Headache in Multiple Sclerosis: A Narrative Review.

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disorder of the central nervous system characterized by autoimmune-mediated damage to oligodendrocytes and subsequent myelin destruction. Clinical implications: Clinically, the disease presents with many symptoms, often evolving over time. The insidious onset of MS often manifests with non-specific symptoms (prodromal phase), which may precede a clinical diagnosis by several years. Among them, headache is a prominent early indicator, affecting a significant number of MS patients (50-60%). Results: Headache manifests as migraine or tension-type headache with a clear female predilection (female-male ratio 2-3:1). Additionally, some disease-modifying therapies in MS can also induce headache. For instance, teriflunomide, interferons, ponesimod, alemtuzumab and cladribine are associated with an increased incidence of headache. Conclusions: The present review analyzed the literature data on the relationship between headache and MS to provide clinicians with valuable insights for optimized patient management and the therapeutic decision-making process.

Effects of Immersive Virtual Therapy as a Method Supporting Recovery of Depressive Symptoms in Post-Stroke Rehabilitation: Randomized Controlled Trial.

Purpose: Depressive symptoms constitute an important group of mental problems that alter the course of post-stroke rehabilitation by reducing quality of life, physical activity, social functioning, and interpersonal relationships. Although several studies have shown the efficacy of virtual reality (VR) in the motor treatment of poststroke patients, there is a lack of studies that would also evaluate the impact of VR on psychological aspects. Thus, we investigated the effectiveness of immersive VR therapy on both functional activity and depressive symptoms in stroke survivors. Patients and Methods: We conducted a single blind, randomized controlled trial comparing VR therapy with Schultz's Autogenic Training (SAT). Patients randomized to the VR group received treatment in an immersive VR therapeutic garden with elements of psychotherapy and physical activity of the upper extremities, whereas patients in the control group received SAT. Additionally, patients in both groups received standard neurological rehabilitation. The full research cycle lasted six weeks. We used Geriatric Depression Scale, Generalized Self-Efficacy Scale, Acceptance of Illness Scale, Visual Analogue Scale of pain, Hospital Anxiety and Depression Scale, Barthel Index, Lawton Instrumental Activities of Daily Living Scale and Rivermead Motor Assessment for outcome assessment. This trial was registered with ClinicalTrials.gov (NCT03830372). Results: We assessed 60 patients and randomly assigned to the VR or control group. The VR group showed a significant reduction in depressive symptoms (ηp2 = 0.13, p < 0.01) compared to SAT. The applied VR therapy significantly increased the sense of self-efficacy and the level of acceptance of the illness; however, this effect was similar to that obtained with the standard intervention. We did not observe statistically significant changes in the functional parameters of post-stroke patients. Conclusion: The use of VR therapy combined with neurological rehabilitation had a positive effect on improving mood and reducing depressive symptoms in post-stroke patients.

No association between MRI changes in the lumbar spine and intensity of pain, quality of life, depressive and anxiety symptoms in patients with low back pain.

INTRODUCTION: The association between changes in magnetic resonance imaging (MRI) and clinical symptoms in patients with low back pain (LBP) is unclear. AIM: To evaluate correlations between combined MRI findings of the lumbar spine (LS) and pain intensity, depressive and anxiety symptoms and quality of life in patients with LBP. MATERIAL AND METHODS: 200 subjects (93 men and 107 women; mean age 51.42 ± 13.21 years) with LBP referred for MRI were enrolled in the study. All patients completed the Hospital Anxiety and Depression Scale (HADS), Quality of Life Scales (EQ-5D, EQ-VAS) and the Visual Analogue Scale (VAS). MRI scans were assessed according to a scoring system prepared by the authors, and the total MRI score was calculated. RESULTS: The mean total MRI score was 11.59 ± 6.73 points (range 0-50 points) and was higher in men than in women (p = 0.015). A correlation was observed between total MRI score and age (p < 0.001) and between total MRI score and BMI (p = 0.005). An association was found between total MRI score and EQ-5D (p = 0.012) and HADS-D results (p = 0.003). VAS and HADS-A results did not correlate with MRI score. When multivariate analysis was done, the total MRI score was only significantly related to age and BMI, and association between the total MRI score and EQ-5D or HADS-D results was not confirmed. Decreased quality of life was associated with increased intensity of pain and depressive and anxiety symptoms. CONCLUSIONS: Combined MRI changes in LS do not correlate with pain intensity, depressive and anxiety syndromes or quality of life in patients with LBP.

[Sexual quality of life in patients with low back pain and the radiological changes evaluated in magnetic resonance].

