Archives 1992-2013

1994, volume 3, issue 2

Farmakoterapia neurologiczna

Current problems of Parkinson's disease pharmacotherapy

Włodzimierz Kuran
Postępy Psychiatrii i Neurologii, 1994, 3, 139-147

In the first part of the paper pathophysiology of parkinsonism is briefly outlined, and various groups of antiparkinsonic pharmaceuticals are presented in the chronological order of their introduction to clinical practice. Then, current possibilities of Parkinson's disease treatment are discussed, with a detailed description of dopaminergic drugs and various methods of their administration, especially in later stages of the disease. Some hypotheses on Parkinson's disease etiology are overviewed, with the emphasis on importance of MAO-B and possible neuroprotective action of its inhibitors. The last part of the paper is devoted to the state-of-the-art directions of research, which may bring about a significant improvement of therapeutic effects.

Farmakoterapia neurologiczna

The third generation of new anti-epileptic drugs

JERZY MAJKOWSKI
Postępy Psychiatrii i Neurologii, 1994, 3, 149-156

The following new pharmaceuticals administered in the treatment of epilepsy are discussed: Sabril (vigabatrine), Lamictal (lamotrigine), Felbatol (felbamate), and Gabapentin (GBP). The paper presents the state-of-the-art (not quite sufficient yet) knowledge about these drugs. They are generally used as a supplementary medication in treatment conducted with another drug. The pharmaceuticals in question are characterized by specificity of action in certain types of epilepsy, and by a low toxicity.

Farmakoterapia neurologiczna

Sclerosis multiplex – new possibilites of immunotherapy

Anna Członkowska, KATARZYNA BIEGANOWSKA
Postępy Psychiatrii i Neurologii, 1994, 3, 156-163

Many years' clinical observations have indicated that the administration of non-specific global immunosupression has no satisfactory effect on the course of SM. Some more selective immunosuppresion methods are discussed in the paper. One of them seems to be clinically hopeful: a cellular vaccine, i.e. T receptor blocking by copolymer 1 and evoking tolerance by oral administration of base-protein of myelin. Less selective methods, such as application of antibodies against immunological reaction mediators (e.g. TNF), or antibodies against some subpopulations of cells are currently under study. The treatment with beta-interferone has stirred much interest in recent years. Research findings of a large multi-center study in the USA suggest that the preparation reduces the relapse rate and prevents the formation of new demyelinisation plaques in the brain. However, the findings require corroboration.

Farmakoterapia neurologiczna

Application of calcium-channel blockers in the treatment of the acute ischeamic stroke

Anna Członkowska
Postępy Psychiatrii i Neurologii, 1994, 3, 165-172

Ischaemia of the brain is associated with a distinct increase in the intracellular concentration of calcium ions inside nervous cells. Calcium not only enters the nervous through calcium channels dependent both on the membrane potential and on the receptor, but also is released from intracellular stores. Due to a high concentration of calcium many abnormal metabolic processes are initiated, leading eventually to death of nervous cell. A number of experimental studies suggests that drugs inhibiting the process of increase of calcium concentration within a cell aid the cell to survive during an ischaemic episode. Clinical research findings are less optimistic. The paper presents a detailed overview of 7 clinical studies using nimodipine, a drug most frequently administered by neurologists and neurosurgeons. A positive effect of nimodipine, i.e. a reduction of neurological deficits and of motor disability, was found in only one study (published in 1992 in the USA), in which the drug was administered orally in the 120 mg/ 24-hour dose within the first 18 hours since the onset of the stroke. The administration of nicardipine and flunarizine in the acute staged of cerebral stroke has found in preliminary studies to have a positive effect, but efficacy of these drugs should be confirmed on a more extensive sample.

Farmakoterapia neurologiczna

Treatment of depression

ELŻBIETA BOGDANOWICZ
Postępy Psychiatrii i Neurologii, 1994, 3, 173-177

The paper presents an overview of issues connected with depressive syndromes prevalence and etiopathogenesis. Basic data are given on antidepressant tricyclic drugs, as well as on the so-called second generation pharmaceuticals: selective inhibitors of serotonin re-uptake and selective reversible MAO-A inhibitors. The most frequent undesirable side-effects occurring in the nervous system in the course of antidepressants administration are discussed.

