2015, Vol 15, No 2
The needs and the condition of multiple sclerosis medical care in Poland
Aktualn Neurol 2015, 15 (2), p. 61–67
DOI: 10.15557/AN.2015.0008

Multiple sclerosis is held to be one of the diseases of the nervous system most firmly linked to disability. In 2013, Poland came (yet another time, as it has been the situation for years) at the very bottom of European Multiple Sclerosis Platform 23-country list ranking patients’ access to treatment. Unfortunately, as was embarrassingly emphasized at the last 31st Congress of the European Committee for Treatment and Research in Multiple Sclerosis, the notorious gap that exists between the leading European countries and Poland is widening still further in many areas of treatment. There have recently occurred some important changes in our multiple sclerosis treatment system, including interferon therapy’s extension from 3 to 5 years in 2011, the removal of the time limit for the administration of first line drugs in 2014, as well as the introduction of a treatment programme with second line drugs in 2013. The number of patients in 116 centres (2014) treated with immunomodulatory drugs has gone up from under 3,000 in 2008 to over 7,700 in 2015, yet the percentage of Polish relapsing remitting multiple sclerosis patients who receive treatment still belongs with the lowest in Europe. Due to the very restrictive criteria in operation, the access to second line drugs is very limited, and treatment is available at few centres only, whereby as few as 660 patients have been covered by the programmes (June 2015). The neurological community has been seeking the improvement of the treatment system, actively aided by the Polish Multiple Sclerosis Society and a variety of foundations and associations. To assess the actual needs in the area of multiple sclerosis treatment countrywide, measures need to be taken to extend the scope of the Registry of Multiple Sclerosis Patients, yet it is the establishment of National Programme of Multiple Sclerosis Treatment, and development of treatment guidelines by the Board of the Polish Society of Neurology that are of utmost importance.

Keywords: multiple sclerosis, treatment, medical care, patient registry
Polish registry of multiple sclerosis patients – current status, perspectives and problems
Aktualn Neurol 2015, 15 (2), p. 68–73
DOI: 10.15557/AN.2015.0009

Multiple sclerosis is a progressive, inflammatory demyelinating disease of the central nervous system, of an unknown aetiology. It predominantly affects younger people. Approximately, 40,000 people in Poland are estimated to suffer from multiple sclerosis, with about 2000 new patients diagnosed annually. Those rates are based solely on the statistics provided by the National Health Fund, and do not cover various essential information e.g. about the course and form of the disease, the degree of disability, the type of treatment, or the data on patients’ quality of life. In most European countries, this information is gathered by national registries of patients, which in many cases have operated for many years now. Up until recently, Poland stood as an embarrassing exception, being the biggest country with so many patients and no systematic registry. In 2013, the National Register of MS Patients was finally created following other countries’ example, in order to evaluate the basic epidemiological parameters collected from all centres specialising in the treatment of multiple sclerosis countrywide. The article presents the most important European databases, and explains the assumptions of the Polish Register of MS Patients that has been in existence since 2013. It also discusses the results from the Świętokrzyskie province, the national leader in multiple sclerosis data collection. As of December 31, 2013, the prevalence in this region of Poland was estimated at 109.1/100,000, and the incidence rate in 2011–2013 at 4.1/100,000 per year, with both rates higher than previously presented. A preliminary analysis of patients’ self-assessment of quality of life is also provided here, along with a discussion of the confinements, limitations and problems the further development of the registry is currently facing.

