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Biomedical subjects

Z Stelmasiak

Publications and source records attributed to Z Stelmasiak.

At least 37 records · Page 2Linked to original sources
PubMed2003

Hemiballismus following general anesthesia. A case report.

Hemiballismus is characterized by the abrupt onset of violent proximal flinging movements, affecting the limbs, neck and trunk on one side of the body. It is caused by the lesion in the region of the contralateral subthalamic nucleus of the Luys. Usually it is a self-limiting disease, lasting 6-8 weeks. A 49-year-old man has been admitted to the hospital after flinging movements of his right arm and the right side of the trunk occurred. A few days earlier he had undergone general anesthesia prior to a dental procedure. There was trouble in waking the patient afterwards. The movements lasted a few days. MRI of the brain revealed ischemic lesions areas in T2-weighted images localized in the region of globus pallidus bilaterally. EEG was abnormal, and showed slowed background activity with slow waves in left temporal lobe. He was treated with haloperidol, clonazepam and vasoactive medications. In spite of administered treatment, hemiballic movements reappeared occasionally. Due to increased frequency of the movements the patient was hospitalized again two years later. The second MRI revealed changes described earlier and a new ischaemic focus in left parietal lobe. Continuation of treatment with haloperidol was administered.

Anesthesia, General↗
PubMed2003

The use of instrumental examinations in the diagnosis of headaches.

Headaches are the most common complaint reported by patients to their physician. They can be divided into spontaneous and symptomatic. The findings of the history and examination may suggest the need for diagnostic testing. The ancillary investigation and management of headache is discussed.

Angiography↗
PubMed2003

Endogenous protectant kynurenic acid in amyotrophic lateral sclerosis.

OBJECTIVES: Excitotoxicity may play a role in neurodegeneration in amyotrophic lateral sclerosis (ALS). Kynurenic acid (KYNA), an endogenous antagonist of excitatory amino acid receptors, may inhibit excitotoxic lesions. The aim of this study was to determine the concentration of KYNA in ALS patients. MATERIAL AND METHODS: KYNA was measured by high-performance liquid chromatography in the serum and cerebrospinal fluid (CSF) from ALS and control patients. RESULTS: Our study revealed that CSF KYNA concentration was significantly higher in patients with bulbar onset of ALS compared to controls, and compared to patients with limb onset of the disease. CSF KYNA was also higher in patients with severe clinical status compared to controls. Serum KYNA was significantly lower in ALS patients with severe clinical status compared to controls, and compared to patients with mild clinical status. There were no significant differences in CSF and serum KYNA concentration between the whole ALS group of patients and controls. There was no difference in CSF KYNA concentration between males and females, and there was no correlation between KYNA concentration and age of patients, and duration of ALS. CONCLUSIONS: An increased CSF KYNA concentration in patients with bulbar onset of ALS and in patients with severe clinical status may indicate neuroprotective role of KYNA against excitotoxicity. The difference of KYNA concentration in CSF of patients with bulbar and limb onset of ALS suggests that these two variants of motor neuron disease may have different etiopathogenetic mechanisms.

Age Factors↗
PubMed2003

A double-blind randomised placebo-controlled evaluation of three doses of botulinum toxin type A (Dysport) in the treatment of spastic equinovarus deformity after stroke.

BACKGROUND/OBJECTIVES: Calf muscle hypertonicity following stroke may impair walking rehabilitation. The aim of this study was to assess botulinum toxin (Dysport) in post-stroke calf spasticity. METHODS: A prospective, multicentre, double-blind, placebo-controlled, dose-ranging study was performed to evaluate dysport at 500, 1,000 or 1,500 units in 234 stroke patients. They were assessed at 4-week intervals over 12 weeks. RESULTS: The primary outcome measure, 2-min walking distance and stepping rate increased significantly in each group (p < 0.05, paired test), but there was no significant difference between groups (including placebo). Following dysport treatment, there were small but significant (p = 0.0002-0.0188) improvements in calf spasticity, limb pain, and a reduction in the use of walking aids, compared to placebo. Investigators' and patients' assessments of overall benefit suggested an advantage for dysport over placebo, but this was not significant. Sixty-eight patients reported 130 adverse events, with similar numbers in each group. The few severe events recorded were not considered to be treatment-related. CONCLUSION: Dysport resulted in a significant reduction in muscle tone, limb pain and dependence on walking aids. The greatest benefits were in patients receiving dysport 1,500 units, but 1,000 units also had significant effects. Dysport 500 units resulted in some improvements. Since few adverse events were reported, this therapy is considered safe and may be a useful treatment in post-stroke rehabilitation of the leg. Possible reasons why functional improvements in gait parameters were not observed are also discussed.

