Replacement therapy is a treatment that is not based on accepted medical knowledge and science that is not in accordance with current medical doctrine. Additional treatment is not contrary to the accepted doctrine of medical schools, but serves only as a supplement to the accepted treatment. Most general practitioners in England and Germany do not contradict these forms of treatment. On average 2/3 of patients with MS in the course of the disease try alternate options and additional treatment. Alternate forms of treatment that are most commonly used are: diet, homeopathy, chiropractic procedures and methods of relaxation Detrimental eff ects of alternative and complementary treatments for patients with MS is not known, but we must avoid the use of active substances entering the body and blood of patients, because in that way we can start a modifi ed immune response. Used are acupuncture, and particularly yoga. Cannabis takes special place. Cannabinoids have antioxidant and neuroprotective eff ect. Oral cannabinoids and marijuana smoking can relieve some symptoms of MS including spasm and pain. Th e controlled studies did not validate the eff ect of oral cannabinoids on spasm in MS. Th e aim is to give a brief overview of dietary supplements and the eff ects of certain vitamins, minerals and oil in people with multiple sclerosis.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS). It is characterized by loss of myelin, the fatty tissue that surrounds and protects nerve fibres allowing them to conduct electrical impulses. Recent data indicate that oxidative stress (OS) plays a major role in the pathogenesis of multiple sclerosis (MS). The aim of this study was to estimate level of serum total antioxidative capacity in patients with multiple sclerosis. Our cross-sectional study included 33 patients with MS and 24 age and sex matched control subjects. All our patients had a Poser criteria for definite diagnostic categories of multiple sclerosis. Serum total antioxidant capacity (TAC) was measured by quantitative colorimetric determination, using Total antioxidant Capacity-QuantiCromAntioxidant Assay Kit (BioAssay systems, USA; DTAC-100). Mean serum TAC in multiple sclerosis group of patients was 119.2 mM Trolox equivalents and was significantly lower (p<0.001) compared to the control group of subjects (167.1 mM Trolox equivalents). Our results showed that oxidative stress plays an important role in pathogenesis of multiple sclerosis. This finding, also, suggests the importance of antioxidants in diet and therapy of MS patients.

In order to examine precipitating factors for occurrence of multiple sclerosis or inception of a relapse in patients suffering from multiple sclerosis a specially designed questionnaire was used, including history records of patients with multiple sclerosis treated at the Clinic of Neurology of the Clinical Center of Sarajevo in the period between January1st and December 31st 2006. The number of patients with MS was 71 (48 women and 23 men). An infection as a precipitating factor was noted in 21 (29.57%) cases, stress was noted in 12 patients (16.9%) whereas 43 patients (60,12%) had the RR type of the disease. Nine patients were treated with interferon therapy (12.67%) and 47 patients (66.1%) with high doses of metilpredinisolone . Depression disorder was noted in 23 (32.9%) patients whereas 7 patients had cognitive dysfunction (9.86%). Results of this study, which have shown epidemiological characteristics of multiple sclerosis for the first time in Bosnia and Herzegovina, indicate that there is a need to create a unified register of patients and to request compliance with therapeutic guidelines.

The aim of this study was to investigate the effect of the duration of diabetes and glycemia on the development of diabetic retinopathy in diabetes types 1 and 2 and the prevalence of retinopathy by sex. It examined 278 diabetics in 1999 and 2004, a questionnaire was used to collect data and results of fasting glucose, HbA1c, glycosuria and ketonurie were recorded. Retinopathy was noted in 80 (28.78%) and 187 (67.27%) patients during 1999 and 2004, respectively (p < 0.001). The number of patients with the nonproliferative and preproliferative (p < 0.001) as well as with proliferative retinopathy (p < 0.01) was significantly higher in 2004 in the comparision with 1999. The average HbA1c in 1999 was 13.02%, whereas in 2004 it was 10.57%. Poor control of diabetes was present during both investigations.

INTRODUCTION Multiple sclerosis (MS) manifests also with the symptoms of affective disorders. Depression is the most common mental disorder among patients with MS and it has negative impact on their working ability, social relations and quality of life. The aim of this study is to investigate gender, age, marital status, education level and employment related to patients with depressive symptoms in population of MS, treated at the Department of Neurology, Clinical Center University of Sarajevo. METHOD In the study it was analyzed 50 randomly selected patients with various types of multiple sclerosis. Severity of depression was evaluated using the Beck Depression Inventory (BDI). RESULTS The study included 33 female and 17 male patients aged 21 to 60 years. In the sample of MS patients there were 56% with depressive disorder. There is no statistically significant difference between patients gender. Depression is more frequent among younger and middle age patients, while all the patients older than 51 years are in a normal mood (total 31.9%). Significantly higher percentage of non-depressive patients (72.2%) are married, while depression is present among all divorced patients (10.7%), majority of single (35.8%) and widowers (21.4%). Taking into consideration level of education, there is a statistically significant difference as follows: depression is more frequent among patients who graduated university (46.4%) and secondary school (50%) compared to ones who finished only primary school (3.6%). There is significantly higher number of unemployed and retired patients with depressive symptoms (75%) in comparison to the employed ones. CONCLUSION Depression occurs more frequently among MS patients who are younger, unemployed, highly educated and without spouse. There is no statistically significant difference between male and female patients.

