Poređenje dijagnostičkih kriterijuma kod bolesnika sa amiotrofičnom lateralnom sklerozom - doprinos elektromiografskih nalaza

Diagnosis of amyotrophic lateral sclerosis (ALS) is based on combination of clinical signs and electrophysiological correlates of pathological process which takes place in general. New electrophysiological criteria Awaji-Shima (AS) additionally qualify the complex fasciculations and neurogenically modified potentials of motor units as signs of active lesions of peripheral motor neuron, contrary to previously valid revised El Escorial criteria (rEE). The objective of this research was to determine the clinical significance and advantages of using the AS criteria in patients with ALS. Methods. Thirty patients (59.2 ± 10.9 years, 57% of them with spinal form of the disease) with clinically suspected ALS were monitored from the time of diagnosis until reaching the category of definitive diagnosis or death. The clinical evaluation and electromyographic (EMG) examinations were carried out at 3-month intervals. Results. By applying the AS criteria, the category of probable or definite diagnosis was achieved in all patients with ALS, except in one (96.6%), as contrary to the rEE (33.3%), after 6 months of the follow-up period. The subclinical affection in more than two body regions has been defined through detection of denervation potentials (80% of the patients by using the AS, or 67% by the rEE criteria). The complex fasciculations were registered particularly often in small muscles of the feet (37- 40%). Conclusion. Application of the AS criteria improve the achievment of category of probable or definite diagnosis of ALS by 2.7 months earlier compared to the rEE. This outcome is particularly affected by a higher frequency of positive EMG findings, when the AS criteria were employed. Early determination of diagnosis provides the better perspective and more frequent participation of the ALS patients in pharmacotherapy studies intended to establish new therapeutic options.Dijagnoza amiotrofične lateralne skleroze (LS) zasniva se na kombinaciji kliničkih znakova i elektrofizioloških korelata patološkog procesa koji se odvija u osnovi. Novi elektrofiziološki kriterijumi, Awaji-Shima (AS), dodatno kvalifikuju kompleksne fascikulacije i neurogeno izmenjene potencijale motornih jedinica kao znakove aktivnih lezija perifernog motornog neurona, nasuprot ranije važećim revidiranim El Escorial kriterijumima (rEE). Cilj ovog istraživanja bio je da se utvrdi klinički značaj i prednosti primene AS kriterijuma, kod obolelih od ALS. Metode. 30 bolesnika (59,2 ± 10,9 godina, od kojih 57% sa spinalnom formom bolesti) sa klinički suspektnom ALS, praćeno je od vremena postavljanja dijagnoze do postizanja kategorije definitivne dijagnoze ili smrtnog ishoda. Kod bolesnika su obavljane klinička evaluacija i elektromiografski (EMG) pregledi u tromesečnim intervalima. Rezultati. Primjenom AS kriterijuma, nakon 6 meseci praćenja, kategorija verovatne ili pouzdane dijagnoze postignuta je kod svih bolesnika sa ALS, izuzev jednog (96,6%), nasuprot rEE kriterijuma (33.3%). EMG nalazi bili su pozitivni u ≥ 2 telesna regiona kod 80% bolesnika primenom AS, odnosno 67% primenom rEE. Kompleksne fascikulacije zabeležene su posebno učestalo u malim mišićima stopala (37-40%). Zaključak. Primenom AS kriterijuma kategorija vjerovatne ili pouzdane dijagnoze ALS postiže se za 2,7 meseca ranije, u poređenju sa rEE, na šta posebno utiče veća učestalost pozitivnih EMG nalaza. Ranije utvrđivanje dijagnoze donosi perspektivu veće zastupljenosti obolelih u farmakoterapijskim studijama sa novim terapeutskim agensima

