The study investigates how the presence of traffic signalling elements (road markings and traffic signs) affects the behaviour of young drivers in night-time conditions. Statistics show that young ...drivers (≤30 years old) are often involved in road accidents, especially those that occur in night-time conditions. Among other factors, this is due to lack of experience, overestimation of their ability or the desire to prove themselves. A driving simulator scenario was developed for the purpose of the research and 32 young drivers took two runs using it: (a) one containing no road markings and traffic signs and (b) one containing road markings and traffic signs. In addition to the driving simulator, eye tracking glasses were used to track eye movement and an electrocardiograph was used to monitor the heart rate and to determine the level of stress during the runs. The results show statistically significant differences (dependent samples t-test) between the two runs concerning driving speed, lateral position of the vehicle, and visual scanning of the environment. The results prove that road markings and traffic signs provide the drivers with timely and relevant information related to the upcoming situation, thus enabling them to adjust their driving accordingly. The results are valuable to road authorities and provide an explicit confirmation of the importance of traffic signalling for the behaviour of young drivers in night-time conditions, and thus for the overall traffic safety.
This study investigated the releasing dynamics of serum ST2 and calprotectin in patients with acute IS. The study included acute IS patients (N = 20) with an NIH Stroke Scale score ≥8. Sampling was ...performed at seven time points: after admission (T0) and at the following 24 h consecutive intervals (T1–T6). Primary outcome at 90 days was evaluated using the modified Rankin scale: 0–2 for good and 3–6 for poor functional outcome. The secondary outcome was all-cause mortality after 90 days. Fifteen patients had a poor outcome, and eight died. Results showed a statistically significant difference in ST2 concentrations between good and poor outcomes at T0 (p = 0.04), T1 (p = 0.006), T2 (p = 0.01), T3 (p = 0.021), T4 (p = 0.007), T5 (p = 0.032), and for calprotectin T6 (p = 0.034). Prognostic accuracy was highest for ST2 at T1 for a cut-off > 18.9 µg/L (sensitivity 80% and specificity 100.0%) and for calprotectin at T5 for a cut-off > 4.5 mg/L (sensitivity 64.3% and specificity 100.0%). Serum ST2 and calprotectin-releasing dynamics showed a valuable prognostic accuracy for IS outcomes.
•Only a very small subgroup of PwE did not adhere to the lockdown measures.•Responses from PwE showed social responsibility appropriate for the existing situation.•Checkup cancellation is an ...important additional stress factor during the COVID-19 lockdown.•Telemedicine during pandemic is in line with the wishes of PwE.
The aim of our study was to gather information on how people with epilepsy (PwE) responded to the COVID-19 pandemic during the national lockdown. An online questionnaire was therefore offered to the visitors of the Croatian Association for Epilepsy's website. The 22-items questionnaire was designed to acquire information from adults with epilepsy living in Croatia on demographic data, cognitive, emotional and behavioral responses to the pandemic, and communication problems between patients and their neurologists during the lockdown. Perceived anxiety and fears were expressed with the Likert scale (1–5) and the results of specific fears added to make the Total Fear Score. Results: Out of 186 respondents in total, only 2.8% did not comply with the lockdown measures, and all of those respondents stated that they did not feel any anxiety related to COVID-19. A canceled neurologist examination during the lockdown was significantly associated with pandemic-related anxiety (2.9 ± 1.28 vs. 2.3 ± 1.19, U = 3039, p = 0.001) and fears (Total Fear Score 31.4 ± 9.70 vs. 28.4 ± 9.79, U = 3341, p = 0.036), and 87.4% of respondents expressed the wish to communicate with their neurologist, either by phone/video call (53.0%) or email (34.4%). Conclusion: We think the results of our survey show that the responses from PwE point to a social responsibility appropriate for the existing situation. During future pandemics, telemedicine could have an important role in tackling the fears and anxieties caused by the cancelation of examinations, which corresponds to the wishes expressed by the great majority of our respondents.
