Agnieszka Machowska-Majchrzak

Essential tremor – assessment of tremor accelerometric parameters' symmetry and the relationship between hand dominance and severity of tremor

BACKGROUND AND PURPOSE Essential tremor (ET) is likely the most common movement disorder. The aim of the study was to carry out spectral analysis of the essential tremor recorded by an accelerometer and assess the symmetry of tremor parameters between the two hands. MATERIAL AND METHODS We examined 39 patients with ET diagnosed clinically using the criteria of the Movement Disorder Society. The control group consisted of 52 healthy persons. A biaxial accelerometer mounted at the dorsal side of the hand was used. Spectral analysis was performed. Tremor intensity, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, and harmonic index were measured. The side-to-side symmetry of these parameters was analysed. The relationship of hand dominance and severity of tremor was also analysed. RESULTS There was significant side-to-side asymmetry of intensity in ET. The intensity in the more affected hand was over two times higher than that in the less affected one. The tremor was more severe in the nondominant hand in 62% of patients. In spite of significant difference in tremor intensity between the two sides, tremor frequency was similar in both hands. The standard deviation of centre frequency was significantly lower and the harmonic index was significantly higher in the more trembling hand. CONCLUSIONS Accelerometric registration revealed that asymmetry of intensity and symmetry of frequency are characteristic features of ET. The remaining two coefficients reflecting the rhythmicity and regularity of tremor also differed considerably between the hands.

Knowledge and attitudes towards epilepsy among inhabitants of Silesia. A questionnaire study

BACKGROUND AND PURPOSE Epilepsy is one of the most frequent neurological diseases. Social acceptance is very important for people with epilepsy and their relatives. The aim of the study was to assess public knowledge and attitudes towards epilepsy in Silesia. MATERIAL AND METHODS We examined 419 people, inhabitants of Silesia, at the mean age of 34 ± 15 years. The study was performed using a questionnaire containing 15 questions evaluating knowledge about epilepsy and attitudes towards people with epilepsy. RESULTS 43.2% of the respondents knew an epileptic person themselves. 44.7% had witnessed an epileptic seizure; 68.8% would help a person during an epileptic seizure, but most of them (73.4%) would do it incorrectly (by putting an object into the mouth to prevent biting the tongue). 94.5% of respondents had nothing against friendship with an epileptic person, but 12.1% suggested that children with epilepsy should attend special schools. 85.9% of all those examined said that people with epilepsy should inform others about their disease, 81.9% would mention the existence of an epileptic person in their family. 40.5% of respondents believe that people with epilepsy can do the same jobs as healthy people, 75.3% would employ an epileptic person themselves. CONCLUSIONS The knowledge about epilepsy and first aid during epileptic seizure is still insufficient among inhabitants of Silesia. Most of the responders, especially better educated ones, declare acceptance and tolerance of people with epilepsy. More effort should be made to improve public knowledge of epilepsy by preparing wide-spread educational programmes.

Searching for factors associated with resistance to acetylsalicylic acid used for secondary prevention of stroke

Introduction The aim of the study was to evaluate the prevalence of resistance to acetylsalicylic acid (ASA), used for secondary prevention of stroke, including the assessment of risk factors associated with the lack of ASA anti-aggregatory action. Material and methods Patients after a transient ischaemic attack (TIA) or ischaemic stroke in the acute (n = 111) and chronic phase (n = 87) were enrolled in the study. The assessment of platelet function was performed by whole blood impedance aggregometry using a multi-channel platelet function analyser (Multiplate). Results A proper response to ASA was found in 121 patients (61.1%) (ASA responders), a partial response to ASA in 59 patients (29.8%) (ASA partial responders), and ASA resistance in 18 patients (9.1%) (ASA non-responders). Acetylsalicylic acid resistance was observed more frequently in the chronic phase. The mean low-density lipoprotein (LDL) concentration was higher in ASA non-responders (p = 0.02). The mean heart rate (p = 0.03) and the mean haematocrit (p = 0.03) were higher in the group of ASA partial responders and ASA non-responders. Angiotensin II receptor antagonists were more often used in the group of ASA partial responders and ASA non-responders (p = 0.04). Diuretics were more rarely used by ASA non-responders, whereas fibrates were more rarely used by ASA partial responders. Conclusions The method enabled the detection of ASA resistance in some patients with cerebrovascular disease. The study revealed some possible risk factors of ASA resistance: long ASA therapy, increased heart rate, higher LDL concentration, and higher haematocrit value. The relationship between the effect of ASA and other medications (angiotensin II receptor blockers, fibrates, diuretics) requires further study. Platelet function monitoring should be considered in patients at a greater risk of ASA resistance.

Antiplatelet and anticoagulant therapy in elderly people with type 2 diabetes mellitus in Poland (based on the PolSenior Study)

Introduction Type 2 diabetes mellitus (T2DM) is an important and common cardiovascular risk factor. The purpose of the study was to evaluate the frequency of use of oral antiplatelet drugs (OAPs) and oral anticoagulant drugs (OACs) among the elderly with T2DM in Poland. Material and methods The study was based on the data collected in the Polish national PolSenior study. Results Among 4979 PolSenior participants aged 65 and over, 883 (17.8%) had previously diagnosed T2DM. Among them, 441 (49.9%) used at least one drug in pharmacological cardiovascular prevention, i.e. OAPs (mostly ASA) in 405 (45.9%) cases and OACs in 38 (4.3%). The use of these drugs significantly depended on the sex (p = 0.02) and personal income (p = 0.05). Age, place of residence and level of education did not affect the prevalence of pharmacological prevention. Previous stroke and myocardial infarction were mostly associated with OAPs, whereas a history of atrial fibrillation (AF) was related to OAC treatment. Among participants treated with OAPs, therapy was applied as secondary cardiovascular prevention in 211 (52.1%) subjects, and as primary prevention in 194 (47.9%) subjects. Among participants treated with OACs, 24 (64.9%) persons had a history of AF. Secondary cardiovascular pharmacological prevention should be considered in 45 untreated participants (12.5%), and primary cardiovascular pharmacological prevention (SCORE ≥ 10 and/or AF) in 154 participants (42.7%). Conclusions Cardiovascular pharmacological prevention in the elderly with T2DM in Poland seems to be unsatisfactory. Educational programmes concerning current recommendations for pharmacological cardiovascular prevention should be developed among general practitioners.