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Background and objective. Vagal nerve stimulation (VNS) represents an alternative therapy for intractable epilepsy. The aim of this study is to analyse seizure reduction and the life quality of these patients. Material and methods. We prospectively examined 28 adult patients treated with VNS that were followed-up at least 6 months after the surgery and we recorded the number of seizures and any other changes. 16 epilepsy patients completed the Quality of Life in Epilepsy-31 questionnaire (QOLIE-31). Results. Our data revealed that 64% of patients were responders with more than 50% seizure reduction. According to McHugh classifi cation of seizure freedom, 36% patients are in class I (80-100% seizure reduction), 29% class II (50-79% reduction), 21% class III (less than 50% reduction), 7% class IV (magnet benefi t only) and 7% class V (no improvement). Only 8 patients presented mild adverse effects, such as hoarseness, fatigue and cough. Life quality has improved for 68% patients. There is a strong correlation between life quality and health and a mild positive relation with the seizure reduction. Conclusions. VNS improves life quality for more than half of patients and is a therapy to consider in refractory epilepsy. [ABSTRACT FROM AUTHOR]

The premotor phase of Parkinson Disease (PD) precedes the classical motor phase and the clinical picture is dominated by nonmotor symptoms. The psychiatric symptoms, an important category of nonmotors symptoms, need to be evaluated and treated. The study objective was to assess the frequency of nonmotor symptoms in patients with PD in early stages of the disease and to establish correlations between these symptoms and the features of disease or clinical characteristics of patients. The group of patients enrolled in the study included a number of 43 patients with early PD, enrolled during a period of one year in Neurology Clinic I, from Cluj-Napoca, Romania. For all patients enrolled in the study, the questionnaire NMS-PD QUEST was applied. Psychiatric complaints play an important role as there were no patients who did not present at least one psychiatric symptom and in most cases patients have described a complex of associated symptoms: roughly one third of the patients of both genders complain about 5 symptoms of each of this type, simultaneneously. Within the psychiatric fi eld, the most prevalent symptoms belonged to affective disorders- depression-81,39%, followed by disorders of attention and concentration-79, 06%. Regarding the correlations monitored in the study, the analysis of parameters show that the only statistically signifi cant correlation was with family history of PD. The fi eld of sleep disorders was well represented by insomnia, present in 69.76% of cases, which was followed by excessive daytime sleepiness and sleep with nightmares in equal percentages of 46.51%. The most common psychiatric symptoms reported by the questionnaire even from the early stages were depression, attention and memory problems and those related to impaired sleep. The results presented highlights the importance of questioning the patients about nonmotor complaints from the very beginning of the diagnostic process. [ABSTRACT FROM AUTHOR]

Rasmunssen Encephalitis is a rare disease characterized by focal cortical infl ammation with progressive extension and diffusion. Clinical features are continuous partial epilepsy non responsive to usual anti-epileptic therapy and unilateral motor defi cit, corresponding with the IRM imaging to cerebral hemiatrophy. The disease mainly affects children but there are some acknowledged cases described in adolescent and adult life. This report aims to present a clinical case of a young female with seven years personal history of generalized epilepsy. Having a clinical and paraclinical evolution a suspicion of chronic focal Rasmunssen Encephalitis took shape. During admission she suffered of weakness and involuntary movements in her left side, which gradually worsened in the last month and memory impairment also. Routine laboratory blood evaluation, infl ammatory and infectious tests were within the normal range. Magnetic resonance imaging of the brain reveals T2 atrophy of the right cerebral hemisphere with a low displacement of median structures to the left and an abnormal hyper intensity signal on T2-weighted, along with FLAIR images. Electroencephalography showed a profoundly altered, slowed, asymmetrically with paroxysmal unilateral right slow activity record with high amplitude. Based on clinical criteria, MRI imaging and EEG we supported the diagnosis of Rassmunsen encephalitis. [ABSTRACT FROM AUTHOR]

Along with the motor symptoms, Parkinson's disease (PD) patients experience a wide range of non-motor problems including visual disturbances. These are multifaceted, but often underreported as such. In a visual survey questionnaire, 78% PD patients reported at least one problem related to vision or visuospatial functioning. The most frequent encountered problems are impaired contrast sensitivity, color discrimination, visuospatial processing, ocular or eyelid movements and diplopia followed by visual misperceptions and hallucinations. Some patients report dry eyes, ocular pain or photophobia. The pathophysiological basis of the visual disturbances is not completely understood. Changes in the visual cortex were detected with functional MRI before the visual symptoms were clinically evident. Further studies are necessary to determine how these changes will contribute to development of visual symptoms in PD patients. Other authors consider a dopaminergic deficit in the retina to be responsible for some of these symptoms, being known that dopamine is the major neurotransmitter in the amacrine and interplexiform cells in the retina. Visual hallucinations are likely to be a result of disruption across related yet diverse neural circuitry. The therapy is only symptomatic and not always satisfactory. It includes ophthalmological treatment and specific treatment for hallucinations. Optical Coherence Tomography (OCT) is a new investigation method who offers quantitative morphology of gross retinal histology. The thinning of the peripapillary retinal nerve fiber layer was observed in PD. Some studies mentioned that macular thickness measured by the OCT could be a promising biomarker of PD. This work shows how complex the visual problems in PD patients can be and the importance of a thorough and multidisciplinary approach. [ABSTRACT FROM AUTHOR]