OBJECTIVE: Introduction: Literature data concerning the association between the back pain syndrome and the quality of sexual life are rare, especially in the Polish literature. There are also no reports on the association between magnetic resonance (MRI) results and sexual satisfaction in patients with low back pain (L-S). The aim: To assess the association between the severity of degenerative-discopathic changes in the MRI of L-S spine and the quality of sexual life in patients with low back pain. PATIENTS AND METHODS: Materials and methods: The study involved 200 patients (107 women and 93 men), referred for MRI of the L-S spine due to the back pain syndrome. The assessment of satisfaction with sexual life at present and before the disease was made by the self-constructed questionnaire and with the use of the Question No. 8 of the Oswestry Questionnaire (ODI). In addition, the VAS (Visual Analogue Scale) was used. MRIs were analyzed based on the author's scoring scale, assessing selected radiological changes at levels L1-S1. The total score was in the range of 0-50 points. RESULTS: Results: There was a statistically significant decrease in the quality of sexual life (8.9 points vs 6.3 points) (<0.001). Back pain did not affect sexual life only in 36.9% of respondents. 26.5% patients were sexually inactive, 7.5% of them declared that pain was the reason for this. There was no statistically significant correlation between the intensity of radiological changes and satisfaction with sexual life. CONCLUSION: Conclusions: Back pain affects the patients' sexual life. There was no association between the severity of degenerative-discopathic changes assessed in the MRI and the quality of sexual life in patients with L-S back pain syndrome.

[The neuroprotective effect of mild therapeutic hypothermia after out-of-hospital cardiac arrest with successful reanimation - a case report]. / Neuroprotekcyjne dzialanie lagodnej hipotermii terapeutycznej po pozaszpitalnym zatrzymaniu krazenia ze skuteczna reanimacja - opis przypadku.

The use of mild therapeutic hypothermia (MTH) in adult patients remaining in a coma following cardiac arrest, regardless of its mechanism and location, is recommended by the European Resuscitation Council. The study presents a case of a 52-year-old man in whom MTH was used following successfully resuscitated out-of- hospital sudden cardiac arrest caused by ventricular fibrillation. On the basis of this case it was indicated that the use of low temperatures may be an effective method of neuroprotective treatment since such activity is compatible with later observed great possibility of the brain to compensate and with the maintenance of brain plasticity which is crucial for neuropsychological rehabilitation.

The effects of mirror therapy on arm and hand function in subacute stroke in patients.

The aim of this study was to evaluate the effect of mirror therapy on arm and hand function in subacute stroke in patients. The study included 60 hemiparetic right-handed patients after ischemic stroke 8-10 weeks after onset. They underwent stationary comprehensive rehabilitation in the rehabilitation centre. They were divided into two randomly assigned groups: mirror (n=30) and control (n=30). For both groups, two subgroups were created: one that included patients with right arm paresis (n=15) and the other that included patients with left arm paresis (n=15). The mirror group received an additional intervention: training with a mirror for 5 days/week, 2 sessions/day, for 21 days. Each single session lasted for 15 min. The control group (n=30) underwent a conventional rehabilitation program without mirror therapy. To evaluate self-care in performing activities of daily living, the Functional Index 'Repty' was used. To evaluate hand and arm function, the Frenchay Arm Test and the Motor Status Score were used. Measurements were performed twice: before and after 21 days of applied rehabilitation. No significant improvement in hand and arm function in both subgroups in Frenchay Arm Test and Motor Status Score scales was observed. However, there was a significant improvement in self-care of activities of daily living in the right arm paresis subgroup in the mirror group measured using the Functional Index 'Repty'. Mirror therapy improves self-care of activities of daily living for patients with right arm paresis after stroke.

Facilities of early rehabilitation after stroke in Poland 2010.

The aim of this work was to survey the contemporary facilities for early poststroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for poststroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging healthcare planners to look for new organizational solutions of services that could enable rehabilitation as early as possible after disease onset. Early poststroke rehabilitation includes many elements that provide for early-onset rehabilitation and its continuation after discharge from the stroke unit. Two questionnaires evaluating neurorehabilitation of individuals who had stroke were designed and distributed: the first questionnaire was distributed to 221 neurological wards and the second questionnaire was distributed to 154 rehabilitation departments in Poland. We obtained information about delay before admission from neurological wards to rehabilitation departments, the number of sessions per day, the time duration of one session, the number of sessions per week, the average length of stay in department, the methods of outcome measurement, etc. We sent out 375 questionnaires and received 129 (35%) responses, 78 from neurological wards and 51 from rehabilitation departments. Only 25% of all patients were moved from neurological wards to the rehabilitation department after stroke (15% directly). Of those moved to rehabilitation departments, only 54% were treated early after stroke; that is, within 3 months of stroke. Considering that about half of stroke survivors will require rehabilitation (30 days after stroke onset), the current facilities of early poststroke rehabilitation in Poland cannot meet this need. We should do our best to introduce rehabilitation services such as early home-supported discharge after stroke, which is currently not available in Poland. Although we have focused on resources in Poland, we anticipate that similar patterns may be found in other countries in the region.