Make an appointment now - with an epilepsy doctor at our hospital

The causes of the disease

The pathogenesis of the disease is not fully known and it is impossible to unequivocally define the reasons for the development of the ailments. Epilepsy may be genetically determined or very often be the result of head injuries. The reasons behind the development of epilepsy are very often:

- stroke,
- inflammation of the brain and meninges,
- subarachnoid hemorrhage,
- cerebral ischemia,
- toxic-metabolic damage to the brain tissue,
- tumors.

Epilepsy diagnosis

The first step in diagnosing epilepsy is to interview the presumed person. This is primarily to determine the appropriate treatment path and adjust the tests. The most common methods used to diagnose symptoms and the severity of the disease are:

• EEG tests

Electroencephalographic examinations belong to the group of routine examinations in cases of suspected epilepsy. This test is most often performed for partial-onset epilepsy. The most valuable EEG recording occurs during a seizure.

• computed tomography and magnetic resonance imaging

Metody obrazowania za pomocą tomografii komputerowej czy tomografii rezonansu magnetycznego pozwalają na zlokalizowanie źródła przypadłości. Dzięki tym badaniom określany jest także charakter choroby oraz wykluczenie chorób współistniejących o podobnych objawach klinicznych.

Imaging methods using computed tomography or magnetic resonance tomography allow to locate the source of ailments. Thanks to these tests, the nature of the disease is also determined, as well as the exclusion of comorbidities with similar clinical symptoms.

• SPECT test

The SPECT (Single Photon Emission Computed Tomography) scintigraphic examination uses radiopharmaceuticals (ligands labeled with radioactive isotopes), ie DTPA labeled with 99m-Tc technetium, which is to help in the assessment of cerebral perfusion during an epileptic seizure in a patient. The SPECT test helps to locate epileptic lesions and verify the oxygenation of the brain.

Epilepsy, seizure symptoms and classification

Epilepsy attacks are usually divided into two types - partial and generalized. These categories also include individual seizure subtypes, assigned based on symptoms and occurrence under specific conditions, such as generalized secondary seizures and vegetative seizures, among others.

Partial seizures

This is the most common group of epileptic seizures that initially only affect specific areas of the brain. They can stop partially or spread, spreading to larger and larger areas of the cerebral cortex, and turning into generalized seizures. The symptoms associated with partial seizures are often Todd's paresis or PP. As the affected area develops, there may be numbness or an unpleasant taste and smell. Partial seizures are divided according to the accompanying symptoms into simple (there are autonomic symptoms, mental and motor disorders), complex (consciousness is disturbed) and generally developing.

Generalized seizures

The second most common form of epileptic seizures is generalized seizures. This group includes a number of seizures that differ in the effects of seizures, including: clonic seizures, tonic seizures, tonic-clonic seizures (characterized by loss of consciousness and an unnatural body position, i.e. straight limbs, clenched hands, head tilted back), seizures unconsciousness, atonic seizures (the patient loses balance due to a sudden loss of muscle tone) and myoclonic seizures (sudden, short-term muscle jerks)

Treatment

The treatment process usually begins only after the second attack has appeared and is based on taking antiepileptic drugs. These are primarily anticonvulsants. The medications used in most cases include phenytoin, valproic acid and carbamazepine. These drugs work independently of the group of epilepsy seizures. Some epilepsy drugs, such as lamotrigine, levetiracetam and valproic acid, can cause side effects. For this reason, they are most often recommended only when safer drugs prove ineffective in the treatment process or in cases of advanced disease.

Equally often used in the treatment of epilepsy is oxcarbazepine. The substance in structure and action resembles such agents as clonazepam or carbamazepine. They have a positive effect on GABAergic conductivity.

However, phenobarbital is the most frequently recommended drug, especially in the first trials of pharmacological treatment of epilepsy. The drug is endorsed by the World Health Organization, especially in developing countries, due to the low price of the dose. Primidone also has a similar effect to this drug.

A relatively frequent phenomenon is the occurrence of side effects during drug therapy, resulting from long-term use of drugs. However, most of the side effects are mild and do not pose a risk to patients. This is often related to the correct dosage of drugs. Symptoms such as sleepiness, mood swings and shaky gait may be present. Less common rash or more serious conditions such as bone marrow suppression or increased liver toxicity. The worst situation in this respect is the situation of pregnant women, as taking epilepsy drugs may be associated with birth defects in children, especially in the case of taking medications that cause side effects during the first trimester of pregnancy. It is suspected that the use of valproic acid poses the greatest risk. However, drug therapy is rarely discontinued for the sake of the patient's health and life, as it is concluded that discontinuing medication may have much more risky consequences. Gradual discontinuation of drugs, towards their complete discontinuation, is only used in people who have noticed stabilization of their health - the seizure has not occurred for at least two or four years. It is estimated that this possibility covers about 60% of sick adults, and among children it is slightly higher - about 70%.

