Helle Nurm 80

Eesti Arst 2018; 97(2):109–11

Transkraniaalne aju ultraheliuuring Eesti parkinsoni tõve haigetel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneEestis läbiviidud uurimustöö eesmärgiks oli näidata aju ultraheli uuringu abil Parkinsoni tõve korral tekkivaid muutusi keskajus asuvas musttuumas, mis aitaks seda haigust diagnoosida. Täiendavalt uuriti ka ultraheliuuringu tulemuste seoseid depressiivsete sümptomite esinemisega. Tegemist on innovaatilise meetodiga Parkinsoni tõve diagnoosimiseks, mida Eestis pole varem uuritud. Uuringus osales 300 PT patsienti ja 200 kontrollisikut. Aju musttuum sisaldab dopamiinirakke, mis Parkinsoni tõvega haigetel haiguse kulu jooksul hävinevad. Läbi kolju tehtava ultraheliuuringu käigus on võimalik mõõta musttuuma piirkonna suurust ja selle kajarikkuse (hüperehhogeensuse) asümmeetria alusel kinnitada Parkinsoni tõve diagnoosi. Uuringul määrati ultraheli diagnostiline väärtus haigete eristamiseks tervetest, mis ühtib varasemalt teistes riikides leitud tulemustega; kõige olulisemaks tulemuse mõjutajaks on vanus. Lisaks näidati erinevust vasaku ja parema ajupoole vahel, mis on seoses esmassümptomite tekkimise poolega. Lisaks aitab ultraheliuuring kirjeldada depressiivsete sümptomite ilmnemist Parkinsoni tõvega haigetel ajutüves asuvate Raphe tuumade ehhogeensuse esinemise põhjal. Raphe tuumad osalevad virgatsaine serotoniini tootmisel, mille vähenemisel kahjustuse korral võivad tekkida depressiooni sümptomid. Uuring näitas, et ultraheli uuring võimaldab hinnata Raphe tuumade terviklikkust ja on hea meetod varjatud depressiooni sümptomite väljaselgitamiseks. Läbiviidud uuring oli esimene ulatuslik aju ultraheliuuring Eestis, mis kinnitas ultraheliuuringu diagnostilist väärtust Parkinsoni tõve diagnoosimiseks. Lisaks teaduslikule väärtusele on sellel oluline kliiniline tähtsus seoses uue meetodi rakendamisega Parkinsoni tõve käsitluses.The aim of the research carried out in Estonia was to show by transcranial brain sonography the changes in Parkinson's disease in substantia nigra, which would help diagnose the disease. Transcranial brain sonography is an innovative method for diagnosing Parkinson's disease, which has not been studied in Estonia before. By sonography examination of the skull, it is possible to measure the size of the substantia nigra echogenicity and confirm the diagnosis of Parkinson's disease on the basis of its asymmetry in substantia nigra hyperechogenicity. The study determined the diagnostic value of SN+ to distinguish patients from healthy ones, which is consistent with the results previously found in other countries. There was a difference between the left and right sides of the SN+ that are related to the onset of the Parkinson’s disease initial symptoms. In addition, age was the most important factor influencing the asymmetry of SN+. The ultrasound study helps to describe the appearance of depressive symptoms in PD patients based on the occurrence of echogenicity of Raphe nuclei in the brainstem. The study showed that the transcranial brain sonography examination provides an estimate of the integrity of the Raphe nuclei and is a good method for detecting the symptoms of hidden depression. The conducted study was the first extensive transcranial brain sonography study in Estonia confirming the diagnostic value of ultrasound in the diagnosis of Parkinson's disease.  https://www.ester.ee/record=b5250326~S

Treemorid

Treemorite kui ühtede sagedasemate neuroloogilisete motoorikahäirete erinevate vormide ja tremoroossete sündroomide jaotus põhineb valdavalt kliinilistel kriteeriumitel. Kõiki treemori erinevaid põhjusi arvesse võtva konsensusliku otsuse võttis 1998. a vastu rahvusvaheline Ekstrapüramidaal- ja Liigutushäirete Ühing. Käesolev artikkel võtab kokku selle otsuse määratlused ning ravisoovitused erinevate treemori vormide kohta. Kliiniliste kriteeriumite alusel on eristatud järgmised tremoroossed sündroomid: väljendunud füsioloogiline, klassikaline essentsiaalne, ortostaatiline, sooritus-, düstooniline, parkinsonistlik, tserebellaarne, Holmesi, ravimitest ja toksiinidest indutseeritud, neuropaatiline ning psühhogeenne treemor. Eesti Arst 2008; 87(6):424−43

Kiire kuluga dementsus, mis osutus Creutzfeldti-Jakobi tõveks: haigusjuhu kirjeldus

