Afazija u bolesnika s ishemijskim moždanim udarom

Aphasia in ischemic stroke patients is associated with increased mortality, decreased rates of functional recovery, and reduced work capability. The aim was to study the prevalence and characteristics of aphasia in ischemic stroke patients. This prospective, cohort study included 177 patients (94 male and 83 female) hospitalized for ischemic stroke at University Department of Neurology in Osijek in 2010. All patients were examined by a neurologist and speech therapist to specify the subtype of stroke and speech disturbance. The study showed 75 (42.4%) study patients to have aphasia (48.2% of females and 37.2% of males). The most frequent clinical type was expressivereceptive aphasia. Aphasic patients were statistically significantly older (75 vs. 70 years) and showed female predominance (53% vs. 42%). Patients with aphasia also had a threefold share of large vessel stroke (51% vs. 17%) and approximately twofold share of cardioembolic stroke (41% vs. 22%). The share of left hemisphere stroke was nearly twofold in aphasic (61%) compared to non-aphasic (31%) patients. The study showed a high prevalence of aphasia in patients with ischemic stroke, which increased with age, was more pronounced in females and most frequently found in patients suffering from large vessel stroke and cardioembolic stroke.Afazija u bolesnika s ishemijskim moždanim udarom udružena je većom smrtnošću, sniženim stopama funkcijskog oporavka i smanjenom radnom sposobnošću. Cilj je bio ispitati učestalost i značajke afazije u bolesnika s ishemijskim moždanim udarom. U ovu prospektivnu kohortnu studiju bilo je uključeno 177 bolesnika (94 muškaraca i 83 žene) hospitaliziranih zbog ishemijskog moždanog udara na Klinici za neurologiju u Osijeku tijekom 2010. godine. Sve bolesnike pregledao je neurolog i logoped kako bi se utvrdila podvrsta moždanog udara i poremećaj govora. Studija je pokazala da afaziju ima 75 (42,4%) bolesnika (48,2% žena i 37,2% muškaraca). Ekspresivno-receptivna afazija bila je najčešći klinički tip afazije. Bolesnici s afazijom bili su statistički značajno stariji (75 prema 70 godina), a prevladavale su žene (53% prema 42%). Uz to, bolesnici s afazijom imali su trostruko veću učestalost moždanog udara velikih krvnih žila (51% prema 17%) i otprilike dvostruko veću učestalost kardioembolijskog moždanog udara (41% prema 22%). Učestalost moždanog udara lijeve polutke bila je gotovo dvostruka u afazičnih (61%) u usporedbi s neafazičnim (31%) bolesnicima. Istraživanje je pokazalo visoku učestalost afazije u bolesnika s ishemijskim moždanim udarom, koja se povećavala s dobi, bila je više izražena u žena, a najčešće se nalazila u bolesnika s moždanim udarom velikih krvnih žila i onih s kardioembolijskim moždanim udarom

Cladribine tablets in people with relapsing multiple sclerosis : A real-world multicentric study from southeast European MS centers

Cladribine is an oral disease-modifying drug authorized by the European Medicine Agency for the treatment of highly active relapsing multiple sclerosis (MS).To provide real-world evidence of cladribine's effectiveness and safety in people with MS (pwMS).A retrospective observational multi-center, multi-national study of pwMS who were started on cladribine tablets in ten centers from five European countries.We identified 320 pwMS treated with cladribine tablets. The most common comorbidities were arterial hypertension and depression. Three patients had resolved hepatitis B infection, while eight had positive Quantiferon test prior to cladribine commencement. There were six pwMS who had malignant diseases, but all were non-active. During year 1, 91.6% pwMS did not have EDSS worsening, 86.9% were relapse-free and 72.9% did not have MRI activity. During the second year, 90.2% did not experience EDSS worsening, 86.5% were relapse-free and 75.5% did not have MRI activity. NEDA-3 was present in 58.0% pwMS in year 1 and in 54.2% in year 2. In a multivariable logistic regression model age positively predicted NEDA-3 in year 1. The most common adverse events were infections and skin-related adverse events. Lymphopenia was noted in 54.7% of pwMS at month 2 and in 35.0% at month 6. Two pwMS had a newly discovered malignant disease, one breast cancer, and one melanoma, during the first year of treatment.Our real-world data on the effectiveness and safety of cladribine tablets are comparable to the pivotal study and other real-world data with no new safety signals

Treatment of relapsing multiple sclerosis - recommendations of the Croatian Neurological Society

Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (≥9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or ≥3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse ≥3), high-efficacy DMT should be initiated. If pwMS experience ≥1 relapse or ≥3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS