Improvement of post-hypoxic action myoclonus with levetiracetam add-on therapy: A case report

Introduction. Chronic post-anoxic myoclonus, also known as Lance-Adams syndrome, may develop following hypoxic brain injury, and is resistant to pharmacological therapy. Case report. The patient we presented developed post-anoxic action myoclonus with severe, completely incapacitating myoclonic jerks. Myoclonus did not respond to the treatment with commonly used agents, i.e. valproate and clonazepam alone or in combination. Improvement of the action myoclonus was observed only after adding levetiracetam. Conclusion. Although Lance-Adams syndrome may not be fully curable at this point, levetiracetam appears to be a promising agent that can significantly improve functional level and overall quality of life of patients with this disorder

Determination of systemic inflammatory biomarkers in multiple sclerosis

Background: Multiple sclerosis (MS) is one of the most common demyelinating diseases of the central nervous system. We aimed to investigate serum and cerebrospinal fluid levels of different laboratory inflammatory biomarkers in patients with MS. Methods: A total of 120 subjects participated in the study, 60 of whom were diagnosed with MS, 30 with the final diagnosis of non-inflammatory diseases of the central nervous system (CNS), and 30 healthy subjects representing the control group. Regarding the progression of radiological findings after 2 years from the initial diagnosis, the MS group was divided into stationary radiological findings (n=30) and radiologically proven disease progression (n=30). In all patients, we analyzed levels of laboratory inflammatory biomarkers: C reactive protein (CRP), Neutrophil-to-lymphocyte ratio (NLR), Growth differentiation factor 15 (GDF15) in serum samples, and neurofilaments (NFs) in cerebrospinal fluid (CSF). NFs and GDF15 were analyzed initially, while CRP and NLR values were analyzed initially and after two years. Results: We found statistically lower GDF15 values and initial CRP values in the MS group regarding the group with non-inflammatory diseases of the CNS (p<0.0001). On the other side, we determined a significant elevation of laboratory markers CRP and NLR, initially and after a two-year period, in the MS subgroup with the progression of magnetic resonance imaging (MRI) findings (p<0.0001 and p=0.050, respectively). Also, we found a positive correlation between CRP and NFs (r=0.243, p=0.04), as well as a positive correlation between CRP and GDF15 in patients with MS (r=0.769, p<0.0001). Conclusions: We found a significant elevation of laboratory markers of systemic inflammation, CRP, and NLR in MS patients who developed disease progression based on MRI findings. There is a need for further studies to validate current parameters to be considered as useful markers of MS activity and disability

Validacija kratke međunarodne kognitivne procjene multiple skleroze u velikoj kohorti bolesnika s relapsno-remitentnom multiplom sklerozom

Cognitive impairment is one of the most frequently reported symptoms in persons with multiple sclerosis (MS). The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recommended as a standardized international screening and monitoring tool for brief cognitive assessment. The aim of our study was to assess the reliability and validity of the Serbian version of the BICAMS. A total of 500 relapsing-remitting MS (RRMS) patients and 69 age-, gender- and education- matched healthy control (HC) subjects were examined. All participants performed the BICAMS test battery, which includes the oral version of the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test second edition (CVLT-II), and Brief Visuospatial Memory Test Revised (BVMTR). A randomly selected subset of patients were retested one to three weeks after baseline. Statistically significant differences between patients and HCs were evident on the SDMT and BVMTR (p<0.001). HCs had higher CVLT-II scores but this difference did not reach statistical significance (p=0.063). Cognitive impairment, defined as an abnormal test score on ≥1 subtest, was found in 62.9% of MS patients. There were statistically significant correlations between BICAMS scores and age, education, EDSS and disease duration in patient sample. Test-retest reliability was confirmed with Pearson correlation coefficient of 0.70 in all measures. This study supported the reliability and validity of the Serbian BICAMS, although the CVLT-II version tested here lacked sensitivity to detect MS compared to healthy volunteers.Kognitivno oštećenje je jedna od najčešće prijavljivanih manifestacija kod osoba s multiplom sklerozom (MS). Kratka međunarodna kognitivna procjena multiple skleroze (engl. Brief International Cognitive Assessment for Multiple Sclerosis, BICAMS) je baterija testova preporučena za brzu kognitivnu procjenu, koja je međunarodno standardizirana. Cilj našeg istraživanja bio je procijeniti pouzdanost i validnost srpske verzije BICAMS-a. Ispitano je ukupno 500 bolesnika s relapsnoremitentnom MS (RRMS) i 69 zdravih kontrolnih osoba (ZK) ujednačenih po uzrastu, spolu i razini obrazovanja. Svim sudionicima u studiji napravljen je BICAMS, koji uključuje usmenu verziju Testa analogije simbola i brojeva (SDMT), Kalifornijski test verbalnog učenja (CVLT-II), drugo izdanje i revidirani kratki test vizualne memorije (BVMTR). Nasumično odabrana podskupina bolesnika je ponovno testirana 1-3 tjedna nakon prvog testiranja. Statistički značajne razlike između bolesnika s MS i ZK zabilježene su za SDMT i BVMTR (p<0,001). ZK su imali viši zbroj CVLT-II, ali ova razlika nije dostigla statističku značajnost (p=0,063). Kognitivno oštećenje definirano kao nenormalni rezultat testa na ≥1 subtestu utvrđeno je kod 62,9% bolesnika s MS. Postojale su statistički značajne korelacije između rezultata testova BICAMS-a i dobi, razine obrazovanja, proširene ljestvice onesposobljenosti (EDSS) i dužine bolesti u skupini bolesnika s MS. Pouzdanost test-retest je potvrđena Pearsonovim koeficijentom korelacije od 0,70 u svim mjerenjima. Ova studija je pokazala pouzdanost i validnost srpskog BICAMS-a, iako verzija CVLT-II koja je ovdje testirana nije bila osjetljiva za otkrivanje kognitivnih poremećaja kod MS u usporedbi sa ZK