Arts, Brain and Cognition.

Art is a product of human creativity; it is a superior skill that can be learned by study, practice and observation. Modern neuroscience and neuroimaging enable study of the processes during artistic performance. Creative people have less marked hemispheric dominance. It was found that the right hemisphere is specialized for metaphoric thinking, playfulness, solution finding and synthesizing, it is the center of visualization, imagination and conceptualization, but the left hemisphere is still needed for artistic work to achieve balance. A specific functional organization of brain areas was found during visual art activities. Marked hemispheric dominance and area specialization is also very prominent for music perception. Brain is capable of making new connections, activating new pathways and unmasking secondary roads, it is "plastic". Music is a strong stimulus for neuroplasticity. fMRI studies have shown reorganization of motor and auditory cortex in professional musicians. Other studies showed the changes in neurotransmitter and hormone serum levels in correlation to music. The most prominent connection between music and enhancement of performance or changing of neuropsychological activity was shown by studies involving Mozart's music from which the theory of "The Mozart Effect" was derived. Results of numerous studies showed that listening to music can improve cognition, motor skills and recovery after brain injury. In the field of visual art, brain lesion can lead to the visuospatial neglect, loss of details and significant impairment of artistic work while the lesions affecting the left hemisphere reveal new artistic dimensions, disinhibit the right hemisphere, work is more spontaneous and emotional with the gain of artistic quality. All kinds of arts (music, painting, dancing...) stimulate the brain. They should be part of treatment processes. Work of many artists is an excellent example for the interweaving the neurology and arts.

Person-oriented perspectives in neurology.

Person-oriented medicine is characterized by a holistic approach in patient ma- nagement that embraces physical, psychological, social and spiritual aspects of health and dise- ase. It responds to the needs of patients and health care workers to form an effective therapeutic relationship based on trust, empathy, compassion and responsiveness to the individual needs of a patient. Person-oriented perspectives in neurology include active collaborative partnership between a physician and a patient, and intuitive perception, which has a neurobiological correlate in the hu- man mirror neuron system, thus expressing a considerable impact on the quality of the physician's diagnostic and therapeutic activities. On the other hand, personalized approach in medicine implies integration of clinical information and personal genotyping. Personalized neurology provides gene- based preclinical prediction of disease with improved risk assessment, early detection of disease and targeted intervention. The combination of personalized approach and clinical information accelera- tes the translation of genetic discoveries into clinical practice, which ultimately results in improved health care system. Person-oriented perspectives contribute significantly to the growing pluralism of medical science and provide a greater humanization of medicine, individualized treatment and autonomy during therapeutic processes.

The role of complementary and alternative medicine in therapy of multiple sclerosis.

The National Center for Complementary and Alternative Medicine defines complementary and alternative medicine as a group of diverse medical and health care systems, practices and products that are not generally considered part of conventional medicine. Multiple sclerosis (MS) is a chronic disabling disease of the central nervous system that affects people during early adulthood. In spite of many approved medications, the treatment options in MS are limited. Many people with MS explore complementary and alternative medicine (CAM) treatments to help control their MS and treat their symptoms. Surveys suggest that up to 70% of people with MS have tried one or more CAM treatment for their MS. People with MS using CAM generally report deriving some benefit from therapies. The CAM therapies most frequently used include diet, omega-3 fatty acids and antioxidants. The therapies with highest potential among CAM therapies that warrant further investigation are low-fat diet, omega-3 fatty acids, lipoic acid, and vitamin D supplementation as potential anti-inflammatory and neuroprotective agents in both relapsing and progressive forms of MS. There are very limited researches evaluating the safety and efficacy of CAM in MS. However, in recent years, the USA National Institutes of Health and the National Multiple Sclerosis Society have been actively supporting the researches in this very important area.

The effectiveness of the therapeutic ultrasound on the psycho-physiological functioning in patients who presented with neck pain.

