Biomedical subjects
Publications and source records attributed to M Ejma.
The authors present recent data about epidemiology, pathogenesis and clinical features of idiopathic and symptomatic restless legs syndrome. A new aspects of pharmacological treatment and modification of daily activity are also described.
On the basis of current literature and their own experiences, the authors present the most common symptoms and syndromes of dysfunction of central and peripheral nervous system which appear in patients with chronic renal insufficiency. Current views on patomechanism of neural dysfunction due to renal failure in dialysed and non-dialysed patients are discussed.
PURPOSE: Functional and morphological evaluation of the optic nerve heads in patients suffering from migraine. MATERIAL AND METHODS: 21 patients--13 women and 8 men (mean age 40 +/- 10) with neurologically confirmed diagnosis of common and classic migraine were examined. The headache history was obtained by standard questions. The patients suffered from migraine from 2 to 30 years and the frequency of attacks was from < 10 to > 100/year. Ophthalmologic examination involved evaluation of visual acuity, anterior segment, irido-corneal angle, retina and optic disc. In all cases optic disc photography, diurnal tension curve and two central visual field examinations with Octopus 101 programm G2 were performed. RESULTS: In all cases IOP was normal (< 21 mm Hg). In 4 eyes (2 patients) there was early glaucomatous-like damage of the optic disc, without visual field defect. In most of these patients the optic nerve head looked normal, in part of them slightly pale. In 28% patients glaucomatous-like visual field defects were found (MD-3.9 dB to 6.6 dB). There was statistically significant relationship between increase of MD and frequency of migraine attacks (Mann-Withney U test, a = 0.05). CONCLUSIONS: Static perimetry of the central visual field has high diagnostic value in ocular vasospastic syndrome. Functional dysregulation of the optic nerve head circulation in patients with migraine might be involved in the pathogenesis of normal-tension glaucoma.
PURPOSE: To evaluate diagnostic sensitivity of clinical tests in optic demyelinating neuropathy. MATERIAL AND METHODS: We examined 21 persons (38 eyes) with confirmed sclerosis multiplex (SM) with no episodes of posterior optic neuritis in the history of the disease. The examination method included: Static perimetry of central visual field (30 degrees, by Octopus 101), pattern visual evoked potentials (p VEP), colour photographs of optic disc and magnetic resonance imaging (MR) of central nervous system, optic nerves and optic chiasm. Visual acuity and colour vision were normal. RESULTS: There was statistically significant elongation in the latency of P 100 in pattern VEP (> 118 ms, 3 x SD), and significant reduction in mean light sensitivity (MS) in central visual field. MRI revealed demyelinisation in cortex and/or spinal cord of all patients and demyelinating lesion in optic nerve of one patient. There was no Gd-DTPA enhancement. In statistical analysis there was no correlation between results of pattern VEP, IMR, morphology of optic disc, and duration of SM, stage of the disease (in Kurtzke gradation scale) or age of patient. In regression analysis there were statistically significant relationships (p < 0.05) between results of central static perimetry, duration and stage of disease.
PURPOSE: To estimate central visual field (30 degrees) of patients suffering from multiple sclerosis (SM). SM was confirmed by magnetic resonance imaging. MATERIAL AND METHODS: There was no posterior optic neuritis in the history of the disease. The visual acuity of examined the 28 eyes was 1,0. The results of static perimetry were analysed by regression analysis. RESULTS: There were significant relationships between mean sensitivity (MS) and duration of the disease, stage of the disease (in Kurtzke gradation scale) and age. Mean defect (MD) was significantly higher in the upper half of central visual field and between 15-30 degrees (p < 0.05). We observed positive relationships between MD, short time fluctuation (STF) and corrected loss variance (CLV). We found negative correlations between MS, MD, CLV and STF. Mean reliability factor RF was < 10%. CONCLUSION: Static perimetry seems to be a useful test in early diagnosis and monitoring of optic nerve neuropathy in SM.
The "transit time to cortex" was estimated in the group of 15 patients living around the copperworks. The somatosensory evoked potentials method has been applied. Clinical and neurographic disturbances (polyneuropathy with prolonged sensory conduction velocity) in this group of patients was accompanied by disturbances of the central nervous system ("transit time to cortex" was prolonged). The examination of averaged evoked potentials has a great value in estimation of early stages of toxic damages of the central nervous system and can be applied in the prevention of chronic industrial poisonings.
The electroencephalograms (EEG) and visual evoked potentials (VEP) were recorded in 100 multiple sclerosis patients treated from 1981 to 1989. In 35 cases the EEG records were pathological and in 12 of them they showed paroxysmal changes. Pathological EEG were mostly seen in young patients, during the first relapse, with high degree of Kurtzke's disability score. Patients with paroxysmal changes showed on physical examination brain stem lesions that could be responsible for paroxysmal activity in EEG. The latencies of P100 wave and amplitudes of P100/N120 complex were analysed in two groups of patients (with and without paroxysmal activity in EEG). There was no statistically important difference between two groups, although in the group with paroxysmal changes in EEG some prolongation of the latency of P100 wave and a little higher amplitude of P100/N120 complex were recorded.
