The role of vitamin D in multiple sclerosis

Multipla skleroza (MS) je kronična idiopatska upalna bolest središnjeg ţivčanog sustava obiljeţena demijelinizacijskim oštećenjima u mozgu i kraljeţničnoj moţdini. Najčešće zahvaća mlaĎu populaciju, s vrhuncem incidencije izmeĎu 25. i 45. godine ţivota te predstavlja značajan uzrok invaliditeta u mlaĎoj dobi. Uzrok bolesti je nepoznat, ali dosadašnja saznanja govore najviše u prilog autoimunoj patogenezi. Brojne epidemiološke i eksperimentalne studije pokazuju da i geni i okolišni čimbenici imaju ulogu u etiologiji MS-a. Od okolišnih čimbenika najviše se spominju infekcija, pušenje i manjak vitmina D. Vitamin D spada u skupinu vitamnina topivih u mastima, a u tijelu igra nekoliko uloga od kojih je najpoznatija odrţavanje zdravlja koštanog sustava i utjecaj na metabolizam minerala. Pored ovog, vitamin D moţe modificirati imunološki odgovor, staničnu proliferaciju, diferencijaciju i apoptozu. Manjak vitamina D povezan je s brojnim bolestima, uključujući MS. Na ulogu vitamina D u MS-u upućuje u prvom redu geografska distribucija bolesti, zatim brojna istraţivanja koja pokazuju da je nedvojbena njegova uloga u nastanku i tijeku bolesti, a temeljena su na proučavanju njegovih imunomodulatornih svojstava, utjecaja na ekspresiju odreĎenih gena i na proučavanju njegove uloge u ţivotinjskom modelu MS-a. Neka su istraţivanja pokazala da vitamin D ima ulogu u prevenciji MS-a, ali velike studije koje trebaju potvrditi moţe li i koliko uzimanje suplemenata vitamina D moţe prevenirati bolest, tek su započele. Rezultati studija koje su se bavile pitanjem uloge vitamina D u terapiji bolesnika koji su već razvili MS nisu jednozančni, ali ipak više govore u prilog pozitivnom učinku i vitamin D danas je dio standradne terapije MS-a čemu pridonosi činjenica da je prirodan, siguran i jeftin. Buduće studije će razjasniti ima li uzimanje vitamina D direktan učinak na tijek bolesti i odgovoriti na pitanje koliko je vitamina D potrebno u liječenju, kao i koja je optimalna razina vitamina D u krvi kod bolesnika sa MS-om.Multiple sclerosis (MS) is a chronic idiopathic inflammatory disease of the central nervous system characterized by demyelinating lesions in the brain and the spinal cord. It most commonly affects young adults, with a peak incidence between the age of 25 and 35 years and is a significant cause of disability in this age group.The cause of the disease is unknown but the current findings argue in favor of autoimmune pathogenesis. Numerous epidemiological and experimental studies have shown that both genes and environmental factors play a role in the etiology of MS. Of the environmental factors the most investigated are infection, smoking and lack of vitamin D. Vitamin D belongs to fat-soluble group of vitamins and plays several roles, of which the maintenance of bone health and influence on metabolism of minerals is the best known. In addition, vitamin D can modify the immune response, cell proliferation, differentiation and apoptosis. Vitamin D deficiency is associated with numerous diseases, including MS. Geographical distribution of the disease refers to the role of the vitamin D in the first place. Also numerous studies, which are based on the study of its immunomodulatory properties, influences on the expression of certain genes and the study of its role in the animal model of MS, have shown that it undoubtedly plays the role in the onset and course of the disease. Some studies have shown that vitamin D has a role in preventing MS. However, large studies which should confirm whether and how taking vitamin D supplements can prevent the disease, have only just begun. Results of the studies that have dealt with the issue of the role of vitamin D in the treatment of patients who have developed MS are rather ambiguous, but they still speak in favor of its positive effects. Furthermore, vitamin D is now part of the standard therapy for MS to which contributes the fact that it is natural, safe and inexpensive. Future studies will clarify whether taking supplements of vitamin D has a direct effect on the disease course and will answer the question of how much vitamin D is required for the treatment, as well as its optimal level in the blood of patients with MS

Korea uzrokovana arteriovenskom malformacijom: prikaz slučaja i pregled literature

Chorea is a movement disorder that can be caused by a large range of degenerative, vascular, metabolic and toxic disorders in basal ganglia. Arteriovenous malformations are rare vascular malformations the clinical presentation of which depends on the malformation characteristics and localization. Th ey are most commonly presented with intracranial hemorrhage, while focal neurological deficit is the rarest presentation. A case is reported of a 64-year-old female patient presented with hemichorea. Magnetic resonance imaging and digital subtraction angiography revealed the presence of arteriovenous malformation in the right temporal lobe.Korea je poremećaj pokreta koji može biti uzrokovan velikim rasponom degenerativnih, vaskularnih, metaboličkih i toksičnih poremećaja u bazalnim ganglijima. Arteriovenske malformacije su rijetke vaskularne malformacije klinička prezentacija kojih ovisi o karakteristikama i lokalizaciji malformacije. Najčešće se prezentiraju intrakranijskom hemoragijom, a najrjeđe fokalnim neurološkim defi citom. Prikazujemo slučaj 64-godišnje bolesnice koja se prezentirala hemikoreom. Učinjena magnetska rezonanca i digitalna subtrakcijska angiografi ja otkrila je prisutnost arteriovenske malformacije u medijalnom dijelu desnog temporalnog režnja

Uspješno liječenje akutnog diseminiranog encefalomijelitisa (ADEM) pravodobnom primjenom imunoglobulina – prikaz slučaja i pregled literature

Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.Akutni diseminirani encefalomijelitis (ADEM) je upalna demijelinizirajuća bolest središnjega živčanog sustava koja obično pogađa djecu i mlade odrasle osobe. Najčešće ima monofazni tijek, iako su zabilježeni i relapsi bolesti. Klinička prezentacija bolesti uključuje encefalopatiju i multifokalne neurološke deficite. Pouzdani kriteriji za dijagnozu ADEM-a nisu utvrđeni i ponekad ga je teško razlikovati od prve atake multiple skleroze, osobito kod odraslih. Dijagnoza ADEM-a temelji se na kliničkim, radiološkim i laboratorijskim nalazima. U liječenju ADEM-a primjenjuju se visoke doze kortikosteroida, plazmafereza i imunoglobulini. Prikazujemo slučaj mlade odrasle bolesnice kod koje je potpun oporavak uslijedio nakon pravodobne primjene visoke doze metilprednizolona i imunoglobulina

Depresija i umor uzrokovani opstrukcijskom apnejom tijekom spavanja u multiploj sklerozi

To our knowledge, there is no study investigating whether fatigue and depression as the most commonly reported symptoms in multiple sclerosis (MS) and obstructive sleep apnea (OSA) patients have arisen from primary mechanisms of MS or from secondary associated conditions such as OSA in MS patients. The aim of our survey study was to determine whether depression and fatigue in MS patients were associated with clinical features of OSA or with MS. We conducted a self-administered survey using four validated questionnaires (STOP-BANG, Epworth Sleepiness Scale, Fatigue Severity Scale and The Center for Epidemiologic Studies Depression Scale-Revised) in 28 consecutive outpatients with proven MS. The prevalence of MS patients at an increased risk of OSA was 29% and age was positively correlated with this risk (p=0.019). None of the clinical features of MS patients (subtype, disability status, disease duration, modifying therapy, other medication) was correlated with depression and fatigue. On the contrary, excessive daytime sleepiness as a hallmark of OSA was significantly and positively associated with the level of depressive symptoms (p=0.004) and level of fatigue (p=0.015). Also, depression was significantly and positively correlated with the increased risk of OSA (p=0.015) and age of MS patients (p=0.016). Finally, a significant positive correlation was found between fatigue severity and level of depressive symptoms (p=0.003). OSA is a common disorder in MS patients. The clinical features and risk factors for OSA in MS patients are associated with the two most commonly reported symptoms of depression and fatigue, thus supporting the hypothesis that both symptoms are due to a secondary condition in MS.Sukladno našim saznanjima nema studije koja je istraživala nastaju li umor i depresija kao najučestaliji simptomi kod bolesnika s multiplom sklerozom (MS) i opstrukcijskom apnejom tijekom spavanja (OSA) primarnim mehanizmima MS ili iz sekundarnih povezanih stanja kao što je OSA kod bolesnika s MS. Cilj naše anketne studije bio je utvrditi jesu li depresija i umor u bolesnika s MS povezani s kliničkim obilježjima OSA ili MS. Proveli smo anketu pomoću četiri validirana upitnika (STOP-BANG, Epworthova ljestvica pospanosti, ljestvica težine umora i revidirana ljestvica depresije Centra za epidemiološke studije) u 28 uzastopnih ambulantnih bolesnika s klinički i paraklinički dokazanom MS. Učestalost bolesnika s MS s povećanim rizikom od nastanka OSA bila je 29%, a dob je bila u pozitivnoj korelaciji s tim rizikom (p=0,019). Nijedna od kliničkih značajka bolesnika s MS (podtip, status invaliditeta, trajanje bolesti, modificirajuća terapija, drugi lijekovi) nije bila u korelaciji s depresijom i umorom. Naprotiv, pretjerana pospanost tijekom dana kao obilježje OSA bila je značajno i pozitivno povezana s razinom simptoma depresije (p=0,004) i razinom umora (p=0,015). Također, depresija je značajno i pozitivno korelirala s povećanim rizikom od OSA (p=0,015) i dobi bolesnika s MS (p=0,016). Konačno, utvrđena je značajna pozitivna korelacija između težine umora i simptoma depresije (p=0,003). OSA je čest poremećaj kod bolesnika s MS. Kliničke značajke i čimbenici rizika za OSA u bolesnika s MS povezani su s dva najčešće prijavljivana simptoma depresije i umora, podupirući tako hipotezu da su oba simptoma posljedica sekundarnog stanja u MS

