Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.4
Domantas Jakubauskas, R. Mameniškienė
Celiac disease (CD) is a gastrointestinal disorder caused by the immune system’s response to gluten, involving both innate and adaptive immune reactions. It leads to various neurological issues, such as gluten ataxia, gluten neuropathy, epilepsy, and gluten encephalopathy. Although neurological presentations are rare in children, they are observed in up to 36% of adult patients with CD. Recent evidence suggests that these manifestations may be linked to gluten-related mechanisms, including antibody cross-reactions, immune-complex deposition, direct neurotoxicity, and, in severe cases, vitamin or nutrient deficiencies. However, there is still no consensus on whether serological, neurophysiological, or neuroimaging findings can effectively diagnose and monitor CD-associated neurological problems at an early stage. The identification of multimodal biomarkers and suitable neuroimaging tools could aid in the diagnosis, monitoring, and enhancement of the quality of life for individuals with neuroceliac disease. Nonetheless, it is essential to provide appropriate treatment to those with CD and neurological symptoms, as prolonged suffering may lead to irreversible disability. The primary treatment for neurological manifestations of gluten-related disorders is a strict gluten-free diet, although a small number of patients may require additional immunosuppressive therapy, typically using mycophenolate or intravenous immunoglobulins. In this literature review, our aim was to explore the relevant neurological disorders associated with CD, early diagnostic and treatment options to prevent related disability in affected patients. Clinicians should consider CD as a potential cause in individuals presenting with unexplained neurological dysfunction.
乳糜泻（CD）是一种胃肠道疾病，由免疫系统对麸质的反应引起，涉及先天性免疫反应和适应性免疫反应。它会导致各种神经系统问题，如麸质共济失调、麸质神经病、癫痫和麸质脑病。虽然神经系统表现在儿童中很少见，但在多达 36% 的 CD 成年患者中都可观察到。最近的证据表明，这些表现可能与麸质相关机制有关，包括抗体交叉反应、免疫复合物沉积、直接神经毒性，严重时还可能与维生素或营养素缺乏有关。然而，对于血清学、神经生理学或神经影像学检查结果是否能有效诊断和早期监测 CD 相关神经系统问题，目前仍未达成共识。确定多模态生物标志物和合适的神经影像学工具有助于诊断、监测和提高神经糜烂性疾病患者的生活质量。尽管如此，为患有 CD 和神经系统症状的患者提供适当的治疗是至关重要的，因为长期的痛苦可能会导致不可逆转的残疾。麸质相关疾病神经系统表现的主要治疗方法是严格的无麸质饮食，但少数患者可能需要额外的免疫抑制治疗，通常使用霉酚酸盐或静脉注射免疫球蛋白。在这篇文献综述中，我们的目的是探讨与 CD 相关的神经系统疾病、早期诊断和治疗方案，以防止患者出现相关残疾。对于出现不明原因神经功能障碍的患者，临床医生应将 CD 视为潜在病因。
{"title":"Pacientų, turinčių celiakijos sukeltų neurologinių simptomų, diagnostikos ir gydymo galimybės","authors":"Domantas Jakubauskas, R. Mameniškienė","doi":"10.29014/ns.2023.27.97.4","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.4","url":null,"abstract":"Celiac disease (CD) is a gastrointestinal disorder caused by the immune system’s response to gluten, involving both innate and adaptive immune reactions. It leads to various neurological issues, such as gluten ataxia, gluten neuropathy, epilepsy, and gluten encephalopathy. Although neurological presentations are rare in children, they are observed in up to 36% of adult patients with CD. Recent evidence suggests that these manifestations may be linked to gluten-related mechanisms, including antibody cross-reactions, immune-complex deposition, direct neurotoxicity, and, in severe cases, vitamin or nutrient deficiencies. However, there is still no consensus on whether serological, neurophysiological, or neuroimaging findings can effectively diagnose and monitor CD-associated neurological problems at an early stage. The identification of multimodal biomarkers and suitable neuroimaging tools could aid in the diagnosis, monitoring, and enhancement of the quality of life for individuals with neuroceliac disease. Nonetheless, it is essential to provide appropriate treatment to those with CD and neurological symptoms, as prolonged suffering may lead to irreversible disability. The primary treatment for neurological manifestations of gluten-related disorders is a strict gluten-free diet, although a small number of patients may require additional immunosuppressive therapy, typically using mycophenolate or intravenous immunoglobulins. In this literature review, our aim was to explore the relevant neurological disorders associated with CD, early diagnostic and treatment options to prevent related disability in affected patients. Clinicians should consider CD as a potential cause in individuals presenting with unexplained neurological dysfunction.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"360 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140228077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.2
Emilijus Žilinskas, Arūnas Vaitkevičius
