Myasthenia gravis (MG) and multiple sclerosis (MS) are thought to have a common autoimmune mechanism as the number of reported co-occurrences of both diseases is increasing. The involvement of both T cells and B cells in the pathogenesis of these two diseases is suspected. As the symptoms and clinical course of MS and MG can be similar in some cases, this makes it difficult to consider the possibility of the coexistence of these disorders. However, laboratory and imagining findings are helpful in distinguishing both diseases and differentiating them from other neurological conditions. Additionally, there can be obstacles in effective treatment selection for patients with MS and MG coexistence. This article presents a clinical case of a woman with previously diagnosed MG who was admitted to hospital 12 years later with new-onset symptoms and was additionally diagnosed with relapsing-remitting multiple sclerosis (RRMS). Remission of MG was achieved with medications and thymectomy, but treatment of MS had its challenges, as first-line immunomodulating drugs interferon beta-1a and dimethyl fumarate were not effective, and second line treatment with monoclonal antibody medication rituximab and ocrelizumab showed efficacy for both diseases, MG and MS. The presented case highlights the importance of considering a manifestation of another disease when treating an already diagnosed disorder. It also emphasizes the importance of further research into the relationship between MG and MS.
重症肌无力（MG）和多发性硬化症（MS）被认为具有共同的自身免疫机制，因为这两种疾病的并发报道越来越多。人们怀疑 T 细胞和 B 细胞都参与了这两种疾病的发病机制。在某些病例中，多发性硬化症和间质性硬化症的症状和临床过程可能相似，因此很难考虑这两种疾病同时存在的可能性。不过，实验室和影像学检查结果有助于区分这两种疾病，并将它们与其他神经系统疾病区分开来。此外，多发性硬化症和间质性硬化症并存的患者在选择有效治疗方法时可能会遇到障碍。本文介绍了一例临床病例：一名女性患者曾被诊断为多发性硬化症，12 年后因新发症状入院，同时被诊断为复发缓解型多发性硬化症（RRMS）。由于一线免疫调节药物干扰素 beta-1a 和富马酸二甲酯疗效不佳，单克隆抗体药物利妥昔单抗和奥克立珠单抗的二线治疗对 MG 和 MS 两种疾病都有疗效。本病例强调了在治疗已确诊的疾病时考虑另一种疾病表现的重要性。它还强调了进一步研究 MG 和多发性硬化症之间关系的重要性。
{"title":"Co-occurrence of Myasthenia Gravis and Multiple Sclerosis: A Case Report","authors":"G. Rynkevič, R. Kizlaitienė","doi":"10.29014/ns.2023.27.13","DOIUrl":"https://doi.org/10.29014/ns.2023.27.13","url":null,"abstract":"Myasthenia gravis (MG) and multiple sclerosis (MS) are thought to have a common autoimmune mechanism as the number of reported co-occurrences of both diseases is increasing. The involvement of both T cells and B cells in the pathogenesis of these two diseases is suspected. As the symptoms and clinical course of MS and MG can be similar in some cases, this makes it difficult to consider the possibility of the coexistence of these disorders. However, laboratory and imagining findings are helpful in distinguishing both diseases and differentiating them from other neurological conditions. Additionally, there can be obstacles in effective treatment selection for patients with MS and MG coexistence. This article presents a clinical case of a woman with previously diagnosed MG who was admitted to hospital 12 years later with new-onset symptoms and was additionally diagnosed with relapsing-remitting multiple sclerosis (RRMS). Remission of MG was achieved with medications and thymectomy, but treatment of MS had its challenges, as first-line immunomodulating drugs interferon beta-1a and dimethyl fumarate were not effective, and second line treatment with monoclonal antibody medication rituximab and ocrelizumab showed efficacy for both diseases, MG and MS. The presented case highlights the importance of considering a manifestation of another disease when treating an already diagnosed disorder. It also emphasizes the importance of further research into the relationship between MG and MS. \u0000 ","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"31 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139841054","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}
Although nitrous oxide (N2O) has long been used as an anesthetic, it’s use as a recreational drug has recently increased. As N2O abuse is associated with a number of adverse health effects, it has become a significant public health issue. Chronic abuse can lead to a number of neurological complications, most commonly related to functional vitamin B12 deficiency. One of the most encountered forms of N2O neurotoxicity is a subacute combined degeneration, which can cause permanent neurological damage. The medical community should therefore be aware of the increasing scale of recreational N2O exposure and the possible complications of this drug abuse. Early recognition and treatment of N2O toxicity are crucial. We present the case of an 18-year-old male who was diagnosed with subacute combined spinal cord degeneration related to N2O abuse.
