Procjena funkcijskog statusa tijekom liječenja beta interferonom

Twenty patients (11 female and 9 male) with remitting relapsing multiple sclerosis were treated with beta interferon at University Department of Neurology, Sestre milosrdnice University Hospital. Thirteen patients were treated with interferon beta-1a (6 MIU 3 times weekly) and seven patients with interferon beta-1b (9.6 MIU every other day). The Expanded Disability Status Scale (EDSS) was recorded before interferon therapy and six months after initiation of interferon therapy. The mean EDSS score was slightly lower after six months of interferon therapy in both groups, but the difference was not statistically significant (p=0.17 in interferon beta-1a group and p=0.36 in interferon beta-1b group). Results in this small group of patients showed early improvement in the functional status of multiple sclerosis patients during interferon therapy. Further follow-up is required to get additional information on the course of functional improvement in multiple sclerosis patients after a prolonged period of interferon therapy.Dvadesetoro (11 ženskih i 9 muških) bolesnika s remitentnom rekurentnom mulitiplom sklerozom liječeno je beta interferonom na Klinici za neurologiju Kliničke bolnice "Sestre milosrdnice" u Zagrebu. Trinaestoro bolesnika liječeno je interferonom beta-1a (6 MIJ 3 puta na tjedan), a sedmoro bolesnika interferonom beta-1b (9,6 MIJ svakog drugog dana). Ljestvica EDSS (Expanded Disability Status Scale) bilježena je prije i šest mjeseci od početka liječenja interferonom. Prosječan zbir na ljestvici EDSS bio je u objema skupinama nešto manji nakon šest mjeseci liječenja interferonom, ali razlika nije bila statistički značajna (p=0,17 u skupini na interferonu beta-1a i p=0,36 u skupini na interferonu beta-1b). Rezultati dobiveni u ovoj maloj skupini bolesnika pokazali su rano poboljšanje funkcijskog statusa u bolesnika s multiplom sklerozom za vrijeme liječenja interferonom. Potrebno je daljnje praćenje kako bi se dobili dodatni podaci o tijeku funkcijskog poboljšanja u bolesnika s multiplom sklerozom uz dugotrajno liječenje interferonom

Procjena funkcijskog statusa tijekom liječenja beta interferonom

Twenty patients (11 female and 9 male) with remitting relapsing multiple sclerosis were treated with beta interferon at University Department of Neurology, Sestre milosrdnice University Hospital. Thirteen patients were treated with interferon beta-1a (6 MIU 3 times weekly) and seven patients with interferon beta-1b (9.6 MIU every other day). The Expanded Disability Status Scale (EDSS) was recorded before interferon therapy and six months after initiation of interferon therapy. The mean EDSS score was slightly lower after six months of interferon therapy in both groups, but the difference was not statistically significant (p=0.17 in interferon beta-1a group and p=0.36 in interferon beta-1b group). Results in this small group of patients showed early improvement in the functional status of multiple sclerosis patients during interferon therapy. Further follow-up is required to get additional information on the course of functional improvement in multiple sclerosis patients after a prolonged period of interferon therapy.Dvadesetoro (11 ženskih i 9 muških) bolesnika s remitentnom rekurentnom mulitiplom sklerozom liječeno je beta interferonom na Klinici za neurologiju Kliničke bolnice "Sestre milosrdnice" u Zagrebu. Trinaestoro bolesnika liječeno je interferonom beta-1a (6 MIJ 3 puta na tjedan), a sedmoro bolesnika interferonom beta-1b (9,6 MIJ svakog drugog dana). Ljestvica EDSS (Expanded Disability Status Scale) bilježena je prije i šest mjeseci od početka liječenja interferonom. Prosječan zbir na ljestvici EDSS bio je u objema skupinama nešto manji nakon šest mjeseci liječenja interferonom, ali razlika nije bila statistički značajna (p=0,17 u skupini na interferonu beta-1a i p=0,36 u skupini na interferonu beta-1b). Rezultati dobiveni u ovoj maloj skupini bolesnika pokazali su rano poboljšanje funkcijskog statusa u bolesnika s multiplom sklerozom za vrijeme liječenja interferonom. Potrebno je daljnje praćenje kako bi se dobili dodatni podaci o tijeku funkcijskog poboljšanja u bolesnika s multiplom sklerozom uz dugotrajno liječenje interferonom

