Cervical dystonia: pain relieving effects of botulinum toxin treatment

Cervical dystonia (CD) is a third most common movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and postures of head and neck. Physical, emotional, cognitive, and self-awareness aspects are also affected, so CD is currently considered to be a “network” disorder with the involvement of multiple brain regions and cellular mechanisms. Pain occurs in 54.6% to 88.9% of patients with CD and is the most disabling non-motor symptom which strongly attributes to the quality of life deterioration. The dystonia-related pain is also the main reason patients are looking for treatment. Despite the high prevalence only small number of studies develops this issue. Botulinum toxin (BoNT) is a safe, efficacious and first choice treatment for CD. Up to 90% of patients reports an improvement in pain and motor symptoms after BoNT injections, however above mentioned effects may be partially independent due to the earlier and longer pain relief compared to muscle relaxation. The results of current studies suggest analgesic effects of BoNT are related to not only the acting in the neuromuscular junction. The central processing of nociceptive stimuli is contributed to be the main effect of BoNT analgesic therapy. To date, evidence for the association between dystonia-related pain and BoNT treatment become more significant but is still lacking. Further research is needed to investigate above correlation and issue an unambiguous high-level recommendations of analgesic therapy in CD

Optimization of pain management in cervical dystonia

Cervical dystonia (CD) is the third most common movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements, postures, or both. Pain in the course of CD is a frequent symptom reported by the 54.6% - 88.9% of patients, which strongly affects the disability and quality of life, and is the most common reason patients are looking for treatment. Despite the main effect of botulinum toxin (BoNT) is muscle relaxation through the inhibition of the acetylcholine release at the neuromuscular junction, the analgesic effect of BoNT is probably attributed to the acting on central nervous system. Up to 20% of patients discontinue therapy due to treatment failure or adverse effects. Most poor responses are related to suboptimal treatment and a minority to immunoresistance which currently concerns only 0-2,5% of CD cases. In case of confirmed immunoresistance to BoNT-A standard therapy, the use of BoNT-B or alternative BoNT-A is recommended. The currently available management of improving the analgesic efficacy of first-line treatment in patients without immunoresistance includes: the eradication of BoNT adverse events, the determination of individual BoNT dosage, reviewing injections technique with electromyography or ultrasound guidance, the implementation of a rehabilitation program and the applying of the invasive or non-invasive brain stimulation methods. However, due to the lack of evidences from the large, randomized, controlled, clinical trials, an issuance of unambiguous recommendations remains difficult. Further studies on a poor response to BoNT injections and analgesic effects of above methods in the treatment of the CD-related pain are needed

Oligoclonal bands as predictors of multiple sclerosis in clinically isolated syndrome

Clinically Isolated Syndrome (CIS) is the first episode of inflammatory and demyelinating symptoms. According to the classification criteria of multiple sclerosis (MS) from 2013, CIS is defined as the first clinical manifestation of the disease. McDonald's 2010 criteria, considered the gold standard in the diagnosis of MS, are based on the clinical symptoms and the characteristic changes in magnetic resonance imaging (MRI). Unfortunately, up to 60-70% of patients with CIS do not meet the criteria for diagnosing MS at an early stage. At the same time, approximately 85% of patients with CIS will develop clinically defined MS (CDMS) in the future. When looking for other diagnostic tools, attention was paid to the role of oligoclonal bands (OBs) as predictors of MS development. Oligoclonal bands are immunoglobulins produced intrathecally by B-lymphocytes and plasma cells. Their level is examined in cerebrospinal fluid (CSF) collected by lumbar puncture. Studies carried out on a group of patients with CIS showed that people with positive test results for oligoclonal bands are twice as likely to develop MS than people with negative OBs. These conclusions are reflected in the revised McDonald's criteria in 2017, where OBs are used in the diagnosis of CIS patients with absence of new symptoms of the disease and changes in MRI. Early diagnosis makes possible to implement modifying disease drugs in the initial stage and, consequently, to achieve better therapeutic effects. The emphasis is also put on the development of other predictors in body fluids, which are effective in the diagnosis of people with CIS and negative oligoclonal bands. Many factors, including Epstein-Barr virus, chitinase-3 like 1, chitinase-3 like 2, chitotriosidase, multi-specific response to measles, rubella and varicella known as "MRZ reaction" or T-cell gene mutation are studied as a potential risk factors for MS development. Their use in diagnostics would improve the detection of MS in earlier stages, and thus the treatment of larger population of patients

