2020, Vol 20, No 1
The usefulness of mental health diagnostic screening in patients with isolated cerebellar lesions
Aktualn Neurol 2020, 20 (1), p. 3–8
DOI: 10.15557/AN.2020.0001

Objectives: The present study evaluated the diagnostic usefulness of selected screening methods for mental disorders in patients with cerebellar lesions. Specifically, the aim was to determine which screening methods allow for rapid identification of executive dysfunctions. Materials and methods: Twenty-five patients with an isolated cerebellar lesion were included in the study. A set of three popular screening methods, i.e. Mini–Mental State Examination, Clock Completion Test, and the Brief Psychiatric Rating Scale, was used. A multivariate regression analysis was conducted to assess their diagnostic accuracy as independent predictors of results in Wisconsin Card Sorting Test and Stroop Color-Word Test, defined as dependent variables. Results: The scores obtained by most patients in the Mini–Mental State Examination indicate very mild to mild cognitive impairment, with a mean score of 26.84 ± 3.44. However, a clinically significant deterioration typically seen in dementia was found in 3 persons (12%). For comparison, an abnormal Clock Test score was found in two patients. According to the clinical profile based on the Brief Psychiatric Rating Scale, selective symptoms of a neurotic rather than strictly psychotic nature, such as somatic concern, emotional tension, and anxiety-depressive symptoms, dominated. Finally, only the Mini–Mental and the Brief Psychiatric Rating Scale emerged in the regression analysis as important and independent predictors of executive dysfunctions. Thus, the diagnostic utility of the Clock Test is limited. Conclusions: Some of the mental screening techniques could be useful as a measure of both the general severity of deterioration, as well as specific cognitive and executive disorders following cerebellar damage.

Keywords: cerebellum, screening methods, cognitive impairment, neuropsychological assessment
The relationship between smoking and disease activity in patients with relapsing-remitting multiple sclerosis on immunomodulatory therapy
Aktualn Neurol 2020, 20 (1), p. 9–13
DOI: 10.15557/AN.2020.0002

Introduction: Recent reports have shown that smoking has a negative impact on the development and course of multiple sclerosis. Aim: The aim of this multicentre (Bydgoszcz, Zabrze, Białystok, Szczecin) study was to analyse the relationship between smoking and disease activity in patients with relapsing-remitting multiple sclerosis on immunomodulatory therapy. Materials and methods: We evaluated demographic and clinical data, such as sex, age, smoking (pack-years), treatment duration, disability status according to the Expanded Disability Status Scale (EDSS). Furthermore, we determined disease activity based on both the annualised relapse rate (ARR) after one and 2 years of treatment and magnetic resonance imaging findings. The obtained data were analysed statistically. Results: The study group included 114 patients: 57 (50%) non-smokers and 57 (50%) smokers. Mean treatment duration was 2.46 (±1.23) years, mean EDSS was 2.12 (±1.03), and ARR at treatment initiation was 1.46 in smokers vs. 1.36 in non-smokers. New magnetic resonance demyelination lesions were found after 1 year of treatment in 15 (26.3%) smokers and 8 (14%) non-smokers. Statistical analysis showed significant relationships between smoking and new cerebral lesions in magnetic resonance imaging (r = −0.21, p < 0.05). Conclusions: Smokers on immunomodulatory therapy show marked radiological progression of the disease in the first 2 years of treatment compared to non-smokers.

Keywords: multiple sclerosis, immunomodulatory therapy, nicotine dependence
Predictors for paraclinoid aneurysm recanalisation after endovascular coiling
Aktualn Neurol 2020, 20 (1), p. 14–19
DOI: 10.15557/AN.2020.0003

Background: Paraclinoid aneurysms (carotid-ophthalmic aneurysms) are surgical challenge, and have been one of the most common indications for endovascular treatment. Nevertheless, coil embolisation continues to be associated with a high rate of residual/recurrent aneurysm. The aim of the study was to find radiological marker for recanalisation in order to facilitate decision process, which would result in fewer treatment-related complications. Methods: Fifty-five patients with saccular ruptured and unruptured paraclinoid intracranial aneurysms treated with coil embolisation were analysed retrospectively. Morphometric measurements were performed in CTA 3D aneurysm models before embolisation. The aneurysm size and volume were measured based on digital subtraction angiography images. The effectiveness of the initial endovascular treatment was determined visually using modified Raymond Roy classification after embolisation and during follow-up digital subtraction angiography. Recanalisation was diagnosed when compaction and filling of the aneurysm occurred, compared to the primary embolisation. Statistical analysis was carried out using Statistica 12.5 software. Results: Statistical analysis has shown that aneurysm height, neck size, packing density and parent artery diameter are risk factors for recanalisation. In addition, we have demonstrated statistically significant independent predictors of recanalisation volume (aneurysm volume, size ratio, aspect ratio, maximal perpendicular height to neck size ration and also aneurysm depth to neck size ratio), which are not themselves risk factors for recanalisation. Conclusions: If the above-mentioned predictors of recanalisation are present preoperatively, microsurgical clipping can be considered.

