Sleep Disorders in Cervical Dystonia, Parkinson’s Disease and Depression – What Is the Difference?

Introduction: Sleep disorders are among the most common non-motor symptoms in patients with cervical dystonia (CD), Parkinson\u27s disease (PD), and depression. The study aimed to assess the prevalence and characteristics of sleep disorders in patients with cervical dystonia compared to healthy controls, patients with Parkinson\u27s disease, and patients with depression. Methods: In this cross-sectional study, we evaluated 122 patients (30 control patients, 30 with cervical dystonia, 32 with Parkinson\u27s disease, and 30 with depression). Demographic data were collected. All of them, except for the depression group, were tested for depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Sleep disorders were evaluated using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Statistical significance was defined at α=0.05. Results: Patients with cervical dystonia differed from the healthy control group in terms of PSQI score and some subscales. The depression group differed in most PSQI subscales when compared to the patients with Parkinson\u27s disease and cervical dystonia, while the latter two groups of patients differed only in the duration subscale. Patients with Parkinson\u27s disease differed from other groups of patients only in one subscale - daytime sleepiness. Conclusion: Cervical dystonia patients suffer from more sleep disturbances when compared to healthy controls. There are differences in the frequency and extent of sleep disturbances with less pronounced symptoms in patients with cervical dystonia and Parkinson\u27s disease, while patients with depression present the most pronounced symptoms. Symptoms of depression and anxiety correlate with sleep disturbances in patients with Parkinson\u27s disease and cervical dystonia. Patients with cervical dystonia do not experience daytime sleepiness problems. (Tomic S, Degmecic D, Gjoni F, Dumencic I, Milanovic S, Gilman Kuric T, Popovic Z, Mirosevic Zubonja T. Sleep Disorders in Cervical Dystonia, Parkinson’s Disease and Depression – What is the Difference? SEEMEDJ 2020; 4(2); 35-47

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

UPDATE ON GUIDELINES FOR PHARMACOLOGICAL TREATMENT OF MULTIPLE SCLEROSIS BY THE CROATIAN SOCIETY FOR NEUROVASCULAR DISORDERS OF THE CROATIAN MEDICAL ASSOCIATION AND CROATIAN SOCIETY OF NEUROIMMUNOLOGY AND NEUROGENETICS

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicama.Multiple sclerosis (MS) affects the central nervous system (CNS) and presents by numerous symptoms from different CNS functional systems. As the number of available treatments has increased in recent years, the need has emerged for continuous evaluation on MS diagnosis and treatment based on evidence-based medicine. This implies the need for continuous renewal of national and international guidelines, in our case, based on the regional guidelines of the European Committee for Treatment and Research in Multiple Sclerosis and European Academy of Neurology (EAN) with the aim of providing the best medical therapy for each patient, based on an individualized approach. These new guidelines are based on the recently updated EAN recommendations that have been derived as the result of exhaustive literature research as of December 2016. Given the risk of system error, the quality of evidence for each outcome has been subdivided into four categories, as follows: very high, high, low and very low. Given the quality of evidence and the risk and benefit ratio, the recommendations are accompanied by strong and weak strength. The research was focused on several key issues, including treatment effectiveness, response to therapy applied, strategy for recognizing appropriate response and safety, and therapeutic strategy for MS treatment during pregnancy. The guidelines cover all medicines that modify the course of the disease and are approved by the European Medicines Agency. Patients with clinically isolated syndrome that do not meet diagnostic criteria for clinically definitive MS have been assigned to special groups while patients with proven MS are divided into different clinical subtypes of MS in accordance with valid diagnostic guidelines

Psychiatric Symptoms in Women with Focal Cervical Dystonia - Exploring New Pathophysiological Pathways

So far there is not much research considering female sex as a risk factor for developing focal cervical dystonia and concomitant psychiatric symptoms such as anxiety. New research proposes ideas of CD baseline pathophysiology targeting neurobiological mechanisms of gamma aminobutyric acid GABAergic function underlying sexual dimorphism and psychiatric symptoms as an intrinsic factor of the disease itself. Our research examines the connection between motor and non-motor symptoms in female patients suffering from focal cervical dystonia and their response to treatment, cit- ing the available literature and hypothesising whether it can be linked to previously described alterations in GABA levels

