Functional Characteristics of the Nav1.1 p.Arg1596Cys Mutation Associated with Varying Severity of Epilepsy Phenotypes.

Mutations of the SCN1A gene, which encodes the voltage-dependent Na+ channel's α subunit, are associated with diverse epileptic syndromes ranging in severity, even intra-family, from febrile seizures to epileptic encephalopathy. The underlying cause of this variability is unknown, suggesting the involvement of additional factors. The aim of our study was to describe the properties of mutated channels and investigate genetic causes for clinical syndromes' variability in the family of five SCN1A gene p.Arg1596Cys mutation carriers. The analysis of additional genetic factors influencing SCN1A-associated phenotypes was conducted through exome sequencing (WES). To assess the impact of mutations, we used patch clamp analysis of mutated channels expressed in HEK cells and in vivo neural excitability studies (NESs). In cells expressing the mutant channel, sodium currents were reduced. NESs indicated increased excitability of peripheral motor neurons in mutation carriers. WES showed the absence of non-SCA1 pathogenic variants that could be causative of disease in the family. Variants of uncertain significance in three genes, as potential modifiers of the most severe phenotype, were identified. The p.Arg1596Cys substitution inhibits channel function, affecting steady-state inactivation kinetics. Its clinical manifestations involve not only epileptic symptoms but also increased excitability of peripheral motor fibers. The role of Nav1.1 in excitatory neurons cannot be ruled out as a significant factor of the clinical phenotype.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

INTRODUCTION: The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. MATERIAL AND METHODS: This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. RESULTS: Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. CONCLUSIONS: Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

The prevalence of occupational burnout and its individual and situational predictors among addiction therapists.

This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group.

Clinical efficacy and safety of anterior thalamic deep brain stimulation for intractable drug resistant epilepsy.

BACKGROUND: Deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) is a neuromodulation therapy for patients with refractory focal seizures evolving into bilateral tonic-clonic seizures when pharmacotherapy as well other neuromodulation techniques including vagus nerve stimulation or responsive neurostimulation have failed. OBJECTIVE: We performed a prospective single-center study investigating the clinical efficacy and exact ANT DBS lead location in patients with DRE. METHODS: The primary outcome measure was the proportion of patients with more than 50 % reduction in diary-recorded seizures when compared to three preoperative months (baseline seizure frequency). The close postoperative follow-up was performed every 3 months. The seizure frequency, stimulation settings and adverse events were closely monitored during follow-up visits. We also analyzed the seizure outcome with location of ANT DBS active contacts. RESULTS: Between May 2020 and October 2022, 10 adult patients with a mean age of 38.5 years (range, 30-48 years) underwent bilateral ANT DBS surgery (mean duration of DRE 28.6 years, range 16-41 years). The median seizure count in three months period preceding surgery (baseline seizure count) was 43.2 (range, 4-150). Nine patients achieved more than 50 % seizure reduction at the last follow-up (mean range 3-33 13.6 months, months). ANT DBS caused seizure reduction 3 months after procedure as well as at last follow-up by 60.4 % and 73.3 %, respectively. Due to relatively small number of studying individuals we cannot precisely locate the area within ANT associated with good clinical outcome. Patients with temporal lobe epilepsy had a remarkable reduction of seizure frequency. No patient suffered transient or permanent neurological deficits. CONCLUSIONS: Clinical efficacy of ANT DBS may support more widespread utilization of this neuromodulation technique especially for seizures originating from temporal lobes.

Attitudes towards the switching of anti-epileptic medications in pharmacies: the patients' perspective.

Purpose: A survey of epilepsy patients' experiences of and attitudes towards the pharmacy switching of anti-epileptic medications. Methods: A structured questionnaire was administered to a group of epilepsy patients treated at the Institute of Psychiatry and Neurology and the Medical University of Silesia, Poland. Two hundred and eleven patients (mean [± SD] age: 41.0 ± 15.6 years) were recruited; 60.6% were women. 68.2% had been treated for over 10 years. Results: Most individuals (63%) claimed that they had never bought a generic substitute medication. Among the patients who declared that a switch had been proposed to them at a pharmacy (~40%), only 68.7% received any explanation at all from a pharmacist. Some reported positive emotions mostly related to a lower price of the new drug but also to the explanations received. Most respondents who accepted the pharmacy switch (67.4%) did not notice any significant changes in the efficacy or tolerability of treatment, while the remaining subjects reported an increase in seizure frequency (23.2%) and deterioration in treatment tolerance (9%). Conclusions: Around 40% of Polish epilepsy patients have been confronted with a proposal to switch their anti-epileptic medications at a pharmacy. More of them report negative attitudes towards the pharmacist's proposal than do not. It is possible that one of the major reasons for this is the insufficient information provided by pharmacists. It remains to be established whether the reported decrease in seizure control could be accounted for by a low concentration of the anti-epileptic drug in the blood after the switch.