The aim of this study was to investigate the effectiveness of the therapeutic ultrasound on the psycho-physiological functioning in patients who presented with neck pain. There is a limited number of scientific studies which provide information on clinical effectiveness of the therapeutic ultrasound and its effect on the psycho-physiological functions. The present study investigated 100 patients (average age 55), 69 females and 31 males, who presented with neck pain. Treatment protocol consisted of 15 treatments spread over three weeks (five treatments per week). Patients were separated into the two groups (test and control). Both groups of patients undertook programed isometric exercises specific for the cervical spine as well as transcutaneous electrical stimulation. The test group received continuous therapeutic ultrasound on the neck five times a day with the intensity of 0.5 w/cm2, while in the control group ultrasound machine was switched off during the therapy. It has been found that programed isometric exercises specific for the cervical spine in combination with transcutaneous electrical nerve stimulation (TENS) had the same therapeutic effect on the psycho-physiological functioning as the combination of these two therapies with the therapeutic ultrasound.

[Diagnosis and conservative treatment of low back pain: review and guidelines of the Croatian Vertebrologic Society]. / Dijagnostika i konzervativno lijecenje krizobolje: pregled i smjernice Hrvatskog Vertebroloskog Drustva.

Low back pain (LBP) is a very common condition with high costs of patient care. Medical doctors of various specialties from Croatia have brought an up-to-date review and guidelines for diagnosis and conservative treatment of low back pain, which should result in the application of evidence-based care and eventually better outcomes. As LBP is a multifactorial disease, it is often not possible to identify which factors may be responsible for the onset of LBP and to what extent they aggravate the patient's symptoms. In the diagnostic algorithm, patient's history and clinical examination have the key role. Furthermore, most important is to classify patients into those with nonspecific back pain, LBP associated with radiculopathy (radicular syndrome) and LBP potentially associated with suspected or confirmed severe pathology. Not solely a physical problem, LBP should be considered through psychosocial factors too. In that case, early identification of patients who will develop chronic back pain will be helpful because it determines the choice of treatment. In order to make proper assessment of a patient with LBP (i.e. pain, function), we should use validated questionnaires. Useful approach to a patient with LBP is to apply the principles of content management. Generally, acute and chronic LBP cases are treated differently. Besides providing education, in patients with acute back pain, advice seems to be crucial (especially to remain active), along with the use of drugs (primarily in terms of pain control), while in some patients spinal manipulation (performed by educated professional) or/and short-term use of lumbosacral orthotic devices can also be considered. The main goal of treating patients with chronic LBP is renewal of function, even in case of persistent pain. For chronic LBP, along with education and medical treatment, therapeutic exercise, physical therapy and massage are recommended, while in patients with a high level of disability intensive multidisciplinary biopsychosocial approach has proved to be effective.

Mediterranean diet in healthy lifestyle and prevention of stroke.

Several studies demonstrated the beneficial and preventive role of Mediterranean diet in the occurrence of cardiovascular diseases, chronic neurodegenerative diseases and neoplasms, obesity and diabetes. In randomized intervention trials, Mediterranean diet improved endothelial function and significantly reduced waist circumference, plasma glucose, serum insulin and homeostasis model assessment score in metabolic syndrome. Several studies support favorable effects of Mediterranean diet on plasma lipid profile: reduction of total and plasma LDL cholesterol levels, plasma triglyceride levels, and apo-B and VLDL concentrations, and an increase in plasma HDL cholesterol levels. This effect is associated with increased plasma antioxidant capacity, improved endothelial function, reduced insulin resistance, and reduced incidence of the metabolic syndrome. The beneficial impact of fish consumption on the risk of cardiovascular diseases is the result of synergistic effects of nutrients in fish. Fish is considered an excellent source of protein with low saturated fat, nutritious trace elements, long-chain omega-3 polyunsaturated fatty acids (LCn3PUFAs), and vitamins D and B. Fish consumption may be inversely associated with ischemic stroke but not with hemorrhagic stroke because of the potential antiplatelet aggregation property of LCn3PUFAs. Total stroke risk reduction was statistically significant for fish intake once per week, while the risk of stroke was lowered by 31% in individuals who ate fish 5 times or more per week. In the elderly, moderate consumption of tuna/other fish, but not fried fish, was associated with lower prevalence of subclinical infarcts and white matter abnormalities on MRI examination. Dietary intake of omega-3 fatty acids in a moderate-to-high range does not appear to be associated with reduced plaque, but is negatively associated with carotid artery intima-media thickness. Greater adherence to Mediterranean diet is associated with significant reduction in overall mortality, mortality from cardiovascular diseases and stroke, incidence of or mortality from cancer, and incidence of Parkinson's disease and Alzheimer's disease and mild cognitive impairment.

