2002, volume 18, issue 2
Maria Barańska-Gieruszczak, Iwona Kurkowska-Jastrzębska, Krystyna Niedzielska, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 97-108
Monotherapy remains the mainstay for treatment of epilepsy. On average, approximately 70% of patients with newly diagnosed epilepsy have seizures effectively controlled with one appropriately selected antiepileptic drug (AED). Moreover a significant proportion up to 50% of patients whose seizures are not effectively controlled by the initial AED treatment can be successfully managed by an alternative AED. The main benefits of monotherapy are less frequency of adverse effects, easier dosage, better compliance and less cost of treatment. Monotherapy with classic AED is efficacious but new AED occur to be equally effective and are better tolerated. The very serious adverse events as impairment of concentration and attention, polycystic ovary syndrome, hormonal disturbances are not reported with new AED. They have also very small number of pharmacokinetic interactions with other AED. Beside refractory epilepsy new AED should be considered for treatment of new diagnosed epilepsy especially for children, elderly patients, woman in reproductive age etc.
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 109-119
In the paper the treatment of spasticity with traditional pharmacological methods – injection of phenol and ethanol was discussed. Spasticity is one of most common and important problem in neurology because of the degree of spasticity may reflect the intensity of disability neurological patients with upper motor neuron injure (due to stroke, multiple sclerosis, trauma). Phenol and ethanol are the long-lasting local blocking agents used traditionally to treat of spasticity. Beside clinical advantages, the main problems with this kind of treatment are correct selection of patients, appropriate selection of involved muscles, and limitation due to unpleasant side effects (painful injections, chronic pain, and dysesthesias).
Additionally to this review the results of some clinical observation 6 patients treated with 40% ethanol were presented. In most cases improvement was observed.
Lidia Darda-Ledzion, Jacek Zaborski, Anna Członkowska
Multiple sclerosis (MS) is the most frequent chronic neurological disease affecting young persons. The majority of patients suffer from lower urinary tract (LUT) dysfunction. In the most cases conservative treatment is enough to improve the bladder function and quality of the patient’s life. In the article the results of the study concerning about "urinary problems" in MS patients were presented. The aim of study was assessment of frequency and nature of LUT in MS population using non-invasive diagnostic methods. 60 consecutive MS patients were included. LUT dysfunction occurred in 93.3% of patients. In 5% of patients LUT symptoms were the first manifestation of the disease. The intensity of LUT symptoms correlates with disability, duration of disease and results of QOL score. Before study only 18% of patients were treated.
Agnieszka Ciesielska, Ilona Joniec, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 130-147
Clinical observations indicate that estrogens exert a neuroprotection against neurodegenerative diseases such as Alzheimer disease. Although it is unclear whether estrogen may be effective, in preventing further cognitive decline in women who already have Alzheimer’s disease. Despite the existence somewhat controversial date from human studies experimental investigations in different animal models of neurodegenerative diseases have shown that estrogen is neuroprotective. Although estrogens are known to exert several direct effects on neurons, the cellular mechanisms involved in the neuroprotective effects of estrogen are still unclear. In this review we focus on the cellular mechanism of estrogen action in neuronal tissue.
Beata Tarnacka, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 148-152
In the present study current therapeutic possibilities were described. Wilson’s disease is a genetic disorder of cooper metabolism. Since the fifties of the past century it led inevitable to death, but after the introduction of chelating therapy the prognosis is good. Nowadays in Poland there are two specimens available in treatment of this disease: d-penicillamine and zinc sulphate, both are equally effective, but d-penicillamine has more side effects. The prognosis of survival in the majority of WD patients is favorable, provided that therapy is introduced in not very advanced stage of disease and long live continued.
Dagmara Mirowska, Aleksandra Paź, Janusz Skierski, Mirosława Koronkiewicz, Jacek Zaborski, Wojciech Wicha, Andrzej Członkowski, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 153-159
Multiple sclerosis (SM) is a chronic demyelinating central nervous system disease, probably of autoimmune origin. Up till now there is no specific treatment for SM. Copaxone (glatiramer acetate) is one of the drugs of great interest however its mechanism of action remains not fully known. The aim of our study was to evaluate if one-year glatiramer therapy affects immune parameters of peripheral blood in MS patient. The analysis was carried out using two-colour flow cytometry.
Katarzyna Kurowska, Dagmara Mirowska, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 160-165
Glicocortycosteroids (GS) are the most common therapy of multiple sclerosis relapses, however mechanism of beneficial effect is not fully known. The aim of our study was to evaluate the changes of immunological profile (percentage of lymphocytes B, T and monocytes, and produced by this cells IL-6 and IL-8) during intravenous administration of Solu-Medrol. Using two-colour flow cytometry we have studied peripheral blood of 10 patients during exacerbation. We have observed statistically significant improvement of distbility measured with EDSS. Statistically significant increase in lymphocyte B percentage and decrease in suppressor T cells was also noted. Results of our study indicate that GS therapy affects not only clinical state but also parameters of peripheral blood immune profile.