The relationship between occupational burnout and work ability among firefighters: exploring the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse.

Purpose: Firefighting is a profession associated with a high risk of elevated levels of occupational stress and burnout. The aim of this cross-sectional study was to explore the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse in the relationship between two dimensions of burnout (i.e., exhaustion and disengagement) and work ability among firefighters. Methods: A total of 460 firefighters from various regions of Poland completed a set of self-report questionnaires to assess constructs of interest. A mediation model was constructed to verify hypothesized paths, adjusted for socio-demographic and work-related background characteristics. Model parameters were estimated using a bootstrapping procedure, with sampling set at N = 1000. Results: The proposed model explained 44% of variance in work ability. Higher levels of both exhaustion and disengagement predicted worsened work ability. When mediators were controlled for, these effects remained statistically significant. Depressive symptoms and feelings of loneliness were found to be partial mediators of the association between exhaustion and work ability, and between disengagement and work ability. The mediating effects of insomnia and alcohol misuse were non-significant. Conclusions: Interventions aimed at counteracting the decrement in work ability among firefighters should target not only occupational burnout, but also depressive symptoms and a sense of loneliness as factors mediating its detrimental effects.

Modulation of neurotrophic factors in the treatment of dementia, stroke and TBI: Effects of Cerebrolysin.

Neurotrophic factors (NTFs) are involved in the pathophysiology of neurological disorders such as dementia, stroke and traumatic brain injury (TBI), and constitute molecular targets of high interest for the therapy of these pathologies. In this review we provide an overview of current knowledge of the definition, discovery and mode of action of five NTFs, nerve growth factor, insulin-like growth factor 1, brain derived NTF, vascular endothelial growth factor and tumor necrosis factor alpha; as well as on their contribution to brain pathology and potential therapeutic use in dementia, stroke and TBI. Within the concept of NTFs in the treatment of these pathologies, we also review the neuropeptide preparation Cerebrolysin, which has been shown to resemble the activities of NTFs and to modulate the expression level of endogenous NTFs. Cerebrolysin has demonstrated beneficial treatment capabilities in vitro and in clinical studies, which are discussed within the context of the biochemistry of NTFs. The review focuses on the interactions of different NTFs, rather than addressing a single NTF, by outlining their signaling network and by reviewing their effect on clinical outcome in prevalent brain pathologies. The effects of the interactions of these NTFs and Cerebrolysin on neuroplasticity, neurogenesis, angiogenesis and inflammation, and their relevance for the treatment of dementia, stroke and TBI are summarized.

The impact of bipolar spectrum disorders on professional functioning: A systematic review.

Aims: The impact of bipolar spectrum (BS) disorders on professional functioning has not been systematically reviewed yet. Since even subsyndromal symptoms may disturb functioning, the determination of the prognostic value of the spectrum of bipolarity for employment seems extremely relevant. The aim of this study was to assess the impact of BS disorders on professional functioning. Materials and methods: A systematic review of the literature (namely, cohort and cross-sectional studies) investigating a link between BS disorders and employment was performed in accordance with PRISMA guidelines. BS was defined based on the concept of two-dimensional BS by Angst. Occupational outcomes and factors affecting employment were evaluated as well. Results: Seventy-four studies were included. All disorders comprising BS had a negative impact on occupational status, work performance, work costs, and salary, with the greatest unfavorable effect reported by bipolar disorder (BD), followed by borderline personality disorder (BPD), major depressive disorder (MDD), and dysthymia. Employment rates ranged from 40 to 75% (BD), 33 to 67% (BPD), 61 to 88% (MDD), and 86% (dysthymia). The factors affecting employment most included: cognitive impairments, number/severity of symptoms, namely, subsyndromal symptoms (mainly depressive), older age, education, and comorbidity (substance abuse, personality disorders, anxiety, depression, ADHD, PTSD). Conclusion: Bipolar spectrum symptoms exert a negative impact on professional functioning. Further evaluation of affecting factors is crucial for preventing occupational disability.

Trends of stroke hospitalisation and fatality rates in young vs. elderly people in Poland during 2010-2019 decade.

