– Stroke is the leading cause of mortality and the main cause of disability in adults in Europe. According to the American Heart Association, “the profile of apoplectic personality is determined by systolic blood pressure greater than 160 mm Hg, diastolic blood pressure higher than 95 mm Hg, family history of cardiovascular diseases, hypercholesterolemia, smoking, alcohol abuse and diabetes mellitus”. The aim of this retrospective study was to assess the correlation between early and late epileptic seizures during and after stroke, and some heart diseases associated with hypertension. Ten-year records (January 1, 1989 till December 31, 1998) of the University Department of Neurology, Sarajevo University Clinical Center, were examined. There were 7001 stroke patients (53.6% with cerebral thrombosis, 17.35% with embolic etiology, 21.96% with intracerebral hemorrhage, and 1.17% with subarachnoid hemorrhage), with a 3.38% incidence of symptomatic epileptic seizures. The following cardiac diseases were considered relevant for the study purpose: absolute arrhythmia, subdecompensated heart state, well treated cardiac decompensation, angina pectoris, postmyocardial infarction state, and extrasystoles. Results revealed a statistically significant difference in the correlation with cardiac diseases between patients with early and late epileptic seizures. The patients with early epileptic fits had severe heart problems compared to those with late seizures. The former suffered from angina pectoris, heart decompensation and chronic subdecompensated state, yielding a ratio of 1.1 to 0.6. There was no statistically significant difference between the groups according to absolute arrhythmia. Study results suggested the patients with cerebrovascular disease and early epileptic fits to have a significantly higher rate of heart problems compared to stroke patients with late epileptic fits, in whom the morphological changes of the brain appeared neurophysiologically to act as an epileptogenic focus.

It is a general rule today, after a relevant diagnostics of an epilepsy, to start a monotherapy treatment, depending on a kind of a seizure, a life age and a general health condition. First line of monotherapy epilepsy drugs remain carbamazapine and sodium valproat. New drugs that are being introduced are: felbamat, gabapentin, lamotrigin, oxcarbazepin, tiagabin, topiramat, vigabatin and zanisamid. These are commonly used as add-on therapy, or as an addition for previously used antiepileptic. Their indicated areas are complex resistant partial seizures with or without generalization. Attention should be paid on proper dosage, interactions and toxicity. Regardless on the new epileptic era, according to reports of International League against epilepsy, most of the patients do not receive the drug that is the most appropriate for them concerning the price (cost-benefit). Neurosurgical methods in epilepsy treatment are: selective amygdalo-hyppocampotomy, temporal lobotomy, subpial resection, hemispherectomy, corpus callosotomy, removal of lesions like tumors or cysts provide encouraging results in reduction of epileptic seizures that can be followed by reduction of drug therapy. N. vagus stimulation is being wider introduced in resident epileptics. Treatment of epilepsy in women requires an approach to sexuality, conception, pregnancy, introduction of medicaments, antiepileptic terratogenity, contraception, motherhood and menopause. A special significance of modern approach to epilepsy is in treatment of elderly who have cerebrovascular and neurodegenerative disease as a cause of seizures. A complex treatment of epilepsy using pharmacological and neurosurgical approach requires supportive psychotherapy, socio-therapy, the work with a family, education about epilepsy and living a life with more quality having one.

