2013, Vol 13, No 1
Pathological processes in the brain during ischaemia
AKTUALN NEUROL 2013, 13 (1), p. 16–23
ABSTRACT

Stroke to the present is one of the most common causes of death and permanent disability. Ischemic stroke (ischemic stroke called IS) is not only a dangerous disease because of its high mortality rate, but also because of a disability in patients who do survive, which represents approximately 76% of cases. It is a heterogeneous disease entity, which is a set of symptoms caused by focal ischemia or bleeding into the brain tissue caused by a wide variety of reasons. There are two types of strokes: haemorrhagic and ischemic. Haemorrhagic strokes accountfor 20% of all strokes, the other 80% are ischemic strokes. Stroke is a systemic disease, mainly resulting from vascular pathology. It plays a huge role in atherosclerosis and the mechanisms involved. The disease process affects the whole of the body, not just the cerebral vessels. From the point of view of pathological, ischemic stroke is the rapidly developing neurodegenerative process that leads to cell death. This disease is beyond the vascular damage, induces cell-molecular immune response to central nervous system and the vascular system, aimed at the development of the inflammatory response. The activated cells of the brain and vascular cells are involved in the synthesis of various molecules, among others. cytokines, chemokines, adhesion molecules and inflammatory enzymes. Continues to grow numerous reports confirming the importance of inflammatory factors in the development of ischemic stroke. In this process, the blood-brain barrier plays an important role. At the cellular level it is the main line of microglia immune surveillance of the central nervous system, which is responsible for the induction of the inflammatory response in stroke. In stroke, a sudden change in the expression of cytokines proceeds, which reveal the neurodegenerative effects of inflammatory cytokines and anti-inflammatory cytokines neuroprotective effect. Processes occurring in the brain during ischemia are very complicated and is not involved in a number of factors.

Keywords: brain, ischaemic stroke, neurodegeneration, inflammation, autophagy, pathological processes, chemokines, blood-brain barrier, cytokines, interleukins
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The current concepts on the role of vitamin D in pathogenesis of multiple sclerosis
AKTUALN NEUROL 2013, 13 (1), p. 24–30
ABSTRACT

Vitamin D is commonly known for its role in calcium-phosphate metabolism but there is growing amount of data showing its pleiotropic actions. Positive correlation between vitamin D deficiency and the prevalence of autoimmune diseases including multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, etc. has been observed. Vitamin D receptors have been found in spectrum of tissues and organs, including bones, muscles, reproductive organs, heart, brain, and within the immune system. Widely investigated immunomodulatory action of vitamin D affects both innate and adaptive immunity by suppressing T cell proliferation and cytotoxity, promoting regulatory T cells differentiation and modulating macrophage and dendritic cell functions. Multiple sclerosis(MS) is an autoimmune disease of the central nervous system caused by complex and predominantly unknown interactions of genetic susceptibility and environmental factors. Epidemiological studies show that the sun exposure and corresponding vitamin D level are important factors that can explain geographical distribution of MS. Some preliminary observations suggest that vitamin D supplementation not only reduces the risk of developing MS but also modulates disease course and reduces relapses rate among patients with relapsing-remitting MS. Further studies and clinical trials are required to confirm the role of vitamin D in MS pathogenesis.

Keywords: vitamin D, multiple sclerosis, autoimmunity, brain, immunomodulator
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Motherhood and multiple sclerosis – facts and myths
AKTUALN NEUROL 2013, 13 (1), p. 31–34
ABSTRACT

Multiple sclerosis is a chronic, demyelinating disease of the central nervous system, which is nearly two times more common in women. It mainly occurs between 2. and 4. decade of life, which is a period of maximum fertility of patients. The social stigma of disease, fear of disability and the lack of sufficient information on the impact of pregnancy on the course of multiple sclerosis, make a decision about having the baby particularly difficult. Meanwhile, available data clearly confirm the beneficial effect of motherhood on the course of multiple sclerosis. Pregnancy, is the only physiological state, which strongly reduces the rate of the disease relapses and at the same time delays appearing of a significant disability in patients with relapsing-remitting multiple sclerosis. All women with diagnosed multiple sclerosis, which are planning to have a baby should also get comprehensive information about the increase in the likelihood of occurring of disease relapse during a period of puerperium. In the first three months after delivery, one third patients have a relapse. This knowledge can help mother to organize earlier the assistance in infant care. A number of issues, including, among other things effect of lactation on clinical activity and the impact of the disease-modifying drugs for multiple sclerosis on motherhood requires further research.

