2012, Vol 12, No 3
Lipid disorders in patients with vertigo
AKTUALN NEUROL 2012, 12 (3), p. 143–148
ABSTRACT

Introduction: The aim of this work was to evaluate lipid disorders in patients with vertigo. Material and methods: Study population included a group of 918 patients, thereof 598 women and 320 men, aged 18–83 (mean age 55±0.5 years), treated for vertigo at the Department of Otolaryngology and Laryngological Oncology, Military Medical Academy, University Teaching Hospital in Lodz since 2009 thru 2011. Each patient underwent a detailed interview with otolaryngological, otoneurological, neurological and ophthalmological examination as well as transcranial ultrasound and computed tomography of cervical spine and head to exclude organic diseases of central nervous system. Laboratory tests included serum total cholesterol, serum triglyceride, serum HDL and LDL, and serum glucose levels. Results: Among 918 vertigo patients,539 cases (58.71%) had central vertigo whereas 379 (41.28%) – mixed vertigo, thereof 366 women (67.90%) with central vertigo and 232 (61.21%) with mixed vertigo. Among 320 men (34.78%), 173 (32.09%) had central vertigo and 147 (38.78%) – mixed vertigo. Lipid fraction analysis in patients with vertigo revealed elevated total cholesterol levels in 67.03% of patients studied, thereof 71.34% men and 64.76% women. Higher LDL cholesterol levels were found in 51.57% of the patients, thereof 54.83% men and 49.83% women. HDL cholesterol levels were normal in most of the patients (61.99%). Triglyceride (69.45%) and glucose (59.25% men and 67.78% women) levels were within normal limits. Conclusions: Lipid disorders, particularly those expressed by elevated total cholesterol and LDL fraction, can be considered as risk factors in vertigo.

Keywords: lipid disorders, hyperlipidemia, hypercholesterolemia, vertigo, dizziness
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Reduction of multiple sclerosis-related mortality is associated with lower prevalence of tobacco smoking among Polish males
AKTUALN NEUROL 2012, 12 (3), p. 149–153
ABSTRACT

Introduction: Longitudinal studies of multiple sclerosis (MS) demonstrated decrease of mortality rates (MR) throughout Europe and United States. The aim of this study was to explore possible a correlation between reduced MR in MS and prevalence rates (PR) of cigarette smoking (CS) in Poland. Method: The study was based on 10 272 MS patients (M – 4367, F – 5905) who died since 1982 thru 2008. Annual, average, crude MR (CMR) and sex-adjusted MR (SAMR) in MS per 100 000 population were correlated to PR of CS per 100 inhabitants in the general population and 2 subpopulations. Data were obtained from the Central Statistical Office and the Centre of Oncology in Warsaw. Results: CMR, SAMR in M and F were significantly higher in the years 1982–1995: 1.33 (SD 0.07), 1.19 (SD 0.13), 1.47 (SD 0.07) than in the years 1996–2008: p=0.000006, p=0.0002, p=0.0008. There was a decrease of CS PR in the years 1982–2008 in the general population (p=0.000003) and in M (p=0.0000004). No decrease of CS PR in F was found (p=0.127). CMR and SAMR among M with MS showed highly significant correlation to PR of CS in the period 1982–2008; r=0.673,p=0.0006; r=0.774, p=0.0001. No correlation was found between SAMR among F with MS and PR of CS: r=0.369, p=0.0910. Conclusion: Reduction of MS mortality was associated with a decreased incidence of CS in the general population and among males, but not among females.

Keywords: multiple sclerosis, tobacco smoking, mortality, association, Poland
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Is there a seasonality and periodic fluctuations in epilepsy?
AKTUALN NEUROL 2012, 12 (3), p. 154–158
ABSTRACT

Introduction: Epilepsy is one of the most common diseases of a nervous system, which often requires emergency treatment, hence the interest of emergency medicine physicians. Aim: Retrospective analysis of medical records from the years 2005–2009 with special emphasis on seasonality and periodic fluctuations in admissions of epilepsy patients to Copernicus Memorial Hospital in Lodz, Poland. Material and methods: Hospital database was searched for age, gender, time and date of admission, duration of hospitalization, type of epilepsy and mortality. Results: Analysis encompassed 2434 patients with epilepsy (982 women, 1452 men), aged 1 month to 97 years (mean age 44.80±19.97 years). Cause of admission was always an epileptic seizure. Onset of attack was mainly in the afternoon (12:00–17:59 – 803 cases, 33%), and from 6:00 a.m. till 11:59 a.m. (775 cases, 32%). Epilepsy-related admissions were most frequent in July (n=233; 10%), January and April (n=228; 9% each month). Conclusions: Onset of epileptic attack was observed most often since 9:00 a.m. thru 10:59 a.m. and in July, possibly indicating seasonality and periodic fluctuations in epilepsy.

Keywords: epilepsy, seasonality, fluctuations, hospitalization, mortality
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Surgical treatment of epilepsy
AKTUALN NEUROL 2012, 12 (3), p. 159–163
ABSTRACT

Despite a systematic and multidrug treatment, about 6–10% epileptic patients continue to present epileptic seizures. This is the so-called drug-resistant epilepsy. Authors discuss currently available surgical epilepsy treatment. Potential candidates are patients with focal epilepsy and epileptogenic foci which may be removed without causing new neurological deficits. We present diagnostic techniques enabling precise location of focus within the brain (Holter EEG, videometry, telemetry, digital EEG, MRI, SPECT, PET, electrocorticography). We also show the types of neurosurgical procedures used in epilepsy therapy: procedures of resection (lobectomy, lesionectomy, hemispherectomy, extensive multilobar resection), procedures of disconnection (callosotomy) and procedures of neurostimulation (vagus nerve stimulation, deep brain stimulation). We consider these methods might be of benefit in a selected group of patients with drug-resistant epilepsy.

