The improvement of motor symptoms in Huntington's disease during cariprazine treatment.

BACKGROUND: Huntington's disease (HD) is a progressive neurodegenerative disease, characterised by motor disturbances and non-motor (i.e., psychiatric) symptoms. Motor symptoms are the hallmark features of HD and take many forms. Their emergence is related to alterations in striatal dopaminergic neurotransmission: dopamine levels increase in the early stages of the disease, while more advanced stages are characterised by reduced dopamine levels. Such a biphasic change potentially explains the alterations in motor symptoms: increased dopamine-production induces hyperkinetic movements early in the disease course, while depleted dopamine storage leads to hypokinetic symptoms in the advanced phase. Dopamine D2-D3 partial agonists could be a promising treatment option in HD, as they have the potential to either elevate or lower the surrounding dopamine levels if the levels are too low or too high, respectively, potentially offering symptom-relief across the illness-course. Therefore, the present study aimed at exploring the effects of cariprazine, a dopamine D2-D3 partial agonist with high affinity to D3 receptors, on motor symptoms associated with HD. METHODS: This was a single-centre, retrospective study where sixteen patients received off-label cariprazine treatment for 12 weeks (1.5-3 mg/day). Motor symptoms were evaluated using the Motor Assessment of the Unified Huntington's Disease Rating Scale. Least Square (LS) Mean Changes from Baseline (BL) to Week 8 and Week 12 in the Total Motor Score (TMS) were analysed using the Mixed Model for Repeated Measures method. In addition, improvement from BL to Week 8 and 12 was calculated for all motor items. RESULTS: Data of 16 patients were collected, but data of only 15 patients were analysed as one patient dropped out due to non-compliance. Significant changes were observed from BL to Week 8 (LS Mean Change: -9.4, p < 0.0001) and to Week 12 (LS Mean Change: -12.8, p < 0.0001) in the TMS. The improvement was captured in the majority of motor functions, excluding bradykinesia and gait. Mild akathisia was the most commonly reported side-effect, affecting 3 patients. CONCLUSION: This is the first study investigating the effectiveness of a D2-D3 partial agonist, cariprazine, in the treatment of HD. The findings of this study revealed that cariprazine was effective in the treatment of a wide range of motor symptoms associated with HD.

Early-Onset Schizophrenia With Predominantly Negative Symptoms: A Case Study of a Drug-Naive Female Patient Treated With Cariprazine.

Schizophrenia is a chronic and severe mental disorder characterized by positive, negative, and cognitive symptoms. Negative symptoms are usually present from the prodromal phase; early diagnosis and management of negative symptoms is a major health concern since an insidious onset dominated by negative symptoms is associated with a worse outcome. Antipsychotic medications, which are effective for treating positive symptoms, are generally ineffective for treating negative or cognitive symptoms. We present a 23-year-old woman showing severe symptoms at her first visit to our department. The patient's parents reported that their daughter had experienced several years of psychosocial decline and putative psychiatric symptoms, but no medical attention had been previously sought; as such, the diagnosis of schizophrenia with predominantly negative symptoms was very much delayed. Early onset of schizophrenia, longer duration of untreated psychosis, and severe negative symptoms, which have limited treatment options, suggested a poor prognosis. We initiated monotherapy with cariprazine, a novel antipsychotic that has recently been proven efficacious in treating schizophrenia with predominantly negative symptoms. This report describes a 52-week cariprazine treatment regimen and follows the patient's impressive clinical improvement confirmed by PANSS and CGI scores, and psychological tests.

Содействие надлежащему использованию антибиотиков для сдерживания развития устойчивости к антибиотикам в медицине человека в Венгрии: Аналитический обзор EVIPNet для формирования политики, номер 2

Министерством человеческих ресурсов Венгрии была инициирована подготовка аналитического обзора – к публикации под эгидой Европейской сети по вопросам использования данных научных исследований при формировании политики (EVIPNet-Европа) – в целях выработки научно обоснованных вариантов реагирования на проблему ненадлежащего использования антибиотиков в стране. Эта задача выполнялась в рамках Двухгодичного соглашения о сотрудничестве (ДСС) между Министерством человеческих ресурсов и ВОЗ с участием национальных политикоформирующих учреждений высокого уровня и национальных экспертов, при поддержке технических специалистов Европейского регионального бюро ВОЗ. Национальным центром медицинских услуг Венгрии была создана рабочая группа, в которую вошли представители из областей клинической медицины, фармакологии, общественного здравоохранения и управления услугами здравоохранения. Участники рабочей группы осуществили поиск, отбор, оценку и синтез актуальных данных научных исследований по данной проблеме, определили три варианта для ее решения и рассмотрели соответствующие аспекты их реализации. К рассмотрению были предложены следующие варианты: разработка национальной программы ответственного руководства в сфере антибиотиков, предусматривающей выпуск научно обоснованных клинических руководств по диагностике и лечению распространенных инфекционных заболеваний; усиление программ высшего и последипломного образования в области медицины, стоматологии и фармацевтики и организация обучения разумному использованию антибиотиков; и повышение осведомленности о разумном использовании антибиотиков с помощью информационных кaмпаний, инфоматериалов и межличностного общения.

