Aktualnosci Neurologiczne

Introduction and objective: Ocrelizumab is used in multiple sclerosis treatment and is available in intravenous and subcutaneous forms. In Poland, only the intravenous form is currently reimbursed. The subcutaneous form offers a shorter administration time, potentially benefiting both healthcare providers and patients. This study evaluates the impact of the different forms of ocrelizumab administration on medical facility workflow and costs. Materials and methods: A survey was conducted in six medical centres involving 329 patients treated with ocrelizumab in 2023, with 46 patients receiving the subcutaneous form of the drug. The study assessed the complete drug administration process, including premedication, preparation, administration, and post-administration observation. The comparison between the two forms of ocrelizumab focused on the costs associated with drug administration, the time patients spent at the medical centre, and the efficiency of the drug administration process. Results: The administration costs of the subcutaneous form were significantly lower (96.80 PLN) than the intravenous form (224.32 PLN). The time patients spent at the medical centre was greatly reduced for the subcutaneous form (56 minutes) compared to the intravenous form (242 minutes). Efficiency in drug administration was also higher for the subcutaneous (26.88) than the intravenous form (2.62). Conclusions: The study highlights the substantial benefits of the subcutaneous form of ocrelizumab over the intravenous form. These advantages are noticeable from both the healthcare provider’s and patient’s perspectives, underscoring the potential for improved efficiency and patient experience with the subcutaneous form.

Ewa Krzystanek

Krzysztof Selmaj

Beata Rękawek

Igor Selmaj

Alina Kułakowska

Paweł Bochniak

Michał Seweryn

Aktualności Neurologiczne

Comparison of intravenous and subcutaneous administration of ocrelizumab. Time and motion study

奥瑞珠单抗静脉注射与皮下注射的比较：时间与动作研究

Extrapyramidal disorders are a rare presentation of multiple sclerosis. One such presentation is paroxysmal hemidystonia. Dystonia is, in the strict sense, the result of damage to various sites in the central nervous system. In one published cases series, lesions causing dystonia occurred in heterogeneous locations, most commonly in the basal ganglia, followed by the thalamus, brainstem, and white matter. In a series of 62 patients with thalamic or peritalamic lesions, only about 5% patients had paroxysmal dystonia. So far, there have been few reported cases of patients with paroxysmal hemidystonic symptoms associated with a specific damage to the central nervous system in the course of multiple sclerosis, especially as a relapse. For these reasons, we present a case of a 57-year-old female patient with a medical history of about 30 years of multiple sclerosis, who developed symptoms of paroxysmal left-sided hemidystonia as a relapse of multiple sclerosis.

Karol Jastrzębski

Jakub Jania

Paroxysmal left-sided hemidystonia as a relapse of multiple sclerosis

阵发性左侧偏侧肌张力障碍作为多发性硬化症的复发

Introduction: Cerebral palsy is one of the most commonly diagnosed neurological syndromes in children today. The most prevalent abnormalities in the development of patients with cerebral palsy are related to general motor skills, body posture and muscle tension. The sum of these disorders affects, inter alia, gross motor skills, which are movements involving either the entire body or a significant part of it. These include, for example, walking, running, jumping, swimming, and cycling. Nowadays, medicine offers many types of therapy to patients with cerebral palsy. Properly adjusted, they provide a chance to maintain appropriate levels of activity and physical fitness, and prevent the patient’s clinical condition from worsening. One of the supportive forms of therapy for people suffering from cerebral palsy is hippotherapy, which, thanks to its universal status, is an important complement to the rehabilitation process. The aim of the study was to assess the effects of hippotherapy on gross motor skills in children with cerebral palsy based on a literature review. Materials and methods: The MEDLINE PubMed medical database was reviewed as recommended by PRISMA, using the following keywords: “cerebral palsy” in combination with “hippotherapy” and “gross motor function.” The review included clinical trials examining the effects of hippotherapy on gross motor skills in children with cerebral palsy. Results: A total of 25 articles published between 1998 and 2021 were identified. The effects of hippotherapy on changes in gross motor activity were assessed using the Gross Motor Function Measure (GMFM), Functional Status Scale, Pediatric Balance Scale, Bruininks–Oseretsky Test of Motor Proficiency. Second Edition (BOT-2) scales, Gross Motor Function Classification System (GMFCS), and changes in selected gait determinants including walking speed and stride length. Conclusions: Hippotherapy improves gross motor skills in children and adolescents with cerebral palsy aged 3–19, classified as GMFCS levels I–V. However, more research is needed to establish the long-term effects of hippotherapy.