{"title":"Poūmės kombinuotos nugaros smegenų degeneracijos, sukeltos diazoto monoksido („linksminančių dujų”) vartojimo, klinikinio atvejo aprašymas","authors":"J. Guk, J. Valančienė, A. Klimašauskienė","doi":"10.29014/ns.2023.27.14","DOIUrl":"https://doi.org/10.29014/ns.2023.27.14","url":null,"abstract":"Although nitrous oxide (N2O) has long been used as an anesthetic, it’s use as a recreational drug has recently increased. As N2O abuse is associated with a number of adverse health effects, it has become a significant public health issue. Chronic abuse can lead to a number of neurological complications, most commonly related to functional vitamin B12 deficiency. One of the most encountered forms of N2O neurotoxicity is a subacute combined degeneration, which can cause permanent neurological damage. The medical community should therefore be aware of the increasing scale of recreational N2O exposure and the possible complications of this drug abuse. Early recognition and treatment of N2O toxicity are crucial. We present the case of an 18-year-old male who was diagnosed with subacute combined spinal cord degeneration related to N2O abuse.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"101 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839707","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}
Although nitrous oxide (N2O) has long been used as an anesthetic, it’s use as a recreational drug has recently increased. As N2O abuse is associated with a number of adverse health effects, it has become a significant public health issue. Chronic abuse can lead to a number of neurological complications, most commonly related to functional vitamin B12 deficiency. One of the most encountered forms of N2O neurotoxicity is a subacute combined degeneration, which can cause permanent neurological damage. The medical community should therefore be aware of the increasing scale of recreational N2O exposure and the possible complications of this drug abuse. Early recognition and treatment of N2O toxicity are crucial. We present the case of an 18-year-old male who was diagnosed with subacute combined spinal cord degeneration related to N2O abuse.
{"title":"Poūmės kombinuotos nugaros smegenų degeneracijos, sukeltos diazoto monoksido („linksminančių dujų”) vartojimo, klinikinio atvejo aprašymas","authors":"J. Guk, J. Valančienė, A. Klimašauskienė","doi":"10.29014/ns.2023.27.14","DOIUrl":"https://doi.org/10.29014/ns.2023.27.14","url":null,"abstract":"Although nitrous oxide (N2O) has long been used as an anesthetic, it’s use as a recreational drug has recently increased. As N2O abuse is associated with a number of adverse health effects, it has become a significant public health issue. Chronic abuse can lead to a number of neurological complications, most commonly related to functional vitamin B12 deficiency. One of the most encountered forms of N2O neurotoxicity is a subacute combined degeneration, which can cause permanent neurological damage. The medical community should therefore be aware of the increasing scale of recreational N2O exposure and the possible complications of this drug abuse. Early recognition and treatment of N2O toxicity are crucial. We present the case of an 18-year-old male who was diagnosed with subacute combined spinal cord degeneration related to N2O abuse.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139779938","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}
Abdominal epilepsy (AE) is an extremely rare condition, classified as temporal lobe epilepsy, and is usually a diagnosis of exclusion. Temporal lobe epilepsy often has no clear cause, although it may be associated with diseases such as temporal lobe sclerosis, dysembryoplastic neuroepithelial tumours, and other benign tumours, as well as arterio-venous malformations, gliomas, defects in neuronal migration, or lesions of the cortex caused by encephalitis. AE is more common in children but has been reported in adults. AEs are characterised by recurrent and unexplained gastrointestinal symptoms such as seizure pain, nausea, bloating and diarrhoea, which improve with antiepileptic treatment. Given the vague nature of these symptoms, patients are at high risk of misdiagnosis. An electroencephalogram and neuroimaging of the brain are needed to confirm the diagnosis. We present the clinical case of a 67-year-old female patient who was investigated at the Gastroenterology Department for a sharp pain in the left side of the abdomen, frequent abdominal distension and gurgles, diarrhoeal episodes, weight loss, paroxysmal hallucinations, and headaches. After a thorough gastroenterological examination, consultations with a psychiatrist and a neurologist, an MRI and an EEG were performed and the patient was diagnosed with focal temporal lobe epilepsy.