Background. As the global burden of neurological diseases has been increasing, clinical trials have become more important. Yet, no systematic analysis of clinical trials of neurological medicinal products has been done in Europe and, specifically, in Lithuania. The aim of this study is to evaluate the tendencies of characteristics and registration dynamics of clinical trials of neurological medicines in Europe and Lithuania.Materials and methods. Analysis of data from the clinical trials register of the European Union drug regulatory authorities (EudraCT) has been performed. Applications of clinical trials of neurological medicines included in the register during the period between 2012–2021 have been reviewed. The following aspects have been evaluated: the phase of the trial, the sponsor status, the neurological condition (indication), the expected sample size of the trial, the trial design, and the number of member countries.Results. 2,242 clinical trials of neurological medicines have been registered in Europe during the period of 2012–2021, and they comprised 6.49% of all clinical trials registered in Europe. The annual registration rates did not change significantly during the period of 2012–2021 (R² = 0.039; p = 0.606). The majority of the trials (72.18%) were sponsored by commercial pharmaceutical companies. Most trials (31.73%) were registered as phase I trials. The majority of the trials (363 (17.20%)) were clinical trials for Alzheimer’s disease and other dementias. During the period of 2012–2021, there was a significant decrease in the annual registration rate of clinical trials for Alzheimer’s disease and other dementias (R² = 0.751, p = 0.001) and an increase of clinical trials for myoneural junction and muscle diseases and motor neuron disease (R² = 0.582, p = 0.010 and R² = 0.635, p = 0.006, accordingly). Commercial trials had a higher planned number of subjects (p = 0.014). Multiple member states participated in commercial trials more frequently (p < 0.001). Fifty-five clinical trials of neurological medicines were registered in Lithuania during the period of 2012–2021, and they comprised 8.08% of all clinical trials registered in Lithuania. The annual registration rate has decreased significantly (R² = 0.401, p = 0.049). Almost all trials in Lithuania (53 out of 55) were sponsored by commercial companies. The majority of trials (23 (42%)) were trials for demyelinating diseases of the CNS.Conclusions. The annual registration rates of trials of neurological medicines remain stable in Europe while decreasing in Lithuania. Commercial clinical trials have more participants, and are more commonly conducted in multiple member states.
{"title":"Neurologijos srityje vartojamų vaistinių preparatų klinikinių tyrimų tendencijos Lietuvoje ir Europoje","authors":"Emilijus Žilinskas, Arūnas Vaitkevičius","doi":"10.29014/ns.2023.27.97.2","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.2","url":null,"abstract":"Background. As the global burden of neurological diseases has been increasing, clinical trials have become more important. Yet, no systematic analysis of clinical trials of neurological medicinal products has been done in Europe and, specifically, in Lithuania. The aim of this study is to evaluate the tendencies of characteristics and registration dynamics of clinical trials of neurological medicines in Europe and Lithuania.Materials and methods. Analysis of data from the clinical trials register of the European Union drug regulatory authorities (EudraCT) has been performed. Applications of clinical trials of neurological medicines included in the register during the period between 2012–2021 have been reviewed. The following aspects have been evaluated: the phase of the trial, the sponsor status, the neurological condition (indication), the expected sample size of the trial, the trial design, and the number of member countries.Results. 2,242 clinical trials of neurological medicines have been registered in Europe during the period of 2012–2021, and they comprised 6.49% of all clinical trials registered in Europe. The annual registration rates did not change significantly during the period of 2012–2021 (R² = 0.039; p = 0.606). The majority of the trials (72.18%) were sponsored by commercial pharmaceutical companies. Most trials (31.73%) were registered as phase I trials. The majority of the trials (363 (17.20%)) were clinical trials for Alzheimer’s disease and other dementias. During the period of 2012–2021, there was a significant decrease in the annual registration rate of clinical trials for Alzheimer’s disease and other dementias (R² = 0.751, p = 0.001) and an increase of clinical trials for myoneural junction and muscle diseases and motor neuron disease (R² = 0.582, p = 0.010 and R² = 0.635, p = 0.006, accordingly). Commercial trials had a higher planned number of subjects (p = 0.014). Multiple member states participated in commercial trials more frequently (p < 0.001). Fifty-five clinical trials of neurological medicines were registered in Lithuania during the period of 2012–2021, and they comprised 8.08% of all clinical trials registered in Lithuania. The annual registration rate has decreased significantly (R² = 0.401, p = 0.049). Almost all trials in Lithuania (53 out of 55) were sponsored by commercial companies. The majority of trials (23 (42%)) were trials for demyelinating diseases of the CNS.Conclusions. The annual registration rates of trials of neurological medicines remain stable in Europe while decreasing in Lithuania. Commercial clinical trials have more participants, and are more commonly conducted in multiple member states.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"30 33","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140226523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.7
Birutė Railienė, Eglė Sakalauskaitė-Juodeikienė
