Releasing Dynamic of Serum ST2 and Calprotectin in Patients with Acute Ischemic Stroke.

This study investigated the releasing dynamics of serum ST2 and calprotectin in patients with acute IS. The study included acute IS patients (N = 20) with an NIH Stroke Scale score ≥8. Sampling was performed at seven time points: after admission (T0) and at the following 24 h consecutive intervals (T1-T6). Primary outcome at 90 days was evaluated using the modified Rankin scale: 0-2 for good and 3-6 for poor functional outcome. The secondary outcome was all-cause mortality after 90 days. Fifteen patients had a poor outcome, and eight died. Results showed a statistically significant difference in ST2 concentrations between good and poor outcomes at T0 (p = 0.04), T1 (p = 0.006), T2 (p = 0.01), T3 (p = 0.021), T4 (p = 0.007), T5 (p = 0.032), and for calprotectin T6 (p = 0.034). Prognostic accuracy was highest for ST2 at T1 for a cut-off > 18.9 µg/L (sensitivity 80% and specificity 100.0%) and for calprotectin at T5 for a cut-off > 4.5 mg/L (sensitivity 64.3% and specificity 100.0%). Serum ST2 and calprotectin-releasing dynamics showed a valuable prognostic accuracy for IS outcomes.

Responses of people with epilepsy to the COVID-19 pandemic in the time of national lockdown.

The aim of our study was to gather information on how people with epilepsy (PwE) responded to the COVID-19 pandemic during the national lockdown. An online questionnaire was therefore offered to the visitors of the Croatian Association for Epilepsy's website. The 22-items questionnaire was designed to acquire information from adults with epilepsy living in Croatia on demographic data, cognitive, emotional and behavioral responses to the pandemic, and communication problems between patients and their neurologists during the lockdown. Perceived anxiety and fears were expressed with the Likert scale (1-5) and the results of specific fears added to make the Total Fear Score. Results: Out of 186 respondents in total, only 2.8% did not comply with the lockdown measures, and all of those respondents stated that they did not feel any anxiety related to COVID-19. A canceled neurologist examination during the lockdown was significantly associated with pandemic-related anxiety (2.9 ±â€¯1.28 vs. 2.3 ±â€¯1.19, U = 3039, p = 0.001) and fears (Total Fear Score 31.4 ±â€¯9.70 vs. 28.4 ±â€¯9.79, U = 3341, p = 0.036), and 87.4% of respondents expressed the wish to communicate with their neurologist, either by phone/video call (53.0%) or email (34.4%). Conclusion: We think the results of our survey show that the responses from PwE point to a social responsibility appropriate for the existing situation. During future pandemics, telemedicine could have an important role in tackling the fears and anxieties caused by the cancelation of examinations, which corresponds to the wishes expressed by the great majority of our respondents.

Labels and epilepsy - An online survey of patients and those close to them.

Publications on the topic of appropriate labels for someone with diagnosed epilepsy have so far almost exclusively consisted of views of professionals in this field. We conducted an online study of patients treated for epilepsy and persons close to them with the aim of identifying which label they prefer, whether they oppose the term "epileptic", and which characteristics are related with their preferences. In total, 328 responses were analyzed. Subjects mostly favored "person-first" terminology ("person having epilepsy" and "person with epilepsy"), and 53.9% disapproved of the term "epileptic". Parents of patients are more likely than patients themselves to favor the label "person having epilepsy" and to disapprove of the label "epileptic". These results can help with shaping future terminology recommendations.

Women with epilepsy in childbearing age: Pregnancy-related knowledge, information sources, and antiepileptic drugs.