Az antibiotikumok felelős alkalmazásának ösztönzése az antibiotikum-rezisztencia visszaszorítására a humán gyógyászatban Magyarországon: EVIPNet Europe Szakpolitikai bizonyíték-összefoglaló, 2. szám

Az Emberi Erőforrások Minisztériuma (EMMI) megbízásából, az Egészségügyi Világszervezet (WHO) Bizonyítékokkal Támogatott Szakpolitikai Hálózatának (EVIPNet) égisze alatt szakpolitikai összefoglaló készült, amely bizonyítékokkal alátámasztott beavatkozási opciókat mutat be a nem megfelelő antibiotikum-alkalmazás problémájának kezelésére Magyarországon. A munkát vezető hazai szakpolitikai intézetek és szakértők végezték, az EMMI és a WHO közötti kétéves együttműködési megállapodás keretében, a WHO Európai Irodájának szakmai támogatásával. Az Állami Egészségügyi Ellátó Központ által létrehozott munkacsoportban infektológus, gyógyszerész, epidemiológus és egészségügyi menedzsmenttel foglalkozó szakemberek vettek részt. A munkacsoport azonosította, értékelte és feldolgozta a problémával, három szakpolitikai opcióval és azok implementációs megfontolásaival kapcsolatos kutatási bizonyítékokat. A három opció a következő: (1) nemzeti antibiotikum stewardship program (ASP) kialakítása, a gyakori fertőzések diagnosztizálására és kezelésére vonatkozó, bizonyítékalapú klinikai ajánlásokkal; (2) az antibiotikumok felelős felírásának hangsúlyosabb oktatása a graduális és posztgraduális orvosi, fogorvosi és gyógyszerészi tanulmányok és képzések során; és (3) a figyelem felhívása a helyes antibiotikum-alkalmazásra tájékoztató kampányok, szórólapok és interperszonális kommunikáció segítségével.

Promoting the appropriate use of antibiotics to contain antibiotic resistance in human medicine in Hungary: EVIPNet evidence brief for policy, number 2

The Ministry of Human Capacities of Hungary commissioned a policy brief, to be published under the aegis of the WHO Evidence-informed Policy Network (EVIPNet) Europe, to develop evidence-informed options for the country to consider in tackling the problem of antibiotic misuse. The task was implemented in frame of the Biennial Collaborative Agreement (BCA) between the Ministry of Human Capacities and WHO, involving high level national policy institutions and national experts, supported by the technical experts of WHO Regional Office for Europe. The National Healthcare Service Center of Hungary convened a working group comprising representatives from the clinical field, pharmacology, public health and health care management. The working group identified, selected, appraised, and synthesized relevant research evidence on the problem, three options for tackling it and considerations in implementing them. The three options are: developing a national antibiotic stewardship programme, complemented by evidence-informed clinical guidelines on the diagnosis and treatment of common infections; strengthening undergraduate and postgraduate medical, dental, and pharmacy education and training on the prudent use of antibiotics; and raising awareness of prudent antibiotic use through information campaigns, leaflets and interpersonal communication.

[Examining the diagnostic accuracy of a new migraine screener]. / Új önkitöltos migrénszuro eszköz diagnosztikus hatékonyságának vizsgálata.

BACKGROUND: Migraine affects more than 10% of the Hungarian population, causes significant disability and severely affects patients' generic and condition-specific quality of life. Despite these facts, a significant proportion of patients is not diagnosed and not treated adequately. Headache centres can provide care for only a fraction of all patients. The task of primary care providers would be greatly simplified by a reliable self-administered migraine screening questionnaire. OBJECTIVE: To develop a short and reliable questionnaire as a migraine screening tool. METHODS: Outpatients at the Headache Service, Department of Neurology, Semmelweis University completed a self-administered questionnaire which contained 9 yes/no questions about their headaches' characteristics. The number of 'yes' answers (the patients' total score) was evaluated in connection with the diagnosis based on the International Headache Society criteria. We calculated the sensitivity, specificity, positive and negative predictive value as well as the misclassification rate for each total score value and used these to establish the final cutoff value of the questionnaire. 306 patients (242 females, mean age 39.1 ± 13.3 years) were enrolled. The diagnosis was migraine in 244. RESULTS: Completing the questionnaire did not pose any difficulty for the patients. At a cutoff value of 5 points the questionnaire's sensitivity was 0.96 and specificity was 0.61. The positive predictive value was 0.91 and the negative pre- dictive value was 0.81. The misclassification rate was 0.11. DISCUSSION: Our results show that the questionnaire may help the diagnosis of migraine. In order to use it in medical practice, its further evaluation is necessary on a large representative sample of the Hungarian population.

