CONFLICT OF INTEREST: NONE DECLARED Goal The goals of this study are to: a) determine the prevalence of diabetic polyneuropathy (DPNP) in hospitalized patients with diabetes mellitus (DM) type 2; b) determine the frequency of DPNP in hospitalized patients with type 2 DM in relation to gender, duration of diabetes, fasting blood glucose and HbA1c; c) identify the dominant DPNP symptoms and the presence of variable risk factors in hospitalized patients; and d) determine the frequency and motor nerve conduction velocity of n. peroneus (electroneuromyography) in relation to the treatment of type 2 DM in hospitalized patients with DPNP. Material and methods The study was conducted on 141 patients diagnosed with type 2 diabetes who were hospitalized at the Neurological clinic of Clinical Center of Sarajevo University in the period from June 1 2009 to June 1 2010. All patients included in the study were older than 18. Values determined for all subjects are: age, sex, dominant symptoms, duration of type 2 DM, fasting blood glucose, HbA1c, motor conduction velocity of n. peroneus, diabetes risk factors (hyperlipidemia, hypertension, smoking, alcoholism, obesity) and DM treatment type. Results Of 141 patients with type 2 DM, DPNP was confirmed in 50 patients (35.5%). Men were slightly more represented in the total sample (51.8%). In a sample of patients with DPNP, there were slightly more male patients (n=26; 52%). The average age of patients with DPNP was higher in men (58.3±12.5) (p<0.05). The average age of the patients with DPNP was 55.1± 13.2. Average values of fasting glucose was higher in the group of patients with DPNP (11.032±5.4 mmol/l) compared to patients without DPNP (9.7±2.8 mmol/l) (p<0.05). Mean values of HbA1C were higher in patients with DPNP (8.212±3.3%) compared to patients without DPNP (6.9±2.6%) (p<0.05). Analysis of DM duration between patients with and without DPNP did not show statistically significant difference (chi-square=3.858, p>0.05). In both groups, most of the patients had duration of DM over 10 years, with a minimum duration of DM of 12 months. There are statistically significant differences in applied DM therapy by gender (chi-square=11.939, p<0.05). Hypertension was more frequent in women (79.2%:69.2%), hyperlipidemia was equally presented in both sexes (50%:50%), obesity was more prevalent among women (25%:7.7%), while alcoholism and smoking were more frequent in men (7.7%:0%; 34.6%:8.3%). There are statistically significant differences in the prevalence of risk factors by gender (chi-square=10.013, p<0.05). Conclusions The DPNP incidence was higher in patients with longer duration of the disease, but without significant gender differences. Fasting blood glucose and HbA1c were significantly higher in patients with DPNP compared to patients without DPNP (p<0.05). The dominant symptoms of DPNP were paresthesia (44%) and hypoesthesia (28%). Regarding variable risk factors, the most common were hypertension and hyperlipidemia, without statistical significance in gender distribution, while smoking was significantly more common in men than women (34.6%:8.3%). DPNP was present in 43.2% of men who use insulin therapy, while 54.2% of women with DPNP used oral therapy. The lowest frequency of DPNP was found in patients treated with combined therapy. Motor conduction velocity of n. peroneus was significantly lower in men using insulin therapy and/or combined therapy (p<0.05), whereas in patients on oral therapy there was no significant gender difference. Timely DM type 2 diagnosis with proper treatment and electromyoneurographic monitoring (especially in older men) can prevent onset of diabetic polyneuropathy and contribute to its successful treatment.

