ABSTRACT Objective To evaluate memory in patients with drug-resistant epilepsy. Methods Following an examination, 50 patients were diagnosed in accordance with the 2005 proposal of the International League Against Epilepsy and the definition of drug-resistant epilepsy from 2010. The neuropsychological examination used the Wechsler Memory Scale. It assessed seven structural types of memory: general knowledge, orientation, mental control, logical memory, number memory, associative memory, and visual reproduction. The values were compared with 50 subjects without epilepsy. Results Patients with epilepsy had statistically significantly lower values in five of seven structural units of memory. The average value of overall memory efficacy in subjects with epilepsy was 96.5 ± 19.6, while in subjects without epilepsy it was 118 ± 15.6 (p = 0.0002). Memory impairments are greater in those taking polytherapy (p = 0.0429). The overall memory efficiency correlated significantly negatively with seizure frequency (p = 0.0015) and insignificantly negative with the duration of epilepsy (p = 0.1935). Conclusion Patients with drug-resistant epilepsy have lower memory efficiency. Memory impairments are greater in those taking polytherapy, as with those with more frequent seizures. The duration of epilepsy has no significant effect on overall memory performance.

BACKGROUND In order to protect itself from the pain or discomfort that would result from the forbidden instinctual impulses, the ego developed defence mechanisms (DM). Mature DMs are associated with adaptive functioning. Immature and neurotic DMs are associated with maladaptive functioning. Our goal was to determine the intensity of the most frequently used immature, neurotic and mature ego DMs in patients with epilepsy. SUBJECTS AND METHODS We examined 50 patients with epilepsy, using a Defense Style Questionnaire (DSQ-40). We measured the intensity of individual DMs. Mature DMs: sublimation, humour, suppression and anticipation; neurotic DMs: undoing, pseudo-altruism, idealization and reactive formation; and immature DMs: projections, passive aggression, acting out, isolation, devaluation, autistic fantasies, denial, displacement, dissociation, splitting, rationalization and somatization. The control group consisted of 36 healthy subjects. Groups are equal in age and level of education. RESULTS Patients with epilepsy use neurotic (p=0.0290) and immature (p=0.0155) defensive styles significantly more. Individually, they most intensively use acting out, humour and sublimation, and statistically significantly more they use displacement (p=0.0161), denial (p=0.05) and somatization (p=0.0019). CONCLUSION Patients with epilepsy use the neurotic and immature styles of ego defence more intensively. As such, they are less adaptable to new situations. Our knowledge can be useful for planning future interventions for people living with epilepsy.

The aim of this study was to evaluate anosognosia in acute stroke phase in order to type of stroke (ischemia, hemorrhage) and stroke localization as well as post-stroke patients recovery. Subjects and methods: In this prospective analysis were included 191 patients (96 males and 95 females) with first-ever stroke who were treated at the Department of neurology of the University Clinical Center in Tuzla. All patients were tested to anosognosia presence in acute stroke phase according to the modified Bisiach scale (7), while the level of disability was assessed using the Rankin scale (8) and level of functioning in daily activities using the Barthel index (9). Re-testing was done in week five post-stroke. Results: The average age of patients was 66.41 (mean age 10.21). Ischemic stroke had 168 patients (88%) while 23 (12%) the hemorrhagic one. The lesions localized to the right hemisphere were in 111 (58.11%) patients as well as in 80 (41.89%) patients with lesions localized to the left hemisphere. Anosognosia with no statistical significance was verified in 28% of patients in acute stroke phase, more often caused by lesions to the right hemisphere. Otherwise, significantly more frequent anosognosia was present in patients with hemorrhagic stroke mostly caused by massive lesions localized to the right hemisphere. Conclusion: Presence of anosognosia in patients with stroke vitally influenced patient’s functional status in re-testing phase just as well as in the acute stroke phase.

Introduction: The depression is a common mental disorder, especially after a stroke, which further aggravates the recovery. Aim: To analyze depression within 48 hours and fifteen days after ischemic stroke in relation to gender and location (brain hemisphere and brain circulation). Methods: We analyzed 40 patients (65.3±10.3 years), half of them were women. Mean age of women was 66.35±7.31 years and men 64.2±12.68 years (p= 0.5). Ischemic stroke was verified by computed tomography. Levels of depression were measured with self-estimated Zung’s scale. On the tests, score of 50 and higher verified depression. Criteria made by Domasio were used to determine location of the IS. Results: Mean value on depression scale in acute phase of ischemic stroke was 46.85 ± 8.6 and in subacute phase 43.4 ± 8 (p =0.06). In 19 (47.5%) patients (55% of women, 40% of men; p=0.3) depression was found during the first and in 10 (25%) patients (35% of women, 15 % of men; p=0.06) during the second evaluation (p<0.019). Mean value on depression in acute phase of illness in women was 49.1 ± 7.38, as well as in men 44.6 ± 9.22 (p=0.088) and in subacute phase in women 45.25 ± 8.04, as well as in men 41.5 ± 7.75 (p=0.16). Concerning location of ischemic stroke, there were no significant differences in levels of depression. Conclusion: Number of patients with post-stroke depression is significantly lower in subacute phase of ischemic stroke. Although the number of depressive women and their depression scores are higher, gender differences are not statistically significant. There is no correlation between post-stroke depression and location of lesion in acute and subacute phase of illness.