The role of vitamin D in multiple sclerosis

Multipla skleroza (MS) je kronična idiopatska upalna bolest središnjeg ţivčanog sustava obiljeţena demijelinizacijskim oštećenjima u mozgu i kraljeţničnoj moţdini. Najčešće zahvaća mlaĎu populaciju, s vrhuncem incidencije izmeĎu 25. i 45. godine ţivota te predstavlja značajan uzrok invaliditeta u mlaĎoj dobi. Uzrok bolesti je nepoznat, ali dosadašnja saznanja govore najviše u prilog autoimunoj patogenezi. Brojne epidemiološke i eksperimentalne studije pokazuju da i geni i okolišni čimbenici imaju ulogu u etiologiji MS-a. Od okolišnih čimbenika najviše se spominju infekcija, pušenje i manjak vitmina D. Vitamin D spada u skupinu vitamnina topivih u mastima, a u tijelu igra nekoliko uloga od kojih je najpoznatija odrţavanje zdravlja koštanog sustava i utjecaj na metabolizam minerala. Pored ovog, vitamin D moţe modificirati imunološki odgovor, staničnu proliferaciju, diferencijaciju i apoptozu. Manjak vitamina D povezan je s brojnim bolestima, uključujući MS. Na ulogu vitamina D u MS-u upućuje u prvom redu geografska distribucija bolesti, zatim brojna istraţivanja koja pokazuju da je nedvojbena njegova uloga u nastanku i tijeku bolesti, a temeljena su na proučavanju njegovih imunomodulatornih svojstava, utjecaja na ekspresiju odreĎenih gena i na proučavanju njegove uloge u ţivotinjskom modelu MS-a. Neka su istraţivanja pokazala da vitamin D ima ulogu u prevenciji MS-a, ali velike studije koje trebaju potvrditi moţe li i koliko uzimanje suplemenata vitamina D moţe prevenirati bolest, tek su započele. Rezultati studija koje su se bavile pitanjem uloge vitamina D u terapiji bolesnika koji su već razvili MS nisu jednozančni, ali ipak više govore u prilog pozitivnom učinku i vitamin D danas je dio standradne terapije MS-a čemu pridonosi činjenica da je prirodan, siguran i jeftin. Buduće studije će razjasniti ima li uzimanje vitamina D direktan učinak na tijek bolesti i odgovoriti na pitanje koliko je vitamina D potrebno u liječenju, kao i koja je optimalna razina vitamina D u krvi kod bolesnika sa MS-om.Multiple sclerosis (MS) is a chronic idiopathic inflammatory disease of the central nervous system characterized by demyelinating lesions in the brain and the spinal cord. It most commonly affects young adults, with a peak incidence between the age of 25 and 35 years and is a significant cause of disability in this age group.The cause of the disease is unknown but the current findings argue in favor of autoimmune pathogenesis. Numerous epidemiological and experimental studies have shown that both genes and environmental factors play a role in the etiology of MS. Of the environmental factors the most investigated are infection, smoking and lack of vitamin D. Vitamin D belongs to fat-soluble group of vitamins and plays several roles, of which the maintenance of bone health and influence on metabolism of minerals is the best known. In addition, vitamin D can modify the immune response, cell proliferation, differentiation and apoptosis. Vitamin D deficiency is associated with numerous diseases, including MS. Geographical distribution of the disease refers to the role of the vitamin D in the first place. Also numerous studies, which are based on the study of its immunomodulatory properties, influences on the expression of certain genes and the study of its role in the animal model of MS, have shown that it undoubtedly plays the role in the onset and course of the disease. Some studies have shown that vitamin D has a role in preventing MS. However, large studies which should confirm whether and how taking vitamin D supplements can prevent the disease, have only just begun. Results of the studies that have dealt with the issue of the role of vitamin D in the treatment of patients who have developed MS are rather ambiguous, but they still speak in favor of its positive effects. Furthermore, vitamin D is now part of the standard therapy for MS to which contributes the fact that it is natural, safe and inexpensive. Future studies will clarify whether taking supplements of vitamin D has a direct effect on the disease course and will answer the question of how much vitamin D is required for the treatment, as well as its optimal level in the blood of patients with MS

Chorea Caused by Unruptured Arteriovenous Malformation: Case Report and Review of Literature

Chorea is a movement disorder that can be caused by a large range of degenerative, vascular, metabolic and toxic disorders in basal ganglia. Arteriovenous malformations are rare vascular malformations the clinical presentation of which depends on the malformation characteristics and localization. Th ey are most commonly presented with intracranial hemorrhage, while focal neurological deficit is the rarest presentation. A case is reported of a 64-year-old female patient presented with hemichorea. Magnetic resonance imaging and digital subtraction angiography revealed the presence of arteriovenous malformation in the right temporal lobe