Choroby kręgosłupa i rdzenia kręgowego

Degenerative diseases of cervical spine due to overload

JERZY KIWERSKI
Postępy Psychiatrii i Neurologii, 1994, 3, 179-183

The paper presents mechanisms underlying degenerative changes in intervertebral discs and vertebras in the cervical segment of the spine. The pathogenic effect of stereotype manual labor, of injuries and congenital defects was pointed out. Methods of pharmacotherapy of pains and disorders due to advanced degenerative changes within cervical vertebrae were discussed, and principles of their surgical treatment were outlined. (Eds.)

Choroby kręgosłupa i rdzenia kręgowego

Advances in the diagnosis of spine and spinal cord injuries in the light of MRI examination

JANUSZ BRONARSKI, ELŻBIETA WOŹNIAK
Postępy Psychiatrii i Neurologii, 1994, 3, 185-188

MRI, the new method of imaging, provides entirely novel, hitherto unknown diagnostic possibilities, especially regarding the CNS. MRI may be used to diagnose, among others, also posttraumatic changes of the spine and spinal cord. This statement is fully confirmed by research findings based on the clinical material from the STOCER Centre in Konstancin. MRI allows to detect a number of abnormalities (e.g. hemorrhagic and ischaemic foci in the spinal cord) which have been so far undetectable with such method as myelography. Moreover, MRI provides data concerning the time of onset of pathological changes and their strict localization. It allows also to assess the scope of changes and their dynamics. It should be noted that this method is absolutely safe, non-invasive, and that results of MRI examination often may determine the course of subsequent treatment. The paper presents clinical data obtained from a group of 26 patients after an injury of the cervical segment of the spine with a concurrent spinal cord damage.

Choroby kręgosłupa i rdzenia kręgowego

Spine and spinal cord injuries in the cervical segment – changes in myelography and MRI imaging

ELŻBIETA WOŹNIAK, JANUSZ BRONARSKI
Postępy Psychiatrii i Neurologii, 1994, 3, 189-196

Since the installation of first MRI apparatus in Poland new perspectives of more and more precise diagnostics have opened. This method due to its advantages (non-invasiveness, and high resolution of imaging) is useful, above all, in the diagnostics of the CNS diseases (neoplasms, hematomas, etc.), including also these of the spinal cord. It is possible for the first time to receive directly images of post-traumatic both early and late pathological changes within the spine. Hitherto used diagnostic methods based on the contrastive examination of the vertebral canal provide no such possibility. Consequently, a question arises of what value is myelography now as compared to MRI? In the paper an attempt was made to compare the two methods usefulness for the diagnostics of post-traumatic changes within cervical spine and spinal cord, on the grounds of clinical data from the STOCER (City Rehabilitation Center) in Konstancin.

Choroby kręgosłupa i rdzenia kręgowego

Neurophysiological examinations in the diagnostics of spinal cord and spine diseases

Maria Rakowicz
Postępy Psychiatrii i Neurologii, 1994, 3, 197-207

In diseases of spine and spinal cord structures somatosensory evoked potentials and magnetic stimulation allow to assess the functional integrity of sensory and motor spinal tracts. These examinations are a supplementation to new radiological techniques of structural changes imaging. The paper outlines the principle of somatosensory evoked potentials and of motor potentials evoked using a magnetic stimulator. The value of these examinations in the diagnostics of some diseases of the CNS was pointed out. (Author/Eds.)

Borelioza

Borreliosis

KRZYSZTOF NADGRODKIEWICZ
Postępy Psychiatrii i Neurologii, 1994, 3, 209-212

Borreliosis or the Lyme disease (tick spirochaetosis) is caused by Borrelia Burgdorferi transmitted by the ticks of Ixodes family. Borreliosis is a multisystemic disease, affecting skin (erythema migrans), cardiac muscle (inflammatory process and ventriculo-atrial conduction disorders), joints (arthritis), and the nervous system (most often – meningopoliradiculoneuritis).The diagnosis is based mainly on serologic tests results: detection of antibodies IgM and IgG is prerequisite for antibiotic therapy which – if started early enough – prevents tardive organic complications.