Цел: Да се откријат функционалните растројства кај болни со мигрена со помош на неврофизиолошките истражувања, како и фамилијарната експресија мигрената, начинот на наследувањето и евентуалните хромозомски аберации кај случаи на фамилијарна мигрена, која се јавува кај повеќе членови во една фамилија

Ilievska, Liljana

UGD Academic Repository

TPET KOHfPEC HA HEBPOJI03 IITE HA PEnYEJIIIKA MAKE)1;OHIIJA c o MEfyHAPOAHO y qECTBO CTpyMH~a, 22-25 CeDTeMBpn 2004 UDK: 61+061.231=866=20 CODEN: MKMPA3 ISlll'f9989-37-012-5 r J CLINICAL NE l RorIlYS lOLO( ;Y I NEUROLOGIC PRACTI E ,5iilflllO IlC () D CpaJ1 rnelli or Nenrul l g y, UntW l", it ' CI ·lllI.:.ll Cenle l'. . ' ho i o f IcJi\: ine. Univers ity ()J Ttl7 1;! Bosni:1 :md Tre r7egovi nJ hn l 'a l llcurupily,i n lngy has t' \ 'olvcJ !'rom e l ec t rnm~ ography \ ',MG) and c lectrocncephal ogra · ph)' to inc lude J number of other Illl!{h, ds , ~llch as nerve umJutirm studIes (dectroncli rogra­phy/ ~ N .r). r [1c tit itvc nerve stlmulatlun lest amI : lIlgle fibe r e\ec tromyngraphy. evo"cd poLen­ti als (EP" (bo th motne unci varll)US [.'pcs of ~ellMlry modalilies ), intrallpera llvc moniwn ng. test­ing \I I the Cl utC1n nl1l ic ne rV()lIS sy"te rn , slcc r studIes , . cns:J.ti o n thrc!ihol d st udies and cogm!J \'c te stmg , These methods are not onl y used In adul t and ped iatri c neu 'oingy, but illso in rehabi lita· tlOn medicine , ps_ ch i~l tr ' and many othe r speei;!1iti es . Thi, pl'csentat ion will foc ll s un ly on the role uf EPs and EM !ENG (electromyoneu ­rography '. 1NG III cl inical neuwlngic prac tice . Evoked fJotentiab (EPs ) are tile electri c rc:sponses (lithe ner (IUS system (cortil'<l l rc~ p(\n ~e ) to motor or sen ory s timul at ion Patte rn -sll1ft visual. brain stem auditory and short-la tency S(l lll..H ()S nsory ev( ked potentials are re ll ahle di ag­nostic tests that yield reproduc ible results t day in routi ne clinical pra<:ti ce. These tes ts pro Ide sensitive. quantita ti ve ex tensions orthe clinical neurological xamination . T hey prinJa rii y afford numerical data, but S Hl1 times the ahs<:ll ce o f .vave nr an ahnormal cnnfigu ration of its poten­ti a ls also provides useful inf0rmati (1n. Th ' numerous di sorders ha ve beell shown to have differ­ent abnormalities of EPs , and among (h m mUlt iple sc leros is (MS), Parkinson's disease and brall1stem lesions. However, they are mos t oft en used in providi ng addit ional evidence in sup­port or diagnosis of MS , The various EMNG mcthods hav pro ell thei r value in the diagnosis, evaluation of prognosi ' and monitoring of neuromuscular di ~ordcrs . hese neurophysiologic tests are important for the pathophysio log ic da~s i fic ati on of neuropathi es and may be only lab­oratory means of determimng the s ite of focal peripheral nerve abnormalities. EMG helps di ffer­entiate between neuropathic and myopath ic afflic tions and provides strong evidence lor specific di sorders, such as myotonic dystrophy, Isaac 's and musek ion channel d iseases (non-dist.rophyc myotonias). Electrophysiological eva luation is of crucial importance in the d iagnosis of neuro­muscular transmiss ion disorders and two main elec{rodiagnostic methods are the repetitive nerve stimulation test and . ingle fiber EMG As general rule, both EPs and particularly