Pregnancy-related issues in epilepsy (PRIE) are essential for management of epilepsy in women. We conducted a study among women with epilepsy (WWE) aged 15–45years about their knowledge, sources, and ...needs for information regarding PRIE, which included their current antiepileptic drugs (AEDs) usage. Women with epilepsy, visitors of Croatian Association for Epilepsy webpage, were offered an online questionnaire, and 200 responses were analyzed. The mean number of correct answers about PRIE was 3.5 out of 5. Main predictors of knowledge on PRIE were a prior consultation with a neurologist and higher usage of books/brochures. A prior neurologist consultation on PRIE was stated by 45% of subjects. As the preferred future mode of being informed on PRIE, majority of women (61%) chooses their neurologist, 22% written materials distributed by a neurologist, and only 13% Internet. Levetiracetam was the most commonly used AED (34.5%). Valproate was used by 26%, and of those 59% stated no previous consultation on PRIE with their neurologist. In summary, we believe our study shows that knowledge of PRIE among WWE in their childbearing age is unsatisfactory, as are the neurologist consultation rates about PRIE. Our results demonstrate that, despite modern technologies, educational activities should be based on neurologist consultations and providing the patients with appropriate written materials. This is especially true for the relatively large proportion of women still taking valproate.
•Women with epilepsy aged 15–45 were surveyed on pregnancy related issues in epilepsy.•Knowledge and the neurologist consultation rates on these issues were unsatisfactory.•Valproate is used by 26%, of those 59% had no neurology consultation on these issues.•Neurologist consultations and written materials should be the core of education.
Publications on the topic of appropriate labels for someone with diagnosed epilepsy have so far almost exclusively consisted of views of professionals in this field. We conducted an online study of ...patients treated for epilepsy and persons close to them with the aim of identifying which label they prefer, whether they oppose the term “epileptic”, and which characteristics are related with their preferences. In total, 328 responses were analyzed. Subjects mostly favored “person-first” terminology (“person having epilepsy” and “person with epilepsy”), and 53.9% disapproved of the term “epileptic”. Parents of patients are more likely than patients themselves to favor the label “person having epilepsy” and to disapprove of the label “epileptic”. These results can help with shaping future terminology recommendations.
•Views on labels in epilepsy were researched among patients and caregivers.•Person-first terminology was favored, and 53.9% opposed the term “epileptic”.•Parents more often disapprove of the label “epileptic” than patients themselves.
Pregnancy-related epilepsy issues (PREIs) are crucial in managing women with epilepsy (WWE). The main PREIs are reduced compliance and self-discontinuation of antiseizure medications (ASMs), ...pharmacokinetic alterations during pregnancy, and the teratogenic potential of particular ASMs. According to a recent study, knowledge of PREIs among reproductive-aged WWE in Croatia is unsatisfactory, as are neurologist consultations about PREIs. Two hundred WWE were polled on their knowledge, sources, and needs for information about PREIs and their current ASMs usage. Prior consultation with a neurologist and increased use of books/brochures were the main predictors of knowledge. Forty-five percent of participants had a prior neurologist consultation on PREIs. Most women (61 %) chose their neurologist as their favourite future source of information, and 13 % favoured Internet. The most usually prescribed ASM was levetiracetam (34.5 %). Valproate was utilized by 26 % of respondents, among which 59 % claimed no prior PREIs consultation with a neurologist. A new campaign called Epilepsy and Pregnancy was launched by the International Bureau for Epilepsy in 2021. In February 2021, a poll of nearly 900 women was conducted across Europe as the first stage in this significant project, including 94 respondents from Croatia. Forty-two percent of Croatian WWE were given no information on pregnancy-related risks. In contrast with the aforementioned study, neurologists provided 82 percent of information about the risks of ASMs. Seventy percent reported they were not given contraception information. Providing clear, accurate and timely information on PREIs should become the norm for all neurologists caring for WWE.
