Valsartan in the treatment of hypertension.

INTRODUCTION: Hypertension represents an important public health problem. Effective treatment of hypertension is imperative for primary care. GOAL: The goal of this study was to examine the efficacy of Valsartan in the treatment of hypertension with emphasis on the overall efficacy in reduction of systolic and diastolic blood pressure in a sample of 738 patients. MATERIAL AND METHODS: The study lasted for 12 months (from January 1, 2012 until December 31, 2012 year) and conducted in 18 public health institutions in B&H. Parallel follow up of Valsartan antihypertensive effect through repeated measurements every three months was conducted. RESULTS AND DISCUSSION: Our results indicate that both systolic and diastolic blood pressure decreased significantly after 12 weeks of Valsartan treatment. Analysis of adverse effects did not showed statistical significance of side effects for total sample. Statistical analysis by Yates chi-square did not show the presence of statistically significant differences in adverse effects by gender. CONCLUSION: We conclude that Val or Val plus are effective and safe antihypertensive drugs for the treatment of mild to moderate

Neoplasms in the clinical material of neurology clinic, Clinical Center of University of Sarajevo in the period 1990-2009.

INTRODUCTION: Brain tumors are a unique and heterogeneous group of tumors with which face a variety of specialties, mostly oncologists, neurologists and neurosurgeons. Due to their specific location all brain tumors are malignant, regardless of their malignant potential, because any expansion process within the skull, increased intracranial pressure and destruction of surrounding structures, which can cause neurological, quantitative disturbances of consciousness or death. GOAL: The goal of this study was to record neoplastic processes of the central nervous system in patients of Neurology Clinic, Clinical Center of Sarajevo University in the twenty-year period (January 1st 1990-December 31st 2009). The study was partly retrospective and partly prospective determined by three time periods. MATERIAL AND METHODS: We reviewed medical records and documentation of patients treated at Neurology Clinic, which has 102 beds. All patients' data were collected using a specially designed questionnaire for this study. RESULTS AND DISCUSSION: The number of secondary tumor process for the period 2000-2005 is greater than in the period 1990-1999, while in the period 2000-2009 is increasing (17.2%-30.3%). The male-female ratio is 52:48. During the first two monitoring period there were statistically significantly more men, and in the last monitoring period there were more women. The mean patient's age was 60 years. The most common symptom was hemiparesis for all observed periods evaluated with standard diagnostic tests: CT and MRI. CONCLUSION: We can conclude that CNS neoplasms in patients of Neurology Clinic, Clinical Center of Sarajevo University are present in the twenty-year period with total of 1.47%, and showed a decrease of 2.7% (1990-1999) to 0.47% for the period 2006-2009.

Characteristics of symptomatic epilepsy in patients with brain tumours.

The aim of our work is to determine the total number, age, gender of the patients with the symptomatic epileptic seizures associated with brain tumours, tumour location, clinical signs and characteristics of epileptic seizures. We have analyzed medical documentation of the patients with brain tumours hospitalized at the Department of Neurology, University of Sarajevo Clinics Centre. This study is retrospective and includes time period from 1st January 2000 until 31st December 2005. During the observed period at the Department of Neurology in Sarajevo there were in total 9753 hospitalized patients, from which 101 (1,1%) patients with the brain tumour diagnosis. Average patient's age was 62,60 +/- 1,28 years. In one third of the patients (32%) were recorded epileptic seizures, without significant difference between genders. In case of symptomatic epilepsy, significantly more frequent locations of tumours were: in several lobes (28%), parietal lobe (25%), as well as frontal and temporal lobe (18,8% each), while there were no changes in cerebellum and brain stem (chi2 =7,174, p<0,05). The most prominent signs of illness in our sample were hemiparesis with the cranial nerves lesion (56,3%), speech problems (25%). Normal neurologic findings were significantly more frequent among patients with the symptomatic epilepsy (chi2 =6,349, p<0,05). The most often was a single seizure (59%), in 38% of cases there were recorded series of seizures, and only 3% of patients had status epilepticus. In relation to the type of seizures, the most often are simple partial seizures with or without secondary generalization (66%), than generalized convulsive (31%), and the rarest one are complex partial seizures (3%). Symptomatic epilepsy in case of brain tumours occurs in one third of patients, at older age, and in both genders. The lesion usually affects several lobes and cause simple partial seizures with or without secondary generalization. The most often clinical signs in case of all brain tumours are cranial nerves lesion and hemiparesis, while the normal neurologic findings are significantly dominant in the group of patients with the epileptic seizures.

