Pain in multiple sclerosis

U pacijenata s multiplom sklerozom bol je jedan od simptoma koji vrlo negativno utječu na kvalitetu života. Procjenjuje se da otprilike polovina bolesnika imaju neku vrstu boli. Međutim, čini se da unatoč tome u zbrinjavanju bolesnika s multiplom sklerozom dijagnostika i liječenje boli nemaju još uvijek mjesto koje po svojoj važnosti zaslužuju. Prema patofiziologiji nastanka, bol se može podijeliti na neuropatsku, nociceptivnu i disfunkcionalnu. Svaka od tih podvrsta ima distinktivne kliničke karakteristike, te je vrlo važno ispravno dijagnosticirati tip boli i primijeniti odgovarajuće liječenje. Dok se kod neuropatske boli kao sredstvo prvoga izbora preporučuju pregabalin, gabapentin i triciklinički antidepresivi, kod nociceptivne i disfunkcionalne boli primjenjuje se medikamentna politerapija u kombinaciji s različitim psihosocijalnim intervencijama.Among persons with multiple sclerosis pain is one of symptoms greatly influencing their quality of life. It is estimated that around 50% of these patients experience some sort of pain. In spite of this, it seems that diagnosis and treatment of pain still has not found its appropriate place in dealing with this condition. According to its pathophysiology, pain in multiple sclerosis can be divided into neuropathic, nociceptive and dysfunctional. Each of these have distinctive clinical characteristics, and it is very important to correctly diagnose the type of pain and apply appropriate treatment. Whereas in neuropathic pain pregabalin, gabapentin and tricyclic antidepressants are recommended as first line medication, in patients with primarily nociceptive or dysfunctional pain, the treatment often consists of drug polytherapy combined with various psychosocial interventions

Epilepshy and driving capability

Nemogućnost dobivanja vozačke dozvole jedno je od važnih pitanja koja u osoba s epilepsijom vrlo negativno utječe na osjećaj kvalitete življenja. Međutim, jasno je da postoji veliki rizik od izazivanja prometne nezgode ako vozač dobije epileptički napadaj za vrijeme vožnje. Razlike u zakonskoj regulativi kojom se određuje jesu li osobe s epilepsijom sposobne upravljati motornim vozilima vrlo su velike između različitih država, u rasponu od potpune zabrane do kratkog intervala bez napadaja od samo tri mjeseca, kao npr. u nekim državama u SAD-u. Tijekom posljednjih nekoliko desetljeća u svjetskim razmjerima došlo je do znatnog napretka u otklanjanju neodgovarajućih restrikcija prilikom ostvarivanja prava na vozačku dozvolu u osoba s epilepsijom. Trend liberalizacije zasniva se na rezultatima istraživanja koji pokazuju da je rizik za sigurnost u prometu prihvatljiv ako se upravljanje motornim vozilima dopusti osobama s dobro kontroliranom epilepsijom. Čini se da će se sadašnji trend liberalizacije nastaviti, no potrebno je istovremeno provođenje kliničkih studija kojima će se nadgledati utjecaj liberalizacije propisa na sigurnost u prometu.The ability to drive is one of the greatest concerns of people with epilepsy (PwE) with a considerable impact on their quality of life. However, it is clear that there is a great risk of causing a traffic accident if a seizure occurs while a person is driving. There are great differences in legislations, which determine whether people with PwE are able to drive; they go from a complete ban in some countries to the seizure free interval of only three months that is required in some USA states. In the past few decades a great progress has been made in declining inappropriate restrictions for PwE in realizing their needs regarding driving. The trend of liberalization is based on the results of studies, which show that the risk for the public safety in traffic is acceptable, if individuals with well controlled epilepsy are allowed to drive. It seems that the current trend of liberalization will continue, but in the future, further clinical studies will be needed, which would be designed to monitor the influence of the liberalized regulations on traffic safety

Acute Oxcarbazepine-Induced Hepatotoxicity in a Patient Susceptible to Developing Drug-Induced Liver Injury

Oxcarbazepine (OXC) is generally accepted as a drug without risk of severe drug-induced hepatotoxicity, but according to recently reported pharmacovigilance data this statement has been challenged. However, in the literature there have been no reports of acute OXC-induced hepatotoxicity without systemic manifestations of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We present a female with seizures one month after delivery who had borderline elevated liver enzymes prior to the initiation of OXC treatment. Two weeks after introducing OXC, highly elevated liver enzymes were found. After discontinuation of OXC the enzymes continued to rise for another week, and afterward gradually decreased. The causal relationship with OXC intake was determined to be highly probable. Two years later, the transitory elevation of liver enzymes was observed during the treatment of acute tonsilopharingitis with amoxicillin + clavulanic acid. The repeated elevation of liver enzymes related to use of different drugs might indicate patient`s susceptibility for drug induced liver injuries.We suggest that monitoring of liver function tests would be clinically rational for early detection of acute OXC-induced liver hepatotoxicity in the patients with clinical and/or laboratory features which might be interpreted as possible risk factors of the increased susceptibility to drug induced liver injuries

