Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose: Obstructive sleep apnea (OSA) is a common sleep dis-order. Despite many studies, its etiology is not clearly known. Polyamines are ubiquitous positively charged amines found in all or-ga-nisms and one of the polyamines types is spermidine. In the literature, some articles demonstrate relationship between sleep dis-orders and polyamines. The common point of OSA and polyamines is oxidative stress. This study aimed to determine the serum levels of spermidine in patients with OSA and compare the results with healthy subjects.

Methods: This cross-sectional case-cont-rol study was designed with 69 subjects. Sub-jects were selected from people who were referred to polysomnography due to complaints of sleep disturbance and snoring. They were divided into two groups according to their Apnea Hypopnea Index (AHI) scores: control (n=29; AHI<5), and OSA (n=40; AHI≥5). Spermidine levels were determined in serum samples by using an enzyme-linked immunosorbent assay (ELISA) kit.

Results: After adjusting for age, body mass index (BMI), and gender, there was no significant difference in spermidine levels between OSA and controls (p=0.063, p=0.063, and p=0.818, respectively). There was no correlation between AHI and spermidine levels (rho=-0.063; p=0.698). The area under the Receiver Operating Characteristic (ROC) curve (AUC) was found to be 0.635 for spermidine.

Conclusion: These results demonstrated that decreased levels of spermidine in OSA patients was related to age, BMI, and gender. The relationship between OSA and the polyamines pathway should be the subject of future studies with more homogenous groups to understand the roles of polyamines in OSA pathogenesis.

Background and purpose: Restless legs syndrome (RLS) is a neurological disorder characterized by an irresistible urge to move the legs, frequently accompanied by unplea-sant sensations. In this study, we aimed to determine the changes in electrophysiologi-cal tests including F-wave responses and H-reflex parameters in patients with idiopathic RLS after pramipexole medication.

Methods: This prospective study was con-ducted with twenty newly diagnosed, idiopathic RLS patients. The electrophysiological parameters, specifically F-wave duration (FWD), the duration of related compound muscle action potential (CMAPD), and FWD/CMAPD ratio, the ratio of maximum H-reflex amplitude(H) to maximum M-response amplitude (M)(H/M) were recorded in patients with idiopathic RLS before and after pramipexole medication.

Results: The results revealed significant improvements in specific electrophysio-lo-gical parameters after pramipexole use. We observed a significant decrease in FWD, CMAPD, and FWD/CMAPD values after pra-mipexole treatment suggesting a reduction in motor neuron excitability. We also ob-ser-ved a significant decrease in H/M ratio after pramipexole medication indicating reduced spinal motor neuron excitability.

Conclusion: This study demonstrated significant improvement in specific electrophysiological parameters following pramipexole treatment in patients with idiopathic RLS. The findings provide better understanding of the effects of pramipexole on nerve function and may contribute to the development of a monitoring tool and lead to more targeted treatments and interventions for RLS, improving the overall management and care for patients' outcomes and quality of life with this debilitating condition.

Myasthenia gravis (MG) is an antibody-mediated disorder of the neuromuscular transmission, presenting with fatigable weakness that is either isolated to ocular muscles only or generalised (limb, bulbar and respiratory muscles can be affected). The disorder is estimated to affect around 1700 patients in our country. In some cases symptomatic treatment with acetylcholinesterase inhibitors may be sufficient, but most patients with MG require immunosuppressive drugs at some point for disease control, which is achieved in about 60-70% of patients. 10-20% of MG cases are refractory; they do not respond adequately to the traditional treatments or suffer from severe side effects. In the past few years, new biological agents against complement, the FcRn receptor, or B-cell antigens have been tested in clinical trials. These new therapies extend the possibilities for targeted immunotherapies and promise exciting new options with a relatively rapid mode of action. The goal of the treatment of MG is achieving remission, avoiding myasthenic crisis and eliminating symptoms which worsen the quality of life of our patients. The disease is rare, the clinical picture is variable, therefore the treatment of MG patients, especially of refractory MG should be conducted in neuroimmunological centres with adequate expertise in MG. For the adequate treatment of refractory MG we need the new drugs to be reimbursed in our country.

Migraine is a disabling primary headache disorder that directly affects a significant proportion of the population. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a panel of experts to develop a clinical approach to the diagnosis and management of migraine. This consensus paper was established by experts and supported by a review of current literature, and it was also endorsed by the Hungarian Pain Society and the Hungarian Headache Society. We introduce typical clinical features, diagnostic criteria, subtypes, pitfalls and differential diagnoses of migraine. We outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, women with childbearing potential (menstruation migraine, pregnancy etc) and the potential cardiovascular risk of migraineurs. 