Natalia Jagielska-Zwierz

Natalia Matysiak

Justyna Zając

Jakub S. Gąsior

Effects of hippotherapy on gross motor function in children and adolescents with cerebral palsy – a scoping review

马术治疗对脑瘫儿童和青少年粗大运动功能的影响——范围综述

Introduction: Carotid atherosclerosis is one of the main causes of ischaemic stroke. The study verified the hypothesis on the relationship between the expression of selected inflammatory markers and the stability of atherosclerotic plaque in stroke patients. Aim: The aim of the study was to determine CCL3 and CCL5 levels in both plasma and carotid atherosclerotic plaques in relation to the history of ischaemic stroke, as well as to assess plaque morphology and stability. Materials and methods: The levels of CCL3 and CCL5 chemokines were determined by ELISA for both plasma and supernatants of atherosclerotic plaque homogenates from patients undergoing endarterectomy due to at least 70% carotid artery stenosis. Results: Both chemokines were found in atherosclerotic plaques, with elevated CCL3 in unstable plaques. Furthermore, patients with atherosclerosis showed significantly higher plasma CCL5 compared to healthy individuals. Conclusions: The chemokines CCL3 and CCL5 are likely to be involved in the inflammatory processes contributing to the development of atherosclerotic plaque, but this needs to be confirmed in further studies.

Maria Konarska-Król

Piotr Szpakowski

Piotr Kaźmierski

Andrzej Głąbiński

CCL3 and CCL5 as potential markers of carotid atherosclerotic plaque stability – preliminary research

CCL3和CCL5作为颈动脉粥样硬化斑块稳定性潜在标志物的初步研究

Multiple sclerosis is a chronic inflammatory disease of the central nervous system associated with demyelination and neurodegeneration. In recent years, vitamin D has gained attention in the medical community following suggestions that there is a correlation between the level of serum vitamin D and the risk of multiple sclerosis, disease progression and activity. The aim of this article was to review recent literature describing the effects of vitamin D supplementation on the immune, inflammatory and oxidative stress parameters in patients with multiple sclerosis. In clinical trials, vitamin D doses ranging from 800 IU/day to 14,000 IU/day were tested. Researchers noticed significant differences in the range of action of vitamin D. However, the overview of studies failed to yield a definite answer concerning an effective dose of vitamin D. We concluded that there was no clear evidence for the impact of vitamin D supplementation on inflammatory parameters in multiple sclerosis patients, even though studies show consistently that the vitamin has an influence on the immune system and contributes to a reduction of pro-inflammatory cytokines. What is more, little is still known about the effects of vitamin D supplementation on oxidative stress, especially with regard to the potential effective dose. Consequently, more research is needed to gain a better understanding of this issue. There is increasing evidence on the significant role of vitamin D in patients with multiple sclerosis but there are as yet no global recommendations regarding the benefits of vitamin D supplementation and the supplementation dose. It is necessary to conduct further studies on the influence of vitamin D on disease activity due to its potential role as an add-on therapy in this group of patients or even as a preventative measure.

Martyna Lis

Jowita Adamczyk-Zostawa

Monika Adamczyk-Sowa

167 Effects of different doses of vitamin D supplementation on immune, inflammatory and oxidative stress parameters in the blood serum of patients with multiple sclerosis – a review

167 不同剂量维生素D补充对多发性硬化症患者血清免疫、炎症和氧化应激参数的影响——综述

A neuropsychological examination forming part of a medical diagnosis – akin to other tests – facilitates the verification of the preliminary nosological diagnosis. The title of a neuropsychologist is obtained through a four-year specialist training in clinical psychology, culminating in a state examination. Neuropsychological diagnosis is functional in nature, and describes the type of cognitive dysfunctions present, their degree of severity, and possible aetiology. Neuropsychological examination is conducted when cognitive deficits are elusive in the screening, or the results of other tests have not clarified the diagnostic hypotheses. In addition to assessing the patient’s cognitive state, neuropsychological diagnosis allows for predicting the further course of dysfunction, setting directions for rehabilitation, and estimating the possibility of returning to professional or school duties. In addition, psychoeducational interventions provide guidance for the family and caregivers on how to deal with the patient. Neuropsychological assessment also describes the interaction between socio-emotional and environmental factors that determine appropriate treatment or subsequent care. This is possible due to an extensive diagnostic process, which, in addition to clinical-experimental methods (clinical trials) and standardised measurement techniques (depending on the patient’s needs and condition), also includes the analysis of available documentation, a clinical interview, and the formulation and communication of feedback. In addition to describing the characteristics of neuropsychological examination, the paper discusses its role and usefulness in medical diagnosis, and outlines the possibilities and limitations of neuropsychological diagnosis. The paper contains practical information for neurologists, which should be considered before referring patients for a neuropsychological examination.

Anna Barczak

What should a neurologist know about a neuropsychological examination?

