Incidencija epileptičnih napadaja tijekom i nakon moždanog udara u desetgodišnjem razdoblju na Neurološkoj klinici Kliničkoga centra Univerziteta u Sarajevu

Association between epilepsy and stroke has been known since 1864. The pathophysiological basis of epileptic seizures during and after stroke is molecular changes that occur in ischemia as primary events and in hemorrhage as secondary events. The aim of the study was to determine the incidence of epileptic seizures during and after stroke, recorded over a 10-year period at the Department of Neurology, Sarajevo University Clinical Center. The study covered the period from January 1, 1989 till December 31, 1998. During the period, 7001 patients were treated at the Department. Cerebral thrombosis predominated (53.6%), whereas there were only 17.25% of patients with cerebral embolism, 21.96% with intracerebral hemorrhage, and 7.17% with subarachnoid hemorrhage. The incidence of symptomatic epileptic seizures for total patient sample according to years ranged from 0.75% to 6.67%. According to type of insult, the incidence of symptomatic epileptic seizures was 1.0%-3.37% for cerebral thrombosis, 1.22%-6.67% for cerebral embolism, 0.65%4.05% for intracerebral hemorrhage, and 1.34%-4.34% for subarachnoid hemorrhage. Associated epileptic seizures, i.e. the seizures accompanying the onset of stroke, were not included in the study. Results of the study showed that there were 75 patients with symptomtic epileptic seizures (47 with late seizures and 28 with early seizures, or 1.998% of total patient sample) during the 10-year period of observation. There were 36 cases of cerebral embolism (23 and 13 in the group of late and early seizures, respectively; 2.980%), 30 cases of intracerebral hemorrhage (23 and seven with late and early seizures, respectively; 1.951%), and seven cases of subarachnoid hemorrhage (four with late and three with early seizures; 1.394%). According to stroke types and subtypes, hemorrhagic stroke was found to be a more common etiologic factor for the occurrence of early and late symptomatic epileptic seizures, whereas cerebral embolism in ischemic stroke was a more common cause of symptomatic epileptic seizures than cerebral thrombosis. During the study period, the years 1993, 1994 and 1995 were characterized by a small number of patients with symptomatic early and late epileptic seizures (9 in total). The incidence of early and late epileptic seizures in the sample of stroke patients during the study period ranged from 1.394% to 2.980%.Veza između epilepsije i moždanog udara poznata je još od 1864. godine. Patofiziološka osnova epileptičnih napadaja tijekom i nakon moždanog udara su molekularne promjene koje u ishemiji nastaju primarno, a u hemoragiji sekundarno. Cilj ovoga rada bio je utvrditi incidenciju epileptičnih napadaja tijekom i nakon moždanog udara u desetgodišnjem razdoblju na Neurološkoj klinici Kliničkoga centra Univerziteta u Sarajevu. Obuhvaćeno je razdoblje od 1. siječnja 1989. do 31. prosinca 1998. godine, tijekom kojega je na Klinici liječen 7001 bolesnik. Najviše je bilo cerebralnih tromboza (53,65), potom cerebralnih embolija(17,25%), intracerebralnih hemoragija (21,96%) i subarahnoidnih hemoragija (7,17%). Incidencija simptomatskih epileptičnih napadaja u pojedinim godinama kretala se za ukupan uzorak od 0,75% do 6,67%. Prema tipovima inzulta incidencija je bila kako slijedi: za cerebralnu trombozu 1,0%-3,375%; za cerebralnu emboliju 1,22%-6,67%; za intracerebralnu hemoragiju 0,65%-4,05%; i za subarahnoidnu hemoragiju 1,34%-4,34%. U studiju nisu bili uključeni asocirani epileptični napadaji (napadaji kojima je započinjao moždani udar). Na temelju ispitivanja zaključeno je da je u desetgodišnjem razdoblju na Klinici bilo 75 bolesnika sa simptomatskim epileptičnim napadajima (47 bolesnika s kasnim napadajima i 28 bolesnika s ranim napadajima ili 1,998% od ukupnog uzorka naših bolesnika tijekom promatranog razdoblja). Bio je 36 bolesnika s cerebralnom embolijom (23 u skupini s kasnim napadajima i 13 u skupini s ranim napadajima; 2,980%), 30 bolesnika s intracerebralnom hemoragijom (23 u skupini s kasnim napadajima i 7 u skupini s ranim napadajima; 1,951%) i sedmoro bolesnika sa subarahnoidnim krvarenjem (4 u skupini s kasnim napadajima i 3 u skupini s ranim napadajima; 1,394%). Prema tipovima i podtipovima moždanog udara utvrđeno je daje hemoragijski moždani udar u našem kliničkom materijalu bio češći etiološki čimbenik za nastanak simptomatskih ranih i kasnih epileptičnih napadaja, dok se cerebralna embolija u ishemijskim inzultima i na našem materijalu pokazala kao češći razlog pojave simptomatskih epileptičnih napadaja u odnosu na cerebralnu trombozu. Tijekom promatranoga razdoblja mali je broj bolesnika sa simptomatskim ranim i kasnim epileptičnim napadajima (ukupno 9) zabilježen u godinama 1993., 1994. i 1995. Na temelju rezultata ovoga ispitivanja zaključeno je da se je incidencija epileptičnih napadaja u ukupnom uzorku bolesnika s moždanim udarom u desetgodišnjem razdoblju kretala od 1,394% do 2,980%