INTRODUCTION: Since the turn of the century, epidemiological studies have shown an increase in stroke hospitalisation rates among young adults in contrast to a decline in rates seen among the older population. The aim of the present study was to investigate the trends of stroke hospitalisation rates and case fatality ratios (CFR) over the decade starting in 2010 in different age groups of the Polish population. MATERIAL AND METHODS: The patients were identified on the basis of the Polish National Health Fund that gathers all the data of the Hospital Discharge Registry as well as the National Cause of Death Registry of patients with stroke who were hospitalised between 2010 and 2019 and who were diagnosed according to the International Classification of Diseases - Tenth Revision (ICD-10) with haemorrhagic stroke (HS; codes I61* and I62*) and ischaemic stroke (IS; codes I63*). RESULTS: From a total nationwide cohort of 799,132 stroke patients (86.2% with IS and 13.8% with HS) treated between 2010 and 2019, a group of 22,329 patients (2.79%) aged 18-44 years was selected, among whom 69.6% had IS and 30.4% had HS. We documented a statistically significant increase in the IS hospitalisation rate in young adults alongside a decrease of this rate in those aged > 64. Among young adults with IS, the highest increase (p = 0.001) was observed for those aged 35-44 in 2019 (up to 39.2), and was significant each year starting from 2017 (2017-2019: p < 0.01). In the case of HS, the annual number of patients did not change significantly. In 2019 (compared to 2010), a decrease in 30-day, 90-day and 1-year CFR was noted in all age groups of patients with IS and HS. Stroke aetiology of IS was diagnosed in 60% of patients. More than 40% of patients with IS were discharged with the diagnosis of stroke of unspecified cause. CONCLUSIONS: In the case of IS, opposite trends of hospitalisation rates in younger and older age groups were documented, with the highest increase of IS in patients aged 35-44. A decline in CFR was observed for both IS and HS in all age groups.

Depression and loneliness may predict work inefficiency among professionally active adults.

PURPOSE: Both depression and loneliness have been recognized as major public health issues, yet investigation into their role among young and middle-aged, professionally active persons is still required. The aim of the present study was to evaluate whether depression and loneliness may independently predict inefficiency at work among professionally active adults. METHODS: This is a cross-sectional study on a representative, nationwide sample. 1795 questionnaires were gathered from among professionally active adults from Poland from 1 to 31 July 2018 with a direct pen-and-paper interview. The sample was chosen by means of the stratified random method. The survey included a Patient Health Questionnaire (PHQ-9) to measure depression and questions, devised by the authors, relating to loneliness and inefficiency at work. Regression models were constructed with depression and loneliness as predictors of inefficiency at work, unadjusted and adjusted for selected sociodemographic, health- and work-related factors. RESULTS: In the unadjusted models, both depression and loneliness were independently associated with an increase of work inefficiency and absence from work, with effect sizes being higher for loneliness than for depression. After accounting for the control variables (i.e., sociodemographic, work- and health-related factors), the PHQ-9 score, but not the loneliness score, was associated with an increased probability of frequent thoughts about changing or leaving a job. CONCLUSION: Depression and loneliness independently predicted occupational functioning and differentially affect its various aspects. Counteracting depression and loneliness among employees should be regarded as a public health priority.

Reliability of prehospital diagnosis of acute cerebrovascular accident.

INTRODUCTION: Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED). MATERIAL AND METHODS: This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. RESULTS: Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians. CONCLUSIONS: Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.

Volume changes of medial temporal lobe structures in patients with genetic generalized and temporal lobe epilepsy in relation to neuropsychological functions.

Purpose: In patients with epilepsy (PWE), cognitive and behavioural dysfunctions are associated with abnormalities in various brain areas. The aim of the study was to compare the volume of the hippocampus (VHIP), amygdala (VAMG) and parahippocampal gyrus (VPHG) with the results of neuropsychological assessment in patients with temporal lobe epilepsy (TLE) and genetic generalized epilepsy (GGE). Methods: 33 PWE were enrolled in the study (mean age 37.3), 10 with TLE and 23 GGE (12 with GGE with tonic-clonic seizure [GGE-GTCS], and 11 with juvenile myoclonic epilepsy). 19 healthy persons (mean age 32.2) were enrolled as the control group (CG). Measurements of VHIP, VAMG and VPHG were made with 3D completely balanced steady state (CBASS) and 3D T1-weighted sequence. All participants underwent a neuropsychological assessment using a multi-domain cognitive battery and emotional state questionnaires. Results: The left hippocampus was significantly smaller in patients with left TLE (LTLE) and with GGE-GTCS, compared to the CG (p = 0.0069). In LTLE a significant enlargement of the right amygdala in comparison to the CG and other types of epilepsy were found (p = 0.0015). Among patients with LTLE and GGE-GTCS, impairment of attention and executive functions was statistically more common than in the CG. VHIP right (r = 0.25 p < 0.01) and VHIP left (r = 0.26 p < 0.04) were positively correlated with phonetic verbal fluency. Conclusions: PWE showed changes in the volume of selected medial temporal lobe (MTL) structures. Selective impairment of attention and executive functions was found. Some neuropsychological findings correlate with volume changes in MTL structures. Antiseizure medications therapy could have an impact on the severity of neuropsychological dysfunctions.

