 component. In conclusion, blink reflex was found to be a very sensitive and useful diagnostic tool in the assessment of brainstem structures, especially because abnormalities are seen not only in CDMS but also in CIS. Slowing of the late component as a sign of dysfunction in the efferent part of the reflex arc is not very specific but is a highly sensitive finding. Key words: Blink reflex; Brainstem; Clinically isolated syndrome; Multiple sclerosis
Klinička slika migrene Stojić, Maristela
Medicus (Zagreb, Croatia : 1992),
05/2021, Letnik:
30, Številka:
1 Migrena
Journal Article
Recenzirano
Odprti dostop
Migrena je prema definiciji primarna, funkcionalna, rekurirajuća glavobolja, srednje jakog do jakog intenziteta, pulsirajućega karaktera i trajanja od 4 do 72 sata. Lokalizirana je uglavnom ...unilateralno, praćena mučninom i/ili povraćanjem, senzornim simptomima u smislu pojačane osjetljivosti na svjetlo i zvukove uz pogoršanje simptoma tijekom fizičke aktivnosti. Epidemiološki podaci upućuju na visoku prevalenciju migrene, do 15 % u općoj populaciji, na temelju čega zauzima visoko treće mjesto najčešćih poremećaja i šesto mjesto kao specifični uzrok onesposobljenosti. Unatoč navedenom, migrena je u općoj populaciji nedovoljno dijagnosticirana i liječena zbog čega osobe s migrenom trpe značajnu bol uz smanjenu kvalitetu života. Dijagnoza migrene postavlja se na temelju detaljne anamneze, kliničke slike i dnevnika glavobolje, koji nam pomaže u praćenju frekvencije glavobolje, ali i pri planiranju i korekciji akutne i profilaktičke terapije. Prema kliničkoj slici migrena se javlja u dva oblika: migrena bez aure i migrena s aurom, a prema frekvenciji napadaja kao epizodna i kronična migrena. U okviru kliničke slike, osim faze u kojoj dominira tipična glavobolja, razlikujemo i kliničke simptome koji prethode glavobolji u okviru premonitorne faze i simptome koji se javljaju nakon glavobolje u postdromalnoj fazi. Migrena predstavlja velik problem za pojedinca i društvo u cjelini, zbog narušavanja kvalitete obiteljskog života bolesnika, smanjene produktivnosti na poslu, što migrenu stavlja u fokus globalnoga svjetskoga zdravstvenog interesa.
Receptor for advanced glycation end products (RAGE) ligands/RAGE interactions have been proposed to have a pathogenic role in neuroinflammatory disorders. Our study aimed to assess changes in ...high-mobility group box (HMGB)1 and its receptor RAGE in peripheral blood (PBL) and cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS) at the disease onset compared with control subjects.
PBL and CSF were collected from control subjects (n = 30) and MS patients (n = 27) at clinical onset. Soluble RAGE (sRAGE), HMGB1, S100 calcium-binding protein A12 (S100A12), interleukin (IL)-1β and tumor necrosis factor (TNF)-α were measured in the CSF and plasma by enzyme-linked immunosorbent assay. Gene expression in PBL mononuclear cells (PBMCs) was detected by quantitative PCR for RAGE, HMGB1, S100A12 and several proinflammatory/immunoregulatory cytokines.
We found a significantly lower expression of IL-10 (p = 0.031) in the PBMCs of MS patients. The level of sRAGE in the CSF of MS patients was lower (p = 0.021), with the ability to discriminate between MS patients and control subjects. Moreover, PBMC gene expression for HMGB1 and S100A12 positively correlated with IL-6.
Our study confirmed that the cytokine network is disturbed in PBL and CSF at MS clinical onset. The deregulated HMGB1/RAGE axis found in our study may present an early pathogenic event in MS, proposing sRAGE as a possible novel therapeutic strategy for MS treatment.
Behavioral and psychological symptoms of dementia (BPSD) are common in individuals with Alzheimer disease (AD). Donepezil and memantine are both widely used for the treatment of moderate AD.
To ...evaluate the effects of donepezil and memantine in relieving BPSD in individuals with moderate AD.
