Favorite colors of patients with drug-resistant epilepsy: pilot study.

OBJECTIVE: To evaluate the favorite colors of patients with drug-resistant epilepsy. METHODS: Following examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drugresistant epilepsy since 2010. The favorite color examination used a six-color tape and Trycolors, an online color mixing tool. The patients' color preferences were compared with those of 50 individuals without epilepsy. RESULTS: Patients with drug-resistant epilepsy preferred the color blue the most (30%), significantly more yellow (p = 0.0001), and significantly less green (p < 0.0001) compared to individuals without epilepsy. By mixing these colors at a certain percentage, we obtained the Go Ben color. SIGNIFICANCE: This information on preferred colors can help to improve compliance and can be utilized in designing medications and environments for patients with epilepsy.

Memory efficiency in patients with drug-resistant epilepsy.

OBJECTIVE: To evaluate memory in patients with drug-resistant epilepsy. METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). CONCLUSION: Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

Major epidemiological features of first-ever ischemic stroke in Tuzla Canton, Bosnia and Herzegovina.

BACKGROUND AND AIMS: Opacity of data on stroke for Bosnia and Herzegovina (B&H) is mainly due to the lack of a unified national stroke registry. This article aims to present updated epidemiological data on the etiology and risk factors for first-ever ischemic stroke in Tuzla Canton, B&H. METHODS: This retrospective hospital-based study included all first-ever ischemic stroke patients admitted between January 1, 2018 and December 31, 2018 at the Neurology Department, University Clinical Center Tuzla. RESULTS: First-ever ischemic stroke was diagnosed in 739 patients. Leading risk factors were hypertension (94%), diabetes mellitus (40.7%), and dyslipidemia (38.8%). The most common stroke subtypes were atherothrombotic (36.8%), cardioembolic (21.9%), and stroke of undetermined etiologies (19.2%). Mean NIHSS score at discharge was 13 (IQR 2-16), and favorable patient outcome (mRs ≤2) was recorded in 26.4% patients. Men (aOR 0.39; 95% CI 0.24-0.64) and younger patients (aOR 0.96; 95% CI 0.93-0.98) had significantly higher probability of having a favorable outcome at discharge. Dyslipidemia could be considered as a predictive factor for patient outcome (aOR 0.66; 95% CI 0.43-1.00). CONCLUSIONS: More than 92% of our patients had at least one modifiable risk factor, with hypertension and diabetes being at the forefront. One out of four patients had become functionally independent at discharge, while hospital mortality was lower than in other Eastern European countries. The overarching goal should be steered toward the development of a national stroke registry, which should be used as a reference for all further stroke management activities.

Acute Stroke Patients with Sleep Apnea Acording to the Disability and Incidence of Relapse.

BACKGROUND: Sleep is a complex process involving the interactions of several brain regions, which play a key role in regulating the sleep process, particularly the brainstem, thalamus, and anterior basal brain regions. The process of sleep is accompanied by a change in body functions, as well as a change in cerebral electrical activity, which is under the control of the autonomic nervous system. OBJECTIVE: The aim of the study was to analyze the frequency of stroke recurrence and disability of patients with stroke and apnea. METHODS: It was analyzed 110 acute stroke patients with sleep apnea. All patients were evaluated with: Glasgow scale, The American National Institutes of Health Scale Assessment, Mini Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale, and The general sleep questionnaire. RESULTS: The largest number of patients with apnea on admission had a degree of disability of 4, and on discharge of 1. There was a statistically significant difference between the mean values of incapacity for admission and discharge. The student's t - test did not determine a statistically significant difference in disability according to the Rankin scale between patients with and without apnea at admission (t = 0.059, p = 0.95) and discharge (t = 0.71, p = 0.48). According to the NIHS scale, patients of both sexes with apnea had a neurological deficit of 7.55 ± 5.22 on admission and 7.1 ± 4.3 without apnea. Statistically significant difference was not found on the neurological deficit of both sexes, with and without apnea, at admission and discharge. With apnea, there were 13 relapses of stroke during one year, and without apnea in only 3 patients. CONCLUSION: Patients with acute stroke have a significantly higher correlation rate according to sleep apnea. There is no significant correlation in the degree of disability between patients with and without apnea.

Does Sleep Apnea Affect the Outcome of Stroke Patients?