The role of alpha-lipoic acid in diabetic polyneuropathy treatment.

Diabetic neuropathy represents late diabetes complications, and diabetes duration and long-term hyperglycemia are the main reasons for polyneuropathy. The goal was to estimate the effects of alpha-lipoic acid on symptoms of diabetic neuropathy after 600 mg i.v. for 3 weeks and 3 months of 300-600 mg of alpha-lipoic acid per os. This study has been designed as a multicentric, in 5-centers in B&H, carried out by 5 physicians with 20 diabetic patients each. Following parameters were monitored in 100 diabetics suffering from Type 1 and Type 2 diabetes, both men and women: diabetes duration, diabetes therapy, duration of polyneuropathy symptoms, height, weight, BMI (body mass index), subjective assessment of patients, objective examinations of physicians and subjective assessment of physicians. 100 diabetics, average age 61,36; oldest 79, youngest 40, suffered from diabetes in average 11,9 years. There were 35 men and 65 women, 16 with Type 1 and 80 with Type 2 diabetes, while 4 patients were not classified. 69 were having insulin therapy and 31 oral hypoglicemics. Shortest diabetic status was less than a year, and longest was 28 years. Average duration of polyneuropathic symptoms was 3,02 years, shortest was less than a year, and the longest was 15 years. Average height was 1,70 m, average weight 76,13 kg, and average BMI 26,51 kg/m2. Significant statistic differences in improvement were recorded (P>0,05) according to Fridman's test for repeated measurements compared to initial findings in assessments: sensory symptoms of polyneuropathy, pain sensations as polyneuropathy symptoms, total score of polyneuropathy symptoms, subjective assessment of patients, subjective findings of physicians, and significant differences were not find (P>0,05) in autonomous and motoric neuropathy. Based on the conducted study, we have concluded that the application of alpha-lipoic acid during 3 months has helped to decrease the symptoms of diabetic neuropathy and in only one case out of 100 included patients there was no subjective improvement after drug application.

Tachycardia as a Negative Prognostic Factor for Stroke Outcome.

INTRODUCTION: The outcome of stroke, especially lethal one is significant, as in the hemorrhagic as well as in ischemic stroke. GOAL: was to show the impact on the stroke outcome of tachycardia correlated with lesion localization. MATERIAL AND METHODS: Material for our work was patients who were treated due to the stroke at the Neurology Clinic Sarajevo in the period from 31 March 2015 until 01 January 2016. A total of 544 stoke patients were treated in the reporting period, 221 (44.6%) died. There were 70.9% patients with ischemic and 29.1% with hemorrhagic stroke. Each patient underwent ECG, which registered tachycardia during admission and on third day of hospitalization. RESULTS: In relation to the presence of tachycardia on admission there were statistically significant differences in the group of patients with hemorrhage and ischemia in relation to presence of tachycardia (p <0.01). In the group of patients with hemorrhage coma was more present (78.9%), while tachycardia was statistically more often in those with loss of consciousness than in the group with coma. Group of patients with ischemia has 52.75% of the patients with tachycardia without statistical correlation between the presence and absence of disorders of consciousness. Midline lesions were statistically more often associated with paroxysmal tachycardia in relation to the lateral lesions (p <0.01). Statistical analysis shows that there are statistically significant differences between observed groups χ2=35.576, p=0.0001. Lethal outcome of hemorrhagic stroke was 55.45%, 32.6% for ischemia. A significant statistical significance of ischemic and hemorrhagic stroke compared to the lethal outcome correlated with the registered tachycardia and medial lesion localization. CONCLUSION: Tachycardia on admission in patients with stroke is a relevant negative predictor for stroke outcome. Medial localization of changes significantly affects the occurrence of tachycardia and lethal outcome of stroke which is statistically significantly more associated with hemorrhagic stroke.

The effect of functional insulin therapy on glycaemic parameters in children with diabetes mellitus type 1.