{"title":"When the Stomach Pain Is Literally “In Your Head”","authors":"D. Jakubauskas, M. Sarafinaitė, R. Mameniškienė","doi":"10.29014/ns.2023.27.16","DOIUrl":"https://doi.org/10.29014/ns.2023.27.16","url":null,"abstract":"Abdominal epilepsy (AE) is an extremely rare condition, classified as temporal lobe epilepsy, and is usually a diagnosis of exclusion. Temporal lobe epilepsy often has no clear cause, although it may be associated with diseases such as temporal lobe sclerosis, dysembryoplastic neuroepithelial tumours, and other benign tumours, as well as arterio-venous malformations, gliomas, defects in neuronal migration, or lesions of the cortex caused by encephalitis. AE is more common in children but has been reported in adults. AEs are characterised by recurrent and unexplained gastrointestinal symptoms such as seizure pain, nausea, bloating and diarrhoea, which improve with antiepileptic treatment. Given the vague nature of these symptoms, patients are at high risk of misdiagnosis. An electroencephalogram and neuroimaging of the brain are needed to confirm the diagnosis. \u0000We present the clinical case of a 67-year-old female patient who was investigated at the Gastroenterology Department for a sharp pain in the left side of the abdomen, frequent abdominal distension and gurgles, diarrhoeal episodes, weight loss, paroxysmal hallucinations, and headaches. After a thorough gastroenterological examination, consultations with a psychiatrist and a neurologist, an MRI and an EEG were performed and the patient was diagnosed with focal temporal lobe epilepsy.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139840751","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}
Introduction. Disulfiram is one of three medications approved by the Federal Drug Administration (FDA) to treat alcohol dependence. Patients tend to abstain from alcohol to avoid the unpleasant effects of alcohol toxicity. There may be some side effects, the most common of which are drowsiness, unusual tiredness, headache, metallic taste in mouth, skin rashes, decreased libido. Disulfiram induced psychosis is a psychiatric side effect that occurs very rarely. Case report. We report the case of a 33-year-old patient with nearly 15 years history of psychiatric personality disorder and alcohol dependence. Approximately 4 days of alcohol abstinence, as an inpatient he was administered disulfiram. After two weeks, the patient began to feel some side effects. He was admitted to hospital and was diagnosed with disulfiram induced psychosis. Discussion. The effect of disulfiram on alcohol metabolism was noticed in the 1940s. It should be used only by motivated patients who must be fully informed about the alcohol-disulfiram reaction. Disulfiram should only be started after about 10 days of sobriety, and the recommended dosage is 500 mg/day. The drug should be used with caution in people with a history of heart disease, diabetes mellitus, hypothyroidism, cerebral damage, nephritis, liver cirrhosis, epilepsy. Caution is recommended for patients who use benzodiazepines, some antibiotics, anticoagulants, tricyclic antidepressants. There may be some adverse effects, more serious ones include changes in vision, numbness, pain or weakness in the limbs, liver cell damage, peripheral neuropathy, seizures – but these are considered to be very rare. Psychiatric side effects may include mood changes, psychotic reactions, memory impairment. Reliable data is lacking, but cases of disulfiram induced psychosis are considered to be rare. Patients taking disulfiram should be monitored carefully.
