[DYSFUNKCJA AUTONOMICZNEGO UKLADU NERWOWEGO W PADACZCE Dysfunction of the autonomic nervous system in epilepsy OPISY PRZYPADKU / CASE REPORTS].

Generalized or partial epileptic seizures may be accompanied by autonomic dysfunction. They may also take the form of self-inflicted seizures or be present during interictal period. Arrhythmias, resulting in haemodynamic disturbances in the circulatory system and prolonged hypoxia of the central nervous system, may itself provoke secondary episodes of seizure morphology. The doctor when diagnosing patients with epileptic seizures should always be aware of the potential for cardiogenic disorders. Consideration should be given to the effect of epilepsy on the structure of the autonomic nervous system, the effect of antiepileptic drugs, and the potential for mutations within the ion channels.

[Genetically determined abnormal electrical activity of the brain and the heart].

Mutations leading to disorders within ion (mainly potassium and sodium) channels, have different degrees of expression in the brain and in the heart, which can cause simultaneous occurrence of disorders in both organs. This is manifested by the occurrence of epileptic seizures and cardiac electrical disturbances, further exacerbated by stimulation of autonomic structures within the central nervous system. In all patients with unclear paroxysmal disorders, and in those with unexplained sudden cardiac death, consideration should be given to the possibility of occurrence of genetically determined disorders in the ion channels. This article concerns the most common genetically determined epilepsy syndromes and genetically determined cardiac diseases.

Interictal heart rate in patients with epilepsy.

INTRODUCTION: Electrocardiographic abnormalities in patients with epilepsy are related to the presence of discharges in central autonomic structures and the effect of antiepileptic drugs. These patients are at risk for sudden unexpected death, and cardiac arrhythmias are one of the most probable causes related to it. THE AIM: The heart rate (HR) assessment recorded on electrocardiography (ECG) in the interictal period in patients with newly diagnosed and previously treated epilepsy, depending on the type of changes in electroencephalography (EEG) and the treatment option. MATERIAL AND METHODS: Fifty patients with epilepsy were enrolled in the study: 22 comprised a non-treated patient (NTP) group with newly diagnosed epilepsy and 28 comprised a treated patient (TP) group that had been treated for more than 2 years. Resting ECG and EEG were performed in all patients. RESULTS: A significantly higher HR was recorded in the TP group compared to the NTP group (80±13 vs 67±15 bpm, p=0.00006). The tendency to higher HR was observed in polytherapy patients, carbamazepine patients and in patients with a focus in the right hemisphere. CONCLUSIONS: There is a relationship between the presence of the disorders related to bioelectric activities of the brain and the heart, therefore the ECG should be periodically monitored in epileptic patients.

Interictal heart rate in patients with epilepsy.

INTRODUCTION: Electrocardiographic abnormalities in patients with epilepsy are related to the presence of discharges in central autonomic structures and the effect of antiepileptic drugs. These patients are at risk for sudden unexpected death, and cardiac arrhythmias are one of the most probable causes related to it. THE AIM: The heart rate (HR) assessment recorded on electrocardiography (ECG) in the interictal period in patients with newly diagnosed and previously treated epilepsy, depending on the type of changes in electroencephalography (EEG) and the treatment option. MATERIAL AND METHODS: Fifty patients with epilepsy were enrolled in the study: 22 comprised a non-treated patient (NTP) group with newly diagnosed epilepsy and 28 comprised a treated patient (TP) group that had been treated for more than 2 years. Resting ECG and EEG were performed in all patients. RESULTS: A significantly higher HR was recorded in the TP group compared to the NTP group (80±13 vs 67±15 bpm, p=0.00006). The tendency to higher HR was observed in polytherapy patients, carbamazepine patients and in patients with a focus in the right hemisphere. CONCLUSIONS: There is a relationship between the presence of the disorders related to bioelectric activities of the brain and the heart, therefore the ECG should be periodically monitored in epileptic patients.

[Psychometric and neurophysiological assessment of cognitive functions in patients with epilepsy].

BACKGROUND: The aim of the study was to assess cognitive functions in patients with epilepsy using the neurophysiological method and psychological tests, and analysis the relationship between clinical features of the disease and test results. MATERIAL AND METHODS: The study included 31 patients with epilepsy aged 37.3±18.4 years. The control group consisted of 40 healthy volunteers aged 33.5±12.2 years. Cognitive functions were assessed using endogenous evoked potential P300 and psychological tests - Mini-Mental State Examination (MMSE), three subtests of Wechsler Adult Intelligence Scale-Revised (WAIS-R), Trail Making Test (TMT), Benton Visual Retention Test (BVRT) and State-Trait Anxiety Inventory (STAI). RESULTS: Epileptic patients achieved significantly lower scores in all, except STAI-1, psychological tests in relation to the controls. A correlation between age and TMT-A (p<0.050) and BVRT (p<0.050) was observed. The disease duration affected results of MMSE (p<0.050), TMT-B (p<0.050) and BVRT (p<0.050). Type of seizures was related to results of MMSE (p=0.005), type of therapy - to results of STAI-1 (p=0.014) and TMT-B (p=0.008). The average latency of P300 was significantly prolonged (p=0.00003) in epileptic patients (348±38ms) in relation to the controls (324±26ms). The relationship between P300 and the duration of seizures (p=0.017) was observed. There was no correlation between P300 and age, sex, frequency and type of seizures and therapy. A correlation between P300 and TMT-B (p<0.050), BVRT-LPO(p<0.050) and STAI-1 (p<0.050) was noticed. CONCLUSION: In epileptic patients cognitive impairment is often found. It is advisable to perform regular neuropsychological testing; P300 can be used only as a preliminary assessment.

