2019, Vol 19, No 4
Nutritional status changing in advanced Parkinson’s disease patients undergoing deep brain stimulation surgery
Aktualn Neurol 2019, 19 (4), p. 155–161
DOI: 10.15557/AN.2019.0021

Nutritional status and body weight change with the progression of Parkinson’s disease. Deep brain stimulation targeting the subthalamic nucleus is a well-established method in the treatment of advanced Parkinson’s disease. Assessing its role in regulating non-motor symptoms remains a challenge. It has been observed that patients undergoing deep brain stimulation surgery may have an increased risk of significant weight gain, but studies on this subject are rather scarce. The benefits of deep brain stimulation surgery may be limited by the risk of metabolic syndrome. The change in eating habits involves, among others, increased appetite for sweets or an increased number of snacks between main meals, which is a negative phenomenon. Postoperative changes in metabolism can be explained by the effect of stimulation of the subthalamic nucleus on the hypothalamic activity, especially given their anatomical proximity and the fact that the energy balance is regulated by the hormones of the hypothalamic-pituitary axis. Considering the possible complications of the procedure, special attention should be paid to patient’s eating habits. Cooperation between dietitians and doctors is needed to control possible postoperative weight gain and to prevent metabolic disease. Nutritional intervention and promotion of new eating habits adequately adapted to patient age, the severity of symptoms, treatment method or the intensity of physical activity is the basis of a holistic approach in the treatment of Parkinson’s disease.

Keywords: Parkinson’s disease, deep brain stimulation, weight gain, eating habits
Primary lateral sclerosis – a literature review
Aktualn Neurol 2019, 19 (4), p. 162–167
DOI: 10.15557/AN.2019.0022

Primary lateral sclerosis is a rare motor neuron degenerative disease of unknown aetiology. The disease occurs sporadically. Genetic mutations have been detected in only few cases. Symptom onset is usually in the fifth or sixth decade of life. Primary lateral sclerosis is a progressive disease involving upper motor neuron dysfunction. Typically, clinical symptoms begin in the lower extremities, but can also begin within the bulbar region, or other regions of the body. These clinical symptoms include spasticity, hyperreflexia, and weakness. No fasciculation, muscle wasting, or sensory symptoms have been observed. The disease is slowly progressive. Diagnostic criteria for this disease are based on the overall analysis of clinical symptoms as well as additional diagnostic tests. Diagnosis is based on the exclusion of other diseases. There is no specific marker for this disease. Also, no effective treatment has been reported. Some authors suggest that primary lateral sclerosis transforms into amyotrophic lateral sclerosis when clinical or electrophysiological signs of lower motor neuron damage appear. There are different points of view as to whether it represents a separate motor neuron disease, or a slowly progressing type of amyotrophic lateral sclerosis. The latest version of the El Escorial criteria classifies primary lateral sclerosis as a limited phenotype of amyotrophic lateral sclerosis.

Keywords: primary lateral sclerosis, clinical symptoms, diagnostic criteria, treatment
Cognitive disorder profile in patients with idiopathic normotensive hydrocephalus
Aktualn Neurol 2019, 19 (4), p. 168–173
DOI: 10.15557/AN.2019.0023

Normotensive hydrocephalus is a form of communicating hydrocephalus. It is characterised by a triad of symptoms referred to as the triad of Hakim: gait disturbance, impaired bladder control, and cognitive disorders. The symptoms are progressive in nature. The disease is usually observed in adults over 60 years of age. The paper presents the results of studies on cognitive function in patients with idiopathic (primary) hydrocephalus. Contrary to previous beliefs, cognitive disorders are not limited to executive dysfunctions. Impairment of psychomotor speed, attention, memory and visual-spatial functions is also observed. Neuropsychological diagnosis should differentiate idiopathic normotensive hydrocephalus from other diseases, including neurodegenerative ones, Alzheimer’s disease in particular. Idiopathic normotensive hydrocephalus is treated by implantation of a shunt system; however, research findings on improved cognitive function in patients after such treatment are inconclusive. Some studies point to significant global improvement in cognitive function, while other indicate changes in single domains. Comparison of results is difficult due to the differences in methodologies used and the time elapsed between the procedure and the measurement. Knowledge of the profile of cognitive disorders occurring in idiopathic normotensive hydrocephalus is important in the context of both neuropsychological diagnosis as well as neurosurgical qualification for shunt implantation. Surgery may improve functioning, but it may also involve the risk of multiple complications. Therefore, neuropsychological assessment proves helpful in the diagnosis and predicting surgical outcomes.