BACKGROUND: Sleep apnea is described as an isolated risk factor for stroke or recurrent stroke which could be cause of death. In our study, the aim was to determine whether sleep apnea affects the outcome of stroke patients. SUBJECTS AND METHODS: This is a prospective study in which a group of 110 patients in the acute phase of a stroke was evaluated sleep apnea. Acute stroke has been diagnosed either by computed tomography and magnetic resonance imaging of the brain. There was no significant difference in patient's age with or without sleep apnea neither in men nor women. Neurological, neuropsychiatric, pulmonary test were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow scale, The American National Institutes of Health Scale Assessment, Mini Mental Test, The Sleep and snoring Questionnaire Test, The Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale and The general sleep questionnaire. RESULTS: One year after the onset of stroke, 91 (82.7%) of 110 patients with apnea survived. The survival rate of patients with sleep apnea is significantly lower than without sleep apnea (p=0.01). In men with apnea, the survival rate was significantly lower in patients without apnea (p=0.004). The largest number of survivors of apnea had diabetes mellitus, followed by survival of patients with heart disease, body mass index >29 kg/m2 and hypertension, with hyperlipoproteinemia and smoking. The highest number of survivors without apnea was body mass index >29 kg/m2, followed by survival of patients with hyperlipoproteinemia, heart disease, hypertension, smoking, and diabetes mellitus. CONCLUSION: Patients with sleep apnea have a significant correlation in survival rates compared with sexually and age-matched subjects, associated with concomitant risk factors such as hypertension, body mass index, and smoking.

Cognitive Functionality of Patients with Delirium after Stroke.

BACKGROUND: Delirium is a syndrome that occurs in all age groups and in many clinical departments, and is most common in intensive care units. It is an emergency, in the overlapping fields of somatic medicine, neurology and psychiatry. Delirium occurs suddenly, dramatically, and requires a quick reaction, recognition and treatment. There are only a small number of studies that have reported delirium after a stroke. In our study, the goal was to determine the cognitive functionality of patients with delirium after a stroke. SUBJECTS AND METHODS: This is a prospective study in which a group of 100 delirium patients in the acute phase of a stroke were evaluated for cognitive function. The control group consisted of the same number of patients with acute stroke who were not diagnosed with delirium. Neurological, neuropsychiatric and neuropsychological tests were performed in all patients at five different time periods. In these time periods, all patients were evaluated: Glasgow Coma Scale; Delirium Assessment Scale; The American National Institutes of Health Scale Assessment; Information-Memory-Concentration test; Dementia Score; Mini-Mental Test. The findings of computed tomography of the brain and magnetic resonance imaging of the brain were interpreted by a radiologist who was not familiar with the goals of this study. RESULTS: Cognitive functioning of delirious patients is statistically significantly worse after three and six months, and one year from stroke compared to those without delirium. There is no statistically significant difference in cognitive functioning between delirious patients in relation to gender, age, location and type of stroke and patients without delirium throughout one year from stroke. There is no significant difference in cognitive functioning between delirious patients during one year from stroke in relation to severity and type of delirium, and statistically significantly higher degree of cognitive dysfunction has those older than ≥65 years. CONCLUSIONS: Delirium significantly reduces the cognitive functioning of patients after a stroke.

Others Are to Blame (Displacement in patients with drug-resistant epilepsy).

OBJECTIVE: To evaluate the defense mechanisms (DM) in patients with drug-resistant epilepsy and, to determine whether displacement is associated with seizures. SUBJECTS AND METHODS: Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humor, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The values were compared with 50 subjects without epilepsy. RESULTS: Patients with drug-resistant epilepsy use immature defensive styles significantly more (p=0.0010). Displacement have a positive correlation with frequency of seizure (p=0.0412). CONCLUSION: Blaming others is a characteristic of the behavior of patients with drug-resistant epilepsy, especially if they have seizures. As such, they may be less adaptable in a micro social environment.

Risk Factors in Acute Stroke Patients With and Without Sleep Apnea.

