[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to evaluate the prevalence of resistance to acetylsalicylic acid (ASA), used for secondary prevention of stroke, including the assessment of risk factors associated with the lack of ASA anti-aggregatory action.
Patients after a transient ischaemic attack (TIA) or ischaemic stroke in the acute (n = 111) and chronic phase (n = 87) were enrolled in the study. The assessment of platelet function was performed by whole blood impedance aggregometry using a multi-channel platelet function analyser (Multiplate).
A proper response to ASA was found in 121 patients (61.1%) (ASA responders), a partial response to ASA in 59 patients (29.8%) (ASA partial responders), and ASA resistance in 18 patients (9.1%) (ASA non-responders). Acetylsalicylic acid resistance was observed more frequently in the chronic phase. The mean low-density lipoprotein (LDL) concentration was higher in ASA non-responders (p = 0.02). The mean heart rate (p = 0.03) and the mean haematocrit (p = 0.03) were higher in the group of ASA partial responders and ASA non-responders. Angiotensin II receptor antagonists were more often used in the group of ASA partial responders and ASA non-responders (p = 0.04). Diuretics were more rarely used by ASA non-responders, whereas fibrates were more rarely used by ASA partial responders.
The method enabled the detection of ASA resistance in some patients with cerebrovascular disease. The study revealed some possible risk factors of ASA resistance: long ASA therapy, increased heart rate, higher LDL concentration, and higher haematocrit value. The relationship between the effect of ASA and other medications (angiotensin II receptor blockers, fibrates, diuretics) requires further study. Platelet function monitoring should be considered in patients at a greater risk of ASA resistance.
Archives of Medical Science 03/2015; 11(1):106-114. DOI:10.5114/aoms.2015.49211 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the concentration of 25-hydroxycholecalciferol and parameters of calcium-phosphate metabolism at different periods of relapsing-remitting multiple sclerosis (RRMS).
Forty-five patients, residents of Poland (49°-50°, N), were enrolled in the study, i.e. 15 immediately after the diagnosis of RRMS, 15 at the early stage and 15 at the advanced stage of RRMS. The results were compared to values obtained in 20 age- and sex-matched controls.
Lower serum concentrations of 25-hydroxycholecalciferol and ionised calcium were found in patients compared to the control group. In patients with the disease duration of 5-6 years, concentrations of 25-hydroxycholecalciferol and ionised calcium were lower than in patients in the earlier period of RRMS. The inverse and clearer direction of changes was found in parathormone serum concentration in patients compared to the controls. In patients with a longer disease duration, a significantly lower 25-hydroxycholecalciferol concentration was found in female patients compared to male patients. In patients, more frequent 25-hydroxycholecalciferol and unsaturated fatty acids' supplementation was observed compared to the controls.
In RRMS patients, calcium-phosphate metabolism is disturbed which increases during disease progression.
[Show abstract][Hide abstract] ABSTRACT: The application of high intense focused ultrasound (HIFU) is currently the subject of many experimental and clinical trials. The combination of HIFU with MRI guidance known as MR-guided focused ultrasound (MRgFUS) appears to be particularly promising to ablate tissues located deep in the brain. The method can be the beginning of interventional neurology and an important alternative to neurosurgery. Studies conducted to date show the effectiveness of the method both in chronic diseases and in emergency cases. The safety and effectiveness of this method have been observed in parkinsonian and essential tremor as well as in neuropathic pain. The procedure does not require anaesthesia. Ionizing radiation is not used and there is no risk of cumulative dose. Such advantages may result in low complication rates and medical justification for further development of MRgFUS.
[Show abstract][Hide abstract] ABSTRACT: The purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors.
The study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study.
Among the study group, 261 people (61.3%) used at least one drug as a secondary prevention. OAPs were regularly used by 237 people (55.6%), and OACs-by 25 people (5.9%). The most often used drug was acetylsalicylic acid. Ticlopidine was more frequently used than clopidogrel, and acenocoumarol was used more often than warfarin. Among all of the concomitant cardiovascular risk factors, congestive heart failure was mostly associated with OAP treatment, and a history of atrial fibrillation-with OAC treatment. Use of drugs did not depend on age, sex, place of residence (rural or urban), level of education and personal income, but it was associated with the region where the respondents lived.
Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly.
Neurologia i neurochirurgia polska 03/2014; 48(2):85-90. DOI:10.1016/j.pjnns.2013.11.001 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives
Orthostatic tremor is a specific form of tremor which is characterized by a subjective feeling of unsteadiness during stance, not present in other positions. The diagnosis can be confirmed in the electromyographic or accelerometric study by recording the tremor (e.g. in the quadriceps muscle) of frequency 13–18 Hz occurring exclusively in the upright position.
In the present case, despite the presence of the classic features of orthostatic tremor the proper diagnosis has been much delayed.
The paper presents the characteristic features of this rare movement disorder, indicates some diagnostic possibilities, and emphasizes the need for disseminating the knowledge about the disease which can be treated successfully.
Postepy Psychiatrii i Neurologii 03/2014; 23(1):53–60. DOI:10.1016/j.pin.2014.03.005
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to assess the health related quality of life in patients suffering from multiple sclerosis (MS) in association with clinical features, fatigue and depressive symptoms.
The examined group consisted of 61 patients (45 women and 16 men) in the mean age of 38.6 +/- 11.4. The mean duration of disease was 7.1 +/- 6.1 years. The control group consisted of 30 healthy volunteers. The following questionnaires were used: EuroQol (EQ5D) with visual scale EuroQol-VAS, Modified Impact Fatigue Scale (MIFS) and Beck Depression Inventory (BDI).
The quality of life in the examined group of MS patients was significantly lower in comparison to the control group. Results of EQ-5D and EQ-VAS were influenced by age, disease course, level of disability and carried treatment. Statistically significant association was also found between results of the questionnaires assessing quality of life and either fatigue or depressive symptoms.
The used questionnaires confirmed that quality of life in patients with MS is significantly worse, especially in the older people with secondary progressive course of the disease, more disable and not treated. Presence of fatigue and depressive symptoms influenced the self-assessment of quality of life. Complex care of MS patient should consider diagnosis and treatment of fatigue and depression which could improve their quality of life.
Psychiatria polska 07/2013; 47(3):433-42. · 0.73 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
Reoperations of patients with recurrent low-grade gliomas (LGG) are not always recommended due to a higher risk of neurological deficits when compared to initial surgery. The purpose of the present study was to evaluate surgical outcomes of patients operated on for recurrent LGG.
Material and methods:
Sixteen patients who had surgery for recurrent LGG out of 68 LGG patients who underwent surgery at the Department of Neurosurgery in Sosnowiec, Poland between 2005 and 2011 were enrolled in the study.
A large tumour volume prior to the initial surgery was the most significant parameter influencing LGG progression (96.6 cm³ vs. 47.9 cm3, p = 0.01). Increased incidence of epileptic seizures and decreased mental ability according to Karnofsky score were the most common symptoms associated with tumour recurrence. In the group of patients with malignant transformation, the relative cerebral blood volume (rCBV) was considerably increased (1.21 vs. 2.41, p < 0.01). No statistically significant difference was found in terms of the extent of resection between initial surgery and reoperation. Similarly, no significant difference was found in the number of patients with a permanent neurological deficit after initial surgery and reoperation.
Reoperations of the patients with recurrent LGG are not burdened with a higher risk of neurological sequelae when compared to initial surgery. The extent of resection during the surgery for LGG recurrence is comparable to initial surgery. The increase of rCBV seems to be a significant biomarker that indicates malignant transformation.
Neurologia i neurochirurgia polska 05/2013; 47(2):116-125. DOI:10.5114/ninp.2013.34399 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
In Poland, the prevalence of cardiovascular diseases is increasing. This might be associated with the constantly growing proportion of elderly people and inappropriate cardiovascular prevention. This study aimed to evaluate the frequency of use of oral antiplatelet (OAP) and oral anticoagulant (OAC) drugs among older people in Poland and to assess their association with cardiovascular risk factors.