Thirty-seven workers occupationally exposed to metallic mercury vapours were subjected to neurological examination and determination of visual (WPW) and somatosensory (SSPW) evoked potentials. In 6 cases slight sings of damage to the central nervous system was demonstrated. Prolonged WPW latency was noted in 15 cases. SSPW abnormalities were observed most frequently in the cortical components (13 cases), less frequently in the brainstem components (4 cases). Simultaneous WPW and SSPW changes were present in 10 cases. In the group of workers with changes of evoked potentials the mean urinary mercury levels were higher and the duration of exposure was longer than in the remaining workers. The use of multimodal electrophysiological methods increases the effectiveness of the diagnosis of subclinical damage to the nervous system in chronic mercury intoxication.
36 workers exposed to mercury vapour intoxication were examined to estimate the abnormalities in peripheral nervous system. 18 workers showed on physical examination features of polyneuropathy and in this group 15 workers had on emg examination sensory polyneuropathy. Statistical analysis was performed to show correlations between polyneuropathy on emg and age, time of exposure to mercury vapour and urinary mercury level. No such correlations were demonstrated.
In 20 patients with parkinsonism somatosensory evoked potentials were studied. The posterior tibial nerves were stimulated successively at the medial ankle. The averaged responses were recorded at the level of the L2 vertebra, C2 vertebra and in the central parietal area (Cz/Pz). The obtained data were compared with similar values in a control group. The conduction velocity in the sensory fibres of the tibial nerves was normal in both groups. No significant differences were found also between the patients and the controls in the latency of the spinal lumbar and cervical potentials, and the spinal conduction time (L2-C2) was normal. In the patients with parkinsonism the cortical evoked response N35 was significantly prolonged. Differences were noted also in the time of central conduction (C2-cortex) between the patients and the controls, but they were not significant statistically. The effects of disturbed dopamine metabolism on the electro-physiological processes in the peripheral and the central nervous system are discussed.
In 21 patients with parkinsonism and 20 healthy controls visual potentials evoked with checker pattern used as an alternating stimulus were studied. The left and right eye were examined separately recording visual cortical responses in the central occipital area. The analysed elements included the latency of the first highest positive wave P100 and the amplitude of the P100/N120 complex. Prolongation of the mean latency of P100 was found in patients with parkinsonism, but it was not significant statistically. No differences were found of the P100/N120 amplitude in the group with parkinsonism in relation to healthy controls. In the patients with parkinsonian syndrome (mainly of atherosclerotic origin) the mean latency of the visual potentials was longer and the amplitude was lower than in cases of Parkinson's disease. Attention is called to the high variability of the visual evoked potentials related to the clinical state and origin of the disease (parkinsonian syndrome and Parkinson's disease).
In a group of patients with non-Hodgkin lymphoma axonal sensorimotor polyneuropathy was found in 15%. It appeared in the treated patients, those receiving doses of oncovin. Polyneuropathy was not correlated with the type of malignancy. Treatment seems to be the important factor which can cause polyneuropathy.
Visual (VEPs) and somatosensory (SEPs) evoked potentials in a group of 33 patients (mean age 49 years) with non-Hodgkin lymphoma (n-HL) without CNS involvement were recorded. There were 24% of patients with pathological VEPs and 30% of patients with pathological SEPs. Pathological VEPs and SEPs were both recorded in 42% of patients. In comparison to the controls the statistically significant prolongation of mean latencies of VEPs, SEPs and transit time to cortex were found in the group of n-HL patients. These abnormalities were noted much more often in patients with long duration of the disease and with intermediate type of malignancy. In the untreated patients evoked potentials were normal. In 6 patients despite normal neurological status and normal eeg the evoked potentials were abnormal. The evoked potentials examination seems to be very sensitive method of afferent pathways involvement estimation and can be used for diagnosis and prognosis in n-HL patients. This method reveals CNS lesions more often than physical examination or eeg.
In a male patient multiple sclerosis was found to coexist with myasthenia. The symptoms of muscle fatiguability and of central nervous system damage developed at the same time. Multiple sclerosis was the predominating disease, especially in later stage of the disease. The authors discuss the possibility of a common immunological substrate for both conditions.
A case of a 22-year female patient with poly-symptomatic reversible dyskinetic syndrome following a single thiethylperazine (Torecan) dose is presented. The patient was 10 weeks pregnant. Detoxication abolished extrapyramidal symptoms within 7 hours. Possible mechanism of such an adverse reaction to thiethylperazine is discussed.