2019, Vol 19, No 1
Entering the new era of cognitive scoring? Eye-tracking assessment in neurodegenerative disorders
Aktualn Neurol 2019, 19 (1), p. 3–7
DOI: 10.15557/AN.2019.0001

Background: The inci dence of dementia and cognitive deterioration is on the rise. Therefore, objective, fast and repetitive cognitive scoring methodology to screen the population and guide the diagnostic process is needed. Eye-tracking provides gaze patterns metrics based on the pupil size and the point of gaze assessment. Methods: The study evaluated 60 patients with medical anamnesis, Montreal Cognitive Assessment – MoCA test, Geriatric Depression Scale – GDS, and eye-tracking protocol. The novel object recognition test consisted of 30 seconds observation of the set of three images, followed by a 90-second pause, and a repeated 30-second observation of the set of three images with the change of one of them. The comparison was made between the metrics of three subgroups, which were created based on MoCA score and named as controls: ≥26, mild cognitive impairment: 21–25, and dementia: <20. Results: For the novel object recognition task, a control group compared to a dementia group was more interested in the new object during a free observation (repeated measure ANOVA, p = 0.03). Moreover, during the observation of the second set of images, the pupil dilation as a result of a memory recall is more prominent in the control group (t-test, p = 0.009). Conclusion: Eye-tracking is a potentially useful tool for objective assessment of patients’ cognitive status. Further studies are needed to evaluate norms across different ages and cut-off points.

Keywords: dementia, eye-tracking, mild cognitive impairment, cognitive deterioration, screening
What is new in the management of the acute ischaemic stroke?
Aktualn Neurol 2019, 19 (1), p. 8–12
DOI: 10.15557/AN.2019.0002

Stroke is a ma jor challenge for medicine in the 21st century. Despite modern diagnostics and even revolutionary methods of treatment, stroke is still the main cause of permanent disability and the second cause of death worldwide. Recent clinical trials have led to a breakthrough in the treatment of stroke. On their basis, many scientific societies updated the guidelines for the management of stroke. We present the most important changes in prehospital care, emergency evaluation, in-hospital non-specific treatment and specific treatment with intravenous thrombolysis and endovascular therapies. The paper is based on the recent recommendations of American Heart Association/American Stroke Association; Canadian Stroke Consortium and the Canadian Association of Emergency Physicians; European Stroke Organisation and Polish Neurological Society. Problems related to the pre- and in-hospital management of patients with acute ischaemic stroke, with a particular emphasis on the dilemma on whether to bypass a primary stroke centre to transport the patient to a comprehensive stroke centre offering endovascular thrombectomy, and the problem of reducing door-to-needle time for intravenous thrombolysis are discussed. The recommendations for the treatment of arterial hypertension and hyperglycaemia in acute ischaemic stroke and the problem of extended time window for intravenous thrombolysis and endovascular thrombectomy are also discussed.

Keywords: ischaemic stroke, acute phase, most important changes in the guidelines
Biomarkers of brain plasticity in multiple sclerosis
Aktualn Neurol 2019, 19 (1), p. 13–18
DOI: 10.15557/AN.2019.0003

Neuroplasticity is the ability of the brain to adjust to internal and external environmental changes that physiologically take place during the entire life. Particularly interesting is the response of the brain to damage in patients with multiple sclerosis, which is a chronic disease that leads to inflammatory and neurodegenerative central nervous system damage. While in healthy individuals brain plasticity is based on brain development, learning processes and memory, in multiple sclerosis it involves changes at the molecular, synaptic and cellular level as well as reorganisation of the cortex and brain fibres, leading to the restoration of functions which were lost in the course of acute or chronic damaging processes. Functional magnetic resonance imaging helps examine functional changes associated with the disease and its evolution. Several studies have shown that abnormal brain activation during certain tasks is seen in early stages of the disease. Enhanced functional activation of the brain has been interpreted as adaptation neuroplasticity to counteract the accumulation of tissue damage. The article presents the principles of functional magnetic resonance imaging which plays a significant role in demonstrating neural plasticity. Moreover, the authors discuss molecular factors that are probably responsible for neuroplasticity.

Keywords: brain plasticity, neuroplasticity, multiple sclerosis, functional magnetic resonance imaging, fMRI, neurorehabilitation
Neuromyelitis optica spectrum disorder (NMOSD) – diagnosis, epidemiology, clinical course, treatment
Aktualn Neurol 2019, 19 (1), p. 19–26
DOI: 10.15557/AN.2019.0004

Devic’s disease (neuromyelitis optica, NMO) was first described under this name in 1894, and it was originally thought of as a variant of multiple sclerosis. However, following the discovery of anti-aquaporin-4 antibodies (anti-Aq4-Ab), neuromyelitis optica was reported as a new nosological entity, and more insights were gained into its pathophysiology. At present, neuromyelitis optica spectrum disorder (NMOSD) is divided into seropositive and seronegative subgroups. Seropositive NMOSD is associated with the presence of anti-aquaporin-4 antibodies, and in the seronegative variant the antibodies are absent. The presence of a third variant, isolated from the seronegative form of NMOSD has also been postulated, characterised by the presence of antibodies against myelin oligodendrocyte glycoprotein (anti-MOG). In 2015, Wingerchuk et al. published updated consensus diagnostic criteria for neuromyelitis optica spectrum disorders. NMOSD is a group of inflammatory demyelinating disorders of the central nervous system characterised by spinal cord and optic nerve involvement. The most common manifestations include recurrent optic neuritis or bilateral optic neuritis, and longitudinally extensive transverse myelitis. The clinical spectrum of neuromyelitis optica also comprises less common presentations such as area postrema syndrome, acute brain stem syndrome, symptomatic narcolepsy or acute diencephalic syndrome. Identification of the new nosological entity has contributed to the verification of conventional medical management, and brought improvements in patient therapy. The paper aims to present updated diagnostic criteria and proposed therapeutic modalities for the management of exacerbations as well as maintenance treatment based on the latest clinical evidence.