Naša iskustva s trombolitičkom terapijom – preliminarno izvješće

Stroke is a rapidly developing clinical disturbance of focal or global cerebral function, lasting for more than 1 hour. It is an acute form of symptoms of brain function disorder, with no apparent cause other than vascular origin. It is the final phase of arterial disease, the main cause of disability, and the second leading cause of death. Today, ischemic stroke can be treated successfully by acting on its cause using a very powerful weapon, thrombolytic therapy. The aim is to present a preliminary report of our experiences with thrombolytic therapy in patients with ischemic stroke. Results recorded in 20 patients who received thrombolytic therapy within three hours of stroke onset are presented. Nineteen patients survived and one patient died from therapy side effects, i.e. intracerebral hematoma. Seventeen of 19 patients were released from the hospital without any neurologic deficit, while two patients had Rankin score 2 (minimum disability) three months after stroke onset. Our experience confirms that thrombolytic therapy is the treatment of choice in patients with ischemic stroke if administered in accordance with precise protocols.Moždani udar je naglo nastali, akutni oblik fokalnog ili globalnog poremećaja moždane funkcije, koji traje duže od jednog sata, poremećaja koji nema drugog vidljivog uzroka osim vaskularnog. Predstavlja završnu fazu bolesti lokalizirane na moždanim arterijama, glavni je uzrok onesposobljenosti i drugi uzrok smrtnog ishoda. U današnje vrijeme postoji mogućnost veoma uspješnog liječenja ishemijskog moždanog udara primjenom moćnog oružja, kauzalne trombolitičke terapije. Ovdje se daje preliminarni prikaz naših iskustava u primjeni trombolitičke terapije kod bolesnika s ishemijskim moždanim udarom. U radu se prikazuju rezultati liječenja 20 bolesnika koji su primili trombolitičku terapiju u prva tri sata od početnih simptoma moždanog udara, od kojih je 19 preživjelo, a jedan bolesnik je umro od sporednih učinaka terapije, tj. intracerebralnog krvarenja. Kod 17 bolesnika došlo je do potpunog oporavka bez neurološkog deficita, dok su dva bolesnika imala minimalnu onesposobljenost, Rankinov zbir 2, nakon tri mjeseca od događaja. Trombolitička terapija je i prema našim prvim iskustvima terapija izbora u liječenju ishemijskog moždanog udara, ako se primjenjuje strogo prema propisanim uputama

Funkcionalni ishod nakon liječenja trombolizom

In this paper, we report our experience from a prospective study in 40 ischemic stroke patients admitted during the last two years at University Department of Neurology Stroke Unit, Banja Luka Clinical Center, in order to assess the safety and efficacy of thrombolytic therapy, the impact of age, sex and risk factors, and functional outcome at 6 months of intravenous tissue plasminogen activator treatment. According to the National Institutes of Health Stroke Scale, there were 5 mild, 22 moderate and 13 severe stroke cases in the study group. The outcome measures at 6 months of thrombolytic treatment were taken in 38 (100%) patients, yielding a Functional Independent Measure score ≥90 (good clinical outcome) in 21 (52.50%) and modified Rankin Score ≤2 (good clinical outcome) in 22 (55%) patients. The rate of symptomatic intracerebral hemorrhage in tissue plasminogen activator treated patients was 5%, with a mortality rate of 17.50%. The outcomes were comparable with those found in the NINDS t-PA trial. Current guidelines recommend a ‘door-to needle’ time of less than 60 minutes and emphasize that ‘time is brain’.U radu iznosimo naša iskustva iz prospektivne studije kod 40 pacijenata sa ishemičnim moždanim udarom, liječenih u Jedinici za moždani udar Klinike za neurologiju Kliničkog Centra Banja Luka tokom posljednje dvije godine, da bi se procijenila pouzdanost i efikasnost trombolitičke terapije šest mjeseci nakon intravenske primjene aktivatora tkivnog plazminogena, kao i uticaj životne dobi, spola i faktora rizika na funkcionalni ishod nakon moždanog udara. Među njima je, prema skali za moždani udar Nacionalnog instituta za zdravlje SAD, bilo pet blagih, 22 umjerena i 13 teških oblika moždanog udara. Efikasnost terapije nakon šest mjeseci od trombolize kod 38 preživjelih pacijenata prezentirana je zbirom Nezavisnog funkcionalnog mjerenja ≥ 90 (dobar klinički ishod) kod 21 (52,50%) pacijenta, te kao modificirani Rankinov zbir ≤ 2 (dobar klinički ishod) kod 22 (55%) pacijenta. Učestalost intrakranijalne hemoragije bila je 5%, sa stopom smrtnosti od 17,50%. Rezultati funkcionalnog ishoda su uspoređeni sa ishodom navedenim u studiji NINDS t-PA. Važeće preporuke savjetuju da vrijeme od “vrata do igle” bude kraće od 60 minuta, naglašavajući izreku “vrijeme je mozak”