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Congresses 2012; 33(Suppl 2): 13-16 PubMed PMID: 23183500 Citation  Keywords:  Atherosclerosis:therapy, Czech Republic, Endocrinology:trends, Humans, Neurology:trends,.   

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Journal Article 2012; 33(6): 619-625 PubMed PMID: 23160231 Citation  Keywords:  Antidepressive Agents:therapeutic use, Bipolar Disorder:drug therapy, Humans, Incidence, Prodromal Symptoms, Risk Factors, Secondary Prevention,.   

OBJECTIVE: The purpose of this qualitative review is to examine prodromes, precipitants, and risk factors for repeated episodes of mania and depression in bipolar disorder.

METHODS: PubMed, EMBASE, and PsychInfo were searched for "bipolar disorder" in conjunction with: "prodromes", "triggers", and "life change events".

RESULTS: Phenomenology and prevalence of prodromes, precipitants, and risk factors are described, and their therapeutic implications are outlined.

CONCLUSIONS: Most patients with bipolar disorder are able to recognize their prodromes. This ability depends largely on insight. Psychoeducation focused on improving various aspects of insight, including treatment adherence, reduces incidence of relapses in bipolar disorder....

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Case Reports 2012; 33(6): 579-589 PubMed PMID: 23160229 Citation  Keywords:  Adult, Antibodies, Monoclonal, Humanized:therapeutic use, Brain:pathology, Drug Resistance, Female, Humans, Magnetic Resonance Imaging, Male, Multiple Sclerosis:drug therapy, Natalizumab, Secondary Prevention, Treatment Outcome, Young Adult,.   

: Pediatric cerebrospinal multiple sclerosis (MS) constitutes about 2-5% of all MS cases. The International Pediatric MS Study Group (IPMSSG) applies diagnostic criteria for adults to MS in childhood and adolescence. Recent publications highlight an increasing number of MS in children resistant to the first-line treatment, i.e. disease modifying therapy (DMT). Furthermore, the number of published case studies on children with highly active MS treated with natalizumab also rises, whereas long-term risks as well as therapeutic potential of this therapy in pediatric population have been at the centre of attention. This paper presents a group of 5 children in whom natalizumab was selected to manage highly active disease or resistance to conventional MS treatment and provided very good clinical as well as MRI results....

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Case Reports 2012; 33(6): 597-599 PubMed PMID: 23160225 Citation  Keywords:  Anti-Inflammatory Agents, Non-Steroidal:administration & dosage, Female, Headache Disorders, Primary:drug therapy, Humans, Indomethacin:administration & dosage, Middle Aged, Remission Induction, Treatment Outcome,.   

: Hypnic headache (HH) is considered as a disorder of the circadian rhythm, mostly affecting the elderly and generally considered a benign disorder, but the pathophysiology of hypnic hedache remains unclear. Various treatments have been suggested for hypnic headache, especially lithium and indomethacin. We report the case of HH fulfilling The International Classification Headache Disorders, 2nd edition criteria (ICHD-II). A 64-year-old woman, who suffered from dull headaches strictly during the night for a period of 5 months. Attacks of headache lasted from 30 to 150 minutes, with a frequency usually 4 times per week. The patient was started on indomethacin 50 mg twice a day (BID). From day 25 on she was free of hypnic headache. On day 31 we tapered the daily dose of indomethacin to 50mg at bedtime, the patient was still without headache. On day 60 the treatment was stopped. 30 months after day 60, the patient was still headache free. We reported the first Czech patient with HH with very good therapeutic response to indomethacin. The effect of therapy with indomethacin 50mg BID was very fast and stable....

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Journal Article 2012; 33(6): 614-618 PubMed PMID: 23160219 Citation  Keywords:  Adenosine-5'-(N-ethylcarboxamide):pharmacology, Animals, Brain Neoplasms, Cell Line, Tumor, Citalopram:pharmacology, Depression:drug therapy, Fluoxetine:pharmacology, GTP-Binding Protein alpha Subunits, Gq-G11:metabolism, Glioma, Neurons:cytology, Puriner.   

OBJECTIVES: Trimeric G-proteins play a crucial role in the transmembrane signalling to intracellular pathways via effector phospholipase C (1,4,5 IP3) or adenylylcyclase (cAMP). G-protein modulation is considered to participate in the antidepressant mode of action by neurotransmitter G-protein coupled receptors (GPCR). Adenosine is naturally occured nucleoside and adenosine receptor belongs to GPCR family. Properties and functions of ubiquitous adenosine receptor were described with number of agonists and antagonists.

METHODS: In C6 glioma cells, we studied acute administration of SSRI antidepressants - fluoxetine, sertraline and citalopram. We used immunochemical estimation (ELISA) of the main types of G-protein alpha subunits from isolated membranes of C6 glioma cells. We also estimated effect of NECA agonist on fluoxetine induced signalling via 1,4,5 IP3 and its levels.

RESULTS: Results show involvement of the antidepressant drugs in the C6 glioma signal transduction cascades and their modulation in dependence on the antidepressant of SSRI type. We measured main G alpha protein profiles after fluoxetine, sertraline and citalopram administration. We found significant changes as following: decreased G alpha Gq/11 for fluoxetine, low G alpha s for sertraline and both high G alpha q/11 and high G alpha s for citalopram. Furthermore the NECA (5´-N-ethylcarboxamido- adenosine) agonist of adenosine receptor alone evoked high decrease of G alpha q/11 levels. Whereas fluoxetine influenced G alpha q/11 decline was abolished by NECA in concentration manner, especially at 10-8 and 10-9 M concentrations. These results support abolishion NECA effect on fluoxetin influenced 1,4,5 IP3 signalling via PLC.