Aim The aim of the study is to evaluate the effect of a prospectively conducted interactive 5-day education programme based on Düsseldorf model on glycated haemoglobin (A1C), and total daily dose of insulin in type 1 diabetes patients. Methods A total of 67 type 1 diabetes patients was analysed; mean age of 11±0.68 years, 43 females and 24 males. The programme was led by a trained team of diabetes specialist doctors and nurses. All subjects and their parents completed a knowledge test about diabetes at beginning, and at the end of education, and after 12 months (30 questions). Subjects were evaluated for total daily insulin, and HbA1c at baseline, as well as 3, 6, 9 and 12 months after the end of the education programme. Results Results of the knowledge test after the education have shown higher knowledge at baseline. At the end of the education programme an average of total daily insulin dose was significantly lower. There was a 3.17% reduction in HbA1c values over 9 months, and 1.8% over 12 months in the comparison to the baseline values (p<0.001). Conclusions Structured education programme of functional insulin therapy was associated with improved glycaemic control in type 1 diabetes patients and their parents. It motivated patients and parents to improve glycaemic control. One year after the follow up, glycaemic control was worsening, due to lack of patients' motivation, therefore, there is a need for yearly re-education.

Serum homocysteine levels in patients with probable vascular dementia.

Aim To investigate total homocysteine (tHcy) serum concentration in patients with probable vascular dementia (VD) and in agematched controls, as well as to determine an association between tHcy serum concentration and cognitive impairment in patients with probable VD. Methods Serum concentration of tHcy was determined by the Fluorescence Polarization Immunoassay on the AxSYM System. Cognitive impairment was tested by the Mini Mental Status Examination (MMSE) score. Body mass index (BMI) was calculated for each subject included in the study. Results Age, systolic, diastolic blood pressure and BMI did not differ significantly between the two groups. Mean serum tHcy concentration in the control group of subjects was 13.35 µmol/L, while in patients with probable VD it was significantly higher, 19.45 µmol/L (p=0.002). A negative but insignificant association between serum tHcy concentration and cognitive impairment in patients with probable VD was found. Conclusion Increased tHcy concentration in patients with probable VD suggests the possible independent role of Hcy in the pathogenesis of VD.

Interferon treatment of multiple sclerosis.

INTRODUCTION: IN THE TREATMENT OF MULTIPLE SCLEROSIS (MS) DIFFER: treatment of relapse, treatment slow the progression of the disease (immunomodulators and immunosuppression), and symptomatic treatment. THE AIM: The aim of this study is to analyze the application of interferon therapy in the treatment of MS-E: Process the disease, patients with multiple sclerosis who have passed the commission for multiple sclerosis at the Neurology Clinic of Clinical Center of Sarajevo University as a reference center for referral to the Commission for multiple sclerosis from the Federal Ministry of Health in 2009 year in terms of total number examined, gender differences, diagnostic tests (MRI, CSF, EP), neurological findings and EDSS scores. Provide a section through the continuous support and education of patients during the introduction Betaferon in therapy with the goal of education for self-use and reduce the incidence of side effects of interferon therapy. MATERIALS AND METHODS: The material for the work they were histories of patients who are registered as patients who have undergone a commission for MS at Department of Neurology, University Clinical Center in Sarajevo. The evaluation was retrospective. It was used a specially designed form, which is usually applied to patients referred to this committee. After the collected material was carried out data processing. The study comprised 34 patients who have undergone a commission of which 16 patients received interferon therapy. RESULTS: In 2009 at the Neurology Clinic CCUS have treated 34 patients who passed the committee for recommendation to interferon therapy (25 women and 9 men). The diagnosis of multiple sclerosis is safe based on the criteria of international panel in 2000. EDSS Average score for men was 1.8, 1.9 for women, the total EDSS score was 1.8. The gender ratio is 3:1 in women than in men. Sixteen patients received interferon by the Commission for multiple sclerosis, the Federal Ministry of Health and their therapy was initiated at the clinic. CONCLUSION: For the period of 2009, a total of 34 patients were examined with multiple sclerosis who received interferon treatment recommendations at the expense of the Federal Solidarity Fund at the Neurology Clinic CCUS Sarajevo. The average EDSS score was 1.8. There were no significant differences in neurological findings between patients who were previously treated with interferon and patients who were waiting for treatment.

Platybasia and Klippel Feil-syndrome: case report.

