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Kwetiapina jest pochodną benzotiazepiny zaliczaną do atypowych leków neuroleptycznych, która w chorobie Parkinsona znajduje zastosowanie w przypadku współistniejących objawów psychotycznych. Chociaż lek jest dobrze tolerowany jego zastosowanie zwłaszcza u pacjentów w podeszłym wieku może wiązać się z różnymi działaniami niepożądanymi. Celem pracy było ustalenie związku pomiędzy wystąpieniem afazji czuciowo – ruchowej u chorego z chorobą Parkinsona i współistniejącymi zaburzeniami psychotycznymi a stosowaniem kwetiapiny. Przedstawiamy przypadek 64 – letniego chorego z rozpoznaną chorobą Parkinsona i współistniejącymi zaburzeniami zachowania w czasie snu REM (RBD) potwierdzonymi w badaniu polisomnograficznym, u którego zastosowanie w terapii dodanej z powodu zaburzeń psychotycznych kwetiapiny (w dawce 50 mg/ dobę) spowodowało wystąpienie zaburzeń mowy o typie afazji mieszanej czuciowo- ruchowej. Afazja wystąpiła w czwartej dobie od rozpoczęcia leczenia atypowym neuroleptykiem. W badaniu MRI głowy nie stwierdzono ,,świeżego'' niedokrwienia mózgowia. W badaniu video- eeg nie zarejestrowano ogniskowego stanu padaczkowego. Całkowite wyleczenie nastąpiło po odstawieniu kwetiapiny. W związku z powyższym jako przyczynę ogniskowych zaburzeń neurologicznych przyjęto efekt uboczny leczenia kwetiapiną.

Introduction: Epilepsy is a chronic disease characterised by a predisposition to the occurrence of recurrent and unprovoked seizures. Due to the unpredictability of the disease (due to the possibility of seizures occurring at any time), the quality of life of these patients is drastically reduced. Stigmatisation of patients with epilepsy is common all over the world and concerns not only developing countries, but also those already highly developed. Patients with epilepsy show less activity in many areas of everyday life, including physical activity (they exercise less than the general public), and also have a lower level of mobility. This may be a significant factor contributing to the observation of balance disorders this group (from discrete, unnoticeable by them and the environment, to clinically manifesting instability of posture). So far, however, this has not been possible to clearly document, and to date, the standards for rehabilitation in this group of patients have not been established. However, it is widely known that balance disorders, apart from epileptic seizures, decrease quality of life.In the control of postural disorders, the co-ordination of the visual, somatosensory and vestibular systems is necessary. The cortical representation of the visual and sensory systems can be analysed during electroencephalographic recording. Additionally, the Biodex Balance SD stabilometric platform is an objective tool used to confirm imbalances. The application of this diagnostic device allows to quickly determine the exact type of imbalance that can subsequently undergo targeted physiotherapy. Research objective: The aim of the study was to assess the impact of targeted physiotherapy in a group of patients diagnosed with epilepsy of unknown etiology and balance disorders. Materials and methods: Patients diagnosed with generalised epilepsy of unknown etiology took part in the study. They were treated at the neurology ward or clinic of John Paul II Specialist Hospital in Krakow. The patients were examined 3 times at monthly intervals using the following methods: - EEG testing, - SF-36 quality of life questionnaire, - Biodex SD stabilometric platform. In addition, between the 2nd and 3rd months of the study, the patients underwent physiotherapy for balance disorders (3 times a week for 1 month, each session lasting 30 minutes). Results: In 10 patients who were subjected to selective physiotherapy using the Biodex SD stabilometric platform, objective improvement in balance stability was noted. All patients also reported oral improvement in the sense of postural stability after the completion of the rehabilitative treatment. Conclusions: Targeted physiotherapy in a group of patients with diagnosed epilepsy of undetermined etiology, and accompanying balance disorders has a positive impact on their daily functioning.

Aim of the study. The 4C Mortality Score was created to predict mortality in hospitalised patients with COVID-19 and has to date been evaluated only in respiratory system disorders. The aim of this study was to investigate its application in patients with COVID-19-associated acute ischaemic stroke (AIS). Clinical rationale for study. COVID-19 is a risk factor for AIS. COVID-19-associated AIS results in higher mortality and worse functional outcome. Predictors of functional outcome in COVID-19-associated AIS are required. Materials and methods. This was a retrospective observational study of patients with AIS hospitalised in seven neurological wards in Malopolska Voivodship (Poland) between August and December 2020. We gathered data concerning the patients’ age, sex, presence of cardiovascular risk factors, type of treatment received, and the presence of stroke-associated infections (including pneumonia, urinary tract infection and infection of unknown source). We calculated 4C Mortality Score at stroke onset, and investigated whether there was a correlation with neurological deficit measured using the National Health Institute Stroke Scale (NIHSS) and functional outcome assessed using the modified Rankin Scale (mRS) at discharge. Results. The study included 52 patients with COVID-19-associated AIS. The 4C Mortality Score at stroke onset correlated with mRS (rs = 0.565, p < 0.01) at discharge. There was also a statistically significant difference in the mean 4C Mortality Score between patients who died and patients who survived the stroke (13.08 ± 2.71 vs. 9.85 ± 3.47, p = 0.04). Conclusions and clinical implications. 4C Mortality Score predicts functional outcome at discharge in COVID-19-associated AIS patients.