{"title":"Disulfiraminės psichozės atvejis","authors":"D. R. Survilaitė, R. Žemaitytė","doi":"10.29014/ns.2023.27.15","DOIUrl":"https://doi.org/10.29014/ns.2023.27.15","url":null,"abstract":"Introduction. Disulfiram is one of three medications approved by the Federal Drug Administration (FDA) to treat alcohol dependence. Patients tend to abstain from alcohol to avoid the unpleasant effects of alcohol toxicity. There may be some side effects, the most common of which are drowsiness, unusual tiredness, headache, metallic taste in mouth, skin rashes, decreased libido. Disulfiram induced psychosis is a psychiatric side effect that occurs very rarely. \u0000Case report. We report the case of a 33-year-old patient with nearly 15 years history of psychiatric personality disorder and alcohol dependence. Approximately 4 days of alcohol abstinence, as an inpatient he was administered disulfiram. After two weeks, the patient began to feel some side effects. He was admitted to hospital and was diagnosed with disulfiram induced psychosis. \u0000Discussion. The effect of disulfiram on alcohol metabolism was noticed in the 1940s. It should be used only by motivated patients who must be fully informed about the alcohol-disulfiram reaction. Disulfiram should only be started after about 10 days of sobriety, and the recommended dosage is 500 mg/day. The drug should be used with caution in people with a history of heart disease, diabetes mellitus, hypothyroidism, cerebral damage, nephritis, liver cirrhosis, epilepsy. Caution is recommended for patients who use benzodiazepines, some antibiotics, anticoagulants, tricyclic antidepressants. There may be some adverse effects, more serious ones include changes in vision, numbness, pain or weakness in the limbs, liver cell damage, peripheral neuropathy, seizures – but these are considered to be very rare. Psychiatric side effects may include mood changes, psychotic reactions, memory impairment. Reliable data is lacking, but cases of disulfiram induced psychosis are considered to be rare. Patients taking disulfiram should be monitored carefully.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"46 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139780109","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}
Myasthenia gravis (MG) and multiple sclerosis (MS) are thought to have a common autoimmune mechanism as the number of reported co-occurrences of both diseases is increasing. The involvement of both T cells and B cells in the pathogenesis of these two diseases is suspected. As the symptoms and clinical course of MS and MG can be similar in some cases, this makes it difficult to consider the possibility of the coexistence of these disorders. However, laboratory and imagining findings are helpful in distinguishing both diseases and differentiating them from other neurological conditions. Additionally, there can be obstacles in effective treatment selection for patients with MS and MG coexistence. This article presents a clinical case of a woman with previously diagnosed MG who was admitted to hospital 12 years later with new-onset symptoms and was additionally diagnosed with relapsing-remitting multiple sclerosis (RRMS). Remission of MG was achieved with medications and thymectomy, but treatment of MS had its challenges, as first-line immunomodulating drugs interferon beta-1a and dimethyl fumarate were not effective, and second line treatment with monoclonal antibody medication rituximab and ocrelizumab showed efficacy for both diseases, MG and MS. The presented case highlights the importance of considering a manifestation of another disease when treating an already diagnosed disorder. It also emphasizes the importance of further research into the relationship between MG and MS.
重症肌无力（MG）和多发性硬化症（MS）被认为具有共同的自身免疫机制，因为这两种疾病的并发报道越来越多。人们怀疑 T 细胞和 B 细胞都参与了这两种疾病的发病机制。在某些病例中，多发性硬化症和间质性硬化症的症状和临床过程可能相似，因此很难考虑这两种疾病同时存在的可能性。不过，实验室和影像学检查结果有助于区分这两种疾病，并将它们与其他神经系统疾病区分开来。此外，多发性硬化症和间质性硬化症并存的患者在选择有效治疗方法时可能会遇到障碍。本文介绍了一例临床病例：一名女性患者曾被诊断为多发性硬化症，12 年后因新发症状入院，同时被诊断为复发缓解型多发性硬化症（RRMS）。由于一线免疫调节药物干扰素 beta-1a 和富马酸二甲酯疗效不佳，单克隆抗体药物利妥昔单抗和奥克立珠单抗的二线治疗对 MG 和 MS 两种疾病都有疗效。本病例强调了在治疗已确诊的疾病时考虑另一种疾病表现的重要性。它还强调了进一步研究 MG 和多发性硬化症之间关系的重要性。
{"title":"Co-occurrence of Myasthenia Gravis and Multiple Sclerosis: A Case Report","authors":"G. Rynkevič, R. Kizlaitienė","doi":"10.29014/ns.2023.27.13","DOIUrl":"https://doi.org/10.29014/ns.2023.27.13","url":null,"abstract":"Myasthenia gravis (MG) and multiple sclerosis (MS) are thought to have a common autoimmune mechanism as the number of reported co-occurrences of both diseases is increasing. The involvement of both T cells and B cells in the pathogenesis of these two diseases is suspected. As the symptoms and clinical course of MS and MG can be similar in some cases, this makes it difficult to consider the possibility of the coexistence of these disorders. However, laboratory and imagining findings are helpful in distinguishing both diseases