Keywords: Devic’s disease, neuromyelitis optica, neuromyelitis optica spectrum disorder, immunosuppression
Modulation of infl ammation in Alzheimer’s disease and omega-3 fatty acids
Aktualn Neurol 2019, 19 (1), p. 27–32
DOI: 10.15557/AN.2019.0005

Due to worldwide elderly population growth and lifespan extension, the number of patients with dementia, most often caused by Alzheimer’s disease, will probably increase exponentially and will be a challenge for European societies. Early diagnosis of cognitive impairment in preclinical phase (mild cognitive impairment) provides opportunity to slow the progression of Alzheimer’s disease and delay dementia onset by taking appriopriate action such as: cognitive training, physical activity and dietary interventions. Since the inflammation hypothesis of the Alzheimer’s disease gained considerable significance, there is a pressing demand in finding dietary factors which can modulate inflammation, prevent or delay the onset, and slow down the progression of the disease. A recently published data reveal that omega-3 long-chain polyunsaturated fatty acids (eicosapentaenoic and docosahexaenoic acids) show multi-directional anti-inflammatory actions by producing anti-inflammatory cytokines and specialised pro-resolving mediators or decreasing pro-inflammatory eicosanoids. Current evidence clearly shows that synergistic action of combined dietary intervention provides stronger benefits than any single component considered separately. Especially the combination of omega-3 with vitamin B complex, vitamin D3, resveratrol and curcumin could be helpful. In this paper, we review the impact, mechanisms, and evidence for the effect of single and combined supplementation on inflammatory processes in Alzheimer’s disease and mild cognitive impairment. Since there is still no cure for dementia, and the available treatment strategies bring only symptomatic benefits, the anti-inflammatory dietary interventions should be considered as a crucial factor in Alzheimer’s disease treatment.

Keywords: Alzheimer’s disease, inflammation, omega-3, polyphenols, vitamins
Changes in concentrations of antiepileptic drugs in pregnant women – a case report
Aktualn Neurol 2019, 19 (1), p. 33–38
DOI: 10.15557/AN.2019.0006

Epilepsy is the most common neurological disorder in pregnant women. Epileptic seizures can be dangerous both for the mother and the foetus. Most pregnant women with epilepsy must use antiepileptic drugs. The aim of the treatment is to gain optimal seizure control while minimising the risk to the foetus (a potential teratogenic effect of antiepileptic drugs). The physiological changes in the pregnant woman’s body may affect the effectiveness of these agents. As pregnancy progresses, their serum concentrations decrease due to the increase in extracellular fluid volume, impaired intestinal absorption, increased renal clearance and enhanced hepatic metabolism. This is true for most antiepileptics, both old and new. Particularly significant fluctuations of serum concentrations are observed for new antiepileptics. The level of lamotrigine and levetiracetam decreases in the third trimester of pregnancy by even 50%, and the level of oxcarbazepine falls by 30–40%. The dosage of antiepileptic drugs should depend primarily on the clinical picture, and it is helpful to determine their serum levels during pregnancy. It is recommended to test the concentration of antiepileptic drugs before pregnancy, at the beginning of each trimester, during the last month of pregnancy and during the eighth week after delivery. The paper presents two cases of pregnant women who experienced a decrease in the level of new-generation antiepileptic drugs during pregnancy. The knowledge about the levels of these drugs was a valuable guide for optimising treatment.

Keywords: antiepileptic drugs, epilepsy, pregnancy
Dysarthria during subacute phase of the fi rst in a life-time ischaemic stroke within left lenticular nucleus – case report
Aktualn Neurol 2019, 19 (1), p. 39–44
DOI: 10.15557/AN.2019.0007

A rare form of dysarthria, previously not described in the Polish literature, is presented from the speech therapist’s perspective. This neuro-logopaedic case study describes dysarthric patient during subacute phase of the first in a life-time ischaemic stroke. Symptoms were associated with the left lentiform nucleus lesion. Speech recordings were collected on the 2nd, 4th and 6th day after the vascular incident. On the 5th day, the patient underwent endarterectomy procedure due to the left internal carotid artery stenosis. Lingual motor control (tongue and lips movements, resistance to the spatula) and word list articulation were assessed. Quantitative results of the Polish version of the Frenchay Aphasia Screening Test were also analysed to exclude aphasia. Results show that both the labial efficiency as well as articulation improved. However, tongue efficiency deteriorated. It was observed that vowels and labial consonants articulation remained mostly unchanged, regardless of endarterectomy procedure. It was only consonant pronunciation that was affected. For further investigation of the symptoms’ dynamics, long-term observation is recommended.

Keywords: dysarthria, aphasia, upper motor neuron, stroke
Multiple sclerosis and syringomyelia – a case report
Aktualn Neurol 2019, 19 (1), p. 45–48
DOI: 10.15557/AN.2019.0008

Syringomyelia is associated with more than two-thirds of Chiari malformation type I cases, and rarely with intramedullary neoplasm or post-traumatic cavitations. Some authors assume that syringomyelia, sometimes observed in patients with multiple sclerosis, is more likely to be a consequence of inflammatory-demyelinating pathology of the spinal cord. We describe a case of a 23-year-old patient who was diagnosed with multiple sclerosis according to the McDonald criteria with syringomyelia and Chiari malformation type I. It to be a very rare case of co-occurrence of syringomyelia and multiple sclerosis as two separate unrelated independent diseases.

Keywords: multiple sclerosis, syringomyelia, Chiari malformation