Iwona Kurkowska-Jastrzębska, Ewa Bałkowiec-Iskra, Ilona Joniec, Anna Muszyńska, Adam Przybyłkowski, Andrzej Członkowski, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 166-174
The aim of this study has been to check the influence of autoimmune response to neurodegeneration caused by MPTP intoxication in mice. MPTP quite selectively destroys dopaminergic neurons of the substantia nigra that leads to dopamine depletion in striatum and to decrease in the number of dopaminergic cells. Before intoxication with MPTP, C57Bl mice received myelin protein MOG 35-55 with Freund adjuvant (CFA) that caused autoimmune response – an autoimmune encephalomyelitis (EAE). On the 6th day following immunization mice revealed first symptoms of EAE and were injected with MPTP. The dopamine level was measured after next 3 and 7 days. Mice suffering from EAE and intoxicated with MPTP showed less dopamine depletion than mice receiving only MPTP (without previous MOG immunization). The dopamine content decrease was by 35% and 20% less in these mice on the 3rd and 7th day respectively. Our findings suggest that autoimmune reaction in the cns may play a protective role towards neurons damaged by other factors.
Tadeusz Mendel, Zofia Łysiak, Dorota Sieklicka, Renata Krawczyk, Romana Bogusławska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 175-182
A case report of 25-years old man who had in anamnesis twice deep vein thrombosis and pulmonary embolism. He was treated with acenocoumarol for a few years. He denied intake this drug. In consequence he suddenly had headache, epilepsy, hemiparesis and quadrantopsia. Venous stroke was diagnosed on anamnesis, clinical symptoms and neuroradiological examinations. During few weeks neurological deficits mostly disappeared but maintain epileptic attacks.
Małgorzata Wiszniewska, Adam Kobayashi, Anna Członkowska
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 183-190
The aim of the study was to establish gender-linked differences and similarities in the distribution of stroke risk factors, functional status and socioeconomic status prior to onset, clinical course in the acute stage and early outcome. The analysis was performed using Stat tm programme. We have accepted p<0.05 as statistically significant. We have reviewed data of 816 stroke patients treated in the 2nd Dept. of Neurology of the Institute of Psychiatry and Neurology, Warsaw, Poland (608 patients) and the Dept. of Neurology of the District Specialist Hospital, Pila, Poland (208 patients). 52.7% of patients were female and 47.3 male. The average age of women was higher than men, 73.1 and 66.2 respectively (p<0.000l) and were more frequently independent in everyday life functioning and professionally active (p<0.001). Hypertension was the most frequent risk factor for both but occurred statistically more often in females. Women also suffered mare frequently of atrial fibrillation and heart failure. +Men more frequently smoked and drank excesive amounts of alcohol (p<0.01). Women tended to have consciousness disturbances (p=0.003) and more severe neurological symptoms (p=0.0002). There was no difference in the occurrence of ischemic and haemorrgagic stroke. Early case fatality affected female more often without statistical significance (p>0.05). In the 3 month follow up male patients were in a better functional state (p=0.0002). Stroke recurrence was similar in both genders (p>0.05). Some differences in the clinical course, distribution of risk factors and outcome need further evaluation.
Maciej Niewada, Bogumił Kamiński, Adam Kobayashi, Anna Członkowska, Andrzej Członkowski
Farmakoterapia w Psychiatrii i Neurologii, 2002, 2, 191-203
The high risk of stroke recurrence can be reduced with effective prevention healthcare programs. 2nd Neurological Department clinical database was reviewed and 105 secondary stroke patients evaluated. Survivors were surveyed on healthcare resources consumption within previous year and indirect costs including care time at home and the employment status. Life expectancy was estimated using Kaplan-Meier method along with parametrical hazard function estimator. Average total cost and its 95% bootstrap confidence interval were calculated. Eventually survey was aimed at evaluating patients disability with Barthel ADL Index and it's relation to the total costs of secondary stroke was determined.
Life expectancy for Polish secondary stroke patient was found to be 3.9 years (95% CI: 2.25; 5.71). Average lifetime secondary stroke costs totaled 52181 USD (95% CI: 43536; 61602 (PPP'2000). The direct costs were estimated at 24099 USD and morbidity productivity loss amounted to 34.3%. It was found that total cost decreased as ADL increased.
In Poland indirect costs determine the substantial costs of secondary stroke. Effective secondary prevention can produce clinical benefits and economic savings resulting from limiting the burden of secondary stroke.