Pain in multiple sclerosis

U pacijenata s multiplom sklerozom bol je jedan od simptoma koji vrlo negativno utječu na kvalitetu života. Procjenjuje se da otprilike polovina bolesnika imaju neku vrstu boli. Međutim, čini se da unatoč tome u zbrinjavanju bolesnika s multiplom sklerozom dijagnostika i liječenje boli nemaju još uvijek mjesto koje po svojoj važnosti zaslužuju. Prema patofiziologiji nastanka, bol se može podijeliti na neuropatsku, nociceptivnu i disfunkcionalnu. Svaka od tih podvrsta ima distinktivne kliničke karakteristike, te je vrlo važno ispravno dijagnosticirati tip boli i primijeniti odgovarajuće liječenje. Dok se kod neuropatske boli kao sredstvo prvoga izbora preporučuju pregabalin, gabapentin i triciklinički antidepresivi, kod nociceptivne i disfunkcionalne boli primjenjuje se medikamentna politerapija u kombinaciji s različitim psihosocijalnim intervencijama.Among persons with multiple sclerosis pain is one of symptoms greatly influencing their quality of life. It is estimated that around 50% of these patients experience some sort of pain. In spite of this, it seems that diagnosis and treatment of pain still has not found its appropriate place in dealing with this condition. According to its pathophysiology, pain in multiple sclerosis can be divided into neuropathic, nociceptive and dysfunctional. Each of these have distinctive clinical characteristics, and it is very important to correctly diagnose the type of pain and apply appropriate treatment. Whereas in neuropathic pain pregabalin, gabapentin and tricyclic antidepressants are recommended as first line medication, in patients with primarily nociceptive or dysfunctional pain, the treatment often consists of drug polytherapy combined with various psychosocial interventions

Epilepshy and driving capability

Nemogućnost dobivanja vozačke dozvole jedno je od važnih pitanja koja u osoba s epilepsijom vrlo negativno utječe na osjećaj kvalitete življenja. Međutim, jasno je da postoji veliki rizik od izazivanja prometne nezgode ako vozač dobije epileptički napadaj za vrijeme vožnje. Razlike u zakonskoj regulativi kojom se određuje jesu li osobe s epilepsijom sposobne upravljati motornim vozilima vrlo su velike između različitih država, u rasponu od potpune zabrane do kratkog intervala bez napadaja od samo tri mjeseca, kao npr. u nekim državama u SAD-u. Tijekom posljednjih nekoliko desetljeća u svjetskim razmjerima došlo je do znatnog napretka u otklanjanju neodgovarajućih restrikcija prilikom ostvarivanja prava na vozačku dozvolu u osoba s epilepsijom. Trend liberalizacije zasniva se na rezultatima istraživanja koji pokazuju da je rizik za sigurnost u prometu prihvatljiv ako se upravljanje motornim vozilima dopusti osobama s dobro kontroliranom epilepsijom. Čini se da će se sadašnji trend liberalizacije nastaviti, no potrebno je istovremeno provođenje kliničkih studija kojima će se nadgledati utjecaj liberalizacije propisa na sigurnost u prometu.The ability to drive is one of the greatest concerns of people with epilepsy (PwE) with a considerable impact on their quality of life. However, it is clear that there is a great risk of causing a traffic accident if a seizure occurs while a person is driving. There are great differences in legislations, which determine whether people with PwE are able to drive; they go from a complete ban in some countries to the seizure free interval of only three months that is required in some USA states. In the past few decades a great progress has been made in declining inappropriate restrictions for PwE in realizing their needs regarding driving. The trend of liberalization is based on the results of studies, which show that the risk for the public safety in traffic is acceptable, if individuals with well controlled epilepsy are allowed to drive. It seems that the current trend of liberalization will continue, but in the future, further clinical studies will be needed, which would be designed to monitor the influence of the liberalized regulations on traffic safety

Gorlin-Goltz Syndrome and Stroke: a Case report

We report on the case of a 32-years old male patient who was previously diagnosed with Gorlin-Goltz syndrome. The patient presented with sudden-onset right-sided hemiparesis, supranuclear facioparesis, and motor aphasia. He was treated with thrombolytic therapy, which successfully alleviated the symptoms. Subsequent radiologic work-up revealed anomalies in the vertebral arteries, a bifid rib, an ischemic lesion in the supply area of the left middle cerebral artery, and falx calcifications. Laboratory tests showed a 4G/4G polymorphism of the plasminogen activator inhibitor 1  (PAI-1) gene whose correlation with stroke is discussed in the article. </p