Surgical treatment

In cases where pharmacological treatment is ineffective, surgical treatment is used, especially in patients with focal seizures. This option is considered after the patient has received at least a few different medications. Surgical treatment is based on the removal of the hippocampus by resection of the anterior temporal lobe or, in the case of people with cancer, removal of the tumor. Such methods are designed to achieve total seizure control. Surgery may also be used to reduce the frequency of seizures (e.g., calosotomy).

=However, it should be borne in mind that not all patients who do not improve through pharmacological treatment can undergo surgery. In people who do not get better under the influence of drugs, and at the same time cannot, for specific reasons, undergo surgical treatment, neurostimulation is the most commonly used. This takes the form of stimulation of the anterior thalamus nucleus, stimulation of the vagus nerve, or reflex stimulation with feedback.

Alternative medicine

 

There are also alternative treatments for epilepsy, which are most often treated as supporting the proper treatment process. In most cases, it is not fully confirmed that these methods have a real impact on the health situation of patients and their quality of life.

One of the alternative and most controversial methods at the same time is the use of medical marijuana. Other popular forms of supporting classic pharmacotherapy are acupuncture, yoga or treatment with a psychologist. Among the known alternative methods, there is also a ketogenic diet, i.e. one that is rich in fats and is based on a low carbohydrate content and a change in the distribution of the macronutrient repertoire in the body. In this case, there is a significant correlation between the method and the disease, as it lowers the frequency of epilepsy seizures. In children, this is a decrease of about 30-40%. The downside of the ketogenic diet is that it often causes constipation, so it is recommended to include low-carbohydrate vegetables in your diet to provide fiber.

The treatment process also supports the minimization or complete exclusion of factors that may have an influence on the triggering of seizures in patients. The most famous in this category are: flickering light or artificial smoke. For this reason, people with epilepsy are advised not to use the television or computer for a long time, and even participate in club concerts.

However, it should be remembered that most of the alternative methods do not have a clearly defined effect on the health of patients with epilepsy, so they can only be some kind of addition to the basic treatment process and lifestyle, not the main treatment pathway.

Source:

• Bergey GK., Neurostimulation in the treatment of epilepsy. „Experimental neurology”. 244, 2013, s. 87–95.
• Birbeck GL, Hays RD, Cui X, Vickrey BG., Seizure reduction and quality of life improvements in people with epilepsy. „Epilepsia”. 43 (5), 2002, s. 535–538.
• Chang BS, Lowenstein DH, Epilepsy. „N. Engl. J. Med.”, 349 (13), 2003, s. 1257–66.
• Chapter 1: Introduction, [w: ] The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre, 2012, s. 21–28.
• Chapter 4: Guidance, [w: ] The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Clinical Guideline Centre, 2012, s. 57–83.
• Doherty MJ., Haltiner AM., Wag the dog: skepticism on seizure alert canines. „Neurology”. 68 (4), 2007, s. 309.
• Duncan JS., Epilepsy surgery. „Clinical medicine (London, England)”. 7 (2), 2007, s. 137–142.
• Duncan JS., Sander JW., Sisodiya SM., Walker MC., Adult epilepsy. „Lancet”. 367 (9516), 2006, s. 1087–1100.
• Epilepsy (ang.), World Health Organization, październik 2019. [dostęp 15 październik 2019].
• Fisher R, Boas van Emde W., Blume W, Elger C., Genton P., Lee P., Engel J., Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). „Epilepsia”. 46 (4), 2005, s. 470–472.
• Kamyar M., Varner M., Epilepsy in pregnancy. „Clin Obstet Gynecol”. 56 (2), 2013, s. 330–41.
• Levy RG., Cooper PN., Giri P., Ketogenic diet and other dietary treatments for epilepsy. „The Cochrane database of systematic reviews”. (3), 2012.
• Perucca P., Gilliam, FG., Adverse effects of antiepileptic drugs. „Lancet neurology”. 11 (9), 2012, s. 792-802.
• Porter E. B., Jacobson C., Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. „Epilepsy & Behavior”, (3), s. 574–577.

 

Make an appointment now - to the doctor treating Alzheimer's disease at our hospital

Factors influencing the development of Alzheimer's disease

In fact, the causes of Alzheimer's disease in a patient are not known. The process that contributes to the progression of the disease is clear, but it is already a symptomatic stage of the disease. However, the very factors that are responsible for the development of the disease are undefined. Certain predispositions may only influence the conditions for the appearance of disturbances in the structure of the brain. Among the most frequently mentioned factors are:

- older age,
- female,
- diabetes,
- gene mutations,
- family genetic predisposition to Alzheimer's.

Alzheimer's disease symptoms and stages

Alzheimer's disease is a type of disease that progresses relatively slowly. It is a complex condition that develops different symptoms. The level of the disorder of the brain structures also increases. The most common classification of Alzheimer's stages is according to Barry Reisberg, which is described in detail below.