The study was based on data collected during the implementation of a multicentre, publicly funded research project called PolSenior.
The study group consisted of 4,979 people with the average age of 79.35 ± 8.69 years. Among them, 1,787 people (35.9%) used at least one drug in the prevention of cardiovascular diseases. OAPs were used regularly by 1,648 (33.1%) elderly people and OACs were used by 165 elderly people (3.3%). Acetylsalicylic acid was used by 32.2% of elderly people. Use of drugs significantly depended on age (p < 0.01), sex (p < 0.01), place of residence (p < 0.001), level of education (p < 0.0001) and personal income (p < 0.0001). Among all the respondents treated with OAPs, therapy was applied as secondary cardiovascular prevention in 717 respondents (43.5%), and as primary prevention in 705 respondents (42.8%). Among the respondents treated with OACs, 117 (71%) elderly people had a history of atrial fibrillation. Secondary cardiovascular prevention should be considered in a further 482 respondents (15.1% of untreated elderly people), and primary cardiovascular prevention in 1,447 respondents (45.3%).
Our study is the first to determine the frequency of use of OAP and OAC drugs among elderly people in Poland in relation to cardiovascular risk factors. The most commonly used drug for cardiovascular prevention is acetylsalicylic acid, but it appears that it is used too rarely in high-risk patients. Educational programs should be developed among general practitioners concerning current recommendations for pharmacological cardiovascular prevention.
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
The aetiopathogenesis of fatigue in multiple sclerosis (MS) is not clear. It could be associated with structural changes of the central nervous system, but also with mood and sleep disorders. The purpose of the study was to evaluate frequency of fatigue and its association with sleep and mood disorders in MS patients.
Material and methods:
The examined group consisted of 122 MS patients (mean age 37.7 ± 10.8 years). The following questionnaires were used: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Athens Insomnia Scale (AIS), Montgomery-Asberg Depression Rating Scale (MADRS), and Hospital Anxiety and Depression Scale (HADS).
Fatigue was present in 75 MS patients (61.5%). Excessive daytime sleepiness was observed in 25 (20.5%), insomnia in 73 patients (59.8%). According to MADRS, depressive symptoms were present in 33 (27%), according to HADS in 15 people (12.3%). Anxiety was present in 32 patients (26.2%). We observed an association between fatigue (FSS) and sleep disorders (ESS, AIS) and also between fatigue and either depression (MADRS, HADS-D) or anxiety (HADS-A). The FSS score was not associated with age, sex, disease course and duration, Expanded Disability Status Stage (EDSS), treatment or level of education in MS patients. In inactive professionally people we noted significantly higher FSS scores (44.8 ± 13.8) in comparison with active individuals (37.2 ± 14.9; p = 0.0053).
Fatigue is a very common symptom in MS, sometimes associated with sleep disorders, depressive symptoms or anxiety. The treatable causes of fatigue in MS such as sleep and mood disturbances should be identified and treated.
Neurologia i neurochirurgia polska 07/2012; 46(4):309-317. DOI:10.5114/ninp.2012.30261 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to perform an analysis of the recorded tremor using accelerometry and select those parameters that are the most useful in differentiation of tremor types.
We examined 45 patients with parkinsonian tremor (PT), 39 patients with essential tremor (ET) and 35 patients with cerebellar tremor (CT). The control group consisted of 52 healthy persons. The analysis included tremor intensity, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, and harmonic index. Parameters of tremor were compared between particular groups of patients with pathological tremor and with the control group. The side-to-side symmetry of these parameters was also analysed.
Tremor intensity was significantly higher in patients than in controls. There was a significant side-to-side asymmetry of intensity in all patient groups. Significantly lower peak frequency, centre frequency and standard deviation of centre frequency were found in patients compared to the control group. The frequency was symmetric in ET and in controls, but asymmetric in other subjects. The differences between hands regarding the standard deviation of centre frequency were significantly greater in all patient groups than in controls, who revealed no difference of this parameter between sides. Harmonic index was significantly greater and asymmetric in all groups of patients when compared to the control group.