Keywords: multiple sclerosis, relapse, pregnancy, motherhood, delivery, puerperium
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The causes of epilepsy in young people between 20 and 45
AKTUALN NEUROL 2013, 13 (1), p. 35–39
ABSTRACT

Epilepsy is one of the common chronic neurologic disorder. Epilepsy affects approximately 50 million people worldwide. The causes of epilepsy can be put into three main groups: symptomatic, idiopathic or cryptogenic epilepsy. Aetiology of epilepsy is different for children and adults. Common causes of childhood epilepsy include genetic factors and prenatal injury. The older the patient, the more likely it is that the cause is an underlying brain disease, such as a brain tumour or cerebrovascular disease, or is the result of head injury. Important diagnostic and therapeutic problems occur in young patients between 20 and 45 years. Despite that incidence rate of epilepsy is the lowest in this group about 65–75 % of all case of epilepsy has no identifiable cause and is known as cryptogenic epilepsy. For many years it has believed that the first epileptic seizures in young after 20 years old have been symptoms of the brain tumour. The authors review data from literature and show that symptomatic epilepsy occurs only in 30% young patients and appears with the head injury, brain tumours, cerebral arteriovenous malformations, alcohol withdraw,infections as meningitis. The new advances in brain imaging such as MRI morphometry, MRI spectroscopy may reveal epileptic lesions in patients considered to have cryptogenic epilepsy. Future improvements in ability to diagnose and localize epileptogenic focus should enable a more-effective clinical evaluation and successful treatment.

Keywords: aetiology of epilepsy, cryptogenic epilepsy, epilepsy in young, symptomatic epilepsy, hippocampal sclerosis
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Selected pharmacokinetic drug interactions during treatment of epilepsy. Part I
AKTUALN NEUROL 2013, 13 (1), p. 40–49
ABSTRACT

Epilepsy is one of the oldest known diseases. The word epilepsia has 2 500 years and comes from the Greek epilamvanein, which means ‘attack’, ‘grab’, ‘possess’. Seizures were treated as an expression possessed by demons, evil spirits and therefore for a long time it was considered as “sacred disease”. Epilepsy is not a disease in the classic sense, but rather a complex pathophysiological process, the numerous and complex symptoms are the result of various disorders of brain function. Epilepsy is one of the most difficult problems neuroepidemiology. Seizures are an expression of pathological brain activity in different areas of the course of many disease processes. Source discharges in the clinical pathological form of epileptic seizure can be traumatic scars, compression changes, inflammatory, degenerative, vascular fire or developmental disorders. Focal epileptic tissue is modified zone lying between the damage and the area healthy. This is a group of neurons that generates periodic paroxysmal bioelectrical activity in the form of paroxysmal discharge depolarization generating clinical seizures. Most epilepsies are primary brain disorder, but there are also many processes outbrain disturbing systemic homeostasis. In the treatmentof epilepsy, there is no one standard way to proceed. The aim of epilepsy treatment is complete seizure control and getting the least side effects during treatment with antiepileptic drugs. Knowledge and experience are the most important practitioners of the factors contributing to the care of patients with epilepsy. The drug should be tailored to the type of seizure or epilepsy syndrome, the frequency and severity of seizures. The emergence of a new generation of drugs gave them some advantage over older-generation drugs. They are characterized by greater specificity of action, improved pharmacokinetic properties, better evaluation of clinical trials and less side effects. These drugs are in clinical trials, and direct observation of lessons can be drawn that they are very useful in some types of epilepsy. There is no doubt that further research and observation.

Keywords: epilepsy, pharmacokinetic drug interactions, treatment of epilepsy, antiepileptic drugs, drug-resistant epilepsy, absorption, drug distribution, cytochrome P450
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Selected pharmacokinetic drug interactions during treatment of epilepsy. Part II
AKTUALN NEUROL 2013, 13 (1), p. 50–55
ABSTRACT

Epilepsy is a disease of unknown cause to the end, mainly characterized by the occurrence of unprovoked seizures. A seizure is a temporary change, in turn, reactivity or physiological change in part or whole brain. Seizures are divided into partial, generalized and unclassified. The concept of drug-resistant epilepsy may seem somewhat obvious and intuitively understandable, but not yet developed a detailed definition of commonly accepted. As a result, doctors and researchers use very different criteria and, in some cases, even give up the precise criteria, which makes it difficult to compare the results of clinical trials and the development of practical guidelines. In the treatment of epilepsy, there is no one standard way to proceed. The aim of epilepsy treatment is complete seizure control and getting the least side effects during treatment with antiepileptic drugs. The drug should be tailored to the type of seizure or epilepsy syndrome, the frequency and severity of seizures. The choice depends on the type of drug seizures, for example, primary generalized seizures, valproic acid is used, and secondarily generalized seizures and partial carbamazepine. Older-generation drugs (phenytoin, phenobarbital, primidone) is slowly becoming obsolete. However, may be prescribed for specific indications. There is also a large group of new drugs (lamotrigine, vigabatrin, oxcarbazepine, gabapentin, levetiracetam, felbamat, topiramate, tiagabine), which are becoming increasingly popular. The emergence of a new generation of drugs gave them some advantage over older-generation drugs. They are characterized by greater specificity of action, improved pharmacokinetic properties, better evaluation of clinical trials and less side effects. These drugs are in clinical trials, and direct observation of lessons can be drawn that they are very useful in some types of epilepsy. There is no doubt that further research and observation. This article presents a brief overview of the pharmacokinetic properties of selected drugs as well as potential interactions between them. Properly processes of absorption, metabolism, distribution and elimination of drugs determine the appropriate therapeutic efficacy. The success of treatment can also significantly affect the pharmacokinetic and pharmacodynamic interactions.