Stage I. No symptoms

The first symptoms of Alzheimer's may not attract much attention. In fact, the first phase of the disease is asymptomatic and this makes it difficult to detect it early and slow down the progression process.

Stage II. Slight cognitive impairment

The second phase of the disease is initially very subtle symptoms that can be associated with conditions other than Alzheimer's or be easily ignored. Especially in the elderly over 65, primary symptoms can be considered a natural part of the aging process. There may be periodic memory disturbances, manifested as slower association of facts, names or problems with concentration. At this stage of the disease, there may also be slight problems with speech in the form of difficulties in matching the appropriate terminology during the conversation. Older people will often find it difficult to lose small things. However, these are confusing symptoms, common in people in the second half of life, and do not clearly indicate Alzheimer's disease.

Stage III. Mild cognitive impairment

In the third stage of the disease development, the symptoms of Alzheimer's become much more pronounced, although they do not yet significantly affect the functioning of patients in everyday life. At this stage, mild cognitive impairment and problems with temporary memory lapses appear most often, which take the form of problems with remembering new information, difficulties with recalling recently learned content or problems with concentration. Planning and organization skills may be impaired. At this stage, performing new activities may prove problematic, and repeating learned tasks may come with a little more effort than usual. Sick people sometimes feel an increased sense of anxiety at this stage.

The symptoms of Alzheimer's disease at the third of the seven stages of the disease development can already be confirmed by clinical tests and a detailed medical history. They become visible to people around the patient. The appearance of symptoms of this stage is a kind of determinant on the basis of which the time of development of the next phase of the disease is predicted. In most cases, the disease progresses over a period of several years to a more advanced form.

Stage IV. Moderate cognitive impairment

The first more serious symptoms of Alzheimer's largely overlap with the signs of senile dementia. It was not for nothing that Alzheimer's disease was initially classified as a subcategory of senile dementia before it was described as a separate condition. In the stage of moderate cognitive impairment, not only do symptoms from the previous stages develop, but also problems with counting or planning simple activities. Sick people most often start to slowly confuse the events that have taken place in their lives. However, they remain aware of the problems they face, which causes irritability. There may be apathy and mood swings due to declining interest in others and increasing feelings of ineptitude and overwhelm with symptoms of the disease. It is estimated that the fourth phase of the disease remains at a similar level for about two years.

Stage V. Intermediate cognitive impairment

At this stage of the disease development, sick people require the assistance of another person so that their life can go on with the daily rhythm. They are unable to independently control matters such as paying bills or completing clothes. This is due to the progressive impairment of cognitive functions, which strongly affects the memory of patients. They have trouble remembering facts, often confuse important information and do not remember basic things such as their own telephone number or home address. There are serious problems with orientation in space and time, which manifests itself in difficulties with the correct determination of the date, time of year, day of the week or place.

Intermediate cognitive impairment results in symptoms that involve depressive or psychotic stages. Patients often show increased apathy and eating disorders. They also often do not pay attention to their own appearance and hygiene, which results in wearing clothes for several days and avoiding toilet activities. There are strong mood swings, and even states of anxiety and paranoia or aggression.

Stage VI. Advanced cognitive impairment

In the penultimate stage of the disease, constant care for the sick is necessary. Neurological disorders, resulting from profound damage to the brain structure at this stage, cause personality changes in ill people. Patients most often remember their names, but often forget other people's names. However, they are able to distinguish relatives from strangers, although they sometimes confuse people. Long-term memory problems make it impossible to fully remember the facts of your own life. Patients do not recognize their immediate surroundings and are unable to recall the latest events in the world around them.

A paranoid state develops, the symptoms of which are suspicion, delusions, and hallucinations. There may also be compulsive reflexes, such as twisting the arm. The sick are not able to function independently, therefore they need help with toilet and everyday activities, such as clothing. The regularity of bowel movements and the sleep-wake cycle are often disturbed.

VII - Very severe cognitive impairment

The last phase completely excludes the affected person from normal functioning. At this stage, they lose contact with their surroundings, both on the physical and mental levels. They are unable to function without the help of another person. They cannot eat, drink, take care of hygiene and toilet matters, walk or make any movements. All vital functions are slowly lost. Patients quickly lose their ability to speak, smile and keep their head upright. The symptoms of the final stage progress quickly and lead to the inevitable - death of the sick person.

Diagnosis and treatment of alzheimer's disease

The diagnosis of Alzheimer's disease is a complex and multifaceted process. It mainly consists in excluding other causes of dementia and finding the basis of potentially reversible cognitive impairment. These causes can be diagnosed by eliminating other diseases that give similar clinical symptoms, using laboratory tests for this purpose, such as anemia, thyroid diseases, electrolyte levels, metabolic disorders or diseases of the urinary system. Computed tomography and magnetic resonance imaging tests can help in the rejection of diseases that require neurosurgical treatment, e.g. hydrocephalus, brain tumors. In order to assess cognitive abilities, the patient is referred to a specialist neurologist.