Arahnoidna cista kao uzrok bipolarnog afektivnog poremećaja: prikaz slučaja

This report presents the course of diagnostic examinations and treatment of a 20-year-old man with bipolar affective disorder for which an organic basis was demonstrated. Computed tomography of the brain revealed an arachnoid cyst that was surgically treated. The patient underwent both psychiatric and neurosurgical treatment. After two-year follow-up and medicamentous treatment prescribed, the patient was symptom-free requiring no psychopharmacotherapy for the next 5.5 years. His overall life functioning is normal, with no signs of disease.Ovaj prikaz predstavlja tijek dijagnostičkih pregleda i liječenja 20-godišnjeg muškarca koji boluje od bipolarnog afektivnog poremećaja, a za kojega je i prikazana organska podloga same bolesti. Kompjutorska tomografija mozga otkrila je kod bolesnika arahnoidnu cistu koja je kirurški liječena. Bolesnik je podvrgnut i psihijatrijskom i neurokirurškom liječenju. Nakon dvije godine kontinuiranog praćenja stanja bolesnika uz primjenu propisane medikamentne terapije bolesnik više nije pokazivao simptome bipolarnog afektivnog poremećaja i nije bila potrebna daljnja primjena psihofarmaka sljedećih 5,5 godina. Njegova ukupna kvaliteta života je zadovoljavajuća, a bolesnik normalno funkcionira u svakodnevnom životu bez ikakvih znakova bolesti

Pain Syndromes in Patients with Multiple Sclerosis

Multipla skleroza (MS)je kronična, demijelinizirajuća bolest za koju se dugo smatralo da ju ne prati bol. Cilj ovoga istraživanja bio je utvrditi učestalost i trajanje bolnih stanja u bolesnika s MS liječenih na Klinici za neurologiju, KB «Sestre milosrdnice». U razdoblju od tri godine obuhvatili smo 280 bolesnika. Sto šezdeset četiri bolesnika (60%) je imalo akutni ili kronični bolni sindrom. šest bolesnika (2.1%) s akutnim bolnim stanjem imalo je paroksizmalne bolne atake u području trigeminalnog živca. Kronični bolni sindrom dijagnosticiran je u 55% (n=154) bolesnika i uključivao je razne oblike glavobolje (38%), bol u vratnom ili lumbosakralnom dijelu kralješnice (58%) te bolne spazme u 4% bolesnika. Na temelju rezultata ove retrospektivne studije vidljivo je da su akutni i kronični bolni sindromi prisutni u velikom broju bolesnika oboljelih od MS te da terapija svakog bolesnika mora biti individualizirana.Multiple sclerosis is a disease of the central nervous system, beginning most often in late adolescence and early adult life, and expressing itself by recurrent attacks of spinal cord, brainstem, cerebellar, optic nerve and cerebral dysfunction, the result of foci of myelinated fiber destruction. In this retrospective study, 280 patients hospitalized at University Department of Neurology during the last three years were evaluated. Study results showed 104 (60%) patients to have suffered either acute or chronic pain syndrome at some time during the course of disease. Six (2.1%) patients with acute pain syndromes had episodes of paroxysmal pain attacks in the trigeminal nerve distribution. Chronic pain syndromes, present for a mean duration of 4.2 years occurred in 154 (55%) patients and included headache in 38% , cervical and lumbosacral syndrome in 58%, and painful leg spasms in 4% of study patients