Keywords: metabolism of drugs, the reaction of the first phase oxidation of drugs, CYP2D6, CYP2C9, CYP2C19, CYP2E1, CYP3A4, reaction of the second phase, glucuronidation, valproic acid, UDP-glucuronosyltransferases, elimination
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Effects of physical activity on cognitive functions in older adults and the course of Alzheimer’s disease
AKTUALN NEUROL 2013, 13 (1), p. 56–61
ABSTRACT

To the extent of ageing society more and more people experience burdensome age associated cognitive impairment. Mild cognitive impairment (MCI) may be a precursor to dementia, at least in some cases. Alzheimer’s disease (AD) is the most common cause of dementia. There is still no pharmacological treatment of AD. At the present time efforts are focusing on the developing of more effective strategies to slow the progression of AD. If illness onset could be delayed we would see significant reduction in AD incidence. Biological research, epidemiological studies and randomized controlled trials suggest that regular physical activity may contribute to prevention of cognitive decline in elderly subjects, to slow down the course of AD and to delay the onset of dementia. It seems that physical activity and other lifestyle nonpharmacological interventions, as intense social activity or cognitive stimulation may be effective, safe and less expensive preventive treatment strategy than pharmacological therapy. Further research is necessary to define precise recommendations in terms of type, duration and intensity of physical exercises, but there is a chance that in the near future a prevention of AD may be based on principles governing lifestyle habits such as diet, cognitive and physical activity. Moreover, these nonpharmacological interventions might positively influence general functioning, and overall quality of life in the elderly population and AD patients.

Keywords: physical activity, cognitive stimulation, cognitive functions, dementia, Alzheimer’s disease
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Assessment of the effect of cardiovascular risk factors on mortality in stroke
AKTUALN NEUROL 2013, 13 (1), p. 62–67
ABSTRACT

Background and purpose: Polish epidemiological data report a high first-ever stroke incidence rate which has been maintained for over ten years, increases with age and is correlated with high mortality. Fatal cases in stroke patients during the first three weeks amount to 25–30%. The aim of this study was to estimate the impact of the risk factors of cardiovascular diseases on mortality in stroke patients treated in the Department of Neurology USK in Bialystok. Material and methods: The study included all the stroke cases treated in the Department of Neurology USK in Bialystok, in the years 2002–2006. The cases were identified by verifying patient files. All the clinical data were calculated using STATISTICA 8.0. Results: We analysed 1129 stroke patients, 541 women and 588 men. The overall observed mortality was 19.6% in all cases. 86% patients had infarction with fatal cases in 16.4%. There were 14% of intracerebral haemorrhages with high mortality rate – 39.2%. Early case fatality in ischaemic stroke decreased in the reported 5 years from 22.1% to 17.8%, with consequently increased incidence. Conclusions: Myocardial infarct and atrial fibrillation are the most important factors predicting mortality in stroke patients. Despite the increase in the incidences of stroke the downturn in mortality is observed.

Keywords: ischaemic stroke, haemorrhagic stroke, epidemiology, risk factors, mortality
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Coexistence of subarachnoid and subdural haemorrhage of spinal canal in a young woman
AKTUALN NEUROL 2013, 13 (1), p. 68–72
ABSTRACT

Subarachnoid haemorrhage of spinal canal is a rare disease and is the 1.5% of all bleeding into the subarachnoid space. In most cases its occurrence is associated with a well-defined etiologic factors, and only in 15% of cases the cause remains unknown. The exceptions are the coexistence of subarachnoid haemorrhage with another type of haemorrhage to the spinal canal. This paper describes the case of 35-year-old woman who has sudden severe headache preceded by a sudden pain in the back area and numbness of left upper limb. MRI revealed bleeding in the subarachnoid space associated with subdural bleeding in the cervical and thoracic spinal canal probably due vascular malformation of the chest. In the absence of symptoms of neurological deficit patient was treated conservatively with good results. The case demonstrates that in selected patients with concomitant haemorrhage of subarachnoid and subdural spinal canal is not necessary neurosurgery. Thus, neurological status should be the most important criterion for the further management of patients with bleeding into the spinal canal.

Keywords: spinal haemorrhage, subarachnoid haemorrhage, spinal cord, subdural haemorrhage, vascular malformation
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