The possible role of the insula in the epilepsy and the gambling disorder of Fyodor Dostoyevsky

Background The retrospective diagnosis of Fyodor Mikhailovich Dostoyevsky’s (1821–1881) neurological and psychiatric disease proves to be particularly interesting. Recent neurobiological data suggest a solution to the questions regarding the writer’s retrospective diagnosis, claiming the insular cortex to be the origin of the rare ecstatic seizures. Regarding Dostoyevsky’s pathological gambling, this hypothesis is consistent with another finding from recent neuroscience, namely that the malfunction of the insula could be an important underlying pathology in gambling disorder. Case study Literary and scientific overview (1928–2015) on the subjects of Dostoyevsky’s epilepsy and gambling disorder. Discussion and conclusion Taking Dostoyevsky’s neurological (ecstatic seizures) and psychiatric (pathological gambling) disease and the crossroads into consideration, these two disciplines make regarding the underlying pathology, we would like to suggest a speculative theory that these two disorders have a common insular pathomechanism, namely, the malfunctioning of the risk prediction–risk prediction error coding system. Furthermore, based on Dostoyevsky’s case, regarding gambling disorder in general, we would like to hypothesize that the three common gambling-related cognitive distortions (near-miss effect, gambler’s fallacy, and the illusion of control) can be all attributed to the impairment of the anterior insular risk prediction–risk prediction error coding system

Az immuntolerancia vizsgálata autoimmun kórképekben = Investigations on the immune tolerance in autoimmune diseases

A "nem differenciált collagenosis-ban" (NDC-ben) a korai diagnózisra, hatékonyabb kezelésre és gondozásra alkalmas immunológiai és szervi eltéréseket mutattunk ki. A primer és szekunder anti-foszfolipid szindróma kutatásának folytatása során az SLE-s betegekben egy elkülönült fenotipust írtunk le. Az SLE-s betegek 5 éves követése alapján terápiás ajánlást fogalmaztunk meg. A regulatív T sejtek (CD+CD25+ FoxP3, CD4+IL-10+) számbeli és funkcionális jellemzését vizsgáltuk különböző poliszisztémás betegségekben. A poliszisztémás autoimmun betegségben (SLE, MCTD, PSS, RA, NDC-ben) szenvedő betegekben kardiovaszkuláris állapot felmérést végeztünk. Az endothel sejtek funkcionális státuszára utaló in vivo mérésekkel korai károsodásokat rögzítettünk, amik összefüggtek az immunológiai eltérésekkel. A pulmonáris hipertoniás, MCTD-s betegekben az anti-endothel autoantitestek patogenetikai szerepét feltételezzük. Új adatokat szolgáltattunk a kortikoszteroidok, D3 vitaminok és a plazmaferezis hatásmechanizmusához az autoimmun betegekben. Bizonyítottuk az UV-A1 fototerápia hatásosságát SLE-ben, és hazánkban elsőként vezettük be az autolog CD34+őssejt terápiát a poliszisztémás betegek kezelésében | We have found immunological and organic alterations suitable for the early diagnosis, more efficient treatment and following up of the patients with 'non differenciated collagenosis' (NDC). During the continuation of the research on primary and secondary anti-phospholipid syndrome, a new phenotype of this disease could be observed in the patients with SLE. An useful therapeutic protocol was composed on the basis of a 5 years long following up study on SLE patients. The quantitative and functional characterizations of the regulative (CD+CD25+Foxp3+, CD4+IL-10+) T cells were carried out in various autoimmune diseases. We analysed the actual cardiac state in the patients with polysystemic autoimmune disease (in SLE, MCTD, PSS, RA, NDC). By the in vivo methods used for the functional testing of endothelial cells, we could record some early alterations connected with the immunological impairments. We suppose the pathogenic role of anti-endothelial autoantibodies in MCTD patients suffering from pulmonary hypertension. New data were presented for the ways of action of corticosteroids, vitamines D3 and the plasmapheresis in autoimmune patients. The efficacy of UV-A1 phototherapy was proven in SLE. We started the first autologous CD34+ stem cell transplantation therapy for polysystemic autoimmune patients in Hungary

