Clinical and sociodemographic predictors of depressive symptoms in epilepsy patients in a single tertiary epilepsy center.

PURPOSE: The purpose of this cross-sectional study was to determine the frequency of depressive symptoms in patients with epilepsy (PWE) in a tertiary epilepsy center and to analyse possible predictors of depression in several domains, including clinical characteristics of epilepsy and sociodemographic factors. METHODS: PWE patients who visited our epilepsy clinic during the 6th month in 2020 and 2021 were enrolled in our study. To collect the data, structured scales were created for the clinical characteristics of the disease and for the sociodemographic data. All participants completed the Back Depression Inventory II (BDI-II). Univariate analysis and binary logistic regression were also conducted to identify the factors associated with depressive symptoms in PWE. RESULTS: A total of 131 PWE were recruited for this study. It was determined that depressive symptoms were present in 51.1% of PWE. Of these, 49.25% manifested severe depressive symptoms. Approximately 18% of PWE use antidepressant medications, which is significantly less than that of PWE who are currently depressed. Univariate regression analysis revealed that female sex (p = 0.013), severe seizure frequency in the past year (p = 0.001), the use of the antiseizure medication polytherapy (p = 0.018), the presence of side effects of antiseizure medications (p = 0.001), a history of febrile seizures (p = 0.015), focal impaired awareness seizures (p = 0,051), and a combination of focal aware seizures with focal impaired awareness seizures combined with bilateral tonic‒clonic seizures (p = 0,006) may be associated with depressive symptoms in PWE patients. Binary logistic regression analysis demonstrated that side effects of antiseizure medications (OR = 3.01; 95% CI = 1.09-8.32), history of febrile seizures (OR = 3.75; 95% CI = 1.07-13.11), female sex (OR = 2.16; 95% CI = 0.984-4.73), and combination of focal aware seizures to focal impaired awareness seizures to bilateral tonic‒clonic seizures (OR = 7.32; 95% CI = 0.830-64.59) were unique, independent predictors of depressive symptoms in patients with epilepsy. CONCLUSION: Depressive symptoms in PWE are frequent, severe, undiagnosed, and mostly untreated. The side effects of antiseizure medications, history of febrile seizures, female sex, and combination of focal awareness seizures and focal impaired awareness seizures combined with bilateral tonic‒clonic seizures are unique, independent predictors of depressive symptoms in PWE.

Uncovering Norway: Descriptions of Four New Aphidiinae Species (Hymenoptera, Braconidae) with Identification Key and Notes on Phylogenetic Relationships of the Subgenus Fovephedrus Chen.

With only 33 reported species, Norway ranks among the European countries with the lowest documented diversity of parasitoids from the subfamily Aphidiinae. The "MUST Malaise" project, carried out by Museum Stavanger in Norway, aimed to assess insect abundance and biodiversity and create a reference base for future studies. The preliminary results of our study revealed four species new to science, indicating that the current number of recorded species in Norway is significantly lower than the actual diversity. All species possess unique combinations of morphological characters, distinguishing them from other known Aphidiinae species. Molecular analysis of the barcoding region confirmed that these specimens all belong to the previously undescribed species. In this study, we describe Aphidius norvegicus sp.n., Praon breviantennalis sp.n., Ephedrus gardenforsi sp.n., and Ephedrus borealis sp.n., all collected in Norway. We also provide an identification key and discuss the phylogenetic relationships within the subgenus Fovephedrus Chen, 1986.

Patients with Acute Lacunar Infarction Have Benefit from Intravenous Thrombolysis.

INTRODUCTION: Usefulness of intravenous thrombolysis in patients with acute lacunar cerebral infarction is questionable. The aim of this study was to evaluate the efficacy and safety of intravenous thrombolysis in patients with lacunar infarction in comparison with patients with nonlacunar infarction as well as with patients with lacunar infarction who were not treated with intravenous thrombolysis. MATERIALS AND METHODS: In the first part of the study, among patients with acute ischemic stroke treated with intravenous thrombolysis, characteristics and outcomes of 46 patients with lacunar and 221 patients with nonlacunar infarction were compared. In the second part, 46 patients with lacunar infarction treated with intravenous thrombolysis were compared with 45 lacunar infarction patients who were not treated with intravenous thrombolysis. RESULTS: Patients with lacunar infarction had a lower National Institutes of Health Stroke Scale score (9.2 versus 13.9, P < .001), a greater Alberta Stroke Program Early computed tomography (CT) score (9.7 versus 9.2, P = .002), a lower prevalence of atrial fibrillation (6.5% versus 41.2%, P < .001), and significantly more frequently an excellent outcome after 3 months (76.1% versus 36.2%, P < .001) compared with patients with nonlacunar infarction. Among patients with lacunar infarction, an excellent outcome at discharge was significantly more frequent in the intravenous thrombolysis group (41.3% versus 15.6%, P = .01), and the length of hospitalization was significantly shorter (9.5 days versus 14.3 days, P = .002). There was no hemorrhagic transformation among patients with lacunar infarction treated with intravenous thrombolysis. CONCLUSION: Intravenous thrombolysis has proven to be effective and safe in patients with lacunar infarction and should always be applied if there are no absolute contraindications.

How is stroke care organised in Europe?

INTRODUCTION: There is a wide difference in stroke care in European Countries, conditioning the performance in stroke management. OBJECTIVE: The authors review current national and regional stroke organisational models and their adherence to current European Stroke Organisation (ESO) guidelines across the Europe and on-going European Stroke Projects. Stroke Care Models investigated in: Austria, Switzerland, Bavaria (Germany), London and Greater Manchester in the UK, Catalonia (Spain), Lombardy Region in Italy, Poland and Northern Portugal. DISCUSSION: There is a lack of uniform stroke care in European Countries as defined by current ESO guidelines. For this reason, ESO has established the Stroke Unit Certification Platform to make uniform stroke care systems with high quality performances in every part of Europe.

