Outcome studies of the treatment of epilepsy have revealed unsatisfactory results in 30-60% of patients. Thanks to their new, more specific pharmacodynamics, new antiepileptic drugs have brought new promise of treatment to drug-resistant epileptic patients. When selecting a drug it is necessary to consider its pharmacological profile, effectiveness, interactions and adverse effects. The authors list the basic criteria for antiepileptic drug selection and pay special attention to the significance of differential diagnosis in therapy. The pharmacodynamics of new generation antiepileptic drugs are discussed. On the basis of numerous observations and clinical tests the authors have gathered data which allow them to evaluate the usefulness of these drugs for the treatment of various types of epileptic attacks. Because they do not interact with other drugs and also because they do not have an adverse effect on mood and cognitive functions, new generation antiepileptic drugs may be extremely valuable in very difficult cases and particularly in the treatment of mentally disturbed patients. Female patients with epilepsy are another group which needs to be given special attention. Although very little is still known about the use of new generation antiepileptic drugs in pregnant women, the experience gathered so far suggests that some of these drugs may be administered with little teratogenic risk. Finally, the fact that new generation antiepileptic drugs have few side effects and do not interact with other drugs renders these AEDs particularly useful and desirable in the treatment of the rapidly increasing population of elderly epileptic patients.
Doppler transcranial ultrasonography (TCD) is a very useful method of identification and monitoring of vascular contraction in patients with subarachnoid bleeding. The method is noninvasive and relatively cheap and may be applied at the bedside whatever the patient's condition. It requires considerable experience and skill on behalf of the person administering it, however. This article discusses the difficulties involved in proper diagnosis of vessel contraction by means of TCD and in differentiating between vessel contraction and other conditions involving increased bloodflow. The article also reviews the latest criteria for identification of contraction of particular brain base arteries. Daily TCN examinations of patients with SAH help to assess the contraction properly and to identify patients in whom the risk of neurological deficit is particularly pronounced. They also help to monitor the effectiveness of treatment. Finally, TCN may help in the optimal timing of the angiography and possible surgery of the aneurysm.
Doppler transcranial ultrasonography (TCD) is a very useful method for the identification and monitoring of ongoing disturbed haemodynamics of brain circulation. The method is noninvasive, relatively cheap and may be applied at the bedside whatever the patient's condition. It requires considerable experience and skill on behalf of the examiner, however. TCD is widely used in the monitoring of patients with serious cranial-cerebral injuries. It allows the examiner to monitor a whole complex of patophysiological changes resulting from brain injury. The major ones include vascular contraction, congestion, degree of maintenance of cerebral vascular self-regulation and, indirectly, changes in intracranial pressure and checked cerebral blood flow. Daily TCD monitoring in brain injury patients are very helpful for correct evaluation and differentiation of type of disturbance of brain circulation haemodynamics and the monitoring of treatment efficacy. The most recent findings in this domain are reviewed.
The aetiopathogenesis of multiple sclerosis (sclerosis multiplex – SM) is not yet fully understood. All we know is the this is a polyaethiological disease in which viral and bacterial injection plays a significant role. This article presents a critical review of the findings indicating the contribution of viral injections to the development of SM. Particular attention is paid to Epstein-Barr virus, JC virus, human herpes-6 virus, human type 1 T-cell leukemia, the SM-related retrovirus and the measles virus. The recently suggested link between SM and the MSRV, SM-related, retrovirus has been strongly emphasized by its discoverers but we have not managed to confirm it in our own studies where the MSRV was found to be present in healthy subjects as well. The hypothetical relationship between viral infection and SM pathogeneses has gained much support, however and further advancements in understanding the contribution of viral injections to the development of SM would surely help us to develop new methods of treating SM patients.
A brief review is given of existing clinical attempts to treat multiple sclerosis with interferons beta-1a and beta-1b. It is quite indisputable today that treating SM patients with interferons has many advantages. This author discusses the effects of interferon beta treatment on the frequency of episodes, exacerbation of motor incapacity, and MR tomographic registration of SM activity. The effects of interferon beta on the immunological of SM are also discussed.