A cure for Alzheimer's disease has not yet been discovered. Only methods are used that will delay the development of the next stages and symptoms of the ailment as far as possible. Palliative treatment in the case of alzheimer's disease, however, consists mainly in eliminating the effects and supervising the condition of patients. Unfortunately, this disease is incurable. The most frequently used methods of treating cognitive dysfunctions are pharmacotherapy and psychosocial influence.

Source:

• Alzheimer’s Association Official Website https://www.alz.org/alzheimer_s_dementia
• Barry Reisberg , Guide to Alzheimer's Disease, New York: The Free Press, 1981.
• Berchtold NC, Cotman CW, Evolution in the conceptualization of dementia and Alzheimer's disease: Greco-Roman period to the 1960s., „Neurobiol. Aging”, 19 (3), 1998, s. 173–189.
• Berrios G E, Alzheimer's disease: a conceptual history, „Int. J. Ger. Psychiatry”, 5 (6), 1990, s. 355–365.
• Bidzan L., Bidzan M., Łukaszewska B., Pąchalska M., Pufal A., Dynamika zmian zaburzeń zachowania w otępieniu typu Alzheimera, „Psychogeriatria Polska”, 6 (2), 2009, s. 43-58.
• Bottino CM, Carvalho IA, Alvarez AM, Renata Avila i inni, Cognitive rehabilitation combined with drug treatment in Alzheimer's disease patients: a pilot study, „Clin Rehabil”, 19 (8), 2205, s. 861–869.
• Brookmeyer R., Gray S., Kawas C., Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset, „American Journal of Public Health”, 88 (9), 1998, s. 1337–42, 09.
• Doody RS, Stevens JC, Beck C, RM Dubinsky i inni, Practice parameter: management of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology, „Neurology”, 56 (9), 2001, s. 1154–1166.
• Gaweł M., Potulska-Chromik A., Choroby neurodegeneracyjne: choroba Alzheimera i Parkinsona, „Postępy Nauk Medycznych”, t. XXVIII, nr 7, 2015, s. 468-476.
• Gerbaldo H., Maurer K., Volk S., Auguste D and Alzheimer's disease, „The Lancet”, 349 (9064), 1997, s. 1546–1549.

Make an appointment now - to the stroke doctor at our hospital

Pathomechanism of stroke

Blood reaches the brain through two internal carotid arteries and two vertebral arteries. The arteries of the brain coming from the internal carotid and vertebral arteries are a system of connections, securing the blood supply to particularly hypoxic brain cells. This is the arterial wheel of the brain known as the Willis wheel. The functioning of this circle can be disturbed due to the formation of atherosclerotic plaques that narrow the lumen of the blood vessels.          

Stands out :

• hemorrhagic strokes
• ischemic strokes, accounting for approximately 80% of all strokes.
  
  
  Differentiation of the most common types of stroke is possible through the use of computed tomography, magnetic resonance imaging or angiography, which explains and distinguishes hemorrhagic stroke and cerebral infarction (ischemic stroke).

Causes of strokes

The main causes of stroke are: high blood pressure and atherosclerotic changes that occur in the blood vessels. In addition, stroke can be caused by heart conditions such as:- heart defects, in particular mitral valve disease,
- myocardial infarction.
The amount of blood flow through the cerebral arteries is important to the proper functioning of the brain because the brain uses a lot of oxygen. The brain uses about 20% of the oxygen supplied to the body.

Hemorrhagic stroke - causes

A hemorrhagic stroke occurs in the course of a rupture of the cerebral artery wall. Due to the outflow of blood outside the cerebral vessel, the blood does not reach the brain tissues in the area supplied by the ruptured artery. The blood destroys the surrounding nervous tissue, causing an increase in intracranial pressure.

Hemorrhagic stroke symptoms

The main symptoms of a hemorrhagic stroke include:- Headache
- nausea
- vomiting
- loss of consciousness
- numbness of the face with a noticeable curve of the mouth 

Types of hemorrhagic strokes

There are intracranial hemorrhages such as:
- subdural hemorrhage,
- epidural hemorrhage,
- intraventricular hemorrhage,
- subarachnoid hemorrhage,
- hemorrhagic presentation of ischemic stroke,
- venous haemorrhage from venous or sinus thrombosis and intracerebral haemorrhage.

Treatment and rehabilitation of patients after hemorrhagic stroke

 In the treatment of hemorrhagic stroke, agents are used to reduce brain swelling, as well as drugs that regulate arterial blood pressure. Rehabilitation involves the use of physiotherapy treatments and improvement exercises, carried out in cooperation with a neurologist, neurosurgeon and physiotherapist,

Major risk factors for strokes

The risk factors include:a) inappropriate lifestyle and environment:
- long-term nicotinism,
- alcoholism,
- taking drugs,
- age (the risk of developing a stroke increases twice every 20 years),
male gender,
genetic factors,
family factors.

