Memory efficiency in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate memory in patients with drug-resistant epilepsy. METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). CONCLUSION: Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

Others Are to Blame (Displacement in patients with drug-resistant epilepsy).

OBJECTIVE: To evaluate the defense mechanisms (DM) in patients with drug-resistant epilepsy and, to determine whether displacement is associated with seizures. SUBJECTS AND METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humor, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with drug-resistant epilepsy use immature defensive styles significantly more (p=0.0010). Displacement have a positive correlation with frequency of seizure (p=0.0412). CONCLUSION: Blaming others is a characteristic of the behavior of patients with drug-resistant epilepsy, especially if they have seizures. As such, they may be less adaptable in a micro social environment.

Contributing Factors to the Quality of Life in Multiple Sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Quality of life (QoL) refers to the perception of an individual's life in the context of the system of culture and values in which they live. AIM: The aim of the study was to determine the distribution of cognitive disorders in people with MS. METHODS: The prospective study included 135 participants with MS and 50 healthy participants. Participants were divided into three groups: the first group consisted of 85 participants where the disease lasted longer than one year, the second group consisted of 50 participants with newly diagnosed MS, the third group consisted of 50 healthy participants. The instruments of clinical assessment were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Beck Depression Scale, and Quality of Life Scale (SF-36, Contemporary Health Survey). RESULTS: The quality of life related to health is impaired in the physical, mental dimension and overall quality of life. In the first group of participants, 62% had mild depression, and in the second group 38% of participants, while more severe forms were recorded in 16% of participants in both groups. As depression increases, the quality of life decreases in all measured dimensions, which would mean that depression negatively affects the quality of life. The results of all dimensions as well as the overall quality of life score are worse with the increase in the degree of clinical disability, for both groups of study patients. CONCLUSION: Quality of life is impaired in MS patients, and a higher degree of clinical disability and an increase in depressive disorder are predictors of deteriorating quality of life in MS patients.

Cognitive Disorders in Patients with Multiple Sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Cognitive disorders are found in over 50% of patients. AIM: The aim of the study was to determine the distribution of cognitive disorders in people with MS. METHODS: The prospective study included 135 respondents with MS and 50 healthy respondents. The respondents were divided into three groups: the first group consisted of 85 respondents where the disease lasted longer than one year, the second group consisted of 50 respondents with newly diagnosed MS, the third group consisted of 50 healthy respondents. Clinical assessment instruments were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Battery of Tests to Assess Cognitive Functions: Wechsler Intelligence Scale, Revised Beta Test, Raven Colored Progressive Matrices, Wechsler Memory Scale, Rey Audio Verbal Learning Test -Osterriecht's complex character test, verbal fluency test. RESULTS: Cognitive disorders were present in 40-60% of respondents with MS. Visuospatial, visuoconstructive and visuoperceptive functions are worse in the first group. Mnestic functions (learning process, short-term and long-term memory, recollection, verbal-logical memory) were most affected in both groups of respondents, ranging from 30-60%. Poorer cognitive domains are in the first groups of respondents. Immediate working process memory (current learning), memory, attention, short-term and logical memory is worse in the examinees of the first group. At the beginning of the disease, 16% had verbal fluency difficulties, and as the disease progresses, the difficulties become more pronounced. CONCLUSION: Cognitive disorders are heterogeneous, they can be noticed in the early stages of the disease. They refer to impairments of working memory, executive functions and attention, while global intellectual efficiency is later reduced.

Post-traumatic Stress Disorder, Metacognitions, Cognitive and Global Functioning in Bosnian War Veterans.

INTRODUCTION: Cognitive impairment is common finding in individuals with PTSD. Dysfunctional metacognitions in variety of anxiety disorders can represent generic vulnerability for anxiety disorders, as well as elements that contribute to maintaining the disorder. There is little empirical information about metacognition in war veterans with PTSD, and its relation to cognitive and/or social, occupational and psychological functioning. AIM: to determine the values and reciprocal correlations of different aspects of metacognition, with cognitive and global functioning in outpatient war veterans with PTSD. METHODS: The study was conducted on 25 war veterans (24 male), with confirmed diagnosis of PTSD by a trained psychiatrist, average age 48,5±6,2 (38-63) years, with average duration of symptoms of 9,9±4,7 (0,5-16) years. We used the Metacognitions questionnaire, Mini Mental Status Examination, and Global Assessment of Functioning Scale to assess metacognition, cognitive impairment, and global functioning. Median values of Metacognitions questionnaire subcomponents, Global Assessment of Functioning Scale and Mini Mental Status Examination were determined, and also reciprocal correlations of all parameters expressed with Spearman Rank Correlation. RESULTS: 12 patients (48%) had impaired cognitive function. Significant negative correlation of score on Mini Mental Status Examination, and negative beliefs about worry is observed (r=-0,4278, p=0,034), as well as non significant correlations between rest of metacognition subscales and score on Mini Mental Status Examination. Cognitive self-consciousness showed high positive correlation with Global Assessment of Functioning Scale (r =0,7436, p<0,0001). CONCLUSION: Follow up of metacognitions, cognitive and global functioning, and its relations, may have an important role in assessment of war veterans with posttraumatic stress disorder.

