Among other symptoms, multiple sclerosis can also produce symptoms of affective and cognitive disorders. The majority of patients have certain cognitive dysfunctions, and the' most common affective disorder is reactive depression. The aim of the study was to determine the correlation of the Mini-Mental State (MMS) and Beck Depression Inventory (BDI) scale scores with the Expanded Disability Status Scale (EDSS) score in patients with multiple sclerosis treated at University Department of Neurology, Sarajevo University Clinical Center in Sarajevo. We evaluated 50 randomly selected patients with various types of multiple sclerosis using the MMS, BDI and EDSS instruments. The study included 33 women and 17 men (66% : 34%), mean age 40.74 years (SD 9.236). The mean value of EDSS score was 3.98, ranging from 1.0 to 8.5 in women and from 1.0 to 6.5 in men. BDI scale scores showed a mean value of 12.56. The mean MMS score in baseline sample was 26.88. Statistically significant positive correlation was found between age and EDSS score, and negative correlation between EDSS and MMS, as well as between BDI and MMS. Study results indicated older patients with multiple sclerosis to have a higher EDSS score with more pronounced cognitive disturbances. There was no statistically significant correlation between EDSS score and depression.

The aim of our work is to determine the total number, age, gender of the patients with the symptomatic epileptic seizures associated with brain tumours, tumour location, clinical signs and characteristics of epileptic seizures. We have analyzed medical documentation of the patients with brain tumours hospitalized at the Department of Neurology, University of Sarajevo Clinics Centre. This study is retrospective and includes time period from 1st January 2000 until 31st December 2005. During the observed period at the Department of Neurology in Sarajevo there were in total 9753 hospitalized patients, from which 101 (1,1%) patients with the brain tumour diagnosis. Average patient's age was 62,60 +/- 1,28 years. In one third of the patients (32%) were recorded epileptic seizures, without significant difference between genders. In case of symptomatic epilepsy, significantly more frequent locations of tumours were: in several lobes (28%), parietal lobe (25%), as well as frontal and temporal lobe (18,8% each), while there were no changes in cerebellum and brain stem (chi2 =7,174, p<0,05). The most prominent signs of illness in our sample were hemiparesis with the cranial nerves lesion (56,3%), speech problems (25%). Normal neurologic findings were significantly more frequent among patients with the symptomatic epilepsy (chi2 =6,349, p<0,05). The most often was a single seizure (59%), in 38% of cases there were recorded series of seizures, and only 3% of patients had status epilepticus. In relation to the type of seizures, the most often are simple partial seizures with or without secondary generalization (66%), than generalized convulsive (31%), and the rarest one are complex partial seizures (3%). Symptomatic epilepsy in case of brain tumours occurs in one third of patients, at older age, and in both genders. The lesion usually affects several lobes and cause simple partial seizures with or without secondary generalization. The most often clinical signs in case of all brain tumours are cranial nerves lesion and hemiparesis, while the normal neurologic findings are significantly dominant in the group of patients with the epileptic seizures.

AIM The aim is to determine the frequency of stroke in 300 patients with type 1 and 2 diabetes mellitus observed in two different time periods with a five-year distance. MATERIALS AND METHODS The survey comprised a group of 300 patients with previously clinically and laboratory diagnosed diabetes. First examination, questionnaire and laboratory testing were performed in all patients in 1999. There were 62 patients with type 1 diabetes and 238 type 2. The final exam, questionnaire and laboratory test were performed on 278 patients in 2004 (diabetes type 1 in 58 (20.9%), diabetes type 2 in 220 (79.1%) patients. Additional anamnesis in 2004 grouped 2 patients into other specific types, and those were two women, previously classified as diabetes type 2. Twenty patients died between the first test in 2000 and the last in 2004. RESULTS In 1999 2.2% of tested patients suffered the stroke, and in 2004, the stroke suffered 3.2%. There was no statistically significant difference in the stroke occurrence in the same group of diabetic patients during the two observed periods with the 5-year time span. There was no statistically significant difference in the occurrence of stroke between males and females, or in type I and II diabetes groups. There were 4.3% of patients in total who suffered stroke during the survey. CONCLUSION There were no statistically significant changes in number of stroke patients which indirectly confirms good treatment of diabetic population in primary care.