1. b) comorbidities:
   
    - hypertension,
   - heart diseases,
   - already had a stroke or a TIA,
   - high hematocrit,
   - diabetes,
   - high fibrinogen

Likely factors include:

1. a) incorrect lifestyle and environment:
   
   -contraceptives,
   - a diet with lots of animal fats,
   - obesity,
   - abnormal lipid values,
   - too little physical activity,
   - early death of the mother due to vascular diseases,
   - geographic location (Japan),
   - poor socio-economic conditions.

1. b) comorbidities
   
   - increased uric acid,
   - gout
   - migraine
   - Hypothyroidism,
   - narrowing of the arteries, e.g. carotid stenosis
   - large difference in blood pressure in the upper limbs,
   - the occurrence of an aneurysm
   - the presence of arteriovenous deformities,
   - fibromuscular dysplasia.
   

Ischemic stroke causes

 Cerebral ischemia can be caused by many factors. Hemodynamic ischemic stroke occurs as a result of impairment of normal cerebral perfusion resulting from critical vasoconstriction or occlusion. The main risk factors are: atherosclerosis, embolism, hypertension. The cerebral circulation in patients with cerebral vasoconstriction is maintained by cerebral autoregulation, which maintains perfusion over a wide range of pressures, and by circulation of blood in the Willis wheel.

Ischemic stroke symptoms

 Ischemic stroke is of special social importance as it is the main cause of severe and chronic disability. They lead to disability of patients more often than death, with enormous costs, including health care expenses and loss of production capacity. Ischemic strokes account for approximately 80-88% of all strokes, the remaining 12-20% are haemorrhagic strokes.

Symptoms of a stroke

 Symptoms of a stroke include:- prickly headache
- weakness in the limbs, on one side
- difficulty pronouncing words, speech disorders
- blurred vision
- unsteady gait

How to recognize an ischemic stroke

The following are distinguished among ischemic strokes (cerebral infarctions):- TIA, transient ischemic stroke, symptoms are not clearly marked and pass within 24 hours.
- RIND - the symptoms of a stroke last more than 24 hours, they disappear after a few days.
- CS - completed ischemic stroke causes permanent defect symptoms (in the form of neuronal death).

Treatment and rehabilitation of patients after ischemic stroke

In the treatment of ischemic stroke, it is important to use therapy to improve cerebral perfusion in the ischemic area and to reduce the effects of stroke. Therefore, it is justified to use procedures aimed at opening blood vessels: vasodilation, lowering blood viscosity and anticoagulant therapy.

Managing a patient after ischemic and hemorrhagic stroke

         In this disease, secondary prophylaxis becomes necessary, i.e. preventing relapses and improving psychomotor functions. For this purpose, drugs are used to reduce blood clotting and improve circulation to the brain, and to prevent arterial hypertension.Medical rehabilitation is an important step in the treatment process as patients have varying degrees of neurological deficit. Therefore, rehabilitation should be incorporated into the treatment of stroke patients as soon as possible.Comprehensive rehabilitation in the acute period of stroke is aimed at reducing mortality in the first month of the disease by preventing life-threatening neurostimulation in the rehabilitation of speech disorders and their positive effect on the improvement of speech. Nursing care in the first phase of the stay is focused on preventing complications typical for patients with urticaria, i.e. pneumonia, contractures, bedsores and various infections. Rehabilitation supports the use of the compensation possibilities of the central nervous system, which will reduce the future neurological deficit, the risk of life-threatening complications (pressure ulcers, as well as aspirin pneumonia, deep vein thrombosis and pulmonary obstruction) and reduces the costs associated with the treatment of stroke

Source:

• Kwolek, A. Szydełko, Granice przeciwskazań do rehabilitacji po udarze mózgu, Udar Mózgu, 2005, t.7, nr,1, s. 31-37
• Bejer, A. Kwolek,Assessmentof qualityof life amongelderly strokepatients-preliminary report,Physiotheraphy2008, nr.16, 1, s..61-62
• J. Piskorz, G. Wójcik, Wczesna rehabilitacja pacjentów po udarze niedokrwiennym mózgu, Medycyna ogólna i nauka o zdrowiu, , 2014, t.20, nr.4,s.352-354
• G. Magoń, A. Bejer, Wpływ depresji na postepy rehabilitcaji u pacjentów po przebytym udarze mózgu- doniesienia wstępne, Postepy Rehabilitacji, 2005, nr.1 , s.41-46
• K. Adamczyk, Pielęgniarstwo neurologiczne, Wyd. Czelej, Lublin 2000, s. 43-57
• Szczudlik, Udar mózgu, Wyd. Uniwersytetu Jagiellońskiego, Kraków 2007, s. 202

Make an appointment now - to the doctor treating multiple sclerosis in our hospital

Multiple sclerosis epidemiology

The incidence of multiple sclerosis (MS) in Poland is estimated at 30-100 cases per 100,000 inhabitants. The incidence of MS is higher in developed countries. It is estimated that there are currently approximately 60,000 patients suffering from multiple sclerosis in Poland.