CONCLUSION: Main G alpha profiles are dependent on SSRI type antidepressant. Abolishing both fluoxetine evoked G alpha q/11 and and 1,4,5 IP3 signalling can indicate parallel interference between G-protein coupled receptors (GPCR) and the cell response. Presented data are first findings about adenosine receptor interaction with fluoxetine signalling. Thus in vitro studies contribute to the clarification of the molecular basis of antidepressant action....

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Journal Article 2012; 33(5): 530-535 PubMed PMID: 23090272 Citation  Keywords:  Age Factors, Animals, Animals, Newborn, Antioxidants:pharmacology, Ascorbic Acid:pharmacology, Cerebral Cortex:drug effects, Epilepsy:drug therapy, Evoked Potentials:drug effects, Female, Hypoxia, Brain:drug therapy, Male, Oxidative Stress:drug effects, P.   

OBJECTIVES: The effects of ascorbic acid and α-tocopherol pre-treatment on hypoxia induced changes in brain cortex excitability were tested in immature rats exposed chronically to simulated altitude of 7 000 m.

METHODS: Rat pups were kept together with their mothers for 8 hours a day in hypobaric chamber since the day of the birth till the postnatal day 11 or 17. Each day immediately before placing to hypobaric chamber pups were pretreated intraperitoneally either with ascorbic acid (100 mg/kg) or α-tocopherol (1 500 mg/kg). Cortical afterdischarges were elicited by repeated stimulation of the right sensorimotor cortex. The duration of evoked cortical afterdischarges was analyzed.

RESULTS: Duration of cortical afterdischarges progressively declines with age. Hypoxia prolonged the duration of afterdischarges in 12-, 18- and 25-day-old animals. Pretratment with ascorbic acid or α-tocopherol shorted afterdischarges duration in youngest experimental group when compared with animals exposed to hypoxia only.

CONCLUSION: Hypoxia significantly affects the brain cortex excitability by prolonging afterdischarges duration. This effect differs with age. Antioxidant pre-treatment brought about shorter duration of cortical afterdischarges only in the youngest experimental group. The antioxidant effect is therefore age dependent....

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Case Reports 2012; 33(5): 483-488 PubMed PMID: 23090264 Citation  Keywords:  Adult, Critical Illness, Dopamine Agonists:therapeutic use, Female, Humans, Neurosurgical Procedures:methods, Pituitary Apoplexy:drug therapy, Pituitary Neoplasms:drug therapy, Pregnancy, Pregnancy Complications:drug therapy, Prolactinoma:drug therapy, Sp.   

: Prolactinoma is the most common secreting pituitary adenoma. It is typically diagnosed in women of reproductive age and is common cause of infertility. Currently the treatment of choice is pharmacotherapy with dopamine agonists, whereas surgical treatment is reserved for a selected group of patients. Pituitary-tumor apoplexy is a rare, life-threatening condition associated with significant morbidity and mortality. The authors present the case of a 25-year-old woman with prolactinoma treated with dopamine agonist. In course of such a treatment the patient became pregnant. The bromocriptine was gradually withdrawn. In the 14th week of pregnancy she was admitted for symptoms suggesting pituitary tumor apoplexy. The treatment with bromocriptine was reinitiated. In the 20th week of pregnancy further deterioration of the patient's neurological condition and visual-field abnormalities were observed. The patient was qualified for surgical treatment - selective transsphenoidal adenomectomy. The successful surgery led to improvement of neurological condition. The early postoperative PRL level decreased significantly and hormonal function of the pituitary was preserved. The pregnancy ended in 38th week with a caesarean section. Endocrinological evaluation conducted after the uneventful delivery confirmed normal function of the pituitary. Magnetic resonance imaging (MRI) did not reveal tumor re-growth. The patient is kept under constant medical care. In this case study the authors discussed therapeutic management and reviewed literature regarding gestational pituitary-tumor apoplexy with particular emphasis on surgical treatment....

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Case Reports 2012; 33(4): 372-374 PubMed PMID: 22936268 Citation  Keywords:  Alzheimer Disease:nursing, Antipsychotic Agents:therapeutic use, Caregivers:psychology, Female, Humans, Middle Aged, Psychotic Disorders:etiology, Risperidone:therapeutic use, Severity of Illness Index, Spouses:psychology, Stress, Psychological:complicati.   

OBJECTIVES: Caring for demented people has been associated with negative effect on caregiver health. One or more severe stress factors can precipitate brief reactive psychosis.

METHODS: A 59-year-old Caucasian married woman with no prior psychosis has been caring for her severely demented husband for more than 3 years. She was treated for anxiety disorder and reaction to severe stress in our clinic for 1 year.

RESULTS: Five days after husband's nursing home placement our patient developed the abnormal thought, that someone might tell her neighbours of her laziness and failures. She believed that she was under constant surveillance. These ideas grew rapidly into delusions and hallucinations. She was diagnosed as having transient psychosis with associated acute stress and was treated with risperidone. The psychosis lasted for two months.

CONCLUSION: Careful differential diagnosis is necessary in the cases of transient psychosis. Psychotic symptoms in overloaded individuals may be more common than was previously thought....

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