Medical and Bioethical Issues in a Pregnant Woman with Epilepsy: Case Report

A case report of a minor, pregnant girl with epilepsy caused by a brain tumour is presented. There are several aspects which make the presented case complex from medical, but also from the bioethical point of view. The decision about keeping the pregnancy or not is the most important bioethical dilemma for the patient and family. A detailed medical multidisciplinary approach and later balanced explanation of the medical situation to the patient are of extreme value for helping the patient’s decision. It is also important to enhance the activities in pregnancy counselling for a woman with epilepsy which will result in a planned pregnancy as a prerequisite for a positive pregnancy outcome

Medical and Bioethical Issues in a Pregnant Woman with Epilepsy: Case Report

A case report of a minor, pregnant girl with epilepsy caused by a brain tumour is presented. There are several aspects which make the presented case complex from medical, but also from the bioethical point of view. The decision about keeping the pregnancy or not is the most important bioethical dilemma for the patient and family. A detailed medical multidisciplinary approach and later balanced explanation of the medical situation to the patient are of extreme value for helping the patient’s decision. It is also important to enhance the activities in pregnancy counselling for a woman with epilepsy which will result in a planned pregnancy as a prerequisite for a positive pregnancy outcome

DEPRESSIVE DISORDER AND ALOPECIA

Psychophysical dermatitis is frequently manifested in patients that suffer from psychiatric illnesses and disorders as well as in patients that suffer from depressive disorders. These diseases occur or worsen after acute stress that may trigger them. Difficulties in expressing feelings or impossibility to verbalise them are connected to somatic diseases. In order to emphasize their importance, we will present a case of a 58 years old woman who has been suffering from alopecia areata that developed after her husband’s death. The patient doesn’t function well since then - she is socially isolated, she has lost self confidence and self esteem. As she has realised it was impossible to live like that, she decided to seek psychiatric help. The patient should be examined through the prism of the interdisciplinary treatment and as an integral structure of the mind and body

Cluster Headache

Cluster glavobolja je oblik snažne, intermitentne glavobolje isključivo hemikranične lokalizacije, karakterizirane razdobljima svakodnevna višekratnog javljanja bolova i prateće istostrane autonomne simptomatologije što se izmjenjuju s asimptomatskim razdobljima neodređena trajanja. U nomenklaturi postoji mnoštvo sinonima od kojih se najčešće koristi naziv cluster headache. Patofiziologija cluster glavobolje predmet je mnogih istraživanja. U posljednje vrijeme veća pažnja pridaje se teoriji o ulozi supstancije P u patogenezi cluster glavobolje, no točan patofiziološki mehanizam još nije definiran. Na osnovi karakteristične simptomatologije dijagnoza se postavlja relativno lako. Najčešće je potrebno diferencijalno-dijagnostički razlikovati klasičnu i običnu migrenu, neuralgiju trigeminusa i kroničnu paroksizmalnu hemikraniju. Provođenje dopunskih pretraga opravdano je u atipičnoj kliničkoj slici ili modificiranoj simptomatologiji cluster glavobolje. Jasna klinička slika ne zahtijeva dopunsku obradu. Medikamentozna terapija cluster glavobolje je podijeljena na simptomatičku i profilaktičku. Neurokirurško liječenje se provodi jedino u slučaju kad prethodna medikamentozna terapija nije dovela do poboljšanja. Djelotvorne terapijske sheme nema, pa je liječenje potrebno prilagoditi epizodnom, odnosno kroničnom obliku bolesti