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{"title":"Talents have their place in different areas of the brain: an overview of organology in the work of Andrius Sniadecki","authors":"Birutė Railienė, Eglė Sakalauskaitė-Juodeikienė","doi":"10.29014/ns.2023.27.97.7","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.7","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"10 30","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140225370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.5
Reda Stankevičiūtė, R. Strumila
Neurosteroids, such as allopregnanolone, are primarily synthesized substances in the central nervous system which influence processes occurring in the brain. Fluctuations in the levels of neurosteroids can result in an increased anxiety and heightened sensitivity. Significant reduction in neurosteroid synthesis usually occurs during the perimenstrual and postpartum periods when very low levels of progesterone are observed. It is believed that a lack of neurosteroids in the body is one of the main causes of postpartum depression. Postpartum depression (PPD) is a form of depression which develops in women during the postnatal period. Clinical studies have been conducted, and the results indicate that Brexanolone (a water-soluble formulation of allopregnanolone) is effective in treating postpartum depression. Based on the evaluation of the HAMD-17 depression scale, women with PGD who received injectable neurosteroid doses achieved remission from postpartum depression more effectively and quickly than those in the placebo group. Subsequent studies were also conducted with the tablet form of neurosteroids (Zuranolone), and the results similarly showed favorable outcomes for postpartum depression. Additionally, during treatment with both injectable and tablet forms of neurosteroids, there were relatively few and non-threatening side effects for patients. This suggests that the benefits of neurosteroids in treating PPD may outweigh the potential harm and should possibly be considered and incorporated into the European psychiatric practice.
{"title":"Pogimdyminės depresijos gydymas neurosteroidais","authors":"Reda Stankevičiūtė, R. Strumila","doi":"10.29014/ns.2023.27.97.5","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.5","url":null,"abstract":"Neurosteroids, such as allopregnanolone, are primarily synthesized substances in the central nervous system which influence processes occurring in the brain. Fluctuations in the levels of neurosteroids can result in an increased anxiety and heightened sensitivity. Significant reduction in neurosteroid synthesis usually occurs during the perimenstrual and postpartum periods when very low levels of progesterone are observed. It is believed that a lack of neurosteroids in the body is one of the main causes of postpartum depression. Postpartum depression (PPD) is a form of depression which develops in women during the postnatal period. Clinical studies have been conducted, and the results indicate that Brexanolone (a water-soluble formulation of allopregnanolone) is effective in treating postpartum depression. Based on the evaluation of the HAMD-17 depression scale, women with PGD who received injectable neurosteroid doses achieved remission from postpartum depression more effectively and quickly than those in the placebo group. Subsequent studies were also conducted with the tablet form of neurosteroids (Zuranolone), and the results similarly showed favorable outcomes for postpartum depression. Additionally, during treatment with both injectable and tablet forms of neurosteroids, there were relatively few and non-threatening side effects for patients. This suggests that the benefits of neurosteroids in treating PPD may outweigh the potential harm and should possibly be considered and incorporated into the European psychiatric practice.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.1
I. Jonušaitė, N. Giedraitienė, G. Kaubrys, R. Kizlaitienė
Multiple sclerosis is the most common chronic demyelinating neurodegenerative central nervous system disease among young adults. Considering its extent in a relatively young population, multiple sclerosis determines a significant socioeconomic burden to the society due to the cost of disease modifying treatment and a lower working capacity of patients and their caregivers. It is important to control neuroinflammation in the central nervous system caused by the pathologic activity of immune cells by considering a high efficacy treatment early in the disease course in order to prevent accumulation of neurological damage and to improve long term outcomes. According to the newest clinical studies, anti-CD20 therapies have proven their effectiveness and safety in active relapsing multiple sclerosis treatment: since 2018, ocrelizumab, and, since 2023, ofatumumab have both been available as treatment options in Lithuania. Because of its high potency and safety, as well as the specific mechanism of action, ofatumumab is effective in lower doses, and, after initial training at a health care facility, it can be self-administered through subcutaneous injection. This article reviews the efficacy, safety data and treatment indications of the latest available anti-CD20 monoclonal antibodies.