Secondary prevention of stroke in elderly people in Poland--results of PolSenior study.

BACKGROUND AND PURPOSE: The purpose of the study was to evaluate the frequency of use of oral antiplatelet (OAP) and anticoagulant (OAC) drugs as secondary stroke prevention among older people in Poland and its association with sociodemographic factors, place of residence, and concomitant cardiovascular risk factors. MATERIAL AND METHODS: The study group consisted of 426 subjects with a history of a previous stroke (mean age of 81.5±8.2 years), participants of multicentre, population-based PolSenior study. RESULTS: Among the study group, 261 people (61.3%) used at least one drug as a secondary prevention. OAPs were regularly used by 237 people (55.6%), and OACs-by 25 people (5.9%). The most often used drug was acetylsalicylic acid. Ticlopidine was more frequently used than clopidogrel, and acenocoumarol was used more often than warfarin. Among all of the concomitant cardiovascular risk factors, congestive heart failure was mostly associated with OAP treatment, and a history of atrial fibrillation-with OAC treatment. Use of drugs did not depend on age, sex, place of residence (rural or urban), level of education and personal income, but it was associated with the region where the respondents lived. CONCLUSIONS: Secondary cardiovascular preventive therapy in Poland is used too rarely in older people after stroke, and it especially concerns anticoagulant therapy in those with a history of atrial fibrillation. Structured educational programmes should be developed in Poland to improve usage of secondary preventive therapy in the elderly.

Estimates of stroke incidence and case fatality in Zabrze, 2005-2006.

BACKGROUND AND PURPOSE: Epidemiological rates for stroke obtained in the United States and Western Europe indicate a decrease in incidence and case fatality. Data published for Poland, as for other Central-Eastern European countries, reported unfavourable results, but this was based on data from the 1990s. The authors evaluated current stroke rates in a population study of the southern Poland city of Zabrze. MATERIAL AND METHODS: A retrospective registry of all stroke cases treated in Zabrze, southern Poland, in 2005-2006, was established, based on data from the National Health Fund. Cases were identified by verifying patient files. Epidemiological rates were calculated and standardized to the European population in both groups: all stroke patients, including recurrent (all strokes, AS), and patients with first-ever stroke (FES) in their history. RESULTS: We registered 731 strokes, including 572 FES cases (78.3%) and 159 recurrent strokes (21.7%). There were 385 strokes in men (52.7%), and 346 in women (47.2%); 88.6% were ischaemic strokes (IS), and 11.4% were intra-ce-rebral haemorrhages (ICH). The standardized incidence rate for AS patients was 167/100 000 (211 for men, 130 for women), and in the FES group 131/100 000 (161 for men, 104 for women). Twenty-eight day case fatality for the AS group was 18.3% (15.4% for IS, 41% for ICH), and 16.6% for FES (13.4% for IS, 40.9% for ICH). CONCLUSIONS: Incidence rates in this southern Poland city are comparable to those reported previously for Poland. Early case fatality decreased, compared to previous data, probably as a result of improved management of acute stroke and hospitalizing all stroke patients.

[Multiple mononeuropathy in the course of the Churg-Strauss syndrome--a case study]. / Mnoga mononeuropatia w przebiegu zespolu Churga i Strauss - opis przypadku.

The Churg-Strauss syndrome (CSS) is a systemic vasculitis. The symptoms of CSS normally occur between the ages of 20 and 40. We present a case of a 60-year-old man with the CSS evolving in three phases. The initial symptoms included bronchial asthma and inflammation of the ethmoid sinuses. Later, the patient was diagnosed with peripheral blood eosinophilia, pulmonary changes, skin changes and neurological symptoms that progressed to multiple mononeuropathy. Electrophysiological tests confirmed progressive damage of the peripheral nervous system. An improvement of the patient's neurological state was observed after application of corticosteroids and rehabilitation. CSS is one of the causes of multiple mononeuropathy and should be taken into account in differential diagnosis. In patients with bronchial asthma, hypereosinophilia and progressive damage of many nerves, the syndrome is diagnosed in accordance with the criteria defined by the American College of Rheumatology.