Uhthoff`s phenomenon 125 years later - what do we know today?

125 years have passed since Wilhelm Uhthoff reported the symptoms he observed after an increased body temperature from physical exertion. Those symptoms, which might have led to the transient impairment of vision in patients with Multiple Sclerosis and also observed in optic neuritis, were later named after him "Uhthoff's phenomenon". This has defined the strategy of rehabilitation procedures in Multiple Sclerosis for more than 100 years, restricting the use of thermal treatments and the possibility of aerobic exercises. The current state of knowledge concerning the Uhthoff's phenomenon and its influence on comprehensive rehabilitation in Multiple Sclerosis were presented in the current review report.

Association of seasonal serum 25-hydroxyvitamin D levels with disability and relapses in relapsing-remitting multiple sclerosis.

BACKGROUND/OBJECTIVES: The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D (25(OH)D) with disability and frequency of relapses in relapsing-remitting multiple sclerosis (MS) patients. SUBJECTS/METHODS: The study included 184 patients with relapsing-remitting MS who were receiving immune-modulating drugs and no vitamin D supplementation. The concentration of 25(OH)D was measured in February and August 2014. The level of disability was assessed twice according to the Expanded Disability Status Scale (EDSS). The patients were divided into two groups: EDSS 0.0-2 and 2.5-4. The control group comprised 58 age- and sex-matched healthy subjects. The 25(OH)D levels were compared with the occurrence of relapses and the level of disability. RESULTS: Mean serum 25(OH)D concentrations were significantly lower in winter in both MS patients and controls. Winter level of 25(OH)D was significantly lower in severe MS cases (EDSS 2.5-4.0) than in mild cases (EDSS 0.0-2.0) (P=0.022), and in the controls (P=0.008), especially in females (r=0.38, P=0.0015). Logistic regression analysis showed the winter serum 25(OH)D was significantly associated with MS (odds ratio 0.925; 95% confidence interval, 0.822-0.970). Serum 25(OH)D levels were significantly lower in MS patients with relapses than in those without relapses both in winter, and in summer. CONCLUSIONS: Hypovitaminosis D was more prevalent during winter than summer, both in the sample group and the control, especially in female MS patients with higher levels of disability. Low vitamin D levels are associated with a more severe course of disease and an increased number of relapses.

Safety of intravenous thrombolysis for acute ischaemic stroke including concomitant neoplastic disease sufferers - experience from Poland.

BACKGROUND: Ischaemic stroke (IS), brain haemorrhage and cerebral venous thrombosis can occur as an early and late complication of cancer in the clinical course. Cancer patients are at increased risk for stroke from direct and indirect effects of their malignancy. AIMS: The aim of our study was to evaluate the relationship between neoplastic disease and the long-term outcome, mortality and the presence of haemorrhagic complications in patients with acute IS treated with i.v. thrombolysis. METHODS: We retrospectively evaluated the demographic and clinical data of 495 Caucasian patients with acute IS and 40 patients with IS and concomitant neoplastic disease who were consecutively treated from 2006 to 2013 in two experienced stroke centres. RESULTS: In analysed group, there were 7.8% of patients with cancer [50.0% male, mean age 72.3 ± 9.3; National Institutes of Health Stroke Scale - 13 (range 9.5-17)]. Cancer was diagnosed before i.v.-thrombolysis in 28 (70.0%) patients. After 3 months of follow up, 60% of patients were independent (mRS 0-2) compared with the group of patients without cancer - 55% (p = 0.54), 17.5% died (18.4%; p = 0.89), 12.4% suffered haemorrhagic transformation (HT) (17.6%; p = 0.41) and 2.5% experienced SICH (4.4%; p = 0.56, respectively). Other clinical complications were not found. A multivariate analysis showed no impact of neoplastic disease on unfavourable outcomes [modified Rankin scale 3-6)] after 3 months (p = 0.15). CONCLUSION: Intravenous thrombolysis performed in Caucasian stroke patients with past or current neoplastic diseases, but not in the course of chemo- and radiotherapy, can be a safe and effective method of treatment. In making decision on the thrombolytic treatment, the risk of bleeding complications and the life expectancy should be assessed.

