The Use of Compounds Derived from Cannabis sativa in the Treatment of Epilepsy, Painful Conditions, and Neuropsychiatric and Neurodegenerative Disorders.

Neurological disorders present a wide range of symptoms and challenges in diagnosis and treatment. Cannabis sativa, with its diverse chemical composition, offers potential therapeutic benefits due to its anticonvulsive, analgesic, anti-inflammatory, and neuroprotective properties. Beyond cannabinoids, cannabis contains terpenes and polyphenols, which synergistically enhance its pharmacological effects. Various administration routes, including vaporization, oral ingestion, sublingual, and rectal, provide flexibility in treatment delivery. This review shows the therapeutic efficacy of cannabis in managing neurological disorders such as epilepsy, neurodegenerative diseases, neurodevelopmental disorders, psychiatric disorders, and painful pathologies. Drawing from surveys, patient studies, and clinical trials, it highlights the potential of cannabis in alleviating symptoms, slowing disease progression, and improving overall quality of life for patients. Understanding the diverse therapeutic mechanisms of cannabis can open up possibilities for using this plant for individual patient needs.

Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement.

Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7−14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.

Cannabinoids-Perspectives for Individual Treatment in Selected Patients: Analysis of the Case Series.

Cannabinoids can be successfully used in the treatment of many symptoms and diseases; however, most often they are not the drugs of first choice. They can be added to the primary therapy, which can improve its effectiveness, or be introduced as the basic treatment when the conventional methods have failed. Small clinical trials and case reports prove the benefits of applying medicinal cannabis in various indications; however, clinical trials in larger groups of patients are scarce and often controversial. Due to limited scientific evidence, it is essential to conduct further experimental trials. Understanding the role of endocannabinoids, as well as the composition of cannabis containing both phytocannabinoids and terpenes plays an important role in their clinical use. The clinical effects of cannabinoids depend, among other things, on the activity of the endocannabinoid system, the proportion of phytocannabinoids, such as Δ9-tetrahydrocannabinol (THC) and cannabidiol (CBD), and the dosage used. The article discusses the role of phytocannabinoids and the potential of using them in different clinical cases in patients suffering from chronic pain, opioid dependence, depression and migraine, who did not respond to the conventional therapeutic methods. In each of the presented cases, the implementation of cannabinoids altered the course of the disease and resulted in symptom relief. Every decision to introduce cannabinoids to the treatment should be made individually with careful attention paid to details. Additionally, it is worth taking care of good clinical communication and education so that the implemented therapy is safe, effective and properly perceived by the patient.

Nonlinear and Linear Measures in the Differentiation of Postural Control in Patients after Total Hip or Knee Replacement and Healthy Controls.

Primary osteoarthritis treatments such as a total hip (THR) or knee (TKR) replacement lead to postural control changes reinforced by age. Balance tests such as standing with eyes open (EO) or closed (EC) give a possibility to calculate both linear and nonlinear indicators. This study aimed to find the group of linear and/or nonlinear measures that can differentiate healthy people and patients with TKR or THR from each other. This study enrolled 49 THR patients, 53 TKR patients, and 16 healthy controls. The center of pressure (CoP) path length, sample entropy (SampEn), fractal dimension (FD), and the largest Lyapunov exponent (LyE) were calculated separately for AP and ML directions from standing with EO/EC. Cluster analysis did not result in correct allocation to the groups according to all variables. The discriminant model included LyE (ML-EO, ML-EC, AP-EC), FD (AP-EO, ML-EC, AP-EC), CoP-path AP-EC, and SampEn AP-EC. Regression analysis showed that all nonlinear variables depend on the group. The CoP path length is different only in THR patients. It was concluded that standing with EC is a better way to assess the amount of regularity of CoP movement and attention paid to maintain balance. Nonlinear measures better differentiate TKR and THR patients from healthy controls.

Prospects for the Use of Cannabinoids in Psychiatric Disorders.