{"title":"Naujųjų anti-CD20 monokloninių antikūnų vaidmuo gydant itin aktyvią recidyvuojančiąją remituojančiąją išsėtinę sklerozę: ofatumumabo klinikinis efektyvumas ir saugumas","authors":"I. Jonušaitė, N. Giedraitienė, G. Kaubrys, R. Kizlaitienė","doi":"10.29014/ns.2023.27.97.1","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.1","url":null,"abstract":"Multiple sclerosis is the most common chronic demyelinating neurodegenerative central nervous system disease among young adults. Considering its extent in a relatively young population, multiple sclerosis determines a significant socioeconomic burden to the society due to the cost of disease modifying treatment and a lower working capacity of patients and their caregivers. It is important to control neuroinflammation in the central nervous system caused by the pathologic activity of immune cells by considering a high efficacy treatment early in the disease course in order to prevent accumulation of neurological damage and to improve long term outcomes. According to the newest clinical studies, anti-CD20 therapies have proven their effectiveness and safety in active relapsing multiple sclerosis treatment: since 2018, ocrelizumab, and, since 2023, ofatumumab have both been available as treatment options in Lithuania. Because of its high potency and safety, as well as the specific mechanism of action, ofatumumab is effective in lower doses, and, after initial training at a health care facility, it can be self-administered through subcutaneous injection. This article reviews the efficacy, safety data and treatment indications of the latest available anti-CD20 monoclonal antibodies.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"99 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140225178","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.6
Aušra Deksnytė, Ramūnas Aranauskas, V. Kasiulevičius, Lukas Aranauskas, A. Navickas, Rugilė Jurkytė, Karolina Palinauskaitė, Diana Zlotnikovienė
Objective. Measure the prevalence of burnout syndrome (BOS) among the healthcare workers (HCW) in Lithuania and the factors influencing it. The respondents were asked to fill out an anonymous online questionnaire which included information on their gender, age, years of work experience, specialty, work hours per week, the average number of patients per day, salary, healthcare chain, and the healthcare sector they are working at. BOS was assessed by using the Copenhagen Burnout Inventory (CBI).Results. A total of 2 806 questionnaires were used in the final analysis. A high prevalence of BOS among the MS in Lithuania was noticed (74% of all respondents), which is more severe in comparison to foreign research. The most significant link with severe BOS was noticed among a high number of patients per day (22.69±14.96 versus 17.77±13.32, t=4.92), a large number of work hours per week (48.89±12.96 versus 46.34±10.77, t=2.54), and a younger age (59.27±14.06 versus 55.73±13.91, t=3.53). Doctors had the highest BOS score compared to nurses, residents, and other specialists (59.72±13.99 versus 57.33±14.13, t=2.4; 57.53±14.20, t=2.2; 54.06±15.22, t=5.67, respectively). No links between gender, years of work experience, salary, healthcare chain, healthcare sector, and BOS were observed.Conclusions. BOS is highly prevalent among Lithuania’s medical staff, and it is more prevalent than in most other EU and non-EU countries. A high number of patients per day, a large number of work hours per week, and a younger age were significantly linked with more severe BOS.