[Need for creating Polish registry of multiple sclerosis patients]. / O potrzebie stworzenia polskiego rejestru chorych na stwardnienie rozsiane.

Multiple sclerosis (MS) is the most common cause of neurological disability of young people. It is estimated that 40 000-60 000 people in the country suffer from MS, and approximately 2000 new cases are diagnosed annually. These are, however, estimated data and require verification by nation-wide research. Results published so far concern only certain regions of Poland. It is also vital to precisely describe the needs of patients in terms of immunomodulating treatment and to perform detailed pharmacoeconomical analysis. In order to estimate basic epidemiological parameters there is a need of creating, in imitation of many other countries, a national register of MS patients which would concentrate all assets concerning MS around this project. The article presented the most important of American and European databases and explained the basis of the Polish register of MS patients, which is already functioning in one of the regions.

Quality of life in Parkinson's disease.

In this review report, current possibilities of evaluation of quality of life in Parkinson's disease have been critically presented. Health Related Quality of Life (-HRQoL) comprises a wide spectrum of consequences of the disease. Measurement of quality of life has become increasingly relevant as an outcome parameter, especially in long-term trials. Most of the available QoL instruments depend on patient self-reports. The data can be collected by written questionnaires. There are universal questionnaires of QoL--for many diseases and the specific ones--specially created for one disease. Among universal questionnaires, the Sickness Impact Profile (SIP) and the Short-Form Health Status Survey (SF-36) are the most popular in Parkinson's disease. As for specific questionnaires: the Parkinson`s Disease Questionnaire (PDQ-39) and the Parkinson's Disease Quality of Life Questionnaire (PDQL) have been described.

[Evaluation of quality of life in patients after stroke]. / Ocena jakosci zycia chorych po udarze mózgu.

The investigations concerning quality of life after stroke provide an alternative approach in comparison with traditional evaluation of the patient's condition focused only on neurological deficits. The full picture of the patient after stroke should take into account not only locomotor inefficiency, but also cognitive deficits, emotional disturbances and limitations in performing one's social functions. The study present attempts to define health related quality of life and reviews questionnaires devised for the examination of post-stroke patients. Despite a wide variety of methods used, the evaluation of all the areas of the patient's life after stroke seems impossible using only one research tool. There is also an urgent need to develop a uniform system of evaluation, appropriate for Polish cultural standards.

[Examination of the quality of life in post stroke patients]. / Badanie jakosci zycia chorych po udarze mózgu.

The clinical assessment of patients after stroke is usually focused on the detection and determination of neurological deficits. However, the full picture of the patient after stroke should take into account also cognitive deficits, emotional and intellectual disturbances as well as limitations in performing one's social functions. Thus, assessing quality of life after stroke is an alternative to traditional methods of evaluation of the patient's condition. The study presents the attempts to define quality of life determined by the health status and to review questionnaires devised for the examination of post-stroke patients. Despite a considerable variety of methods used, reliable evaluation of all the areas of the patients life after stroke seems impossible using only one research tool. There is also an urgent need to develop an uniform system of evaluation, appropriate for Polish cultural standards.

[The effect of pentoxifylline on treatment results and course of rehabilitation of patients after ischemic stroke]. / Wplyw pentoksyfiliny na wyniki leczenia i przebieg rehabilitacji chorych po niedokrwiennym udarze mózgu.