A case is presented of a 35-year-old woman diagnosed with platybasia associated with Klippel-Feil syndrome type I. She was admitted to University Department of Neurology for clinical examination because of walking difficulties, dizziness, and intermittent vision disturbances. Neurological examination revealed a predominance of cerebellar symptomatology. Relevant diagnostic work-up included craniogram, cervical spine x-ray, computed tomography (CT) of the brain and craniocervical junction, magnetic resonance imaging of the brain, electroencephalography, ophthalmologic examination, urinary tract ultrasonography, laboratory tests, and psychological testing. CT of the craniocervical junction showed platybasia, congenital fusion of the second and third cervical vertebrae, and basilar invagination of dens axis. Platybasia is leveling of the angle between the floor of the anterior cranial fossa and posterior cranial fossa in the area of sella turcica, which is normally at 115-140 degrees. Basilar impression or invagination is moving up of the basis of the occiput and occipital condyles into the cranium, which means that the borders of the foramen magnum, condyles and adjacent bone are invaginated into the posterior fossa. Klippel-Feil syndrome type II is massive fusion of two of seven cervical vertebrae associated with short neck and low hair line.

[Epidemiology of multiple sclerosis in Bosnia and Herzegovina]. / Epidemioloske karakteristike multiple skleroze u Bosni i Hercegovini.

In order to examine precipitating factors for occurrence of multiple sclerosis or inception of a relapse in patients suffering from multiple sclerosis a specially designed questionnaire was used, including history records of patients with multiple sclerosis treated at the Clinic of Neurology of the Clinical Center of Sarajevo in the period between January1st and December 31st 2006. The number of patients with MS was 71 (48 women and 23 men). An infection as a precipitating factor was noted in 21 (29.57%) cases, stress was noted in 12 patients (16.9%) whereas 43 patients (60,12%) had the RR type of the disease. Nine patients were treated with interferon therapy (12.67%) and 47 patients (66.1%) with high doses of metilpredinisolone . Depression disorder was noted in 23 (32.9%) patients whereas 7 patients had cognitive dysfunction (9.86%). Results of this study, which have shown epidemiological characteristics of multiple sclerosis for the first time in Bosnia and Herzegovina, indicate that there is a need to create a unified register of patients and to request compliance with therapeutic guidelines.

[Influence of lasting diabetes and non-adjustable glycosylated haemoglobin on occurrence of retinopathy]. / Utjecaj trajanja dijabetesa i neregulirane glikemije na nastanak retinopatije.

The aim of this study was to investigate the effect of the duration of diabetes and glycemia on the development of diabetic retinopathy in diabetes types 1 and 2 and the prevalence of retinopathy by sex. It examined 278 diabetics in 1999 and 2004, a questionnaire was used to collect data and results of fasting glucose, HbA1c, glycosuria and ketonurie were recorded. Retinopathy was noted in 80 (28.78%) and 187 (67.27%) patients during 1999 and 2004, respectively (p < 0.001). The number of patients with the nonproliferative and preproliferative (p < 0.001) as well as with proliferative retinopathy (p < 0.01) was significantly higher in 2004 in the comparision with 1999. The average HbA1c in 1999 was 13.02%, whereas in 2004 it was 10.57%. Poor control of diabetes was present during both investigations.

Depression in multiple sclerosis patients.

INTRODUCTION: Multiple sclerosis (MS) manifests also with the symptoms of affective disorders. Depression is the most common mental disorder among patients with MS and it has negative impact on their working ability, social relations and quality of life. The aim of this study is to investigate gender, age, marital status, education level and employment related to patients with depressive symptoms in population of MS, treated at the Department of Neurology, Clinical Center University of Sarajevo. METHOD: In the study it was analyzed 50 randomly selected patients with various types of multiple sclerosis. Severity of depression was evaluated using the Beck Depression Inventory (BDI). RESULTS: The study included 33 female and 17 male patients aged 21 to 60 years. In the sample of MS patients there were 56% with depressive disorder. There is no statistically significant difference between patients gender. Depression is more frequent among younger and middle age patients, while all the patients older than 51 years are in a normal mood (total 31.9%). Significantly higher percentage of non-depressive patients (72.2%) are married, while depression is present among all divorced patients (10.7%), majority of single (35.8%) and widowers (21.4%). Taking into consideration level of education, there is a statistically significant difference as follows: depression is more frequent among patients who graduated university (46.4%) and secondary school (50%) compared to ones who finished only primary school (3.6%). There is significantly higher number of unemployed and retired patients with depressive symptoms (75%) in comparison to the employed ones. CONCLUSION: Depression occurs more frequently among MS patients who are younger, unemployed, highly educated and without spouse. There is no statistically significant difference between male and female patients.