Treatment of migraine and tension-type headache in Croatia.

The aim of this study was to assess the treatment patterns of migraine and tension-type headache in the Croatian population. Analysis included the proportion of patients who were taking specific antimigraine therapy and the number of tablets per attack per month, the proportion of patients who were taking prophylactic therapy or using alternative treatment methods and their satisfaction with the treatment. The design of the study was a cross-sectional survey. Self-completed questionnaires were randomly distributed to adults >18 years of age in the Croatian population. A total of 616 questionnaires were analyzed: 115 patients with migraine (M), 327 patients with tension-type headache (TTH), and 174 patients with probable migraine (PM) and TTH. Specific antimigraine therapy was taken by half of patients with migraine: 35.7% of patients used triptans and 21.7% ergotamines. Prophylactic treatment had been used by 13.9% of M, 1.2% of TTH, and 6.9% of PM patients. Alternative methods of treatment were tried by 27% of M and TTH patients. Only 16.8% of patients with M pay regular visits to physicians, while 36.3% never visited a physician. More than half of TTH patients have never visited a physician. The majority of patients are only partially satisfied with their current treatment, and almost one-third are not satisfied. Results of this study indicate that the treatment of primary headaches in Croatia should be improved.

Prospective surveillance of Croatian pregnant women on lamotrigine monotherapy--aspects of pre-pregnancy counseling and drug monitoring.

We prospectively surveyed 23 pregnant women with epilepsy on lamotrigine monotherapy and reported outcome of their pregnancies, including one fetal intrauterine death, one spontaneous abortion and two preterm deliveries. There were no congenital malformations in their offspring. Women with pregnancy planning and folic acid intake delivered babies with higher values of birth weight and birth length. There was large inter-patient variation during drug monitoring and in the need of dose adjustment. Individual approach to every woman and monotherapy with minimal effective lamotrigine dose with frequent drug monitoring enhances the possibility for successful pregnancy. The management of women with epilepsy should begin with pre-pregnancy counseling. Planned pregnancy enables periconceptional folic acid supplementation. Despite the small number of cases, these data indicate that la motrigine treatment during pregnancy might be relatively safe. Larger prospective studies are needed to obtain adequate power for statistical analysis including long-term cohort studies.

Music as an auditory stimulus in stroke patients.

Auditory stimulation increases mean blood flow velocity (MBFV) in the middle cerebral artery (MCA) in healthy individuals. Our aim was to monitor such changes in the affected MCA of patients with acute ischemic stroke (AIS). The study included 66 non-thrombolysed patients with AIS who were divided into groups according to National Institutes of Health Stroke Scale (NIHSS) score. Group I consisted of patients with NIHSS score 10 and group II with NIHSS score > or =11. Affected MCA was insonated with transcranial Doppler (TCD). MCA MBFVs were monitored during listening to music for 30 minutes. The first response of MBFV increase was measured as time (Tmax) and percentage of amplitude change (Amax). Pearson Chi-Square test was used. In 78.85% of patients there was a significant increase in MBFV compared to baseline values as a reaction to the music. There was no significant difference in Tmax or Amax between the two groups. However, a trend of longer Tmax was observed with every 2 NIHSS score increase. Music is an auditory stimulus in stroke patients and can be measured with TCD as MCA MBFV increase. Although our study showed no significant change of reaction time with the severity of stroke, a trend of prolonged Tmax was observed with NIHSS score increase.

Recommendations for neuropathic pain treatment.

