Hashimoto's encephalopathy: a long-lasting remission induced by intravenous immunoglobulins.

BACKGROUND: Hashimoto's encephalopathy (HE) is a rare autoimmune syndrome characterized by various neuropsychiatric manifestations, responsive to steroid treatment and associated with Hashimoto's thyroiditis. There are only a few reports suggesting that intravenous immunoglobulins (IVIG) might represent an efficacious treatment modality for the severe steroid-resistant HE cases. We presented a patient with HE who developed a complete recovery after the IVIG therapy followed by a long-lasting remission. CASE REPORT: We described herien a female patient with the one-year history of autoimmune thyroiditis before the development of neuropsychiatric manifestations. In May 1999, a 38-year-old woman presented at the Institute of Neurology, Clinical Center of Serbia, Belgrade, with the brain-stem syndrome which responded well to steroid treatment. After detailed examinations, the diagnosis of Hashimoto's encephalopathy was established. Two years later, in June 2001, new manifestations (unsteadiness in gait, personality changes, seizures, and persistent headache) gradually developed during a 6-month period. Response to steroids was unsatisfactory and partial, since headaches and personality changes had continuously worsened. In January 2002, the patient received IVIG (0.4 g/kg body weight daily for 5 days). Gradual improvement was noticed and a complete recovery developed over the following weeks. Up to March 2009, during a 7-year follow-up period, remission persisted. CONCLUSION: To our best knowledge, this is the first report of a long-lasting remission of Hashimoto's encephalopathy after IVIG therapy. Therefore, this case further supports administration of IVIG, as a potentially beneficial treatment modality, in severe cases of Hashimoto's encephalopathy which are completely or partially resistant to steroids.

[Effects of a one-year weight reduction program and physical activity on obesity and comorbid conditions]. / Uticaj jednogodisnjeg programa redukcione ishrane i dozirane fizcke aktivnosti na pratece bolesti gojaznosri.

INTRODUCTION: Obesity prevalence is increasing all over the world. Obese patients are at increased risk for developing many medical problems, including insulin resistance and type 2 diabetes mellitus, hypertension, dyslipidemia, cardiovascular diseases and stroke. Excess body weight is associated with substantial increase in mortality from all causes, cardiovascular diseases in particular. Weight control is part of the major health priorities identified for the future. The aim of the study was to evaluate effects of a one-year weight reduction program on obesity and its comorbid conditions and to make a model for long term weight reducing program. MATERIAL AND METHODS: Two hundred obese (ITM > 30 kg/m2) subjects, who attended a 15-day weight reduction ("Cigota") program, three times during a year, were followed up. Participants from group A strictly adhered to the prescribed regimen, while participants from group B followed their own routine of diet and physical activity. Two groups were comparable in terms of gender, age, duration of obesity, previous and concomitant diseases. RESULTS: A year later, a statistically significant mean weight loss was established in both groups, but it was greater in group A (p<0.05). In both groups, all serum lipid parameters, parameters of glycemic control, as well as values of systolic and diastolic blood pressures improved. There was a further decrease in serum levels of total cholesterol, LDL-cholesterol, and LDL/HDL ratio in group A. As compared to group B, group A experienced better glycemic control in diabetic and non-diabetic obese patients, and enhanced reversion from diabetes to impaired glucose tolerance or normal glucose tolerance. This study has demonstrated a well-known fact that body mass reduction is associated with a decrease in blood pressure. CONCLUSION: Treatment of obesity can make a substantial contribution to reducing hyperlipidemia, improving glycemic control, and treating hypertension. Prevention and treatment of obesity may reduce overall morbidity and mortality in the years to come. We suggest starting with weight reducing program "Cigota" and combining it with balanced program of diet and physical activity until normalizing body weight.