ALLERGIC REACTIONS - OUTCOME OF SERTRALINE AND ESCITALOPRAM TREATMENTS

The treatment of dysthymia in itself poses a problem in the everyday psychiatric practice and it can be further hindered when accompanied by pronounced personality traits (which are indicative of disorder). Due to its pathology and duration dysthymia interferes with the patient\u27s quality of life and the ability to function in some segments of everyday life. These interferences enticed our patient to opt for psychiatric treatment. During a three-year period, despite all the efforts made by psychiatrists in this comprehensive and challenging dysthymia treatment (psychotherapy, group psychotherapy, psychopharmacotherapy), the expected outcomes of the treatment did not occur. The patient\u27s goals and expectations included lifestyle change, achieving life satisfaction and mood improvement. The patient was refusing suggested psychopharmaca until confronted, in psychotherapy, with the fact that she is the one prolonging her own helplessness and directing her passive agression at the members of the group. In the end the patent agreed to take psychopharmaca. Therefore, sertraline was introduced in the treatment, but the patient experienced a severe allergic reaction (Qiuncke\u27s oedema). After four months the second attempt was made and escitaloptam was introduced, which resulted in urticaria. Due to these allergic reactions to antidepressants, the patient decided not to pursue the psychopharmacological treatment

Cluster Headache

Cluster glavobolja je oblik snažne, intermitentne glavobolje isključivo hemikranične lokalizacije, karakterizirane razdobljima svakodnevna višekratnog javljanja bolova i prateće istostrane autonomne simptomatologije što se izmjenjuju s asimptomatskim razdobljima neodređena trajanja. U nomenklaturi postoji mnoštvo sinonima od kojih se najčešće koristi naziv cluster headache. Patofiziologija cluster glavobolje predmet je mnogih istraživanja. U posljednje vrijeme veća pažnja pridaje se teoriji o ulozi supstancije P u patogenezi cluster glavobolje, no točan patofiziološki mehanizam još nije definiran. Na osnovi karakteristične simptomatologije dijagnoza se postavlja relativno lako. Najčešće je potrebno diferencijalno-dijagnostički razlikovati klasičnu i običnu migrenu, neuralgiju trigeminusa i kroničnu paroksizmalnu hemikraniju. Provođenje dopunskih pretraga opravdano je u atipičnoj kliničkoj slici ili modificiranoj simptomatologiji cluster glavobolje. Jasna klinička slika ne zahtijeva dopunsku obradu. Medikamentozna terapija cluster glavobolje je podijeljena na simptomatičku i profilaktičku. Neurokirurško liječenje se provodi jedino u slučaju kad prethodna medikamentozna terapija nije dovela do poboljšanja. Djelotvorne terapijske sheme nema, pa je liječenje potrebno prilagoditi epizodnom, odnosno kroničnom obliku bolesti

Epilepsy in the Elderly and Depression

Epilepsy is one of the most common neurological problems affecting approximately 1% of the world’s population with higher incidence among elderly individuals. Although depression is a common comorbid condition in patients with epilepsy, there is a paucity of information regarding depression in geriatric patients with epilepsy. This study analysed a group of 83 patients affected by different epilepsy phenotypes accompanied by mental disorders, especially depression. Antiepileptic and antipsychotic drug treatment has been evaluated, particularly a positive effect of the new antiepileptics (monotherapy and polytherapy) both on the reduction of seizures and mental disorders

WEIGHT GAIN - AS POSSIBLE PREDICTOR OF METABOLIC SYNDROME

Rapid weight gain among patients with mental disorders can further compound psychological distress and negatively influence compliance. Weight gain associated with treatment with atypical antipsychotic medication has been widely recognized as a risk factor for the development of diabetes type II and cardiovascular diseases. This paper describes a 33-year old female patient treated for schizoaffective disorder. Within two months after introducing quetiapine the patient experienced considerable weight gain amounting to 19 kg. The replacement of antipsychotic during inpatient psychiatric care resulted in weight loss

Dilemma of Antiepileptic Drugs Withdrawal in Symptomatic Epilepsy

A successful treatment of epilepsy depends on numerous factors such as etiology, genetics and environmental impact. An exact diagnosis, treatment and an adequate selection of antiepileptic drugs (AED) are important from the very beginning. The patient with symptomatic epilepsy caused by the brain tumor (low-grade astrocytoma in the left parietal lobe, surgically removed 17 years after the first manifestation of illness) is presented in this study. He has been seizure free for 6 years. The represented case study deals with the risk-benefit analysis of the discontinuation of the prescribed antiepileptic treatment that has lasted for 23 years