Kliničke i psihijatrijske manifestacije sindroma pečenja usta

According to International Headache Society (IHS) classification, burning mouth syndrome (BMS) is intra oral burning sensation without obvious medical and dental cause. IHS diagnostic criteria of the disorder include the presence of burning oral sensation during the most period of day without obvious changes of oral mucosa. Local and systemic causes have to be excluded by appropriate diagnostic procedures. Subjective feeling of dry mouth, paraesthesia and taste changes could be associated symptoms. Estimated prevalence of BMS in general population varies between 1 and 15% and the disorder is seven times more common in females. This condition is probably of multifactor origin, oft en idiopathic, and its etiology and pathogenesis has not been elucidated completely yet. More recently, increasing attention has been given to the altered perception of sensory functions as well as to the changes in the psychological profile of many BMS patients. As a result, both disturbances should be included in the clinical spectrum of BMS. BMS represents a disorder with a poor prognosis in terms of quality of life and treatment possibilities. As a result, BMS subjects continue to be high consumers of healthcare resources. As in the other chronic pain conditions it has been reported that depression and anxiety are strongly associated with BMS and that they are significantly more frequent in BMS patients than in non-BMS subjects.Prema međunarodnoj klasifikaciji glavobolja Internacionalnog društva za glavobolje (International Headache Society-IHS), sindrom pečenja usta (burning mouth syndrome-BMS) predstavlja osećaj pečenja u usnoj duplji, a bez očiglednog medicinskog ili stomatološkog uzroka. IHS dijagnostički kriterijumi za ovaj poremećaj uključuju prisustvo senzacije pečenja u usnoj duplji za vreme najvećeg perioda dana, bez vidljivih promena sluznice usne duplje. Lokalni i sistemski uzroci moraju biti isključeni primenom odgovarajućih dijagnostičkih procedura. Subjektivni osećaj suvoće usta, parestezija i izmena osećaja ukusa mogu biti udruženi simptomi. Procenjena prevalenca BMS u opštoj populaciji varira između 1 i 15%, a poremećaj je sedam puta češći kod žena. Ovaj poremećaj je verovatno multifaktorijelnog porekla, često idiopatski, a njegova etiologija i patogeneza nisu u potpunosti razjašnjeni. U skorašnjim studijama, posebno se ističe značaj izmenjene percepcije senzornih funkcija i sistema kao i specifična promena psihološkog profi la mnogih pacijenata sa BMS. Zbog toga se preporučuje da oba navedena poremećaja budu uključena u klinički raznovrstan spektar BMS. BMS ima lošu prognozu u pogledu kvaliteta života obolelih i terapijskih mogućnosti, a kao rezultat ovaj poremećaj predstavlja veliki socio-ekonomski i medicinski problem. Kao i kod drugih hroničnih bolnih stanja, postoji značajna udruženost BMS sa depresijom i anksioznošću. Ovi ali i drugi psihijatrijski i psihološki poremećaji su značajno češći kod pacijenata sa BMS u odnosu na zdravu populaciju

Efficacy of gamma knife radiosurgery for the treatment of trigeminal neuralgia

Introduction: Trigeminal neuralgia, also called 'tic douloureux', is a chronic pain condition that affects the trigeminal nerve and it is the most common cause of facial pain in adults. Gamma knife radiosurgery has been increasingly used in the treatment of medically refractory trigeminal neuralgia, as a non-invasive alternative to microvascular decompression and rhizotomies. Aim: The aim of this study was to determine the early efficacy of gamma knife radiosurgery in a group of patients with trigeminal neuralgia, treated in the Clinical Center of Serbia. Material and methods: We checked all the patients treated with gamma knife radiosurgery for trigeminal neuralgia at the Clinic of Neurosurgery at the Clinical Center of Serbia in Belgrade, in a period between the end of 2015 and beginning of 2018. They were examined after the first, third, sixth, ninth month and a year after the radiosurgery. Informations about the pain and its intensity, type and dosage of pharmacotherapy were collected. Surgery was considered successful if it reduced the pain for a minimum of 30% or led to the reduction of pharmacotherapy needed to control the pain in comparison to the dosages before surgery. Results: There was a trend of decreased efficacy that lasted for a year after the implementation of procedure, which, most likely, resulted from a short period of monitoring and assessment of the patient's condition. Conclusion: The results from this study show that gamma knife radiosurgery could be one of the options in treatment of trigeminal neuralgia

Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort

Background: Sex is a significant determinant of survival and functional outcome after stroke. Long-term cognitive outcome after acute lacunar stroke in the context of sex differences has been rarely reported. Methods: A cohort of small vessel disease (SVD) patients presenting with first-ever acute lacunar stroke and normal cognitive status has been evaluated 4 years after the qualifying event for the presence of cognitive impairment (CI) with a comprehensive neuropsychological battery. Differences in baseline clinical and neuroimaging characteristics were compared between sexes in relation to cognitive status. Results: A total of 124 female and 150 male patients were analyzed. No difference was detected between the groups regarding age (p = 0.932) or frequency of common vascular risk factors (p > 0.1 for all). At the baseline assessment, women had more disabilities compared to men with a mean modified Rankin scale (mRS) score of 2.5 (1.5 in men, p < 0.0001). Scores of white matter hyperintensities (WMH) of presumed vascular origin and a total number of lacunes of presumed vascular origin on brain MRI were higher in women compared to men (p < 0.0001 for all). As many as 64.6% of patients had CI of any severity on follow-up, women more frequently (77.4%) than men (54.0%; p < 0.0001). Univariate logistic regression analysis showed that female sex, higher NIHSS and mRS scores, presence of depression, and increasing WMH severity were associated with an increased risk for CI. Multivariate regression analysis indicated that only depression (OR 1.74, 95%CI 1.25–2.44; p = 0.001) and WMH severity (OR 1.10, 95%CI 1.03–1.17; p = 0.004) were independently associated with the CI. Conclusion: At the long-term follow-up, women lacunar stroke survivors, compared to men, more frequently had CI in the presence of more severe vascular brain lesions, but this association was dependent on the occurrence of depression and severity of WMH, and could not be explained by differences in common vascular risk factors. Copyright © 2023 Pavlovic, Pekmezovic, Mijajlovic, Tomic and Zidverc Trajkovi

Afektivni status kod bolesti malih krvnih sudova mozga

Introduction. Cerebral small vessel disease is a neurological con- dition characterized by motor, cognitive and affective disorders, often found on brain magnetic resonance imaging scans in patients with vascular risk factors. Affective disorders may have a major impact on patients’ quality of life, although they are often ignored as an entity in cerebrovascular pathology. Material and Methods. This prospective study included 80 patients with the diagnosis of cerebral small vessel disease admitted at the Clinic of Neurology, Clinical Center of Serbia in the period from January 1, 2017 to January 1, 2019. Baseline demographic data and brain magnetic resonance findings were obtained along with the results of cogni- tive function and affective status tests. Data were analyzed using standard statistical tests. Results. Standard screening tests revealed that 51.25% and 33.75% of our patients with cerebral small vessel disease suffer from apathy and depression, respectively. A sig- nificant correlation was found between the severity of white mat- ter changes on magnetic resonance scans and apathy (p = 0.0092). Additionally, white matter changes were also significantly associ- ated with depression (p = 0.021). Conclusion. Affective disorders are not uncommon in cerebral small vessel disease and apathy was the leading phenomenon among our patients. Since a strong cor- relation was detected between affective disorders and severity of vascular changes on magnetic resonance scans, we may conclude that both apathy and depression are key features of an underlying brain injury, rather than just comorbidity.Uvod. Bolest malih krvnih sudova mozga je neurološko stanje za koje su karakteristični motorni, kognitivni i afektivni poremećaji i koje se često dijagnostikuje na snimcima mozga magnetnom rezo- nancijom kod pacijenata sa vaskularnim faktorima rizika. Promene u afektivnom statusu imaju veliki uticaj na kvalitet života pacijena- ta iako su neretko bile zanemaren fenomen u cerebrovaskularnoj patologiji. Materijal i metode. U prospektivnoj studiji obuhvaćeno je 80 pacijenata sa dijagnozom bolest malih krvnih sudova mozga lečenih i ispitivanih na Klinici za neurologiju Kliničkog centra Sr- bije, u periodu od 1. januara 2017. godine do 1. januara 2019. godine. Analizirani su osnovni demografski podaci, nalaz na magnetnoj rezonanciji mozga i rezultati testova kognitivnih funkcija i afektiv- nog statusa, upotrebom standardnih statističkih metoda. Rezultati. Rezultati testova za apatiju i depresiju ukazali su da je 51,25% bo- lesnika sa ovom bolešću pokazivalo prisustvo apatije, a 33,75% prisustvo depresivnog poremećaja. Dokazana je statistički značajna povezanost između težine lezija bele mase mozga na magnetnore- zonantnim snimcima mozga i apatije (p = 0,0092), odnosno težine lezija bele mase i depresije (p = 0,021). Zaključak. Izmene afektiv- nog statusa nisu retka manifestacija cerebralne bolesti malih krvnih sudova mozga, a najčešći fenomen u našoj grupi bolesnika bila je apatija. Budući da je detektovana značajna povezanost između afek- tivnih poremaćaja i težine vaskularnih lezija na magnetno-rezonan- tnim snimcima mozga, smatramo da su apatija i depresivnost najpre deo kliničke slike ove bolesti a ne jedan od komorbiditeta