Treatment of relapsing multiple sclerosis - recommendations of the Croatian Neurological Society

Untreated multiple sclerosis (MS) irretrievably leads to severe neurological impairment. In European health care systems, patient access to disease modifying therapies (DMT) is often confined to more advanced stages of the disease because of restrictions in reimbursement. A discrepancy in access to DMTs is evident between West and East European countries. In order to improve access to DMTs for people with MS (pwMS) living in Croatia, the Croatian Neurological Society issued new recommendations for the treatment of relapsing MS. The aim of this article is to present these recommendations. The recommendations for platform therapies are to start DMT as soon as the diagnosis is made. If poor prognostic criteria are present (≥9 T2 or FLAIR lesions on the initial brain and spinal cord magnetic resonance imaging [MRI] or ≥3 T1 lesions with postcontrast enhancement on the initial brain and spinal cord MRI or Expanded Disability Status Scale after treatment of the initial relapse ≥3), high-efficacy DMT should be initiated. If pwMS experience ≥1 relapse or ≥3 new T2 lesions while on platform therapies, they should be switched to high-efficacy DMT. Further efforts should be made to enable early and unrestricted access to high-efficacy DMT with a freedom of choice of an appropriate therapy for expert physicians and pwMS. The improvement of access to DMT achieved by the implementation of national treatment guidelines in Croatia can serve as an example to national neurological societies from other Eastern European countries to persuade payers to enable early and unrestricted treatment of pwMS

Update on guidelines for pharmacological treatment of multiple sclerosis by the croatian society for neurovascular disorders of the Croatian medical association and Croatian society of neuroimmunology and neurogenetics

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicam

Update on guidelines for pharmacological treatment of multiple sclerosis by the croatian society for neurovascular disorders of the Croatian medical association and Croatian society of neuroimmunology and neurogenetics

Multipla skleroza (MS) je bolest središnjeg živčanog sustava koja se prezentira brojnim simptomima iz različitih funkcijskih cjelina toga sustava. Kako se posljednjih godina povećao broj dostupnih lijekova, ukazuje se potreba trajne provjere saznanja o dijagnostici i liječenju ove bolesti putem medicine temeljene na dokazima. Time se nameće i potreba kontinuiranog obnavljanja nacionalnih i međunarodnih smjernica, u našem slučaju, na razini regionalnih smjernica Europskog odbora za liječenje i istraživanje multiple skleroze (engl. ECTRIMS, European Committee of Treatment and Research in Multiple Sclerosis) i Europske neurološke akademije (engl. EAN, European Academy of Neurology) s ciljem omogućavanja najbolje medicinske terapije za svakog bolesnika, koja je temeljena na individualiziranom pristupu. Temelji novih smjernica su nedavno ažurirane EAN-ove preporuke za razvoj smjernica, koje su rezultat iscrpnog istraživanja literature do prosinca 2016. godine. S obzirom na rizik od sistemske pogreške, kvaliteta dokaza za svaki ishod bila je stupnjevana u četiri kategorije kako slijedi: vrlo visoka, visoka, niska i vrlo niska. S obzirom na kvalitetu dokaza te omjera rizika i dobrobiti preporukama je pridružena snažna i slaba jačina. Pozornost istraživanja bila je usmjerena na nekoliko najvažnijih pitanja, koja su obuhvaćala uspješnost liječenja, odgovor na primijenjenu terapiju, strategiju za prepoznavanje odgovarajućeg odgovora i sigurnost, te terapijsku strategiju liječenja multiple skleroze u trudnoći. Smjernicama su obuhvaćeni svi lijekovi koji modifi ciraju tijek bolesti, a koji su odobreni od strane Europske agencije za lijekove (engl. EMA, European Medicine Agency). U posebne skupine raspoređeni su bolesnici s klinički izoliranim sindromom koji ne ispunjavaju dijagnostičke kriterije za klinički defi nitivnu MS, dok su bolesnici s dokazanom MS podijeljeni s obzirom na različite kliničke podtipove MS-a sukladno važećim dijagnostičkim smjernicam