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.
Several types of modern roundabouts are alternatives to standard ones. They are either in use or at the development stage today. One such intersection is the two-geometry roundabout. Its circulatory ...roadway has an elliptical outer edge and a circular inner edge that is defined by a circular central island resulting in variable circulatory roadway width. The investigation presented in this paper aims to determine the influence of this variable width on the design of other geometric elements and its impact on roundabouts’ speed reduction capabilities. There is not enough experimental data collected to make a comparison to other roundabout types, so this investigation is based on computer simulations and speed estimations. The investigation is conducted on 40 four-legged single-lane roundabout schemes. These were designed in the Autodesk AutoCAD 2021 software through computer simulations of vehicle movement and the resulting swept paths of a tractor with a semi-trailer generated by the Autodesk Vehicle Tracking 2020 software. The results show that truck aprons must be included in the design of two-geometry roundabouts with a major axis between 18 and 25 m to achieve appropriate circulatory roadway widths, personal car path deflection, and the resulting relative speed and speed consistency.
Repetitive transcranial magnetic stimulation (rTMS) is an evidence-based treatment option for major depressive disorder (MDD). However, comparisons of efficacy between the two FDA-approved protocols ...of rTMS modalities are lacking. The aim of this industry-independent, randomized-controlled, single-blind trial was to evaluate clinical outcome of the two FDA-approved rTMS protocols delivered by H1-coil and the figure-8-coil, in MDD patients. A total of 228 MDD patients were randomized to 20 sessions of H1-coil or 8-coil as an adjunct to standard-of-care pharmacotherapy, or standard-of-care pharmacotherapy alone. Baseline MDD symptom severity was almost the same in the three groups. Hamilton depression rating scale (HAM-D17) mean score was 17 (5.3) in H1-coil, 17 (5.4) in 8-coil, and 19 (6.1) in control group. The primary outcome was the proportion of patients achieving remission defined as HAM-D17 score ≤7 at end-of-treatment at week-4. In the intention-to-treat analysis odds ratio for remission was 1.74 (CI95% 0.79–3.83) in H1-coil compared to the 8-coil group. The difference between two rTMS protocols was not significant. Remission rate was significantly greater in both HF-rTMS groups compared to the control: 60% (CI95% 48–71%), 43% (CI95% 31–55%) and 11% (CI95% 5–20%) respectively. The response was significantly better in H1-coil, than in 8-coil group OR = 2.33; CI95% 1.04–5.21 (P = 0.040). The HAM-D17 was lowered by 59% in the H1-coil, 41% in the 8-coil (P = 0.048), and 17% in the control group (P < 0.001 vs H1-coil; P = 0.003 vs 8-coil). Safety, tolerability, and the changes in quality of life were comparable. We confirmed the safety and efficacy of both FDA-approved protocols as adjunctive treatments of MDD. Better response rate and greater reduction of depression severity were observed in the H1-coil group, but without a significant difference in the remission rate between the two rTMS modalities.
Clinicaltrials.govNCT02917499
•Remission rate was significantly greater in HF-rTMS groups compared to the control.•Main-analyses showed no difference in remission rate between H1-coil, and 8-coil group.•Better response rate and reduction of depression severity was observed in H1-coil, than in 8-coil group.•Both rTMS modalities ware equally safe and well tolerated.
The aim of the study was to evaluate the possible association between Apo E polymorphisms and age at seizure onset in patients with non-lesional temporal lobe epilepsy. Eighty patients with ...non-lesional temporal lobe epilepsy with or without bilateral tonic-clonic propagation were analyzed. Age at seizure onset was defined as age at the first unequivocal seizure (excluding febrile convulsions). ApoE alleles were determined by a procedure where genome DNA was amplified by chain reaction along with polymerase, using the LightCycler kit (Roche) for ApoE mutations on codons 112 and 158. There was a statistically significant difference between the groups of patients with ApoE ε2/3 and ε3/4 genotypes (p=0.03), but not between patients with ApoE, ε2/3 and ε3/3, and those with ApoE ε3/4 and ε3/3. In conclusion, the results of our study suggested positive association of a specific ApoE genotype and onset of non-lesional temporal lobe epilepsy.