{"title":"Burnout Syndrome among Healthcare Workers in Lithuania as a Former Soviet Country","authors":"Aušra Deksnytė, Ramūnas Aranauskas, V. Kasiulevičius, Lukas Aranauskas, A. Navickas, Rugilė Jurkytė, Karolina Palinauskaitė, Diana Zlotnikovienė","doi":"10.29014/ns.2023.27.97.6","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.6","url":null,"abstract":"Objective. Measure the prevalence of burnout syndrome (BOS) among the healthcare workers (HCW) in Lithuania and the factors influencing it. \u0000The respondents were asked to fill out an anonymous online questionnaire which included information on their gender, age, years of work experience, specialty, work hours per week, the average number of patients per day, salary, healthcare chain, and the healthcare sector they are working at. BOS was assessed by using the Copenhagen Burnout Inventory (CBI).Results. A total of 2 806 questionnaires were used in the final analysis. A high prevalence of BOS among the MS in Lithuania was noticed (74% of all respondents), which is more severe in comparison to foreign research. The most significant link with severe BOS was noticed among a high number of patients per day (22.69±14.96 versus 17.77±13.32, t=4.92), a large number of work hours per week (48.89±12.96 versus 46.34±10.77, t=2.54), and a younger age (59.27±14.06 versus 55.73±13.91, t=3.53). Doctors had the highest BOS score compared to nurses, residents, and other specialists (59.72±13.99 versus 57.33±14.13, t=2.4; 57.53±14.20, t=2.2; 54.06±15.22, t=5.67, respectively). No links between gender, years of work experience, salary, healthcare chain, healthcare sector, and BOS were observed.Conclusions. BOS is highly prevalent among Lithuania’s medical staff, and it is more prevalent than in most other EU and non-EU countries. A high number of patients per day, a large number of work hours per week, and a younger age were significantly linked with more severe BOS.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"7 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140227910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.3
R. Kizlaitienė, D. Mickevičienė, L. Malcienė, N. Giedraitienė, R. Balnytė, D. Jatužis
Cladribine is a disease-modifying drug used for the treatment of the highly active relapsing-remitting form of multiple sclerosis. Cladribine is a purine nucleoside analogue which selectively targets lymphocyte subpopulations involved in the pathogenesis of multiple sclerosis, and therefore it is classified as an immune reconstitution therapy drug. Two short courses of cladribine tablets given over two years significantly reduce the multiple sclerosis relapse rate and disability progression. For most patients, the effect persists in the third and the fourth year. This makes cladribine convenient for patients with multiple comorbidities, difficulties in adhering to their prescribed treatment regimen, those planning a pregnancy, or those for whom long-term immunosuppression is undesirable. Cladribine tablets are denoted by good safety characteristics, with the most prominent adverse effect being lymphopenia, which does not lead to an increased risk of infections other than Herpes zoster.However, in clinical practice, there are a number of issues related both to the initial administration of cladribine tablets and the strategy of treatment in different clinical situations during the first-to-fourth years of treatment, and particularly after the fourth year. Although there are no contraindications for additional courses of cladribine tablets, the product information does not provide detailed guidance on their continued use. During more than five years after the approval of the medicinal product, the new clinical trial data and the Real-World Evidence (RWE) on the efficacy and safety of cladribine tablets have become available, based on which, several national and international expert panels, as well as the Lithuanian Association of Neurologists, have issued guidance on the use of cladribine tablets reviewed in this article. Upon reactivation of the disease, additional courses of cladribine tablets or other disease-modifying therapies may be prescribed, depending on various factors related to the severity of the relapse, patient characteristics, and previously used medications. If the patient’s condition remains stable after the fourth year, extension of the treatment-free period with the structured monitoring approach could be appropriate.
{"title":"Treatment of Multiple Sclerosis with Cladribine Tablets: Literature Review and the Guidance of the Lithuanian Association of Neurologists","authors":"R. Kizlaitienė, D. Mickevičienė, L. Malcienė, N. Giedraitienė, R. Balnytė, D. Jatužis","doi":"10.29014/ns.2023.27.97.3","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.3","url":null,"abstract":"Cladribine is a disease-modifying drug used for the treatment of the highly active relapsing-remitting form of multiple sclerosis. Cladribine is a purine nucleoside analogue which selectively targets lymphocyte subpopulations involved in the pathogenesis of multiple sclerosis, and therefore it is classified as an immune reconstitution therapy drug. Two short courses of cladribine tablets given over two years significantly reduce the multiple sclerosis relapse rate and disability progression. For most patients, the effect persists in the third and the fourth year. This makes cladribine convenient for patients with multiple comorbidities, difficulties in adhering to their prescribed treatment regimen, those planning a pregnancy, or those for whom long-term immunosuppression is undesirable. Cladribine tablets are denoted by good safety characteristics, with the most prominent adverse effect being lymphopenia, which does not lead to an increased risk of infections other than Herpes zoster.However, in clinical practice, there are a number of issues related both to the initial administration of cladribine tablets and the strategy of treatment in different clinical situations during the first-to-fourth years of treatment, and particularly after the fourth year. Although there are no contraindications for additional courses of cladribine tablets, the product information does not provide detailed guidance on their continued use. During more than five years after the approval of the medicinal product, the new clinical trial data and the Real-World Evidence (RWE) on the efficacy and safety of cladribine tablets have become available, based on which, several national and international expert panels, as well as the Lithuanian Association of Neurologists, have issued guidance on the use of cladribine tablets reviewed in this article. Upon reactivation of the disease, additional courses of cladribine tablets or other disease-modifying therapies may be prescribed, depending on various factors related to the severity of the relapse, patient characteristics, and previously used medications. If the patient’s condition remains stable after the fourth year, extension of the treatment-free period with the structured monitoring approach could be appropriate.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"73 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140224368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20DOI: 10.29014/ns.2023.27.97.8