Keywords: idiopathic normotensive hydrocephalus, neuropsychology, cognitive functions
Cervical myelopathy: current knowledge on the diagnosis and treatment
Aktualn Neurol 2019, 19 (4), p. 174–178
DOI: 10.15557/AN.2019.0024

Cervical myelopathy, also known as cervical spondylotic myelopathy or degenerative cervical myelopathy, is one of the most common causes of disability in the elderly. This disease entity is much more common than it is diagnosed. Degenerative changes leading to critical spinal stenosis are the cause of pressure on the roots and spinal cord in the cervical spine. The first symptoms usually include numbness in the hands and brachial neuralgia; after some time gait disturbances, sphincter dysfunction and impotence appear. Neurological examination shows paresis and atrophy of the muscles of the hands, which may be followed by pyramidal paresis of the lower extremities with neurogenic dysfunction of the bladder. Problems with potency are the reason for the first visit to a doctor for many men. The diagnosis is based on magnetic resonance imaging as well as neurological and neurophysiological examination. There are a number of specific clinimetric scales and tests that facilitate diagnosis and evaluation of cervical myelopathy treatment outcomes. The natural course of the disease, difficult to predict, is usually slow. Some patients require surgical treatment; however; the improvement seen at the beginning disappears over time. This review article presents the current state of knowledge about the diagnosis, course and treatment of cervical myelopathy.

Keywords: cervical myelopathy, CSM, DCM, diagnosis, treatment, prognosis
Lasmiditan in the treatment of migraine attacks
Aktualn Neurol 2019, 19 (4), p. 179–182
DOI: 10.15557/AN.2019.0025

Triptans are the drugs of choice in moderate to severe migraine attacks. It is estimated that they are ineffective in one-third of patients. Moreover, triptans are contraindicated in patients with cardiovascular diseases. Therefore, there is a need for novel antimigraine treatments devoid of vasoconstrictor activity. The aim of this review paper is to report current data on 5HT1F agonist – lasmiditan. Its efficacy was confirmed in randomized controlled trails – SAMURAI, SPARTAN and GLADIATOR. The percentages of patients free of migraine pain and migraine bothersome symptoms were higher in the group treated with lasmiditan compared to placebo. Generally, lasmiditan has a favourable safety profile. Dizziness was the most frequently reported adverse event. No toxic effects on the liver or negative effects on hemodynamic or laboratory parameters were reported. The discontinuation rate due to adverse events in patients treated with lasmiditan was low. According to the available data, lasmiditan is safe, efficacious and well tolerated in treating migraine attacks. Lasmiditan does not exhibit vasoconstrictive proprieties and may be used in patients with cardiovascular diseases, in whom triptans are contraindicated. The results of studies on effectiveness and tolerability of lasmiditan are promising and it is hoped that in the future it will expand abortive therapeutic options for migraine. In October 2019, lasmiditan was approved by the US Food and Drug Administration for the treatment of migraine attacks in adult patients. Currently this drug in not available in Poland.

Keywords: migraine, CGRP, treatment, ditans
Stroke-like symptoms in patient with scleromyxedema – case report
Aktualn Neurol 2019, 19 (4), p. 183–187
DOI: 10.15557/AN.2019.0026

Scleromyxedema is a rare fibromucinous disorder also known as Arndt–Gottron disease. The diagnosis must fulfil the following criteria: generalised papular and sclerodermoid eruption, monoclonal gammopathy (mostly IgG, light lambda chains), no signs of thyroid disorders (differentiation with pretibial myxedema), and pathognomonic biopsy result (triad: mucin deposition, fibroblasts proliferation, fibrosis). In 60–90% of patients with scleromyxedema organs other than the skin are affected, and in 10–15% of patients the central nervous system may be involved. The aetiology of the disease still remains unclear. Currently, IVIg is considered the best therapeutic option. We present the case of a 64-year-old man with a 14-year history of scleromyxedema currently treated with intravenous immunoglobulins, in whom we observed episodes of transient aphasia, and aphasia with hemiparesis, with no radiological evidence of acute cerebral lesions. The patient was treated with rt-PA with initial good results. Dermato-neuro syndrome was considered as a cause of the patient’s symptoms

Keywords: scleromyxedema, dermato-neuro syndrome, immunoglobulins
Carcinomatous meningitis as a clinical presentation of lung adenocarcinoma – case report
Aktualn Neurol 2019, 19 (4), p. 188–192
DOI: 10.15557/AN.2019.0027

Carcinomatous meningitis is a rare complication of a malignant disease with a fatal outcome. The greatest predilection for neoplastic meningitis was observed in the course of hematological malignancies, breast cancer, lung cancer, melanoma and gastrointestinal adenocarcinomas. The simultaneous and multilevel nervous system involvement results in the diverse clinical manifestation, therefore it requires a wide differential diagnosis. The diagnosis is based on the correlation of the clinical presentation with the results of additional tests, especially the examination of cerebrospinal fluid and magnetic resonance imaging with contrast. We present the case of 59-year old woman with the carcinomatous meningitis as the first manifestation of lung adenocarcinoma.

Keywords: carcinomatous meningitis, neoplastic meningitis, carcinomatosis, leptomeningeal carcinomatosis, lung adenocarcinoma