Tamás Járdánházy

The Prevalence of Multiple Sclerosis, Distribution of Clinical Forms of the Disease and Functional Status of Patients in Csongrád County, Hungary

Objective: The aim of this study was to determine the prevalence of multiple sclerosis (MS) in the population of Csongrád County, Hungary (400,128 inhabitants) and to determine the functional status (based on the Expanded Disability Status Scale; EDSS) of the patients according to the clinical forms of the disease. Methods: The diagnosis was established with the aid of the Poser diagnostic criteria, and the degree of physical disability was determined using the Kurtzke EDSS. Results: In Csongrád County, the prevalence of MS is 62/100,000. The distribution of patients according to the clinical forms of MS was as follows: 15% had the benign form, 54% had relapsing-remitting MS, 20% had secondary chronic progressive MS and 11% had the primary chronic progressive form of MS. Sixty percent of relapsing-remitting MS patients had an EDSS score of 0–4 points and 33% had an EDSS score of 4.5–6.5 points. Conclusion: The distribution of patients according to the clinical forms of the disease in this representative population is comparable to results in other regions of the world.

Increased mydriatic response to tropicamide is a sign of cholinergic hypersensitivity but not specific to late-onset sporadic type of Alzheimer's dementia

Several recent reports have noted defective central control of the autonomic nervous system in Alzheimers dementia (AD), such as altered cardiac (Aharon-Peretz et al 1992) and vasomotor (Algotsson et al 1995) functions. Additionally, an increased sensitivity of the iris to cholinergic agents has been reported in subjects with Down syndrome (Sacks and Smith 1989), and recently in a pilot study (Scinto et al 1994) in AD. These results has been successfully replicated by different laboratories (Idiaquez et al 1994; Schweitzer et al 1996), whereas other studies, however, failed to demonstrate the increased mydriatic response to tropicamide in patients with AD (Loupe et al 1996). Such a screening method could be important, because no simple neurobiological tests are yet available for the early diagnosis of AD. Therefore, the aim of our present study was twofold: 1) to provide further data on the sensitivity and specificity of the pupil dilatation test in the two most common forms of dementia (Jellinger et al. 1990): late onset sporadic type of AD and

Familial multiple sclerosis: Case study of three affected siblings

Bencsik K, Rajda C, Seres E, Vörös E, Janáky M, Dibó Gy, Járdánházy T, Vécsei L. Familial multiple sclerosis: case study of three affected siblings. Acta Neurol Scand 2002: 106: 392–395.

Non-linear quantitative electroencephalographic (qEEG) changes during processing of chemo-sensory stimulations : A preliminary study

The present study was to investigate the processing of pleasant smell and taste stimuli by non-linear EEG measures. Point correlation dimension (PD2i) has been used for studying the local, and synchronization likelihood (SL) the global dynamical organization. Nine healthy subjects participated in this study. After a baseline period of 30s the patients were given a perfume cap or a chocolate taste for 30s. The analysis was performed off-line on 16 channels. After smell stimulation an immediate bilateral but short response was seen. First a decrease and afterwards an increase were found in the mean PD2i. In contrast, the taste stimulation resulted in a later reaction mainly on the right side. The SL in the slow alpha band decreased during the first 15s after both stimulations. In the second 15s, however, a remarkable SL increase was seen mainly in the 7-14Hz and in every frequency band. The decreased mean PD2i and SL values could be interpreted by the simplified network preparation to cognitive data processing. The PD2i and SL methods detected subtle dynamical changes during olfactory and gustatory processes suitable for collection normative database to pathological conditions.

Sodium lactate differently alters relative EEG power and functional connectivity in Alzheimer's disease patients' brain regions

Bilateral temporo‐parietal hypoperfusion and decreased glucose metabolism are characteristic in vivo findings in Alzheimer’s disease (AD). Lactate is a metabolic vasodilator and is known to induce increased cerebral blood flow in healthy adults. The present study addresses the issue whether sodium lactate infusion affects functional state and resulting electroencephalographic patterns of AD patients. Twelve late‐onset sporadic AD probands participated in this self‐control study. The relative power and synchronization likelihood (SL) values of the electroencephalographic samples were calculated and compared off‐line before and after sodium lactate infusion (0.5 m, 5 ml/kg body weight). Based on the reactivity to sodium lactate the scalp could be divided into three parts; no significant changes were seen in the seriously damaged (P3–P4) areas. The moderately affected regions in the close neighborhood showed a paradoxic inactivation with electroencephalographic slowing, a likely consequence of the metabolic‐like steal effect of the near‐normal areas outside. These results indicate a diminished vascular and/or metabolic reserve capacity to sodium lactate challenge in AD and confirm the formerly described electroencephalographic abnormalities.

Phase-Synchronization of Daily Motor Activities Can Reveal Differential Circadian Patterns

The aim of the study was to determine any alteration of the 24 h motor activity pattern of a bipolar patient in different mood states. Actigraphic records were collected on an outpatient basis for a total of 387 days. The daily actograms were synchronized in phase to the time of morning awakening before averaging, which significantly enhanced the structure of the averaged traces. The actograms were divided into three groups based on total daily count. The daily motor activity patterns of the low- and high-activity days have a different circadian pattern. We propose it may have a relevance to the different mood states. The phase-synchronization of the 24 h actograms to the patients sleep-wake cycle, specifically to the time of awaking from the nighttime sleep, may help reveal differences in the daily temporal patterns of motor activity.

Unilateral thalamic infarction causing downward gaze palsy in a patient with uncorrected tetralogy of Fallot: A case report

Introduction - Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD). Adults with surgically uncorrected forms of this condition are extremely rare, since operation is recommended in childhood to prevent cyanosis. Cyanotic CHD increases the risk of thromboembolic events. An endothelial dysfunction caused by chronic hypoxia and shear stress due to rheological alterations with a platelet dysfunction appear to be the explanation behind this finding. Paramedian thalamic infarction causing vertical gaze palsy without midbrain involvement is an infrequent finding. We report here a rare case of a patient with untreated TOF, who suffered a left-sided unilateral thalamic infarction presenting as downward gaze palsy and diplopia. Case presentation - A 44-year-old women complained of sudden onset diplopia and vertigo. Neurological examination revealed a downward gaze palsy with other symptoms related to a vertebrobasilar territory circulatory disturbance. The MRI scan revealed an acute infarction, 8 mm in diameter in the left medial thalamic region without midbrain involvement. Discussion - Adults with uncorrected forms of TOF are extremely uncommon, and descriptions of stroke in these patients are therefore rarities. We set out to give a concise survey of the literature regarding TOF patients with stroke. Conclusion - We present a rare case of unilateral thalamic infarction causing downward gaze palsy in an adult patient with uncorrected TOF. Cyanotic CHD is regarded as one of the risk factors of stroke. Besides other pathologic conditions, ischaemic stroke at an early age should raise the suspicion of a cardioembolic origin and, in rare cases, might result from cyanotic CHD.