Ego Defence Mechanisms in Patients with Epilepsy.

BACKGROUND: In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS: We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS: Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION: Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

Gender Differences in Biochemical and Electroneurographic Parameters of Median and Ulnar Nerve.

INTRODUCTION: In this article are demonstrated differences in the aspects of the metabolic syndrome (MSy) between genders, as well as the association of MSy and neuropathy. THE AIM: The aim of our study was that in patients with newly discovered metabolic syndrome of both sexes make comparison of fasting blood glucose levels and after oral glucose tolerance test, as well as neurophysiological parameters of n.medianus and n.ulnaris. PATIENTS AND METHODS: All participants were examined dermatologically. The analysis included the 36 male and 36 female respondents with a newly discovered MSy. RESULTS: The average age of men was 52.75±7.5 (40-65) years and women 52.1±7.7 (38-67) years. The average value of fasting blood glucose in women was 5.86±0.87 (4.5-8) mmol/L, and non significantly higher in men (p=0.0969) as 6.19±0.8 (4.7-8) mmol/L. Average values of blood sugar 120 minutes after oral glucose tolerance test were not significantly different (p=0.7052), and was 5.41±1.63 (3.3-9.7) mmol/L in women and 5.27±1.52 (2.7-9.8) mmol/L in men. Median motor velocity were significantly higher in women for n.medianus on the left (p=0.0024), n.ulnaris on the left (p=0.0081) and n.ulnaris on the right side (p=0.0293), and the median motor terminal latency were significantly longer in n.ulnaris on the left (p=0.0349) and n.ulnaris on the right side (p=0.011). There was no significant difference in the sensory conductivity velocity in n.medianus and n.ulnaris between the groups, but the amplitude with the highest peak of the sensory response was significantly higher in n.medianus on the left (p=0.0269) and n.ulnaris on the left side (p=0.0009) in female patients. CONCLUSION: The results indicate that there are differences in neurophysiological parameters of the investigated nerves between the genders, and that tested nerve structures in the course of MSy are affected slightly more in men. There were no significant differences in skin changes between genders.

Cutaneous silent period in the assessment of small nerve fibers in patients on hemodialysis.

AIM: In hemodialysis patients renal disease may cause an impairment of central and peripheral nervous system. In most cases of the peripheral nervous system polyneuropathy is reported. The aim of this study was to evaluate the function of small A-delta nerve fibres, whose function is often overlooked. METHODS: The function of large diameter nerve fibers was performed by standard routine neurophysiological examination. Cutaneous silent period (CSP) was elicited by single electrical stimulations at the tip of digit II by the bipolar electrodes. The superficial electrodes were placed on the muscle belly of m. abductor pollicis brevis. The onset latency (L1) was recorded at the beginning of voluntary muscle activity suppression, the late latency (L2) at the start of new muscle activity. The difference between two latencies indicates the duration of CSP. RESULTS: The study included 38 consecutive patients (male/female - 21/17, median age 56.6±10.9 years) treated with hemodialysis (one month to 30 years) and 35 healthy subjects (male/female 23/17, age 47.4±10.1 years). The results of the conduction study demonstrated a significant prolongation of F-waves of the median and ulnar nerves, decreased motor and sensory velocities of both nervesin patients on hemodialysis (p less than 0.001). In patients with A-V fistulas a significant prolongation of the onset CSP latency L1 was obtained (p less than 0.001), whereas duration of CSP was not changed. CONCLUSION: In hemodialysis patients the significant impairment of small nerve fibers was recorded. The evaluation of small nerve fibers contributes to the assessment of the whole peripheral nerve function.

Cutaneous silent period in the evaluation of small nerve fibres.

INTRODUCTION: High intensity cutaneous stimulus transiently suppresses tonic voluntary muscle activity resulting in cutaneous silent period (CSP). AIM: The aim of our study was to evaluate the normal values of an onset latency L1, a late latency L2 and a duration of CSP after stimulating sensory fibres of the median nerve. MATERIAL AND METHODS: This prospective study was performed at the Neurology Department, Clinical Center of Sarajevo University in period from January 1st 2013 to December 1st 2013. In our study we examined 61 subjects. The group included our relatives, coworkers and friends. The informed consent from testing subjects was obtained. RESULTS: The origin of silent period is stimulation of small A-delta nerve fibres. The pre-synaptic or post-synaptic interruption of the electrical volley to motor neurons is discussed. Median values of muscle activity suppression in healthy female is 55.0 ms (45.0-74.0) and 59.0 ms (52.0-67) male subjects. There is a correlation between the onset latency L1 and the late L2 latency (p < 0.03). In the on-going study it seems that delay of L1 and shorter muscle activity suppression might provide a sign of small nerve fibres involvement. CONCLUSION: The use of CSP improves the value of neurophysiology examination.

