2018, Vol 18, No 1
Comparative evaluation of rehabilitation systems for patients with chronic lumbar overload syndrome
Aktualn Neurol 2018, 18 (1), p. 5–13
DOI: 10.15557/AN.2018.0001

Introduction: Lower back pain affects about 65–80% of population in highly developed countries. The main causes include sedentary lifestyle and limited physical activity. Certain overloads of the spine and sacroiliac joints are considered to account for most cases of spinal pain. The aim of the study was to perform a comparative analysis of the efficacy of segmental stabilisation exercises and post-isometric relaxation vs. exercises restoring balance of spinal muscular tension in combination with post-isometric relaxation. Material and methods: A total of 100 patients diagnosed with chronic lumbar overload pain syndrome were included in the study group. Participants were randomly classified into two same-size groups, which received a 2-week selective manual therapy in an outpatient setting. The study used (before and after the 2-week rehabilitation process) Visual Analogue Scale, Low Back Pain Rating Scale, Oswestry Low Back Pain Disability Questionnaire and Roland Morris Disability Questionnaire, Schober’s test, test assessing spinal muscle strength and overall mobility test. Results: Based on the observations, reduced lumbar pain was shown after the use of both rehabilitation methods. There was also a decrease in the number of patients receiving analgesics. Improvement in the functional status, spinal muscle strength parameters, lumbar mobility and overall physical fitness was observed in all patients. Conclusions: Segmental stabilisation exercises improve spinal muscular strength parameters and lumbar mobility to a greater extent than exercises restoring balance of spinal muscular tension, which in turn have a greater impact on the decrease in the number of patients receiving analgesics.

Keywords: low back pain, muscle relaxation, therapeutic exercises
Depression in Parkinson’s disease. The role of pharmacotherapy
Aktualn Neurol 2018, 18 (1), p. 14–20
DOI: 10.15557/AN.2018.0002

Psychiatric symptoms seem to be an immanent part of Parkinson’s disease. Patients may present with psychotic symptoms, cognitive disorders, sleep disturbances (mainly associated with the REM sleep), dementia as well as depression and anxiety. Depression and anxiety are the most common psychiatric disorders, and are observed in nearly a half of patients with Parkinson’s disease. They are caused by both neurochemical and neuroanatomical abnormalities occurring in this disease. This decreases the quality of life and significantly affects patients’ functioning. Moreover, these disorders are frequently not diagnosed correctly. Numerous studies have shown that the most common drugs are those from the group of selective serotonin reuptake inhibitors. However, there is no strong evidence for their high efficacy. Due to the multifactorial mechanism of action, more effective, but also related with more adverse events, are selective norepinephrine reuptake inhibitors and tricyclic antidepressants. Daily practice and various publications reveal that non-ergoline dopamine agonists, such as ropinirole and pramipexole, may constitute an alternative to antidepressants.

Keywords: Parkinson’s disease, depression, anxiety, dopamine agonists
Histaminergic transmission in narcolepsy type 1 – therapeutical implications
Aktualn Neurol 2018, 18 (1), p. 21–26
DOI: 10.15557/AN.2018.0003

Narcolepsy type 1 (narcolepsy with cataplexy) is a disease manifested by excessive daytime sleepiness, uncontrolled falling asleep, episodes of cataplexy (sudden loss of muscle tone), hypnagogic and hypnopompic hallucinations and sleep paralysis. Due to its clinical course, it significantly reduces the functioning of patients. The aim of the paper is to present actual data on histaminergic transmission in narcolepsy and its clinical implications. The main cause of narcolepsy type 1 is the deficiency of the hypothalamic neurotransmitter orexin/hypocretin. Current therapeutic options, including the use of psychostimulants and anti-cataplectic drugs, are limited and have significant adverse effects. In recent years attention has been given to the role of histaminergic transmission in circadian rhythm control and in the course of narcolepsy. Histaminergic neurons significantly modify action of hypocretin neurons in the control of circadian rhythm. The result of this research was the introduction of the H3R inverse agonist pitolisant in clinical trials. This drug has been shown to be effective in the treatment of daytime sleepiness and cataplexy in patients with type 1 narcolepsy. The success of pitolisant clinical trials demonstrates the therapeutic potential of interventions on histaminergic transmission. Pitolisant – drug influencing the histaminergic transmission efficiently reduces symptoms of narcolepsy type 1. It is a safe molecule, without addiction potential. Due to its discovery the therapeutic armamentarium for narcolepsy type 1 is significantly broadened.

Keywords: narcolepsy, cataplexy, hypocretin, histamine, orexin, pitolisant
The role of the psychologist in the diagnosis and therapy of multiple sclerosis patients
Aktualn Neurol 2018, 18 (1), p. 27–33
DOI: 10.15557/AN.2018.0004

Multiple sclerosis is one of the most common neurological diseases among young people. Treatment and physical therapy are usually focused on motor and sensory deficits experienced by patients. Less attention is paid to cognitive dysfunction, which is very common in this population (30–70% patients). Neuropsychological impairment has a negative effect on numerous aspects of daily living, for instance ability to maintain employment or social life. Cognitive deficits also detrimentally affect functional therapy. Neuropsychological impairment may vary in its severity and type from subtle deficits to dementia. Because of their character and frequent lack of patient’s or caregiver’s complaints, they can remain underestimated or missed during routine neurological examination. Therefore, formal neuropsychological assessment performed with sensitive and reliable methods is required. Patients with cognitive dysfunction should also be provided with neuropsychological therapy. Comprehensive therapy should be aimed at improving motor as well as social and psychological functioning. Hence, it is necessary to include the psychologist in the diagnosis and treatment of multiple sclerosis patients. The psychologist’s presence is important not only to the patient but also to the interdisciplinary treatment team. Information provided by the psychologist helps to assess the patient’s emotional and cognitive functioning, allowing to improve the quality of pharmacological and physical therapy interventions and nursing care.