Epilepsziasebészeti beavatkozások eredményei a Pécsi Epilepszia Centrumban 2005 és 2016 között = Postoperative outcome of surgical interventions for epilepsy between 2005 and 2016 at the Epilepsy Center of Pécs

Absztrakt: Bevezetés: Az epilepszia krónikus, súlyos neurológiai betegség, mely jelentősen befolyásolja az életminőséget. A megfelelő indikációval végzett epilepsziasebészeti beavatkozás rohammentességet eredményezhet, mely önmagában vagy rehabilitációt követően jelentősen javíthatja az életminőséget. Célkitűzés: Jelen tanulmányunk célkitűzése a Pécsi Epilepszia Centrumban 2005 és 2016 között epilepsziasebészeti beavatkozáson átesett betegek posztoperatív eredményeinek felmérése. Módszer: Az adatgyűjtés a betegek klinikai anyagának áttekintésén túlmenően kérdőívek alkalmazásával történt, a rohamállapot értékelésén kívül a foglalkoztatottsági státuszra mint az életminőség egyik fontos indikátorára is fókuszálva. Eredmények: Reszektív epilepsziasebészeti beavatkozás 72 esetben történt. A betegek 76%-a tartósan rohammentessé vált. A betegek 10%-ánál műtét után csak igen ritkán lépett fel roham, 7%-uknak jelentősen csökkent a rohamszáma, míg 7%-ban nem változott érdemben a rohamállapot. A rohammentes és a nem rohammentes betegek csoportjainak foglalkoztatottsági adatait vizsgálva azt találtuk, hogy a rohammentesség befolyásolja a páciensek elhelyezkedési lehetőségeit. A rohammentes betegek 67%-a állt foglalkoztatottság alatt, míg a nem rohammenteseknek mindössze a 19%-a (p<0,01, Fisher-féle egzakt teszt). Következtetés: Eredményeink a nemzetközi adatoknak megfelelve alátámasztják az epilepszia reszektív sebészi kezelésének klinikai és szociális eredményességét. Orv Hetil. 2019; 160(7): 270–278. | Abstract: Introduction: Epilepsy as a chronic, severe neurologic disease significantly influences the quality of life of the epileptic patients. In candidates well selected for surgery, the seizure freedom is realistically achievable, and the quality of life can be further improved with complex individual rehabilitation. Aim: We aimed to evaluate the postoperative outcome of patients who underwent epilepsy surgery between 2005 and 2016 at the Epilepsy Center at Pécs. Method: We evaluated seizure status at regular follow-up visits after surgery and the quality of life using questionnaires focusing on employment and social status. Results: 76% of the 72 patients who underwent surgical resection for epilepsy were free from disabling seizures , and 10% had rare disabling seizures (almost seizure-free), 7% experienced worthwhile improvement and 7% had no worthwhile improvement. Comparing the employment status of patients free from disabling seizures to patients not free from disabling seizures, we found that the employment status is significantly influenced by seizure freedom (p<0.01, Fisher’s exact test). While 67% of seizure-free patients were employed, only 19% of patients not free from disabling seizures were hired. Conclusion: Our results resemble the international tendencies and success rate, proving epilepsy surgery as an available, valid and effective treatment in well selected patients. Orv Hetil. 2019; 160(7): 270–278

