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.
U profilaksi kronične migrene donedavno su se rabili lijekovi koji, prema međunarodnim smjernicama, imaju dokazanu učinkovitost pri epizodnoj migreni. Nakon što su dvjema velikim kontroliranim ...studijama
PREEMPT 1 i 2 dokazane učinkovitost i dobra podnošljivost botulinskog toksina tipa A u profilaksi kronične migrene, stručna povjerenstva u Europi (prvo u Ujedinjenom Kraljevstvu) i Sjedinjenim Američkim Državama odobrila su njegovu uporabu kao druge linije profilaktičkog liječenja pri indikaciji kronične migrene u nacionalnim sustavima zdravstvenih osiguranja. U Hrvatskoj su dostupni profilaktički lijekovi za migrenu iz skupina blokatora beta-adrenergičkih receptora (registrirani za indikaciju migrene) i antikonvulziva (nisu registrirani za migrenu). U
ovim preporukama smatramo da u Hrvatskoj, s obzirom na omjer troškova i prednosti liječenja, botulinski toksin tipa A treba rabiti u drugoj liniji profilaktičkog liječenja kronične migrene tek nakon iscrpljivanja učinka ili nepodnošljivostin dvaju oralnih profilaktika u prethodnim ciklusima liječenja. Botulinski toksin tipa A valja aplicirati
prema protokolu studijâ PREEMPT 1 i 2, s razmakom aplikacija od tri mjeseca. Lijek treba primjenjivati u bolničkim centrima pod nadzorom stručno osposobljenog neurologa iz Ambulante/Odjela/Zavoda za glavobolje ili neurologa koji se bavi užim područjem glavobolja. Odluku o produljenju/prestanku liječenja donosi neurolog na temelju postojanja/nepostojanja povoljnog učinka lijeka na redukciju dana glavobolje za 30% na mjesec u razdoblju od 3 mjeseca nakon druge primjene lijeka.
Schwannoma as an extracranial nerve sheath tumor rarely affects brachial plexus. Due to the fact that brachial plexus schwannomas are a rare entity and due to the brachial plexus anatomic complexity, ...schwannomas in this region present a challenge for surgeons. We present a case of a 49-year-old female patient with a slow growing painless mass in the right supraclavicular region that was diagnosed as schwannoma and operated at our department. The case is described to remind that in case of supraclavicular tumors, differential diagnosis should take brachial plexus tumors, i.e. schwannomas, in consideration. Extra caution is also required on fine needle aspiration procedures or biopsies of schwannomas due to the possible iatrogenic injury of the nerve and adjacent structures. On operative treatment of schwannoma, complete tumor resection should be achieved while preserving the nerve.
Akupunktura je starokineska metoda liječenja s pomoću igala koje se zabadaju u točno određene točke na koži. Počela se primjenjivati u Kini, a prva knjiga u kojoj se opisuje datira iz 475. godine pr. ...Kr. Godine 1979. Svjetska zdravstvena organizacija sastavila je listu od 43 bolesti u kojima se akupunktura pokazala korisnom. Na konferenciji National Institute of Health održanoj 1997. godine pregledano je više od 2000 znanstvenih studija o temi akupunkture te je zaključeno da postoje dokazi koji podupiru primjenu akupunkture kao adjuvantne metode liječenja. Postoji nekoliko različitih teorija o mehanizmima djelovanja akupunkture. Studije sugeriraju da akupunktura dovodi do inhibicije transmisije boli u središnji živčani sustav stimulacijom aferentnih A-delta i C-vlakana te dovodi do neuromodulacije. Također dovodi do otpuštanja antialgogenih tvari uključujući endorfine. Akupunktura je iznimno sigurna metoda. Najčešće su nuspojave blage i uključuju manje modrice ili krvarenje na mjestu uboda, pogoršanje postojećih simptoma, pospanost, opuštanje ili euforiju (koja se često doživljava kao nešto ugodno) i bol na mjestu uboda igle. Godine 2016. objavljeni su u Cochraneovoj bazi pregledni radovi koji su potvrdili učinkovitost akupunkture u profilaksi epizodične tenzijske i migrenske glavobolje. Neupitno je da je akupunktura metoda stara 5000 godina i da se i dalje primjenjuje u terapiji različitih bolnih sindroma te je predmet izučavanja mnogih studija, za razliku od brojnih farmakoloških i nefarmakoloških metoda koje su bile jako popularne nekoliko godina ili desetljeća te su zatim potpuno izbačene iz primjene zbog nedjelotvornosti i nuspojava.