Pregnancy-related issues in epilepsy (PRIE) are essential for management of epilepsy in women. We conducted a study among women with epilepsy (WWE) aged 15-45years about their knowledge, sources, and needs for information regarding PRIE, which included their current antiepileptic drugs (AEDs) usage. Women with epilepsy, visitors of Croatian Association for Epilepsy webpage, were offered an online questionnaire, and 200 responses were analyzed. The mean number of correct answers about PRIE was 3.5 out of 5. Main predictors of knowledge on PRIE were a prior consultation with a neurologist and higher usage of books/brochures. A prior neurologist consultation on PRIE was stated by 45% of subjects. As the preferred future mode of being informed on PRIE, majority of women (61%) chooses their neurologist, 22% written materials distributed by a neurologist, and only 13% Internet. Levetiracetam was the most commonly used AED (34.5%). Valproate was used by 26%, and of those 59% stated no previous consultation on PRIE with their neurologist. In summary, we believe our study shows that knowledge of PRIE among WWE in their childbearing age is unsatisfactory, as are the neurologist consultation rates about PRIE. Our results demonstrate that, despite modern technologies, educational activities should be based on neurologist consultations and providing the patients with appropriate written materials. This is especially true for the relatively large proportion of women still taking valproate.

Factors associated with perceived stigma of epilepsy in Croatia: a study using the revised Epilepsy Stigma Scale.

PURPOSE: It is believed that a large number of factors influence feelings of stigma, but their relative contribution is not yet entirely clear. Most studies to date were conducted using the Epilepsy Stigma Scale (ESS); only one used a revised version of the ESS (rESS). The following study aims to determine factors contributing to epilepsy stigma in outpatients with chronic epilepsy in Croatia, and to analyze some psychometric properties of the Croatian translation of the rESS. METHODS: Alongside standard testing for validity of the scale, a simulation model of the original ESS (smESS) was created. This model, which does not include a grading Likert 0-3 scale, was compared with the rESS. RESULTS: In total, 159 out of 298 subjects (53%) reported feeling stigmatised, with 136 (45%) mild to moderately and 23 (8%) highly. Internal consistency of the Croatian translation of the rESS was 0.887. Feelings of stigma were significantly associated with age ≤ 50 years, younger age of epilepsy onset, more than 50 seizures to date, generalized tonic-clonic seizures, and a shorter seizure-free period. Multiple stepwise regression showed number of seizures to date as a significant variable (Beta=0.246). By adapting data into the smESS significant associations with younger age and age of epilepsy onset were lost. Internal consistency of the smESS was 0.849. CONCLUSIONS: The Croatian translation of the rESS has been proved to be a suitable instrument for diagnosing epilepsy stigma. The results of our model point to the possibility that the rESS might be more sensitive than the original ESS.

Acute oxcarbazepine-induced hepatotoxicity in a patient susceptible to developing drug-induced liver injury.

Oxcarbazepine (OXC) is generally accepted as a drug without risk of severe drug-induced hepatotoxicity, but according to recently reported pharmacovigilance data this statement has been challenged. However, in the literature there have been no reports of acute OXC-induced hepatotoxicity without systemic manifestations of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We present a female with seizures one month after delivery who had borderline elevated liver enzymes prior to the initiation of OXC treatment. Two weeks after introducing OXC, highly elevated liver enzymes were found. After discontinuation of OXC the enzymes continued to rise for another week, and afterward gradually decreased. The causal relationship with OXC intake was determined to be highly probable. Two years later, the transitory elevation of liver enzymes was observed during the treatment of acute tonsilopharingitis with amoxicillin + clavulanic acid. The repeated elevation of liver enzymes related to use of different drugs might indicate patients susceptibility for drug induced liver injuries. We suggest that monitoring of liver function tests would be clinically rational for early detection of acute OXC-induced liver hepatotoxicity in the patients with clinical and/or laboratory features which might be interpreted as possible risk factors of the increased susceptibility to drug induced liver injuries.

Changes of attitudes toward epilepsy in college-preparatory high school students population: an indicator of global campaign successfulness?