Disekcija kraniocervikalnih arterija

Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle; however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients were operated on. Six (75.0%) patients showed partial post-therapeutic recovery of neurologic deficits and improvement of ultrasound findings of dissected arteries. One patient developed a stroke postoperatively, with deterioration of the motor deficit, and one patient was readmitted three months later for a newly developed stroke and died soon thereafter. It is concluded that early detection of craniocervical arterial dissection is important to minimize the morbidity and mortality associated with this condition.Disekcija unutarnje karotidne ili vertebralne arterije je rijetka, ali sve češće prepoznata. Disekcija kraniocervikalnih arterija rijetko je uzrokom cerebrovaskularnog inzulta u općoj populaciji, ali je češća u bolesnika mlađe dobi, ispod 40 godina. Rane kliničke manifestacije često su jedva zamjetljive, a u slučaju neprepoznate dijagnoze moguć je trajni neurološki deficit, pa i smrtni ishod. U studiju je bilo uključeno osmoro bolesnika (četiri žene i četiri muškarca) s disekcijom kraniocervikalnih arterija. Odmah nakon prijma uzeti su anamnestički podaci te je učinjen klinički neurološki pregled. Bolesnici su podvrgnuti dijagnostičkim metodama koje su uključivale ultrazvučne (CDFI i TCD) i radiološke ( CT i DSA) pretrage. Vodeći simptomi bolesti bili su žarišni neurološki znakovi i naglo nastala glavobolja i bolovi u stražnjem dijelu vrata. U 7 (87,5%) slučajeva CDFI karotidnih i vertebralnih arterija pokazao je pozitivan nalaz disekcije žile. Petoro (62,5%) bolesnika je imalo pozitivan, a jedan bolesnik negativan nalaz DSA, dok u dvoje bolesnika ova pretraga nije provedena zbog alergije na kontrastno sredstvo. Petoro (62,5%) bolesnika liječeno je antikoagulantnom terapijom, jedan antiagregansima, a dvoje operacijski. U šestoro (75,0%) bolesnika je nakon primijenjene terapije došlo do djelomičnog kliničkog oporavka i poboljšanja ultrazvučnog nalaza na diseciranim krvnim žilama. Jedan je bolesnik nakon operacijskog zahvata doživio recidiv moždanog udara uz pogoršanje neurološkog deficita, a u jednom je slučaju nakon tri mjeseca nastupio recidiv moždanog udara sa smrtnim ishodom. Od velike je važnosti rano prepoznati disekcije kraniocervikalnih arterija, kako bi se smanjio njihov pobol i smrtnost

Disekcija kraniocervikalnih arterija

Once considered rare, dissection of the internal carotid artery or vertebral artery is an increasingly recognized entity. Craniocervical arterial dissection is an uncommon cause of stroke in the general population, but is relatively common in patients below the age of 40. The early clinical manifestations are often subtle; however, permanent neurologic disability and death can result if the diagnosis is delayed. The present report describes eight patients (four men and four women) with dissection of the craniocervical arteries. Patient history was taken and clinical neurologic examinations were performed immediately upon admission. Diagnostic procedures included ultrasound (CDFI and TCD) and radiologic (computed tomography and digital subtraction angiography) examinations. The leading symptoms were focal neurologic deficits, and headache and neck ache. Ultrasound findings (CDFI) were positive for vessel dissection in seven (87.5%) patients, and DSA was consistent with dissection in five (62.5%) patients and negative in one patient, whereas in two patients this examination was not performed due to the known allergy to contrast medium. Five (62.5%) patients were treated with anticoagulants, one with platelet aggregation suppressants, and two patients were operated on. Six (75.0%) patients showed partial post-therapeutic recovery of neurologic deficits and improvement of ultrasound findings of dissected arteries. One patient developed a stroke postoperatively, with deterioration of the motor deficit, and one patient was readmitted three months later for a newly developed stroke and died soon thereafter. It is concluded that early detection of craniocervical arterial dissection is important to minimize the morbidity and mortality associated with this condition.Disekcija unutarnje karotidne ili vertebralne arterije je rijetka, ali sve češće prepoznata. Disekcija kraniocervikalnih arterija rijetko je uzrokom cerebrovaskularnog inzulta u općoj populaciji, ali je češća u bolesnika mlađe dobi, ispod 40 godina. Rane kliničke manifestacije često su jedva zamjetljive, a u slučaju neprepoznate dijagnoze moguć je trajni neurološki deficit, pa i smrtni ishod. U studiju je bilo uključeno osmoro bolesnika (četiri žene i četiri muškarca) s disekcijom kraniocervikalnih arterija. Odmah nakon prijma uzeti su anamnestički podaci te je učinjen klinički neurološki pregled. Bolesnici su podvrgnuti dijagnostičkim metodama koje su uključivale ultrazvučne (CDFI i TCD) i radiološke ( CT i DSA) pretrage. Vodeći simptomi bolesti bili su žarišni neurološki znakovi i naglo nastala glavobolja i bolovi u stražnjem dijelu vrata. U 7 (87,5%) slučajeva CDFI karotidnih i vertebralnih arterija pokazao je pozitivan nalaz disekcije žile. Petoro (62,5%) bolesnika je imalo pozitivan, a jedan bolesnik negativan nalaz DSA, dok u dvoje bolesnika ova pretraga nije provedena zbog alergije na kontrastno sredstvo. Petoro (62,5%) bolesnika liječeno je antikoagulantnom terapijom, jedan antiagregansima, a dvoje operacijski. U šestoro (75,0%) bolesnika je nakon primijenjene terapije došlo do djelomičnog kliničkog oporavka i poboljšanja ultrazvučnog nalaza na diseciranim krvnim žilama. Jedan je bolesnik nakon operacijskog zahvata doživio recidiv moždanog udara uz pogoršanje neurološkog deficita, a u jednom je slučaju nakon tri mjeseca nastupio recidiv moždanog udara sa smrtnim ishodom. Od velike je važnosti rano prepoznati disekcije kraniocervikalnih arterija, kako bi se smanjio njihov pobol i smrtnost

