Krystyna Pierzchała

Evaluation of postural balance control in patients with multiple sclerosis – effect of different sensory conditions and arithmetic task execution. A pilot study

BACKGROUND AND PURPOSEnThe purpose of this study was to investigate the effect of concomitant cognitive task execution and different sensory conditions on balance control in patients with multiple sclerosis (MS).nnnMATERIAL AND METHODSnThirty-two subjects with MS and 30 healthy age- and sex-matched control subjects were included in the study. Balance Performance Oriented Mobility Assessment was performed in all subjects. Their spontaneous sway characteristics while standing with different sensory conditions and during execution of a simple arithmetic task were analysed. Mean sway in the coronary and sagittal plane, as well as sway velocity, were measured.nnnRESULTSnThe values of all evaluated variables obtained in all tests were significantly higher in the MS group than in controls. In the MS group, more pronounced progression of changes in response to increased difficulty of the test was also observed. Analysis of risk of falls in MS revealed a significant increase of sway velocity and mean sway in the mediolateral and anteroposterior plane in the majority of tests.nnnCONCLUSIONSnPostural stability in patients with MS is significantly decreased in comparison with the control group in all evaluated conditions. Stability deficit is enhanced in response to more difficult conditions of evaluation. Increased risk of falls is related to the increased postural sway velocity and length of mean sway; this association is most pronounced in the coronary plane.

Difficulties in the diagnosis of autonomic dysfunction in multiple sclerosis.

Autonomic function was assessed in 24 patients with multiple sclerosis using a questionnaire, cardiovascular reflex tests and sympathetic skin responses. Most patients had some degree of dysautonomia.

Cerebral venous sinus thrombosis

Diagnostic imaging in cerebral venous sinus thrombosis poses difficulties due to the relatively rare incidence of this pathology and its usually inconclusive clinical and radiological symptoms. The preliminary examination is usually performed using computed tomography, whereas magnetic resonance imaging (MRI) provides better visualisation of the lesion. Computed tomography and magnetic resonance imaging angiography enable the characterisation of the blood flow in the pathologically affected vessels in more detail. Familiarity with the anatomic variations of the venous system and with the advantages and limitations of computed tomography/magnetic resonance imaging enables faster diagnosis of the pathology. This is significant for treatment, which, in many cases, can be efficient only if introduced at a sufficiently early stage.

Padaczka oporna na leczenie – epidemiologia i aktualny stan badań

In the last years interest in epileptology has focused on determining the cause and pathomechanism of farmacoresistance in epilepsy. According to epidemiology, the problem of pharmacoresistance concerns about 30% of patients suffering from epilepsy, mainly temporal epilepsy coexisting with hippocampal sclerosis. Drug-resistant epilepsy is frequently based on static or dynamic organic brain damage. Furthermore, those morphological changes and related clinical/psychological dysfunctions lead to intellectual and social consequences as well as to an increase of the mortality rate. n nPharmacoresistant epilepsy afflicts various patients with the same form of epilepsy and concerns many antiepileptic drugs with different mechanisms of action. Thus, the genetic conditioning of this state was considered. So far, the multidirectional investigations have proved the importance of interleukin IL-1β gene polymorphism, prodynorphin, GABA receptors and the APOE∑4 allele in pharmaco-resistant epilepsy. Moreover, further factors such as transport protein gene polymorphism (ABCB1, RLIP76/RALBP1), genetically modifying receptor changes within the activating/inhibiting system (SCN1A – sodium channels, KV7 – potassium channels) and drug metabolizing enzyme gene polymorphism (UG T1 A1*28) are also considered important.Streszczenie W ostatnich latach zainteresowania epileptologią zogniskowaly sie na wyjaśnianiu przyczyny i patomechanizmu oporności na leczenie w padaczce. Opornośc na leczenie dotyczy ok. 30% chorych na padaczke, przewaznie plata skroniowego ze stwardnieniem hipokampa, czesto rozwija sie na tle organicznego uszkodzenia mozgu – statycznego lub dynamicznego. Powoduje morfologiczne zmiany tkanki nerwowej oraz nastepstwa kliniczno-psychologiczne prowadzące do postepującej dysfunkcji intelektualnej i spolecznej oraz wzrostu wskaźnika śmiertelności. Opornośc na leczenie dotyczy wielu lekow przeciwdrgawkowych o roznym mechanizmie dzialania i roznych chorych z tą samą postacią padaczki, dlatego podjeto badania nad uwarunkowaniami genetycznymi. Dotychczas przeprowadzono roznokierunkowe badania, w ktorych oceniano znaczenie polimorfizmu genu interleukiny IL-1β, prodynorfiny, receptora GABA, allela APOE∑4. W wielu badaniach oceniano polimorfizm genow dla bialek transportujących (ABCB 1 , RLIP76/RALBP 1 ), genetycznie modyfikowanych zmian receptorow w ukladzie aktywującym lub hamującym (SCN1A – kanaly sodowe, KV 7 – kanaly potasowe) i polimorfizm genow dla enzymow metabolizujących leki (UG T1 A1*28).