Multiple sclerosis causes

The cause of multiple sclerosis is not clearly defined, but many researchers point to the importance of the immune system in its formation.

The factors that trigger this disease were also identified, including:

1. intrinsic:
- genetic basis,
- impaired immune regulation (immune defect),
- physicochemical changes in myelin,
- disorders of myelin metabolism.
1.extrinsic:
-infection with a retrovirus or a common nonspecific virus (parainfluenza or measles virus, etc.),
-factors,
1.geographical,
2.environmental.
- climate.

Pathomechanism of multiple sclerosis development

Multiple sclerosis is a disease of the central nervous system. It is characterized by the occurrence of relapses and remissions, i.e. asymptomatic periods. The myelin surrounding the nerve fiber breaks down, scarring or scarring appears in its place, hence the name of the disease. The disease is characterized by multifocality. The available outbreaks can occur in different parts of the nervous system and illustrate widespread use involving the latter part of the term. Due to the diffuse nature of the disease

Varieties of multiple sclerosis

There are four types of multiple sclerosis:

- cerebrospinal,
- spinal (parapetic - with the predominance of paresis of the lower limbs),
- cerebellar,
- hemiparetic (in this variant, hemiparesis is mainly present

Multiple Sclerosis symptoms

The first symptoms of multiple sclerosis are: optic neuritis, cerebral ataxia, dizziness, numbness in the limbs, problems with urination .. Myelin damage causes conduction blockage and causes various symptoms.

Common disorders caused by MS include:

• spastic paresis, mostly of the lower limbs,
• ataxia (ataxia),
• abolition of abdominal reflexes,
• paresthesia,
• emotional lability,
• Charcot's triad (nystagmus, intentional tremor, chanted speech),
• disturbance

1. sphincter (vesico-rectal) activity,
2. logical thinking,

• affective

1. sexual (impotence).

• feeling tired / weary

In addition, the following disorders are accompanied by psychological symptoms:

-regarding the current state of health,
- for your and your immediate family's future (as anticipatory fears),
- concerns about finances,
- problems of a personal-intimate nature,
- fear of loneliness,

Multiple sclerosis treatment

Treatment of multiple sclerosis is based on therapy that reduces disease symptoms, reduces the duration of the relapse, its severity, and measures that influence the natural course of the disease. Interferon therapy is currently one of the most common and longest-used therapy in this disease. For years, the important role of vitamin D3 in modulating the clinical course of MS has been emphasized. In addition, the following are used: a special drug, which is Copolymerem, as well as Immunoglobulins and Immunosuppressive drugs. In the treatment of multiple sclerosis, it is important to assess the patient's health at each stage of the disease. The basic health recommendations for people with MS who leave hospital are a healthy lifestyle. In this case, the patient should exercise daily, eat healthy food, sleep 7-9 hours a day, rest, and effectively deal with stress. The patient should avoid rush. In the course of MS, regular sports should be practiced in order to improve muscle strength and maintain a full range of movements and normalize muscle tone.

Patients with MS are not advised to do any exercises in the acute period of multiple sclerosis, and after leaving the hospital, they should take a 10-day break for adaptation purposes. In the course of MS, a well-chosen diet containing 6-8 glasses of fluids a day, including apple juice, grape juice, orange juice, and chilled milk, is very important.

Rehabilitation in multiple sclerosis

An effective management strategy for treating MS must take into account the complexity of the disability caused by the disease, including the fact that treating one symptom may exacerbate another. In such a situation, comprehensive action is multidirectional and includes information provision, patient education, multidisciplinary treatment and pharmacotherapy. Finally, the diverse and variable nature of multiple sclerosis means that the needs of a particular patient will change over time, often suddenly, to encompass an ever wider spectrum of activities.

Rehabilitation, where the emphasis is on patient education and independence, is ideal for the complex and changing needs of MS patients. This is to increase the independence and quality of life of the patient by maximizing the opportunities and commitment of patients.

The World Health Organization has defined it as “an active process by which people with disabilities due to injury or disease achieve full recovery or, if full recovery is impossible, realize their physical, mental and social potential and are integrated into the appropriate environment.

The basic elements of rehabilitation in multiple sclerosis are:

- multidisciplinary assessment by a specialist,
- adopting a line of therapy aimed at achieving goals,
- assessment of the impact on the patient and the degree of achievement of goals.
This type of rehabilitation applies to all stages of the disease, from diagnosis to treatment of people with the most severe disabilities. In order to establish an action plan according to the needs of people with multiple sclerosis, it seems appropriate to detail the major stages of the disease. In this case, they are:

-diagnosis
- light disability
- moderate disability
- severe disability
At each of these steps, you should consider: access to up-to-date information, multi-disciplinary expertise, flexibility and accessibility, good communication, and empowerment of people with MS.