Korelacija između ranih i kasnih epileptičnih napadaja tijekom i nakon moždanog udara i srčanih bolesti

Stroke is the leading cause of mortality and the main cause of disability in adults in Europe. According to the American Heart Association, "the profile of apoplectic personality is determined by systolic blood pressure greater than 160 mm Hg, diastolic blood pressure higher than 95 mm Hg, family history of cardiovascular diseases, hypercholesterolemia, smoking, alcohol abuse and diabetes mellitus". The aim of this retrospective study was to assess the correlation between early and late epileptic seizures during and after stroke, and some heart diseases associated with hypertension. Ten-year records (January 1, 1989 till December 31, 1998) of the University Department of Neurology, Sarajevo University Clinical Center, were examined. There were 7001 stroke patients (53.6% with cerebral thrombosis, 17.35% with embolic etiology, 21.96% with intracerebral hemorrhage, and 1.17% with subarachnoid hemorrhage), with a 3.38% incidence of symptomatic epileptic seizures. The following cardiac diseases were considered relevant for the study purpose: absolute arrhythmia, subdecompensated heart state, well treated cardiac decompensation, angina pectoris, postmyocardial infarction state, and extrasystoles. Results revealed a statistically significant difference in the correlation with cardiac diseases between patients with early and late epileptic seizures. The patients with early epileptic fits had severe heart problems compared to those with late seizures. The former suffered from angina pectoris, heart decompensation and chronic subdecompensated state, yielding a ratio of 1.1 to 0.6. There was no statistically significant difference between the groups according to absolute arrhythmia. Study results suggested the patients with cerebrovascular disease and early epileptic fits to have a significantly higher rate of heart problems compared to stroke patients with late epileptic fits, in whom the morphological changes of the brain appeared neurophysiologically to act as an epileptogenic focus.Moždani udar je vodeći uzrok smrtnosti i glavni uzrok invalidnosti u odraslih osoba u Europi. Prema Američkom udruženju za srce, "profil apoplektične osobe određen je sistoličkim krvnim tlakom višim od 160 mm Hg, dijastoličkim krvnim tlakom višim od 95 mm Hg, obiteljskom poviješću kardiovaskularnih bolesti, hiperkolesterolemijom, pušenjem, zlouporabom alkohola i šećernom bolešću. Cilj ove retrospektivne studije bio je procijeniti korelaciju između ranih i kasnih epileptičnih konvulzija tijekom i nakon moždanog udara uz neke srčane bolesti povezane s hipertenzijom. Studija je obuhvatila bolesnike liječene na Klinici za neurologiju, Klinički bolnički centar u Sarajevu, kroz razdoblje od deset godina (od 1. siječnja 1989. do 31. prosinca 1998.). Ukupno je bio 7001 bolesnik s moždanim udarom (53,6% s moždanom trombozom, 17,35% s moždanim udarom embolijske etiologije, 21,96% s moždanim krvarenjem i 1,17% sa subarahnoidnim krvarenjem). Incidencija simptomatičnih epileptičnih konvulzija bila je 3,38%. U radu su obrađene slijedeće srčane bolesti: apsolutna aritmija, subdekompenzirano srčano stanje, liječena srčana dekompenzacija, angina pektoris, stanje nakon infarkta miokarda i ekstrasistole. Rezultati su pokazali statistički značajnu razliku između bolesnika s ranim i onih s kasnim epileptičnim napadajima u odnosu na sretane bolesti. Tako su bolesnici s ranim epileptičnim napadajima imali ozbiljnije srčane probleme u usporedbi s onima s kasnim napadajima. U prvoj je skupini zabilježena angina pektoris, srčana dekompenzacija i kronično stanje subdekompenzacije, uza statistički omjer od 1,1 prema 0,6. Nije bilo statistički značajne razlike između dviju skupina glede apsolutne aritmije. Zaključano je da su bolesnici s cerebrovaskularnom bolešću i ranim epileptičnim konvulzijama imali značajno više srčanih problema negoli oni s moždanim udarom i kasnim epileptičnim napadajima, u kojih su morfološke promjene na mozgu u neurofiziološkom smislu predstavljale epileptogeno žarište

