P300 potential as a diagnostic factor of central nervous system changes in subjects addicted to alcohol
Aktualn Neurol 2006, 6 (2), p. 78-87
Introduction: P300 potential belongs to endogenic potentials associated with cognitive functions. It constitutes a bioelectric indicator of cognitive processes and that is why it found application in the diagnostics of nervous and mental diseases. Numerous investigations of P300 potential have been carried out in subjects addicted to alcohol.
Aim: The aim of the study was to evaluate the usefulness of P300 potential as a diagnostic exponent of central nervous system changes in subjects chronically abusing alcohol and subjects in the period of abstinence and also to find the correlation between the changes of parameters of P300 potential and radiological indicators of brain atrophy in these subjects. Material: The material comprised three groups of men aged 30-55 years. Group I consisted of 30 men meeting the criteria of alcohol dependency syndrome, with diagnosed alcohol-related toxic liver damage Group II consisted of 30 men with alcoholic history, meeting the criteria of alcohol dependency syndrome, with no traits of toxic liver damage, remaining abstinent for at least one year Control group consisted of 30 physically and mentally healthy men, with no alcohol dependency syndrome. Methods: The following were carried out in all the examined: examination of auditory endogenic P300 potential cerebral computed tomography. Results: Between the studied groups the existence of statistically significant differences concerning parameters of P300 and radiologic indices of brain atrophy (F/A, A + B, C, SW) was found; no statistical significance of D/A index was found between the studied groups (p > 0,05). Conclusions: The diagnostic value of endogenic P300 potential as an electrophysiologic exponent of cognitive dysfunction in subjects addicted to alcohol, also in the period of abstinence, has been confirmed.The decrease of P300 amplitude in alcoholics may be acknowledged as a permanent feature of alcohol abuse.In subjects abusing alcohol chronically, also in the period of abstinence, there has been found a correlation between latency of P300 and radiological indicators of brain atrophy: SW (width of sulci on the surface of brain) and C (width of the third ventricle) and between P300 amplitude and SW index.
Keywords: event-related P300 potential, addiction to alcohol, cognitive functions, radiological indicators of brain atrophyDOWNLOAD ARTICLE (PDF)
SYMPOSIUM: DEMENTIAS. Alzheimer’s disease as preventable illness: a risk factors based approach
Aktualn Neurol 2006, 6 (2), p. 88-94
The prevalence of dementias in westernized countries, including Alzheimer’s disease, is on the rise, mainly due to graying of the populations as well as to the advances of treatment and care of infectious diseases, cancer and cardiovascular disorders, which all lead to a decreased mortality rate in the elderly. The costs of dementia care worldwide grows on parallel, including both direct and indirect cost for patients and their families, as well as health care systems. It has been estimated that modifying strategy delaying the onset of dementia symptoms of merely 5 years would have already a major impact of both prevalence and costs. Several drugs have been proposed as potentially delaying or preventing dementia, including statins, non-steroid anti-inflammatory drugs, hormonal therapies, vitamins, natural products and even cholinesterase inhibitors; none of them have been, however, approved for that purpose yet. A number of risk factors might be, on the other hand, managed by non-pharmacological interventions, including lifestyle modifications and early life prevention strategies. In this paper I review current strategies based mainly on cognitive reserve hypothesis. Although no definite recommendations are possible at this point, it looks as if some general issues might already be raised. According to current estimates elderly who keep physically and mentally active, taking care of their cardiovascular fitness as well as moderately restricting their caloric intake (without compromising vitamins and micronutrients) might delay the onset of dementia of several years or even reduce a total risk of developing dementia.
Keywords: Alzheimer’s disease, dementia, prevention, diet, fitness, mental activityDOWNLOAD ARTICLE (PDF)
SYMPOSIUM: DEMENTIAS. Immunological aspects of Alzheimer’s disease
Aktualn Neurol 2006, 6 (2), p. 108-115
Alzheimer’s disease (AD) is an incurable neurodegenerative disease, which is accompanied by chronic inflammation. The immune system has an important role in the process of the disease. The deposition of amyloid β (Aβ) protein is a key pathological feature in Alzheimer’s disease. This article reviews immunotherapeutic strategies against AD. In murine models of AD, both active and passive immunization against Aβ induces a marked reduction in an amyloid brain burden and an improvement in cognitive functions. The findings from murine studies lead to clinical studies. One Phase II clinical trial of active immunization against Aβ was discontinued after 18 patients developed meningoencephalitis. After this lesson learned, new immunotherapeutic strategies, including both active and passive immunization, are investigated in clinical centers.