Quantitative evaluation of crossed cerebellar diaschisis, using voxel-based analysis of Tc-99m ECD brain SPECT

BACKGROUND: In the recent literature there is no consensusregarding the relationships between crossed cerebellar diaschisis(CCD) with the primary lesion size, severity or location.Thus, the aim of the present study was to investigate relationshipbetween the size and severity of cerebral lesions and CCD in patientswith chronic stroke, using voxel-based analysis of Tc-99mECD single-photon emission computed tomography (SPECT).MATERIAL AND METHODS: We retrospectively reviewed dataof 57 patients with chronic ischemic lesions localized unilaterallyin the cerebral hemisphere. SPECT evaluation was performedwith the voxel-based analysis. The percentage inter-hemisphericasymmetry index (AI) and the volume of abnormal clusters ofvoxels (CV) were ascertained for hypoperfusion in the supratentoriallesion and contralateral cerebellum.RESULTS: CCD was present in 35.1% cases. In Group CCD(+), the CV and AI of supratentorial hypoperfusion (median128.1 ml and 21.9%, respectively) were significantly highercompared with Group CCD(–) (median 41.4 ml and 18.0%,respectively). Statistically significant correlation was foundbetween CV of supratentorial and cerebellar perfusion defects(r = 0.4; p < 0.05), between AI of supratentorial and cerebellarperfusion defects (r = 0.6; p < 0.05) and between CV of supratentorial defect and AI of cerebellar perfusion defects (r = 0.6; p < 0.05).CONCLUSIONS: Our data suggest, that in the chronic stageof stroke, the size and severity of the supratentorial lesion aredeterminants of CCD, correlating with the degree of cerebellarhypoperfusion

Biomarkers in Multiple Sclerosis: a review of diagnostic and prognostic factors

Introduction. Multiple Sclerosis (MS) is a chronic, demyelinating disease of the central nervous system which affects mostly young people. Because it leads to disability and cognitive impairment, it is crucial to recognise MS at an early stage.State of the art. Magnetic resonance imaging is the golden standard in MS diagnosis. However, it is not an infallible diagnostic tool, especially at the stage of clinically isolated syndrome. The incorporation of oligoclonal bands in the diagnostic process of MS is a step towards the extension of diagnostic methods. Recently, a lot of research has been carried out on potential biomarkers in blood serum and cerebrospinal fluid that may be useful in the diagnosis of MS.Clinical implications. This article summarises current knowledge on the use of new prognostic factors such as neurofilament light chain, chitinase 3-like 1 and 2, heat shock proteins, and tubulins in MS.Future directions. Despite numerous studies on the use of biomarkers in the diagnosis of MS, more extensive research is needed to determine the clinical usefulness of these molecules and to develop diagnostic tests applicable in everyday practice. This in turn may result in earlier MS detection, faster implementation of treatment, and better therapeutic effects

Predyktory objawów depresyjnych u pacjentów po udarze mózgu – obserwacja trzymiesięczna

