Obelienienė, Diana

Naujausia vaistų grupė skirta profilaktiniam migrenos priepuolių gydymui yra monokloniniai antikūnai, kitaip žinomi kaip CGRP. Pagrindinis ir pirmasis jos atstovas Lietuvoje erenumabas. Penkerių metų pasaulinė patirtis rodo šio vaisto saugumą, veiksmingumą ir gerus epizodinės ir lėtinės migrenos gydymo rezultatus. Erenumabo veiksmingumas didėja vartojant šj vaistą ilgą laiką, su gydymu susiję nepageidaujami reiškiniai su laiku sumažėja, o tai rodo šio vaisto palankų toleravimą. Dabar pats laikas gydyti migreną, pasauliui tokiu sudėtingu pandemijos laikotarpiu įmanomas net nekontaktinis migrenos gydymas atliekant virtualią paciento apžiūrą ir skiriant tinkamiausią medikamentą.

Vadovėlis skirtas medicinos studijų programos studentams, studijuojantiems neurologiją. Pagrindinis dėmesys skiriamas neuroanatomijai, klinikiniam neurologiniam paciento tyrimui ir topinei neurologinei diagnostikai – pagrindams, be kurių neįmanoma neurologinių ligų diagnostika, paraklinikinių tyrimų ir gydymo taktikos pasirinkimas. Šie pagrindai buvo išdėstyti vadovėlyje "Nervų ligos", nuo kurio 2-ojo leidimo 1996 metais praėjo 20 metų, tačiau studentai vis dar jį studijuoja. Neurologijos studijas turėtų palengvinti informacija, pateikta lentelėse ir paveiksluose. Klinikinė vadovėlio dalis apima tik pagrindines ir dažniausias neurologines ligas, kurias turėtų žinoti medicinos gydytojas. Tikimės, kad šis vadovėlis bus naudingas ir pirmųjų metų neurologijos gydytojams rezidentams.

In order to effectively study and manage headache disorders, diagnosis is essential. In both research and clinical areas, separating secondary causes from primary headache disorders is a crucial first step, followed by further specificity within these broader categories. Historical approaches to classifying headache disorders culminated in the International Classification of Headache Disorders (ICHD), published in 1988. This was revised as the International Classification of Headache Disorders, (ICHD II) in 2004. The International Headache Society's Subcommittee on Classification began work on the 3rd edition in 2010. ICHD-3 was published as the first issue of Cephalalgia in 2018, followed the publication of ICHD-3 beta version in 2013. The idea behind the beta version was to promote more field testing before presentation of the final ICHD-3. There have been excellent field-testing studies published, in migraine with aura, cluster headache, idiopathic intracranial hypertension and trigeminal neuralgia among others. Consequently, these symptoms are included only in the Appendix of ICHD-3, where they invite further study. These are examples of the evidence-based process of disease classification that now underpins all future changes to the ICHD. The diagnostic criteria for more than 200 causes of headaches are based upon evidence when available, of a number of primary and secondary headache disorders. This presentation will attempt to provide an overview of the rationale behind the ICHD, a guide to its use, and a summary of important diagnostic features of the primary and secondary headaches, particularly where these have changed significantly in the ICHD III from ICHD II.

In order to effectively study and manage headache disorders, diagnosis is essential. In both research and clinical areas, separating second ary causes from primary headache disorders is acrucial first step, followed by further specificity within these broader categories. Historical approaches to classifying headache disorders culminated in the International Classification of Headache Disorders (ICHD), published in 1988. This was revised as the International Classification of Headache Disorders, (ICHD II) in 2004. The International Headache Society’s Subcommittee on Classification began work on the 3rd edition in 2010. ICHD-3 was published as the first issue of Cephalalgia in 2018, followed the publication of ICHD-3 beta version in 2013. The idea behind the beta version was to promote more field testing before presentation of the final ICHD-3. There have been excel lent field-testing studies published, in migraine with aura, cluster headache, idiopathic intracranial hypertension and trigeminal neuralgia among others. Consequently, these sym toms are included only in the Appendix of ICHD-3, where they in vite further study. These are examples of the evidence based process of disease classification that now underpins all future changes to the ICHD. The diagnostic criteria for more than 200 causes of headaches are based upon evidence when available, of a number of primary and secondary headache disorders.