EMNG in clin­ical practi ce should always be an extension of the neurologic examination, and diagnost ics as well as interpretati on of the results of the tes ts should , in ev ry ind iv idu ' l case , be guided by the clinical picture based on widely diagnostic alg rithms. Even with the deve lopment of new meth­ods , uch as hi stoch mistry, biochemistry, genetics. neu roimuno!ogy, and neuroimaging technics it is clear that electroph ysiological information is stil l an important part of the study of ne rvous system and muscles . HEBPOtlJ I13HOJIomKH CTYAHH BO HCnHTYBAILETO HA ctJAP­MAKOKHHETHKATA HA AHTIfEnHJIEITUHTE '!.fllleaCKG J7~ K.1JI1HI1 Ka 3a Heapono r llj a, KJJI1 I1WI KH ll.eHTap CKonj e, P. MaKe,UoHl1ja UeJl: fla ce nOK3)!(e .ueKa uepe6 p allHrrre eaOUHp3HH nOTeHuHjanYl ce KaKO oojeKTH13eH I1H,UI1KaTOp BO cpapMuKOKliHeTIlKUT3 Ha 3HH lCmmenTH'UYlTe, MaTepnj3JI I' MeTOA: Ha· npaB HI1 ce I1cfmryBal-b<'l Ha 50 n aUl1eHT11 co CTlHJJencHj a, Kaj KOR He 6HJIa np eTXO.!lHO nOBe,UeHa 3HTHenI1JJerrTHt.JH3 Tepanuja. n OJ\e emf ce Ha 3 r p yrrM. BO 3aBI1CH()CT O,U Hcml­TyaaI·mOT aHTHemlJJenTI1K. B npaaTCl ['py na 6ea 16 naUHeH'T'H , Kaj K H e TeCTHpaH Aml­IlencHH npc Ky ecj:JeKTOT Ha C n , BTOPUTU p yna j a CO'I HHYBaa :1 9 rrU UHeHTH Kaj KOH e TeCTl1paH ecpeKTOT Ha TerpeToJ1 , i:l Kaj TPCT3T3 rpyna 0/1, 15 naU;Jf eTI1 e HcnwrYBClH cl>e­Ho(5ap6J.1 T OHOT . PC3YJlTaTI1Te ce KOMl1apHp8HI1 co K lfTp OJ!H a l"pyna . Kaj CI1Te n<JI\l1e HTI1 4S e lI~trTpaBeH ~En n pef]. T epannj a'fa KOj en )0KH Ka KO en IOKOH'fPO ct , a nO'l'U iI CYK llc CI1 11HO C Cf-l HMaH CEn Hal:=; r--n m yTIl. 3() Mlmy'fll If 2 ' Iaea, n o egHoKpan r,na a n JlHKa!\ ltja Hi.! JleKOT. JTa TOj HCI'-UIH eo p egeHl) npll JlIDKI!O'fO BpeM HCl pU': pnT\ llJ a lIa eK( l T H Hero­HOTO ltejcTBo IlpeKy xeMaTo eHl..\ t:¢anlla a 6ap~lcpa B n JCTB' lTO H3 UI Ie, KaKO 11 rreromWT ~taKCHMaJ1 eH e ¢ eK . KOH'fPOJll-mO CEn n o I Mec ' l..\ ynaTy n<l Ha 'fpa H e (!),~KT tl<l nCKO . n apanenHo C oApeA , BaHO HHBOTO Ha allHlemIJlell'!'I1KOT !)(J ,:cPYM0 'f. KclJ uITe llLlL(l1eHTH e ll anpaBc H EEr . c e H30pH aT a 6 p3HITtl ll Ll cnpo Bc gYl:lCl1bt: Ita ne p M¢epHlwT Hep l3 If nCl1xo OWKO 'feCT lIpa l-b e. . PC3}'JI'f8 tt : ¢eKToT Ita Ter peTOJlOT J-1 a En C 800­' IeH YWTe BO rrpBHTC J5 MI1Hy Tl! , a :.l<l A llBJle lll'HHOT 11 <PeHooapCiI1TOHOT IlO ] U ~ [ HllyTl[ Oil a llJll IKaJ\HpTa Hd Jlt:KOT. MaKnfMaJle ll <::1 (!K 'f' c nOCTIrrI-I <l T 110 2. Lfa ca, e lHl CllTHPd HO co pl'~yK l..\Hj a Ha aMIT ¥11'YAc.lTa Ha D4Q H H 60. UITO YIIc.tTytl.l J(eKa T Ile Jlt;;j CTB. ijtlHT npc Ky II ' CflCl\llqHl 'UlIflY' CII ~TcM . ct)t:}!o Ciap6nTOH IT 1I0K,\)KYBa CKpaTYl3al-be Hn JI <I '( t:Jl l\l1j aT<l lld H-p c:cj:lJle KcOT. LlITO He ce j aBYSU Kaj Te ,pC:Ton OT H AllHJ1t: fl CIlHOT NEUROPHYSIOLOGICAL ASSESSMENT OF VASClJLAR BRAIN STEM SYN­DROMES f.);imr: V . .Ioli{. ~ A·f., .Io1i(. ~ S. £Jjllf7C' S C llll ic of Neurology. C lini ca l Centre . N is, . erbi a & M ontenegro Blink and masseter inhibitory r ll exes (BR and MIR) cannot be te sted clin ical ly. b ut their eJec­trophys iological evaluation is feasible . C lin ical in e~ti gati ons up to the pr sent den lI1st rate tha t BR and MIR abnonna liti .. are the result of the various leSion. of trigemina l and fac ial nerve, brain stem, hemi spheres and ext rapirarnidal ~ys l e I1 .. T here are very few stud ies which eval uate th si gnificance o f these refl ex s in vascul ar brain stem synd romes in view of lopograph . - local­ization. The purpose of th is study was to inves ti gat e the cor Ilation of BR and MIR w ith clini­ca l and brain CT findings. and brai n stcm lesions loca lization w ith these re llex ~ . Invesllga ted was the group of 30 patients with various vasc ular ynd romes o f the brain stem-c lt lllcall y.neuro­fCllii o logically (CT)and e lectrophys iologlca ly (BR and Mm.). Our result s sh w abnormal BR (76,66%) and MJR (73.33%) findings in correlation with clinical s ituaLion . H owever, BR and MIR correlate with CT findings in only 400/0 of the subject . Abnormal BR and MIR result s were registered contra la terally as well-on the hea lthy bra in stem side, which indi cates different les ions localizations and thei r significant di ag nos tic cnsi tl vity. HEBPO(J)H3HOJlOlUKH H rEHETCKH HCTPA)({YBAIbA KAJ MIU'PEHA I1Jn/ (' (iCKG JI. K JH1HIIKt1 3 D HeBp 0 J10nlj a , KJB1HWIKll U -.:HTap C lwnje. P. MdKc'~Ol-lHja UCJ1: ,LI,a ce OTKPl1j i.lT cP ' HKl\HOHc JTHJ lTe p a Tpoj CTS3 !-; ilJ 6 0 nHH co MI1 L'p e HU CO IlOMOI.lI Ha He s p o(I)H3110nOIlIKHTe 11('TP,1)K),Sdl-ba , KaKo II ¢aMI!J1Hj apH3T<.I CKcrrp ec nj a ~lIIrpeHaTa, JHl'1I11 10 T li n HacncAysal-beTO 11 eBeHTY'.1n ll l1'1'e ' p , lMOJ OI>I CKI1 a6ep al..\Hl1 K :1j cn Y'13 11 H <:l ¢ :tMII l-\jap l-Ja MH,pn!a, Koj a cc j aBYBd K uj rrOBl: KC ' [J1CHOBII no t:1\HH (l l d:-'U !J1l1ja . M'lTepujaJI If Jl.teTOJr M Clll1T ' SaHrI' 60 60.'1 1111 KOI1 c-rpaJ(uT 0 MHrpeHa, co BlYJp aCT 0 15 go 57 ['onuml. OJ]; OSI1 6e 60'Yo A<e HH, d 4() '};", M<liKl-1. J1 c l'Tp O II l(C CP LlJ10rt.J~ I (PC KIITC pe rHCrpal(11 11 6ea lIa n p 'IBc: BH flO n Ol3eKe n 3npan f , llaj L[ CCT O 8 0 Hpe ~I C 1I'3M e r MW 'p C1IOJ ­HIIT C <IT<lKH . J ca M~ K aj ~ CJ1Y '-l aH c e Han p anel!l ! "JClspCMe Ha MlIrp ' H0 3 \-lCl dTLlKa. npl1K' ­iKaHH CC pOJ(OCn O IHH ne Apna Ha )..tBt; cp a IIInHI'I c o OO r'LITa Cp a Ml'lJl l'lFl P J[a eKcn pcurj a ria . III I'P <.~ ll <l. Kaj 1l0 Be[{ t:TU -OJlHH 01-lJ1<..; Han panella ill SiJlI XIIOPIIAII:1<ll..\Hjd n Me OHO 1I<l Scnt i Phili ps (1 974). PC3)'nTaTI(; b.Er Hao/.trrTt: R'<I HOp Idmlll Kaj 35 (58% ) 6 ) .'11[>-1 c o MH r'p Bll , 0 )1, KO I1 K;Jj 6 ' 0 peril 'Tpat(lIj a II qC JIOll KI! :1.[\cnpnHdl\l tj a Ha COlluT i\ JOUCHI1 c,' -16 111J, r OCT· THI'H n OfflKYI npOMellH. K·~j OCT,lf ICJT!lT C 24 (4 1.f) °j,, ) EE r HaO)J.HTC oea naT0J10IllKYI. KG II VllilTVna ;lT Ha q:J YHKl\HOHilllHH npoM 'lUI K 3 ' ()BHC Go lI H co MHrpc lJa. j3 KOH He cc naj i\C fJH ~[OP(I) llCTPYKTyp(l H II np ):vrCflfJ co KT . MHP ~I a llnto MIlP. K aj 2 ' InCHa Oil C)l Il Li cp a~HlJll lF1 Gnna ~(;]jll.C H:l aG I[Op M3 HOCT li a 19 XPI)M (Yl (' I . Kaj ~ 'In eH<1 O Il. IXpyranl CP ClMII ­!THja, HCTll T aKa, bHJW HajIXeHa afiu opMa.llHOCT Ha I1CTHOT XPOM030M . T paRcMIKHjanl rIa "3<160 YR ::U b CTO e <l RT030MHO }lOMHHaH HO H<:ICn C ' TI <.l l b C 8 0 f(HcKycHjaT3 ce On(paT~lm IWTuqHf3110nl U1K BT C MeXaHH.3M}l HCl ltaCT<lHy'B<.I I-bCTO H<l MlIrpcI·IaTil , CO!1 CC6CH OCHpT llCl reHCTCKIiTC cj:Ja KTo jJH H n OBp33H()CTa Ha MnrpCIHl1'a co enHJlencHja. DIAG NOSTIC IMPORTANCE OF NEUROPHY IOLOGICAL TESTS IN VEGETATIVE STATE ANJ) BRAIN DEATH .loIit M, f)1!!7/ S, Joli(.