Procjena propriocepcije standardnim instrumentom za mjerenje pokreta vratne kralješnice - sustava za vratno mjerenje

Whiplash injury is one of the most common injuries in traffic accidents. Patients who suffer a whiplash injury may have sprain and partial rupture of cervical musculature, sprain of the esophagus and larynx, lesions of temporomandibular joints, or injury of proprioception receptors located in the neck. The aim of the study was to estimate whether subjects who had suffered a whiplash injury experienced loss of proprioception, which was defined as the ability of repetitive predetermined head positioning. The study included 60 patients (age range 20-50 years) with whiplash injury and 60 asymptomatic age- and sex-matched control subjects. The patient ability to accomplish a defined head position during rightward and leftward cervical spine rotation at 30° angle was assessed by repeat measurements using Cervical Measurement System three months after medical treatment. The study showed the patients who had sustained a whiplash injury to have statistically significantly poorer results as compared with control subjects (p>0.001). Results of the study support the hypothesis that subjects with whiplash injury have worse perception of the head position, which may pose a disturbing problem in their daily activities.Trzajna ozljeda je među najčešćim ozljedama u prometnim nesrećama. Bolesnici s trzajnom ozljedom mogu imati iščašenje ili djelomično puknuće vratnih mišića, iščašenje jednjaka i grkljana, oštećenje temporomandibularnih zglobova ili ozljedu propriocepcijskih receptora smještenih u vratu. Cilj ispitivanja bio je utvrditi osjećaju li osobe koje su zadobile trzajnu ozljedu gubitak propriocepcije koja je definirana kao sposobnost opetovanog zauzimanja prethodno utvrđenog položaja glave. U studiju je bilo uključeno 60 bolesnika (raspon dobi 20-50 godina) s trzajnom ozljedom i 60 asimptomatskih ispitanika jednake dobi i spola. Sposobnost ispitanika da zauzmu definirani položaj glave tijekom rotacije vratne kralješnice za 30° udesno i ulijevo ispitivana je ponovljenim mjerenjima pomoću sustava za vratna mjerenja tri mjeseca nakon liječenja. Ispitivanje je pokazalo kako bolesnici koji su zadobili trzajnu ozljedu imaju statistički značajno lošije rezultate u usporedbi s kontrolnim ispitanicima (p>0,001). Rezultati ove studije govore u prilog pretpostavci da osobe s trzajnom ozljedom imaju lošiju percepciju položaja glave, što može predstavljati problem u njihovim svakodnevnim radnjama

Liječenje multiple skleroze

Multiple sclerosis is an autoimmune inflammatory demyelinating disease of the central nervous system, characterized by multifocal inflammatory destruction of myelin, axonal damage and loss of oligodendrocytes. The disease is carried through two stages: inflammatory and degenerative. The most common form of disease in approximately 85% of the cases is RRMS (relapsing-remitting form). The treatment of MS is divided into: treatment of the acute phase of illness, prevention of new relapses and disease progression, and symptomatic treatment. Most of the changes in treatment of multiple sclerosis and most of the news in recent years concerning new drugs are used in the treatment of progression of the disease and prevention of disease relapses. Some of these drugs are registrated in most European countries and USA, and others are in various stages of research.Multipla skleroza (MS) je upalna autoimuna demijelinizacijska bolest središnjega živčanog sustava obilježena multifokalnom upalnom destrukcijom mijelina, oštećenjem aksona i gubitkom oligodendrocita. Bolest se odvija kroz dvije faze, upalnu i degenerativnu. Najčešći oblik bolesti, u otprilike 85% slučajeva je RRMS (relapsno-remitentni oblik). Liječenje MS dijeli se na liječenje akutne faze bolesti, prevenciju novih recidiva i progresije bolesti te simptomatsko liječenje. Posljednjih godina najviše promjena i novih lijekova u liječenju multiple skleroze rabi se u liječenju odnosno sprječavanju progresije bolesti te prevenciji recidiva bolesti. Neki od tih lijekova su registrirani u većini europskih zemalja i u Americi, a drugi su u različitim fazama istraživanja

