Objective
The aim of this study was to compare self-perceived health between migraine and early stages of relapsing-remitting multiple sclerosis (RRMS) and to explore whether and how accurate those ...health domains predict overall quality of life.
Methods
Ninety patients aged 18–55 years were enrolled in this cross-sectional study. Thirty follow-up outpatients were recruited with migraine (with or without aura), 30 patients with RRMS, and 30 healthy subjects. They were asked to complete the Health status questionnaire (SF-36) and Personal Wellbeing Index (PWI).
Results
Patients with RRMS and migraine had significantly worse self-reported health regarding role limitation due to physical problems and general health than the healthy control group. Additionally, migraine patients had more bodily pain, while RRMS patients expressed more difficulties regarding physical functioning. Differences between migraine and RRMS patients were not significant. Hierarchical regression analysis revealed that role limitation due to physical problems, mental health, and general health represents significant predictors of overall quality of life.
Conclusions
Migraine may affect quality of life similarly to early stages of RRMS. Bio-psycho-socio-medical understanding of the two diseases and their impact on patients QoL should be reconsidered.
We present a patient with a clinically isolated syndrome suggestive of multiple sclerosis, who developed a full-blown picture of paranoid psychosis with suicidal attempt. Four new lesions were ...observed on brain MRI, one in the left and one in the right temporal lobe, one subcortically in the cingulate gyrus and one centrally in the tegmentum of the midbrain. The patient was treated with plasma exchange and recovered completely. Psychosis is not so rare symptom of multiple sclerosis as previously reported, and poses a major treatment challenge. A combination of lesions at strategic locations was a presumed mechanism of psychosis in this patient.
The objective of this work is to describe the neuropathological findings of a patient clinically presenting with rapidly progressive nonspecific neurological symptoms suggestive of Creutzfeldt-Jakob ...disease. Methods used were clinical description with laboratory analyses, repeated electroencephalogram, cerebral computed tomography, magnetic resonance imaging studies and details on neuropathological work-up. Neuropathological examination excluded Creutzfeldt-Jakob disease. By contrast other neurodegenerative changes combining Alzheimer-type pathology and Lewy body pathology were detected as the most likely substrate of neurological symptoms. Dementia with Lewy bodies should be included in the differential diagnosis in individuals presenting with rapidly progressive dementia.
The aim of this investigation was to determine whether Helicobacter pylori infection (HBPI) is an independent risk factor for acute noncardioembolic stroke, and also if there is a link between HBPI ...and other established and well-known risk factors for stroke, as well, to find if there is link between HBPI and severity of disease. In this prospective single centre study where enrolled 82 patients with acute stroke and control group was consistented 93 healthy individuals. The results of this study showed no difference between H.pylori seropositivity distribution in the investigate and control group (25.8 vs. 34.8%), additionally, there was no significant difference on the severity of the disease. Furthermore there was no evident association between acute stroke and HBPI in the patientes with three and more risk factors, but we found significant link between HBPI and carotid stenosis. Further studies are needed to clarify the possible causal relation between infection by this organism and stroke. It is necessary not only the elucidate of pathophysiology related to the association, but also to evaluate whether antibiotic treatment may result in clinical benefit of the patient.
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.
Objective
To evaluate the efficacy, tolerability, and safety of once‐daily 1200 mg and 2400 mg SPN‐804 (Oxtellar XR™, Supernus Pharmaceuticals), an extended‐release tablet formulation of ...oxcarbazepine (OXC), added to 1‐3 concomitant antiepileptic drugs (AEDs) in adults with refractory partial‐onset seizures, with or without secondary generalization.
Methods
The Prospective, Randomized Study of OXC XR in Subjects with Partial Epilepsy Refractory (PROSPER) study was a multinational, randomized, double‐blind, parallel‐group Phase 3 study. The primary efficacy endpoint was median percent reduction from baseline in monthly (28‐day) seizure frequency for the 16‐week double‐blind treatment period in the intent‐to‐treat (ITT) population with analyzable seizure data. Other efficacy analyses included proportion of patients with ≥ 50% seizure reduction, proportion of patients seizure free, and the relationship between clinical response and plasma concentration.
Results
Median percent reduction was ‐28.7% for placebo, −38.2% (P = 0.08 vs placebo) for once‐daily SPN‐804 1200 mg, and −42.9% (P = 0.003) for SPN‐804 2400 mg. Responder rates were 28.1%, 36.1% (P = 0.08), and 40.7% (P = 0.02); 16‐week seizure‐free rates in a pragmatic ITT analysis were 3.3%, 4.9% (P = 0.59), and 11.4% (P = 0.008), respectively. When data were analyzed separately for study site clusters, a post hoc analysis demonstrated that both SPN‐804 dosages were significantly superior to placebo in median percent seizure reduction (placebo: −13.3%; 1200 mg: −34.5%, P = 0.02; 2400 mg: −52.7%, P = 0.006) in the North American study site cluster. A concentration–response analysis also supported a clinically meaningful effect for 1200 mg. Adverse event types reflected the drug's established profile. Adverse event frequency was consistent with a pharmacokinetic profile in which SPN‐804 produces lower peak plasma concentrations vs immediate‐release OXC. Once‐daily dosing was not associated with any new safety signals.
Conclusions
Adjunctive once‐daily SPN‐804 improved seizure control in patients with inadequately controlled partial‐onset seizures. Adverse event occurrence and discontinuations due to adverse events suggest improved tolerability vs previously published data with immediate‐release OXC.
The aim of this investigation was to determine whether H. pylori infection is an independent risk factor for acute myocardial infarction (AMI), determine is there a link between H. pylori infection ...and severity of disease. In this prospective, single centre study, were enrolled 100 patients with AMI and control group was consisted 93 healthy individuals. The results of this study showed no difference between H. pylori seropositivity distribution in the investigate and control group (29 vs. 26 %) and there was no significant difference on the severity of the disease. There was significant association in the patients with three and more risk factors, where the patients with lower blood pressure (124.4/77.4 vs. 145.9/87.7 mmHg) and better controlled diabetes (HbA1c 6.1% vs. 6.9%) had greater risk for AMI if they are H. pylori seropositive. The large multicentric trials would be needed to define a precise role of H. pylori infection on the developement of AMI.
The aim of this investigation was to determine whether Helicobacter pylori infection (HBPI) is an independent risk factor for acute noncardioembolic stroke, and also if there is a link between HBPI ...and other established and well-known risk factors for stroke, as well, to find if there is link between HBPI and severity of disease. In this prospective single centre study where enrolled 82 patients with acute stroke and control group was consistented 93 healthy individuals. The results of this study showed no difference between H.pylori seropositivity distribution in the investigate and control group (25.8 vs. 34.8%), additionally, there was no significant difference on the severity of the disease. Furthermore there was no evident association between acute stroke and HBPI in the patientes with three and more risk factors, but we found significant link between HBPI and carotid stenosis. Further studies are needed to clarify the possible causal relation between infection by this organism and stroke. It is necessary not only the elucidate of pathophysiology related to the association, but also to evaluate whether antibiotic treatment may result in clinical benefit of the patient.
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