[Movement analyzing devices for assessing the actual state of patients with movement disorders]. / Mozgásérzékelô eszközök neurológiai betegségben szenvedôk aktuális állapotának elemzésére.

Movement analysis gives valuable information on the actual state of patients. Based on it, the early diagnosis and objective assessment of the progress of several diseases can be helped. Our research work has been focused on developing clinically applicable movement analyzing devices.

Decreased frequency of the TNF2 allele of TNF-alpha -308 promoter polymorphism is associated with lacunar infarction.

BACKGROUND AND PURPOSE: Enhanced release of proinflammatory cytokines may contribute to the pathogenesis of stroke. It was examined whether G to A promoter polymorphism in the tumor necrosis factor-alpha gene at position -308 affects the risk of stroke. METHODS: We genotyped 336 patients with ischemic stroke and 333 healthy controls for this polymorphism. Patients were divided into different groups based on the Oxfordshire Community Stroke Project (OCSP) or a modified TOAST classification. Distribution of the alleles at -308 G>A promoter polymorphism was determined by PCR-RLFP method. RESULTS: Patients with ischemic stroke had a significantly (p<0.001) decreased (0.115) frequency of the -308 A (TNF2) allele compared to the healthy controls (0.196). When patients were categorized according to the OCSP classification, it turned out that significant (p=0.002) decrease in TNF2 allele frequency (0.065) was restricted to the patients with lacunar infarct (LACI) whereas the frequency of the TNF2 alleles in patients with the other three subtypes (TACI, PACI, and POCI) did not significantly differ from that in healthy controls. Similar results were obtained when the patients were divided according to the modified TOAST classification: the frequencies of the TNF2 allele were 0.068 and 0.140 (p=0.010) in the patients with small-vessel and non-small vessel (large vessel infarction or ischemic stroke of other origin) infarction, respectively. The age-adjusted odds ratio of the patients carrying the TNF2 allele to develop lacunar infarct was 0.33 (0.16-0.68) (p=0.002) compared to the non-carriers. This difference was also restricted to the male patients. CONCLUSIONS: Our results suggest that male carriers of TNF2 allele are less susceptible for the development of lacunar subtype of ischemic stroke than the non-carriers.

[Clinical effectiveness and safety of paroxetine in post-stroke depression: results from a phase 4, open label, multicenter clinical trial with 26 weeks of follow-up]. / A paroxetin klinikai hatékonysaga és biztonságossága stroke-ot követo depresszióban: 4. fázisú multicentrikus, nyílt, 26 hetes utánkövetéses klinikai vizsgálat eredményei.

INTRODUCTION: Prevalence of post-stroke depression ranges from 20% to 50%. Treatment of depression positively correlated with the success of rehabilitation, quality of life, and the post-stroke patient's independence. AIM: The primary goal of the study was to establish the therapeutic efficacy of paroxetine (measured by the changes of Hamilton Depression Scale Score) in post-stroke depression. Secondary outcomes were changes in clinical status (based on Clinical Global Impression), alterations of mental capabilities (by Mini-Mental State Examination) and changes in quality of life (based on Quality of Life values). METHOD: An estimation of the efficacy of paroxetine treatment of 788 patients with post-stroke depression (Hamilton Depression Scale Score > 18) was performed in an open-label phase IV multicenter trial, during a clinical (8 weeks) as well as a follow-up period (a total of 26 weeks). The applied doses of paroxetine were: 20, 30 or 40 mg per day, subject to their therapeutic effect. RESULTS: On the third week of the study (i.e.: at the 2nd visit) the mean Hamilton Depression Scale Score decreased significantly to 12.3 points; from a starting mean basic score of 24.8 points. At the conclusion of the clinical phase (by the end of the 8th week) we found an Hamilton Depression Scale Score of 8.6 points, which decreased further to 6.6 points by the end of the follow-up period (i.e.: the 26th week). At the end of the 3rd week 92% of the patients stated that paroxetine was effective while this number grew to 93.1% by the end the 8th week. Events related to secondary outcomes also showed significant improvements of similar size: by the end of the 8th week the clinical status of 92.8% of the patients improved (in 81.3% by a remarkable rate); mental output of the patients (based on Mini-Mental State Examination) grew significantly from a starting score of 26.7 to 27.9 and their Quality of Life values grew from 204 points to 238 points by the end of the 8th week and by the end of the 26th week it reached to 251 points; another indication of a significant improvement of their quality of life. In the course of the study 8.21% of the patients experienced side effects; the most frequent of these were: nausea/vomiting, dizziness, headaches and diarrhea. Serious adverse events occurred in 1.9% of the patients during the 26 weeks period of the study although these were unrelated to the taking of paroxetine. In the course of the study the patients' compliance was clearly good: by the end of the 8th week 94%, at the end of the 26th week 90.7% of them reported for control visitation, in other words, during the 6 months study their dropout rate was less than 10%. CONCLUSION: the selective serotonin-reuptake inhibitor paroxetine effectively improved the symptoms of depression, the functional and cognitive performance, as well as the quality of life of patients with post-stroke depression. The drug was safe and well tolerable.

Analysis of finger-tapping movement.

The piano-playing-like finger-tapping movement has been analyzed with a precision image-based motion analyzer (PRIMAS). 32 healthy subjects (148 recordings) and 10 Parkinsonian patients (25 recordings) were tested. The tracking of fingers during the whole movement increased the level of information obtained from the finger-tapping test compared to visual observation or to measurement with simple contact sensors. Different feature extraction methods have been developed to evaluate the movement and thus the actual performance of the tested person. The reliability of a novel parameter, the finger-tapping test score (FTTS), that takes into account both the speed and the regularity (periodicity) of finger-tapping, was assessed in six control subjects, with four subjects tested at least 14 times. FTTS helps in staging of Parkinsonian patients. A simple and cheap device (passive marker-based analyser of movement, PAM) has been developed that is affordable for routine clinical use.