COMORBIDITIES IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA

Background: Comorbidities in multiple sclerosis (MS) have a big role in management of this chronic demyelinating neurodegenerative disorder. The aim of this study was to evaluate comorbidities in patients with MS in Croatia. Subjects and methods: This was a prospective cross-sectional study carried out in an out-patient setting at a tertiary healthcare centre over 10 months, which included 101 consecutive patients with MS (mean age 42.09 (range 19-77) years, 75 female, 26 male, EDSS score 3.1 (range 0.0- -42) years. Thirty-six patients were treated with disease modifying therapies (DMTs). Information on comorbidities was obtained during the medical interview. Data was analysed using software package IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. Results: 33% (n=34) patients did not have any comorbidities, and there is an equal number of patients (n=34, 33%) that just had one comorbidity. 17.6% (n=18) of patients had two comorbidities, and 15.7% (n=16) three or more comorbidities. The most frequent comorbidity was depression found in 25 (24.75%) patients (19 (18.8%) women, 6 (5.9%) men), followed by the hypertension in 12.87% (n=13). Hyperlipidemia and migraine were each found in 6.93% (n=7), and hypothyreosis and arrhythmia each in 3.96% (n=4). The number of the comorbidities was found to significantly increase with the duration of MS (r=0.232, p=0.037). Women were found to have significantly bigger numbers of comorbidities than men (t=-2.59, df=74, p<0.05). Older patients with MS were found to have significantly more comorbidities (r=0.335, p<0.01). Conclusions: This study gives insight into the presence of comorbidities in Croatian patients with MS. Connection with comorbidities must be considered when managing patients with MS. Any other comorbidity in MS may also affect the condition of the patient in general, and also their quality of life, and requires a tailored approach in management

SEXUAL DYSFUNCTION AND DEPRESSION IN PATIENTS WITH MULTIPLE SCLEROSIS IN CROATIA

Background: Both depression and sexual dysfunction (SD) may be present in patients with multiple sclerosis (MS). Objective: The aim of this study was to evaluate a possible association between SD and depression in patients with MS in Croatia. Subjects and methods: This was a prospective cross-sectional study carried out in tertiary healthcare centre over 10 months, which included 101 consecutive pwMS (mean age 42.09 (range 19-77) years, 75 female, 26 male, EDSS score 3.1 (range 0.0-7.0)). SD was assessed using Multiple Sclerosis Intimacy and Sexuality Ques tionnaire (MSISQ), which was for this purpose successfully translated and validated into Croatian. Information on treatment for depression was obtained during the medical interview. Data were analysed and interpreted using parametric statistics (IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.). Results: 89 patients completed MSISQ. 25 patients were in treatment for depression, while 75 did not have depressive symptoms. On MSISQ 57 (43women, 14 men) patients had responded with ‘almost always/ always’ suggestive of SD. Majority of patients reported primary SD, followed by secondary and tertiary SD. Most difficulties were found regarding difficulty in getting or keeping a satisfactory erection (34.6% (N=9) men), followed by 32.9% (N=27) reporting that it takes too long to orgasm or climax, followe d with bladder or urinary symptoms in 32.6% (N=29). There were no significant differences between female and male patients re- garding treatment for depression ( Ȥ2=0.018, df=1, p>0.05). Results in all subcategories on t-test found that depressive patients had higher impact on SD when compared to non-depressive: overall (t=-2.691, df=87, p<0.01) and in regards to primary (t=-2,086, df=87, p<0.05), secondary (t=-2.608, df=87, p<0.05) and tertiary (t=-2.460, df=86, p<0.05) SD. Depressive patients on 7 questio ns showed significantly (p<0.05) higher SD symptoms: Muscle tightness or spasms in my arms, legs, or body; Tremors or shaking in hands or body; Pain, burning, or discomfort in their body; Feeling less attractive; Fear of being rejected sexually because of MS; Lack of sexual interest or desire; Less intense or pleasurable orgasms or climaxes. Conclusions: This study gives insight into the presence of depression and SD in Croatian patients with MS for which purpose valid questionnaire for the assessment of SD in MS patients MSISQ was with permission successfully translated and validated int o Croatian. The connection between depression and SD must be considered when managing patients with MS