Progress in multiples sclerosis (MS), since the pioneering work of Charcot and his predecessors, has not occurred suddenly through dramatic scientifi c breakthroughs, but through the continued eff orts of thousand of investigators. Advances in understanding of basic science, particularly immunology and phar-macology as well as developments in the investigation clinical disease, especially magnetic resonance imaging , ultimately contributed to the approval of the fi rst drugs to impact the natural history of the disease. At the dawn of twenty-fi rst century, the availability of interferons and glatiramer acetate has accentuated the hopes of those aff ected with MS and their families. Multiple sclerosis is and autoimmune neurological disease characterized by dissemination of changes in the CNS white matter in both time and space. Historical overview of the events provides insight into the understanding of the disease and in many medical trends during last two centuries. Th e fi rst description of the disease is in St Lidwine van Schiedam who lived in late XIV and early XV centuries. Th e history of her ailment was described by Medaer. She was born on April 18 1380 in Schiedam, the Netherlands. Dr Sonderdank, the physician who had treated her, said to his colleagues: " Believe me when I tell you that this disease has no cure; it comes straight from God. Neither Hippocrates, nor Galen would be able to help here. Th is woman was touched by the hand of God " 1. A well documented case, before the disease was recognized in medical circles, is the case of Augustus d'Este (1794-1848), George III's grandson. He had been writing a detailed journal since 1822 where he had described symptoms very graphically and followed the progression of his disease during several decades. Another notable personality who is believed to have had multiple sclerosis was the poet Heinrich Heine (1797-1856). Charles Prosper Olliveier d'Auders was the fi rst to give an account of MS in a monograph published in Paris in 1824 in the work entitled " Maladies de la moelle epiniére " , where he described a twenty-year-old with relapsing-remitting neurological symptoms. Robert Carswell was the fi rst to describe pathologic changes of MS in an atlas published in 1838. In France Jean Cruveilhier had described four cases in a text entitled " Diseases of the spinal cord ". Charcot gives Cruveilhei-ru the primacy as the fi rst MS illustrator. Carswell's pictures …

Multiple sclerosis is autoimmune, inflammatory, demyelinating chronic disease of the CNS with degenerative disseminated changes of the white mass of brain and spinal cord. Due to its frequency, chronic course and tendency to affect younger people, it is one of the most common, the most severe and the most important neurological disease.The aim of the investigation is to make an insight into application of pulse corticosteroid therapy of multiple sclerosis at the Neurological clinic of the Clinical Center of Sarajevo University during 2005 compared to psychical disorder in patients. A modified questionnaire form was used for analyzing patient’s histories of ilness and it is routinely used at the Neurological clinic of the Clinical Center of Sarajevo University.The investigation included 34 patients who were treated at the Neurological clinic of the Clinical Center of Sarajevo University during 2005. 20 patients were female (59%), and 14 were male (41%). 40% of patients were age 40-49, 29% workers, 73% of patients had secondary school level of education, in 3 patients psychic stress was identified as precipitating factor for development of the disease. Average period of hospitalization was 17.5 days. Not a single patient quoted any psychic disorder as a disease symptom, nor in the onset or relapse of the disease. Also, following pulse corticosteroid therapy not a single patient reported any changes of psychic condition that would be important to evidence observe and treat.Conclusion: 34 patients were treated at the Neurological clinic of the Clinical Center of Sarajevo University during 2005 with confirmed diagnosis of multiple sclerosis during relapse of the disease with pulse corticosteroid therapy. There were more female patients, with secondary school level of education, with significant cognitive dysfunctions and existing depressive affect. Doctrinarian approach to the treatment of relapse with high doses of methyl-prednisolone lead to significant improvement of neurological dysfunction.