Background and purpose: Post-COVID condition (also known as long COVID) is a syndrome characterized by persistent symptoms following a suspected or confirmed SARS-CoV-2 infection, lasting for at least two months and are not attributable to other conditions. The most common symptoms include fatigue, diffuse pain, post-exertional malaise and “brain fog” (impairment of memory and concentration). The pathomechanism of long COVID is the subject of ongoing, intensive research. Our purpose was to review the literature on the pathomechanism of long COVID.

Methods: We reviewed original and review articles in Hungarian and English on the pathomechanism of long COVID, published between January 2019 and June 2024, in the PubMed and Google Scholar databases.

Results: Potential underlying causes of the symptoms are outlined in three main theories. 1) The concept of “long COVID as a distinct neurological disease” suggests that direct viral neuroinvasion, apoptosis, and demyelination processes are responsible for the symptoms. 2) The theory of “long COVID as a systemic disease with neurological symptoms” is based on the virus induced, prolonged cytokine and chemokine release, as well as the reactivation of latent viral infections. 3) According to the concept of “long COVID as a somatoform disorder”, the disease results from abnormal activation of the proinflammatory cytokine network leading to central nervous system sensitization, a well-known psychoneuroimmunological mechanism. Our study highlighted significant overlaps between long COVID and conditions such as chronic fatigue syndrome/myalgic encephalomyelitis, a group of symptoms not defined as a distinct mental disorder in DSM-5, but commonly referred to as Gulf War syndrome, chronic Lyme disease and somatic symptom disorder.

Conclusion: The pathomechanism of long COVID, which presents with a wide range of nonspecific symptoms, remains unknown, and no reproducible disease-specific biomarker has been identified to date. Clarifying the etiology of the disease is crucial for determining adequate and effective therapeutic methods.

Background and purpose: Recognising neurological diseases is challenging without accurate diagnostic tools. Therefore, many approaches have been taken to recognise and evaluate these diseases through speech, movement, or drawing modalities.The purpose of the study is to compare the recognition of Parkinson’s and cerebellar symptoms using spiral and line drawings recorded from the same subjects. We also investigate the importance of pin pressure in classification. Furthermore, an attempt is made to use the two types of drawings together for more accurate classification.

Methods: Images were generated from the raw data with and without pressure data. We then performed classification with the help of pre-trained and own deep learning feature extraction models. Mann-Whitney U test is used to test the significance of the results with a 0.05 significance level.

Results: The results showed that spiral drawings significantly performed better than lines (p-value: 0.001). Furthermore, combining the two types of drawings improves recognition when pressure is available (p-value: 0.017). However, no performance degradation can be expected without pressure data using one drawing task (p-value: 0.507).

Conclusion: The spiral is recommended as the primary drawing, but combining multiple drawings can contribute to a more confident recognition. By excluding pressure, no significant decrease is expected in the model’s performance.

Background and purpose: Aging, inactivity, malnutrition and diseases cause sarcopenia and stroke is an important reason of sarcopenia. The aim of this study was to determine the sarcopenia and to evaluate the relationship between functional outcome and temporal muscle thickness using brain CT in older acute stroke patients. 

Methods: A retrospective study was conducted with acute stroke patients in a single neurology clinic. A total of 114 patients aged 65 years and older were included. Temporal muscle thickness was measured manually using brain computed tomography on admission and third month. Sarcopenia risk and modified Rankin scale scores at 3 months after stroke were assessed. 

Results: The mean temporal muscle thickness was 5.85±0.96 on admission and 5.67±0.97 on third month in the entire group (p=0.004). Patients with sarcopenia risk score ≥4 on third month, the mean temporal muscle thickness was 5.63±1.02 and 5.32±0.98 on admission and 3rd month respectively (p<0.001). There was a significant correlation between baseline temporal muscle thickness and age (r=-0.728, p<0.001) and body mass index (r= 0.360 , p=0.017). 23 patients (20.1%) had poor functional outcome at 3 months after stroke (mRS>3). A significant correlation was found between temporal muscle thickness on admission and the third month modified Rankin scale score (r=-0.613, p<0.001). 

Conclusion: Measurement of temporal muscle thickness using brain CT in stroke patients may be a useful method for muscle mass determination and treatment of sarcopenia. 