BACKGROUND: More than 50% of stroke patients have sleep-disordered breathing (SDB), mostly in the form of obstructive sleep apnea (OSA). SDB represents both a risk factor and a consequence of stroke. The presence of SDB has been linked with the poorer long-term outcome and increased long-term stroke mortality. About 20 to 40% of stroke patients have sleep-wake disorders (SWD), mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). OBJECTIVE: The aim of this study was to analyze the frequency of risk factors in patients with acute stroke and sleep apnea. METHODS: The study included patients without cognitive impairment or with mild cognitive impairment. The diagnosis of apnea syndrome was made on the basis of the Snoring and Apnea Syndrome Questionnaire, the Epworth Sleep Scale, the Berlin Questionnaire, the Stanford Sleepiness Scale, and the General Sleep Questionnaire. The severity of stroke was assessed by the National Institutes of Health Stroke Scale and the Rankin Disability Scale. Patients with a Glasgow score <8 on the day of neuropsychiatric examination were excluded from the study, as well as patients with epileptic seizures at the onset of stroke, with aphasia, with Mini - mental test <23, with verified previous dementia / cognitive impairment. RESULTS: There is no statistically significant difference in the age of men and women, both with apnea and without apnea. In patients with apnea, heart disease was in the first place 91.8%, followed by hypertension 86.4%, Body mass index 79.1%, hyperlipidemia 50%, smoking 38.2 % and diabetes mellitus 20.9%. Hypertension was the most common risk factor in patients without apnea 83.6%, followed by heart disease 81.0%, Body mass index 60.9%, hyperlipidemia 48.21%, smoking 28.2 % and diabetes mellitus 20%. CONCLUSION: Heart diseases, hypertension and body mass index are significantly more frequent in patients with than in patients without sleep apnea.

Oleh Hornykiewicz (1926-2020): Sixty Years since the Pioneering L-DOPA Application - One Year since the Death of the Pioneer.

Oleh Hornykiewicz was born on November 17, 1926 in Lamberg, Ukraine. After completing his studies in July 1951, he moved to the "Pharmacological Institute of the University of Vienna". In 1958, he started his research on centrally acting drugs at the same institute and came up with the idea of linking laboratory observations with animals with the basal ganglia of the human brain. Soon, Hornykiewicz initiated a new question: L-DOPA as a therapy for Parkinson's disease? Fortunately, after administration of this new drug, patients were able to perform motor activities which could not be prompted to any comparable degree by any known drug. In the following decades, initial fiction became an unavoidable fact. Dopamine, adapted and combined with carbidopa or benzerazide, has evolved into a drug that no longer recognizes the borders of countries and continents. Distinguished emeritus prof. Oleh Hornykiewicz died on May 26, 2020 at the age of 93 in Vienna, Austria. Unfortunately, despite everything he has done and deserved, the Nobel Prize was not received.

Cognitive Disorders in Patients with Multiple Sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Cognitive disorders are found in over 50% of patients. AIM: The aim of the study was to determine the distribution of cognitive disorders in people with MS. METHODS: The prospective study included 135 respondents with MS and 50 healthy respondents. The respondents were divided into three groups: the first group consisted of 85 respondents where the disease lasted longer than one year, the second group consisted of 50 respondents with newly diagnosed MS, the third group consisted of 50 healthy respondents. Clinical assessment instruments were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Battery of Tests to Assess Cognitive Functions: Wechsler Intelligence Scale, Revised Beta Test, Raven Colored Progressive Matrices, Wechsler Memory Scale, Rey Audio Verbal Learning Test -Osterriecht's complex character test, verbal fluency test. RESULTS: Cognitive disorders were present in 40-60% of respondents with MS. Visuospatial, visuoconstructive and visuoperceptive functions are worse in the first group. Mnestic functions (learning process, short-term and long-term memory, recollection, verbal-logical memory) were most affected in both groups of respondents, ranging from 30-60%. Poorer cognitive domains are in the first groups of respondents. Immediate working process memory (current learning), memory, attention, short-term and logical memory is worse in the examinees of the first group. At the beginning of the disease, 16% had verbal fluency difficulties, and as the disease progresses, the difficulties become more pronounced. CONCLUSION: Cognitive disorders are heterogeneous, they can be noticed in the early stages of the disease. They refer to impairments of working memory, executive functions and attention, while global intellectual efficiency is later reduced.

Contributing Factors to the Quality of Life in Multiple Sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). Quality of life (QoL) refers to the perception of an individual's life in the context of the system of culture and values in which they live. AIM: The aim of the study was to determine the distribution of cognitive disorders in people with MS. METHODS: The prospective study included 135 participants with MS and 50 healthy participants. Participants were divided into three groups: the first group consisted of 85 participants where the disease lasted longer than one year, the second group consisted of 50 participants with newly diagnosed MS, the third group consisted of 50 healthy participants. The instruments of clinical assessment were: Extended Disability Score in Multiple Sclerosis Patients, Mini Mental Status, Beck Depression Scale, and Quality of Life Scale (SF-36, Contemporary Health Survey). RESULTS: The quality of life related to health is impaired in the physical, mental dimension and overall quality of life. In the first group of participants, 62% had mild depression, and in the second group 38% of participants, while more severe forms were recorded in 16% of participants in both groups. As depression increases, the quality of life decreases in all measured dimensions, which would mean that depression negatively affects the quality of life. The results of all dimensions as well as the overall quality of life score are worse with the increase in the degree of clinical disability, for both groups of study patients. CONCLUSION: Quality of life is impaired in MS patients, and a higher degree of clinical disability and an increase in depressive disorder are predictors of deteriorating quality of life in MS patients.