A seizure is a disturbance of movement, feeling or consciousness occasioned by sudden, inappropriate and excessive electrical discharges in the grey matter of the brain. The most common psychiatric disorder in epilepsy is interictal depression, with lifetime prevalence of 40 to 60%. Particular attention should be paid to suicidal ideations, due to the fact that most of the patients have easy access to potentially lethal when overdosed, antiepileptic drugs. The aim of our paper is to determine the presence of depressive symptoms in epileptic patients according to their treatment protocols (monotherapy or polytherapy), gender, age, social status, age when diagnosed, type and frequency of seizures. Prospective evaluation of monotherapy and polytherapy in 60 subjects, (30 subjects in each group), who were diagnosed with epilepsy. Assessment of depressive symptoms was performed with the use of BDI scale. In both groups there was a similar structure according to gender, mean age was 34 (with an s.d. of 11.06). More than 96 percent of the subjects had low or average socioeconomic status. Average age of first attack was 20.43 (with an s.d. of 11.9). In the group treated with monotherapy there was the biggest number of generalized convulsive seizures, and in the group treated with polyantiepileptic therapy there was the biggest number of partial complex seizures. Symptoms of moderate and severe depression were registered in 33% patients treated with monotherapy and 60% of patients treated with polytherapy (t = 2.198, for p less than 0.05). 16.7 percent of the patients had suicidal ideation. On the basis of our research we can conclude that significantly more frequent and severe depressive symptoms were found in the group of epileptic patients who were treated with polytherapy. In those patients the occurrence of partial complex seizures was the biggest, and their frequency was weekly or even daily.

UNLABELLED The state of mental confusion is described as an dependent risk factor in development of early and late epileptic-onset seizures following CVI. The aim of this paper is to determine the influence of confused state as possible predictor of symptomatic seizures in the course and following CVI. MATERIAL AND METHODS The patients who were treated in The Department of Neurology for early and late-onset seizures in the course and following CVI in the period between 1.1.1989 and 31.12.1998. RESULTS We had total number of 106 patients with symptomatic seizures, 56 in the group of late-onset and 50 in the group of early seizures. 52.8% of the patients have a registered state of mental confusion at the admission to hospital (in the stage of acute CVI), 19.2% of patients had a clear sensorium. Disorder of consciousness of the type of coma was registered in 27.4% of the patients. There was statistically significant increase of the occurrence of mental confusion in the group of patients with late-onset seizures, 62.5% while there was a statistically significant increase of coma in conditions related to type, frequency and outcome of seizures. We can conclude that mental confusion has significant influence of the occurrence of late-onset seizures while it does not influence the type and frequency of seizures.

Data was analyzed retrospectively of a ten year period at the Neurology clinic in Sarajevo, with regards to the treatment of patients with acute cerebrovascular accident (CVA or stroke). The whole period has been divided into three segments: a) pre-war period 01.01.1990-05.04.1992, b) the war period 06.04.1992-15.12.1995, and c) post-war period 16.12.1995-31.12.1999. There has been the total of 6,255 patients with a completed stroke, while the patients with transitory ischemic attacks were not involved in the study. General mortality from stroke rose considerably during the war, the rate is somewhat reduced post-war, but not as low as pre-war (35%, 48%, 38% respectively). During the war there was a greater number of patients with intracerebral haemorrhage compared to the atherothrombotic brain infarction group, but the relationship changed after the war in favor of the latter. No difference in sex structure was noticed in the observed three periods. During the war, there was 0 minor increase in the percentage of patients in the 51-60 years age group, but after the war there was a remarkable increase in the 70+ age group. As far as risk factors are concerned, we have traced a marked raise in rates of the hypertension and cardiopathy during the war, with a lower frequency of diabetes. The first two risk factors have kept the same trend post-war, and diabetes returned to the its approximately pre-war level. All changes described here are pointing towards a remarkable influence of war activities on morbidity and mortality of the cerebrovascular accident, where the rates are slowly and incompletely returning to its pre war levels.