We conducted a prospective, randomized, 6-month clinical trial involving 85 individuals with moderate AD divided into two groups: group 1 (n = 42) was treated with donepezil; group 2 (n = 43) was treated with memantine. We used the Neuropsychiatric Inventory (NPI) to assess the prevalence and severity of BPSD at baseline and after 6 months of treatment with donepezil or memantine.
The two groups' baseline characteristics, including age, sex, mean length of education, and disease duration, were comparable, as were their baseline Mini-Mental State Examination scores. The NPI Total score improved from baseline to month 6 in both groups (P < 0.0001). Analyses of the NPI subdomains revealed that both donepezil treatment and memantine treatment produced statistically significant improvement in all of the NPI domains except euphoria and apathy, for which no improvement was observed after memantine treatment. Both treatments were well tolerated, with mostly mild and transient adverse effects.
Specific drugs for AD, including donepezil and memantine, may be effective in treating BPSD in individuals with moderate AD, with a favorable safety profile.
Highlights • Non-motor symptoms (NMS) are common in early, untreated Parkinson’s disease (PD). • Higher prevalence and different NMS domains are present in untreated PD patients compared to healthy ...controls. • The available non-motor scales (NMSS and NMSQ) should be introduced in everyday work with PD patients.
Aim
Rheumatoid arthritis is associated with accelerated atherosclerosis. However, little is known about preclinical atherosclerosis in hypertensive rheumatoid arthritis patients. In this ...cross‐sectional study we assessed the expression of preclinical atherosclerosis in hypertensive rheumatoid arthritis patients in comparison with matched hypertensive non‐rheumatoid arthritis patients.
Methods
The study included 52 hypertensive rheumatoid arthritis patients and 42 hypertensive non‐rheumatoid arthritis patients. The patients were extensively examined clinically and laboratory tested. The expression of preclinical atherosclerosis was estimated by assessing ambulatory arterial stiffness index and common carotid intima‐media thickness.
Results
Arterial stiffness index and common carotid intima‐media thickness were higher in hypertensive rheumatoid arthritis patients than in hypertensive non‐rheumatoid arthritis patients. There was no correlation between arterial stiffness index and common carotid intima‐media thickness with markers of inflammation and disease activity in hypertensive rheumatoid arthritis patients.
Conclusion
The expression of subclinical atherosclerosis is more pronounced in hypertensive rheumatoid arthritis than in hypertensive non‐ rheumatoid arthritis patients.
This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent ...asthma we tested the benefit of individual verbal instructions (IVI), written information (“asthma booklet”, B), and integrated asthma classes (“asthma school”, AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.
This study investigated the effectiveness of different educational programs in obtaining better asthma control and asthma-related quality of life (QoL). In 60 adult patients with moderate persistent ...asthma we tested the benefit of individual verbal instructions (IVI), written information ("asthma booklet", B), and integrated asthma classes ("asthma school", AS). At the enrollment and at the end of the study, all participants completed the questionnaires regarding their asthma-related knowledge (ArK) and QoL. During the 12-week period all patients recorded their asthma symptoms, morning and evening peek expiratory flow rates (PEFR), and the use of rescue medication. AS and IVI groups showed a significantly greater improvement in QoL than the B group. AS group obtained the highest ArK but no difference in the level of improvement among the groups has been documented. The improved average asthma symptom score and decreased utilization of the rescue medication were documented in all groups without significant differences among them. We also found significant improvements in both morning and evening PEFR in IVI group as well as in the morning PEFR in AS group. We conclude that among tested educational interventions the AS caused the best improvement in QoL while IVI produced the best overall response in both parameters of the asthma control and QoL.
Akutni diseminirajući encefalomijelitis (ADEM) upalna je, demijelinizirajuća bolest središnjeg živčanog sustava koja se pojavljuje kao imunološki odgovor na virusnu ili bakterijsku infekciju ili ...cijepljenje. Prikazujemo bolesnika s kliničkom prezentacijom i radiološkim manifestacijama ADEM-a koji je nastao nakon ugriza pauka. Kortikosteroidna terapija nije postigla zadovoljavajući rezultat u liječenju. Bolesnik se oporavio nakon pet dana liječenja imunoglobulinima. Križna reaktivnost između paukovog toksina i mijelina mogla bi objasniti patofiziološki mehanizam demijelinizacije. O ADEM-u treba razmišljati kao mogućoj komplikaciji ugriza pauka.
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