Increasing evidence suggests an essential role of the endocannabinoid system in modulating cognitive abilities, mood, stress, and sleep. The psychoactive effects of cannabis are described as euphoric, calming, anxiolytic, and sleep-inducing and positively affect the mood, but can also adversely affect therapy. The responses to cannabinoid medications depend on the patient's endocannabinoid system activity, the proportion of phytocannabinoids, the terpenoid composition, and the dose used. There is some evidence for a therapeutic use of phytocannabinoids in psychiatric conditions. THC and CBD may have opposing effects on anxiety. Current guidelines recommend caution in using THC in patients with anxiety or mood disorders. In a small number of clinical trials, cannabinoids used to treat cancer, HIV, multiple sclerosis, hepatitis C, Crohn's disease, and chronic neuropathic pain report decreases in anxiety or depression symptoms and presented sedative and anxiolytic effects. Several studies have investigated the influence of potential genetic factors on psychosis and schizophrenia development after cannabis use. THC may increase the risk of psychosis, especially in young patients with an immature central nervous system. There is limited evidence from clinical trials that cannabinoids are effective therapy for sleep disorders associated with concomitant conditions. There is evidence for a possible role of cannabis as a substitute for alcohol and drugs, also in the context of the risks of opioid use (e.g., opioid-related mortality). In this narrative review of the recent evidence, we discuss the prospects of using the psychoactive effects of cannabinoids in treating mental and psychiatric disorders. However, this evidence is weak for some clinical conditions and well-designed randomized controlled trials are currently lacking. Furthermore, some disorders may be worsened by cannabis use.

Effect of LLLT on endothelial cells culture.

Growth factors as vascular endothelial growth factor (VEGF), produced by the endothelial cells, take an essential part in pathological and physiological angiogenesis. The possibility of angiogenesis modulation by application of laser radiation may contribute to the improvement of its use in this process. Thus, the aim of the study was to investigate the influence of low-level laser therapy (LLLT) on the proliferation of endothelial cells, secretion of VEGF-A and presence of soluble VEGF receptors (sVEGFR-1 and sVEGFR-2) in the medium after in vitro culture. Isolated human umbilical vein endothelial cells (HUVECs) were irradiated using a diode laser at a wavelength of 635 nm and power density of 1,875 mW/cm(2). Depending on radiation energy density, the experiment was conducted in four groups: I 0 J/cm(2) (control group), II 2 J/cm(2), III 4 J/cm(2), and IV 8 J/cm(2). The use of laser radiation wavelength of 635 nm, was associated with a statistically significant increase in proliferation of endothelial cells (p = 0.0041). Moreover, at 635-nm wavelength, all doses of radiation significantly reduced the concentration of sVEGFR-1 (p = 0.0197).

Evaluation of differentiated neurotherapy programs for a patient after severe TBI and long term coma using event-related potentials.

BACKGROUND: This article examines the effectiveness of differentiated rehabilitation programs for a patient with frontal syndrome after severe TBI and long-term coma. We hypothesized that there would be a small response to relative beta training, and a good response to rTMS, applied to regulate the dynamics of brain function. CASE REPORT: M. L-S, age 26, suffered from anosognosia, executive dysfunction, and behavioral changes, after a skiing accident and prolonged coma, rendering him unable to function independently in many situations of everyday life. Only slight progress was made after traditional rehabilitation. The patient took part in 20 sessions of relative beta training (program A) and later in 20 sessions of rTMS (program B); both programs were combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment, after the completion of program A, and again after the completion of program B. As hypothesized, patient M.L-S showed small improvements in executive dysfunction and behavioral disorders after the conclusion of program A, and major improvement after program B. Similarly, in physiological changes the patient showed small improvement after relative beta training and a significant improvement of the P300 NOGO component after the rTMS program. CONCLUSIONS: The rTMS program produced larger physiological and behavioral changes than did relative beta training. A combination of different neurotherapeutical approaches (such as neurofeedback, rTMS, tDCS) can be suggested for similar severe cases of TBI. ERPs can be used to assess functional brain changes induced by neurotherapeutical programs.

The impact of laser irradiation on global stability in patients with vertebrobasilar insufficiency: a clinical report.

BACKGROUND: The purpose of our experiment was to determine whether laser stimulation can improve microcirculation in the posterior regions of the brain in patients with vertebrobasilar insufficiency (VBI). MATERIAL/METHODS: We studied 25 patients (20 female, 5 male, mean age 64) diagnosed with chronic VBI. All were evaluated using the De Klyn test, followed by qualitative assessment of stability using a Berg Balance Scale and evaluation of global stability using an electronic balance platform. A CTL-1100 low power laser was used with standard parameters. We established a protocol for laser irradiation at 5 points along the vertebral artery in the cervical region bilaterally. Irradiation was performed 10 times over two weeks. RESULTS: Significant improvement occurred after therapy in headache (p=0.0005), vertigo (p<0.0000), and tinnitus (p=0.0387). No significant differences were observed in nausea or nystagmus caused by head rotation. The Berg Balance Scale results showed significant differences in almost all features. There was a tendency towards improved stability in all parameters, and statistically significant differences in the total surface of support and the spread surface of support for the left foot. CONCLUSIONS: Laser stimulation as applied in this study can be useful in the treatment of patients with VBI. The main reason for improvement in global stability, balance, and other VBI symptoms is better blood perfusion.