Stroke in diabetic patients in Cantonal Hospital Zenica.

AIM: The aim is to determine the frequency of stroke in 300 patients with type 1 and 2 diabetes mellitus observed in two different time periods with a five-year distance. MATERIALS AND METHODS: The survey comprised a group of 300 patients with previously clinically and laboratory diagnosed diabetes. First examination, questionnaire and laboratory testing were performed in all patients in 1999. There were 62 patients with type 1 diabetes and 238 type 2. The final exam, questionnaire and laboratory test were performed on 278 patients in 2004 (diabetes type 1 in 58 (20.9%), diabetes type 2 in 220 (79.1%) patients. Additional anamnesis in 2004 grouped 2 patients into other specific types, and those were two women, previously classified as diabetes type 2. Twenty patients died between the first test in 2000 and the last in 2004. RESULTS: In 1999 2.2% of tested patients suffered the stroke, and in 2004, the stroke suffered 3.2%. There was no statistically significant difference in the stroke occurrence in the same group of diabetic patients during the two observed periods with the 5-year time span. There was no statistically significant difference in the occurrence of stroke between males and females, or in type I and II diabetes groups. There were 4.3% of patients in total who suffered stroke during the survey. CONCLUSION: There were no statistically significant changes in number of stroke patients which indirectly confirms good treatment of diabetic population in primary care.

Cognitive and depressive disorders in multiple sclerosis.

Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the' most common affective disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.

[Mechanism of therapy effects by botulinum neurotoxin]. / Mehanizam djelovanja i terapija botulinum toksinom.

Botulinum neurotoxin (BoNT) is produced by Clostridium botulinum as a complex of proteins containing the neurotoxin itself and other nontoxic proteins. Activation of the neurotoxin occurs upon proteolytic cleavage into the heavy and light chains. This di-chain moiety is essential for neurotoxin and each chain is playing a unique role; the heavy chain mediates neurospecifics cell binding and entry, whereas the light chain, a protease, catalyzes the cleavage and inactivation of neuronal proteins that mediate neurotransmitter release. There are seven BoNT serotypes (A,B,CI,D,E,F, and G), all of which inhibit acetylcholine release, though their intracellular target proteins, the characteristics of their actions, and their potencies vary substantially. BoNT type A has been the most widely studied and applied serotype for therapeutic purposes. It has been a mainstay in the treatment of cervical dystonia, blepharospasm, and hemifacial spasm for years. BoNT has more recently emerged as an increasingly important therapeutic option in the clinical management of a broad array of conditions, including other focal dystonias, spasticity, cerebral palsy, equinovarus, gastrointestinal (GI) and urogenital disorders, hypersecretory disorders, facial lines due to hyperfunctional facial muscles and recently, musculoskeletal pain disorders and headache.

[Neuropathic pain]. / Neuropatska bol.

Neuropathic pain is result of damage or dysfunction of periphery or central nervous system. There is no adequate adaptation and produce suffering without biological helpfulness. The aim of treatment of patient with neuropathic pain is soothing of pain and suffering and prevention of further development of pathological process. Periphery mechanisms of neuropathic pain include hyperexcitability of cell membrane and periphery sensibilization. Central mechanism includes central sensibilization, central reorganization of alphabeta fibers and loss of inhibition mechanisms. The main symptoms of neuropathic pain are described as lancinating, stabbing, or shooting pain. Hyperalgesia and allodynia are special kind of neuropathic pain that is provoked by mechanic or thermal stimuli. Mononeuropathy, plexopathy, radiculopathy, and myelopathy, lesions of thymus, cortex or brain stem are real cause of neuropathic pain. In the treatment of neuropathic pain drug such as opioid, nonsteroid antirheumatics, analgetics, tricyclic antidepressant and antiepileptic are used. The most successful treatment is with antiepileptic drugs of second generation. Carbamazepin was the drug of choice till ten years ago. Since then the leader position in treatment has belong to gabapentin in dose from 900-2400 mg daily. Currently the new drug is tested, antiepileptic pregabaline. The first experiences are promising.