PURPOSE: Within the "Out of the Shadows" campaign in Croatia, numerous activities have been organized. The aim of this study is to investigate the changes in knowledge and attitudes toward epilepsy in the population of college-preparatory high school students, and to consider whether such changes could be the result of these activities carried out between 2002 and 2010. METHODS: This study was completed in Croatia's capital city, Zagreb, and sampled adolescent college-preparatory high school students. The surveys conducted in both 2002 and 2010 have been evaluated and compared. In both years the examinees completed a questionnaire made up of identical questions concerning the students' knowledge and attitudes toward epilepsy. RESULTS: In total, 430 respondents (227 students in 2002; 203 in 2010) completed a questionnaire. The 2010 survey indicates a higher degree of knowledge of epilepsy amongst the students (p<0.05), as well as more positive attitudes related to marriage (p<0.05), and the employment of persons with epilepsy (PwE) (p<0.01). The percentage of positive attitudes related to playing with children with epilepsy was high in both surveys (>97%). The results for the total sample reveal that students with a better knowledge of epilepsy had more positive attitudes (p<0.05). Yet in the survey conducted in 2010, when the level of factual knowledge about epilepsy was higher, this relationship was not possible to prove; improvement of attitudes was greater in students with worse knowledge of epilepsy than in those with better knowledge. CONCLUSION: Based on the obtained results we conclude that improvement in factual knowledge is only one of the factors that can induce improvement in attitudes. The positive changes found in Croatia most likely stem from the cumulative effect of the various activities conducted in accordance with the principles of the "Out of the Shadows" campaign.

Impact of partial liberalization of driver's license regulations on the driving behavior of people with epilepsy: experience from Croatia.

Until 2005 Croatia had a driving ban for people with epilepsy (PWE) on antiepileptic therapy. To investigate the impact of partial liberalization of legislation, the results of polling performed in 1999 and 2009 were compared. The results revealed that in 1999, despite the driving ban, 46.9% of respondents had a driver's license, whereas in 2009, the majority of respondents with a driver's license (60.2%) fulfilled the requirement criterion of 2 years' remission. In both pollings, one-third of respondents answered that they were driving less often than other drivers. The rate of PWE who were driving was inversely proportional to the seizure rate. In 2009 a greater proportion stated that they drove motorcycles, and few PWE (<5%) declared they were driving more often than others. The inefficiency of rigid legislation and indicators of self-restraint of PWE may be arguments in favor of liberalization, but liberalization should be accompanied by appropriate education programs.

Electrophysiological findings in early Guillain-Barré syndrome.

The aim of the study was to identify the most common electrophysiological abnormalities in early Guillain-Barré syndrome (GBS). Neurophysiological data on 51 GBS patients assessed within 12 days of symptom onset were reviewed. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was present in 46 of 51 GBS patients. The following abnormalities were observed in our AIDP patients: absent H reflex in 90.7%, conduction block in the Erb-to-axilla segment in 78.6%, motor conduction velocity suggestive of demyelination in the Erb-to-axilla segment in 45.2%, prolonged F wave latency in 65.2%-73.8% of patients but only 20.0%-37.0% with prolonged F wave latency suggestive of demyelination, and reduced or absent sensory nerve action potential in 62% of patients. Abnormal values of terminal latencies, and motor and sensory conduction velocities in distal nerve segments suggestive of demyelination were recorded in less than 30% of patients. In conclusion, the most sensitive parameter in early GBS patients is conduction block in the most proximal segments of the peripheral nervous system, directly determined in the Erb-to-axilla segment or indirectly as absent H reflex. Motor conduction studies in the Erb-to-axilla segment are very informative in early GBS patients.

Progressive encephalomyelitis with rigidity: a case report.

BACKGROUND/OBJECTIVE: The most prominent clinical features of progressive encephalomyelitis with rigidity (PER) are painful spasms and rigidity accompanied by clinical signs of brainstem and spinal cord involvement. In initial reports, PER had fatal outcome. Later, clinical improvement related to corticosteroid therapy has been described in some cases. The objective of this study was to signify a reputed clinical significance of corticosteroid therapy in PER. METHODS: Case report. RESULTS: A 50-year-old man developed progressive syndrome of tonic extensor spasms. Magnetic resonance imaging (MRI) showed areas of signal changes in cervical spinal cord and lower brainstem, whereas cerebrospinal fluid analysis indicated subacute encephalomyelitis. His condition dramatically improved on oral corticosteroid therapy. Clinical improvement was accompanied by normalization of MRI findings. CONCLUSION: For this patient with PER, corticosteroid therapy was a dramatically effective and life-saving treatment, although initiated rather late in the course of the disease.

Social and medical care of preschool children with epilepsy in Croatia: population-based survey.

