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Open access

Liene Elsone, Ardis Platkajis, Guntis Karelis, Sarmite Dzelzite and Maira Murzina

Tumefactive Multiple Sclerosis Mimicking Neoplasm

Acute demyelination may present as a rapidly expanding space-occupying or tumefactive lesion (TDL). Tumefactive demyelinating lesions are misdiagnosed quite frequently and can result in unnecessary and potentially harmful surgical resection, radiation or toxic chemotherapeutic interventions therapy. Systematic literature review from available articles and abstracts in PubMed database was summarized in purpose to describe typical presentation and diagnostically challenging features of TDL. One clinical case report presenting tumor-like lesion of the brain, when the diagnosis of TDL was established, is added as an illustrative material.

Open access

Normunds Sūna, Madara Lazdāne, Guntis Karelis and Egils Vītols

Abstract

Sudden unexpected death in epilepsy (SUDEP) is a common cause of mortality in patients with epilepsy, but it is unknown how neurologists disclose this risk when counselling patients. This study was aimed at examining SUDEP discussion practices of neurologists in Latvia, as well as the awareness of the syndrome. Two hundred questionnaires were distributed, and we received 84 responses. We found that the majority of Latvian neurologists (79.0%) do not inform their patients of SUDEP, which is opposite to the findings in other countries. Despite the existing practice, 93.1% of neurologists believed that patients should be informed about SUDEP. A partial explanation for not discussing the negative aspects of epilepsy is that 75.3% of caregivers believe that being informed about SUDEP would cause permanent anxiety in patients, whereas 69.4% believe that it would improve compliance. This study revealed average awareness of SUDEP risk factors and warrants further studies for in-depth analysis of existing counselling practice.

Open access

Lana Vainšteine, Andrejs Kostiks, Guntis Karelis, Viktorija Ķēniņa, Natalja Zlobina and Angelika Krūmiņa

Abstract

Therapeutic plasma exchange (TPE) is used in many neurological disorders to remove immunoglobulin and other immunologically active substances. We observed patients that were admitted in Rīga East Clinical University Hospital “Gaiļezers”, Clinic of Neurology and Neurosurgery, Multiple Sclerosis Unit, and were diagnosed with relapsing remitting multiple sclerosis (MS), according to McDonald criteria 2010 (five patients), Neuromyelitis optica (NMO) spectrum disorders (three patients) and one with NMO, according to Wingerchuk 2006 criteria. All relapses were confirmed according to clinical criteria. Visual acuity was assessed by an ophthalmologist, and neurological status by a neurologist. All patients received at least 1 cycle of 1000 mg methylprednisolone intravenous for five to seven days. The expanded disability status scale score in the MS patient group was in range 4.0-9.0 before TPE and 3.5-6.5 range after TPE. Best improvement was observed in the MS group: mean symptom reduction of 20%. Patients with NMO spectrum disorder had an EDSS score of 8.0-8.5 range on admission and 6.5-8.0 range after TPE. After one month, one patient in the NMO spectrum disorder group had good response to TPE and EDSS was 3.5, two patients had only slight improvement (EDSS scores 8.0 and 7.5). Condition of patients with NMO did not improve even after a month.

Open access

Normunds Sūna, Evija Gūtmane, Madara Lazdāne, Guntis Karelis and Valdis Folkmanis

Abstract

People with epilepsy have increased mortality rates, which is partially attributed to sudden unexpected death in epilepsy syndrome (SUDEP). Poor seizure control appears to be the strongest SUDEP risk factor. Management of epilepsy and adherence to therapy is critical to seizure control. The belief by caregivers of negative influence caused by being informed about the syndrome is the main reason SUDEP is not disclosed. There are no clear recommendations when to disclose the risk of SUDEP and how much information should be provided. We addressed the preferences of Latvian epilepsy patients for discussing SUDEP as well as awareness of the syndrome. Our study involved 55 epilepsy patients. We found that, as in other studies, our patients were relatively well informed about SUDEP. We found that a considerable proportion of patients preferred to receive information about SUDEP from a general practitioner. We note the belief of patients that the disclosure of SUDEP would either improve or have no effect on the quality of life. We were able to identify groups of patients with a self-reported belief of more frequent expected anxiety and poor adherence to medical treatment. Our data improves the understanding of preferences of patient for discussing the negative aspects of epilepsy.

Open access

Līga Mekša, Guntis Karelis, Lana Vainšteine, Sandra Svilpe, Gundega Gulbe, Anželika Gudreniece and Jolanta Kalniņa

Abstract

Cognitive changes are common in people with multiple sclerosis (MS). The neuropsychological testing requires specialised trained staff, time-consuming expert analysis and complicated test result interpretation. An expert committee recommended the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), which is optimised for small centres. We conducted the Symbol Digit Modalities Test (SDMT) and Brief Visuospatial Memory Test (BVMT), for which the results were comparable with similar results in literature. Most MS patients showed decreased attention and processing speed, while visual memory was generally normal. Cognitive impairment occurrence is not strongly related to Expanded Disability Status Scale (EDSS) score.