Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by obstructions of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen ...desaturation and arousal from sleep. OSA can be successfully treated with continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, hypoglossal nerve stimulation, and surgical procedures. It has been observed that untreated OSA is related to chronic disorders including hypertension, arrhythmias, congestive heart failure, coronary heart disease, diabetes mellitus, hyperlipidemia, stroke, depression, and cognitive decline. Event-related potentials (ERPs) is the procedure that has been widely used for evaluating cognitive brain functions. Using auditory event-related potentials (P300), this study aimed to examine the effect of CPAP therapy on cognitive functions in patients with moderate and severe OSA. The results of the study showed improvement in P300 latency and amplitude after 3 months of CPAP therapy, indicating a positive effect of CPAP therapy in the prevention of cognitive decline in patients with OSA.
Epilepsy is one of the most prevalent chronic neurological diseases, affecting about 70 million people worldwide. Patients with epilepsy often encounter cognitive dysfunction, which is influenced by ...different factors including age at the onset of epilepsy, etiology of epilepsy, type of seizures, seizure frequency and duration, psychiatric comorbidity, and antiepileptic drug (AED) therapy. Event-related potentials are useful, noninvasive, objective clinical and research instrument for evaluation of cognitive functions in patients. The aim of this study was to investigate and determine the effect of AED monotherapy and polytherapy on cognitive changes in patients with epilepsy, detected with P300 event-related potentials and compared with age- and gender-matched healthy individuals. The study was conducted in 82 patients with generalized and focal epilepsy and 82 healthy individuals aged 18-65 years. Cognitive evoked P300 potentials were recorded in all study subjects using auditory ‘oddball’ paradigm. The results showed the patients taking AED polytherapy to have a significantly longer P300 latency and significantly lower N200-P300 amplitude. These results indicate that AED polytherapy might worsen cognitive impairment in patients with epilepsy.
SAŽETAK
Međunarodne smjernice za farmakološko liječenje epilepsija općenite su, sveobuhvatne i ne prepoznaju lokalne specifičnosti poput ekonomskih i tehničkih mogućnosti u pojedinim državama, ...dostupnosti pojedinih antiepileptika ili drugih metoda liječenja i slično. Stoga se nameće potreba izrade nacionalnih smjernica, čiji su zapravo temelj međunarodne smjernice Internacionalne lige protiv epilepsije. Hrvatske smjernice za farmakološko liječenje epilepsija plod su suradnje svih relevantnih stručnih društava i referentnih centara u RH, na čelu s Hrvatskom ligom protiv epilepsije te Hrvatskim neurološkim društvom i Hrvatskim društvom za dječju neurologiju Hrvatskoga liječničkog zbora, a odražavaju aktualne socioekonomske i regulatorne specifičnosti u našoj zemlji, najnovije spoznaje farmakoloških profila i učinkovitosti pojedinih antiepileptika kao i ekspertna mišljenja. Antiepileptička terapija se uvodi nakon postavljanja dijagnoze epilepsije, stoga profilaktička primjena nije opravdana. Nakon postavljanja dijagnoze potrebno je bolesnika informirati o prognozi bolesti, mogućnostima liječenja i samopomoći, životnim ograničenjima te mogućim neželjenim događajima. Ciljevi farmakoterapije epilepsija su potpuna kontrola napada uz izbjegavanje nuspojava te održavanje ili poboljšanje kvalitete života. Zlatni standard liječenja je monoterapija odnosno primjena adekvatnog antiepileptika u adekvatnoj dozi. Izbor i titracija lijeka su individualni, a temelje se na smjernicama za liječenje pojedinih vrsta napada, karakteristikama bolesnika i regulatorno specifičnim čimbenicima. Nakon neuspjeha inicijalne monoterapije, potrebna je reevalucija anamnestičkih i dijagnostičkih podataka te potom postupna i spora zamjena antiepileptika. Racionalna politerapija podrazumijeva kombinaciju dvaju antiepileptika različitih mehanizama djelovanja, prvog ili eventualno drugog izbora za postavljenju dijagnozu, niskoga interakcijskog potencijala, različitog profila nuspojava i sinergističkog ili aditivnog djelovanja. Zamjena generičkih ili originalnog i generičkog oblika lijeka nije preporučljiva, a poglavito nakon postizanja remisije ili prilikom uzimanja visokih doza lijeka. Ukidanje antiepileptičke terapije treba biti postupno i sporo, u slučaju politerapije jedan po jedan lijek, a u donošenju odluke o ukidanju, kao i o uvođenju antiepileptika, mora biti uključen bolesnik i njegova obitelj.
Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by obstructions of the upper airway during sleep, resulting in repetitive breathing pauses accompanied by oxygen ...desaturation and arousal from sleep. OSA can be successfully treated with continuous positive airway pressure (CPAP), weight loss, positional therapy, oral appliances, hypoglossal nerve stimulation, and surgical procedures. It has been observed that untreated OSA is related to chronic disorders including hypertension, arrhythmias, congestive heart failure, coronary heart disease, diabetes mellitus, hyperlipidemia, stroke, depression, and cognitive decline. Event-related potentials (ERPs) is the procedure that has been widely used for evaluating cognitive brain functions. Using auditory event-related potentials (P300), this study aimed to examine the effect of CPAP therapy on cognitive functions in patients with moderate and severe OSA. The results of the study showed improvement in P300 latency and amplitude after 3 months of CPAP therapy, indicating a positive effect of CPAP therapy in the prevention of cognitive decline in patients with OSA. Key words: obstructive sleep apnea; continuous positive airway pressure; auditory event-related potentials; P300 Opstruktivna apneja u spavanju (OSA) je poremecaj disanja u spavanju karakteriziran opstrukcijom gornjih disnih puteva tijekom spavanja koji dovodi do prestanka disanja u spavanju, desaturacije krvi kisikom i budenja. OSA se uspjesno lijeci uredajima za potpomognuto disanje s neprekinutim pozitivnim tlakom (CPAP), gubitkom tjelesne tezine, pozicijskom terapijom, oralnim udlagama, stimulacijom zivca hipoglosusa i operativnim lijecenjem. Opazeno je da je nelijecena OSA povezana s kronicnim poremecajima, ukljucujuci arterijsku hiperteziju, aritmije, kongestivno zatajenje srca, koronarnu srcanu bolest, secernu bolest, hiperlipidemiju, mozdani udar, depresiju i kognitivno propadanje. Kognitivni evocirani potencijali se koriste za proucavanje kognitivnih funkcija. Cilj ovog rada je ispitati ucinak terapije CPAP-om na kognitivne funkcije bolesnika s umjerenom i teskom OSA--om koristeci slusne kognitivne evocirane potencijale. Rezultati ove studije su pokazali poboljsanje P300 latencija i amplituda, ukazujuci na pozitivni ucinak terapije CPAP--om u prevenciji kognitivnog poremecaja u bolesnika s OSA--om. Kljucne rijeci: opstruktivna apneja u spavanju; disanje s neprekinuitim pozitivnim tlakom; slusni kognitivni evocirani potencijali; P300
Epilepsy is the only chronic neurological disease that can be fully controlled by drugs or introduced into permanent remission. Nonetheless, pharmacological treatment of epilepsy is often accompanied ...by a range of diagnostic and therapeutic challenges. Due to a wide variety of available antiepileptics, the selection of the first antiepileptic, as well as the combination of polytherapy, is extremely large. The choice of the ideal antiepileptic is individual and depends on a variety of factors based on the pharmacological properties of the drug and the disctinctiveness of every patient (type of seizure, age,sex, profession, comorbidity, co medication, etc.) with specific regulatory limitations (availability,price, indications of regulatory bodies). The basics of rational pharmacotherapy include slow titration of antiepileptics in monotherapy to satisfactory effect, slow drug replacement in the event of failure of the first antiepileptic, combination of two antiepileptics of different mechanism of action or selection of synergistic combinations if dual therapy is necessary, avoiding three or multiple polyterapies whenever possible, and slow reduction of antiepileptic drug after achieving a long-lasting remission.Current ILAE guidelines for epilepsy treatment imply basic and comprehensive recommendations that are acceptable worldwide, including countries with the lowest economic standard. Therefore, these guidelines do not reflect the ideal treatment options, especially in developed countries, and are actually the basis for making national guidelines. The Croatian guidelines for pharmacological treatment of epilepsy are the product of the co-operation of all relevant professional societies and reference centers in the Republic of Croatia, headed by the Croatian League Against Epilepsy and the Croatian Neurological Society. These guidelines reflect the current socioeconomic specificities in our country,the latest knowledge of pharmacological profiles, and efficacy of certain antiepileptics as well as expert opinions.
Epilepsija je jedna od najčešćih kroničnih neuroloških bolesti od koje boluje oko 70 milijuna ljudi diljem svijeta. Bolesnici
s epilepsijom često imaju poremećaj kognitivnih funkcija uzrokovan ...početkom bolesti, vrstom epileptičkih napadaja, trajanjem
bolesti i antiepileptičkim lijekovima. Kognitivni evocirani potencijali P300 su korisna, neinvazivna, objektivna klinička
i istraživačka metoda za ispitivanje kognitivnih funkcija. Cilj ovoga istraživanja bio je ispitati i utvrditi učinak antiepileptičkih
lijekova (AEL) u monoterapiji i politerapiji na kognitivne promjene u bolesnika s epilepsijom uz pomoć kognitivnih
evociranih potencijala P300 i usporediti ih sa zdravim pojedincima usklađenim prema dobi i spolu. U ispitivanju je sudjelovalo
82 bolesnika s generaliziranom i žarišnom epilepsijom i 82 zdrava pojedinca u dobi od 18-65 godina. Kognitivni evocirani
potencijali P300 su snimani koristeći slušnu oddball paradigmu. Rezultati ove studije ukazuju na to da bolesnici na politerapiji
AEL imaju značajno produženu latenciju vala P300 i značajno nižu amplitudu N200-P300. Prema rezultatima ove
studije može se zaključiti kako politerapija AEL u bolesnika s epilepsijom može dovesti do pogoršanja kognitivnog poremećaja.
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