This article discusses attempts to treat patients with subacute sclerosing panencephalitis with interferons. This method of treatment was applied over a span of about twenty years in one of three variants: (1) in seven patients natural interferon beta (Rentschler's Fiblaferon) was administered into the fluid space intralumbarly, (2) in seven patients naturalinterferon alpha (produced by the Institute of Hygiene in Helsinki) was administered intraventricularly by means of an epidurally implanted Rickham receptacle, and (3) in five patients recombined alpha 2b interferon was likewise administered intraventricularly by means of a Rickham receptacle. The best clinical outcomes were observed in group (2). No effects of the interferon treatment on immunological disorders were observed. Slight modifications of the bioelectrical activity of the brain were observed, however.
This study measured the three dimensions of sense of coherence (comprehensibility, manageability and meaningfulness) in patients with multiple sclerosis (sclerosis multiplex – SM) and compared the results with the results of neurologically, psychologically and physically healthy controls. Thirty patients with SM were given Antonovsky's SOC-29 and a personal inventory developed by Kossakowska to control for sex, duration of illness, activity and physical fitness. The healthy controls were also given the SOC-29 and controlled for sex, age and education. No significant differences in level of sense of coherence were found between the healthy subjects and the SM patients. However, sick women had higher comprehensibility scores than sick men and even healthy women and therefore sick men had significantly lower comprehensibility scores than healthy men and sick women. No significant differences in level of meaningfulness were found between the sick men and women on the one hand and healthy controls on the other. Sick women had higher manageability than sick men. Level of self-sufficiency and duration of illness did not contribute significantly to the variance of sense of coherence. On the other hand, patients who were occupationally or socially active or active in the family had higher sense of meaningfulness then non-active patients. These results suggest that special attention in the rehabilitation of SM patients should be given to enhancing sense of meaningfulness of patients' experiences, if only by encouraging patients to be more active occupationally, socially and in the family.
This article discusses the latest advancements in the evaluation of quality of life in stroke patients. Such evaluation is usually made no sooner than six months after the stroke and its purpose is to predict long-term functioning. Brain stroke usually has a serious effect on the patient's further life. Stroke patients usually have poorer earning potential, often go onto disability pension, are less active, have difficulty speaking, reading, arranging official business, talking on the telephone and writing. They seldom leave home, seldom entertain, have trouble travelling independently, are less active socially and are reluctant to speak up. Several of the questionnaires most frequently used to evaluate quality of life in stroke patients are presented. Three of these questionnaires, the 20-Jtem Short-Form Health Survey – SF-20, SF-36 and the Sickness Impact Profile are discussed more thoroughly. Greatest attention is paid to the most recent scale, the Stroke-Adapted 30-Item Version of the Sickness Impact Profile – SA-SIP 30), the first quality of life scale specially designed for stroke patients which is discussed at length.
Postnatal depression is a special risk both for mother and for children. Described in present work and used in many countries Edinburgh Postnatal Depression Scale (EPDS) seems particularly useful for women lying-in, better than others scales.
Patients with chronic facial and/or head pain are often unsuccessfully treated by psychiatrists. Forty-six patients with such conditions were studied: 67.3% with diagnosed psychogenic pain, 21.7% with masked depression and 11% with neurotic depression or anxiety neurosis. Psychiatric treatment was unsuccessful in 71.7% of these patients. Dislocation and or dysfunction of the mandibular discs was detected in every patient. Local causative treatment by means of a disc repositioning splint led to complete subsidence of pain in 32.6% cases and considerable improvement in 60.9% cases. The treatment resulted in complete normalisation of mental condition in 56.5% cases and considerable improvement in 37% cases. Co-operation between the psychiatrist and a dentist specialising in the treatment of craniomandibular dysfunction is essential in cases of patients suffering from facial and/or head pain.
Two families with positive histories of genetic diseases involving rapidly progressing dementia and various neurological syndromes are presented. Clinical symptoms and laboratory test outcomes in members of both families suggested family susceptibility to Creutzfeldt-Jakob's disease but were insufficiently pronounced to justify a diagnosis of "probable CJD". Later post mortem neuropathological examinations, together with monoclonal antibody responses led to diagnosis of Alzheimer's disease in the first family and spongiform encephalopathy in the second family. The final, complete diagnoses were only reached after genetic tests were conducted. These revealed: family AD with early onset and mutation in the preseniline 1 gene (codon 117 – Prol117Leu) and GSS syndrome with mutation in gene PrP (codon 102 – Prol102Leu). The significance of genetic and neuropathological tests for the diagnosis of family susceptibility to dementia diseases and atypical neurological symptoms is emphasized.
A case study of an elderly woman with symptoms of paranoid schizophrenia, unresponsive to neuroleptic treatment but responsive to electroconvulsive therapy, is presented.