Multiple system atrophy is a progressive neurodegenerative disorder that is characterized by autonomic failure, cerebellar ataxia and parkinsonism syndrome in various combinations. In spite of the presence of well-established clinical criteria for multiple system atrophy, ante-mortem diagnosis is difficult. In our case report, we present a 78-year-old female patient who presented with early progressive aphasia and severe autonomic dysfunction. Two years after appearance of the first symptoms, she fulfilled all the major criteria for probable multiple system atrophy with rapid progression. In addition, brain magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography findings were more typical for progressive supranuclear palsy. Clinically differentiating multiple system atrophy from progressive supranuclear palsy and other similar neurodegenerative disorders may be challenging in all stages of the disease, especially with atypical disease presentation.

Susac syndrome is characterized by a clinical triad of encephalopathy, branch retinal artery occlusion, and hearing loss. Due to the absence of the whole complex of the triad in the majority of cases at disease presentation, the syndrome often remains underdiagnosed and untreated. Headache is estimated to affect up to 80% of Susac syndrome patients, but the relevance of headache characteristics and profile is not yet clear. The proposed diagnostic criteria of the European Susac Consortium acknowledge headache as a possible brain manifestation if it is new, described as migrainous or oppressive, and precedes the other symptoms by not more than 6 months. Herein, a case series of different migraine-like headache associations attributed to Susac syndrome is presented and discussed in relevance with previously published literature. Our patients experienced different presentations of migraine-like headache related with Susac syndrome: exacerbation and chronification of headache just before the manifestation of the first symptoms of Susac syndrome, the manifestation of headache during the first episode of the syndrome, and an increasing frequency of headache during the course of the disease. The diagnosis of Susac syndrome in all three cases was confirmed by typical clinical symptoms and findings in retinal fluorescein angiography, audiometry, and brain magnetic resonance imaging, based on the diagnostic criteria of the European Susac Consortium. Based on the analysis of our presented cases, we conclude that headache attributed to Susac's syndrome is of migraine-like type but could be of different presentations in relation to the onset of the syndrome.

Vadovėlis skirtas medicinos studijų programos studentams, studijuojantiems neurologiją. Pagrindinis dėmesys skiriamas neuroanatomijai, klinikiniam neurologiniam paciento tyrimui ir topinei neurologinei diagnostikai – pagrindams, be kurių neįmanoma neurologinių ligų diagnostika, paraklinikinių tyrimų ir gydymo taktikos pasirinkimas. Šie pagrindai buvo išdėstyti vadovėlyje "Nervų ligos", nuo kurio 2-ojo leidimo 1996 metais praėjo 20 metų, tačiau studentai vis dar jį studijuoja. Neurologijos studijas turėtų palengvinti informacija, pateikta lentelėse ir paveiksluose. Klinikinė vadovėlio dalis apima tik pagrindines ir dažniausias neurologines ligas, kurias turėtų žinoti medicinos gydytojas. Tikimės, kad šis vadovėlis bus naudingas ir pirmųjų metų neurologijos gydytojams rezidentams.

Most studies demonstrate that aging is associated with a weakened thermoregulation. However, it remains unclear whether heat transfer (for heat loss) from the lower (uncompensable) to the upper (compensable) body during passively-induced severe lower-body heating is delayed or attenuated with aging. Therefore, the main purpose of this study was to investigate heat transfer from uncompensable to compensable body areas in young men and healthy older men during passively-induced whole-body hyperthermia with a demonstrated post-heating change in core body (rectal; Tre) temperature. Nine healthy older men and eleven healthy young men (69±6 vs. 21±1 years old, mean±SD, P<0.05) participated in passively-induced severe lower-body heating in water at approximately 43°C. Despite a similar increment in Tre (approximately 2.5°C) in both groups, the heating rate was significantly lower in older men than in young men (1.69±0.12 vs. 2.47±0.29°C/h, respectively; P<0.05). The temperature increase in calf muscle and calf skin (uncompensable areas) was significantly higher in older men than in young men (5.10±0.18 vs. 3.99±0.14°C; P<0.05 and 9.92±0.22 vs. 7.65±0.33°C; P<0.05, respectively). However, the temperature increase in back skin and forearm skin (compensable areas) was significantly lower in older men than in young men (0.76±0.63 vs. 2.83±0.68°C; P<0.05 and 0.39±0.76 vs. 2.73±0.5°C; P<0.05, respectively). Furthermore, a post-warming increase in Tre of approximately 0.2°C was observed only in older men (P<0.05). In conclusion, older men whose lower extremities were immersed showed greater accumulation and storage of heat in the skin and deep muscles than young men, and this was associated with a greater heat-transfer delay and subsequent inertia in the increased core body (Tre) temperature.