  Prioonhaigused on haruldased neurodegeneratiivsed haigused, mis põhjustavad kiire kuluga dementsuse ja lõpevad alati surmaga. Creutzfeldti-Jakobi tõbi kuulub prioonhaiguste hulka ning sellesse haigestub keskmiselt 1 inimene 1 miljoni kohta aastas. Haiguse sümptomid on mittespetsiifilised ja heterogeensed, mistõttu võib õige diagnoosini jõudmine osutuda sageli keeruliseks. Artiklis on kirjeldatud 70aastase naise haigusjuhtu, kes sattus neuroloogiaosakonda peaajuinfarkti kahtlusega. Edasiste uuringute käigus selgus, et patsiendil esineb Creutzfeldti-Jakobi tõvele iseloomulik kliiniline leid. Naine suri 5 kuud pärast hospitaliseerimist. Prioonvalgu määramine ajukoest osutus negatiivseks. Haigusjuht näitab, kui mitmekülgne on kiire kuluga dementsuse tänapäevane käsitlus ning milliseid haigusi ja sündroome tuleb nendel juhtudel kahtlustada. Artiklis on pakutud välja erinevaid diagnoosimisvõimalusi Creutzfeldti-Jakobi tõve elupuhuseks diagnostikaks. Eesti Arst 2018; 97(4):213–21

Adapting The Sniffin' Sticks Olfactory Test To Diagnose Parkinson's Disease In Estonia.

The aim of the study was to develop a culturally adapted translation of the 12-item smell identification test from Sniffin' Sticks (SS-12) for the Estonian population in order to help diagnose Parkinson's disease (PD). A standard translation of the SS-12 was created and 150 healthy Estonians were questioned about the smells used as response options in the test. Unfamiliar smells were replaced by culturally familiar options. The adapted SS-12 was applied to 70 controls in all age groups, and thereafter to 50 PD patients and 50 age- and sex-matched controls. 14 response options from 48 used in the SS-12 were replaced with familiar smells in an adapted version, in which the mean rate of correct response was 87% (range 73-99) compared to 83% with the literal translation (range 50-98). In PD patients, the average adapted SS-12 score (5.4/12) was significantly lower than in controls (average score 8.9/12), p < 0.0001. A multiple linear regression using the score in the SS-12 as the outcome measure showed that diagnosis and age independently influenced the result of the SS-12. A logistic regression using the SS-12 and age as covariates showed that the SS-12 (but not age) correctly classified 79.0% of subjects into the PD and control category, using a cut-off of <7 gave a sensitivity of 76% and specificity of 86% for the diagnosis of PD. The developed SS-12 cultural adaption is appropriate for testing olfaction in Estonia for the purpose of PD diagnosis.20830-

Randomized Double-Blind Placebo-Controlled Trial of the Corticosteroid-Sparing Effects of Immunoglobulin in Myasthenia Gravis

Background and objectivesMyasthenia gravis (MG) is an autoimmune disease characterized by dysfunction at the neuromuscular junction. Treatment frequently includes corticosteroids (CSs) and IV immunoglobulin (IVIG). This study was conducted to determine whether immune globulin (human), 10% caprylate/chromatography purified (IGIV-C) could facilitate CS dose reduction in CS-dependent patients with MG.MethodsIn this randomized double-blind placebo-controlled trial, CS-dependent patients with MG (Myasthenia Gravis Foundation of America Class II-Iva; AChR+) received a loading dose of 2 g/kg IGIV-C over 2 days (maximum 80 g/d) or placebo at week 0 (baseline). Maintenance doses (1 g/kg IGIV-C or placebo) were administered every 3 weeks through week 36. Tapering of CS was initiated at week 9 and continued through week 36 unless the patient worsened (quantitative MG score ≥4 points from baseline). CS doses were increased (based on the current CS dose) in patients who worsened. Patients were withdrawn if worsening failed to improve within 6 weeks or if a second CS increase was required. The primary efficacy end point (at week 39) was a ≥50% reduction in CS dose. Secondary and safety end points were assessed throughout the study and follow-up (weeks 42 and 45). The study results and full protocol are available at clinicaltrials.gov/ct2/show/NCT02473965.ResultsThe primary end point (≥50% reduction in CS dose) showed no significant difference between the IGIV-C treatment (60.0% of patients) and placebo (63.3%). There were no significant differences for secondary end points. Safety data indicated that IGIV-C was well tolerated.DiscussionIn this study, IGIV-C was not more effective than placebo in reducing daily CS dose. These results suggest that the effects of IGIV-C and CS are not synergistic and may be mechanistically different.Trial registration informationThe trial was registered on clinicaltrialsregister.eu (EudraCT #: 2013-005099-17) and clinicaltrials.gov (identifier NCT02473965).Classification of evidenceThis study provides Class II evidence that IVIG infusions in adult patients with MG do not increase the percentage of patients achieving a ≥50% reduction in corticosteroid dose compared with placebo