Adult↗
PubMed2001

2-deoxyglucose enhances epileptic tolerance evoked by transient incomplete brain ischemia in mice.

The aim of the study was to assess the influence of chronic treatment with a non-metabolisable glucose analogue, 2-deoxyglucose (2-DG) at a 150 mg/kg dose on long-term epileptic tolerance (ET) evoked by 30 min bilateral carotid artery clamping (BCCA) in mice. The effects of protein synthesis inhibition with cycloheximide (CHX), given in three daily doses of 2.5 mg/kg starting either 1 day before (peri-insult regimen) or 1 day after the priming insult (post-insult regimen), on ET development was also studied. Seizures were induced 14 days after BCCA with 3.5 mg/kg of bicuculline; this dose (CD97) evokes convulsions in 97% of normal untreated mice. BCCA resulted in decreased mortality, prolonged latency to the onset of generalised convulsions and decreased overall seizure score. CHX given in the post-insult regimen did not influence, while the peri-insult regimen abolished, all signs of BCCA-evoked ET. 2-DG treatment of sham-operated animals resulted in a moderate but significant decrease in mortality rate and a tendency toward a lower seizure score. BCCA combined with 2-DG treatment resulted in a marked decrease in mortality rate, as well as reduction in all indicators of seizure susceptibility. CHX abolished the antiepileptic effects of BCCA alone, as well as BCCA combined with 2-DG, while it did not influence the 2-DG-related decrease in mortality. We conclude that the development of BCCA-induced epileptic tolerance, as well as unmasking antiepileptic effects of 2-DG by BCCA, is dependent on protein synthesis.

Animals↗
PubMed2001

The effects of citicoline and/or MK-801 on survival, neurological and behavioral outcome of mice exposed to transient hyperglycemia and oligemic hypoxia.

UNLABELLED: The effects of citicoline and/or low dose of MK-801 (sufficient to prevent the development of seizures) on survival, neurological and behavioral recovery following transient hyperglycemic-oligemic-hypoxic insult have been evaluated in mice. Neurological recovery was assessed semi-quantitatively on the third and the 10th day after the insult, and behavioral tests evaluating spontaneous locomotor activity, motor coordination and spontaneous alternation performance were performed on day 10. Neither drug given alone did influence survival rate, but the combination of MK-801 and higher citicoline dose decreased mortality on day 10. Behavioral performance was markedly compromised by the insult. Citicoline, but not MK-801, slightly but significantly improved behavioral outcome in all three tests. CONCLUSION: when brain ischemic insult is complicated with acute hyperglycemia, post-treatment with citicoline combined with MK-801 in low anti-convulsive dose improves survival and neurological recovery, and citicoline but not MK-801 enhances behavioral recovery.

Animals↗
PubMed2001

Interleukin-1beta converting enzyme/Caspase-1 (ICE/Caspase-1) and soluble APO-1/Fas/CD 95 receptor in amyotrophic lateral sclerosis patients.

OBJECTIVES: The aim of the study was to investigate the role of ICE/ Caspase-1 and soluble APO-1/Fas/CD 95 receptor in amyotrophic lateral sclerosis patients. MATERIAL AND METHODS: The apoptosis parameters were measured by enzyme-linked immunosorbent assay (ELISA) in serum and cerebrospinal fluid from 25 amyotrophic lateral sclerosis and 15 control patients. RESULTS: There has been shown a significant increase of ICE/Caspase-1 level in serum, and significant decrease of this parameter in cerebrospinal fluid from amyotrophic lateral sclerosis patients. Soluble APO-1/Fas/CD 95 level in amyotrophic lateral sclerosis patients did not differ from the control group. There was no significant correlation between clinical status, duration of amyotrophic lateral sclerosis, and levels of ICE/Caspase-1 and soluble APO-1/Fas/CD 95. CONCLUSION: Our study suggests that ICE/Caspase-1 may play a role in neurodegeneration in ALS. Due to ethical difficulties we cannot include patients suffering from progressive neurological diseases, who are a more appropriate control group for the amyotrophic lateral sclerosis patients. Therefore we are limited in drawing conclusions from the research.