INTRODUCTION Multiple sclerosis (MS) is the most common, chronic debilitating disease in young adults characterized by a wide variety of neurological symptoms and unpredictable increasing disability. Worldwide, MS affects about 2.5 million people, with a female-to-male ratio of approximately 2:1. The therapies used in the chronic treatment of MS are immune-modulating agents. Interferon beta -1b has been shown to decrease the rate of relapses, the burden of lesions seen on MRI, and the rate of accumulated disability. AIM Determine the efficacy of Betaferon in patients with RR form of MS in terms of the degree of disability and the number of relapses during the two years of continuous treatment. SUBJECTS AND METHODS The study, partly retrospective, partly prospective, included 58 patients of both sexes with MS, RR type, from the Federation of Bosnia and Herzegovina, who received Betaferon treatment, from the Solidarity Fund, during 2 years period. Evaluation of efficacy was based on the degree of disability measured by EDDS scale and number of relapses. RESULTS In our sample, women were represented in the ratio of 3:1 compared to men. 44.8% of patients were referred from Clinical Centre University in Sarajevo (UCCS), 34.5% from University Clinical Centre Tuzla (UCCT) and 20.7% from Clinical Hospital Center Mostar (CHCM). The smallest number of patients have had a relapse sent from CCUS (0.04, SD = 0.196), which was in direct correlation with input EDSS score at baseline (= 1.3) compared to patients from the UCCT, who had an average of 1.05 relapses, SD = 1.35, and the input EDSS score is 2.15. Patients referred from CHCM had an average of 0.08 relapses, SD = 0.93, while the input EDSS score was around 1. In terms of the degree of disability, measured by EDSS, we get a minimal increase in the patients from UCCS and UCCT, while patients from CHCM had a reduction of EDDS for the 0.45 (p < 0.05). CONCLUSION Betaferon therapy must start as soon as possible, preferably when clinically isolated syndrome (CIS) is diagnosed. The reason for early start is to delay the transfer of disease in to definite multiple sclerosis, and thereby reduce disability, which disease brings to young people. Key words:

Conflict of interest: none declared. Goals The goals of this research are: a) to determine the number, gender and age representation of patients with a working diagnosis of acute stroke referred by the Institute for Emergency Medical Care (IEMC) in the Clinical Center of Sarajevo University (CCSU); b) determine the incidence of patients that have been or have not been hospitalized and why; c) determine the time and procedure for emergency medical care; d) to determine the characteristics and outcomes of patients hospitalized with ischemic stroke at the Neurology Clinic CCUS. Material and methods The study was retrospective and included time period from 1st June 2010 to 30th November 2010. The study included patients of both sexes, older than 18 years of age. Results The study included a total of 233 patients. Of these, 65% are female, while 35% of patients were male. Of 82 patients who were admitted to hospital treatment at the Neurology Clinic, 55% of the patients were male and 45% female. The largest number of patients is older than 70 years (71%). Minimum time for emergency medical team arrival was 6 minutes and maximum 70 minutes (mean 35, SD 11.989). Motor weakness was noted in 31% of patients – left sided motor weakness was significantly more represented. In 73% of patients the diagnosis was confirmed. In 5% of patients thrombolytic therapy was administered, while 95% of patients were treated conservatively. Lethal outcome occurred in 30% of hospitalized patients, 37% were discharged as recovered, 30% were discharged as unaltered state, while 3% were discharged with worsening symptoms. Among risk factors, hypertension is the leading one, followed by an earlier stroke, diabetes mellitus, and cardiac arrhythmias. Conclusions In 91% of patients consciousness was preserved. In 73% of transported patients has been confirmed the diagnosis of ischemic stroke. Of the patients with confirmed diagnosis 59% were hospitalized. A significant number of strokes occur for the first time in relation to relapse. 5% of patients were treated with thrombolysis, while others were treated with conservative therapy. Recurrent stroke and patient confusion have significant impact on the outcome.