The study has been taken up to compare the effect of treatment with pentoxifylline and typical treatment in early ischaemic stroke. The study included 107 patients aged 42-85, with the ischaemic stroke confirmed by CT scan, in early stage of stroke (within 24 hours after onset). Excluded from the study were patients with severe physical diseases. The patients were divided into two groups. Group I was treated typically, group II had been profited from a typical, appropriate therapy and pentoxifylline delivery during 30 days as well, with a daily dose of 1200 mg i.v. within the first 5 days followed by an oral dose of 800 mg subsequent days. Such a treatment has been continued until 12th month. The neurological state was assessed according to the European Stroke Scale (ESS) and Mathew Scale (MS), general fitness according to the Kamofsky Scale (KS) and Barthel Index (IB) at the admission, after 30 days and 12 months of the treatment. Quality of life assessment using by Oxford Handicap Scale and Frenchay Activities Index. After 30 days and 12 months of the treatment, no statistically significant differences between all study groups was found in: 1) mortality, 2) mean survival time, 3) neurological and functional state, 4) quality of life. According to the above results the beneficial influence of pentoxifylline treatment of ischaemic stroke was not confirmed.

[Transient global amnesia]. / Przemijajaca niepamiec ogólna.

Transient global amnesia is a disease of nonuniform pathogenesis. Based on review of the literature, etiology, prevalence, clinical pictures and differentiation of this interesting but not always recognized syndrome have been discussed in the article.

[Evaluation of treatment outcome after nicergoline and pentoxifylline in patients with ischemic stroke]. / Ocena wyników leczenia nicergolina i pentoksyfilina chorych z niedokrwiennym udarem mózgu.

The study has been taken up to compare the effect of treatment with nicergoline or pentoxifylline and typical treatment in early ischaemic stroke. The study included 121 patients aged 42-75, with the ischaemic stroke confirmed by CT scan, in early stage of stroke (within 24 hours after onset). Excluded from the study were patients with severe physical diseases. The patients were divided into three groups. Group I was treated typically, group II was given both typical treatment and nicergoline during 30 days, with a daily dose 8 mg i.v. within the first 5 days followed by an oral delivery with a dose of 30 mg per day during the following 25 days. Group III had been profited from a typical, appropriate therapy and pentoxifylline delivery during 30 days as well, with a daily dose of 1200 mg i.v. within the first 5 days followed by an oral dose of 800 mg subsequent days. The neurological state was assessed according to the European Stroke Scale (ESS), general fitness according to the Karnofsky Scale (KS) at the admission and after 30 days of the treatment. After 30 days of the treatment, no statistically essential differences between all study groups was found in: 1) mortality, 2) mean survival time, 3) neurological state, 4) patients general fitness. According to the above results the beneficial influence of nicergoline and pentoxiphylline treatment of ischaemic stroke was not confirmed.

[Pathologic laughing and crying in neurologic disorders]. / Patologiczny smiech i placz w chorobach ukladu nerwowego.

Affective disorders are complications of many nervous system diseases. Pathological laughing and crying may accompany cerebrovascular lesions, multiple sclerosis, ALS, Alzheimer disease or cerebral tumours. Precise mechanisms of how these disorders arise are still unknown. Reviews of the literature were been accomplished in the article where, taking the examples of stroke and multiple sclerosis, have been discussed: the clinic picture, pathogenesis in neuroanatomic and neurophysiologic aspects as well as diagnostic criteria and the treatment of uncontrolled pathological laughing and/or crying.

[Depression as a complication of stroke]. / Depresja jako powiklanie udaru mózgu.

Depression remains frequent occurrenced (25-60%) but rare detected and treated stroke complication. It may have an essential influence on patients' rehabilitation by delaying their time of health remittance. On the basis of literature review present prevalence, pathogenesis and phenomenology of the poststroke depression. We have also paid attention on so called silent strokes role, which may be cause of depression syndromes occurred at elder and pre-elder people.

[Methods for evaluating treatment and rehabilitation progress in patients with stroke]. / Metody oceny postepów leczenia i rehabilitacji chorych z udarem mózgu.

Based on the contemporary literature review, we have been introduced generally used neurological scales estimating the influence of new method of treatment on stroke progress. They are used to evaluate to treatment and rehabilitation progress. We also paid attention on the necessary elements, which every scale should contain and have been characterized generally used scales in neurological practice.