BACKGROUND: Early detection of mental retardation and other epilepsy-associated impairments is essential for successful medical and social care of children with epilepsy; the corresponding information for children in Croatia has not yet been known. AIMS OF THE STUDY: To obtain the basic information of epilepsy-associated disability in preschool children, and fundamentals of their medical and social care. METHODS: Data about mental retardation and other associated impairments (motor, speech, seeing, hearing), antiepileptic drug therapy and diurnal residence were collected by means of questionnaires completed by physicians working in primary health care (PHPs). Only children (0-7 years) with active epilepsy confirmed previously by neuropaediatricians were included. RESULTS: A total of 37 PHPs provided the required data for 116 children. One or more impairments were found in 56% children; most frequent were motor impairments (47%), speech impairments (42%) and mental retardation (40%). The regular kindergarten attendance rate of children without impairment (33%) was not different from the children without epilepsy, but high proportion (76%) of children with impairment stayed with their families during weekdays. In this subgroup monotherapy was more rarely used (64% vs. 90% in children without impairment (p<0.01)). Valproate was predominantly used (56%) in children with and without impairment; lamotrigine was more frequently used in the former subgroup (p<0.01). CONCLUSIONS: Existence of associated impairments has significant impact on medical and social care in preschool children with epilepsy. These children need an early diagnosis and consecutive multidisciplinary care of their intellectual and body impairments, as well as problems in social development.

Age-related pattern of the antiepileptic drug utilization in active epilepsy: a population-based survey.

The aim of this study was to investigate the relationship between antiepileptic drug (AED) utilization and patient age in a population of patients treated by primary health care physicians. Data were collected by using questionnaires completed by family physicians and paediatricians working in primary health care. Only patients with active epilepsy confirmed previously by neurologists or neuropaediatricans were included. One hundred and twenty-three physicians provided the requested data for 966 patients (range 1-92 years). Most frequently prescribed AEDs were barbiturates (BARB) (37%) and carbamazepine (CBZ) (37%). Valproic acid derivates (VPA) were prescribed in 28%, but the rate was higher (51%) in children. By calculating the correlation between age and the prescription of single AEDs across the whole sample, linear correlations were found for BARB (r = 0.94; p < 0.01), VPA (r = -0.93; p < 0.01) and for topiramate (TPM) (r = -0.90; p < 0.01). Since our results showed significant correlations between age and the use of the majority of AEDs, we concluded that the age may be considered a methodological bias in the presentation of data. Therefore we calculated AED utilization as the age-adjusted prevalence rates (per/1000 inhabitants). For the most commonly prescribed AEDs they were: BARB 1.8 (95% CI 1.6-2.0), CBZ 1.9 (95% CI 1.7-2.1), VPA 1.3 (95% CI 1.1-1.5), lamotrigine (LTG) 0.7 (CI 95% 0.6-0.8), TPM 0.6 (CI 95% 0.5-0.7). In conclusion, the age of patients has a significant impact on the prescription patterns not only between children and adults, but at every age. Therefore we suggest that reporting of AED utilization pattern should also include age-standardized prevalence rates of individual AED utilization.

[Specificity of hyperglycemia treatment in acute stroke patients]. / Posebnosti lijecenja hiperglikemije u bolesnika s mozdanim udarom.