Jevgenija Guk, Rūta Kaladytė Lokominienė, D. Jatužis
Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterised by both motor and non-motor symptoms. While most PD medications currently available can improve motor symptoms, there is currently no treatment available to halt or slow down the progression of the disease. Recently, there has been increasing focus on environmental factors in the pathophysiology of PD and their possible neuroprotective effects. According to Braak’s hypothesis, an unknown pathogen in the gastrointestinal tract may initiate the production of pathogenic α synuclein, which would subsequently spread to the central nervous system. The microbiome-gut-brain axis may be implicated in this process, whereas nutrition can be one of the modifiable regulatory variables. A variety of foods and nutrients have been suggested as either risk or protective factors based on biological theories. Although epidemiological and experimental studies in animal models have shown their neuroprotective properties, their effectiveness was not confirmed in clinical trials. However, daily food intake comprises many nutrients that can interact and produce either a synergistic or antagonistic effect on the human body. Therefore, dietary patterns that include a certain set of nutrients have recently gained increased interest as potential modifiers of disease progression and alleviators of symptoms. This article reviews the current literature on the role of different nutritional factors and diets in the pathogenesis of PD and their possible neuroprotective and symptomatic effects.
{"title":"The Microbiome-Gut-Brain Axis, Nutrition and Parkinson’s Disease","authors":"Jevgenija Guk, Rūta Kaladytė Lokominienė, D. Jatužis","doi":"10.29014/ns.2023.27.97.8","DOIUrl":"https://doi.org/10.29014/ns.2023.27.97.8","url":null,"abstract":"Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder characterised by both motor and non-motor symptoms. While most PD medications currently available can improve motor symptoms, there is currently no treatment available to halt or slow down the progression of the disease. Recently, there has been increasing focus on environmental factors in the pathophysiology of PD and their possible neuroprotective effects. According to Braak’s hypothesis, an unknown pathogen in the gastrointestinal tract may initiate the production of pathogenic α synuclein, which would subsequently spread to the central nervous system. The microbiome-gut-brain axis may be implicated in this process, whereas nutrition can be one of the modifiable regulatory variables. A variety of foods and nutrients have been suggested as either risk or protective factors based on biological theories. Although epidemiological and experimental studies in animal models have shown their neuroprotective properties, their effectiveness was not confirmed in clinical trials. However, daily food intake comprises many nutrients that can interact and produce either a synergistic or antagonistic effect on the human body. Therefore, dietary patterns that include a certain set of nutrients have recently gained increased interest as potential modifiers of disease progression and alleviators of symptoms. This article reviews the current literature on the role of different nutritional factors and diets in the pathogenesis of PD and their possible neuroprotective and symptomatic effects.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"45 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140225118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Rynkevič, E. Žilinskas, D. Streckytė, D. Radzišauskienė, R. Mameniškienė
Background. In Lithuania, the incidence rate of tick-borne encephalitis (TBE) increases and remains the highest in the whole Europe. Diverse clinical manifestations cause difficulties in diagnosing and treating this infectious disease. The aim of the study was to analyze clinical manifestations of the TBE and to indicate predictive variables for unfavorable outcome. Methods. A retrospective study of case histories of patients diagnosed with TBE and treated at the Vilnius University Hospital Santaros Klinikos in the years 2019-2021. Demographic variables, symptoms and clinical form of the disease, laboratory values, and aspects of treatment were recorded. Results. Six hundred and seven case histories were analyzed. Of these, 588 case histories were included in the final analysis. Men made up 56.97% of the population studied. The median age of the patients was 54 years (18-86). The median length of hospitalization was 9 days (1-50). Seventeen (2.89%) patients were immunized against TBE, the others were not immunized (401, 68.20%) or their immunization status was unknown (170, 28.91%). The most common symptoms were headache (509, 86.56%) followed by febrile fever (403, 68.54%), fatigue (400, 68.03%), and dizziness (394, 67.01%). The most prevalent clinical form of TBE cases was meningoencephalitis (387, 76.18%) followed by meningitis (88, 17.32%), meningoencephalomyelitis (29, 5.71%), and encephalitis (4, 0.79%). Patients with the meningoencephalomyelitic form of TBE less often had headache on admission, more often had diabetes, and had fewer lymphocytes in the CSF (all p<0.05). Six patients (1.02%) died. The latter patients were significantly older (71 vs. 53 years, p=0.003), had higher protein concentration and cytosis in the CSF (1.04 vs. 0.70 g/L, p=0.006 and 422 vs. 84 cells per milliliter, p=0.003, respectively), whereas the percentage of lymphocytes in the CSF was lower (62% vs. 81%, p<0.001). Univariate analysis showed that older age, absence of headache and fatigue, higher cytosis and percentage of neutrophils in the CSF may be prognostic variables for the lethal outcome of the disease. Multivariate analysis showed that the absence of fatigue and higher pleocytosis were significant predictors of unfavorable outcome. Conclusions. Clinical forms of TBE differ based on symptoms and laboratory values. Symptoms and laboratory results may prognose the outcome of the disease.
