Učinak botulinum toksina tip A u bolesnika s esencijalnim blefarospazmom

The aim of this study was to determine the effect of botulinum toxin type A and satisfaction in patients with essential blepharospasm. The study included 12 subjects suffering from essential blepharospasm who received therapy with botulinum toxin type A injections. Respondents were given a Blepharospasm Disability Index (BSDI) survey before and three weeks after the procedure with questions related to quality of life. They were also given a Jankovic Rating Scale with questions related to the severity and frequency of symptoms. The overall level of difficulties was reduced, meaning the quality of life increased after the application of botulinum toxin, and the study found that the increase was statistically significant (p = 0.003). The severity of symptoms after the application of botulinum toxin was reduced, which meant that there was a decrease in the severity of the difficulties, and the study found a statistically significant difference (p=0.003). The frequency of symptoms was reduced after botulinum toxin administration, and the study revealed a statistically significant difference (p = 0.012). From the results of this study, we can determine that the use of botulinum toxin type A increases the quality of life and that the severity and frequency of symptoms are statistically significantly reduced.Cilj je bio utvrditi učinak botulinum toksina tip A i zadovoljstvo u bolesnika s esencijalnim blefarospazmom. U istraživanje je uključeno 12 ispitanika u dobi od 49 do 86 godina s esencijalnim blefarospazmom kojima je primijenjena terapija injekcijama botulinum toksina tip A. Ispitanicima je prije te tri tjedna nakon postupka dana anketa Blepharospasm Disability Index (BSDI) u kojoj su bila pitanja vezana za kvalitetu života. Dana im je i ljestvica Jankovic Rating Scale s pitanjima koja se odnose na težinu i učestalost simptoma. Ukupna razina poteškoća je smanjena, što znači da se kvaliteta života povećala nakon primjene botulinum toksina, a studija je pokazala da je povećanje statistički značajno (p = 0,003). Ozbiljnost simptoma nakon primjene botulinum toksina smanjena je, što znači da je došlo do smanjenja težine poteškoća, a istraživanje je utvrdilo statistički značajnu razliku (p=0,003). Učestalost simptoma smanjena je nakon primjene botulinum toksina, a studija je pokazala statistički značajnu razliku (p = 0,012). Iz rezultata ovog istraživanja možemo utvrditi da primjenom botulinum toksina tipa A dolazi do povećanja kvalitete života, te da se ozbiljnost i učestalost simptoma statistički značajno smanjuju

Structural changes in brains of patients with disorders of consciousness treated with deep brain stimulation

Disorders of consciousness (DOC) are one of the major consequences after anoxic or traumatic brain injury. So far, several studies have described the regaining of consciousness in DOC patients using deep brain stimulation (DBS). However, these studies often lack detailed data on the structural and functional cerebral changes after such treatment. The aim of this study was to conduct a volumetric analysis of specific cortical and subcortical structures to determine the impact of DBS after functional recovery of DOC patients. Five DOC patients underwent unilateral DBS electrode implantation into the centromedian parafascicular complex of the thalamic intralaminar nuclei. Consciousness recovery was confirmed using the Rappaport Disability Rating and the Coma/Near Coma scale. Brain MRI volumetric measurements were done prior to the procedure, then approximately a year after, and finally 7 years after the implementation of the electrode. The volumetric analysis included changes in regional cortical volumes and thickness, as well as in subcortical structures. Limbic cortices (parahippocampal and cingulate gyrus) and paralimbic cortices (insula) regions showed a significant volume increase and presented a trend of regional cortical thickness increase 1 and 7 years after DBS. The volumes of related subcortical structures, namely the caudate, the hippocampus as well as the amygdala, were significantly increased 1 and 7 years after DBS, while the putamen and nucleus accumbens presented with volume increase. Volume increase after DBS could be a result of direct DBS effects, or a result of functional recovery. Our findings are in accordance with the results of very few human studies connecting DBS and brain volume increase. Which mechanisms are behind the observed brain changes and whether structural changes are caused by consciousness recovery or DBS in patients with DOC is still a matter of debate

Ovalni i okrugli otvor: karakteristike postnatalnog razvoja

The sphenoid bone development occurs in both prenatal and postnatal periods. Sphenoid bone openings are used as surgical landmarks and are of great importance for neurosurgeons in everyday practice. The aim of this study was to identify morphological characteristics, postnatal development and remodeling, as well as clinical aspect of the sphenoid bone openings and to investigate their relationship and difference in size. The macerated sphenoid bones analyzed in this study were scanned by micro-computed tomography. Areas and distance in-between foramen ovale and foramen rotundum were measured. In addition, different shapes of foramen ovale were described. The most common shape of foramen ovale on both sides was oval, followed by the round, almond and elongated shapes. Modest to strong positive correlations between all foramina and age for the whole sample and both subsamples were presented, except for the right foramen rotundum area in the male subsample, which did not show significant correlation with age. Our study revealed changes in postnatal development and anatomy of foramen ovale and foramen rotundum, primarily in the aspects of size and shape, and should contribute to reducing the risk of damage to neurovascular structures during surgical procedures.Razvoj klinaste kosti odvija se u prenatalnom i postnatalnom razdoblju. Otvori klinaste kosti se koriste kao kirurški orijentiri i od velike su važnosti za neurokirurge u svakodnevnoj praksi. Cilj ovoga istraživanja bio je prikazati morfološke karakteristike, postnatalni razvoj i preoblikovanje, kao i klinički aspekt koštanih otvora klinaste kosti te istražiti njihov odnos i razliku u veličini. Macerirane klinaste kosti analizirane u ovom istraživanju skenirane su mikroCT-om. Izmjerene su površine i udaljenost između ovalnog i okruglog otvora. Uz to, opisani su različiti oblici ovalnog otvora. Najčešći oblik ovalnog otvora obostrano je ovalni, potom okrugli, bademasti i izduženi oblik. Prikazane su umjerene do jake pozitivne povezanosti između svih otvora i starosti za cijeli uzorak i oba poduzorka, osim površine desnog okruglog otvora u muškom poduzorku koji nije pokazao značajnu povezanost s godinama. Naše istraživanje otkrilo je promjene u postnatalnom razvoju i anatomiji ovalnog i okruglog otvora, prvenstveno u pogledu veličine i oblika, što bi trebalo doprinijeti smanjenju rizika od oštećenja krvožilnih i živčanih struktura tijekom kirurških zahvata