Post-Stroke Depression.

INTRODUCTION: The depression is a common mental disorder, especially after a stroke, which further aggravates the recovery. AIM: To analyze depression within 48 hours and fifteen days after ischemic stroke in relation to gender and location (brain hemisphere and brain circulation). METHODS: We analyzed 40 patients (65.3±10.3 years), half of them were women. Mean age of women was 66.35±7.31 years and men 64.2±12.68 years (p= 0.5). Ischemic stroke was verified by computed tomography. Levels of depression were measured with self-estimated Zung's scale. On the tests, score of 50 and higher verified depression. Criteria made by Domasio were used to determine location of the IS. RESULTS: Mean value on depression scale in acute phase of ischemic stroke was 46.85 ± 8.6 and in subacute phase 43.4 ± 8 (p =0.06). In 19 (47.5%) patients (55% of women, 40% of men; p=0.3) depression was found during the first and in 10 (25%) patients (35% of women, 15 % of men; p=0.06) during the second evaluation (p<0.019). Mean value on depression in acute phase of illness in women was 49.1 ± 7.38, as well as in men 44.6 ± 9.22 (p=0.088) and in subacute phase in women 45.25 ± 8.04, as well as in men 41.5 ± 7.75 (p=0.16). Concerning location of ischemic stroke, there were no significant differences in levels of depression. CONCLUSION: Number of patients with post-stroke depression is significantly lower in subacute phase of ischemic stroke. Although the number of depressive women and their depression scores are higher, gender differences are not statistically significant. There is no correlation between post-stroke depression and location of lesion in acute and subacute phase of illness.

Ego Defence Mechanisms in Patients with Epilepsy.

BACKGROUND: In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS: We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS: Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION: Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

Mortality and Functional Disability of Poststroke Delirium.

INTRODUCTION: Small number of studies have evaluated the mortality and the degree of functional disability of post-stroke delirium, and our aim was to determine that. PATIENTS AND METHODS: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glasgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. RESULTS: Delirious patients had a significantly higher mortality (p = 0.0005). As opposed to the type of stroke mortality was higher after ischemic (p = 0.0005). The patients without delirium had significantly better cumulative survival during the first year after stroke (p = 0.0005). Delirious patients aged ≥65 years had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). In relation to the type of stroke delirious patients with ischemic had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). Delirious patients had a greater degree of functional impairment at discharge (p = 0.01), three (p = 0.01), six months (p = 0.01) and one year (p = 0.01) after stroke. CONCLUSION: Delirious patients have a significantly higher mortality, lower cumulative survival and a greater degree of functional disability in the first year after stroke.

Cognitive syndromes after the first stroke.

AIM: The aim of this study is to determine impairments of certain cognitive functions in certain vascular cognitive syndromes and to identify predictors of dementia. PATIENTS AND METHODS: One-year prospective study included 275 patients, who were hospitalized at the Department of Neurology Tuzla and therefore fulfilled certain criteria. Patients were divided into following subgroups of vascular cognitive impairment (VCI): dementia of strategic infarct (DSI), cortical dementia (CD), sub cortical dementia (SCD), hemorrhagic dementia (HD), and patients without dementia. Each of the patients underwent the clinical examination and scoring with appropriate measurement scales. RESULTS: Some of the types of VCI were verified in 190 (69%) patients, and the most common was SCD (58%). There was statistically significant connection between the level of intelligence and occurrence of VCI in patients after stroke (p < 0.001). We found significant connection between occurrence of dementia and impairment in narrative memory, numerical memory, visual perceptive, and visual constructive functions in patients with dementia compared with non-demented (p = 0.0001). The executive functions were statistically impaired in patients with CD (p = 0.004) and SCD (p < 0.001). Patients without dementia have significantly better quality of life than the demented ones (p < 0.0001). The algorithm "tree of decision" can help us in the prediction of dementia based on the impairment of certain cognitive functions. CONCLUSION: Vascular cognitive syndromes are common after stroke. Some of the cognitive functions are significantly impaired in patients with dementia. Impairment of the certain cognitive functions can help in predicting the onset of dementia. Patients without dementia have better quality of life.