Non-steroid anti-inflammatory drugs (NAD) have rather strong analgesic and antifebrile effect. In neurology they are administered in the basic treatment of spinal pain syndromes and headaches. However, they have many undesirable side effects, sometimes resulting in serious complications. The major ones include: bleeding from the alimentary tract, aplastic and hemolytic anemia, agranulocytosis, damage to parenchymal organs, subjective and objective neurological disorders, as well as allergies. Moreover, the drugs in question are habit-forming. Increased tolerance leads to increased dosage, heightening the risk of side effects. The most frequent errors in NAD administration are the following: prolonged treatment, prescribing several NADs simultaneously, lack of knowledge about half-life time of the drug and its toxicity, prescribing severel drugs from the same group in succession, and disregarding counterindications, especially in the elderly. In lower back pain NADs are administered in any stage of the disease. In stage I one drug is ad-ministered for a short period. In stages II and III the treatment is somewhat longer and it should be associated with a physical treatment, while in the treatment of chronic pains – with antidepressants. In spontaneous headaches NAD may be applied in order to interrupt a migraine attack, and besides, as the drug of choice in chronic hemicranial attacks. NAD should be never administered in long-term treatment, e.g. in tension headaches.
The important, although frequently underestimated problem of drug-induced headaches is discussed in the paper. Pathogenesis of these headaches may be different. The first category includes headaches due directly to the action of a drug on blood vessels and blood pressure, or to the resulting intracranial pressure increase (with the symptoms described as "pseudotumor cerebri"). In the second group mechanisms underlying drug-induced migraine attacks are outlined. Particular attention was paid to the third category of headaches, including the so-called "contre-coup" or "ricochet" pains that are paradoxical sequelae of long-term medication with ergotamine or with other drugs. (Eds.)
Undesirable side effects occuring in parkinsonic patients during the treatment with anticholinergic drugs, amantadine, and L-Dopa preparations are discussed in the paper, with special emphasis on motor disorders developing after long term administration of drugs from the latter group. General indications concerning methods of elimination, at least reduction of the side effects, are given. (Eds.)
Adverse side effects of the neuroleptic treatment, with an emphasis on the malignant neuroleptic syndrome and tardive dyskinesias, are presented. Interactions of neuroleptics with other drugs are discussed. (Eds.)
Two methods of monitoring of patients with suspected or preliminarily recognized epilepsy are described in the paper: (1) continuous casette recording and (2) video recording of eeg. The former method facilitates recording and classification of epileptic seizures in the patient's home setting, in his daily life. Video-eeg monitoring during hospitalization allows to analyse the type of attacks, and thus aids a more accurate differential diagnosis. (Eds.)
The paper overviews the current generally accepted principles of pharmacotherapy of patients suffering from epileptic seizures. Special emphasis was laid on the recommendations to undertaking the treatment, on the criteria of choice of the first drug, and on benefits of monotherapy. (Eds.)
The effect of pregnancy on the onset of epileptic seizures and on the course of previously existing epilepsy is discussed on the grounds of the literature and author's observations. Principles of undertaking anti-epileptic treatment and its continuation are presented. The frequency of epileptic seizures during pregnancy and epileptic status are taken under consideration. The author presents also the current view that breast-feeding by mothers treated for epilepsy is possible, due to very low indices of drug permeation to mother's milk.
In the first part of the paper various types of patient's non-compliance, reducing efficacy of the treatment of epilepsy, are discussed. Then, medical errors leading to therapeutic failure are presented, including diagnostic, therapeutic (also strategical), and psychological mistakes. Finally biological characteristics and particular types of epilepsy really resistant to treatment are presented. Eeg monitoring and serum drug levels monitoring are evaluated as method supporting the diagnostics and therapy of epilepsy. (Eds.)
Przedstawiono przegląd dostępnego piśmiennictwa dotyczącego objawów niepożądanych leków przeciwpadaczkowych. Jest także dyskutowana możliwość zapobiegania negatywnym skutkom terapii przeciwpadaczkowej.
A group of 85 patients with probable Alzheimer's disease was examined for 4 risk factors (dementia in close relatives, Down's syndrome in the family, head trauma in the past, and a history of general anesthesia). No statistically significant differences were found between the group under study and a control group of 30 persons matched for age, as regards these factors frequency of occurence. (Eds.)
The paper presents an overview of proposed by various author's hypothetical mechanisms of cerebral changes in the course of Alzheimer's disease. (Eds.)
B12 vitamin and folic acid serum levels were estimated in 25 patients with probable Alz-heimer's disease, 35 patients with multi-infarct dementia, and in 27 non demented persons aged over 65. Decreased cobalamin levels was found only in 2 patients (8%) with Alzheimer's disease. Mean levels of both vitamins were similar in the Alzheimer and control groups. No discernible effects were yielded by year of substitutive treatment in the 2 persons with low B12 levels. (Eds.)
Basic mechanisms explaining the role of immunological processes in the development of clinical symptoms of Alzheimer's disease are presented in the paper. The need for early detection of immunological defects in this disease was pointed out, since this allows to apply the appropriate immunocorrective treatment. Moreover, current approaches to immunomodulatory treatment in this disease are discussed.
Biochemical disorders occuring in the brain in the course of a sudden arrest of cerebral circulation are discussed in the paper. The subject matter includes: the role of ATP hydrolysis; disorders in the translocation of sodium, kalium and calcium iones, as well as glutamine metabolism in the brain in the course of global ischaemia. Besides, the sequence of cerebral changes in the post-ischaemic syndrome was characterized. (Eds.)
General opening remarks are followed by a presentation of current views on the effects of hyperventilation, hypothermy, administration of barbiturates, nootropic drugs and gluccoorticoids on the course of cerebral changes in the acute, complete arrest of cerebral blood circulation. Good results yielded by anti-oedematous medication and by drugs im-proving cerebral blood flow are discussed and doubtful clinical value of calcium channel blockers is pointed out.