An ischemic stroke caused by the occlusion of the artery of Percheron encompasses both posterior thalami, and the resulting clinical presentation can mask the clinical presentation of a stroke. We ...present the case report of a 62-year-old female patient who was admitted to our emergency department in a soporous state after initial headache and dizziness. A neurological exam found left-sided spasticity and a flexor response to pain. Systemic thrombolysis was administered after an urgent computerized tomography (CT) of the brain with angiography. The interventional radiologist proposed a digital subtraction angiography which found a vasospasm in the right medial cerebral artery from the M2 seg- ment reaching distally, and a balloon dilation was done. Following the endovascular procedure, a CT scan showed ischemia in both posterior thalami. Additionally, the patient’s neurological impairment improved at that moment showing Parinaud syndrome, drowsiness, and left-sided palsy. The patient experienced a possible reversible cerebral vasoconstriction syndrome, the cause of which is still unknown, which resulted in an ischemic stroke. The typical clinical presentation of that syndrome was lacking, probably due to the presence of the artery of Percheron ipsilateral to the vasospasm. Our goal in presenting this case study is to draw attention to the artery of Percheron syndrome as a potential clinical sign of an acute ischemic stroke that can easily lead us to be misled.
Abstract Purpose It is believed that a large number of factors influence feelings of stigma, but their relative contribution is not yet entirely clear. Most studies to date were conducted using the ...Epilepsy Stigma Scale (ESS); only one used a revised version of the ESS (rESS). The following study aims to determine factors contributing to epilepsy stigma in outpatients with chronic epilepsy in Croatia, and to analyze some psychometric properties of the Croatian translation of the rESS. Methods Alongside standard testing for validity of the scale, a simulation model of the original ESS (smESS) was created. This model, which does not include a grading Likert 0–3 scale, was compared with the rESS. Results In total, 159 out of 298 subjects (53%) reported feeling stigmatised, with 136 (45%) mild to moderately and 23 (8%) highly. Internal consistency of the Croatian translation of the rESS was 0.887. Feelings of stigma were significantly associated with age ≤50 years, younger age of epilepsy onset, more than 50 seizures to date, generalized tonic–clonic seizures, and a shorter seizure-free period. Multiple stepwise regression showed number of seizures to date as a significant variable (Beta = 0.246). By adapting data into the smESS significant associations with younger age and age of epilepsy onset were lost. Internal consistency of the smESS was 0.849. Conclusions The Croatian translation of the rESS has been proved to be a suitable instrument for diagnosing epilepsy stigma. The results of our model point to the possibility that the rESS might be more sensitive than the original ESS.
Abstract Purpose Within the “Out of the Shadows” campaign in Croatia, numerous activities have been organized. The aim of this study is to investigate the changes in knowledge and attitudes toward ...epilepsy in the population of college-preparatory high school students, and to consider whether such changes could be the result of these activities carried out between 2002 and 2010. Methods This study was completed in Croatia's capital city, Zagreb, and sampled adolescent college-preparatory high school students. The surveys conducted in both 2002 and 2010 have been evaluated and compared. In both years the examinees completed a questionnaire made up of identical questions concerning the students’ knowledge and attitudes toward epilepsy. Results In total, 430 respondents (227 students in 2002; 203 in 2010) completed a questionnaire. The 2010 survey indicates a higher degree of knowledge of epilepsy amongst the students ( p < 0.05), as well as more positive attitudes related to marriage ( p < 0.05), and the employment of persons with epilepsy (PwE) ( p < 0.01). The percentage of positive attitudes related to playing with children with epilepsy was high in both surveys (>97%). The results for the total sample reveal that students with a better knowledge of epilepsy had more positive attitudes ( p < 0.05). Yet in the survey conducted in 2010, when the level of factual knowledge about epilepsy was higher, this relationship was not possible to prove; improvement of attitudes was greater in students with worse knowledge of epilepsy than in those with better knowledge. Conclusion Based on the obtained results we conclude that improvement in factual knowledge is only one of the factors that can induce improvement in attitudes. The positive changes found in Croatia most likely stem from the cumulative effect of the various activities conducted in accordance with the principles of the “Out of the Shadows” campaign.
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.
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