Hyperlipidemia as a risk factor for persons in specific professions.

INTRODUCTION: The increase in lipid levels associated with other risk factors for the occurrence of ischemic heart disease and stroke is one of the most important health problems in the world. Risk for development of changes is greater for people of specific occupations such as police officers. MATERIAL AND METHODS: This prospective study included 300 police officers, 150 as experimental and 150 respondents as a control group. To both groups same methods have been applied: A detailed history, physical examination, complete laboratory evaluation, lipid electrophoresis targeted to hypercholesterolemia, ultrasound of the abdomen and Color Doppler of the neck vascular structures. The results obtained by statistical analysis of the data showed that there was a significant increase in levels of cholesterol and triglyceride levels in experimental compared to the control group. Ultrasound of the abdomen showed fatty infiltrated liver in 16% of respondents from the experimental and 2% of the respondents in the control group 2%. Color Doppler of the neck blood vessels in 14% of respondents from experimental group showed changes in blood vessels, which ranged from mild thickening of the intima of the vessel to a 50% decrease in circulation. For the control group, this percentage was 0.66%. Considering that this study involved young, active working population, hyperlipidemia becomes a bigger problem.

Correlation of aggressiveness and anxiety in fighting sports.

INTRODUCTION: in fighting sports there are many opened issues related with levels of aggression and anxiety. MATERIAL AND METHODS: Our study is performed with healthy young athletes: kick boxers, karate fighters, and boxers. Examined group consisted of 55 members (45 male) with average age of 20.2 +/- 3.8 years. In analysis of level of aggression Questionnaire A-87 is used. Its purpose is assessment of aggressive behaviour in provoked situations, or measurement of impulsive aggression. Questionnaire A-87 consists of 15 items of different situations with five possible responses. RESULTS AND DISCUSSION: The possible responses or reactions are the five most frequent forms of aggressive responses: a) verbal manifest aggression (VM); b) physical manifest aggression (PHM); c) indirect aggression (IND); d) verbal latent aggression (VL), and e) physical latent aggression (PHL). In the analysis of anxiety is used Beck Anxiety Inventory, BAI. Average training period was 7.8 +/- 3.6 years. Even 37 athletes during sporting carriers were injured, and most of examiners (precisely 13) experienced 3 injuries. Average value of BAI was 12.7 +/- 8.7. Average value of total aggression was 152.2 +/- 40.9; highest levels were observed in VM (33.9) and VL (30.1). Significant positive correlations of all components of aggression with level of anxiety is observed (p < 0.05), most prominent IND (r = 0.4263; p = 0.0012), and VL (r = 0.4163; p = 0.0016), and also total aggression (r = 0.4822; p = 0.0002). Slightly significant positive correlation of total aggression with age of examiners is also observed (r = 0.2668, p = 0.0489). Positive correlation VM (r = 0.4928; p = 0.0001), PHL (r = 0.2761; p = 0.0413), and total aggression (r = 0.347; p = 0.0094) is observed with number of injuries of examined athletes. Also, positive correlation (r = 0.2927, p = 0.0301) is observed with level of anxiety and number of injuries. Higher level of aggression and anxiety might change attitude of some sports authorities (especially coaches), and additional psychological training of fight sports might be necessary. CONCLUSION: Assessment of basically levels of aggression and anxiety of athletes might be valuable not only in sport activities, but in overall aspects of life.

Correlation between hormonal and lipid status in women in menopause.

It is widely accepted that menopause leads to changes in hormonal status, metabolism and lipid profile. The aim of this study was to analyze the influence of menopause on the concentrations of lipids, lipoproteins and, the influence of estradiol, progesterone, FSH, LH on lipid profile in menopausal women as well. The menopausal women had higher but non-significant (p>0,05) concentrations of total cholesterol, VLDL, LDL, and triglycerides than women with regular menstruation. The concentration of HDL was significantly lower in menopausal women than in women with regular menstruation (p<0,05). Also, the concentration of apolipoprotein B was significantly higher in menopausal women (p<0,05), but the concentrations of apolipoprotein and lipoprotein (a) were lower but without significance (p>0,05). Estrogen concentration has significant negative correlation with VLDL and triglycerides (p<0,05) and significant positive correlation with HDL (p<0,05) in menopausal women. Progesterone concentration has shown no correlation with concentrations of lipids and lipoproteins in menopause. We can conclude that menopause leads to changes in lipid profile by reducing HDL, and elevating apolipoprotein B levels, thus increasing the risk for cardiovascular disease. These changes were caused by reduction of estrogen concentrations in menopause.