The prediction of stop dwell time is a major issue in travel speed modeling, i.e., in the definition of travel time for high-frequency and high-ridership rail public transport. This is due to the ...numerous influential factors associated with stop dwell time, variable both in space and time, such as passenger flow, vehicle and stop design characteristics, and traffic organization. To investigate the impact of the heterogeneity of tram vehicles on stop dwell time, a survey was conducted regarding the tram network of the City of Zagreb. The dwell time at three consecutive island stops served by three different tram vehicle types was analyzed. The stops are located near the city center, in a separate tram corridor, at the far side of signalized intersections. Dwell time was determined and evaluated through the statistical analysis of observed, measured, and video-recorded data. The results show that at stops with up to 200 passengers per hour, the dwell time is around 15 s. For volumes of 20 passengers or less per tram, the dwell time is mostly affected by the tram door opening mechanism and opening/closing time. As the passenger volumes become higher, the number of doors per vehicle becomes more significant.
Coronavirus disease 2019
(
COVID-19), caused by the late 2019 outbreak of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes a respiratory disease which could put myasthenia gravis ...patients at a greater risk of developing severe disease course. This paper presents a single-institution case series of hospitalized myasthenia gravis patients with COVID 19. We identified eight patients previously diagnosed with myasthenia gravis, four of whom presented with clear signs of myasthenia gravis symptom worsening on admission. No form of respiratory support was needed during the complete duration of stay for three patients, oxygen therapy was administered to two patients, while the remaining three patients required mechanical ventilation. Treatment was successful for seven patients, six of whom were discharged without any myasthenia gravis symptoms. One patient died after eleven days of intensive care unit treatment. Although treatment of patients with myasthenia gravis and COVID-19 patients is challenging, case series of myasthenia gravis patients with COVID-19 treated in our institution demonstrates relatively favorable treatment outcome. Our data seem to support the notion that immunosuppressive medication does not seem to result in worse outcomes. Our data also support the notion that intravenous immunoglobulin treatment is safe and should be administered to patients with myasthenia gravis and COVID-19 in case of myasthenia gravis worsening since benefits seem to greatly outweigh the risks.
Pharmacoresistant epilepsy poses a great burden to patients, their families, and the whole healthcare system, with numerous social, economic, physical, and psychical consequences. Hence, it is a ...diagnosis that has to be made only in cases of high certainty, after all potential causes of epilepsy have been evaluated. One of the important causes of pharmacoresistant epilepsy is false pharmacoresistance, an entity that implies a condition in which poor disease control is not a consequence of the biology of the disease itself, antiepileptic drug inefficacy, and/or patient specificity. It is a consequence of human error and strongly depends on the experience of the treating physician, as well as on the attitude of the patient. Despite its ‘falseness’, this entity is accompanied by real consequences for the patient and his family, and at the same time, it delays appropriate treatment of the actual disease from which the patient is suffering. In order to introduce appropriate treatment and avoid unnecessary and harmful diagnostic procedures, false pharmacoresistance is a condition that has to be ruled out in any patient with difficult-to-treat seizures.
The most common neurological symptoms in patients with SARS-CoV-2 infection are headache, myalgia, encephalopathy, dizziness, dysgeusia and anosmia, making more than 90 percent of neurological ...manifestations of COVID-19. Other neurological manifestations such as stroke, movement disorder symptoms or epileptic seizures are rare but rather devastating, with possible lethal outcome. The primary aim of this study was to estimate the prevalence of acute symptomatic seizures among COVID-19 patients, while secondary aim was to determine their possible etiology. Out of 5382 patients with COVID-19 admitted to Dubrava University Hospital from November 1, 2020 until June 1, 2021, 38 (seizure rate 0.7%) of them had acute symptomatic seizures. Of these 38 patients, 29 (76.3%) had new-onset epileptic seizures and nine (23.7%) patients with previous epilepsy history had breakthrough seizures during COVID-19. Although acute symptomatic seizures are an infrequent complication of COVID-19, seizure risk must be considered in these patients, particularly in the group of patients with a severe course of the disease. Accumulation of proinflammatory cytokines may contribute to the occurrence of seizures in patients with COVID-19, but seizures may also be secondary to primary brain pathology related to COVID-19, such as stroke or encephalitis.
These are evidence based guidelines for the management of medical complications in patients following aneurysmal subarachnoid hemorrhage, developed and endorsed by the Croatian Society of ...Neurovascular Disorders, Croatian Society of Neurology including Section for Neurocritical Care, Croatian Neurosurgical Society, Croatian Society for Difficult Airway Management and Croatian Medical Association. They consist of recommendations for best monitoring, medical treatment and interventions based on the literature, evaluation of the results of large international clinical trials, and collective experience of the authors.
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