Currently available pharmacotherapeutics (cholinesterase inhibitors and memantin) for Alzheimer’s disease (AD) exert mainly symptomatic effect and doubtful, if any, disease-modifying activities. Strategies of active and passive immunization were very successful in the last 10 years, mainly, however, with the use of experimental animal models of the disease. More recently, several human trials have been undertaken with mixed results obtained. Some support was found for the idea that immunotherapy may influence natural disease history, at least at the level of neuropathology and biomarkers and, to the less extend, neuroimaging findings and cognition. The paper presents recent developments in the use of immunotherapy of AD both with animal models as well as human clinical trials. An attempt is also made to elucidate possible mechanisms of action of this novel treatment approach. Particularly, the difficulties in translating results obtained in animal studies into clinical trials in humans has been underlined and discussed. The results of the very first human trial with the use of AN-1792 vaccination are critically discussed with special reference to the possible mechanisms of the observed severe complications of this treatment modality (brain inflammation). currently, several other studies with active immunization are on the way, in which novel technologies diminishing the risk of brain inflammation were used. Finally, article presents several clinical trials with the use of passive immunization strategies, showing the advantages of this approach, particularly in the context of tolerability.
Abdominal obesity becomes very significant health’s problem, especially because it is connected with pathogenesis of cardiovascular diseases. Adipose tissue is not only a store of excess energy but a hormonally active system too. The substances produced by adipose tissue are adipocytokines. Two of them are leptin and adiponectin. Adiponectin levels are inversely related to the adiposity degree, despite of adipose tissue is only source of it. concentrations of adiponectin have been reported to be decreased in patients with coronary artery diseases, type II diabetes mellitus, hypertensions and dyslipidemia patients in some insulin resistant states. It takes part in processes regulate glucose and lipid metabolism and it has anti-inflammatory and antiatherogenic properties. Adiponectin has a potential protective ability towards to cardiovascular diseases. Positive correlation with degree of adiposity has been reported for leptin – hormone involved in the regulation of food intake and energy expenditure. Leptin exerts many potentially atherogenic effects. It has been reported to influence on arterial hypertension, endothelial dysfunction, platelet aggregation, insulin resistant and activation of sympathetic system. In this way it can play very important role in development of stroke. Recent studies suggest that adiponectin and leptin may play an important role in obesity-associated cerebrovascular diseases. There is still too little evidence to say that these two hormones are independent marks of ischemic stroke and confirm their role in stroke pathogenesis.
Migraine is a common neurological condition characterized by recurrent episodes of often severe headache accompanied by symptoms such as nausea, vomiting, photophobia, and phonophobia. The prevalence of migraine has been estimated to be approximately 6% in men and 15 to 18% in women. The prevalence of migraine peaks at age 40, and thus most affects individuals in their peak productive years. The diagnosis is based on International Headache Society (IHS) criteria. In addition to classic and common, migraine headache can take several other forms: hemiplegic migraine, ophthalmoplegic migraine, basilar artery migraine, migraine in adolescent and young adult and menstrual migraine and status migrainosus. In children migraine can take picture periodic vomiting, systemic vertigo, abdominal pain. Basilar type migraine should be considered and differentiate with other type of vascular diseases. Chronic migraine is a specific type of disease with pain duration more than 15 days per month and more than three months. It can take picture a whole day’s headache, what concern mainly patients suffering migraine without aura, abusing analgesic drugs. This form should be prophylactic treated especially with antiepileptic and antidepressant drugs. In article have been prescribed those types of disease.
Disorders of neuronal migration are a relatively frequent cause of neuropaediatric syndromes such as: epilepsy, cerebral palsy, hydrocephalus, congenital muscular dystrophy and they may coexist with autism and other neurodevelopmental disorders. Migration of neuroblasts depends on genetic regulation, growth factors and it may be destroyed by some environmental factors such as virus infections. Some proteins, products of genes, included in the migration process are responsible for particular phase of migration, such as: filamin, double-cortin, LIS1, fucutin, astrotactin and reelin. The author describes some neuropaediatric syndromes associated with protein missing in the migration phase of neurodevelopment. The most frequent disorder is lissencephaly with its four genetic types: isolated lissencephaly (ILS), Miller-Dieker syndrome (MDS), X-linked lissencephaly and subcortical laminar heterotopia (XLIS). Mutation in the doublecortin gene leads to “double cortex” syndrome, which affects females and most frequently causes drug-resistant epilepsy and mental retardation of different severity. Fukuyama muscular dystrophy (FMD) belongs to syndromes associated with the final phase of neuronal migration. FMD manifests general muscular hypotonia, joint contractures, cerebral and cerebellar cortical malformations, cortical dysplasia with X-linked hydrocephalus. In the final part of the study the author presents own results concerning the course of early-infantile epilepsy in malformations of cortical development.
Although children are a minority among patients with cerebral artery aneurysms, aneurisms in this age group remain a problem not to be ignored. The cause of this is a much higher incidence of giant aneurisms in children in comparison to adults, sometimes with dramatic manifestation. Two children with giant aneurysms of cerebral arteries, operated on at the Department of Neurosurgery Polish Mother Memorial Hospital Research Institute in Łódź are presented in this paper. Thirteen-year-old girl had an aneurysm on the left internal cerebral artery (25 mm in diameter). Ten-year-old boy had an aneurysm on the right medial cerebral artery (40 mm in diameter). Both aneurysms presented with subarachnoid hemorrhage. Surgical treatment consisted of aneurysm clipping in the case of the boy and proximal internal cerebral artery ligation in case of the girl. In spite of surgery, the treatment was unsuccessful. on the basis of presented cases some problems connected with the management of pediatric patients with giant cerebral aneurysms are discussed.
Episodic ataxia type 2 (EA-2) is a rare neurological disorder of the autosomal dominant inheritance classified to the channelopathies (mutation in the calcium channel gene CACNA1A located on chromosome 19p13). EA-2 is characterized by episodes of the ataxia commonly triggered by physical and emotional stress, exercises, fatigue, alcohol. Between episodes of the ataxia the most common neurologic finding is isolated nystagmus. The authors report 22-year-old women hospitalized because of vertigo and gait imbalance. Exercise-induced attacks of incoordination recurred at least once a half-year, since age 18 years. On examination during an acute episode patient exhibited ataxia and horizontal nystagmus. During hospitalization we ruled out the diseases, which may cause episodic ataxia. The ataxia withdraw after treatment of acetazolamide, gait imbalance abated. Between attacks the horizontal nystagmus were found on neurological examination. The history of the patient family was uncompleted because she was adopted. The follow-up is continued and the patient hasn’t new attacks of ataxia. This EA-2 is the first case reported in Poland.