ECT in an Adolescent With Schizophrenia and Seizures: Case Report.

Electroconvulsive therapy (ECT) has been recognized as an effective treatment option in catatonia, and for prolonged or severe affective episodes and schizophrenia. Response rates vary from 40 to 80% in adolescents. The procedure is safe if the required precautions are undertaken. Nonetheless, ECT remains a serious clinical challenge in patients with comorbid seizures. We present a case study of a 17-year-old female student suffering from schizophrenia who was scheduled for ECT due to prior treatment inefficacy. Seizures had occurred a few days before the first ECT session. Nevertheless, the patient received the ECT course, combined with clozapine at 125 mg/day, after neurological diagnosis and treatment modification because the illness became life-threatening. The patient's clinical outcome was satisfactory without any seriously adverse events and further improvements were observed in the mental state following long-term psychosocial treatment at our inpatient unit. A few months later, epilepsy was however diagnosed with probably coexistence of partial seizures and seizure-like events without EEG correlate. Administering ECT in patients with seizure comorbidity was also investigated based on previous research. Data on this is, however, extremely scarce and to the best of our knowledge, the safety and efficacy of using ECT in adolescents with schizophrenia and seizures has yet not to any great extent been discussed in the literature.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients.

INTRODUCTION AND HYPOTHESIS: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. METHODS: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. RESULTS: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.

The prevalence of depressive and anxiety symptoms in Polish epilepsy patients - The context of pharmaco-resistance.

PURPOSE: Patients with epilepsy (PWE) are at a higher risk of experiencing depressive and anxiety symptoms than the general population; these symptoms are more prevalent in patients with drug-resistant epilepsy (DRE) compared to those with non-drug-resistant epilepsy (NDRE). The aim of the present study was to compare the level of reported depressive and anxiety symptoms in patients with DRE and patients with NDRE and to examine the relationships between demographic and epilepsy-related variables and severity of depression and anxiety symptoms. MATERIAL AND METHODS: A total of 193 adult PWE, divided into a DRE group (n = 87), and an NDRE group (n = 106), completed the Beck Depression Inventory (BDI) and the Stat-Trait Anxiety Inventory (STAI-Sand STAI-T). Data analysis included sociodemographic and disease-related variables such as the type of epilepsy syndrome, age at onset of disease, and duration of the disease. RESULTS: The DRE group presented a higher score of BDI than the NDRE group (p = 0.04). Age correlated with the score of STAI-S in the NDRE group (r = 0.22). Sex was the only significant predictor of the score of STAI-T in the NDRE group. Men from the DRE group presented higher scores in BDI, STAI-S, and STA-T compared with the NDRE group. CONCLUSIONS: Patients with DRE reported more severe depressive symptoms than patients with NDRE. In NDRE patients, the level of anxiety, considered as a state, was correlated with age. Sex was a significant predictor of the level of anxiety in DRE patients. Pharmaco-resistance was significantly associated with severity of depression and anxiety in male patients.

Coronavirus anxiety as a predictor of burnout, depressive symptoms and insomnia among professionally active nurses: a preliminary report.

Purpose: A preliminary assessment of the direct association between coronavirus anxiety and burnout syndrome, depressive symptoms and insomnia among nurses in the context of selected work-related factors. Methods: This is a cross-sectional study. Fifty professionally active nurses were recruited from various psychiatric facilities and asked to fill out a set of questionnaires: the authors' survey on sociodemographic data, the Coronavirus Anxiety Scale (CAS), the Maslach Burnout Inventory - General Survey (MBI-GS), the revised version of the Center for Epidemiologic Studies Depression Scale (CESD-R), and the Athens Insomnia Scale (AIS). Linear regression models were constructed to predict the AIS, CESD-R and MBI-GS dimensions scores, with the CAS score as a predictor. The models were adjusted for sex, marital status, place of residence, length of service and working hours per week. Results: A rise in the CAS score was associated with rises in the CESD-R, MBI Exhaustion and MBI Cynicism scores. The effects were of similar size regardless of whether models were adjusted or unadjusted. Unadjusted and adjusted models predicting AIS total scores and MBI-Efficacy score were not fit to empirical data. In these models, the CAS score was not found to be significantly associated with the AIS and MBI-Efficacy scores. Conclusions: The severity of coronavirus anxiety contributed to the severity of depressive symptoms, cynicism and exhaustion among nurses. The ability to cope effectively with fear of being infected with SARS-CoV-2 may be crucial in preventing and mitigating other mental health sequelae.