The validation of a new comprehensive headache-specific quality of life questionnaire.

BACKGROUND: Measuring quality of life (QOL) is an important means of assessing the impact of headache. The currently used QOL questionnaires are usually geared toward migraine and focus on a limited number of factors, thus they are not necessarily informative in other headache types. We report the psychometric properties of a new questionnaire, the Comprehensive Headache-related Quality of life Questionnaire (CHQQ) that may be more sensitive to the burden of headache. PATIENTS AND METHODS: A total of 202 patients suffering from migraine (n = 168) or tension-type headache (TTH) (n = 34) completed the CHQQ and SF-36, a generic QOL questionnaire. We assessed the reliability and validity of the CHQQ and its physical, mental and social dimensions. RESULTS: The questionnaire was easy to administer. Reliability was excellent with Cronbach's alpha being 0.913 for the whole instrument (0.814-0.832 for its dimensions). The dimensions and total score showed significant correlations with the patients' headache characteristics (criterion validity), and were also significantly correlated with the SF-36 domains (convergent validity). The total score and dimensions were significantly (p < 0.005) lower in the migraine group than in the TTH group (discriminative validity). CONCLUSION: In this study the new headache-specific QOL instrument showed adequate psychometric properties.

[Examining the psychometric properties of a new quality of life questionnaire in migraineurs]. / Uj életminoség-kérdoív pszichometriai tulajdonságainak vizsgálata migrénes betegek esetében.

BACKGROUND: The deleterious effect of primary headaches on the sufferers' quality of life (QOL) has been abundantly documented using both generic and headache-specific instruments. The currently used questionnaires focus on a limited number of factors and therefore may not be sensitive enough to detect the effect of headache type and headache characteristics on QOL, despite the obvious clinical differences. We have devised a comprehensive questionnaire that may be more sensitive to the burden of headache. OBJECTIVE: To assess the psychometric properties of the new questionnaire on a group of migraineurs. PATIENTS AND METHOD: We studied 117 migraineurs who completed the validated Hungarian version of the SF-36 generic QOL measure and our new, 25-item questionnaire. Reliability was assessed by internal consistency, measured by Cronbach's alpha of all items. Content validity was examined by calculating the correlation of the items with subscales of the SF-36 measure. The correlation of the patients' migraine characteristics with the questionnaire's items was used to assess criterion validity. RESULTS: The questionnaire was quick and easy to administer. The questionnaire demonstrated good reliability, with Cronbach's alpha being 0.893. Content validity was adequate; most "physical" items of the new questionnaire showed significant correlations with the bodily pain and role physical SF-36 subscales and most "psychical" and "social" items were correlated with mental health and social functioning SF-36 subscales. Criterion validity was adequate, with headache severity being correlated with most of the items. DISCUSSION: In this study the new headache-specific quality of life instrument showed adequate psychometric properties.

Cervical juxtafacet cyst combined with spinal dysraphism.

Juxtafacet cysts of the cervical and thoracic spine are rare and often cause radiculopathy or myelopathy. We present a case of a patient with radicular pain and early onset myelopathy. A juxtafacet cyst at the cervico-thoracic junction combined with discal herniation and spina bifida occulta was diagnosed with computed tomography (CT) and magnetic resonance imaging (MRI). Laminectomy with removal of the cyst was the treatment and the patient recovered rapidly.

One-and-a-half syndrome--two cases.

One-and-a-half syndrome is characterized by combination of the clinical features of unilateral horizontal gaze palsy and internuclear ophthalmoplegia. The common symptoms are double vision and oscillopsia. The lesion is located in the paramedian pontine reticular formation, involving the centre of horizontal gaze and medial longitudinal fasciculus. More extensive brainstem damage may result in additional neurological signs. The most frequent underlying diseases are vascular insults, multiple sclerosis, and brainstem tumor. We present two cases of one-and-a-half syndrome. Both patients had lacunar infarction in the paramedian pontine tegmentum, revealed by MRI. The first patient had isolated eye movement disorder, while the second had additional nuclear-type facial paresis. In the first case brainstem evoked potentials indicated brainstem damage, in the second patient it was normal. Ocular symptoms improved within some days in both patients.