Adult↗
PubMed2001

[Tick-borne encephalitis versus multiple sclerosis: clinical and immunological aspects].

The condition of making the diagnosis of tick-borne encephalitis is the performance of serological investigation, quite apart from careful evaluation of medical history and clinical status of patient. Contemporary diagnostics of tick-borne encephalitis uses immuno-enzymatic test (ELISA), which enables detection of specific IgM antibodies (in initial phase of disease) or IgM and IgG antibodies (in the phase of the disease with neurological symptoms). The highest diagnostic value in the infection phase of disease has the demonstration of at least fourfold increase of viral antibodies level, measured in acute phase and 2 to 6 weeks after that. In case of multiple sclerosis, a laboratory test, specific for the illness, has not been established as yet. The basis for establishing the diagnosis is the clinical picture. Results of auxiliary examinations are used for the completion of clinical evaluation and for differential diagnosis. Seroepidemiological investigations were carried out in multiple sclerosis patients to estimate the level of antibodies against tick-borne encephalitis. The investigations indicated low level of IgG antibodies in patients' serum.

Diagnosis, Differential↗
PubMed2001

Clinical evaluation of Gabitril and Lamictal for drug-resistant epilepsy in adults.

Second generation antiepileptics lamotrigine (LTG) and tiagabine (TGB) were primarily licensed for adjunctive treatment of simple and complex partial seizures with/without secondary generalisation as similarly effective drugs. Reduction of seizures frequency is the most important index of drug efficacy, but overall therapeutic benefit estimated as a quality of life is nowadays the target goal of management. In this study efficacy and tolerability of LTG or TGB as short-term add-on treatment in patients with refractory complex partial seizures were assessed by the use of both physician-rated measures (mean monthly seizure frequency, responders rate, adverse events, clinical biochemistry) and patients perceived change in their own quality of life estimation (descriptive scale and visual analogue scale-VAS). Comparable efficacy of LTG (n-22, 378 mg/day) and TGB (n-26, 43 mg/g) was assessed as 41 and 35% of responders and above half of patients with noticeable improvement. 25% of patients in both groups reported reduction of seizures severity in 4-points descriptive scale. Biochemistry values did not show clinically significant changes after treatment. 13% of patients on LTG reported adverse events (headache, asthenia, irritability, insomnia). This coefficient was greater for TGB-35% (asthenia, headache, sleepiness, vertigo). However, no case of discontinuation as a result of adverse events was reported for either of the tested drugs. Even if efficacy of LTG and TGB was comparable in objective measurements, only patients on LTG reported a significant quality of life improvement in VAS. This might be the consequence of more frequent adverse events and treatment schedule of TGB (triple dosing/day). This trial confirmed that VAS might be used as an easy additional test in evaluation of antiepileptic drug for individual patient in everyday clinical practice.

Adolescent↗
PubMed2001

Biochemical markers of damage of the central nervous system in multiple sclerosis.

The examination of biochemical markers of the damage of the central nervous system may be the excellent complement of the neuroimaging methods. There are factors in the cerebrospinal fluid which indicate the damage of the precise structures of the CNS. In this paper there are described the main markers which are used in diagnostic multiple sclerosis: myelin basic protein (MBP) as a marker of demyelination of the white matter, neuron specific enolase (NSE) as a marker of neuronal damage, tau protein, 14-3-3 protein, neurofilament protein-subunit light (NFL) as markers of axonal damage and S-100 protein and glial fibrillary acidic protein as markers of astroglial damage.

Biomarkers↗
PubMed2001

A case of the Roussy-Levy syndrome family.