Epilepsy Surgery, Anti-epileptic Drug Trials and the Role of Evidence

OBJECTIVE: We assessed whether recent randomized controlled trials (RCTs) of antiepileptic drugs (AEDs) are informed by evidence about surgical effectiveness. We explored whether RCTs of AEDs consider the patients' candidacy for surgery in their eligibility criteria, and whether the necessary investigations are requested in participating patients to determine their potential eligibility for surgery. METHODS: We systematically analyzed RCTs published in the last 2 years investigating the efficacy of new AEDs in localization-related epilepsy. Results from a surgical RCT and recommendations from an epilepsy surgery practice parameter were used to assess the degree to which surgical evidence informed the drug study design. RESULTS: Eleven RCTs were analyzed. All were conducted in countries with access to epilepsy surgery. None of the studies required magnetic resonance imaging (MRI) with an epilepsy protocol or explicit statement of the epilepsy syndrome, which could lead to the identification of surgical candidates. Having temporal lobe epilepsy or being a potential surgical candidate were not exclusion criteria in any of the trials. The primary efficacy end point was the reduction in seizure frequency or responder rate. Seizure freedom was never the primary outcome, and it was reported in only seven studies. The pooled data analysis of these trials revealed that 1.9% of patients became seizure-free on placebo and 4.4% on the study drug (p < 0.01). CONCLUSIONS: Important aspects of patient selection for new AED trials are not informed by the evidence about surgical effectiveness. Investigations that could lead to identification of patients for presurgical evaluation were not required in any of the studies

ANTIEPILEPTIKUMOK ALKALMAZÁSA AZ EPILEPSZIA KEZELÉSÉBEN ÉS HATÁSOSSÁGUK KÖVETÉSE

Epilepsy is one of the most common neurological diseases usually demanding long term treatment. The prime goal of therapy is to achieve seizure freedom with avoidance of side effects. Precise diagnosis is fundamental selecting the proper antiepileptic drug(s). In addition of wide-spectrum antiepileptics, selective syndrome-specific antiepileptic drugs are available. Pharmacological features of the new antiepileptics allow more personalized clinical use. Aim of this paper is to provide a comprehensive pragmatic review of therapeutic possibilities and recommendations currently accessible in Hungary

Peri-ictal vegetative symptoms in temporal lobe epilepsy

We investigated peri-ictal vegetative symptoms (PIVS) in 141 patients with adult temporal lobe epilepsy (TLE) and assessed frequency, gender effect, and lateralizing value of peri-ictal autonomic signs. We recorded abdominal auras in 62%, goosebumps in 3%, hypersalivation in 12%, spitting in 1%, cold shivering in 3%, urinary urge in 3%, water drinking in 7%, postictal nose wiping (PNW) in 44%, and postictal coughing in 16%. At least one vegetative sign appeared in 86% of the patients. The presence of PIVS did not have a significant lateralizing value. PNW occurred in 52% of women and in 33% of men, whereas any PIVS was present in 93% of women and 77% of men. In summary, contradictory to previous studies, the presence of PIVS has no lateralizing value, which may be linked to a low frequency of occurrence of PIVS. PIVS, especially PNW, occurred more frequently in women, supporting the gender differences in epilepsy. ? 2007 Elsevier Inc. All rights reserved

Patients' ability to react before complex partial seizures

Objective: The purpose of the study described here was to investigate the pathophysiology of patients' ability to react during the conscious (aura) phase of complex partial seizures (CPS) originating from the temporal lobe. Methods: We reviewed video recordings of CPS experienced by 130 adult patients who had undergone epilepsy surgery for intractable medial temporal lobe epilepsy. All patients were instructed to push the alarm button when they felt an aura. We defined the preictal reactivity as the ability to push the alarm button before the complex partial (unconscious) phase of seizures. Results: Seventy-seven patients (59%) pushed the alarm button before seizures. Patients with preictal reactivity were significantly younger, more often had lateralized EEG seizure patterns, and had a better postoperative outcome. Patients who did not push the alarm button had secondarily generalized seizures more often. Conclusions: Ability to react before CPS is associated with a circumscribed region involved at seizure onset and spread, and with a seizure-free postoperative outcome. ? 2006 Elsevier Inc. All rights reserved