Real-life anti-smoking practices among Polish neurologists.

Purpose: The aim of the present study was to assess attitudes of Polish neurologists towards cigarette smoking and their real-life anti-smoking practices. Methods: A study questionnaire was constructed, and distributed among Polish neurologists (n = 101; 73% females). More than two thirds (70%) of the study group worked in in-patient neurological wards with separate stroke units. Results: Seventy five percent of the study group documented the smoking status of their patients in medical files. Two thirds of the study group collected data on patient's cigarette smoking during each visit. Only 54% and 22% of study participants routinely assessed the severity of tobacco dependence and diagnosed tobacco dependence according to the ICD-10 criteria, respectively. Two thirds of physicians declared routinely using any anti-smoking intervention, but only 12% used the recommended 5'A (Ask, Advice, Assess, Assist, Arrange) model of behavioral intervention and only 11% introduced Evidence Based Medicine (EBM)-supported pharmacotherapy. The vast majority of study participants (80%) did not try to increase their professional skills in anti-smoking interventions. Conclusions: Real-life anti-smoking practices among Polish neurologists are generally unsatisfactory and do not follow EBM-based guidelines. The low percentage of neurologists who diagnose and treat nicotine dependence may negatively impact the efficacy of secondary stroke prevention in Poland.

Differences in acute ischaemic stroke care in Poland: analysis of claims database of National Health Fund in 2017.

Selected and basic indicators of acute ischaemic stroke care in Poland are reported cross-regionally based on the analysis of claims data of the National Health Fund (NFZ) in 2017, the most reliable source of healthcare funding in the country, being a single public payer. For research purposes, a selection algorithm based on the diagnosis coded as I63 according to the International Classification of Diseases (ICD-10) was used to identify all ischaemic stroke patients in the claims database provided by the NFZ. Stroke units and other centres providing treatment for acute ischaemic stroke patients were examined. The analysis showed marked differences between provinces in terms of stroke unit treatment availability. The crude and standardised rates of acute ischaemic stroke admissions to stroke units varied between provinces. Moreover, substantial differences were observed for the thrombolysis implementation rate, access to rehabilitation, hospital stay and early prognosis. As the leading cause of disability and the second leading cause of death in developed countries, stroke requires a well-organised, evidence-based healthcare system provided for both acute treatment and rehabilitation. Continuous monitoring of healthcare is crucial to identify weaknesses and areas for improvement.

Alterations in transcranial sonography among Huntington's disease patients with psychiatric symptoms.

Transcranial sonography (TCS) is a diagnostic tool in mood and movement disorders. Alterations within the raphe mesencephalic nucleus in the brain have been reported not only in patients with major depression but in patients with depressive symptoms accompanying several neurodegenerative disorders. The aim of the study was to assess the echogenicity of the nucleus raphe and other basal ganglia in patients with Huntington's disease (HD). TCS was performed in 127 HD patients participating in observational studies (Registry/Enroll-HD) in the Institute of Psychiatry and Neurology (Warsaw, Poland). Raphe hypoechogenicity was found in 78% of HD patients with current symptoms of depression (according to DSM-IV criteria), 57% of patients with a previous history of depression, and 56.8% patients who lacked signs or history of depression. Patients with hypoechogenic raphe reported significantly higher depression as measured on the BDI (15.6 ± 1.7) as compared to patients with normal echogenicity (9.5 ± 1.2), (p = 0.023). The diameter of the third ventricle was negatively correlated with Mini-Mental State Examination (MMSE) (rho - 0.37) and total functional capacity (TFC) scores (rho - 0.26). Hyperechogenic substantia nigra was visualized in 66,4% patients with HD and the degree of hyperechogenicity was correlated with the total motor score (TMS) (rho - 0.38). Changes in echogenicity of the basal ganglia are related to both depressive and motor symptoms among patients with HD.