Background and purpose Depression is one of the most common post-stroke complications, which could impair rehabilitation outcome and quality of life, and could also increase mortality after stroke. The aim of the present study was to assess the association between demographic, socioeconomic and clinical (stroke risk factors, type of stroke, location of vascular lesion, cognitive functions) factors on the presence and severity of post-stroke depressive symptoms in patients after first ever stroke as well as on their social functioning. Material and methods A prospective, cohort study with a three-month observation period was performed in seven centres. Severity of depressive symptoms was assessed with the help of a short, 15-item version of the Geriatric Depression Scale (GDS), 3 months after stroke onset. Results On the basis of GDS (GDS ≤ 5 points or > 5 points) patients were allocated to a group without (n = 160) or with symptoms suggestive of depression (n = 82). The study groups did not differ with respect to age, sex or place of residence. Univariate logistic regression analysis showed that independent predictors for the presence of symptoms suggestive of depression at 3 months after stroke were: low level of education, low income, greater severity of stroke, worse functional status, self-reported problems with daily-living activities and need of help in daily living activities. More than 60% of patients with depressive symptoms limited their social contacts. Patients with depressive symptoms were unsatisfied with their relations with life partners and friends. Conclusions Our study showed a complex aetiology of post-stroke depressive symptoms with an important role of socioeconomic factors. Depressive symptoms after stroke worsen existing health, social and economic problems, and cause social isolation of patients.Wstęp i cel pracy Depresja jest jednym z najczęstszych powikłań udaru mózgu, które znacząco wpływa zarówno na postęp rehabilitacji po udarze, jakość życia pacjentów, jak i umieralność. Celem badania była ocena wpływu czynników demograficznych oraz klinicznych związanych z udarem (czynniki ryzyka udaru mózgu, typ udaru, lokalizacja ogniska naczynio-pochodnego, nasilenie deficytu neurologicznego, funkcje poznawcze) na występowanie i nasilenie objawów depresyjnych u pacjentów po pierwszym w życiu udarze mózgu. Oceniano również funkcjonowanie społeczne pacjentów po udarze mózgu w zależności od nasilenia objawów depresyjnych. Materiał i metody Prospektywne, kohortowe badanie z 3-miesięcznym okresem obserwacji prowadzono w 7 ośrodkach. Nasilenie objawów depresyjnych po 3 miesiącach od udaru oceniano w 15-punktowej wersji Geriatrycznej Skali Depresji (Geriatric Depression Scale – GDS). Wyniki Na podstawie wyników uzyskanych w skali GDS (GDS ≤ 5 lub > 5 punktów) wyodrębniono grupę pacjentów bez depresji (n = 160) i z objawami sugerującymi depresję (n = 82). Chorzy z obu grup nie różnili się pod względem wieku, płci i miejsca zamieszkania. Znaczącymi predyk-torami występowania nasilonych objawów depresyjnych u pacjentów po udarze mózgu były: niższy poziom wykształcenia, niższe dochody, gorszy stan neurologiczny i funkcjonalny oraz trudności w życiu codziennym i potrzeba pomocy. Ponad 60% pacjentów z objawami depresyjnymi ograniczyło po udarze kontakty społeczne. Chorzy z objawami sugerującymi depresję oceniali gorzej swoje kontakty z rodziną i przyjaciółmi. Wnioski Badanie pokazuje złożoność przyczyn występowania objawów depresyjnych po udarze mózgu, wśród których istotną rolę odgrywają również czynniki społeczno-ekonomiczne. Występowanie objawów depresyjnych po udarze mózgu powoduje dodatkowo narastanie istniejących problemów oraz izolację społeczną chorych

Predyktory objawów depresyjnych u pacjentów po udarze mózgu : obserwacja trzymiesięczna

Background and purpose Depression is one of the most common post-stroke complications, which could impair rehabilitation outcome and quality of life, and could also increase mortality after stroke. The aim of the present study was to assess the association between demographic, socioeconomic and clinical (stroke risk factors, type of stroke, location of vascular lesion, cognitive functions) factors on the presence and severity of post-stroke depressive symptoms in patients after first ever stroke as well as on their social functioning. Material and methods A prospective, cohort study with a three-month observation period was performed in seven centres. Severity of depressive symptoms was assessed with the help of a short, 15-item version of the Geriatric Depression Scale (GDS), 3 months after stroke onset. Results On the basis of GDS (GDS ≤ 5 points or > 5 points) patients were allocated to a group without (n = 160) or with symptoms suggestive of depression (n = 82). The study groups did not differ with respect to age, sex or place of residence. Univariate logistic regression analysis showed that independent predictors for the presence of symptoms suggestive of depression at 3 months after stroke were: low level of education, low income, greater severity of stroke, worse functional status, self-reported problems with daily-living activities and need of help in daily living activities. More than 60% of patients with depressive symptoms limited their social contacts. Patients with depressive symptoms were unsatisfied with their relations with life partners and friends. Conclusions Our study showed a complex aetiology of post-stroke depressive symptoms with an important role of socioeconomic factors. Depressive symptoms after stroke worsen existing health, social and economic problems, and cause social isolation of patients