Spoznajni i depresivni poremećaji kod multiple skleroze

Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the most common affective disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.Među drugim simptomima multipla skleroza može uzrokovati i simptome afektivnih i spoznajnih poremećaja. Većina bolesnika ima određene spoznajne disfunkcije, dok je najčešći afektivni poremećaj reaktivna depresija. Cilj studije bio je utvrditi korelaciju vrijednosti dobivenih pomoću ljestvica Mini-Mental State (MMS) i Beck Depression Inventory (BDI) s vrijednosti na ljestvici Expanded Disability Status Scale (EDSS) u bolesnika s multiplom sklerozom liječenih na Neurološkoj klinici Kliničkog bolničkog centra u Sarajevu. Procjena je obuhvatila 50 nasumce izabranih bolesnika s različitim tipovima multiple skleroze uz primjenu MMS, BDI i EDSS. Bilo je 33 žena i 17 muškaraca (66%:34%) srednje dobi od 40,74 (SD 9,236) godine. Srednja vrijednost EDSS bila je 3,98, u rasponu od 1,0 do 8,5 kod žena te od 1,0 do 6,5 kod muškaraca. Na ljestvici BDI srednja vrijednost je bila 12,56, dok je srednja vrijednost za MMS u ispitanom uzorku bila 26,88. Utvrđena je statistički značajna pozitivna korelacija između dobi i vrijednosti EDSS, dok je negativna korelacija utvrđena između EDSS i MMS te između BDI i MMS. Rezultati ovoga ispitivanja pokazali su da stariji bolesnici s multiplom sklerozom imaju višu vrijednost EDSS uz jače izražene kognitivne smetnje. Nije bilo statistički značajne korelacije između vrijednosti EDSS i depresije