[Infections in respiratory tract in patents after head injures]. / Infekcje w drogach oddechowych u pacjentów po urazach czaszkowo-mózgowych.

BACKGROUND: Traumatic brain injury has became one of a very import medical and social problem and one of the most serious causes of disability and morbidity. A long-term immobility leads to negative cardiovascular, respiratory, metabolic and musculoskeletal changes and put the patient at high risk of serious infections. Respiratory track infections are after urinary track infections the main cause of morbidity. Long-term ventilation and intubation are responsible for a hospital-acquired pneumonia (HAP). MATERIAL AND METHOD: 398 patients after TBI hospitalized in rehabilitation clinic were evaluated taking into account the incidence of HAP. The microbiological studies were collected and the most frequent pathogen were described. RESULTS: The most frequent pathogen were Pseudomonas aeruginosa and Staphylococcus aureus. Patients admitted to the rehabilitation clinic were infected with very refractory cultures of bacteria, drug resisted. These infections interrupt rehabilitation process and make it longer. There are no standards for managing patients after TBI with tracheostomy. There is a necessity of creating such standards. CONCLUSIONS: One of the most frequent pathogens involved in respiratory tract infections are: Pseudomonas aeruginosa and Staphylococcus aureus. Most patients hospitalized at Intensive Care Units were in carrier state. These complications extend the rehabilitation process and generate high costs. It is necessary to create standards of care of patients with tracheostomy after head injury.

[Urinary tract infection in patient after brain injury]. / Zakazenia ukladu moczowego u chorych rehabilitowanych z powodu urazu czaszkowo-mózgowego.

INTRUDUCTION: One of the most important problems in treating patients after head injury is urinary complication. The first place take urinary infections, which disturb rehabilitation process. Clean intermittent catherization, bladder training and good care do not preserve infection. The purpose of our study was to present the frequency of urinary infections and main pathogens involved in these infections among patients treated in The Department of Rehabilitation after head injury. MATERIAL AND METHODS: We gathered microbiological tests and observations from 398 patients (from 2 to 73 years old) after head injury treated in years 2003-2005. Some of them survived head injury and some of them had also multiorgan injury. RESULTS: In 133 of them we found bladder and urethra infections, vesical calculus in 11 cases. In one case we found prostatic abscessus and in one case urethroscrotal fistula. Each patient had microbiological test of urine after he was admitted to the Department. If the test was positive he had pharmacological treatment. In 157 urinary infections we selected Proteus sp., Pseudomonas aeruginosa, Escherichia coli, Klebsiella sp., Enterococcus sp., Acinetobacter sp. Serratia marcescens, Morganella morganii, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae and Candida albicans was represented not so often. CONCLUSIONS: The most frequent pathogens were: Proteus mirabilis, Pseudomonas aeruginosa, E. coli. Most of patients had positive microbiological tests at the admittance to our Department. These complications extend the rehabilitation process and generate high costs. It is necessary to create standards of care of neuropathic bladder in patients after head injury.

Differential diagnosis of behavioral variant of fronto-temporal dementia (bvFTD).

BACKGROUND: The aim of the paper is the differential diagnosis of various types of Fronto-Temporal Dementia (FTD), with the focus on its behavioural variant (bvFTD). MATERIAL/METHOD: Screening was done in order to assess the depth of dementia with the short version of MMSE, while evaluation of various variants of FTD was performed with the use of such neuropsychological tests as Newcomb and Chicago Fluency Tests, Wechsler Memory Scale-III (WMS-III), Western Aphasia Battery (WAB-R), and the Boston Naming Test (BNT). Behaviour was evaluated with a Polish version of the Frontal Behavioral Inventory (FBInv). The inventory consists of 24 questions which enable an evaluation of social behaviour disorders. The study included 112 patients--68 men and 46 women treated in the Reintegrative-Training Centre of the Foundation for Persons with Brain Dysfunctions in Kraków and in the Clinic for Developmental Psychiatry, Psychotic Disorders and Old Age Psychiatry, of the Medical University at Gdansk, who were suffering from various types of dementia. RESULTS: It was found that FTD patients scored the highest, while the VAD patients scored somewhat lower in the FBInv. At the same time the scores obtained by PPA patients were higher in comparison to the control groups, but not as high as in the case of patients with FTD. In the process of the neurotherapy of FTD patients we found a reduction of the behavioral disturbances, despite the progression of the illness. CONCLUSIONS: The results obtained in the present study confirmed the diagnostic value of FBInv in the differential diagnosis of various types of FTD and in the evaluation of neurotherapy efficacy.