{"title":"Clinical Features and Predictors of Lethal Outcome in Tick-Borne Encephalitis: A Retrospective Study from Lithuania","authors":"G. Rynkevič, E. Žilinskas, D. Streckytė, D. Radzišauskienė, R. Mameniškienė","doi":"10.29014/ns.2023.27.11","DOIUrl":"https://doi.org/10.29014/ns.2023.27.11","url":null,"abstract":"Background. In Lithuania, the incidence rate of tick-borne encephalitis (TBE) increases and remains the highest in the whole Europe. Diverse clinical manifestations cause difficulties in diagnosing and treating this infectious disease. The aim of the study was to analyze clinical manifestations of the TBE and to indicate predictive variables for unfavorable outcome. \u0000Methods. A retrospective study of case histories of patients diagnosed with TBE and treated at the Vilnius University Hospital Santaros Klinikos in the years 2019-2021. Demographic variables, symptoms and clinical form of the disease, laboratory values, and aspects of treatment were recorded. \u0000 Results. Six hundred and seven case histories were analyzed. Of these, 588 case histories were included in the final analysis. Men made up 56.97% of the population studied. The median age of the patients was 54 years (18-86). The median length of hospitalization was 9 days (1-50). Seventeen (2.89%) patients were immunized against TBE, the others were not immunized (401, 68.20%) or their immunization status was unknown (170, 28.91%). The most common symptoms were headache (509, 86.56%) followed by febrile fever (403, 68.54%), fatigue (400, 68.03%), and dizziness (394, 67.01%). The most prevalent clinical form of TBE cases was meningoencephalitis (387, 76.18%) followed by meningitis (88, 17.32%), meningoencephalomyelitis (29, 5.71%), and encephalitis (4, 0.79%). Patients with the meningoencephalomyelitic form of TBE less often had headache on admission, more often had diabetes, and had fewer lymphocytes in the CSF (all p<0.05). Six patients (1.02%) died. The latter patients were significantly older (71 vs. 53 years, p=0.003), had higher protein concentration and cytosis in the CSF (1.04 vs. 0.70 g/L, p=0.006 and 422 vs. 84 cells per milliliter, p=0.003, respectively), whereas the percentage of lymphocytes in the CSF was lower (62% vs. 81%, p<0.001). Univariate analysis showed that older age, absence of headache and fatigue, higher cytosis and percentage of neutrophils in the CSF may be prognostic variables for the lethal outcome of the disease. Multivariate analysis showed that the absence of fatigue and higher pleocytosis were significant predictors of unfavorable outcome. \u0000Conclusions. Clinical forms of TBE differ based on symptoms and laboratory values. Symptoms and laboratory results may prognose the outcome of the disease.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"63 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139779945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. COVID-19 in patients with Parkinson’s disease leads to worsening of symptoms and development of severe/critical conditions; its long-term consequences are still being investigated. Data on vaccination against SARS-Cov-2 in Parkinson’s disease are inconsistent. There are no publications on this topic regarding Lithuania. Materials and methods. The retrospective study COVPARK-LT was performed in the Vilnius University Hospital Santaros Clinics in 2022. Methods: analysis of anonymous data from electronic patient histories obtained during consultations for Parkinson’s disease in the out-patient department (form E025). Objective: To investigate COVID-19 vaccination status and associated factors in patients with Parkinson’s disease. Results. 