Damage to the somatosensory nervous system poses a risk for the development of neuropathic pain. Such an injury to the nervous system results in a series of neurobiological events resulting in sensitization of both the peripheral and central nervous system. The symptoms include continuous background pain (often burning or crushing in nature) and spasmodic pain (shooting, stabbing or "electrical"). The diagnosis of neuropathic pain is based primarily on the history and physical examination finding. Although monotherapy is the ideal approach, rational polypharmacy is often pragmatically used. Several classes of drugs are moderately effective, but complete or near-complete relief is unlikely. Antidepressants and anticonvulsants are most commonly used. Opioid analgesics can provide some relief but are less effective than for nociceptive pain; adverse effects may prevent adequate analgesia. Topical drugs and a lidocaine-containing patch may be effective for peripheral syndromes. Sympathetic blockade is usually ineffective except for some patients with complex regional pain syndrome.

Hemispheric asymmetries in blood flow during color stimulation.

Visual stimulation influences mean blood flow velocities (MBFV) in posterior cerebral arteries (PCA). In 51 healthy, right-handed volunteers MBFV were measured in PCA with opened and closed eyes and while watching colored light (red, yellow, green, blue) for 1 minute. Volunteers had eyes closed 2 minutes between different colors. MBFV in left PCA was 41.2 +/- 8.6 cm/s (mean +/- 2SD) and 27.8 +/- 8.5 cm/s with eyes opened and closed, respectively. For red light MBFV in left PCA was 31.4 +/- 7.1 cm/s, for yellow 31.4 +/- 7.2 cm/s, for green 32.0 +/- 8.3 cm/s, and for blue 33.0 +/- 7.6 cm/s. MBFV in right PCA 41.7 +/- 8.9 cm/s and 28.2 +/- 9.1 cm/s with eyes opened and closed, respectively. For red light MBFV in right PCA was 39.4 +/- 8.4 cm/s, for yellow 38.9 +/- 9.2 cm/s, for green 37.8 +/- 9.4 cm/s and for blue 38.0 +/- 8.8 cm/s. There was no significant difference in MBFV between left and right PCA with eyes opened and closed, but MBFV were significantly higher in right PCA for each color than corresponding MBFV in left PCA. These findings could indicate the greater metabolism of visual cortex in right occipital lobe while watching colors. Visual cortex of right occipital lobe could have greater importance in color perception than visual cortex of left occipital lobe.

Doppler ultrasonography of the vertebrobasilar circulation in patients with sudden sensorineural hearing loss.

BACKGROUND: The etiology of sudden sensorineural hearing loss (SSNHL) is still unclear and is most probably diverse. OBJECTIVE: To determine the relationship between vertebrobasilar circulation and hearing in patients with SSNHL treated with pentoxifylline. DESIGN: Case-control study of 32 consecutive patients with SSNHL. METHODS: Patients with onset of SSNHL within 72 hours were treated with pentoxifylline infusions for 10 days. Transcranial Doppler (TCD) ultrasonography of vertebrobasilar circulation and hearing levels were examined at the onset of SSNHL (before treatment), after 10 days of therapy, and after 3 months. MAIN OUTCOME MEASURES: Hearing levels and TCD ultrasonographic findings at the onset of SSNHL, after 10 days, and after 3 months. RESULTS: Patients with SSNHL had more frequent pathologic TCD ultrasonographic findings compared with a normal population. Thirteen patients with SSNHL had normal TCD ultrasonographic findings, eight had borderline findings, and six had pathologic findings, and in five patients, initially, pathologic TCD ultrasonographic findings improved during therapy. Patients with normal TCD ultrasonographic findings had an average hearing improvement of 17 dB, whereas patients with borderline and pathologic TCD ultrasonographic findings had 3 and 0 dB of average hearing improvement, respectively. The greatest improvement (28 dB) was noticed in patients who showed improvement in TCD ultrasonographic findings. CONCLUSION: Although the number of patients is small, our results led to the conclusion that SSNHL has vascular etiology, at least in some patients. Consequently, the therapy for SSNHL should depend on etiology; that is, vasoactive medications should be reserved for patients with supposed vascular etiology. TCD ultrasonography could have a role in the decision regarding the optimal treatment of SSNHL.