A misdiagnosed patient: 16 years of locked-in syndrome, the influence of rehabilitation.

BACKGROUND: LiS can be mistakenly recognized as a vegetative state, minimally conscious state or akinetic mutism. It can be caused by isolated lesions--bilateral infarction, vertebrobasilar artery osslusion, haemorrhage or tumor of the ventral portion of the basis pontis or midbrain. CASE REPORT: The case of a 65-year-old patient with a brain tumor localized in the posterior part of the posterior commissure of the brain was presented. He lost consciousness in 1991, was diagnosed as being at a terminal stage and from 2005 he started to improve. In MRI brain tumor stated in 1989 with the same localization and size in 2007 without any disturbance in cerebral fluid flow. The patients remained in this condition for 14 years without any rehabilitation, because he was diagnosed as a terminal stage, a non-operative stage. When exercises were introduced in 2005 the patient started to recover. In 2007 he was conscious with quadriplegia, a neuropsychological test showed memory problems, without any dementia. After intensive rehabilitation functional improvement and speech improvement was observed, GOS (4), Ranczo Los Amigos Scale (6), DRS (18). CONCLUSIONS: It is important to carry out full diagnostics before determining a terminal stage and to continue a rehabilitation program and multisensory stimulation. Even after 16 year of lying in bed without communication there is a chance in LiS to witness improvement after stimulation, without any signs of dementia.

An evaluation of executive functions in sportsmen after traumatic brain injury.

Background. A particularly difficult problem in the rehabilitation of patients with closed-head injuries (TBI) is executive dysfunction, i.e. difficulty in the transition from thinking to acting. The goal of this study was to evaluate the impact of premorbid sports background on the outcome of rehabilitation oriented towards executive functions.
Material and methods. This retrospective study included over 80 TBI patients treated at the authors' rehabilitation centers from 2000 to 2003, using the same program. The experimental group (E) consisted of 9 persons actively involved in sports before their accidents. The controls (group K) included 9 TBI patients not involved in sports prior to the accident, matched to the patients in group E for age, sex, and severity of coma. In addition to clinical interview and observation, we used the Clinical Test of Executive Functions and the Neurolinguistic Test of Attention as outcome measures.
Results. Our results indicated clearly that patients who had been active in sports before injury showed significantly better results in both outcome measures, though the advantage was somewhat greater on the Clinical Test of Executive Functions.
Conclusions. All the TBI patients we studied presented at baseline with serious executive dysfunction. The program of neurorehabilitation we applied showed good effects for the patients in both groups. However, those who had previously been active in sports achieved significantly better outcomes than those who had not. In planning and improving rehabilitation programs for TBI patients the possibility of a sports background should be taken under consideration.

Gram-positive microorganisms isolated from patients treated in the Department and Clinic of Rehabilitation at Rydygier Medical University in Bydgoszcz, Poland, 2000-2001.

Background. The purpose of our study was to evaluate the occurrence of Gram-positive microorganisms isolated from patients hospitalized in the Department and Clinic of Rehabilitation at the Rydygier Medical University in Bydgoszcz. Materials and methods. The material analyzed consisted of 533 clinical samples collected from patients hospitalized in 2000-2001. The study included 485 Gram-positive bacterial strains isolated from clinical material. Morphological characteristics provided the basis for the identification of bacteria. The species were identified by using API 20 STREP and API STAPH tests (bioMerieux). The isolates were screened for antimicrobial susceptibility by the disk-diffusion method. Results. The most often isolated bacteria were Enterococcus spp. (46,8%) and Staphylococcus spp. (31,5%), followed by Corynebacterium spp. (9,1%) and Streptococcus spp. (6,6%). The most frequently identified Enterococcus species were E. faecalis (92,9%) and E. faecium (7,1%). All the Enterococcus strains were susceptible to glycopeptides. More than 90% of the Enterococus isolates were sensitive to nitrofurantoine, about 44% to high concentrations of gentamycin, 17,9% to ciprofloxacin. During this period, and S. simulans, and 21 strains of S. auerus (46,7%). 92% of all the tested CNS strains (80%) than in the S. aureus isolates (10%). Conclusions. The most frequently observed bacterium was E. faecalis, which showed significant resistance to quinolones and to high level aminoglycosides. The CNS strains showed a high level of resistance to methicilline. All these strains were susceptible to glycopeptides.