Dyslipidemia as a risk factor for primary intracerebral hemorrhage.

AIM: Most of the studies proved association between some lipoprotein fractions and hypocholesterolemia as risk factors for primary intracerebral hemorrhage (ICH). However, there are studies that emphasize hypercholesterolemia (Hyper-Hol) as a risk factor. The present study aims at determining lipid fractions as risk factors for intracerebral hemorrhage in our region. METHODS: A retrospective study included 92 patients with primary ICH treated during one year at the Department of Neurology in the Clinical Centre of Vojvodina, Novi Sad. Following clinical and demographic data, age and gender, risk factors with a focus on certain lipid fractions (total cholesterol, triglycerides, low density- LDL, and high density - HDL cholesterol), types of hyperlipoproteinemia and disease outcome were analyzed. RESULTS: Fifty-one (55%) females and forty-one (45%) males, mean age 67.6 years were enrolled in the study. Hyper-Hol was observed in 63 (69%) patients, hyper-LDL cholesterolemia in 68 (74%) patients and hypo-HDL cholesterolemia in 77 (84%) patients, while triglyceride levels were normal in majority of patients. No statistical significance between males and females was observed considering levels of total cholesterol (p=0.068), LDL cholesterol (p=0.156), triglycerides (p=0.363), while levels of HDL cholesterol were significantly higher in females (p=0.023). Hyperlipoproteinemia IIa was found in 51 (78%). Mortality rate was 25%. CONCLUSION: Hypertrigliceridemia was not proved as a risk factor, while hyper-LDL cholesterolemia, hypo-HDL cholesterolemia, and hyper-Hol can be associated with primary ICH, which could justify further statin treatment in secondary prevention of this disease.

[Factors predisposing to cervical artery dissection].

INTRODUCTION: Cervical artery dissection is a major cause of cerebral ischemia in young adults and can lead to various clinical symptoms, some of which are benign (e.g. headache, neck pain, Horner's syndrome, and cranial nerve palsy). However, most patients have a stroke or transient ischemic attack. EPIDEMIOLOGY: The incidence of cervical artery dissection is low and is estimated to be around 2.6 per 100,000 inhabitants. Mortality and short-term recurrence rates are low: however; they may have been underestimated. PATHOPHYSIOLOGY: Although the pathophysiology is still unclear constitutional and partly genetic susceptibility of the arterial wall has been proposed as a causal factor; triggered by infection or minor trauma. PREDISPOSING FACTORS: In addition to the trauma to the neck, other risk fractors have been suggested, such as infection, migraine, hyperhomocisteinamia, and the 67TT genotype of the 5,10-methylene-tetrahydrofolate reductase gene although evidence is sparse. GENETIC FACTORS: Cervical artery dissection is now considered a multifactorial disease caused by several genetic abnormalities and environmental factors acting synergistically. CONCLUSION: Research aimed at improving our understanding of the environmental and genetic factors predisposing to cervical artery dissection and assessment of long-term outcomes of this disease is needed. Better understanding of the underlying pathophysiology and the natural history of the disease through large prospective multicentre cohorts could also be helpful to improve therapeutic and preventive strategies. Several mutlticentre efforts are already under way to meet these needs.

Trauma exposure in childhood impairs the ability to recall specific autobiographical memories in late adolescence.

J. M. G. Williams (1996) predicted that exposure to potentially traumatizing events at an early age would give rise to overgeneral recall from autobiographical memory, i.e., recall of general rather than specific events, and that in adolescence this tendency would be uncorrelated with psychopathological symptoms, e.g., depression. This was supported by two studies where war-exposed Bosnian adolescents produced significantly fewer specific autobiographical memories than a Norwegian control group, as did bombing-exposed Serbian adolescents compared to nontrauma-exposed Serbians. No significant correlations were found between autobiographical memory specificity and measures of depression, anxiety, dissociation or impact of trauma, which is consistent with Williams' idea that an overgeneral memory retrieval strategy is at first protective, and a risk factor for depression only upon reaching adulthood.

[Origin and distribution of brain metastases]. / Poreklo i lokalizacija metastatskih tumora mozga.

INTRODUCTION: Malignant neoplasmas account for 20% of overall mortality in developed countries, and are the second leading cause of death. According to the World Health Organization central nervous system tumors account for 4% of all tumors and brain tumors cause 0.2-2.4% of all hospital deaths. By their origin, brain tumors are classified into primary and secondary tumors or metastases. The aims of this study were to examine the number of metastases, their origin and distribution and to compare the prevalence of primary and secondary brain tumors during the same period. MATERIAL AND METHODS: A retrospective cohort study included 63 adults (40 males and 23 females) with diagnosed brain tumors treated during 2001 and 2002 at the Department of Neurology in Novi Sad. Tumors were diagnosed by computed tomography and magnetic resonance imaging. RESULTS: Secondary tumors were also diagnosed, but without statistical significance (2 = 0.38; p > 0.05) and metastases were significantly more frequent among men (2 = 14.22; p < 0.01). Supratentorial metastases were significantly more frequent than tumors in other localizations (2 = 23.6; p < 0.01). Multiple metastases were estimated in 56% of patients and solitary tumors in 44%, without statistical significance (2 = 0.48; p > 0.05). In most cases metastases originated from primary lung cancers and tumors of unknown origin. CONCLUSIONS: During the studied period more secondary than primary tumors have been diagnosed and more multiple than solitary metastases. They were more frequent in men with supratentorial distribution as most frequent. Lung cancer proved to be their most common source.