Although the number of new AEDs available has considerably increased in recent years, still the choice of the best treatment for a given patient with epilepsy ought to be preceded by the diagnosis of the type of seizures or epileptic syndrome, his clinical status and individual needs. VPA and CBZ are the first-line conventional AEDs for monotherapy of all types of generalized and partial seizures, respectively. PHT and PB are also wide-spectrum and patent AEDs, but their usefulness is limited by their toxicity. If no symptomatic diagnosis is evident, then the safest are wide-spectrum AEDs (VP A) that do not evoke seizures of other types (PHT, PB, CBZ). New generation AEDs (VGB, LTG, TGB, GBP, TPM, FBM) are used as adjunctive to those of first choice in polytherapy of patients with drug resistant epilepsy. The effective dose of a chosen drug should be built step-by-step on the grounds of clinical assessment of its efficacy and toxicity in each case. A possibility of not only acute dose-dependent side effects, but also idiosyncratic or allergic reactions and chronic toxicity of AEDs should be taken into account. Monitoring of serum drug concentrations is presently considered to be of limited value for the evaluation of treatment efficacy.
CADASIL is a hereditary stroke disease linked to chromosome 19. The defective gene is Notch 3. The clinical spectrum of the disease includes recurrent strokes, migraine, transient ischaemic attacks, mood changes, and dementia. MRI brain scans show multiple well-delineated ischaemic lesions within the subcortical white matter, as well as diffuse leukoencephalopathy. Focal lesions can also be found in the basal ganglia, corpus callosum, thalamus, and infratentorial brain structures. The angiopathy in CADASIL consists in deposition of basophilic granular material inside the smooth muscle cells of the media without appreciable atherosclerotic alterations or amyloid depositions, involving mainly the small cerebral arteries. The diagnosis of CADASIL is based on the typical clinical features without vascular risk factors, neuroradiological signs of extensive leukoencephalopathy, and the autosomal dominant pattern of inheritance.
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving damage to the upper and lower motoneurones. The etiopathogenesis of the disease is probably associated with many factors, but still unclear. Such variables as oxidative damage, glutamate toxicity, trophic factors deficit, genetic, environmental and autoimmunological factors are taken into consideration. The treatment should be combined so as to affect various potential neurodegeneration mechanisms. Medicines inhibiting glutamate hyperactivity and drugs eliminating free radicals should be administered together with the application of neurotrophic factors and gene therapy.
Advances in the molecular genetics research into the etiology of affective disorders are outlined. Two approaches are used in the research: the candidate gene method and the whole genome screening. The paper presents findings of studies using the former approach, where the candidate gene (theoretically associated with the etiology of a given disorder) is selected. The studies refer mostly to biochemical concepts of affective disorders etiology. Reported findings of these studies indicate that in bipolar affective disorder a significant role is played by genes coding tyrosine hydroxylase, catechol-0-methyltransferase, monoamine oxidase type A and B, gamma-aminobutyric acid receptors and adenosine triphosphatase, while in unipolar affective disorder the D4 dopamine receptor coding gene may be of importance.
The paper presents the state-of-the-art knowledge about schizophrenic psychoses with their onset in late life. This is most probably a group of heterogeneous disorders with the prevalence rate between 2 and 9 percent in the general population. Female sex seems to be a risk factor. Psychotic symptoms are usually less pronounced than in younger patients, while recognized cognitive disorders are of diverse nature. Reports concerning etiology of the disorder are equivocal. Atypical neuroleptics are preferred in the treatment. Prognosis is more favourable than in younger patients, but full recovery is rare. The problem requires further study.
The paper presents an overview of the recent literature on leptin metabolism, relationship between leptin and other hormonal systems, its role in the regulation of appetite and body mass, as well as a comparison of leptin concentrations in patients with various eating disorders including anorexia nervosa. Numerous research findings indicate that there are still no univocal data on the regulation of leptin synthesis and release. Thus, there is still no answer to the question whether low concentrations of leptin in patients with anorexia nervosa result from their chronic undernutrition and oh gene repression, or are due to disturbances in the functioning of negative feedback between peripheral and central mechanisms regulating body mass in humans. The lack of leptin central action (which may be responsible for various patterns of eating disorders) has probably diverse determinants.
A case is reported of a female patient who had several very dramatic psychotic episodes at the age 25. During the subsequent 22 years of follow-up there have been no more psychotic episodes, and the patient attained a very good level of her professional and social functioning. Arguments on behalf of diagnosing a cycloid psychosis in this case are presented.
The paper presents a case of a female patient with Alzheimer's dementia associated with behavioural disorders and anorexia unresponsive to neuroleptic treatment but favourably responding to ECT.
A case is reported of a female anorexic patient, repeatedly hospitalised over long periods of time. Difficulties emerging in the course of treatment are discussed, as well as the effect on the course of illness of such factors as the father's alcoholism, co-operation of the patient and the family in the treatment, and role of family secrets.
This paper outlines diagnostic difficulties due to the presence of mental disorders in suprarenal insufficiency. In the reported case patient's somatic complaints had been underestimated, and premature administration of neuroleptic resulted not only in a deterioration of her physical condition, but also in a delayed introduction of an appropriate treatment.
The paper presents an overview of the current status, plans and problems of the mental health care system in Poland.