Real-world operation of multiple sclerosis centres in Central-Eastern European countries covering 107 million inhabitants.

BACKGROUND: In 2018 multiple sclerosis (MS) care unit (MSCU) recommendations were defined. Nevertheless, the information on MS care, and whether MS centres fulfil the international recommendation is limited. Thus our objectives were to assess whether centres meet the MSCU recommendations and gain a comprehensive overview of MS care in Central-Eastern European countries. METHODS: A self-report questionnaire assessing aspects of the MSCU recommendations, disease-modifying therapy (DMT) and registry use and the patient number was assembled and sent to nine Central-Eastern European countries. Furthermore, one Danish and one German centre were contacted as a reference. RESULTS: In 9/9 countries, MS care was pursued in centres by MS neurologists and MS nurses. In Austria and the Czech Republic, management of MS was conducted under strict regulations displaying a referral centre system, fundamentally similar to but independent of the MSCU criteria. Several centres fulfilled all aspects of the MSCU criteria, while others had similar insufficiencies consisting of a speech therapist, continence, pain and spasticity specialist, neuro-ophthalmologist, and oto-neurologist. In 9/9 countries, DMTs were reimbursed. However, some centres did not provide every available DMT. A national registry was available in 4/9 countries with mandatory registry use only in Austria and the Czech Republic. CONCLUSION: In countries where MSCU recommendations are not fulfilled, a strictly regulated centre system similar to the Austrian and Czech model with a registry-based quality control might ensure appropriate care for people with MS.

The effect of photic stimulation alone and in combination with sleep deprivation after a seizure-like event - reappraisal by using linear and nonlinear EEG methods.

ObjectivesThe present study aimed to compare the effectiveness of different provocation tests used for the study of the 'susceptibility to seizure' by quantitative electroencephalography (EEG) analysis.MethodsEight subjects with a history of a seizure-like disturbed consciousness participated in this preliminary study. A routine EEG was carried out with photic stimulation (eyes closed and after eyes open) at the beginning of the investigation. Some days later, a sleep-deprived EEG was recorded with the same protocol. Selected epochs (in eyes closed condition) after the stimulations were analysed with Point(wise) Correlation Dimension (PD2i) and Synchronization Likelihood (SL) methods. The results were compared to those obtained by similar analysis of the resting state (control) epochs with Wilcoxon Signed Rank Test (p ≤ 0.05).ResultsIn our study, significantly lower grand mean PD2i and higher delta SL values were found in sleep-deprived state after stimulation with eyes closed compared to the control. Our results indicated a lower-dimensional, hypersynchronous state of the brain as a consequence of these combined provocations.DiscussionThis may correspond to a possible 'preictal' state of the brain. Accordingly, it is suggested that photic stimulation together with sleep deprivation seems to be more effective in provocation - especially when the stimulation was made with eyes closed.

Synergistic interaction between p-glycoprotein modulators and epirubicine on resistant cancer cells.

The macrocyclic lathyrane diterpene latilagascene B, previously isolated from Euphorbia lagascae, was acylated to afford three new diterpene esters, latilagascenes G (1), H (2), and I (3), whose structures were assigned by spectroscopic methods. These acyl derivatives, and the macrocyclic diterpenes of the jatrophane-type, tuckeyanols A (4) and B (5), and euphotuckeyanol (6), isolated from Euphorbia tuckeyana, were tested for P-gp modulating properties on human MDR1 gene-transfected and parental L5178 mouse lymphoma cell lines. All the compounds displayed very strong activity. The molecular orbital energies (HOMO and LUMO) of diterpenes 1-6 and 7-13, previously isolated, have also been calculated in order to estimate their probable charge transfer interactions with P-gp. Structure-activity relationships (SAR) are discussed. Furthermore, compounds (1-6) were assayed, in vitro, for their antiproliferative effects in combination with epirubicine and all of them synergistically enhance the effect of the antitumor drug.

Non-linear quantitative electroencephalographic (qEEG) changes during processing of chemo-sensory stimulations: a preliminary study.

The present study was to investigate the processing of pleasant smell and taste stimuli by non-linear EEG measures. Point correlation dimension (PD2i) has been used for studying the local, and synchronization likelihood (SL) the global dynamical organization. Nine healthy subjects participated in this study. After a baseline period of 30s the patients were given a perfume cap or a chocolate taste for 30s. The analysis was performed off-line on 16 channels. After smell stimulation an immediate bilateral but short response was seen. First a decrease and afterwards an increase were found in the mean PD2i. In contrast, the taste stimulation resulted in a later reaction mainly on the right side. The SL in the slow alpha band decreased during the first 15s after both stimulations. In the second 15s, however, a remarkable SL increase was seen mainly in the 7-14Hz and in every frequency band. The decreased mean PD2i and SL values could be interpreted by the simplified network preparation to cognitive data processing. The PD2i and SL methods detected subtle dynamical changes during olfactory and gustatory processes suitable for collection normative database to pathological conditions.