~ S; Z il/cOI:ie M, D;im(' V S/{1mel7Of.i c 'J, Z / IJ{{dli70V/{' B curolDgy Clinic, C linical Cente r Ni s. Serbi a & Monteneg ro for 30 years now there has been a d ile mma in clinic;)l practice: W hen is a person dead ? From the biological aspect the re is no d iffe rence hetween the death of heart and the death of brain s ince the time pcriod of its survival does not exceed couple of minu tes. Nowadays. we adopted an alti­tude that a person is dead when h is brain is dead, or more precisely, when his brains tcm is dead , which requires proofs that the brain, as an organ, has ceased to fun c tion. Vegetative state pres­ents a chronic disorder of consciousne s. called prolonged coma by some authors . In clini e<11 practice. di s tinction between th ose two s tates by means of clinical test only is some times very delicate . This has lead to the necess tty for neurophysiological evaluation of brainstem function and hemispheres. The most common ly used tests are evo ked potentia ls, most of aiL acoustic (AEPs) , somatosnsiti ve, obtained through sti mulation of n.med ianis (SEPs), visual (YEPs) along with blink reflex and electroenceha log raphy. which is the oldes t neurophysio logical method used for the diagnosis of brain death . T he purpose of thi s paper is to show, through study of our patients , the necess ity and diagnostic s ignificance of the aforementioned neurophysiological tests in brain death and vegetative state. ELECTROPHYSIOLOGI CAL EVALUATfON OF BELL'S PALSY EJorr(jcv/c G , f)lII1G~ S, S/tll7'CTt{)1Ji( ~.I? Klinic of neuro logy, KC N is , Serbi a and Mo ntenegro Bell"s palsy is one of the most frequent cranial mononeuropath ies. E lectrophysiological evalua­tion , besides clini cal findin gs , are of a g reit importance in diagnoses of Bell' s palsy. The goal od our inves ti gation was to re vea l e lectrophysiological changes during the fi rst three weeks of lhe illness and find ing the most apropriate mome nt for electrophysiological evaluation . F ifty patients with c linical signs of B e ll's pals y were included in our stud y. E JectrophysiologicaJ test were per­formed on the third , seventh. fourteenth and twen ty fi rst day from the onset of the sympt ol1l ~ . Following electroph ysiologi 'al parameters are anal ysed : amplitude and latency o f muscle evoked pote ntial (l'vtEP) , latency of early CR 1) monosynaptic component of bl ink rd l e x (BR). inerva tio na l sample (EMG pattern), and denervation act ivity in muscles . ur investi gation show that electrophysiological changes are evident d uring first day:; of ill ness as reduced inervat ion sample as well as increased latency ti me or complete abse nce of R l component of BR. Progress ive decrease of MEP amplitude was reg istered from 7th to 14th day of illness and it cul­minated on 21 th day of illness . Changes in MEP latency were the most evident on 14th and 21th day of palsy. Denervation muscle ac tivity is observed on 14th day with 25 patients (SO Ck) and on 21th day w ith 44 patie nts (8 8% ), Our results show that electrophysi ological in vestigations con­tribute to Bell 's palsy diagnosi s and to the definition of the degree of nerve damage. Changes are 47 

Неврофизиолошки и генетски истражувања кај мигрена

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