Liječenje snižavanjem masti u sekundarnoj prevenciji moždanog udara

Secondary preventive measures such as measuring serum cholesterol levels and treatment of hypercholesterolemia with statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, are insufficiently used in patients with acute stroke or transient ischemic attack, although statins offer potential benefits for reducing the incidence and improving the prognosis of stroke. Besides lipid lowering, statins could have additional effects such as improvement of endothelial-dependent flow-mediated vasodilatation, modulating inflammatory response, decreasing clot formation, and decreasing platelet adherence to ruptured plaque, thus stabilizing the atherosclerotic plaque. Other antiatherosclerotic properties of statins include reduction of inflammatory cell accumulation in atherosclerotic plaques, inhibition of vascular smooth muscle cell proliferation, inhibition of platelet function, and improvement of vascular endothelial function. Randomized clinical trials and evidence based medicine support the role of statin therapy in preventing ischemic stroke in patients at risk of cerebrovascular disease.Mjere sekundarne prevencije, kao što su mjerenje serumskih razina kolesterola i liječenje hiperkolesterolemije statinima, inhibitorima reduktaze 3-hidroksi-3-metilglutaril koenzima A (HMG-CoA), nedovoljno se primjenjuju u bolesnika s akutnim moždanim udarom ili prolaznim ishemijskim ispadom, iako statini nude moguće koristi u snižavanju incidencije i poboljšanju prognoze moždanog udara. Uza snižavanje masti, statini bi mogli imati i dodatne učinke, kao što je poboljšanje o endotelu ovisne i protokom posredovane vazodilatacije, moduliranje upalnog odgovora, smanjeno stvaranje ugrušaka, te smanjeno prianjanje trombocita uz rasprsnuti plak, stabilizirajući time aterosklerotski plak. Ostala antiaterosklerotska svojstva statina uključuju smanjeno nakupljanje upalnih stanica u aterosklerotskom plaku, suzbijanje proliferacije krvožilnih glatkomišićnih stanica, suzbijanje funkcije trombocita, te poboljšanje funkcije krvožilnog endotela. Randomizirana klinička ispitivanja i medicina zasnovana na dokazima govore u prilog uloge liječenja statinima u sprječavanju ishemijskog moždanog udara u bolesnika s rizikom za cerebrovaskularnu bolest

Autoimmune Encephalitis

The purpose of this paper is to provide a comprehensive review of recent literature data for autoimmune encephalitis (AIE). AIE refers to inflammatory, non-infectious, immune-mediated encephalitis characterised by neuroinflammation, synthesis of neuronal autoantibodies (NAAs), directed against surface, synaptic and intracellular antigens, with subsequent neuronal dysfunction. It is characterised by heterogeneous anatomic-clinical syndromes and prominent neuropsychiatric symptoms. Due to overlapping of different clinical and diagnostic biomarkers, AIE is often considered diagnosis of exclusion and requires an extensive work-up. Systematic search of the term «autoimmune encephalitis» in the PubMed database was performed, with limitation set for systematic review in papers English, published from 2004- 2022. Further analysis was performed by the search of the author’s reference list and Autoimmune Encephalitis Alliance (AEA) website. The analysis was conducted according to PRISMA (The Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Outcomes that were sought included: AIE classification and presentation; diagnostic processing; treatment. Preset search of published systematic reviews in PubMed database, derived eighty six papers. Further screening of derived data, author’s reference list and AEA website was performed, according to previously defined out- comes. Finally, sixteen papers were independently selected and thoroughly analysed, with relevant conclusions present- ed in this paper. AIE is a severe inflammatory central nervous system (CNS) disorder with a complex differential diagnosis that often remains unrecognised. AIE research has established a wide range of new autoimmune antibodies syndromes, clinical and diagnostic biomarkers, which have improved diagnostic approach and treatment. Initial application of immunotherapy improves the outcome of disease

COGNITIVE ASPECTS IN MULTIPLE SCLEROSIS

Background: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised word fluency, complex attention deficit and executive dysfunction. Methods: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the recently published literature on cognitive decline in MS. Results: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging parameters of the disease. Conclusions: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely, irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection of cognitive relapse in MS patient

COGNITIVE ASPECTS IN MULTIPLE SCLEROSIS

Background: Cognitive dysfunction appears all through the course of multiple sclerosis (MS). Mild and moderate cognitive impairment is present in up to 40% of MS patients and severe cognitive decline affects more than 50% of patients in progressive course of the disease. The most common cognitive disorders in MS include diminished information processing speed, compromised word fluency, complex attention deficit and executive dysfunction. Methods: In this mini review, we present the reader with the most common neuropsychological assessments for the evaluation of cognition in MS, addressing the question of cognitive relapse. Source of data presented in this review is PubMed search of the recently published literature on cognitive decline in MS. Results: Patients with cognitive relapse often fail to meet diagnostic criteria for classical relapse in MS. Although, cognitive decline relates poorly to functional disability in MS, it correlates well with neuropsychological testing and with neuroimaging parameters of the disease. Conclusions: Cognitive decline might be considered as additional indicator of MS activity, and therefore evaluated routinely, irrespective of clinical presentation. Brief cognitive assessment, with confirmed psychometric qualities, might be useful in detection of cognitive relapse in MS patient

Impact of nutrition on prevention of stroke

Several studies demonstrated the importance of nutrition, beneficial and preventive role of Mediterranean diet in the occurrence of cardiovascular diseases, chronic neurodegenerative diseases and neoplasms, obesity and diabetes. In randomized intervention trials,Mediterranean diet improved endothelial function and significantly reduced waist circumference, plasma glucose, serum insulin and homeostasis model assessment score in metabolic syndrome. Several studies support favorable effects of Mediterranean diet on plasma lipid profile: reduction of total and plasma LDL cholesterol levels, plasma triglyceride levels, and apo-B and VLDL concentrations, and an increase in plasma HDL cholesterol levels. This effect is associated with increased plasma antioxidant capacity, improved endothelial function, reduced insulin resistance, and reduced incidence of the metabolic syndrome. The beneficial impact of fish consumption on the risk of cardiovascular diseases is the result of synergistic effects of nutrients in fish. Fish is considered an excellent source of protein with low saturated fat, nutritious trace elements, long-chain ω-3 polyunsaturated fatty acids (LCn3PUFAs), and vitamins D and B. Fish consumption may be inversely associated with ischemic stroke but not with hemorrhagic stroke because of the potential antiplatelet aggregation property of LCn3PUFAs. Total stroke risk reduction was statistically significant for fish intake once per week, while the risk of strokewas lowered by 31% in individualswho ate fish 5 times or more per week. In the elderly, moderate consumption of tuna/other fish, but not fried fish, was associated with lower prevalence of subclinical infarcts and white matter abnormalities on MRI examination. Dietary intake of ω-3 fatty acids in a moderate-to-high range does not appear to be associated with reduced plaque, but is negatively associated with carotid artery intima-media thickness. Greater adherence to Mediterranean diet is associated with significant reduction in overall mortality, mortality from cardiovascular diseases and stroke, incidence of or mortality from cancer, and incidence of Parkinson’s disease and Alzheimer’s disease and mild cognitive impairment

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