Introduction: Vertebral basilar (VB) insufficiency or vertebral basilar ischemia refers to temporary complex of symptoms caused by the reduced blood flow in posterior blood circulation of the brain. Common tests needed to be done are basic laboratory blood tests: lipid status, cholesterol, urea, creatinine, mineral panel, blood sugar, coagulation time. A Transcranial Doppler Sonography (TCD) is a non invasive ultrasound method which enables the insight into the circulation state of the intracranial portion of the posterior vertebral basilar basin. Aim: To determine the correlation between vertebral basilar insufficiency and clinical findings with special emphasis on duration of dizziness and a correlation of mean blood velocity (MBV) and laboratory findings. Material and methods: The survey was conducted at the Neurology Clinic, Clinical Center University of Sarajevo as a prospective study of hospitalized and ambulatory treated patients in the period from February 1 2007 until May 31 2007. It included 100 patients, 56 females and 44 males with dizziness mean duration of 30 days. A specially designed questionnaire was used in the study. For all patients included in the study we obtained: history (with a special emphasis on dizziness, vomiting impulse, double vision and balance disturbance), risk factors, laboratory findings: blood sugar, cholesterol, triglycerides. The TCD was performed by TRANS SCAN 3D, made by NIKOLET, with a 2 MHz transducer. Results: 58% of patients were 51-70 years old. 12% had elevated blood sugar, 39% elevated cholesterol and 30 had elevated triglycerides. Mean blood velocity in vertebral arteries bilaterally and in basilar artery were significantly lowered. In the case of males, the results show that there is statistically significant correlation between MBV in RVA (lowered values) and increased values of cholesterol and triglycerides. In females, there is a connection of reduced MBV and LVA with lowered values of cholesterol and triglycerides. Conclusion: Our survey showed a significant correlation between lowered values of MBV in arteries of VB basin with elevated values of laboratory parameters such as: blood sugar, triglycerides and cholesterol. The sensitivity of the TCD as a diagnostic tool in the VB insufficiency was 72% in our study.

Ljubica Todorovic1,Vida Demarin2, Azra Alajbegovic1, Nedim Loncarvic1 Neurology Clinic, Clinical Center Of Sarajevo University, B&H1 University Department Neurology “ Sestre Milosrdnice, Zagreb, Croatia2 AIM 2. The aim of this paper is early detection and evaluation of the acute cerebral stroke by following the mean values of blood flow velocities (MBFV) trough intracranial blood vessels and comparative analysis of the hemodynamic of left and right hemisphere.

PURPOSE Multiple sclerosis is a chronic progressive disease with multiple neurological and psychological impairments. The object of this study was to investigate the relation between quality of life of MS patients and main clinical parameters of the disease. METHODS The study included 100 patients diagnosed with multiple sclerosis who were treated at the Department of Neurology, Clinical Center University in Sarajevo. Quality of life was evaluated by using MSQOL-54 questionnaire. Internal consistency of Bosnian MSQOL-54 version was evaluated. Associations between disability level (EDSS score), clinical type, disease duration, presence of pain and sphincteral problems and the MSQOL-54 physical and mental health composite scores were determined. RESULTS The MSQOL -54 questionnaire, translated to Bosnian, proved to be highly reliable (Cronbach alfa > 0.75 on all scales). All clinical determinants used in the sudy proved to be significantly related to the quality of life scores based on the Mann-Whitney test (p < 0.05). Method of linear regression analysis showed presence of pain and EDSS score as the most significant independent predictive factors of the physical health composite score (R2 = 0.827). The presence of pain and clinical type of disease, proved to be independent predictive factors of the mental health composite score with present, but less significant role of EDSS score (R2 = 0.598). CONCLUSION The presence of pain retained the most significant role in the prediction of both physical and mental composite scores, which proved the importance of pain management in treatment of MS patients. Disability level (EDSS score) showed minor importance in predicting mental health composite scores which proved deficiency of clinical scales and emphasize the importance of the quality of life measures as independent criteria in the evaluation of multiple sclerosis patients.

Botulinum neurotoxin (BoNT) is produced by Clostridium botulinum as a complex of proteins containing the neurotoxin itself and other nontoxic proteins. Activation of the neurotoxin occurs upon proteolytic cleavage into the heavy and light chains. This di-chain moiety is essential for neurotoxin and each chain is playing a unique role; the heavy chain mediates neurospecifics cell binding and entry, whereas the light chain, a protease, catalyzes the cleavage and inactivation of neuronal proteins that mediate neurotransmitter release. There are seven BoNT serotypes (A,B,CI,D,E,F, and G), all of which inhibit acetylcholine release, though their intracellular target proteins, the characteristics of their actions, and their potencies vary substantially. BoNT type A has been the most widely studied and applied serotype for therapeutic purposes. It has been a mainstay in the treatment of cervical dystonia, blepharospasm, and hemifacial spasm for years. BoNT has more recently emerged as an increasingly important therapeutic option in the clinical management of a broad array of conditions, including other focal dystonias, spasticity, cerebral palsy, equinovarus, gastrointestinal (GI) and urogenital disorders, hypersecretory disorders, facial lines due to hyperfunctional facial muscles and recently, musculoskeletal pain disorders and headache.