神经科医生应了解哪些神经心理学检查内容？

Itch, or pruritus, is a common sensation, yet it is often treated lightly due to its usually transient nature. However, problems can arise once it becomes intense or prolonged, and treatment is ineffective. Itch generally affects diseased skin and accompanies systemic diseases; however, it can also be a reaction to allergens (mostly drugs) or have a psychogenic origin. Neurological itch is an itch that results from nervous system damage rather than issues with the skin. It affects non-diseased skin and arises as a result of dysfunction or damage to the neurons of the peripheral or the central nervous system. Its emergence can be influenced by metabolic, neurodegenerative, traumatic, infectious, autoimmune, and iatrogenic factors. Itch is accompanied by secondary symptoms including swelling, scrapes, excoriations or ulcerations, which result from the patient’s attempts to alleviate the symptoms. The diagnosis of itch is difficult and based on a detailed medical history and physical examination carried out in order to recognise the nature of the itch, which can also, in many cases, help find the most probable cause. There are no effective treatments for neurological itch. Management consists of a combination of patient education, physical therapy, psychotherapy, and attempts at a pharmacological treatment (antidepressants; antiepileptics − gabapentin and pregabalin; capsaicin; topical glucocorticosteroids).

Waldemar Brola

Aleksandra Piąta

The neurology of itch

瘙痒的神经学

Rett syndrome is a rare, severe neurodevelopmental disorder with X-linked dominant inheritance. It mainly affects women, causing cognitive and physical impairments due to rapid developmental regression in infancy. Rett syndrome is usually recognised in children between six and 18 months old, when they begin to miss developmental milestones or lose the abilities they have gained. One characteristic symptom involves continuous repetitive hand movements. Rett syndrome is one of the most common causes of complex disability in girls. However, the condition can be misdiagnosed. Differential diagnoses that should be considered include cerebral palsy, autism, Angelman syndrome, and non-specific developmental delay. Rett syndrome is related to the loss-of-function mutations in the gene encoding methyl-CpG-binding protein 2 (approximately 90% of reported cases). These mutations have been associated with impacting the development of neurons and axodendritic connections. Progress has been made over the past 50 years since the first report of Rett syndrome. Several promising clinical trials and exciting novel therapeutic options are being tested in both laboratory and clinical settings. Research findings led to the registration in March 2023 of the first drug for therapy, trofinetide. The medication was found to improve brain function and communication skills in recent studies. There are also promising clinical trials investigating the replacement of the mutated gene. This study aims to analyse the latest pharmacological treatment and gene therapy in Rett syndrome, which brings a glimmer of hope to patients and their families, who anticipate a future where Rett syndrome is a reversible and curable condition.

Anna Dąbrowska

Adrian Kruszewski

Natalia Paduszyńska

Karolina Błaszczak

Paulina Przybysz

Monika Szyszka

Maja Kucharska

Barbara Wawrzyńska

Rett syndrome – advances in gene and trofinetide therapy

Rett综合征——基因与特罗菲奈肽治疗的进展

Arterial hypertension is a chronic inflammatory process. The brain centre that controls blood pressure is located in the rostral ventrolateral medulla. Chronic diseases of the circulatory system, such as hypertension or heart failure, result in changes in the expression of genes for neurotransmitters and neuromodulators of the brain, which leads to disturbances in the central regulation of homeostasis. Approximately 700–900 mL of blood flows through the brain per minute, which is approximately 15–20% of the cardiac output. Cerebral blood flow in physiological conditions is on average 50 mL/100 g/min and depends on the value of intracranial pressure and the degree of vascular resistance. Maintaining proper blood pressure homeostasis is essential for the brain to function correctly. Central autonomic regulation of blood pressure and the influence of blood pressure on brain function create an inseparable mutual feedback loop. Chronically high blood pressure values lead to irreversible changes in the cerebral vessels and are among the main risk factors for the development of atherosclerosis and stroke. Acute hypertension, as demonstrated in animal models, may lead to cognitive impairment caused by modification of protein transcription due to oxidative stress. Blood pressure values are subject to seasonal and circadian variations, which should be taken into account when planning treatment. This article compiles key information regarding the interdependence between blood pressure values and brain functionality, taking into account the basics of physiology and pathophysiology of the phenomenon and the latest reports from the scientific literature.

Dariusz Dziubek

Karolina Dziubek

Correlations between blood pressure and brain function

血压与脑功能之间的关联

Publication Information	Publisher: Medical Communications，Publishing cycle: ，Journal Type: journal，Open Access Journals: Yes
Basic data	Year of publication: 2020，Proportion of original research papers: 92.31%，Self Citation Rate:N.A.， Gold OA Rate: 90.48%
Average review cycle	16 weeks

Aktualnosci Neurologiczne

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Comparison of intravenous and subcutaneous administration of ocrelizumab. Time and motion study

Paroxysmal left-sided hemidystonia as a relapse of multiple sclerosis

Effects of hippotherapy on gross motor function in children and adolescents with cerebral palsy – a scoping review

CCL3 and CCL5 as potential markers of carotid atherosclerotic plaque stability – preliminary research

167 Effects of different doses of vitamin D supplementation on immune, inflammatory and oxidative stress parameters in the blood serum of patients with multiple sclerosis – a review

Comparison of intravenous and subcutaneous administration of ocrelizumab. Time and motion study

What should a neurologist know about a neuropsychological examination?

The neurology of itch

Rett syndrome – advances in gene and trofinetide therapy

Correlations between blood pressure and brain function

Abbreviation
Quartiles(Global)	CLINICAL NEUROLOGY(Q4)