The aim of this study was to estimate the role of transcranial sonography in detecting basal ganglia changes as structural biomarkers in migraine. Transcranial sonography was performed on Aloka ...prosound
α
-10. Semiquantitative and planimetric methods were applied when basal ganglia changes were detected. Comparison between groups was performed by unpaired Student’s
t
test and Spearman’s correlation test. We analyzed 30 migraine patients and 30 age-/sex-matched controls. Substantia nigra hyperechogenicity was detected in 36.7% migraineurs and in 13.3% controls (
t
test,
p
= 0.036888). Hyperechogenic substantia nigra was found in 70% aura patients and in 20% patients without aura (
p
= 0.007384). Mean substantia nigra echogenic size of all migraine patients was 0.16 ± 0.07 and 0.12 ± 0.043 cm
2
in controls (
t
test,
p
= 0.0011). Lentiform nucleus hyperechogenicity was seen in 50% migraine patients and 13.3% controls (
t
test,
p
= 0.002267). Mean lentiform nucleus echogenic size of all migrenous patients was 0.34 ± 0.08 cm
2
and in controls 0.20 ± 0.008 cm
2
(
t
test,
p
= 0.0021). Caudate nucleus hyperechogenicity was found in 26.7% migraine patients and in 6.6% controls (
t
test,
p
= 0.037667). Mean frontal horn width in migraine patients was 8.73 ± 1.76 mm and in controls 7.10 ± 1.71 (
t
test,
p
= 0.0006). Substantia nigra hyperechogenicity correlated with disease duration (rho = −0.35521,
p
= 0.05467) and third ventricle width (rho = −0.68221,
p
= 0.02976). No other differences between migraineurs and controls were found. Our study has revealed differences in transcranial findings between migraineurs and controls, but overall significance of those findings are still to be evaluated.
The BNT162b2 (Pfizer BioNTech) mRNA vaccine is an effective vaccine against COVID-19 infection. Here, we report an adverse event following immunization (AEFI) in a 48-year-old female patient who ...presented with fasciculations, migraine auras without headaches and in an increased discomfort of previously present palpitations, as well as excitation and insomnia. Her fasciculations were intermittently present until the time this paper was written, starting from the 6th day post-vaccination; they changed localization and frequency, but most commonly they were generalized, affecting almost all muscle groups. The patient also suffered from two incidents of migraine auras with visual kaleidoscope-like phenomena without headaches a few months after the vaccination. These symptoms were considered to be AEFI and no causal relation with the vaccine could be proven.
This study was undertaken to evaluate the effect of galanthamine, a new cholinesterase inhibitor on cognitive performances in 84 patients with various apoE genotype and Alzheimer's disease (AD) ...during the six-month treatment. The diagnosis of AD was made on the basis of NINCDS/ADRDN criteria. ApoE4 genotype was determined by PCR procedure. The cognitive performance was assessed MMSE at baseline and six months later. The difference among the groups was statistically analyzed by ANOVA model and Pearson's chi2-test. The MMSE at baseline in all completes was 18.0 +/- 3.73, whereas the mean value of MMSE after 6 months was 16.4 +/- 5.61 indicating significant deterioration (p < 0.01). Of the 84 patients, 14 (169%) were apoE4 homozygous, 41 (49%) were heterozygous, whereas 29 (35%) were apoE4 negative. The significant number of responders was observed among apoE4 homozygous patients (71%; chi2 = 6.89; p = 0.032). The subgroup of apoE4 homozygous patients with AD in its mild to moderate stage may be considered as responders to galanthamine.
In a patient with a deficit of ocular movement that goes beyond any anatomically specific pattern one must always bear in mind the role of thalamic nuclei in ocular motor function. We present three ...case reports depicting manifestations of infarction in the vascular territories of arteries that supply thalamus. The first case presented with a complete, ipsiversive ocular tilt reaction and the second case presented with Parinaud's syndrome as a result of a paramedian thalamic infarction extending into the rostral midbrain. The third one presented as a left eye ptosis with Korsakoff-like amnestic syndrome due to anteromedian thalamic infarction, which can be a result of both tuberothalamic and paramedian artery infarction. An unusual presentation of ocular movement disorders without an unequivocal anatomical correlation or an ocular movement disorder coupled with an amnestic syndrome should raise suspicion for possible infarction in one of the thalamic arteries.
Cognition in Parkinson's disease Basić, Jasna; Katić, Silvija; Vranicć, Andrea ...
Croatian medical journal
45, Številka:
4
Journal Article
Recenzirano
Studies of accentuated drop in cognitive functioning of Parkinson's disease patients mostly use global intelligence measures that have a masking effect on differential drop in specific cognitive ...abilities. The goal of this study was to investigate the possible differential drop in different types of cognitive tasks. Applied tests tapped fluid and crystallized intelligence, memory, and metacognition.
A sample of 116 participants participated in the study. Half of the participants were diagnosed with Parkinson's disease (average duration of disease 6.5 years) and control group participants equaled them in age, sex, and education level. All participants were tested using Raven's Colored Progressive Matrices (CPM), Crichton Vocabulary Scale (CVS), memory subtests from Wechsler Adult Intelligence Scale (WAIS DS-F, WAIS DS-B), and Mini-mental Status Examination (MMSE). Participants, and in the case of clinical group their caregivers as well, were asked questions concerning their metamemory and metacognition.
Parkinson's disease patients scored lower than control group on all instruments used but the difference was significant only on CPM (F1,114=19.14, p=0.001) and MMSE (F1,110=4.04, p=0.047).
Patients with Parkisons' disease have greater cognitive damage in fluid intelligence than in crystallized intelligence. They seem to have relatively accurate metamemory and metacognition.
These guidelines have been developed to assist the physician in making appropriate choices in work-up and treatment of patients with headaches. The specific aim of the Evidence Based Guidelines for ...Treatment of Primary Headaches--2012 Update is to provide recommendations for establishing an accurate diagnosis and choose the most appropriate therapy in the group of patients with primary headaches, based on a comprehensive review and meta-analysis of scientific evidence with regard to treatment possibilities in Croatia. These data are based on our previous Evidence Based Guidelines for Treatment of Primary Headaches published in 2005 and other recommendations and guidelines for headache treatment.
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