Estimates of stroke incidence and case fatality in Zabrze, 2005–2006

BACKGROUND AND PURPOSEnEpidemiological rates for stroke obtained in the United States and Western Europe indicate a decrease in incidence and case fatality. Data published for Poland, as for other Central-Eastern European countries, reported unfavourable results, but this was based on data from the 1990s. The authors evaluated current stroke rates in a population study of the southern Poland city of Zabrze.nnnMATERIAL AND METHODSnA retrospective registry of all stroke cases treated in Zabrze, southern Poland, in 2005-2006, was established, based on data from the National Health Fund. Cases were identified by verifying patient files. Epidemiological rates were calculated and standardized to the European population in both groups: all stroke patients, including recurrent (all strokes, AS), and patients with first-ever stroke (FES) in their history.nnnRESULTSnWe registered 731 strokes, including 572 FES cases (78.3%) and 159 recurrent strokes (21.7%). There were 385 strokes in men (52.7%), and 346 in women (47.2%); 88.6% were ischaemic strokes (IS), and 11.4% were intra-ce-rebral haemorrhages (ICH). The standardized incidence rate for AS patients was 167/100 000 (211 for men, 130 for women), and in the FES group 131/100 000 (161 for men, 104 for women). Twenty-eight day case fatality for the AS group was 18.3% (15.4% for IS, 41% for ICH), and 16.6% for FES (13.4% for IS, 40.9% for ICH).nnnCONCLUSIONSnIncidence rates in this southern Poland city are comparable to those reported previously for Poland. Early case fatality decreased, compared to previous data, probably as a result of improved management of acute stroke and hospitalizing all stroke patients.

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

BACKGROUND AND PURPOSEnEssential 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.nnnMATERIAL AND METHODSnWe 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.nnnRESULTSnThere 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.nnnCONCLUSIONSnAccelerometric 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 PURPOSEnEpilepsy 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.nnnMATERIAL AND METHODSnWe 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.nnnRESULTSn43.2% 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.nnnCONCLUSIONSnThe 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.

Changes in Serum Ceruloplasmin Levels Based on Immunomodulatory Treatments and Melatonin Supplementation in Multiple Sclerosis Patients

Background The cause of multiple sclerosis (MS) is currently unknown, but it is thought that oxidative damage and iron metabolism mechanisms are involved. The aim of this study was to examine ceruloplasmin concentration in MS patients based on various immunomodifying therapies and to test the effect of antioxidative melatonin on ceruloplasmin levels. Material/Methods This prospective study included 102 MS patients and 15 healthy controls. Patients were divided into groups according to different immunomodifying therapies: interferons beta 1a, interferons beta 1b, glatiramer acetate, mitoxantrone, and immunomodifying pre-treatment (A, B, G, Mx, and P groups, respectively), and the relapse R group. MS patients were supplemented with melatonin for 3 months. Serum ceruloplasmin concentrations, EDSS, brain MRI, serum C-reactive protein level, and white blood cell count were examined. Results The results indicated significantly increased levels of ceruloplasmin in MS patients. No differences in ceruloplasmin concentrations between the relapse group and controls were observed. In A and G groups, ceruloplasmin levels before and after melatonin were similar to levels in controls. In group B, ceruloplasmin concentration was significantly higher vs. control and relapse groups. After melatonin administration in group B, ceruloplasmin levels decreased. Ceruloplasmin concentrations in the Mx group were significantly higher compared to controls. Conclusions We found for the first time that ceruloplasmin concentration in MS patients varies depending on different immunomodulatory treatment and decrease after 3 months of melatonin administration. Ceruloplasmin could be a valuable serum marker for the chronic demyelinating process participating in oxidative stress mechanisms, as well as a neurodegenerative marker, but not a marker of acute-phase MS.

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.

Assessment of Biochemical and Densitometric Markers of Calcium-Phosphate Metabolism in the Groups of Patients with Multiple Sclerosis Selected due to the Serum Level of Vitamin D3

Background In addition to the widely known effect of vitamin D3 (vitD3) on the skeleton, its role in the regulation of the immune response was also confirmed. Aim The assessment of biochemical and densitometric markers of calcium-phosphate metabolism in the groups of patients with relapsing-remitting multiple sclerosis (RRMS) selected due to the serum level of vitamin D3. Methods The concentrations of biochemical markers and indices of lumbar spine bone densitometry (DXA) were determined in 82 patients divided into vitamin D3 deficiency (VitDd), insufficiency (VitDi), and normal vitamin D3 level (VitDn) subgroups. Results The highest level of the parathyroid hormone (PTH) and the highest prevalence of hypophosphatemia and osteopenia were demonstrated in VitDd group compared to VitDi and VitDn. However, in VitDd, VitDi, and VitDn subgroups no significant differences were observed in the levels of alkaline phosphatase (ALP) and ionized calcium (Ca2+) and in DXA indices. A negative correlation was observed between the level of vitamin D3 and the Expanded Disability Status Scale (EDSS) in the whole MS group. The subgroups were significantly different with respect to the EDSS scores and the frequency of complaints related to walking according to the EQ-5D. Conclusions It is necessary to assess calcium-phosphate metabolism and supplementation of vitamin D3 in RRMS patients. The higher the clinical stage of the disease assessed with the EDSS, the lower the level of vitamin D3 in blood serum. Subjectively reported complaints related to difficulties with walking were reflected in the EDSS in VitDd patients.