Keywords: multiple sclerosis, epidemiology, patient registry
The needs of multiple sclerosis patients and the availability of rehabilitation in Poland
Aktualn Neurol 2015, 15 (2), p. 74–79
DOI: 10.15557/AN.2015.0010

The nature of multiple sclerosis makes the rehabilitation of patients suffering from the disease one of the most challenging tasks neurologic rehabilitation is faced with. The numerous multiple sclerosis symptoms considerably impair the quality of life of the approx. 40,000 Polish multiple sclerosis patients. Even though rehabilitation does not significantly affect the relapse frequency, or prevent the progression of the disease, still, when adequately carried out, making use of contemporarily available options, it manages to improve not only the objective indicators, but also the patients’ subjective sense of well-being and self-esteem, resulting with patients’ more positive self-image. The needs of Polish patients are huge, yet the availability of rehabilitation options remains scarce. Therefore, it is crucial to optimize the quality of rehabilitation regime the patients follow independently on at-home basis. Hence, the patient’s knowledge concerning the impact of rehabilitation on their disease and the available forms of therapy, as well as their awareness of the potential outcome of neglecting this aspect of treatment, become of utmost importance. Multiple sclerosis, regardless of its form, leads to impaired function/disability and affects very adversely the quality of patients’ life, limiting one’s independence, putting them at risk of losing employment, and making daily life activities increasingly more difficult. The role of therapeutic rehabilitation teams, ones including neurology and rehabilitation specialist as well as physiotherapists, is therefore crucial, and these should be found at every single outpatient centre specialising in multiple sclerosis-related diagnostics and treatment. The effects that the disease’s progression has on patients’ lives could be curbed with such teams available to patients to establish the extent of the sustained loss of function, and determine the therapy objectives and a detailed therapy plan.

Keywords: needs, physical activity, rehabilitation, treatment, multiple sclerosis
The plasticity of the adult human brain cortex
Aktualn Neurol 2015, 15 (2), p. 80–87
DOI: 10.15557/AN.2015.0011

The human brain is characterized by high plasticity, a feature well-illustrated by many examples described in medical literature. Over the last decades, there has been a significant increase in our knowledge concerning the above, made possible by the appearance of new diagnostic tools, such as functional magnetic resonance imaging, or molecular biology. These methods allow to follow the changes taking place at various levels, including behaviour, anatomy, physiology, and especially at the cellular and subcellular level. Some studies confirm the important role of neuroplasticity, not only in childhood, when the potential is the greatest, and the central nervous system is still developing, but also at later stages of human life. It has now been established that the brain remains plastic at any age, also senile. Understanding the role of brain plasticity in the pathogenesis of diseases has the potential to develop new therapeutic techniques. Based on the latest scientific reports, it can be concluded that neuroplasticity is increasingly becoming the target of novel therapeutic techniques, which make use of the brain’s natural ability to regenerate or compensate lost function. An example would be the use of transcranial magnetic stimulation in neurorehabilitation of patients with structural brain damage, e.g. after stroke, or the targeted use of pharmacotherapy in selected mental illnesses. The purpose of this review is to present the available results of the research on the basic characteristics of brain plasticity, also in adulthood, and the potential influence of drugs on neuroplasticity

Keywords: neuroplasticity, neural plasticity, neural transmission, pharmacotherapy, learning processes
The use of SMR neurofeedback in the treatment of drug-resistant epilepsy
Aktualn Neurol 2015, 15 (2), p. 88–90
DOI: 10.15557/AN.2015.0012

Epilepsy is one of the most frequent neurologic disorders. The main aim of epilepsy treatment is to improve the quality of life, and to reduce epileptic seizures. Epilepsy is described as drug resistant if adequate trials of two tolerated and appropriately chosen and used treatments fail to achieve sustained seizure freedom. In Poland, 400,000 people suffer from epilepsy, and 30% of them have drug-resistant epilepsy. Surgical treatment is available for only some of these patients. The pursuit for new methods of alternative treatment continues, with neurofeedback seemingly emerging as one of viable options. Neurofeedback is a training method based on biofeedback, which can be described as providing information about the changes of the physiological signals to the trained person. In essence, neurofeedback takes place, if the bioelectrical activity of the brain (EEG) is the signal registered during the biofeedback training. The aim of this article is to present the knowledge regarding the use of SMR neurofeedback in the treatment of resistant epilepsy. In 1972, Sterman and Friar, encouraged by the positive results of studies in animals, for the first time attempted to use neurofeedback for the treatment of drug-resistant epilepsy. In the last decade, two independent meta-analyses were published. It seems that SMR neurofeedback should be considered as adjunctive method of treatment in patients with resistant epilepsy, particularly in cases where other methods have failed. More randomised controlled studies are needed to confirm the efficacy of this method of treatment. The directions of future studies have been highlighted in the article.

