Uhthoff`s phenomenon 125 years later - what do we know today?

125 years have passed since Wilhelm Uhthoff reported the symptoms he observed after an increased body temperature from physical exertion. Those symptoms, which might have led to the transient impairment of vision in patients with Multiple Sclerosis and also observed in optic neuritis, were later named after him "Uhthoff's phenomenon". This has defined the strategy of rehabilitation procedures in Multiple Sclerosis for more than 100 years, restricting the use of thermal treatments and the possibility of aerobic exercises. The current state of knowledge concerning the Uhthoff's phenomenon and its influence on comprehensive rehabilitation in Multiple Sclerosis were presented in the current review report.

Quality of life in Parkinson's disease

In this review report, current possibilities of evaluation of quality of life in Parkinson's disease have been critically presented. Health Related Quality of Life (-HRQoL) comprises a wide spectrum of consequences of the disease. Measurement of quality of life has become increasingly relevant as an outcome parameter, especially in long-term trials. Most of the available QoL instruments depend on patient self-reports. The data can be collected by written questionnaires. There are universal questionnaires of QoL--for many diseases and the specific ones--specially created for one disease. Among universal questionnaires, the Sickness Impact Profile (SIP) and the Short-Form Health Status Survey (SF-36) are the most popular in Parkinson's disease. As for specific questionnaires: the Parkinson`s Disease Questionnaire (PDQ-39) and the Parkinson's Disease Quality of Life Questionnaire (PDQL) have been described.

Activities of daily living and quality of life in Alzheimer disease

Alzheimer's disease is known for placing a significant burden on caregivers, which includes social, psychological, physical or economic aspects. The disease decreases patients' capacity for activities of daily living and quality of life. Information about functional status is useful in the interpretation of the quality of life assessment results. In this paper the most commonly used scales evaluating activities of daily living and quality of life in Alzheimer's disease, either generic or specific, is presented.

Quality of life in multiple sclerosis

An overall aim of treatment in multiple sclerosis is to lower the negative impact of the disease on functioning and quality of life of patients. Therefore, a measurement of functioning and quality of life should be included in the evaluation of the effectiveness of treatment. The most commonly used quality of life questionnaires, either generic or specific, were presented in this paper,. Information about clinical and functional status is useful in the interpretation of the quality of life assessment results. Because of that, instruments for the assessment of depression, cognitive functions, functional ability and fatigue in multiple sclerosis were also described.

Quality of life of post-stroke patients and their caregivers

With improvements in health care, more people survive stroke but many have to cope with the physical, psychological, social and functional sequelae, resulting in increased personal and public costs. Cerebral stroke causes a significant deterioration of the patient's functioning and worsening of her/his quality of life. Long-term disability caused by stroke is a common problem in all countries and its incidence increases markedly with advancing age. The assessment of the Quality of Life could be as well the evaluator of sequelae of stroke as an indicator of the effectiveness of the post-stroke rehabilitation. In this review article, the contemporary state of art in assessment of the post-stroke Quality of Life has been presented. The emphasis was placed on participation in terms of personal factors and environmental factors of post-stroke persons and their caregivers.

EFNS guideline on diagnosis and management of post-polio syndrome. Report of an EFNS task force

Post-polio syndrome (PPS) is characterized by new or increased muscular weakness, atrophy, muscle pain and fatigue several years after acute polio. The aim of the article is to prepare diagnostic criteria for PPS, and to evaluate the existing evidence for therapeutic interventions. The Medline, EMBASE and ISI databases were searched. Consensus in the group was reached after discussion by e-mail. We recommend Halstead's definition of PPS from 1991 as diagnostic criteria. Supervised, aerobic muscular training, both isokinetic and isometric, is a safe and effective way to prevent further decline for patients with moderate weakness (Level B). Muscular training can also improve muscular fatigue, muscle weakness and pain. Training in a warm climate and non-swimming water exercises are particularly useful (Level B). Respiratory muscle training can improve pulmonary function. Recognition of respiratory impairment and early introduction of non-invasive ventilatory aids prevent or delay further respiratory decline and the need for invasive respiratory aid (Level C). Group training, regular follow-up and patient education are useful for the patients' mental status and well-being. Weight loss, adjustment and introduction of properly fitted assistive devices should be considered (good practice points). A small number of controlled studies of potential-specific treatments for PPS have been completed, but no definitive therapeutic effect has been reported for the agents evaluated (pyridostigmine, corticosteroids, amantadine). Future randomized trials should particularly address the treatment of pain, which is commonly reported by PPS patients. There is also a need for studies evaluating the long-term effects of muscular training.

[Possibilities of subjective and objective evaluation of spasticity]

In this paper the most commonly used methods of assessment patients with spasticity has been presented. "Measuring" of spasticity is necessary for evaluation of new methods of treatment. This could be made directly or indirectly--in that case the sequela of spasticity is measured. In this elaboration as well subjective as objective methods of examination in spasticity has been described. The tone intensity scales, spasm frequency scores, global scales of motor impairment, ADL scales, upper extremity dexterity and strength testing, examination techniques and maneuvers to differentiate rectus femoris from iliopsoas and gastrocnemius from soleus tightness, clinical gait scores, EMG and goniometric pendulum test has been mentioned.

Prediction of pharmacokinetic parameters and the assessment of their variability in bioequivalence studies by artificial neural networks

PURPOSE

The methodology of predicting the pharmacokinetic parameters (AUC, cmax, tmax) and the assessment of their variability in bioequivalence studies has been developed with the use of artificial neural networks.