Role of α-Lipoic Acid in Diabetic Polyneuropathy Treatment

Diabetic neuropathy represents late diabetes complications, and diabetes duration and long-term hyperglycemia are the main reasons for polyneuropathy. The goal was to estimate the effects of alpha-lipoic acid on symptoms of diabetic neuropathy after 600 mg i.v. for 3 weeks and 3 months of 300-600 mg of alpha-lipoic acid per os. This study has been designed as a multicentric, in 5-centers in B&H, carried out by 5 physicians with 20 diabetic patients each. Following parameters were monitored in 100 diabetics suffering from Type 1 and Type 2 diabetes, both men and women: diabetes duration, diabetes therapy, duration of polyneuropathy symptoms, height, weight, BMI (body mass index), subjective assessment of patients, objective examinations of physicians and subjective assessment of physicians. 100 diabetics, average age 61,36; oldest 79, youngest 40, suffered from diabetes in average 11,9 years. There were 35 men and 65 women, 16 with Type 1 and 80 with Type 2 diabetes, while 4 patients were not classified. 69 were having insulin therapy and 31 oral hypoglicemics. Shortest diabetic status was less than a year, and longest was 28 years. Average duration of polyneuropathic symptoms was 3,02 years, shortest was less than a year, and the longest was 15 years. Average height was 1,70 m, average weight 76,13 kg, and average BMI 26,51 kg/m2. Significant statistic differences in improvement were recorded (P>0,05) according to Fridman's test for repeated measurements compared to initial findings in assessments: sensory symptoms of polyneuropathy, pain sensations as polyneuropathy symptoms, total score of polyneuropathy symptoms, subjective assessment of patients, subjective findings of physicians, and significant differences were not find (P>0,05) in autonomous and motoric neuropathy. Based on the conducted study, we have concluded that the application of alpha-lipoic acid during 3 months has helped to decrease the symptoms of diabetic neuropathy and in only one case out of 100 included patients there was no subjective improvement after drug application

Characteristics of Symptomatic Epilepsy in Patients with Brain Tumours

The aim of our work is to determine the total number, age, gender of the patients with the symptomatic epileptic seizures associated with brain tumours, tumour location, clinical signs and characteristics of epileptic seizures. We have analyzed medical documentation of the patients with brain tumours hospitalized at the Department of Neurology, University of Sarajevo Clinics Centre. This study is retrospective and includes time period from 1st January 2000 until 31st December 2005. During the observed period at the Department of Neurology in Sarajevo there were in total 9753 hospitalized patients, from which 101 (1,1%) patients with the brain tumour diagnosis. Average patient’s age was 62,60 ± 1,28 years. In one third of the patients (32%) were recorded epileptic seizures, without significant difference between genders. In case of symptomatic epilepsy, significantly more frequent locations of tumours were: in several lobes (28%), parietal lobe (25%), as well as frontal and temporal lobe (18,8% each), while there were no changes in cerebellum and brain stem (χ2 =7,174, p<0,05). The most prominent signs of illness in our sample were hemiparesis with the cranial nerves lesion (56,3%), speech problems (25%). Normal neurologic findings were significantly more frequent among patients with the symptomatic epilepsy (χ2 =6,349, p<0,05). The most often was a single seizure (59%), in 38% of cases there were recorded series of seizures, and only 3% of patients had status epilepticus. In relation to the type of seizures, the most often are simple partial seizures with or without secondary generalization (66%), than generalized convulsive (31%), and the rarest one are complex partial seizures (3%). Symptomatic epilepsy in case of brain tumours occurs in one third of patients, at older age, and in both genders. The lesion usually affects several lobes and cause simple partial seizures with or without secondary generalization. The most often clinical signs in case of all brain tumours are cranial nerves lesion and hemiparesis, while the normal neurologic findings are significantly dominant in the group of patients with the epileptic seizures