and differentiating them from other neurological conditions. Additionally, there can be obstacles in effective treatment selection for patients with MS and MG coexistence. This article presents a clinical case of a woman with previously diagnosed MG who was admitted to hospital 12 years later with new-onset symptoms and was additionally diagnosed with relapsing-remitting multiple sclerosis (RRMS). Remission of MG was achieved with medications and thymectomy, but treatment of MS had its challenges, as first-line immunomodulating drugs interferon beta-1a and dimethyl fumarate were not effective, and second line treatment with monoclonal antibody medication rituximab and ocrelizumab showed efficacy for both diseases, MG and MS. The presented case highlights the importance of considering a manifestation of another disease when treating an already diagnosed disorder. It also emphasizes the importance of further research into the relationship between MG and MS. \u0000 ","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"118 49","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139781179","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":"98 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139839762","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}
Introduction. Disulfiram is one of three medications approved by the Federal Drug Administration (FDA) to treat alcohol dependence. Patients tend to abstain from alcohol to avoid the unpleasant effects of alcohol toxicity. There may be some side effects, the most common of which are drowsiness, unusual tiredness, headache, metallic taste in mouth, skin rashes, decreased libido. Disulfiram induced psychosis is a psychiatric side effect that occurs very rarely. Case report. We report the case of a 33-year-old patient with nearly 15 years history of psychiatric personality disorder and alcohol dependence. Approximately 4 days of alcohol abstinence, as an inpatient he was administered disulfiram. After two weeks, the patient began to feel some side effects. He was admitted to hospital and was diagnosed with disulfiram induced psychosis. Discussion. The effect of disulfiram on alcohol metabolism was noticed in the 1940s. It should be used only by motivated patients who must be fully informed about the alcohol-disulfiram reaction. Disulfiram should only be started after about 10 days of sobriety, and the recommended dosage is 500 mg/day. The drug should be used with caution in people with a history of heart disease, diabetes mellitus, hypothyroidism, cerebral damage, nephritis, liver cirrhosis, epilepsy. Caution is recommended for patients who use benzodiazepines, some antibiotics, anticoagulants, tricyclic antidepressants. There may be some adverse effects, more serious ones include changes in vision, numbness, pain or weakness in the limbs, liver cell damage, peripheral neuropathy, seizures – but these are considered to be very rare. Psychiatric side effects may include mood changes, psychotic reactions, memory impairment. Reliable data is lacking, but cases of disulfiram induced psychosis are considered to be rare. Patients taking disulfiram should be monitored carefully.
{"title":"Disulfiraminės psichozės atvejis","authors":"D. R. Survilaitė, R. Žemaitytė","doi":"10.29014/ns.2023.27.15","DOIUrl":"https://doi.org/10.29014/ns.2023.27.15","url":null,"abstract":"Introduction. Disulfiram is one of three medications approved by the Federal Drug Administration (FDA) to treat alcohol dependence. Patients tend to abstain from alcohol to avoid the unpleasant effects of alcohol toxicity. There may be some side effects, the most common of which are drowsiness, unusual tiredness, headache, metallic taste in mouth, skin rashes, decreased libido. Disulfiram induced psychosis is a psychiatric side effect that occurs very rarely. \u0000Case report. We report the case of a 33-year-old patient with nearly 15 years history of psychiatric personality disorder and alcohol dependence. Approximately 4 days of alcohol abstinence, as an inpatient he was administered disulfiram. After two weeks, the patient began to feel some side effects. He was admitted to hospital and was diagnosed with disulfiram induced psychosis. \u0000Discussion. The effect of disulfiram on alcohol metabolism was noticed in the 1940s. It should be used only by motivated patients who must be fully informed about the alcohol-disulfiram reaction. Disulfiram should only be started after about 10 days of sobriety, and the recommended dosage is 500 mg/day. The drug should be used with caution in people with a history of heart disease, diabetes mellitus, hypothyroidism, cerebral damage, nephritis, liver cirrhosis, epilepsy. Caution is recommended for patients who use benzodiazepines, some antibiotics, anticoagulants, tricyclic antidepressants. There may be some adverse effects, more serious ones include changes in vision, numbness, pain or weakness in the limbs, liver cell damage, peripheral neuropathy, seizures – but these are considered to be very rare. Psychiatric side effects may include mood changes, psychotic reactions, memory impairment. Reliable data is lacking, but cases of disulfiram induced psychosis are considered to be rare. Patients taking disulfiram should be monitored carefully.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"260 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139840140","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":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139780336","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}