Standard deviation of centre frequency and harmonic index are the most valuable variables in differentiation of tremor. The assessment of symmetry of tremor parameters is useful in discrimination of various types of pathological tremor.
Neurologia i neurochirurgia polska 01/2012; 46(2):145-56. DOI:10.5114/ninp.2012.28257 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epilepsy is one of the most frequent neurological diseases. Social acceptance is very important for people with epilepsy and their relatives. The aim of the study was to assess public knowledge and attitudes towards epilepsy in Silesia.
We examined 419 people, inhabitants of Silesia, at the mean age of 34 ± 15 years. The study was performed using a questionnaire containing 15 questions evaluating knowledge about epilepsy and attitudes towards people with epilepsy.
43.2% of the respondents knew an epileptic person themselves. 44.7% had witnessed an epileptic seizure; 68.8% would help a person during an epileptic seizure, but most of them (73.4%) would do it incorrectly (by putting an object into the mouth to prevent biting the tongue). 94.5% of respondents had nothing against friendship with an epileptic person, but 12.1% suggested that children with epilepsy should attend special schools. 85.9% of all those examined said that people with epilepsy should inform others about their disease, 81.9% would mention the existence of an epileptic person in their family. 40.5% of respondents believe that people with epilepsy can do the same jobs as healthy people, 75.3% would employ an epileptic person themselves.
The knowledge about epilepsy and first aid during epileptic seizure is still insufficient among inhabitants of Silesia. Most of the responders, especially better educated ones, declare acceptance and tolerance of people with epilepsy. More effort should be made to improve public knowledge of epilepsy by preparing wide-spread educational programmes.
Neurologia i neurochirurgia polska 01/2011; 45(2):107-14. DOI:10.1016/S0028-3843(14)60020-7 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Essential tremor (ET) is likely the most common movement disorder. The aim of the study was to carry out spectral analysis of the essential tremor recorded by an accelerometer and assess the symmetry of tremor parameters between the two hands.
We examined 39 patients with ET diagnosed clinically using the criteria of the Movement Disorder Society. The control group consisted of 52 healthy persons. A biaxial accelerometer mounted at the dorsal side of the hand was used. Spectral analysis was performed. Tremor intensity, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, and harmonic index were measured. The side-to-side symmetry of these parameters was analysed. The relationship of hand dominance and severity of tremor was also analysed.
There was significant side-to-side asymmetry of intensity in ET. The intensity in the more affected hand was over two times higher than that in the less affected one. The tremor was more severe in the nondominant hand in 62% of patients. In spite of significant difference in tremor intensity between the two sides, tremor frequency was similar in both hands. The standard deviation of centre frequency was significantly lower and the harmonic index was significantly higher in the more trembling hand.
Accelerometric registration revealed that asymmetry of intensity and symmetry of frequency are characteristic features of ET. The remaining two coefficients reflecting the rhythmicity and regularity of tremor also differed considerably between the hands.
Neurologia i neurochirurgia polska 01/2011; 45(2):121-7. DOI:10.1016/S0028-3843(14)60022-0 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Central pontine myelinolysis (CPM) is a neurologic disorder that the most often is related to rapid correction of hyponatremia. It is concentrated, frequently symmetric, noninflammatory demyelination within the base of the pons with a relative sparing of the axons and the nerve cells. Focal demyelination can occur outside the pons (extrapontine myelinolysis--EPM). Clinical symptoms have various manifestations and the prognosis can be different. In the diagnosis of CPM the most useful is magnetic resonance imaging (MRI), that is more sensitive than computed tomography (CT). The authors present two cases of CPM with different aetiology, clinical features and course of the disease.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was an analysis of causes, clinical symptoms, complications and predictors of an unfavorable course of status epilepticus (SE).
Retrospective evaluation of medical files of 28 patients (17 M, 11 F, aged 52 +/- 15 yrs) was made. Patients were treated for status epilepticus in a Neurology Clinic in Zabrze between January 1997 and March 2008.