 

Source:

• W. Palasik, Leki biologiczne w leczeniu stwardnienia rozsianego. Przegląd aktualnych osiągnięć, Postępy Nauk Medycznych 10/2013, s. 715-719
• K. Adamczyk, Pielęgniarstwo neurologiczne, Wyd. Czelej, Lublin 2000, s. 60-67
• Ch. H. Polman, Przewodnik po lekach i leczeniu, Stwardnienie rozsiane, Polskie Towarzystwo stwardnienia rozsianego, Warszawa 2007, s. 33-49, s.59
• R. C. Kalb, Stwardnienie rozsiane, Polskie Towarzystwo stwardnienia rozsianego, Warszawa 2008, s. 1-16

Make an appointment now - to a doctor who treats urolithiasis in our hospital 

Symptoms of kidney stones 

The main and most troublesome symptom of this disease is pain - the so-called renal colic. Characteristic for it are: occurrence in the lumbar spine, radiation to the inner surface of the thighs and to the genitals. In the course of renal colic, vomiting and nausea may also occur. Pain ailments are caused by irritation of the walls of the urinary system organs (usually the ureters) by the deposits moving through them. When kidney stones are accompanied by a urinary tract infection (UTI), colic may be accompanied by chills and fever. The pain may go away on its own. This happens when the plaque "shifts" into the bladder and is thus excreted in the urine.

Diagnosis of kidney stones

The symptoms described above are characteristic of this ailment, hence the interview conducted by the doctor alone allows for an initial diagnosis of nephrolithiasis. A positive Goldflam symptom (causing severe pain as a result of a slight impact on the patient's lumbar region) during the examination also supports the discussed diagnosis. In order to make a diagnosis, the following are also performed:

general urine test - usually there is haematuria or haematuria. In the presence of urinary tract infection, bacteriuria (presence of bacteria in the urine) and leukocyturia (presence of leukocytes in the urine) are also possible

- blood test - usually leukocytosis (increase in the number of leukocytes in the blood). Increased CRP and ESR in the presence of UTIs.

Imaging tests are also performed to visualize deposits within the urinary tract. The most common methods used for this purpose are: abdominal X-ray and ultrasound. In case of doubt, diagnostics may be extended to include computed tomography. Nephrolithiasis can also be diagnosed by accident, when the patient is examined for another ailment, e.g. during an ultrasound of the abdominal cavity.

The causes of kidney stones

Based on the composition of deposits in the urinary system, we can determine the causes of their formation. These are the most common:

- endocrine diseases: hyperparathyroidism, chronic diseases of the digestive system, certain cancers or hematological diseases, e.g. lymphomas.

- dietary mistakes: habitual intake of vitamin C, diet rich in oxalate, low-calcium diet,

- recurrent urinary tract infections - refers to the formation of struvite deposits.

Complications of kidney stones

The most common consequence of untreated nephrolithiasis is its recurrence. The risk of recurrence in the absence of treatment increases by several percent with each subsequent year. Another common consequence of urinary tract deposits is recurrent urinary tract infections. There is a risk of hydronephrosis in the event of long-term obstruction of urine flow caused by stones. Due to the formation of cast struvite deposits in the calyx and renal pelvis, damage to the interstitial tissue of the kidneys may occur. This type of kidney stone is therefore particularly dangerous.

Treatment

In order to relieve pain, non-steroidal anti-inflammatory drugs, opioid drugs and drugs that relax the smooth muscle of the urinary system are used. If: the deposit is> 5mm in diameter, symptoms are accompanied by nausea or vomiting, and pharmacological treatment does not bring results, invasive treatment of nephrolithiasis should be considered. For this purpose, the following are most often carried out:

ESWL (extracorporeal shock wave lithotripsy) - extracorporeal lithotripsy. It consists in breaking the deposits with the use of electromagnetic or electrohydraulic waves. The procedure is performed under anesthesia.
PCNL (percutaneous nephrolithotomy) - percutaneous nephrolithotripsy. The purpose of this method is also to break down the deposit. This is done using an endoscope, which is introduced into the urinary system through carefully located puncture
URSL (ureteroscopy and laser stone fragmentation) - Ureterorenoscopic lithotripsy. Using an endoscope (ureterorenoscope) inserted through the urethra, deposits are removed from the ureters and the renal calyco-pelvic system.
classic surgery. In the case of large stones, the kidney may need to be removed.
Underestimating the symptoms of urolithiasis can lead to serious complications. Currently, surgical procedures performed during the treatment of the ailment in question are safe and do not require hospitalization for several days. If a patient experiences the symptoms discussed above, he should contact a physician in order to assess his health condition and, if necessary, to choose a treatment method.

Source:

• Ritter M, Krombach P, Michel MS. Percutaneus Stone Removal M. European Urology Supplements 2011; 10(5): 433-439.