INTRODUCTION: Although most of clinical studies suggest that hyperglycemia is associated with poor clinical outcome in acute stroke patients, there still are many theoretical and practical doubts that are reflected in some differences in treatment recommendations from clinical guidelines developed in Europe (European Stroke Initiative, Croatian Association for Neurovascular Disorders) and in the USA (American Stroke Association). PURPOSE: To point to the most important acts and doubts related to the acute treatment of hyperglycemia in stroke patients. METHODS: On literature review, the following databases were used: Medline (1976-2006), National Guideline Clearinghouse and Stroke Trials Registry-Internet Stroke Center. Selection of the articles depended on clinical experience and knowledge of the authors. RESULTS: The most important facts indicating a high prevalence of glucose regulation disturbances in stroke patients are highlighted, along with data on the reactive and iatrogenic pathophysiological mechanisms leading to hyperglycemia. Literature data that undoubtedly suggest an association of hyperglycemia with poor clinical outcome and the unfavorable effect of hyperglycemia on the outcome of thrombolysis are pointed out. Some contradictory data on the postulated pathophysiological mechanisms by which hyperglycemia causes cerebral damage are reviewed, especially regarding the role of tissue lactic acidosis induced by hyperglycemia. The favorable results of insulin therapy in critically ill patients are presented, along with the fact that there is still no definitive evidence that strict control of hyperglycemia can improve the outcome in stroke patients. DISCUSSION: At present, it is not possible to claim whether hyperglycemia contributes to the poor outcome of acute stroke as an independent factor or it is just a marker of the disease severity. It seems that the unfavorable effect of hyperglycemia is not only associated with the level of the brain lactic acidosis. Rather, a complex interaction of several different mechanisms appears to be involved. The threshold of blood glucose concentration at which it becomes a predictor of unfavorable outcome has not yet been exactly established. The different levels of hyperglycemia recommended to be treated with insulin partly reflect different evaluation of the guidelines regarding the potential risks of insulin-induced hypoglycemia and further iatrogenic metabolic disorders. It might be expected that the results of ongoing randomized controlled trials should contribute to developing of more precise and more harmonized clinical guidelines for the treatment of hyperglycemia in stroke patients.

[Seizures in the peracute stage of stroke: incidence and effect on inpatient mortality]. / Epilepticki napadaji u perakutnoj fazi mozdanog udara: incidencija i utjecaj na unutarbolnicki letalitet.

INTRODUCTION: According to literature data, the effect of seizures on inpatient mortality has not yet been not definitly determined and data on seizure incidence significantly vary with different methods used in various studies, AIM: Our aim was to determine the effect of seizures in the peracute stage of stroke on inpatient mortality and to detect the possible association of seizure incidence and stroke subtype, age and sex. SUBJECTS AND METHODS: Medical documentation of patients hospitalized at the ward for cerebrovascular diseases, Department of Neurology, Sveti Duh General Hospital from 1998 to 2005 was retrospectively analyzed. There were 3,542 patients with hemorrhagic or ischemic stroke. Seizures were defined as seizures occurring immediately before or within the first 24 hours of the neurological deficit development. Patients were subdivided into two groups, with and without seizures. Patients with a previous history of seizures were excluded from the study. RESULTS: In a total of 3542 patients, there were 1885 (53.21%) male and 1657 (46.78%) female patients, mean age 70.06+11.03 in the non-seizure group and 67.93 +/- 13.02 in the seizure group. Seizures were significantly more frequent (p = 0.0002, OR 2.63) in patients with hemorrhagic stroke. Seizures were observed in 42 of 2931 (1.43%) patients with ischemic stroke and in 23 of 611 (3.76%) patients with hemorrhagic stroke. Total inpatient mortality was 21.4% in the group without seizures, and 30.8% in the group with seizures (p = 0.04). The ischemic stroke inpatient mortality in the seizure group was 19.5% (17.4% in non-seizure group), and hemorrhagic stroke inpatient mortality was 52.2% in the seizure group (41% in non-seizure group). There was no significant age and sex difference between the groups with and without seizures. DISCUSSION: The rate of seizures has been estimated 1.7% to 8.9%. Different incidence rates are the result of different methods and different seizure definitions used in various studies. In our study seizures were significantly more frequent in patients with hemorrhagic stroke than in those with ischemic stroke, which is comparable to other studies. The slightly higher percentage of seizures reported in other studies is the result of the fact that they have analyzed seizures occurring from 48 hours to up to 30 days from stroke onset. The influence of seizures on inpatient mortality remains uncertain since different studies used different definitions of seizures and analyzed different stroke subtypes. Some studies found that seizures were associated with increased inpatient mortality; after accounting for stroke severity, population-based studies found no association between seizures and lethality. Our results support the conclusion that seizures cannot be taken as a prognostic factor in stroke. CONCLUSION: The incidence of seizures during the first 24 hours of stroke onset was statistically significantly higher in patients with hemorrhagic stroke than in those with ischemic stroke. When all patients irrespective of stroke subtypes were analyzed, total inpatient mortality was statistically significantly higher in the seizure group. However, there was no statistically significant difference in inpatient mortality when ischemic and hemorrhagic groups were analyzed separately. There was no age and sex difference in the rate of seizures,