Ivan Bielen

Factors associated with perceived stigma of epilepsy in Croatia: A study using the revised Epilepsy Stigma Scale

PURPOSE It is believed that a large number of factors influence feelings of stigma, but their relative contribution is not yet entirely clear. Most studies to date were conducted using the Epilepsy Stigma Scale (ESS); only one used a revised version of the ESS (rESS). The following study aims to determine factors contributing to epilepsy stigma in outpatients with chronic epilepsy in Croatia, and to analyze some psychometric properties of the Croatian translation of the rESS. METHODS Alongside standard testing for validity of the scale, a simulation model of the original ESS (smESS) was created. This model, which does not include a grading Likert 0-3 scale, was compared with the rESS. RESULTS In total, 159 out of 298 subjects (53%) reported feeling stigmatised, with 136 (45%) mild to moderately and 23 (8%) highly. Internal consistency of the Croatian translation of the rESS was 0.887. Feelings of stigma were significantly associated with age ≤ 50 years, younger age of epilepsy onset, more than 50 seizures to date, generalized tonic-clonic seizures, and a shorter seizure-free period. Multiple stepwise regression showed number of seizures to date as a significant variable (Beta=0.246). By adapting data into the smESS significant associations with younger age and age of epilepsy onset were lost. Internal consistency of the smESS was 0.849. CONCLUSIONS The Croatian translation of the rESS has been proved to be a suitable instrument for diagnosing epilepsy stigma. The results of our model point to the possibility that the rESS might be more sensitive than the original ESS.

Impact of troponin I on outcome of ischemic stroke patients

Abstract Introduction. Stroke is one of the leading causes of morbidity and mortality. Cardiac troponins have been found to be increased in other conditions apart from the cardiac diseases, such as stroke. The aim of the study was to assess the correlation between elevated troponin I levels and stroke outcome. Methods. This retrospective study included 198 acute ischemic stroke patients in whom troponin I levels have been obtained at admission. Exclusion criteria were concomitant acute coronary syndrome, congestive heart failure, pulmonary embolism, renal failure, rhabdomyolysis and septic conditions. Results. There was a statistically significant difference in the proportion of deaths during hospitalization (p = 0.041) and modified Rankin Scale scores (p = 0.016) between the group of patients with elevated troponin I levels and the control group. Prior ischemic strokes were more common in the group with elevated troponin I levels (p = 0.032). No other differences were observed. Conclusions. Our study showed that patients with elevated initial troponin I levels are associated with unfavorable outcome or death. Stroke may be associated with mild elevation of troponin levels, contrary to higher levels which are usually related to other conditions.

Carotid Body Tumor as a Cause of Stroke

We herein report a case of a 78-year-old woman who was admitted to our hospital due to a stroke with left-sided hemiparesis. Ultrasound of the carotid arteries showed a carotid body tumor on the bifurcation of the right common carotid artery, which was subsequently confirmed by a further neuroradiological investigation. Magnetic resonance imaging of the head confirmed an acute ischemic lesion located in the right periventricular region. The carotid body tumor (CBT) was surgically removed and confirmed on histopathology. Our case reveals the role of carotid ultrasound in the diagnosis of a CBT, which may be a potential cause of stroke.

Social and medical care of preschool children with epilepsy in Croatia: population-based survey.