Patients with either type 1 or type 2 diabetes mellitus (DM) carry a risk of developing chronic diabetic complications. The aim of the study was to establish the prevalence of diabetic neuropathy in 300 patients with type 1 and 2 diabetes evaluated at two time points 5 years apart. The study included 300 patients with clinically diagnosed and laboratory verified diabetes. Initial examination, questionnaire and laboratory testing were performed in all patients in 1999 (type 1 diabetes 62 patients and type 2 diabetes 238 patients). Final examination, questionnaire and laboratory testing were performed in 2004 in 278 patients (type 1 diabetes 58 (20.9%) patients and type 2 diabetes 220 (79.1%) patients). Additional history taken on 2004 examination placed two female patients previously classified as type 2 diabetes to another specific diabetes type group. Twenty patients died in the period between March 31, 2000 and final examination taken on February 1, 2004. In 1999, 51.1% of patients had diabetic neuropathy; in 2004, symptoms and signs of diabetic polyneuropathy were recorded in 84.2% of the same diabetic population. The increase in the number of patients with diabetic neuropathy recorded during the 5-year period was statistically significant. The average duration of diabetes was 13 years at initial examination and 18 years at final examination. In conclusion, diabetic neuropathy was significantly more common in 2004 than in 1999 in the same group of patients (p<0.01). The risk of developing diabetic neuropathy increased with longer duration of diabetes (p<0.05). Therefore, a more aggressive approach is necessary in the treatment of our diabetic patients, including education, physical activity and use of appropriate medication.

Bilateral retrobulbar optic neuritis in young adults are most often caused by demyelinate disease (MS). In all cases where MS was eliminated, we have used selected tests regarding to history, clinical findings and differential diagnosis. Diagnosis of Lyme disease is approved by diagnostic criteria proposed by Center for Control and Prevention of disease. In our case diagnosis of Lyme disease was established by history of illness, clinical findings and positive serlological tests.

Studies indicate that inflammatory mechanisms may play an important role in the pathogenesis of Alzheimer's disease (AD). C-reactive protein (CRP), marker and mediator of inflammation, has been detected in lesions typical for the affected areas of AD brain. There have been conflicting reports on serum CRP concentration in AD. Scarce data exist on association of CRP and measures of adiposity in AD patients. Thus, we investigated serum CRP concentration in fifteen overweight institutionalized patients with probable AD and fifteen age-matched control subjects. Body mass index (BMI) and waist/hip ratio (WHR) were calculated for each subject included in the study. Age, systolic and diastolic blood pressure, BMI and WHR did not differ significantly between the two groups. Serum CRP concentration was significantly higher in patients with AD compared to controls (p<0.0001). Although not significant, positive correlations between serum levels of CRP and BMI and WHR were found. Obtained results support the notion that low-grade inflammation is present in patients with AD. Absence of significant association between CRP and measures of total and central adiposity in overweight AD patients needs further investigation and explanation.

INTRODUCTION Recent studies show that psychological status of HD patients has been changed in terms of an increased score of the called neurotic triad: hypochondria, depression and hysteria. The aim of this study was to evaluate the correlation between the development of psychopathological tendencies in HD patients and the demographic features such as: gender, age, marital status, education level, employment status and HD duration. MATERIAL AND METHODS There were 56 patients on HD. Depending on registered psychopathological tendencies, we compared patients according to the mentioned demographical characteristics. We applied MMPI 201. Previously, all patients were psychologically examined by explorative interview regarding demographical data and the pre-dialysis psychological status. To compare categorical variations, we use 6 multivariant analysis of variance. A p value of <0.5 was considered to be statistically significant. RESULTS The overall profile of psychopathological tendencies of HD patients indicates increase of scores on neurotic triad. Female patients showed significantly higher level of psychosteny than male patients (FPt=4.86, p<0.05): singles showed significantly higher scores on some psychotic subscales--paranoia, schizophrenia, mania--in relation to the group of married patients (FPa=7.21, FSc=6.84, FMa=5.35, p<0.05): patients with only primary school have significantly more expressive paranoia in relation to patients with university education (FPa=3.80, p<0.05); unemployed patients have significantly more expressed paranoia and tendencies to emphasize pathology in relation to employed patients (FF=5.13, FPa=5.94, p<0.05). CONCLUSION Depression could be taken as a a primary psychiatric complication associated with life on haemodialysis. Gender, marital status, education level and employment status significantly influence the differences in occurrences of psychopathological tendencies in HD patients.