BACKGROUND Research data from studies of functional neuroanatomy and neurochemistry indicate various dysfunctions in certain areas of the brain in individuals who suffer from chronic Posttraumatic Stress Disorder. These abnormalities are involved in the evolution of symptoms of PTSD, deterioration of cognitive functions and decreased quality of life of the survivors. The intensity of these symptoms is in direct correlation with the degree of dysfunction in the central nervous system. The aim of our study, was to evaluate the subjective perception of the Quality of life in subjects suffering from chronic PTSD and to compare prior to treatment results to results three and six months after receiving therapy, as well as to analyze whether perception of the Quality of life change related to treatment. The study was conducted at the Psychiatric Clinic of the Sarajevo University Clinical Center. SUBJECTS AND METHODS The sample consisted of 100 male persons, with war trauma experiences, whose age range was between 35 and 60 years, who were seeking treatment at the Psychiatric Clinic, University of Sarajevo Clinical Center and met the criteria for the diagnosis of chronic PTSD (Posttraumatic Stress Disorder) according to ICD-10. (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). The exclusion criterion was prior psychiatric illness (traumatization before the war) and less than 8 years of education. All subjects received out-patient treatment. Their treatment involved psychopharmacological and psychotherapeutic therapy. The subjects were assessed using the following instruments: Sociodemographic Questionnaire designed by the authors for registering the social and demographic characteristics of the subjects (age, years of education, current employment, and socioeconomic status) and Manchester Quality of Life Scale (MANSA) as a self-report scale. The subjects were assessed prior to treatment, and three and six months after beginning the treatment (follow-up). RESULTS There was an increase in the mean values of subjective perception of Quality of Life between the first (3.2352), second (3.4447), and third test (3.6090). Differences between these mean values were not statistically significant between the first and second test, but significant between the second and third test. Also differences between sociodemographic characteristics prior to treatment and during six month follow-up were not statistically significant. A significant increase has been noted in the number of contacts with close friends between the first, second and third test. Also, we recorded a decrease in pertaining aggressive and criminal behavior between the three tests. CONCLUSION The results of our study indicate that subjects who are suffering from chronic PTSD have a lower subjective perception of their quality of life. Combined psychopharmacological and psychotherapeutic treatment over a period of six months lead to improvement in the perception of quality of life. This may indicate the need for longer treatment of individuals suffering from chronic PTSD. A significant increase has been noted in the number of contacts with close friends between the first, second and third test, reflecting positive treatment effects on everyday life functioning and coping skills.

INTRODUCTION Myasthenia gravis (MG) is an autoimmune disease characterized by weakness and fluctuating pathological tiredness of cross-striped muscle with improvement after rest. GOAL To compare the outcomes of treatment in myasthenic crisis therapy and conventional therapy with high doses of human immunoglobulin. Epidemiological research, mainly retrospective, partly prospective, descriptive-analytical and clinical-application nature, was carried out on Neurology Clinic Clinical Center University of Sarajevo in the period from January 1st 2002 to December 31st 2008. RESULTS Total of 25 patients were examined, with more women (2.5: 1), with women average age 40 years (SD = 15.2) and men average age 54.3 years (SD = 19.6). Men with myasthenia gravis had the disease duration longer than 15 years with generalized form of myasthenia gravis dominant (60%). Women with myasthenia gravis had more intensive symptoms of the disease (p < 0.01), which ultimately did not lead to significantly higher lethal outcomes. Almost 90% of the respondents were repeatedly hospitalized. All our respondents were treated with anticholinesterarasis therapy with a significant change in the outcome of treatment (which was primarily lethal) brought with human immunoglobulins (introduced at our Clinic in 2003). It is important to note that since then we have no lethal outcomes. Half of the female and 43% of male patients after the treatment had stable remission and were released without MG symptoms, while 28% of patients additionally had improved status. Lethal outcome, primarily due to cardiopulmonal relaxation, was in 28.6% men and 22.2% of women with myasthenia.

Introduction: Epilepsy is the most common neurological disorder of the brain and also the least understood. Fear, misunderstanding and the resulting social stigma surrounding epilepsy can result in social, and sometimes even legal, discrimination against those living with this condition. Although attitudes toward people with epilepsy have improved over the years, for many people with epilepsy, stigma continues to adversely impact their psychological well-being and quality of life. Goal: To determine social and economic characteristics of the patients with epilepsy, presence of depression in comparison to duration of illness and stigmatizing circumstances. Material and methodology: Prospective study included 300 patients with epilepsy treated at the Ambulatory for epilepsies of the Clinical Center of Sarajevo University. Besides standardized questionnaire, all patients were tested using Beck Hamilton depression scales and QOLIE-31 questionnaire. Results: Our sample included 300 patients from both genders, where the male patients was slightly more dominant with the average age of 37.67 years +/- 12.86 compared to female patient which were significantly (p< 0.05) younger with mean age of 32.83 +/- 12.26. For the female patients average age of the first epileptic seizure was at 14.05 years +/- 8.55, and for males 19.53 years +/- 12.39. Significant difference is noted also regarding the marriage and work in favor of men’s, which is important stigmatizing factor for the women with epilepsy. Presence of depression was noticed among 34% of patients at the Beck Depression Scale, and 38.9% at the Hamilton scale with the significant difference in presence of severe depression among women. 14% of patients had suicidal ideas, which requires special attention during the treatment. Conclusion: Epilepsy stigma, recurrent epileptic seizures and early occurrence of epilepsy in life have significant influence on development of depression and quality of life, especially for women.

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.

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.