[Catamenial epilepsy]. / Katamenijalne epilepsije.

Seizures are influenced by the physiologic variation in sex hormone secretion during the menstrual cycle and throughout the reproductive life of women with epilepsy. Catamenial epilepsy is defined as the occurrence of seizures around menses or an increase in seizures in relationto the menstrual cycle. The incidence of catamenial epilepsy varies from 10% to 78%, largely because of methodological differences among studies. Variation in concentracion of antiepileptic drugs across the menstrual cycle may also contribute to increased seizure susceptibility. It is important for the physician to work closely with the patient to determine whether her seizures are indeed catamenial and to design an appropriate treatment plan.

[Botulinum toxin in spasm treatment in adults]. / Botulinum toksin u tretmanu spazma kod odraslih.

Botulinum toxin (BTX) is a powerful neurotoxin which blocks cholinergic transmission at the neuromuscular junction. Judiciously applied it can reduce local muscle over activity while maintaining the strength in other muscles. For focal or segmental dystony it has been a medication of choice. Refined botullinum toxin A being applied in affected groups of muscles weaker power of contraction. Basic mechanism which weaker contraction remands the same. Controlled trials have provided evidence of the effectiveness of BTX both in reducing spasticity itself and in achieving functional gain. The guidance given here to clinicians involved in the management of spasticity covers the types of patient suitable for treatment using BTX, the appropriate dosage, and the necessary follow-up procedures and documentation.

[Confused states as predictors of epileptic seizures during and after cerebrovascular accident]. / Konfuzno-smeteno stanje kao prediktor epileptickih napada u toku i poslije cerebrovaskularnoga inzulta.

UNLABELLED: The state of mental confusion is described as an dependent risk factor in development of early and late epileptic-onset seizures following CVI. The aim of this paper is to determine the influence of confused state as possible predictor of symptomatic seizures in the course and following CVI. MATERIAL AND METHODS: The patients who were treated in The Department of Neurology for early and late-onset seizures in the course and following CVI in the period between 1.1.1989 and 31.12.1998. RESULTS: We had total number of 106 patients with symptomatic seizures, 56 in the group of late-onset and 50 in the group of early seizures. 52.8% of the patients have a registered state of mental confusion at the admission to hospital (in the stage of acute CVI), 19.2% of patients had a clear sensorium. Disorder of consciousness of the type of coma was registered in 27.4% of the patients. There was statistically significant increase of the occurrence of mental confusion in the group of patients with late-onset seizures, 62.5% while there was a statistically significant increase of coma in conditions related to type, frequency and outcome of seizures. We can conclude that mental confusion has significant influence of the occurrence of late-onset seizures while it does not influence the type and frequency of seizures.

[Modern aspects of epilepsy treatment]. / Savremeni aspekti tretmana epilepsija.

It is a general rule today, after a relevant diagnostics of an epilepsy, to start a monotherapy treatment, depending on a kind of a seizure, a life age and a general health condition. First line of monotherapy epilepsy drugs remain carbamazapine and sodium valproat. New drugs that are being introduced are: felbamat, gabapentin, lamotrigin, oxcarbazepin, tiagabin, topiramat, vigabatin and zanisamid. These are commonly used as add-on therapy, or as an addition for previously used antiepileptic. Their indicated areas are complex resistant partial seizures with or without generalization. Attention should be paid on proper dosage, interactions and toxicity. Regardless on the new epileptic era, according to reports of International League against epilepsy, most of the patients do not receive the drug that is the most appropriate for them concerning the price (cost-benefit). Neurosurgical methods in epilepsy treatment are: selective amygdalo-hyppocampotomy, temporal lobotomy, subpial resection, hemispherectomy, corpus callosotomy, removal of lesions like tumors or cysts provide encouraging results in reduction of epileptic seizures that can be followed by reduction of drug therapy. N. vagus stimulation is being wider introduced in resident epileptics. Treatment of epilepsy in women requires an approach to sexuality, conception, pregnancy, introduction of medicaments, antiepileptic terratogenity, contraception, motherhood and menopause. A special significance of modern approach to epilepsy is in treatment of elderly who have cerebrovascular and neurodegenerative disease as a cause of seizures. A complex treatment of epilepsy using pharmacological and neurosurgical approach requires supportive psychotherapy, socio-therapy, the work with a family, education about epilepsy and living a life with more quality having one.