Introduction: Epilepsy is one of the most common diseases of the central nervous system. According to the World Health Organization, it accounts for 1% of the global burden of disease worldwide. Pharmacotherapy remains the primary therapeutic tool in this disease. However, more and more emphasis is placed on approaching this group of patients in an interdisciplinary manner, taking their various needs into account: social, professional, economic or psychological. Attention is also paid to the positive impact of physical activity on the quality of life of patients with epilepsy. The patients with diagnosed epilepsy often complain of a feeling of instability not reflected in standard neurological examination. Early detection of postural control disorders is possible using an objective research tool which is the modified CTSIB test (Clinical Test of Sensory Interaction and Balance). Aim of the study: The aim of the study was to assess the influence of targeted physical therapy on the quality of life among patients with diagnosed epilepsy of unknown etiology using the SF-36 quality of life questionnaire. Materials and methods: The study included 11 professionally active adults with diagnosed generalized epilepsy of unknown etiology, treated at the Department or Outpatient Clinic of Neurology at John Paul II Specialist Hospital in Kraków. Finally, out of the 11 recruited patients (5 women and 6 men), 1 patient was excluded from the study due to a history of craniocerebral trauma. Patients were examined 3 times every month using EEG and the SF-36 quality of life questionnaire. Additionally, between the 2nd and the 3rd month of the pilot study, the study group underwent physical therapy focused on balance disorders using the Biodex SD stabilometric platform. Results: Overall, the quality of life index measured using the SF-36 quality of life questionnaire in the study group improved after the completion of targeted physical therapy. Conclusions: 1. Generalized epilepsy of unknown etiology results in a significant deterioration in the quality of life of patients, which may also be accompanied by disorders of postural control. 2 A targeted program of physiotherapy in the treatment of patients with generalized epilepsy of unknown etiology may has a positive effect on their quality of life. null

Objective The aim: To draw attention to the need for careful analysis of patients with epilepsy in terms of the possibility of co-occurring arrhythmia. Patients and methods Material and methods: Analysis of video-EEG registration in the inter-seizure period in a patient with diagnosed epilepsy. Results Case study: The authors present a 33-year-old patient with generalised epilepsy of unknown etiology diagnosed in childhood. In this subject, generalised seizure discharges without clinical manifestation of epileptic seizure and with concomitant cardiac arrhythmias in the form of atrial fibrillation were recorded during video-EEG registration. This was carried out during the patient's of hospitalisation at the neurology ward. Conclusion Conclusions: The case study presented is as an example of existing complex and not fully understood interactions between epilepsy and arrhythmia. A mutation within the SCN1B encoding genes, which is responsible for channelopathy within the voltage-dependent Nav sodium channels, may be considered as a potential cause for this state. However, further analysis and research is needed that would eventually allow to find out the reason for these relationships.

Sexual dysfunction is a frequent and overlooked problem in patients with epilepsy. Despite the importance o f this pathology, there are still only a few scientific reports regarding this issue. This is particularly significant in the event of sexual dysfunction following the implementation of anti-epileptic pharmacotherapy. In this paper, the case of a patient with this type of disorder during antiepileptic levetiracetam monotherapy is presented.

Background Quetiapine is an atypical neuroleptic, which is used in Parkinson’s disease when concomitant psychotic symptoms occur. Although the drug is well-tolerated, its use, especially in elderly patients, may be associated with various side effects. Material and methods We present the case of a 74-year-old male with diagnosed Parkinson’s disease and coexisting REM sleep disorders (RBD) confirmed by a polysomnography examination, who was prescribed quetiapine (50 mg per day) for psychotic disorders during the night. Speech disturbances occurred 4 days after the onset of treatment. During the neurological examination of this patient, apart from features of extrapyramidal syndrome, characteristics of global sensory-motor aphasia were found to a moderate degree, without any other symptoms of focal brain damage and without the symptoms of meningitis. A brain MRI scan during the episode of global aphasia excluded ”fresh” cerebral ischemia. Focal status epilepticus was also excluded on the basis of video-EEG examination. The results of laboratory tests also allowed to exclude electrolyte imbalances, infection or metabolic problems. Results Complete recovery occurred following discontinuation of this drug. During the 2-week observation period after administration of the drug, aphasia did not return. Conclusions In connection with the above, the side effect of quetiapine should be considered as the cause of global aphasia.To the best of our knowledge, this is the second case report on reversible aphasia as a side effect of this neuroleptic. Further follow-ups among patients are necessary. Perhaps this is only a coincidence of events that is not directly correlated with this drug.