2019, Vol 19, No 3
MOG antibody-associated disease – a new entity or one of the forms of the NMO spectrum?
Aktualn Neurol 2019, 19 (3), p. 119–124
DOI: 10.15557/AN.2019.0016

Myelin oligodendrocyte glycoprotein (MOG) is a protein involved in the maintenance of the myelin structure. Recent studies have shown that serum anti-MOG antibodies are found in some of the patients who meet the diagnostic criteria for neuromyelitis optica spectrum disorders, but do not have detectable aquaporin-4 (AQP4) antibodies. Anti-MOG antibodies are components of the inflammatory response to myelin leading to primary demyelination, while the anti-AQP4 antibodies mediate astrocyte destruction in the first place. The available data on the diverse immunopathological mechanisms, demographic characteristics of patients as well as the clinical course suggest the need for classifying anti-MOG-related disorders as a separate form of demyelinating disease. The clinical picture is dominated by an isolated optic neuritis, which is bilateral in 50% of cases. Myelitis and encephalitis are less common manifestations. Long-term prognosis should be considered serious. Long-term disability, mainly in the form of reduced visual acuity and unsteady gait, is observed in almost half of patients. Previous studies showed that intravenous corticosteroid therapy is most effective for relapses, while therapeutic plasma exchange should be used if the desired clinical effect is not observed. As for maintenance therapy, most data support the use of corticosteroids. Reports on relapse prevention using intravenous immunoglobulin preparations, rituximab and other immunosuppressants are also available. The knowledge on MOG antibody-associated neurological conditions is certainly incomplete. Further systematic research is needed, particularly in the context of effective differentiation with other demyelinating conditions and efficacious therapy.

Keywords: oligodendrocyte myelin glycoprotein, neuromyelitis optica spectrum disorders, aquaporin-4, isolated optic neuritis, myelitis
Urological complications after stroke
Aktualn Neurol 2019, 19 (3), p. 125–131
DOI: 10.15557/AN.2019.0017

Urological complications affect 57–83% of patients in the early phase of stroke. Urinary incontinence, which may affect 40–60% of people with stroke, with 25% still having problems when discharged from hospital and 15% remaining incontinent after one year, is the most common complication. Urological disturbances can cause a variety of long-term complications; the most significant being deterioration of renal function. Infections of the urinary tract, diagnosed in 2–44% of patients after a stroke, are a frequent consequence of bladder dysfunction. Urinary tract infections significantly deteriorate patient’s condition, causing an elevated body temperature and a general inflammatory response, which may extend the ischaemic penumbra. Urinary incontinence increases the risk of skin damage and falls, reduces the quality of life, and delays recovery. The treatment of patients suffering from neurogenic bladder and urethral dysfunction requires the collaboration of specialists representing multiple disciplines. Without the treatment of the key symptoms of neurological diseases and rehabilitative treatment, no improvement in bladder function can be expected. Moreover, bladder dysfunction may result from the adverse impact of drugs used in the treatment of neurological diseases. Considering the possible occurrence of these post-stroke complications, collaboration with a urologist may be found valuable.

Keywords: stroke, neurogenic bladder, urinary tract infection, urodynamic testing, treatment
New strategies for migraine treatment and prevention
Aktualn Neurol 2019, 19 (3), p. 132–140
DOI: 10.15557/AN.2019.0018

Migraine is a neurological disorder characterised by recurrent attacks of headache accompanied by vegetative symptoms. It is estimated that 11–12% of the world’s population suffers from migraine. Triptans are the drugs of choice for emergency treatment, but they are ineffective in 30–35% of patients. Triptans also have serious contraindications, mainly from the cardiovascular system. Hence the need to look for new, more effective therapeutic methods for both interrupting and preventing migraine attacks. Studies on the pathogenesis of migraine have shown that the dominant role during an attack is played by the trigeminovascular system and release of a number of peptides, of which the calcitonin gene-related peptide (CGRP) is the strongest. Great hopes are associated with the use of CGRP receptor antagonists (gepants) and monoclonal antibodies directed against CGRP and its receptors. Selective 5-HT1F receptor agonists (ditans) may also make some progress. Studies are ongoing on antagonists of other neuropeptides associated with migraine pathogenesis – pituitary adenylate cyclase-activating polypeptide (PACAP), nitric oxide synthase (NOS), glutamate, a vasoactive intestinal peptide (VIP), and neurokinin A (NKA). The results of studies assessing the efficacy and safety of CGRP antagonists are promising. Some of them have already been registered for the prevention of migraine attacks and there is hope that in the near future they will expand the possibilities of effective emergency and preventive treatment.

Keywords: migraine, CGRP, monoclonal antibodies, gepants, ditans
Mini-Cog as a screening tool for dementia
Aktualn Neurol 2019, 19 (3), p. 141–144
DOI: 10.15557/AN.2019.0019

Due to the growing number of elderly people, dementing diseases pose a serious diagnostic challenge. This is also due to the fact that, despite the increasing knowledge of neurodegenerative diseases, there are still few specialists in this area. Moreover, specialised dementia centres have a significantly longer waiting period for admission. Although complaints about cognitive disorders, memory problems in particular, are common in the elderly population, actual cognitive problems suggesting dementia are found in only a small proportion of patients. Therefore, proper diagnosis should always involve objectification of patient’ complaints. There are many screening tools for the assessment of cognitive functions, but most of them require time and, sometimes, a worksheet, and the method of examination and assessment is not always simple. This is a common reason for a physician to fail to perform the initial assessment. It is not a rare situation that the diagnosis and treatment of dementia are based non complaints alone, and thus implemented in individuals without cognitive impairment. Another problem is referring healthy elderly patients to specialised facilities, which can be a traumatic experience. The article discusses the methodology for the evaluation and interpretation of the Mini-Cog score – a tool allowing for a quick decision on extended diagnosis of dementia. The results of the scale may be insufficient to establish a nosological diagnosis, but they usually allow for a preliminary verification of the presence of evident cognitive disorders.

Keywords: cognitive impairment, dementia, diagnosis, screening methods
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) – a case report
Aktualn Neurol 2019, 19 (3), p. 145–148
DOI: 10.15557/AN.2019.0020

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a newly described inflammatory disease of the central nervous system. The diagnosis is based on the clinical, radiological and neuropathological findings. Prominent response to steroids is also a characteristic diagnostic feature of the disorder. We present a case of a patient with probable CLIPPERS disease as well as discuss treatment and differential diagnosis. The patient received chronic immunosuppressive treatment with the use of steroids and steroid-sparing agent (methotrexate), which led to clinical and radiological improvement. There are no treatment guidelines due to the limited number of such cases. The knowledge of this disorder is important for neurologists and radiologists.

Keywords: brainstem encephalitis, CLIPPERS, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids, encephalitis, vasculitis