BACKGROUND Early detection of mental retardation and other epilepsy-associated impairments is essential for successful medical and social care of children with epilepsy; the corresponding information for children in Croatia has not yet been known. AIMS OF THE STUDY To obtain the basic information of epilepsy-associated disability in preschool children, and fundamentals of their medical and social care. METHODS Data about mental retardation and other associated impairments (motor, speech, seeing, hearing), antiepileptic drug therapy and diurnal residence were collected by means of questionnaires completed by physicians working in primary health care (PHPs). Only children (0-7 years) with active epilepsy confirmed previously by neuropaediatricians were included. RESULTS A total of 37 PHPs provided the required data for 116 children. One or more impairments were found in 56% children; most frequent were motor impairments (47%), speech impairments (42%) and mental retardation (40%). The regular kindergarten attendance rate of children without impairment (33%) was not different from the children without epilepsy, but high proportion (76%) of children with impairment stayed with their families during weekdays. In this subgroup monotherapy was more rarely used (64% vs. 90% in children without impairment (p<0.01)). Valproate was predominantly used (56%) in children with and without impairment; lamotrigine was more frequently used in the former subgroup (p<0.01). CONCLUSIONS Existence of associated impairments has significant impact on medical and social care in preschool children with epilepsy. These children need an early diagnosis and consecutive multidisciplinary care of their intellectual and body impairments, as well as problems in social development.

Translati onal challenges of neuroprotection strategy in ischemic stroke

Neuroprotection is a therapeutic strategy that attempts to save neurons from irreversible injury by modifying the effects of the ischemic cascade or facilitating reperfusion. Although numerous agents have shown neuroprotective effect in preclinical trials, their translation to clinical trials failed to show any meaningful effect. The Stroke Therapy Academic Industry Roundtable (STAIR) guidelines were made for performing research on neuroprotective agents in pre-clinical and clinical trials. Although the STAIR guidelines have been available for more than ten years, we still do not have any adequate neuroprotective agents. Reasons for unsuccessful translation from preclinical to clinical research can be considered along stages of drug development: 1) preclinical, 2) transitional and 3) clinical. By extending the therapeutic window for application of intravenous thrombolysis in acute stroke patients to 4.5 hours, as well as increasing the use intra-arterial thrombolysis and development of mechanical devices for thrombectomy in 6 hour period we may be able to achieve some degree of neuroprotection in acute stroke. Future therapy is likely to add to the current thrombolytic therapy with potential neuroprotective drugs or procedures.

32 Vertigo with hearing loss as the first symptom of leptomeningeal carcinomatosis originating from colorectal carcinoma

Introduction Leptomeninges are common dissemination site of advanced malignant disease. The most frequent primary sites are breast, lung, melanoma and stomach, whereas colon is rarely reported. Case report We report a case of a 70- year-old man who was admitted to the neurology department with a three-week history of mild frontal headache, vertigo and vomiting. The patient had no history of malignancies or any other serious diseases. The neurological examination showed an ataxic gate and hearing loss on the right ear. Findings of the multi-slice computed tomography (MSCT) of the brain were unremarkable. Magnetic resonance imaging (MRI) of the brain showed multiple periventricular white matter lesions. During the next few days the patient symptoms progressed to include right peripheral facial nerve palsy, complete hearing loss and mental alteration. Body temperature and inflammation parameters were normal all of this time. Gadolinium-enhanced MRI was performed and revealed diffuse leptomeningeal enhancement of the cranial base a thickening of both of the vestibulocochlear nerves especially right one. Cerebrospinal fluid (CSF) analysis showed sterile hypercellular (1184/3mm3) CSF with predominantly low-differentiated malignant cells with numerous mitoses (Figure 1), hypoglycorrhachia (1, 7 mmol/L) and elevated protein level. The highly increased serum levels of the tumor marker carbohydrate antigen 19-9 was present. Ultrasound and MSCT of the abdomen, esophagogastroduodenoscopy as well as ultrasound of the thyroid gland and chest X-ray did not find any signs of malignant disease. However, colonoscopy revealed an infiltrating process that prominates to the lumen of the ascending colon. The patient showed no symptoms of intestinal obstruction or any other GI tract symptoms. Histopatological analysis of biopsy samples verified adenocarcinoma. The patient refused intratecal chemotherapy and underwent whole-brain radiotherapy. Despite treatment, the patient’s state deteriorated and as a result he died shortly after. Conclusion Unilateral hearing loss progressing to bilateral deafness within short period of time is a rare clinical manifestation of the leptomeningeal carinomatosis.