Keywords: Alzheimer’s disease, immunotherapy, neuroinflammationDOWNLOAD ARTICLE (PDF)
SYMPOSIUM: DEMENTIAS. Dementia with Lewy bodies – current diagnostic criteria and treatment
Aktualn Neurol 2006, 6 (2), p. 116-123
Early diagnosis of dementia with Lewy bodies (DLB) – the second most frequent type of primary degenerative dementia following Alzheimer’s disease – is still a tall order in everyday clinical practice. This paper reviews the revised criteria for the clinical diagnosis of DLB and therapeutic options in patient management. Patient management in DLB is a complex and difficult matter, including early detection, performing necessary investigations and finally establishing diagnosis. Treatment, consisting of both nonpharmacologic and pharmacologic interventions, has to be multimodal and targeted at compensation of cognitive impairment, assessment and management of neuropsychiatric and behavioral symptoms, alleviation of parkinsonian symptoms, monitoring and management of autonomic dysfunction and sleep disorders. Cholinesterase inhibitors are the drugs of choice in DLB (evidence favours rivastigmine) and may provide benefit for both cognitive impairment and activities of daily living. The effectiveness of DLB treatment is reported as being generally more pronounced than in Alzheimer’s disease, despite using the same class of medications. In case cholinesterase inhibitors are ineffective it may be necessary to prescribe an atypical antipsychotic. First generation antipsychotics should be avoided and clinicians should be aware of the possibility of a severe neuroleptic hypersensitivity reaction.
Keywords: Dementia with Lewy bodies, criteria, treatment, cholinesterase inhibitorsDOWNLOAD ARTICLE (PDF)
Can nucleoside and nucleotide precursors become future successful anti-epileptic drugs?
Aktualn Neurol 2006, 6 (2), p. 124-130
Many examples of experimental epilepsy show that epileptic seizures occur due to release of stimulatory neurotransmitters into intracellular spaces. In CNS adenosine suppresses exocytosis of glutamate and asparginate but guanosine increases the reverse uptake of glutamate by astrocytes and thus lowers it concentration outside the cell. In this process both nucleosides participate in suppressing the epileptic seizures. By decreasing concentration of ectoadenosine and ectoguanosine outside the cell, that compounds can protect neurons from cellular degeneration. It was shown in many animal models for experimental epilepsy that adenosine A1 and A2A receptors were involved in the process of stopping the seizures. Moreover, some of the conventional anti-epileptic drugs reveal enhance their therapeutic abilities by interactions with the adenosine receptors, being either agonists or antagonists. These interactions modulate the activity of receptors and consequently regulate the neuroprotection processes.
Some agonists of adenosine receptors increase the epileptic episodes reaction to those compounds. Anti-episode action of adenosine and guanosine as well as agonists and antagonists of nucleoside receptors indicate the possibility of applying the knowledge about these processes towards production of new anti-epileptic medication. Successful anti-epileptic medication may be based on compounds that have the ability to increase the concentration of ectoadenosine i.e; adenosine deaminase inhibitors, adenosine kinase inhibitors or compounds with ability to suppress reverse uptake of nucleosides. Another method to increase the concentration of extracellular adenosine is to increase the activity of 5' nucleotidase. That in effect will increase the amount of ectoadenosine by degradation of ectoAMP. There are very promising results revealed that oral administration of guanosine and GMP as well as guanosine by itself given intraperitoneally and intraventricularly what halted epileptic seizures caused by quinolinic acid which is a glutamate agonist.
Keywords: epileptic seizure, neuroprotection, adenosine, guanosine, adenosine receptorsDOWNLOAD ARTICLE (PDF)
Slight manifestation of dissection of carotid arteries case report
Aktualn Neurol 2006, 6 (2), p. 131-135
Dissection of carotid arteries is seldom recognize as a reason of stroke. It more often appears in young people. The reasons leading to dissection are hypertension, injuries head or neck, neurosurgical or cardiosurgical interventions and illnesses embracing walls of arteries as well. In most cases dissection is a spontaneus process. We present the case of 59-year-old man with dissection of brahiocephalic trunk, right and left subclavian artery, right common carotid artery, aorta and iliac arteries. It is one of the few cases, with so extensive dissection about oligosymptomatic course, described in medical literature.
Keywords: dissection of carotid arteries, young people, stroke, USG-doppler, angio-CT scanDOWNLOAD ARTICLE (PDF)
Arteriovenous malformation (AVM) with transverse myelitis symptoms – case report
Aktualn Neurol 2006, 6 (2), p. 136-140
The authors present a case of 24-year-old patient admitted to Neurological Department with ascending transverse myelitis symptoms with subacute course. At the admission neurological examination revealed: spastic paraparesis (3rd stage in the Lovette scale), sensory disturbances on the level Th9, and urinary incontinence. Asymmetry in thighs’ circumference was disclose (the difference was 4 cm, P>L). There were no pathological changes in CT scanning of spinal cord on the level Th7-Th11. In cerebrospinal fluid analysis increased cytosis and protein level were confirmed. During clinical observation the sensory level was ascending up to Th5. The worsening of lower extremities palsy and proctoparalysis were also observed. Spinal cord MRI examinations disclosed a huge spinal vascular malformation extended from C2 to level of cauda equina. Spinal magnetic resonance angiography (MRA) examination revealed a feeding artery from aorta at Th7-Th8 level with the possibility of additional vascularisation from intercostal arteries on the level Th12. This case indicates the rare aetiology of spastic tetraparesis, and necessity of AVMs consideration in the differential diagnosis of myelopathy apart tumours, infections, multiple sclerosis and other vascular diseases.
Keywords: spinal arteriovenous malformations (AVMs), juvenile AVM, magnetic resonance imaging (MRI)DOWNLOAD ARTICLE (PDF)