Electroneurography of right median and ulnar nerves in diabetic patients with and without retinopathy.

In this study we examined motor and sensory conduction velocities in right median and ulnar nerves in diabetic patients. Control group consisted of 25 healthy volunteers (13 males) with average age of 52 years. The first examined group consisted of 25 diabetic patients (13 males) without retinal changes, 59,6 years old on average, and the second group consisted of 40 patients (15 males) 59,4 years old on average: 22 of them with type 1, and 18 with type 2 retinal changes. The motor and sensory conduction velocities in right median nerve in the control group were significantly higher than those measured in the first group (p<0,0005 for motor, and p=0,0027 for sensory velocity), and the second group (p<0,0001 for motor, and p=0,0001 for sensory velocity). Significantly higher conduction velocities in sensory median nerve were compared between the examined groups (p<0,001), but motor conduction velocity was not significantly higher (p=0,09). The motor conduction velocity in ulnar nerve in the control group was significantly higher in comparison with the patients of first (p=0,0027) and second examined group (p=0,0001). The sensory conduction velocity in ulnar nerve was not significantly higher compared with the first (p=0,081), and significantly higher compared with the second examined group (p<0,0001). The sensory conduction velocity of ulnar nerve was significantly higher (p=0,019) in diabetic patients without retinopathy compared with patients with retinopathy. Diabetic patients with retinal changes have higher risk of developing more severe neurophysiologic signs of neuropathy. So, simple observation with ophthalmoscope may be useful diagnostic tool in its determination and may be the target of further therapeutic strategy.

Median nerve: neurophysiological parameters in third trimester of pregnancy.

An examination of neurophysiologic features of median nerve in third trimester of regularly controlled normal risk pregnancies is performed at the Department of Neurophysiology of Primary Health Centre in Tuzla during January / April 2006. Examined group consisted of 40 young females in third trimester of pregnancy, and average age of 25,6 +/- 4,9 years. Control group consisted of young healthy females with average age of 31,1 +/- 4,4 years. Symptoms and signs of carpal tunnel sy. (CST) had 12 patients, but diagnosis is neurophysiologically confirmed in 9 (75%) patients. In group of pregnant females without symptoms 3 (10,7%) patients showed neurophysiologic evidence of CTS. Sensory velocity of right median nerve was significantly lower in pregnant group of patients (p=0,002), but area of sensory potentials on both sides were lower in pregnant group (p<0,0001). Area of CMAP of right median nerve was significantly lower in pregnant group (p=0,0003). Significant differences in CTS group compared with control group were in sensory velocities of median nerve (left median nerve p=0,0007, right p<0,0001), and area of SNAP of both sides (left p<0,0001, right p=0,0001), but area of CMAP right (p=0,0003). In CTS group 7 females had unilateral and 5 had bilateral neurophysiological changes. Our conclusion is that neurophysiological parameters of median nerve in third trimester of pregnancy are changed mainly due to high prevalence of CTS that might disturb quality of life and have psychological and physical implications on future mother. Hence, it is necessary to, continuously, pay enough attention in prevention or treatment of mentioned syndrome in this population group.

[Czech and Polish women as the first female physicians in Bosnia-Herzegovina]. / Cehinje i Poljakinje--prve lijecnice u Bosni i Hercegovini.

Bajerova, Keckova, Krajevska and Olsevska--female physicians pioneers which worked in B&H. Born in Czech Republic and Poland, they began her medical work far from B&H, and full affirmation of her job received in this area.

[The DNA test in the diagnosis of Huntington disease]. / Primjena DNA testa u dijagnostici Huntingtonove bolesti.

Huntington's disease is the most prominent basal ganglion disease. Huntington's gene, IT15, in chromosome 4p16.3, has 67 axons with 10,366 bp coding space and unstable CAG sequence that codes glutamine on 5' terminal. The molecular-genetic analysis of disease determined expansion of nucleotide repeated CAG sequences. In large Bosnian family with Huntington's disease specific DNA diagnosis of IT15 gene mutation is performed, according the wishes of one female member with "high genetic risk", that voluntarily accessed to DNA test in order to make plans for her own family "without risk" of pathologic gene transmission. A mutation in IT15 gene (number of CAG tandem repeats 46, size of DNA fragment 165 bp and 245 bp) is detected in DNA of her clinically affected brother. But, results of PCR analysis of her DNA sample showed 23 CAG tandem repeats (fragment size 180 bp) that excluded presence of Huntington's disease. We accentuate importance of DNA test in persons with "genetic risk", that are not gene carriers. In that case there are able to create own future without fear of pathological gene transmission.