Make an appointment now - to a doctor who treats prostate enlargement in our hospital

Causes, nature, symptoms, complications 

The cause of prostate enlargement is currently unknown. There is a hypothesis that the hormonal changes taking place over the years may have a significant contribution to increasing the volume of the organ. The symptoms of an enlarged prostate in most cases worsen over time. Belong to them:

Disorders of urination.
The prostate surrounding the urethra, as a result of its enlargement, begins to compress it, narrowing its lumen, which causes problems with urination: It can be manifested by:

- weakening of the urine stream,

- interrupting the urine stream

-feeling that there is urine in the bladder.

Ailments resulting from irritation of the bladder by an enlarged prostate:
Due to its close proximity, the enlarged prostate gland irritates the walls of the bladder, which may result in:

- frequent urination,

- experiencing a sudden, urgent need to urinate.

These symptoms are very bothersome for the patient and significantly reduce the comfort of his life.

An enlarged prostate that has not been treated can lead to a serious complication - urinary retention. It consists in the inability to completely empty the bladder due to a mechanical "obstacle" preventing the flow of urine through the organs of the urinary system. In the case of the ailment in question, it is an enlarged prostate gland which causes local narrowing of the urethra. There are acute (when symptoms occur suddenly) and chronic (when they occur over a long period of time) urinary retention, which may lead to further, serious consequences:

urinary tract infection

obstruction nephropathy (impaired kidney function due to difficulty in draining urine from the urinary tract)

How does the doctor diagnose prostatic hyperplasia?

The first issue that draws the doctor's attention to this problem are the characteristic complaints reported by the patient, discussed earlier. In order to confirm his suspicions as to the diagnosis, the doctor performs additional tests:

- Rectal examination - it is a finger examination of the size and consistency of the prostate through the anus. This procedure also allows for the assessment of the end segment of the gastrointestinal tract in men, which is important in the prevention of cancers of this organ.

- Urine test

- PSA test

- Ultrasound examination of the prostate gland

What does an ultrasound examination look like?

Patients are very often afraid of this diagnostic method because they equate it with transrectal (transrectal) ultrasound of the prostate. This is a misinterpretation, as nowadays the standard examination is similar to an ultrasound examination of the abdominal cavity. The prostate is assessed on the basis of the image of the pelvic organs. During the examination, the head of the apparatus is placed in the area of ​​the lower abdomen. This procedure takes a maximum of 20 minutes.

In addition, valuable information can also be provided by:

- Cystoscopy - involves inserting a speculum through the urethra into the bladder to assess these structures,

- Urodynamic examination - allows the evaluation of the bladder in terms of its function.

Risk factors

The factors that predispose to the occurrence of prostatic hyperplasia include: age, genetic tendencies, and diet. Chronic diseases such as diabetes and cardiovascular diseases also increase the risk of this disease.

Treatment

The choice of treatment method depends on the severity of symptoms and the patient's health. If the disease is not in an advanced stage and the symptoms do not significantly impair the patient's quality of life, conservative treatment is possible. These include lifestyle changes and drug treatment. It is advisable to avoid substances that may irritate the bladder (nicotine, caffeine) and to reasonably limit the consumption of diuretics, e.g. tea. In the treatment of prostate enlargement, drugs are used to relax the smooth muscles of the bladder wall, which will facilitate the outflow of urine. Another group of agents are preparations reducing the size of the prostate. If there is no improvement, surgical treatment is recommended. The most common surgical techniques include:

Transurethral resection of prostate (TURP). It consists in introducing a special electrode through the urethra, the purpose of which is to destroy part of the prostate tissue by the action of high voltage electric current pulses (electroporation). The treatment covers the tissues around the urethra, which reduces its pressure and improves the possibility of urine outflow.

This method is considered effective and safe, which is why it is most often used.

Transurethral incision of the prostate. In the case of slight enlargement of the prostate gland, it is possible to incision the bladder neck to the area of ​​the prostate capsule. This procedure (TUIP - transurethral incision of the prostate) is recommended for a younger man.
Prostate removal:
- using a laser, the transurethral method
- a classic surgical method

Enlargement of the prostate gland is a problem that affects a large proportion of elderly men. Unfortunately, the fact that our population is aging means that there will be more and more patients with this ailment. In order to avoid the unpleasant results of an untreated prostate enlargement, prophylaxis is recommended to cure possible ailments at the earliest possible stage. Periodic examination also allows for the early detection of prostate cancer, which at some stage of development may give similar symptoms as the discussed benign prostatic hyperplasia.

Source:

• Mitterberger M, Horninger W, Aigner F, Pinggera GP, Steppan I, Rehder P, Frauscher F. Ultrasound of the prostate. Cancer Imaging. 2010; 10(1): 40–48.
• Dybowski B, Przezcewkowa resekcja stercza. Przegląd Urologiczny, 2009.
• Welliver C, Helo S, McVary KT. Technique considerations and complication management in transurethral resection of the prostate and photoselective vaporization of the prostate. Transl Androl Urol. 2017 Aug; 6(4): 695–703.