METHODS

The data sets included results of 3 distinct bioequivalence studies of oral verapamil products, involving a total of 98 subjects and 312 drug applications. The modeling process involved building feedforward/backpropagation neural networks. Models for pharmacokinetic parameter prediction were also used for the assessment of their variability and for detecting the most influential variables for selected pharmacokinetic parameters. Variables of input neurons based on logistic parameters of the bioequivalence study, clinical-biochemical parameters, and the physical examination of individuals.

RESULTS

The average absolute prediction errors of the neural networks for AUC, cmax, and tmax prediction were: 30.54%, 39.56% and 30.74%, respectively. A sensitivity analysis demonstrated that for verapamil the three most influential variables assigned to input neurons were: total protein concentration, aspartate aminotransferase (AST) levels, and heart-rate for AUC, AST levels, total proteins and alanine aminotransferase (ALT) levels, for cmax, and the presence of food, blood pressure, and body-frame for tmax.

CONCLUSIONS

The developed methodology could supply inclusion or exclusion criteria for subjects to be included in bioequivalence studies.

[Possibilities of objective evaluation of treatment and rehabilitation effects after the stroke]

The development of scoring scales has been initiated because of the need of documentation of results as well treatment as rehabilitation of stroke hemiplegic patients. Directly after onset at stroke unit there is demand for defining of prognosis. In rehabilitation the interest in stroke scales has been aroused from the need of evaluation of functional state (activities of daily living), disability, handicap, quality of life, statement of capacity for work or need of home-care. For evaluation of outcome after rehabilitation the most usefull seem to be functional scales (ADL) and quality of life measures (QOL). It is also suitable to mention the scales that evaluate motor function--those functions are the most important task in poststroke rehabilitation.

[Clinimetrics in parkinsonism]

Clinimetrics, which has been developed beginning from stroke scales, nowadays is used in evaluation of many other diseases. It is needed as well for evaluation of impairment and functional state as for clinical assessment of new drugs. Lately one can observe shifting of attention to psychosocial issues. In this paper the most commonly used scales for evaluation of impairment, activities in daily living and quality of life in parkinsonism have been critically presented. Those scales are reliable and valid in the assessment of treatment, prognosis, classification of invalidity and social care decisions.

["Repty" stroke scale . "Repty" Scale for the evaluation of the degree of injury after cerebral stroke. Part I]

Own modification of stroke scale, which enables evaluation of impairment in hemiplegic patients is presented. The scale named "Repty" consists of 15 items, including bowel and bladder function, enables precise evaluation of neurological impairments. The comparison between "Repty" scale and Orgogozo scale was carried out. Interobserver agreement and correlation between both scales was calculated.

["Repty" scales of strokes. Functional index "Repty" for the evaluation of ADL in hemiplegic patients after cerebral stroke. Part II]

Own modification of the Functional Independence Measure, which enables evaluation of activities of daily living in hemiplegic stroke patients is presented. The index of function "Repty", shorter and simpler, consists of 15 items, and makes possible exact estimation of functional state. This is useful in evaluation of the effects of treatment, and rehabilitation, and state of disability as well. The advantage of the "Repty" index over Barthel index results from evaluation of verbal communication and more extended scoring system.

[Comprehensive rehabilitation of multiple sclerosis patients]

Rehabilitation of Multiple Sclerosis patients is one of the most specific problems because of its variable and unforeseeable course. Rehabilitation procedures of those patients must be performed individually and very elastic in every case. In this elaboration the most commonly appeared forms and course of MS have been presented. According to it the planing of the rehabilitation has been adapted. Basic rules of the exercises during the relapse and during the remission have been presented. The greatest attention has been paid to the problems of managing spasticity and the reeducation of neurogenic bladder.

[Functional marker "Repty" for evaluation of independence in patients with paraplegia]

The use of "Repty" index for functional assessment of treatment results in 40 patients with paraplegia aged 13-65 (mean 37) is presented. The outcome has been compared with Barthel Index- the oldest scale assessing activities of daily living. High correlation of both scales sensitivity was found; in some functional parameters "Repty" index was more sensitive.

Treatment of spinal spasticity by electrical stimulation

We present the results and the methodology of trials using transcutaneous electrical stimulation. The aim of our work was to decrease spasticity in 44 patients with traumatic damage to the spinal cord; 35 non-electrically stimulated spastics were used as controls. Both groups were randomly selected from inpatients in the Paraplegic Department at the Hospital Rehabilitation Centre. This electrical stimulation procedure leads to a long-lasting reduction in spasticity, an increased range of passive and active movements, the facilitation of lost functions, an improvement in breathing, an increase in pulmonary capacity, the reappearance of some neurological reflexes, and a diminution of supersensitivity to skin irritation. Blood pressure and neurogenic bladder functions were restored to normal. In addition to clinical observations, we investigated muscle force and the electromyogram; other measurements used in the trials involved the use of a specially adapted neurological hammer, a pendulum test, spirometry, cystometry, sphincterometry and biochemical estimations.

[Course of cerebral cysticercosis]

In the light of 4 cases of cerebral cysticercosis observed in the period 1970-1976 in Zabrze the authors call attention to the possibility of a very long, lasting even tens of years, time period preceding development of intracranial hypertension and to the diagnostic difficulties in this period. If immunological reactions are negative and the cerebrospinal fluid is normal, presence of calcified cysts in skeletal muscles visible on radiograms may be helpful. An uncertain syndrome of cerebral manifestations in a patient with occupational exposure (butchers) requires ruling out of cysticercosis. Three of these patients were butchers. In 2 plain radiograms showed calcified cysticerci in the muscles, in one they were present in the brain.