Keywords: paraclinoid aneurysm, embolisation, recanalisation, risk factors
Pharmacokinetics of antiepileptic drugs and their safety in breastfeeding women
Aktualn Neurol 2020, 20 (1), p. 20–31
DOI: 10.15557/AN.2020.0004

Despite the unquestionable benefits of breastfeeding for both the child and the mother, many women on antiepileptic therapy are concerned about their child’s safety and refrain from breastfeeding. This decision is sometimes also influenced by doctors, who base their knowledge regarding the safety of pharmacotherapy during breastfeeding on information provided by manufacturers in the summary of product characteristics. Meanwhile, most agents fail to reach breast milk levels high enough to cause significant clinical levels in the infant’s blood. Furthermore, some agents, such as levetiracetam, gabapentin or topiramate, may reach high levels in breast milk, but their serum levels in the infant remain very low. An analysis of pharmacokinetic, physicochemical and clinical parameters of a given drug provides information on the risk of its use in a breastfeeding mother. The paper discusses the general principles of drug penetration into breast milk and the factors influencing this process. Parameters of different antiepileptic drugs, which determine the safety of their use in breastfeeding women are presented along with research data and recommendations. Most of the older generation drugs are characterised by favourable pharmacokinetics, with phenytoin, carbamazepine and valproic acid considered the safest during breastfeeding. As for new generation agents, only incomplete data indicating that levetiracetam, gabapentin and lamotrigine are moderately safe during lactation, is available.

Keywords: antiepileptic drugs, pharmacokinetics, breastfeeding
Laryngeal electromyography – a review of guidelines and current literature
Aktualn Neurol 2020, 20 (1), p. 32–38
DOI: 10.15557/AN.2020.0005

The aim of this paper was to present current guidelines on the analysis and interpretation of laryngeal electromyography (LEMG) along with a review of the main trends in the use of EMG in otolaryngology and phoniatric practice. Current guidelines were developed by the American Academy of Otolaryngology – Head and Neck Surgery in 2009 and by the European Laryngological Society in 2012. Both scientific societies postulate adaptation and inclusion of LEMG in standard clinical practice in ENT departments. The activities of the European Laryngological Society for the development of LEMG resulted in the implementation of regular training workshops (since 2014) and the creation of www.lemg.org website for those interested in laryngeal neurophysiology. The standards for the interpretation of electromyographic recordings include identification and description of such patterns as insertional activity, spontaneous activity, fibrillations, positive sharp waves, polyphasia, fasciculations, and repetitive discharges. Motor unit recruitment pattern is assessed during phonatory and non-phonatory tasks. Literature analysis indicates that there are four main areas of LEMG application in otolaryngology and phoniatric practice. These include an assessment of vocal fold motion disorder, evaluation of the physiology of the laryngeal muscles, intraoperative monitoring of laryngeal nerves and monitoring of laryngeal muscle activity using surface electromyography. Scientific communities emphasise the importance of LEMG as a component of otolaryngological and phoniatric diagnostic standards and make efforts to expand the use of LEMG. The authors of current recommendations encourage the continuous development of the method. The perspective of further development assumes the search for appropriate objectifying parameters and a change of the guidelines, which are currently limited to qualitative assessment of LEMG findings.

Keywords: laryngeal electromyography, dysphonia, vocal fold paralysis, dysphagia
Ephedrone encephalopathy – a disease of 19th century miners in the era of the Internet
Aktualn Neurol 2020, 20 (1), p. 39–43
DOI: 10.15557/AN.2020.0006

Ephedrone encephalopathy is a rare disease associated with the abuse of methcathinone. Methcathinone, also known as ephedrone, is a psychostimulant that can be synthesised at home using over-the-counter medications containing pseudoephedrine and potassium permanganate. Accumulation of excessively ingested manganese causes damage to the basal ganglia. Clinically, patients present with Parkinson’s syndrome with dominant motor slowing, symmetrical rigidity, falls, and hypophonia, slightly resembling progressive supranuclear palsy. The characteristic symptoms of the disease have previously been associated with manganese poisoning (manganism), which affected miners and steel workers. In 30% of cases, the disease develops into a progressive form, leading to significant disability despite discontinuation of methcathinone. Any treatment attempts fail to yield expected results. Magnetic resonance plays a special role in the diagnosis of ephedrone encephalopathy, showing extensive hyperintense areas in the brain. The article presents basic information about the disorder, along with case reports.

Keywords: encephalopathy, methcathinone, Parkinson’s syndrome, addiction