The Neoplasms are the second leading cause of the mortality of the adult according to WHO. The last decade is the decade of the increase of all the epidemiologic parameters of the neoplasms in general, so also the neoplasms of the central nervous system. The goal of the work was to realize the frequency of the appearance of the neoplasms of the CNS on the clinical material of the Neurologic clinic CC University of Sarajevo with the special accent on the influence of the war as the specific stressor and the factor sui generis at the epidemiologic parameters of the neoplasms of the CNS. The study is retrospective: it is comprehended the period from the 1st January 1990 till 31st December 1999 year. The patients have been analyzed according to years, according the kind of the neoplastic processes and according to the time periods. At the analyzed period was treated 10,329 patients per year, according to the kind of the neoplastic processes and according to the time periods we evidenced the mild decrease from 1991-1999 year (3.03%-2.44%). According to the sex we register 167 males (60%) and 116 females (40%). The most frequent occurrence is in the age period from 55 to 69 years (55% patients). Of the primary neoplastic processes we had in 178 patients (64), with metastases 105 patients (36%). We analyzed the time periods: the prewar period (1st January 1990-5th April 1992), the war period (6th April 1992 till 14th February 1955), and the postwar period (15th December 1995 till 31st December 1999 year). The primary neoplasms in the postwar period we had in 70 patients (40%), in the course og est 35 patients (20%) and after war 69 patients (40%). The metastatic processes are in the evident increase during the war and after the war: before the war 19 patients (18%), during the war 32 patients (31%) and after the war 54 patients (51%). In the collected material during the war and after the war was evidenced the increase of the primary neoplastic processes at the lungs and other organs which have methastized at the nervous system. On the basis of our examination we can conclude that the total clinical material was present the mild percentage decrease of the neoplasms in the relation to all other admitted patients. The primary neoplastic process have been equally present in the patient material before and after the war with certain decrease during the war (probably because of the war and the reduced diagnostics). It is noticed the significant increase of the metastatic processes of the nervous system during the war and after the war. We are of opinion that the increase of the metastatic processes during the war and after the war is more many fold conditioned: the conditions of life of people during the war, shellings, fright from death and wounding, mourning for the killed and the wounded members of the most narrow family, the weak and inadequate nutrition, the increased smoking of the cigarettes, decrease of the total immune forces of an organism and others.

The epileptic seizures occur as the consequence of THE cerebrovascular insult. The morphologic changes at the brain after cerebrovascular insult are responsible for its occurrence. The pathophysioloogic basis of the late epileptic manifestations (after the second week after CVI) are the epyleptic activities of the morphological brain changes which behave according to the type of the "epileptogene focus". The epileptic seizures which occur during CVI are the result of the moleculary changes which occur in ischemia as the primary, and in haemohagia as secondary ones. The aim of our paper is to see the therapeutic aspects of the early and late epileptic seizures during and after cerebrovascular insult. In the course of the retrospective processed treatment of the patients at our clinic, and in the ten years period (01.01.1989-31.12.1998), we treated 7001 patients with the various types and subtypes of CVI. The incidence of the epileptic seizure moved from 0.65% (1994) till 3.14% (1998). In our sample we had 111 patients with late epileptic seizures, and 56 patients with early epileptic seizures. The early epileptic seizures in most cases were treated by Diazemap intravenously, while in the group of the patients with late seizures, most frequently we applied Fenobarbiton, and later diazepam intravenously. After the seizures and admission at the Clinic and in the future treatment most often we recommended and gave diazemap, phenobarbiton and karabo zepine. The therapeutic effects of the applied therapy were statistically significant. It is significant that there were more patients of the applied therapy statistically significantly. It is significant that there were more patients had no later seizures or of whose the seizures were more rarely (Hi2 = 14.209, n = 2, p < 0.01). On the basis of our research we can conclude that the therapeutic principle of the symptomatic epileptic seizures during and after cerebrovascular insult is the principle of the MONOTHERAPY. On the basis of our material we came to the conclusion that kabazepin optimally antiepileptic for this group of symptomatic epileptic seizures.

The facial nerve has predominantly the motoric, and less sensitive function and gets nerved the muscle musculature of the face and its damages, significantly disturbs the function of the series of the muscles of the face. Regarding to this that the parases of the nervus facialis are often in the physician practice, we have written this article with aim to facilitate to the physicians in the practice the early establishing of the diagnosis, and also to give the instructions into the basic physical and rehabilitation procedures which is with success to carry out in patients with the damages of this nerve.