Keywords: multiple sclerosis, cognitive dysfunction, neuropsychological diagnosis, neuropsychological therapy
Stress and self-image in multiple sclerosis patients and selected positive aspects of struggling with the disease
Aktualn Neurol 2018, 18 (1), p. 34–39
DOI: 10.15557/AN.2018.0005

Multiple sclerosis is an inflammatory demyelinating disease of the central nervous system. It is a chronic disease, with an unpredictable course, involving a heterogeneous clinical picture, and is commonly considered life-changing for both the patient and their family. The diagnosis of multiple sclerosis and the reality of living with the condition come as powerful stress to the affected individual, often rapidly altering their previous self-image and self-esteem. The lowered self-esteem contributes to the patient’s suffering, impedes their daily functioning, and affects their ability to perform their social roles. It is not only the diagnosis as such that weighs the patient down, but the increasing toll the disease takes on all areas of life with time. There is a reciprocal correlation between stress and multiple sclerosis flare-ups, with stress being a well-recognised trigger of multiple sclerosis relapses, and relapses, in turn, being extremely stressful to the patient. Any psychological therapy for multiple sclerosis patients must account for the central role of their way of perceiving reality and interpreting stress factors. The patient’s ability to look for and acknowledge good things, positive aspects and favourable circumstances in life may become their shield against the condition’s impact, relieving the negative effects of chronic stress. In the case of multiple sclerosis patients, the increasingly popular positive psychology calls for focus to be placed on exploring the existing assets and resources of one’s situation rather than the deficits in self-image and one’s reality. Studies examining such variables as the willingness for personal growth, or the patient’s levels of optimism, gratitude, sense of meaning, positive orientation, spirituality and satisfaction facilitate the construction of therapies aimed at identifying the positive aspects of life, helping to shift the person’s perspective on the unpleasant experiences associated with their condition.

Keywords: multiple sclerosis, stress, self-image, positive psychology, emotional support and counselling
Dizziness and falls in elderly patients – selected practical aspects
Aktualn Neurol 2018, 18 (1), p. 40–46
DOI: 10.15557/AN.2018.0006

Dizziness and disequilibrium are one of the more frequent complaints reported by elderly patients. They are significant intrinsic risk factors for falls among the elderly. Balance depends on many factors, including adequate function of sensory, vestibular, visual, somatosensory structures, muscle strength and joint mobility. The structure of the balance system can be impaired by common diseases of aging and by senility of the peripheral and central vestibular system. Dizziness may vary from real vertigo with a precisely described illusion of environmental motion to the feeling of instability, imbalance or fear of falling. Peripheral vestibular pathologies, responsible for half of the cases, are associated with a good prognosis. However, the quality of life of elderly patients with vestibular disorders is greatly impaired by dizziness causing functional limitations in their activities of daily living. Common peripheral vestibular disorders in the elderly include benign paroxysmal positional vertigo, Ménière’s disease and vestibular neuritis. Dizziness caused by diseases of the central nervous system or orthostatic disorders are, on the other hand, associated with a poor prognosis. Transient ischaemic attacks, strokes, migraines, tumours and neurodegenerative disease of the brain may lead to central vertigo. Orthostatic hypotension may cause dizziness and increase the risk of falls, cardiovascular disease, heart failure and stroke. History and careful examination will typically reveal the underlying cause in the majority of cases, allowing the full diagnostic workup and management to be targeted appropriately.

Keywords: dizziness, falls, elderly
CADASIL caused by stereotyped p.Arg207Cys mutation of NOTCH3 gene
Aktualn Neurol 2018, 18 (1), p. 47–51
DOI: 10.15557/AN.2018.0007

The most common hereditary cerebral small vessel disease, associated with strokes and vascular dementia, is known as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). CADASIL is caused by mutations of the NOTCH3 gene. Since most pathogenic mutations at the protein level result with cysteine being replaced with another amino acid or another amino acid being replaced with cysteine, they are referred to as stereotyped mutations. A 55-year-old male patient, suddenly affected by speech disturbances, was diagnosed with a sporadic case of CADASIL on the basis of radiological imaging, particularly an magnetic resonance imaging scan. The diagnosis was conclusively confirmed by genetic testing, which revealed one of the rarer mutations, located in one allele of the NOTCH3 gene, namely p.Arg207Cys, reflecting at the DNA level a transition changing cytosine to thymine in position 619. In magnetic resonance imaging, classical radiological changes were seen, along with the presence of microhaemorrhages in subcortical nuclei, which is an atypical clinical manifestation of the disease. Despite the advanced cerebral changes, the patient continued to be professionally active. Currently, no effective treatment for the condition is available.

Keywords: stroke, small vessel disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CADASIL, NOTCH3, p.Arg207Cys