173 patients were enrolled, 68 males (39.3%) and 105 females (60.7%), the average age of the cohort was 67.99±1.34 years, the duration of Parkinson’s disease was 7.73±0.54 years. The rate of vaccination against SARS-Cov-2 with at least one dose was 85.6% among study patients and 69.8% in the general population. The rate of full vaccination against SARS-Cov-2 was 81.5% in COVPARK-LT and 33.4% in the general population. The rate of laboratory-proven COVID-19 was 20% (N=5) in the non-vaccinated group of the cohort and 22.3% (N=33) in the vaccinated group (p=0.087). COVID-19 vaccine-negativity was associated with the history of vaccination against non-SARS-Cov-2 infections (odds ratio, OR: 0.18, p < 0.01), vaccination against influenza (OR: 0.21, p<0.01), male gender (OR: 0.68, p<0.05), male age (OR: 0.88, p<0.05), duration of Parkinson’s disease (OR: 1.1, p<0.001), and Parkinson’s disease stage according to Hoehn-Yahr (OR: 0.51, p<0.05). Conclusions. The rate of vaccination against SARS-Cov-2 was higher in the COVPARK-LT cohort patients than in the general population in Lithuania. Non-vaccinated status was positively associated with female gender, younger age in men and earlier stage of Parkinson’s disease according to Hoehn-Yahr staging. Vaccinated status was associated with vaccination against other infectious diseases (influenza, tick-borne encephalitis, pneumococcus). The rate of COVID-19 in the COVPARK-LT cohort did not differ between non-vaccinated and vaccinated patients with Parkinson’s disease.
{"title":"Parkinsono liga sergančių asmenų vakcinacija nuo Sars-cov-2 viruso, remiantis covpark-lt tyrimo rezultatais","authors":"R. Kaladytė Lokominienė, G. Lokominaitė","doi":"10.29014/ns.2023.27.12","DOIUrl":"https://doi.org/10.29014/ns.2023.27.12","url":null,"abstract":"Background. COVID-19 in patients with Parkinson’s disease leads to worsening of symptoms and development of severe/critical conditions; its long-term consequences are still being investigated. Data on vaccination against SARS-Cov-2 in Parkinson’s disease are inconsistent. There are no publications on this topic regarding Lithuania. \u0000 Materials and methods. The retrospective study COVPARK-LT was performed in the Vilnius University Hospital Santaros Clinics in 2022. Methods: analysis of anonymous data from electronic patient histories obtained during consultations for Parkinson’s disease in the out-patient department (form E025). \u0000 Objective: To investigate COVID-19 vaccination status and associated factors in patients with Parkinson’s disease. \u0000Results. 173 patients were enrolled, 68 males (39.3%) and 105 females (60.7%), the average age of the cohort was 67.99±1.34 years, the duration of Parkinson’s disease was 7.73±0.54 years. The rate of vaccination against SARS-Cov-2 with at least one dose was 85.6% among study patients and 69.8% in the general population. The rate of full vaccination against SARS-Cov-2 was 81.5% in COVPARK-LT and 33.4% in the general population. The rate of laboratory-proven COVID-19 was 20% (N=5) in the non-vaccinated group of the cohort and 22.3% (N=33) in the vaccinated group (p=0.087). COVID-19 vaccine-negativity was associated with the history of vaccination against non-SARS-Cov-2 infections (odds ratio, OR: 0.18, p < 0.01), vaccination against influenza (OR: 0.21, p<0.01), male gender (OR: 0.68, p<0.05), male age (OR: 0.88, p<0.05), duration of Parkinson’s disease (OR: 1.1, p<0.001), and Parkinson’s disease stage according to Hoehn-Yahr (OR: 0.51, p<0.05). \u0000Conclusions. The rate of vaccination against SARS-Cov-2 was higher in the COVPARK-LT cohort patients than in the general population in Lithuania. Non-vaccinated status was positively associated with female gender, younger age in men and earlier stage of Parkinson’s disease according to Hoehn-Yahr staging. Vaccinated status was associated with vaccination against other infectious diseases (influenza, tick-borne encephalitis, pneumococcus). The rate of COVID-19 in the COVPARK-LT cohort did not differ between non-vaccinated and vaccinated patients with Parkinson’s disease.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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