Keywords: drug-resistant epilepsy, epilepsy surgery, diagnosis of epileptogenic area, lobectomy, callosotomy, neurostimulation
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Tiagabine in anxiety disorders
AKTUALN NEUROL 2012, 12 (3), p. 164–168
ABSTRACT

With currently available drugs, patients with anxiety disorders experience only partial response to pharmacotherapy and require augmentation therapy. Selective serotonin reuptake inhibitors (SSRIs) and benzodiazepines are commonly used in the treatment of anxiety disorders. Unfortunately many patients do not achieve a complete response and experience significant adverse effects. Thus, pharmacotherapy for anxiety disorders is an active area of research. Results of these trials suggest potential usefulness of antiepileptic drugs in treatment of anxiety disorders. Tiagabine, a selective GABA reuptake inhibitor, has been shown to reduce symptoms of anxiety. γ-Aminobutyric acid (GABA) is the most potent inhibitory neurotransmitter in the central nervous system. There is evidence that GABA is implicated in both aetiology and treatment of anxiety. Tiagabine acting by GAT-1 transporter presynaptic blockade, facilitates GABA neurotransmission. Recent studies suggest than tiagabine may have anxiolytic properties with a reasonable adverse events profile, including dizziness, headache and nausea. Tiagabine has shown promise in the treatment of generalized anxiety disorder, post- traumatic stress disorder, and panic disorder, and as monotherapy or augmentation therapy for patients with anxiety disorders who are partial responders.

Keywords: tiagabine, antiepileptic drugs, anxiety disorders, GABAergic system, pharmacotherapy
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Evaluation of post-isometric relaxation influence on muscle tone in cervical vertigo patients
AKTUALN NEUROL 2012, 12 (3), p. 169–175
ABSTRACT

Introduction: The aim of this work was to evaluate the effect of post-isometric relaxation on muscle tone in patients with cervical vertigo. Material and methods: The study was conducted on a group of 100 patients including 65 women aged 20–76 years and 35 men aged 20–73 years, treated at the Department of Otolaryngology and Laryngological Oncology, Medical University Teaching Hospital in Lodz. The patients were randomized into 2 groups: I – 50 patients with cervical vertigo, II – control group of 50 healthy people without vertigo. Each patient underwent a detailed interview, subjective, otolaryngological, otoneurological and physical interviews, and routine laboratory tests. Neurology, ophthalmology and internal medicine specialists were consulted for each case. The patients underwent Doppler ultrasound study of cranial vessels, computed tomography of cervical spine and head. Each patient had an individually selected set of exercises taking into account his/her disease and possible contraindications. Exercises included post-isometric relaxation of paravertebral muscles of cervical spine during 2 months. Objective analysis of therapy outcome was performed (before, after 2 weeks, after 1 month and after 2 months) based on linear measurement of active range of motion (ROM) in the cervical spine, muscle strength (Lovett’s scale) and severity of vertigo (Silvoniemi’s criteria). Results: The study showed a significant improvement of range of cervical spine motion and muscle strength as a result of exercises performed. Conclusions: Most patients (82.3%) obtained complete resolution or significant reduction of severity of cervical vertigo both in the objective tests (active ROM of cervical spine and muscle strength) and in subjective reports (Silvoniemi’s criteria).

Keywords: post-isometric relaxation, kinesiotherapy, muscle tone, Lovett’s scale, cervical vertigo
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Successful steroid treatment for probable non-paraneoplastic limbic encephalitis – case report
AKTUALN NEUROL 2012, 12 (3), p. 176–181
ABSTRACT

Limbic encephalitis (LE) was first described in the ‘60s as a clinical-pathological syndrome in adults. Non-infectious cases are usually a manifestation of paraneoplastic syndrome, related mostly to small-cell lung cancer. Infection-related LE is usually caused by herpes simplex virus (HSV). Non-paraneoplastic LE subtype (NPLE) accompanying autoimmune diseases with antibodies directed against cell membrane antigens were also described. Basing on clinical symptoms, MRI findings, absence of tumour and long-term follow-up, a still another group of NLPE patients without the abovementioned antibodies has been identified. Here, LE symptoms were not preceded by an acute infection. Temporal lobe epilepsy is a prominent symptom of this variant. NPLE is a potentially reversible LE variant. We report a 62-year-old man, with a two years’ history of memory loss, orientation and mood disorders and seizures. His brain MRI T2-weighted fluid-attenuated inversion recovery (FLAIR) scan revealed classic hyperintense foci within the temporal structures. He had no antibodies against onconeural antigens in serum. There was no evidence of a neoplasm. The entire clinical picture suggested a diagnosis of non-paraneoplastic limbic encephalitis. A course of steroids improved his clinical symptoms with significant resolution of radiological abnormalities. Lacking generally accepted diagnostic criteria of NPLE, we recommend a long-term follow-up with repeated neurological examination and oncological survey of patients presenting without evidence of a malignancy.

Keywords: limbic encephalitis, autoantibodies, paraneoplastic neurological syndrome, steroid therapy, magnetic resonance imaging
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