Association between epilepsy and stroke has been known since 1864. The pathophysiological basis of epileptic seizures during and after stroke are molecular changes that occur in ischemia as primary events, and in hemorrhage as secondary events. The aim of the study was to determine the incidence of epileptic seizures during and after stroke, recorded over a 10-year period at the Department of Neurology, Sarajevo University Clinical Center. The study covered the period from January 1, 1989 till December 31, 1998. During the period, 7001 patients were treated at the Department. Cerebral thrombosis predominated (53.6%), whereas there were only 17.25% of patients with cerebral embolism, 21.96% with intracerebral hemorrhage, and 7.17% with subarachnoid hemorrhage. The incidence of symptomatic epileptic seizures for total patient sample according to years ranged from 0.75% to 6.67%. According to type of insult, the incidence of symptomatic epileptic seizures was 1.0%-3.37% for cerebral thrombosis, 1.22%-6.67% for cerebral embolism, 0.65%4.05% for intracerebral hemorrhage, and 1.34%-4.34% for subarachnoid hemorrhage. Associated epileptic seizures, i.e. the seizures accompanying the onset of stroke, were not included in the study. Results of the study showed that there were 75 patients with symptomtic epileptic seizures (47 with late seizures and 28 with early seizures, or 1.998% of total patient sample) during the 10-year period of observation. There were 36 cases of cerebral embolism (23 and 13 in the group of late and early seizures, respectively; 2.980%), 30 cases of intracerebral hemorrhage (23 and seven with late and early seizures, respectively; 1.951%), and seven cases of subarachnoid hemorrhage (four with late and three with early seizures; 1.394%). According to stroke types and subtypes, hemorrhagic stroke was found to be a more common etiologic factor for the occurrence of early and late symptomatic epileptic seizures, whereas cerebral embolism in ischemic stroke was a more common cause of symptomatic epileptic seizures than cerebral thrombosis. During the study period, the years 1993, 1994 and 1995 were characterized by a small number of patients with symptomatic early and late epileptic seizures (9 in total). The incidence of early and late epileptic seizures in the sample of stroke patients during the study period ranged from 1.394% to 2.980%.

BACKGROUND Vertiginous syndrome appears in more then 100 diseases, therefore subject of intensive investigation. Insufficient research has been done on vertiginous syndrome in patients on chronic program of haemodialisis. The aim of this study is to search anatomical and structural changes on blood vessels of the brain by neuroimaging techniques, as well as increased circulatory resistance on TCD, in patients on chronic program of haemodialysis. METHODS The research has been done on 30 patients with vertiginous syndrome, 22 males and 8 females, average age 45.9 years, average duration of haemodialysis 5.83 +/- 4.5. In all patients relevant diagnostic procedures had been done (EEG, TCD, audio vestibulogram, X-ray of cervical spine), and in 14 patients with increased circulatory resistance TCD we have done MRI and MRA of the brain. Pathological EEG has been found in 10%, 40% of the patients have had normal EEG finding, while 50% had slowing (non-specific disfunction) in EEG record. RESULTS MRI and MRA had been done in 14 patients of average age 51.21 +/- 10.82. In 13 patients we had a pathological finding of MRI and MRA, while in one patient only we had normal finding of MRA, and another one patient with normal MRI scan. In 64.2% of the sample we have had cortical cerebral atrophy, in 57.1% cortical atrophy of cerebellum, while in 35.8% apart from the mentioned changes atrophy of cerebellar vermis had been found. In 71.4% of all patients cerebrovascular disease (stroke) could be identified. Atherosclerosis changes in blood vessels of anterior or posterior circulatory segment were found in 78.5% of the patients, while spasm of arteries had been registered in 21.4% of the sample. CONCLUSION MRI and MRA of the brain brought light on aethiological aspect of vertigo in these patients. Results of our research indicate vascular aethiology of vertiginous syndrome in patients on chronic program of haemodialysis.