Corticobasal degeneration (CBD) is one of the primary tauopathies with a disease onset in the 5th to 7th decade. CBD is a progressive condition of unknown aetiology, which is characterised neuropathologically by neuronal loss, astrogliosis and deposition of filamentous tau inclusions, composed entirely of 4-repeat tau isoforms, in neurons and glial cells in cerebral cortical areas, basal ganglia, brainstem and cerebellar nuclei. The term CBD is now a neuropathological diagnostic one and for the canonical clinical syndrome associated with CBD neuropathological changes, the corticobasal syndrome (CBS) term is used. In addition to CBS, the clinical spectrum also includes a behavioural variant of frontotemporal dementia syndrome, speech disorders, Richardson’s syndrome and, rarely, posterior cortical syndrome. In addition to CBD, CBS can also be caused by other pathologies. A number of genetic risk factors of CBD have been identified. As specific biomarkers confirming CBD as the underlying pathology responsible for CBS or other clinical manifestations are still lacking, for a definitive diagnosis of CBD neuropathological investigation is required. Recent cryo-electron microscopic studies have proven that CBD is a distinct tauopathy associated with a unique molecular structure of the tau filaments, which firmly differentiates it from other primary tauopathies. 

Background and purpose: When examining coping with chronic pain, it is important to consider not only the physical characteristics of pain but also its psychological and social aspects, such as depression or pain catastrophizing. The relationship between pain and the psychological characteristics of patients has been studied in various approaches in previous research. The aim of this study was to separate groups within a clinical sample using a profiling method and to identify risk factors related to illness behaviour.

Methods: The study involved 136 patients aged 18 and above diagnosed with chronic pain of various etiologies. Data collection involved the use of psychological questionnaires measuring levels of health literacy, social support, depressive symptoms, and pain catastrophizing, in addition to pain characteristics. Statistical analysis of the data was conducted using independent samples t-tests, one-way ANOVA, and K-means cluster analysis.

Results: Three clusters significantly different from each other in terms of all grouping variables (p < 0.001 in each case) were identified within the studied sample. These clusters were named “Conscious Worriers” (1st), “Balanced Symptom Perceivers” (2nd), and “Abandoned Catastrophizers” (3rd). We successfully identified the 2nd cluster as a protected group and the 3rd cluster as a risk group.

Conclusion: Identified clusters can facilitate the application of group-specific pain therapies by describing the characteristic combinations of risk factors. Our results support the importance of pain education and prevention.

Background and purpose: Parkinson's disease (PD) is the most common movement disorder and the second most common neurodegenerative disease of the central nervous system. Dizziness is frequently reported by PD patients, yet there is a paucity of research focusing on the vestibulo-ocular reflex (VOR) in this population using high-frequency vestibular testing. This study aims to investigate the VOR in individuals with PD using the video head thrust test with and without suppression.

Methods: Forty individuals with PD and 40 healthy individuals were included in the study. According to the Hoehn-Yahr Scale, individuals with PD were defined as early stage with a score of 1-2.5 and middle to late stage with a score of 3 to 5. The Head Impulse Testing Paradigm (HIMP) and Suppression Head Impulse Testing Paradigm (SHIMP) were applied to all individuals.

Results: No statistically significant difference was observed between the PD group and the control group in terms of semicircular canal (SCC) gains in both HIMP and SHIMP tests. No catch-up saccades were observed in the right anterior, right posterior, left anterior, and left posterior SCC planes in the PD and control groups. However, in the right lateral SCC plane 32 patients in the PD group had saccades, while 8 patients in the control group had saccades. In the left lateral SCC plane, 32 patients in the PD group and 9 patients in the control group had catch-up saccades. A statistically significant difference was observed in the number and amplitude of saccades in the right and left lateral SCC planes compared to the control group (p<0.05). In addition, in the PD group, the amplitude, peak velocity, and latency of the anticompensatory saccades seen in SHIMP showed a statistically significant difference compared to the control group (p<0.05).

Conclusion: VOR in the vertical SCC plane was not affected in individuals with PD. However, VOR in the lateral SCC plane was affected. It was concluded that when evaluating VOR with both HIMP and SHIMP in individuals with PD, the presence of catch-up saccades should be focused on and evaluated for possible vestibular dysfunction, even though SCC gains are normal. This study will contribute to a deeper understanding of vestibular function in PD, potentially informing better management strategies for dizziness in this population.