Psychic changes in patients with brain tumor

Aim: To analyze prevalence and type of psychic changes in primary and secondary brain tumors consideringage, gender, location of the tumor, neurologic status and treatment of patients.Patients and method: In this retrospective study medical records of 101 patients with brain tumor treatedat the Department of Neurology, Clinical Center University of Sarajevo in the period 2000 – 2005were analyzed: 58 males and 43 females with age mean of 62.60 ± 1.28 years; the number of patientsaccording to neoplasm origin was equal (51 primary and 50 secondary tumors).Results: Psychic changes appeared more often in patients with primary tumors (54.2%) as comparedto patients with metastases (45.8%), but the difference was not significant. Mental status changes werealmost equally distributed according to gender. Significantly more often disturbances occurred amongolder patients as compared to the younger and middle age patients (p=0.0074). The most frequent tumorlocation was in the right hemisphere in patients with altered mental state (40.7%). Leading mental statusabnormality in patients with primary tumors was bradyphrenia, and disorientation in patients withmetastases (p=0.0038).Conclusion: Psychic changes in cases of brain tumors are unspecific and mostly manifest in elderly patients.Detailed examination of the psychic status is indispensable for all the suspect cases to neoplasmin order for timely diagnosis of the disease

Characteristics of Symptomatic Epilepsy in Patients with Brain Tumours

The aim of our work is to determine the total number, age, gender of the patients with the symptomatic epileptic seizures associated with brain tumours, tumour location, clinical signs and characteristics of epileptic seizures. We have analyzed medical documentation of the patients with brain tumours hospitalized at the Department of Neurology, University of Sarajevo Clinics Centre. This study is retrospective and includes time period from 1st January 2000 until 31st December 2005. During the observed period at the Department of Neurology in Sarajevo there were in total 9753 hospitalized patients, from which 101 (1,1%) patients with the brain tumour diagnosis. Average patient’s age was 62,60 ± 1,28 years. In one third of the patients (32%) were recorded epileptic seizures, without significant difference between genders. In case of symptomatic epilepsy, significantly more frequent locations of tumours were: in several lobes (28%), parietal lobe (25%), as well as frontal and temporal lobe (18,8% each), while there were no changes in cerebellum and brain stem (χ2 =7,174, p<0,05). The most prominent signs of illness in our sample were hemiparesis with the cranial nerves lesion (56,3%), speech problems (25%). Normal neurologic findings were significantly more frequent among patients with the symptomatic epilepsy (χ2 =6,349, p<0,05). The most often was a single seizure (59%), in 38% of cases there were recorded series of seizures, and only 3% of patients had status epilepticus. In relation to the type of seizures, the most often are simple partial seizures with or without secondary generalization (66%), than generalized convulsive (31%), and the rarest one are complex partial seizures (3%). Symptomatic epilepsy in case of brain tumours occurs in one third of patients, at older age, and in both genders. The lesion usually affects several lobes and cause simple partial seizures with or without secondary generalization. The most often clinical signs in case of all brain tumours are cranial nerves lesion and hemiparesis, while the normal neurologic findings are significantly dominant in the group of patients with the epileptic seizures

Utjecaj trajanja dijabetesa i neregulirane glikemije na nastanak retinopatije

Cilj ovog istraživanja bio je utvrditi utjecaj trajanja dijabetesa i glikemije na nastanak dijabetične retinopatije kod pacijenata s dijabetesom tipa 1 i 2, te učestalost retinopatije prema spolu.Pregledano je 278 dijabetičara 1999. i 2004. godine, a anketnim listom uzeti su određeni podaci i upisani rezultati glikemije natašte, HbA1c, glukozurije i ketonurije. Retinopatija je 1999.godine zabilježena kod 80 (28,78 %) bolesnika, a 2004. godine 187 (67,27) (p<0,001). Broj bolesnika 2004. godine s neproliferativnom i preproliferativnom (p<0,001), kao i proliferativnom retinopatijom (p<0,01), bio je značajno viši u odnosu na 1999. godinu. Prosječni HbA1c iznosio je 1999. godine 13,02%, a 2004. godine 10,57%. Loša regulacija dijabetesa bila je bila prisutna tokom oba perioda istraživanja