Parkinson's disease is a common neurodegenerative disorder of unknown cause and with inevitably progressive character. The disease has a long preclinical period-premotor phase when the nonmotor symptoms are in the first plan and when is the time which neuroprotective therapy should start. One important biomarker for the premotor phase of idiopathic Parkinson's disease is olfactory dysfunction. This deficit is frequent, significant, small-changes once motor features are evident and it is independent of motor and cognitive status and medication use. Smell loss affects all areas of olfaction and is easily measured by standard quantitative tools. The objective of this study is to evaluate the frequency and character of olfactory dysfunction among 40 patients, recently diagnosed with Parkinson's disease, as well as to assess correlations between olfactory function and the stage, duration or type of Parkinson's disease. Olfactory function was assessed using a 12-marker Smell Test: Sniffin' Sticks-Screening 12. This is a validated method of identification of sense of smell that can be used easily and quickly. The percentage summed of patients with hypoosmia and anosmia at this testing was important and the study finds no correlation between olfactory function and duration or stage of Parkinson disease. Hyposmia is one of the cardinal early symptoms of Parkinson's disease and can be evaluated as marker of the premotor state. [ABSTRACT FROM AUTHOR]

In recent years, transcranial ultrasonography (TCS) has become widely used for the visualization of the brainstem. With this method, changes of the echotexture - increased echogenicity - of the substantia nigra (SN) in about 90% of patients with Parkinson's disease (PD). In contrast, increased SN echogenicity is rarely found in patients with atypical or symptomatic Parkinsonian syndromes, providing a valuable tool for differential diagnosis. Interestingly, increased SN echogenicity can also be found in about 8 to 10% of healthy subjects. The studies showed that the ultrasound signal does not change in the course of the disease and this hypercogenicity of the SN is present in the early stages of the disease, also in the presymptomatic patients. So, TCS may represent a biomarker for vulnerability of the nigrostriatal system and this method may even be helpful for the preclinical identification of people at risk for PD. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the second most frequent neurodegenerative disorder following Alzheimer's disease. Advanced stages of PD, 4 or 5 of the Hoehn and Yahr Scale, are characterized by severe motor complications, limited mobility without assistance, risk of falling, and non-motor complications. The aim of this review was to provide a practical overview on specific artificial intelligence (AI) systems for the management of advanced stages of PD, as well as relevant technological limitations. The authors conducted a systematic search on PubMed and EMBASE with predefined keywords searching for studies published until December 2020. Full articles that satisfied the inclusion criteria were included in the systematic review. To minimize results bias, the reference list was manually searched for pertinent articles to identify any additional relevant missed publications. Exclusion criteria included the following: Other stages of PD than 4 and 5 of the Hoehn and Yahr Scale, case reports, reviews, practice guidelines, commentaries, opinions, letters, editorials, short surveys, articles in press, conference abstracts, conference papers, and abstracts published without a full article. The search identified 21 studies analyzing AI-based applications and robotic systems used for the management of advanced stages of PD, out of which 6 articles analyzed AI-based applications for autonomous management of pharmacologic therapy, 5 articles analyzed home-based telemedicine systems and 10 articles analysed robot-assisted gait training systems. The authors identified significant evidence demonstrating that current AI-based technologies are feasible for automatic management of patients with advanced stages of PD. Improving the quality of care and reducing the cost for patients and healthcare systems are the most important advantages. [ABSTRACT FROM AUTHOR]

Objectives. Continuous delivery of levodopa-carbidopa intestinal gel (LCIG) represents a gold standard option for the treatment of advanced PD and the benefits of intestinal gel delivery are significative superior from those obtained with available medical therapies. We aimed to investigate the percutaneous endoscopic transgastric jejunostomy (PEG-J) use and the occurrence of procedural complications in a group of patients diagnosed with PD Hoehn and Jahr 3 and 4 stages, receiving LCIG therapy. Materials and methods. We performed an observational retrospective cohort study on 24 PD patients recruited from a single regional tertiary center in Cluj-Napoca, Romania, between 2009 and 2019. We included PD patients with Hoehn and Jahr 3 and 4 stages under LCIG therapy. Results. PEG-J replacement was found in 54.2% of the patients. Erythema and inflammation at the level of stoma (37.5%) and allergic reactions (20.8%) were the most common complications. The most frequent reason for PEG-J replacement was tube dislocation (20.8%), and rarely the plied tube, the excess of adipose tissue, or bezoar (4.3% each). A third of the patients received PEG-J therapy during the night, after a median time of three years, after PEG-J initiation. A quarter of all the subjects had their Levodopa-Carbidopa therapy interrupted. The median time untill interruption was one year. The reasons for the interruption were patient, or patient's relative refuses, for a sixth of the cases, or gastric polyps, in very few cases. Conclusions. The most frequent complication of LCIG delivered by PEG-J was erythema and inflammation at the level of stoma. However LCIG therapy discontinuation was in particular due to the decision of the patient or relatives. [ABSTRACT FROM AUTHOR]