Antanas Vaitkus, J. Čiauškaitė, M. Malakauskaitė, M. Baublytė
Myasthenia gravis is an autoimmune disease in which autoantibodies against the postsynaptic membrane proteins of the neuromuscular junction disrupt impulse transmission thus causing pathological muscle weakness and fatigue that worsens throughout the day. Although the disease is not yet curable, most patients can achieve complete symptom control and improved quality of life with appropriate treatment. Four treatment strategies are used in clinical practice: symptomatic, immunosuppressive, immunomodulatory, and surgical treatment, which can help control the disease but are not equally effective for all patients. Symptomatic treatment with acetylcholinesterase (AChE) inhibitors is often not effective enough, so additional treatment with immunosuppressants is indicated. These are effective, but can cause systemic side effects if taken for long periods. Even polytherapy is often not sufficient enough to treat patients with myasthenia gravis. The challenges of treating this disease are encouraging to seek alternatives. Increasing attention is being paid to antibodies against acetylcholine receptors (AChRs) and other structures of the neuromuscular junction that are important in pathogenesis of myasthenia gravis. Drugs are being developed that target specific links in the immune system to reduce the risk of systemic adverse effects. Currently, only two drugs are approved for the treatment of generalized myasthenia gravis – eculizumab and efgartigimod. Both of them are safe and effective in treating generalized myasthenia gravis with prevalent anti-AChR antibodies. Currently, 10 other drugs are clinically tested for their safety and efficacy in treating patients with myasthenia gravis. In this article, we review publications that analyze biological therapy and its novelty in the treatment of myasthenia gravis. We focus more on already approved biological drugs.
{"title":"New treatment options for generalized myasthenia gravis","authors":"Antanas Vaitkus, J. Čiauškaitė, M. Malakauskaitė, M. Baublytė","doi":"10.29014/ns.2023.27.9","DOIUrl":"https://doi.org/10.29014/ns.2023.27.9","url":null,"abstract":"Myasthenia gravis is an autoimmune disease in which autoantibodies against the postsynaptic membrane proteins of the neuromuscular junction disrupt impulse transmission thus causing pathological muscle weakness and fatigue that worsens throughout the day. Although the disease is not yet curable, most patients can achieve complete symptom control and improved quality of life with appropriate treatment. Four treatment strategies are used in clinical practice: symptomatic, immunosuppressive, immunomodulatory, and surgical treatment, which can help control the disease but are not equally effective for all patients. Symptomatic treatment with acetylcholinesterase (AChE) inhibitors is often not effective enough, so additional treatment with immunosuppressants is indicated. These are effective, but can cause systemic side effects if taken for long periods. Even polytherapy is often not sufficient enough to treat patients with myasthenia gravis. The challenges of treating this disease are encouraging to seek alternatives. Increasing attention is being paid to antibodies against acetylcholine receptors (AChRs) and other structures of the neuromuscular junction that are important in pathogenesis of myasthenia gravis. Drugs are being developed that target specific links in the immune system to reduce the risk of systemic adverse effects. Currently, only two drugs are approved for the treatment of generalized myasthenia gravis – eculizumab and efgartigimod. Both of them are safe and effective in treating generalized myasthenia gravis with prevalent anti-AChR antibodies. Currently, 10 other drugs are clinically tested for their safety and efficacy in treating patients with myasthenia gravis. In this article, we review publications that analyze biological therapy and its novelty in the treatment of myasthenia gravis. We focus more on already approved biological drugs.","PeriodicalId":479531,"journal":{"name":"Neurologijos seminarai","volume":"27 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139780086","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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