Keywords: epilepsy, neurofeedback, treatment
A case of late presentation of precocious puberty due to pituitary astrocytoma
Aktualn Neurol 2015, 15 (2), p. 91–95
DOI: 10.15557/AN.2015.0013

The importance of assessing precocious puberty, especially in boys, is not only due to the great complications it has for the affected patients, but also to the fatal underlying diseases. Therefore, children with central precocious puberty should first undergo neuroimaging. In this case study, we present a 9.5-year-old boy who was referred to Rasoul-e-Akram Medical Center with increased intracranial pressure, nausea/vomiting, and severe headache having begun three months earlier. The development of secondary sexual changes had started two years earlier, and had been neglected. His testes, penis, and pubic hair were at the fourth Tanner stage. He had elevated luteinizing and follicle stimulating hormones. Microscopic evaluation confirmed low-grade pilocytic astrocytoma WHO grade 1. Emergency brain surgery was conducted in which the brain was decompressed, and chemotherapy was started postoperatively. Two years after the surgery, he remains under chemotherapy, with obvious sexual maturation and a height of 154 cm. Training families and medical staff efficiently can help prevent the late diagnosis and treatment of precocious puberty and, as a result, help patients in their social life.

Keywords: puberty, precocious, central
Flaccid paraplegia of organophosphate-induced delayed polyneuropathy leading to early spastic paraplegia. Case report
Aktualn Neurol 2015, 15 (2), p. 96–98
DOI: 10.15557/AN.2015.0014

Organophosphate insecticides have been widely used for pest control. They have been readily used as a suicidal agent in developing countries. This paper reports the case of a middle aged male patient with acute organophosphate compound poisoning who in turn had acute cholinergic crisis and was put on ventilator. Within one week, he developed flaccid areflexic paraplegia with preserved sensation. Two weeks later, he had spasticity in both lower limbs with hyperreflexia. The reported case demonstrates the myelopathic presentation of organophosphate-induced delayed polyneuropathy.

Keywords: organophosphate, poisoning, flaccid, spastic, paraplegia, polyneuropathy
The course of early rehabilitation after brain stroke with acute coronary syndromes in the case of a patient with bilateral crural amputation. Case report
Aktualn Neurol 2015, 15 (2), p. 99–102
DOI: 10.15557/AN.2015.0015

Ischaemic stroke as a complication of acute coronary syndrome occurs in approximately 1.40% of cases. Multimodal rehabilitation is an essential component of treatment following a stroke. Case report: The clinical case refers to a patient after a stroke and acute coronary syndrome preceded by bilateral leg amputation. This paper presents the course of the 25-day psychomotor rehabilitation programme conducted in the department of neurological rehabilitation. Methods: The treatment has been evaluated using functional scales (Activity Daily Living Scale, Modified Rankin Scale, National Institutes of Health Stroke Scale, Rivermead Motor Assessment) and psychological tests (Geriatric Depression Scale, Mini–Mental State Examination). Results: The functional improvement focused mainly on the upper limb and global movements. The intensity of the depressive disorders decreased from severe to mild (21 versus 11). Mini–Mental State Examination results normalized (19 versus 27). Conclusions: Early-applied individual rehabilitation program with intensive psychological therapy is a very important element of treatment of patients with a multifactorial mobility decrease.

Keywords: brain stroke, multimodal rehabilitation, quality of life, functional status