Chronic epilepsy existed in 64% pts, for 10 yrs on an average, in 10% pts SE was a subsequent one. Chronic alcoholism was defined as a most frequent cause of SE, followed by cerebrovascular disorders and brain tumor (32, 14 and 14%, resp.); in 25% pts the cause was not specified. Generalized seizures predominated (82%), in 90% they lasted longer than 60 minutes. In 43% pts biochemical inflammatory indicators on admission were found, more than 20% had fever, in 10% pneumonia was diagnosed. 1/3 of individuals suffered from respirocirculatory insufficiency and in more than 21% new neurological deficits appeared. In treatment, following benzodiazepines, intravenous phenytoin (50%) was used. 35% pts was subjected to pharmacological coma, predominantly by means of thiopental and propofol (25 and 7%, resp.). Mechanical ventilation was necessary in 40% pts. Mortality rate was 32%, with 33% of deaths on the 1st day and 78% before the 7th day.
Chronic alcoholism and older age predominate among causes of death in patient with SE.
[Show abstract][Hide abstract] ABSTRACT: Accelerometric registration of tremor with the subsequent estimation of its parameters allows objective collection of information. The aim of the study was an analysis and visualization of the signal of the recorded tremor, including assessment of spectral components at the dominant frequency and selection of those parameters that are most useful in differentiation of tremor types.
We examined 44 patients with parkinsonian tremor (PT), 39 patients with essential tremor (ET), and 13 patients with cerebellar tremor (CT), diagnosed clinically using the criteria of the Movement Disorders Society and the Tremor Investigation Group. The control group consisted of 26 healthy persons. A biaxial accelerometer mounted at the dorsal surface of the hand was used. Spectral analysis was performed. The analysis focused on determination of spectrum shape, frequency of spectral peaks, centre frequency, standard deviation of the centre frequency, harmonic index, as well as changes in frequency over time.
In patients with pathological tremor (PT, ET, and CT), a single spectral peak was observed that persisted for the whole registration period. In the control group, tremor was characterized by a wide range of spectral frequencies with marked variability in time. Statistical analysis revealed significantly lower frequencies of the highest peak and of the central frequency, a significantly smaller standard deviation of the central frequency and a significantly higher harmonic index in cases of pathological tremors as compared to the control group.
The presented method enables distinction between pathological and physiological tremor and helps in differentiation of various types of pathological tremor.
Neurologia i neurochirurgia polska 01/2007; 41(3):241-50. · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epilepsy is one of the most common chronic neurological conditions. The prevalence of epilepsy is estimated at 0.5-5% of population. The etiology of seizures is in a great extent age-related. It is multifactorial in any given individual and is a result of a combination of acquired and genetic factors. The epidemiological studies indicate an increasing number of patients who suffer from active epilepsy with the first epileptic fit in the elderly. In that age range epilepsy, after stroke and dementia, is the third most frequent disease of nervous system. The most frequent causes of the late-onset epilepsy, especially in the elderly, seem to be: cerebrovascular disease, head trauma and alcoholism. On the basis of literature the authors present the epidemiology, clinical and electroencephalographical features and treatment of different kinds of epilepsy: vascular, posttraumatic and related to alcohol abuse.
[Show abstract][Hide abstract] ABSTRACT: SUMMARY Objectives. Clinical characteristics of various types of tremor and methods used in their treatment are presented on the grounds of the literature. Background. Tremor is a common symptom of a variety of neurological disorders as well as of other conditions. The following types of tremor are outlined: physiological, spontaneous, orthostatic, primary writersí, of voice, cerebral, rubral (mesencephalic), palatal, associated with peripheral neuropathy, elicited by some kinds of food and drink, induced by drugs and exposure to neurotoxic substances, and psychogenic. Conclusions.Treatment efficacy depends on a correct diagnosis. Identification of the type of tremor depends on a carefully obtained case history and clinical examination, as well as tremor registration with subsequent analysis of its parameters, particularly ampli- tude and frequency. Even though drugs are available for effective treatment of various forms of tremor, some types of tremor are resistant to pharmacological treatment. In such cases surgery is an alternative (including thalamotomy, pallidotomy, or grafting of stimulating systems).