Afektivni status kod bolesti malih krvnih sudova mozga

Introduction. Cerebral small vessel disease is a neurological con- dition characterized by motor, cognitive and affective disorders, often found on brain magnetic resonance imaging scans in patients with vascular risk factors. Affective disorders may have a major impact on patients’ quality of life, although they are often ignored as an entity in cerebrovascular pathology. Material and Methods. This prospective study included 80 patients with the diagnosis of cerebral small vessel disease admitted at the Clinic of Neurology, Clinical Center of Serbia in the period from January 1, 2017 to January 1, 2019. Baseline demographic data and brain magnetic resonance findings were obtained along with the results of cogni- tive function and affective status tests. Data were analyzed using standard statistical tests. Results. Standard screening tests revealed that 51.25% and 33.75% of our patients with cerebral small vessel disease suffer from apathy and depression, respectively. A sig- nificant correlation was found between the severity of white mat- ter changes on magnetic resonance scans and apathy (p = 0.0092). Additionally, white matter changes were also significantly associ- ated with depression (p = 0.021). Conclusion. Affective disorders are not uncommon in cerebral small vessel disease and apathy was the leading phenomenon among our patients. Since a strong cor- relation was detected between affective disorders and severity of vascular changes on magnetic resonance scans, we may conclude that both apathy and depression are key features of an underlying brain injury, rather than just comorbidity.Uvod. Bolest malih krvnih sudova mozga je neurološko stanje za koje su karakteristični motorni, kognitivni i afektivni poremećaji i koje se često dijagnostikuje na snimcima mozga magnetnom rezo- nancijom kod pacijenata sa vaskularnim faktorima rizika. Promene u afektivnom statusu imaju veliki uticaj na kvalitet života pacijena- ta iako su neretko bile zanemaren fenomen u cerebrovaskularnoj patologiji. Materijal i metode. U prospektivnoj studiji obuhvaćeno je 80 pacijenata sa dijagnozom bolest malih krvnih sudova mozga lečenih i ispitivanih na Klinici za neurologiju Kliničkog centra Sr- bije, u periodu od 1. januara 2017. godine do 1. januara 2019. godine. Analizirani su osnovni demografski podaci, nalaz na magnetnoj rezonanciji mozga i rezultati testova kognitivnih funkcija i afektiv- nog statusa, upotrebom standardnih statističkih metoda. Rezultati. Rezultati testova za apatiju i depresiju ukazali su da je 51,25% bo- lesnika sa ovom bolešću pokazivalo prisustvo apatije, a 33,75% prisustvo depresivnog poremećaja. Dokazana je statistički značajna povezanost između težine lezija bele mase mozga na magnetnore- zonantnim snimcima mozga i apatije (p = 0,0092), odnosno težine lezija bele mase i depresije (p = 0,021). Zaključak. Izmene afektiv- nog statusa nisu retka manifestacija cerebralne bolesti malih krvnih sudova mozga, a najčešći fenomen u našoj grupi bolesnika bila je apatija. Budući da je detektovana značajna povezanost između afek- tivnih poremaćaja i težine vaskularnih lezija na magnetno-rezonan- tnim snimcima mozga, smatramo da su apatija i depresivnost najpre deo kliničke slike ove bolesti a ne jedan od komorbiditeta

Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

Level of education and cerebral small vessel disease

Bolest malih krvnih sudova mozga (BMKS) je odgovorna za najveći broj možda- nih udara i vaskularno kognitivno oštećenje i obično je posledica klasičnih vaskularnih faktora rizika. Cilj našeg rada je da se u kohorti bolesnika sa BMKS ispita povezanost stepena obrazovanja i kliničke i radiološke sli- ke BMKS. U studiji je analizirano 424 ispitanika, srednje životne dobi od 62 godine, 53% muškog pola, različitog stepena obrazovanja u trajanju od 8 do 20 godina. Pokazana je statistički značajna povezanost stepena obrazovanja sa postojanjem simptoma depresije (p=0,050), ukupnom težinom lezija na MR moz- ga (p=0,029), kao i ukupnim brojem izolovanih lakunarnih ishemija (p=0,032). Zabeležena je povezanost pola (p=0,055) i lezija u periventrikularnoj regiji (p=0,062) sa stepenom obrazovanja na nivou statističkog trenda. Mehanizmi kojima stepen obrazovanja može uticati na rizik za nastanak vaskular- nih lezija mozga nisu u potpunosti razjašnjenji. Deo ove povezanost se može objasniti nižim socijalno-ekonomskim statusom, povećanom učestalošću vaskularnih bolesti (hipertenzija, dijabetes) i nezdravim navikama (pušenje, visokokalorijska ishrana, sedentarni način života), ali postoje dokazi da je ova korelacija nezavisna od klasičnih vaskularnih faktora rizika. Otkrivanje i rano korigovanje preventibilnih faktora za nastanak vaskularnih lezija mozga od velikog je društvenog značaja, uz potencijal da rane socijalne i eduka- tivne intervencije pozitivno utiču na status cerebralne cirkulacije kasnije u životu.Cerebral small vessel disease (CSVD), the most frequent cause of stroke and vascular cognitive impairment, is typically associated with common vascular risk factors. Our paper aims to analyze the correlation between the level of education and clinical and radiological presentation in a cohort of patients with CSVD. A total of 424 patients have been recruited, with a mean age of 62 years, 53% males, with years of education ranging from 8 to 20. We found a statistically significant correlation between depressive symptoms (p=0.050), total severity of cerebral lesions on MR scans (p=0.029), and the total number of lacunar ischemic lesions (p=0.032). The correlation between sex (p=0.055) and periventricular lesions (p=0.062) with educational status was at the level of the statistical trend. The putative mechanisms of the association between education and the risk for vascular brain lesions were not fully elucidated. Partially, this association can be explained by lower socioeconomic status, increased incidence of vascular diseases (hypertension, diabetes), and unhealthy lifestyle (smoking, poor diet, sedentary lifestyle), however, this association might also be independent of common vascular risk factors. Identification and early management of preventable risk factors for cerebral vascular lesions are of most importance to society, with the potential of early social and educational intervention to positively affect cerebral circulation status later in life

Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the “patient journey”) with perplexing obstacles. High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary. The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded. It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses

Pharmacotherapy of the most frequent headaches in adults

Tension-type headache, migraine, cluster headache and medication overuse headache are the most frequent headaches in adults. First-line treatments for migraine attack are nonsteroidal anti-inflammatory drugs and triptans, and metoprolol, propranolol, topiramate, valproates and flunarizine (not registered in Serbia) for prophylactic therapy. Nonsteroidal anti-inflammatory drugs are recommended for attacks of tension-type headache and amitriptyline, mirtazapine and venlafaxine as prophylactic therapy. Cluster headache attack should be treated with oxygen, sumatriptan or zolmitriptan, while verapamil and prednisone are efficacious as prophylactics for episodic and lithium carbonate for chronic form of the disorder. Medication overuse headache is treated by withdrawal of overused medication with or without introduction of prophylactic treatment. Careful selection of drugs is needed for pregnancy and lactation, as well as for elderly patients