Neurologia i neurochirurgia polska最新文献

Over recent decades, the search for sensitive and specific biomarkers of degenerative parkinsonisms has intensified. So also has the number of clinical trials aimed at disease modification and the subsequent need for improved recruitment of participants in the earliest possible stages and with the highest diagnostic certainty. Also increasing in number have been searches for ways to determine target engagement and biological effect, along with tracking of disease progression or its modification. With post mortem neuropathological confirmation remaining the most definite diagnostic category for most conditions, the updated diagnostic criteria are slowly introducing some routine biomarkers as supportive tools, mostly related to symptoms such as loss of smell in Parkinson's Disease (PD) or demonstration of REM sleep behaviour disorders in both PD and multiple system atrophy (MSA), or structural or functional (chiefly dopaminergic) imaging, which sometimes lacks either sensitivity or specificity [specific MRI signs for MSA or progressive supranuclear palsy (PSP)]. However, potential new tools such as seed amplification assays (SAAs) and PET imaging of underlying alpha-synuclein and 4R-tau pathologies, while not without their own challenges, are being increasingly seen as the next generation of diagnostic tools. In this setting, proposals to biologically define these conditions, primarily for research purposes (which might eventually include clinical trials) are emerging. In this review, we aimed to overview of the current use of routine biomarkers and any future promise of biological definition by molecular markers tracking underlying pathology.

Aim of study: To investigate the treatment strategies of Parkinson's Disease (PD) among movement disorder specialists in tertiary centres in Poland, and how literature warnings (levodopa and dopamine agonist phobia) have influenced their practice.

Material and methods: The survey was conducted between 30 November, 2020 and 18 October, 2021, in four Polish tertiary referral centres for PD (two in Gdansk, one in Sosnowiec, and one in Warsaw). Movement disorder specialists collected information on the treatment of 494 consecutive patients diagnosed with PD. The questionnaire included information on the age of the patient, the duration of PD, the Hoehn&Yahr (H&Y) stage, comorbidities, pharmacotherapy, and advanced PD therapies i.e. deep brain stimulation (DBS), levodopa/carbidopa intestinal gel (LCIG), and continuous subcutaneous apomorphine infusions (CSAI).

Results: Levodopa was the most prescribed medication (n = 465/494), followed by dopamine agonists (n = 292/494). The mean dose of levodopa was 810.58 ± 473.11 mg, and it did not exceed 2,000 mg/d in 98.5% of patients. The mean doses of dopamine agonists used were relatively low (ropinirole 8.64 ± 3.94 mg, pramipexole base 1.76 ± 0.65mg). Amantadine (n = 197/494) and MAO-B inhibitors (n = 202/494) were prescribed less frequently. Catechol-o-methyltransferase (COMT) inhibitors (n = 7/494) and anticholinergics (n = 4/494) were rarely used in the studied population. Complex polytherapy with three or more PD medications was the most often used treatment strategy (n = 223/494).

Conclusions and clinical implications: Levodopa remains the gold standard in PD treatment in tertiary movement disorder centres in Poland. Dopamine agonists formed the second most frequently prescribed group of medications; however, the observed low dosages of both levodopa and dopamine agonists may suggest a cautious approach by clinicians. Amantadine and MAO-B inhibitors (mainly rasagiline) constituted important elements of PD pharmacotherapy. The high prevalence of complex polytherapy underlines the complexity of PD management, the cautious use of single medication at high doses, and the need for personalised therapeutic strategies.

A working group convened by the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society, the Polish Society of Family Medicine, and the Polish Society of Vaccinology has developed a consensus on supplementary data to the recommendations of the expert group of the Polish Society of Vaccinology, the Polish Society of Family Medicine, the Polish Dermatological Society, the Polish Association for the Study of Pain, and the Polish Neurological Society, and ECTRIMS/EAN of 2023 with regard to the currently available in Poland recombinant herpes zoster vaccine (RZV). It is intended for the prevention of herpes zoster and postherpetic neuralgia in individuals aged > 50 and individuals aged ≥ 18 who belong to herpes zoster risk groups. In Poland it is available with 50% reimbursement exclusively for patients aged 65 and older who have an increased risk of developing herpes zoster. This statement is based on the literature available as of 12 July 2024. The guidance will be updated as new data emerges. All data regarding the above-mentioned vaccine comes from clinical trials which have been reviewed, published and approved by the regulatory authorities and an increasing number of recommendations that might have an impact on real world data.

Introduction: An expert panel of the Section of Multiple Sclerosis and Neuroimmunology of the Polish Neurological Society has developed principles for the management of neuromyelitis optica spectrum disorders (NMOSD). These principles are based on expert opinion and data from the literature published up to May 2023. Recommendations were developed based on the results of the most recent clinical trials, guidelines of foreign and international scientific societies, and the authors' clinical experience.

Clinical implications: The principles for diagnosing NMOSD are discussed, with particular emphasis on serological and neuroimaging diagnosis. Recommendations for the treatment of relapses and chronic immunosuppressive treatment, including the most recent methods of immunotherapy, are also presented. Additionally, the principles of monitoring treatment efficacy and safety are included. Therapy regimens are completed with recommendations for symptomatic treatment. The paper also includes an algorithm for vaccination in patients with NMOSD. Therapeutic management in pregnant women with NMOSD is discussed.

Aim of study: This study aimed to evaluate changes in prescription practices for treating idiopathic generalized epilepsy (IGE) in women of childbearing age, and to assess how switching from valproate (VPA) affects seizure outcomes. IGE accounts for 15-20% of all epilepsy cases. While VPA is the most effective treatment, its teratogenic risk limits its use in women of reproductive age, leading to recommendations for safer alternatives such as lamotrigine (LTG) and levetiracetam (LEV).

Material and methods: We retrospectively analysed the data from 130 women aged 18-49 diagnosed with IGE from 2000 to 2022.

Results: Of the 107 who used VPA, 44 remained on it until the last follow-up. 74% of participants achieved seizure freedom at some point, and 62% remained seizure-free at the last follow-up. The attempt to switch from VPA to other medications was unsuccessful in 23 (21.5% out of 107) patients due to adverse effects or loss of seizure control. Seizure freedom rates after 12 months were similar between VPA and alternative ASMs like LEV and LTG.

Conclusions and clinical implications: Our study indicates that LEV and LTG are effective alternatives to VPA for many women with IGE. However, some patients still require VPA for optimal seizure control. Further large-scale, randomised studies are needed to confirm these findings.