Roussy-Levy syndrome, also known as hereditary areflexic dystasia, is a very rare genetic neuromuscular disorder that typically becomes apparent during early childhood. The disorder is characterised by inherited gait ataxia, pes cavus and areflexia which are eventually associated with distal muscle atrophy, postural tremor and minor sensory loss. We report a family whose members in three generations (grandmother, mother, daughters) were showing these clinical signs of Roussy-Levy syndrome. All of these women have displayed gait ataxia, areflexia, pes cavus and sideways curvature of the spine (kyphoscoliosis).

Adult↗
PubMed2000

The effect of CGP-40116 on pilocarpine evoked seizures in mice exposed to transient episode of brain ischemia.

The objective of the study was to examine the role of N-methyl-D-aspartate (NMDA) receptors in the modulation of a brain tolerance after a transient cerebral ischemia. Adult mice were exposed for 30 min to bilateral clamping of common carotid arteries (BCCA) under anaesthesia. The competitive NMDA antagonist CGP-40116 was administered intraperitoneally (i.p.) in two experimental paradigms, (a) acute treatment: twice, 4.0 mg/kg; 1.5 h before the clamping of vessels and 6 h after re-circulation and (b) chronic treatment in a dose of 1.0 mg/kg; started 24 h after re-circulation and continued once daily for 13 days with the last injection 24 h before the induction of convulsions. Seizures were evoked with pilocarpine (400 mg/kg, i.p.) 14 days after BCCA. The preliminary study showed that BCCA induced protection against pilocarpine toxicity. The acute treatment with CGP-40116 partially diminished the anticonvulsant phenomenon. In contrast, the chronic treatment with the drug led to a marked potentiation of the effect. The whole brain gamma-aminobutyric acid (GABA) analysis performed 14 days after BCCA showed a moderate increase in vehicle-treated mice and a significant elevation after chronic treatment with CGP-40116. It can be concluded that NMDA antagonists may exert the opposite effects on the brain tolerance against pilocarpine toxicity after BCCA. The acute treatment with CGP-40116 diminished its induction while the chronic low-dose treatment enhanced a brain tolerance, possibly through the mechanism of chemical preconditioning.

2-Amino-5-phosphonovalerate↗
PubMed2000

[Differential diagnosis in multiple sclerosis: description of selected cases].

Multiple sclerosis (MS) should be differentiated with diseases causing disseminated lesions of central nervous system or imitating clinical course of MS. Clinical course and results of laboratory investigations also immunological tests should be taken into account in differential diagnosis of MS. We present four patients whose proper diagnoses were based on the immunological investigations.

Adolescent↗
PubMed2000

Pharmacotherapy of epilepsy.

Epilepsy represents the most common serious neurologic complications affecting approximately 1% of the world's populations. Although standard therapy permits control of seizures in about 80% of affected individuals, millions of global population have uncontrolled epilepsy. In the United States alone, the uncontrolled epilepsy represents more than 500,000 people. In the past decade, we have witnessed an array of new generations of antiepileptic drugs (AEDs) with more favorable pharmacokinetics and pharmacodynamic parameters, providing wider option to neurologists/epileptologists for more clinically effective and safer treatment. This was in part due to our better understanding of neural and molecular mechanisms in recurrent seizures. The new generations of AEDs currently include tiagabine, vigabatrin, lamotrigine, zonisamide, felbamate, oxacarbazine, topiramate, and gabapentine. There will be newer generations of AEDs being developed by pharmaceutical companies in United States, Japan, and European countries and will enter into global market sometimes during this decade. Although more clinical trails concerning the existing new generations of AEDs are needed, the available data suggest that in principal, these agents offer advantageous in terms of seizure control, fewer side effects and drug-drug interactions compared to traditional agents phenytoin, carbamazepine, phenobarbital, and valproate. The new generations of AEDs are significantly more expensive than the traditional agents. The two most clinical concerns over the use of traditional AEDs include (i) deleterious adverse effects and (ii) drug interactions, however, these agents are widely used in the third world countries. A thorough understanding of clinical pharmacology of both traditional and new antiepileptic agents will enable clinicians to have better appreciation of their clinical use and the treatment outcome, especially when the traditional agents are pharmacoeconomically preferred. Clinical pharmacology of AEDs is a vast science in medicine consisted of two principal arms, (i) pharmacokinetics and (ii) pharmacodynamics. This article briefly describes the pros and cons of common AEDs in practice, with more emphasis on new AEDs.

Anticonvulsants↗