SUMMARY Introduction: New antiepileptic drugs have opened a new era of therapy in the epilepsy treatment. The aim of this paper is to establish a therapeutic effect of the new antiepileptic (AE) as a supplement therapy in the treatment of those types of epilepsy which proved to be resistant to previously used therapy, with a special emphasis on lamotrigine. Aim: To prove the efficacy of new antiepileptics as an additional therapy in treating those forms of epileptic seizures which had proved resistant to previously used therapy. Material and methods: The research was undertaken at the Sarajevo Neurology Clinic. It included 60 epileptic patients (30 patients with the old antiepileptic therapy, 30 with the new antiepileptics as add on). All patients had partial epileptic fits with secondary generalizations. Results: The male female ratio in both groups was the same 16M:14F. 33% of patients were under 20, mean age was 27.2 years. The most frequent antiepileptic therapy was the combination of carbamazepine and lamotrigine in 67% of patients in the group with the new AE, while 90% of patients in the group with the old AE received carbamazepine. Conclusion: New antiepileptics have proven to be efficient as a supplement therapy in the treatment of previously resistant epileptic fits. The frequency of fits was reduced in 66.7% of patients, and in 16.7% of patients the fits were alleviated. The new AE did not significantly influence the psychological traits of patients; in all patients an improved quality of life was noted after introducing the new lamotrigine to the therapy.

Diabetes type 1 and 2 carry the risk of chronic diabetic complications including microvascular disease (microangiopathy), which is specific to diabetes and macrovascular disease (macroangiopathy). Microangiopathic changes affect renal glomerulus and small blood vessels in the retina and nerves, causing diabetic nephropathy, diabetic retinopathy and diabetic neuropathy, although the cause of diabetic neuropathy may not only be disease of small blood vessels. Goal: To assess the prevalence of chronic diabetic complications of the kidneys in the two time periods studied in diabetic populations. Materials and Methods: The study involved a group of 300 patients with clinical and laboratory earlier clearly diagnosed diabetes. Reviews, interviews, and provided laboratory testing were performed in all subjects in the two time periods 1999 and 2004. (Diabetes type 1–62 patients, type 2–238). Results: The average duration of diabetes in the examined 58 type 1 diabetic patients accounted for 12.57 years and in the 220 type 2 diabetic patients 13.24 years. The total sample studied has the average duration of diabetes for 13.07 years. In the group of type 2 diabetic patients, women had significantly longer average duration of diabetes than men. From the total sample in 1999 years microalbuminuria had 27.3% of our respondents and in 2004. 49.6%. Proteinuria in 1999 had 9.3% of our respondents in 2004 13.3%. In type 1 diabetic patients with microalbuminuria was not significantly different in the two investigated years. Evident is a significant increase in type 2 diabetic patients with microalbuminuria in 2004 compared to 1999. Also evident is a significant increase in the number of diabetics in the total sample with microangiopathy in 2004 compared to 1999. Registered is a significant increase in the number of women with microalbuminuria in 2004 compared to 1999. Statistically significantly higher number of men studied had microalbuminuria in 2004 compared to 1999. Terminal renal failure had 2.2% of our respondents in 1999 and in 2004 year 7.2%. Statistically significantly higher number of diabetic patients studied had terminal renal failure in 2004 compared to 1999. Conclusion: In the tested sample we had a statistically significantly higher values increased an average cratinaemia in 2004 compared to 1999, a larger number of subjects with microalbuminuria and terminal renal failure. Based on this conclusion there is need for more intensive work on the prevention of diabetic nephropathy

Alzheimer;s disease (AD) is a multifactorial disease but its aetiology and pathophisiology are still not fully understood. Epidemiologic studies examining the association between lipids and dementia have reported conflicting results. High total cholesterol has been associated with both an increased, and decreased, risk of AD and/or vascular dementia (VAD), whereas other studies found no association. The aim of this study was to investigate the serum lipids concentration in patients with probable AD, as well as possible correlation between serum lipids concentrations and cognitive impairment. Our cross-sectional study included 30 patients with probable AD and 30 age and sex matched control subjects. The probable AD was clinically diagnosed by NINCDS-ADRDA criteria. Serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) levels were determined at the initial assessment using standard enzymatic colorimetric techniques. Low-density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C) levels were calculated. Subjects with probable AD had significantly lower serum TG (p<0,01), TC (p<0,05), LDL-C (p<0,05) and VLDL-C (p<0,01) compared to the control group. We did not observe significant difference in HDL-C level between patients with probable AD and control subjects. Negative, although not significant correlation between TG, TC and VLDL-C and MMSE in patients with AD was observed. In the control group of subjects there was a negative correlation between TC and MMSE but it was not statistically significant (r = -0,28). Further studies are required to explore the possibility for serum lipids to serve as diagnostic and therapeutic markers of AD.