Epilepsy is a paroxysmal cerebral dysrhythmia defined by three important characteristics: the suddenness of the process, brain origin and the disorder of the rhythm of the electrical brain activity (1). Seizures (crises, ictus events, attacks) are common to all epilepsies. They include a variety of clinical manifestations or sudden episodes of disturbance of motor, sensibility, behaviour, perception, awareness or other psychic functions, autonomic and other regulations. The classification of seizures and epilepsy syndrome takes the central place in modern epileptology, although the classification process itself is as old as the study of epilepsy. The international classification, based mainly on the clinical form of seizure and the electroencephalographic findings, was adopted in 1981 and has been further modified. In 1989, ILAE (International League Against Epilepsy) adopted the International classification of epilepsies, epilepsy syndromes and disorders, which highlights the symptoms and signs that show the localization of initial cerebral dysfunction and its spread (2). In 2017, the ILAE released a new classification of seizure types, based upon the existing classification formulated in 1981. and its extension from 2010. The differences include the following: "partial seizures" become "focal"; consciousness is used as a classifier of focal seizures; terms such as „dyscognitive”, „simple partial”, „complex partial”, „psychic” and „secondary generalized” are eliminated; new focal seizures include automatisms, behavioural changes, hyperkinetic, autonomic, cognitive and emotional; atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be either focal or generalized phenomena; „focal seizure evolving to a bilateral tonic-clonic seizure” replace the term „secondary generalized seizure”; new generalized types of attack are absence with eyelid myoclonia, myoclonic absence, myoclonic-atonic and myoclonic-tonic-clonic and seizures of unknown onset (3). Biometeorology is an interdisciplinary science that studies the interaction system between living organisms and the environment. The biometerological warning, bioforecast, contain a description of the meteorological situation and announces the arrival of those weather conditions which may adversely affect human health in the next days. The goal of bioprognosis is the organization of preventive measures for the protection of the vulnerable groups health (4). Variations in biometeorological factors have an influence on the overall balance of the human body, as well as to changes in the condition of patients, primarily those with chronic diseases. Le Blanc and Mills (1932) stated that one of the oldest and best known disease whose association with climatic factors is mentioned, is epilepsy (5). Fluctuation in some climatic factors, e.g. air pressure, might influence one or more of the above mentioned factors, and thus lead to seizure. The purpose of this study was to determine the effect of atmospheric pressure on the specific seizure types frequency as well as on patient's subjective perception of the seizure "severity".

Background: Epilepsy as a disorder of the brain characterized by an enduring predisposition to generate epileptic seizures and by the biologic, cognitive, psychological, and social consequences of this condition. This association may reflect the anatomical and neurobiological source of both epileptic seizures and the behavioral manifestations. The aim of this research was to analyze emotional profile of patients with epilepsy, and to determine the relationship between dimensions of emotions and employment. Methods: The research was conducted on the sample of 100 participants, 50 patients with epilepsy and 50 healthly subjcts. Subgroups are equal in age (between 25 and 65 years of age) and level of education. In the estimation of emotional characteristics was used Plutchik’s Emotions Profile Index (EPI). Basic socio-demographic data were also collected. Results: Patients with epilepsy are significantly less employed (p <.001). Deviations of the reference values emotions dimension were found in seven of eight dimensions in study group, and in five of eight dimensions in control group. Significantly diferencts found in the rejection dimension (p = .043). In other dimensions don't be significant differences. Limitations: This study has, however, also several limitations. One of all, we only evaluated the motivated participants, not randomly selected Conclusion: The patients with epilepsy are significantly fewer employment, and significantly more inclined to the opposition / rejection (delay, hostility, contempt and critical) compared with healthy control group. Our knowledge can be useful for planning future interventions for people living with epilepsy.

Introduction: Small number of studies have evaluated the mortality and the degree of functional disability of post-stroke delirium, and our aim was to determine that. Patients and Methods: Comprehensive neuropsychological assessments were performed within the first week of stroke onset, at hospital discharge, and followed-up for 3, 6 and 12 months after stroke. We used diagnostic tools such as Glasgow Coma Scale, Delirium Rating Scale, National Institutes of Health Stroke Scale and Mini-Mental State. Results: Delirious patients had a significantly higher mortality (p = 0.0005). As opposed to the type of stroke mortality was higher after ischemic (p = 0.0005). The patients without delirium had significantly better cumulative survival during the first year after stroke (p = 0.0005). Delirious patients aged ≥65 years had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). In relation to the type of stroke delirious patients with ischemic had a significantly lower cumulative survival during the first year after stroke (p = 0.0005). Delirious patients had a greater degree of functional impairment at discharge (p = 0.01), three (p = 0.01), six months (p = 0.01) and one year (p = 0.01) after stroke. Conclusion: Delirious patients have a significantly higher mortality, lower cumulative survival and a greater degree of functional disability in the first year after stroke.

Objectives: To present a case of co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis. Methods: Case report. Clinical presentation: We presented 49-year-old Caucasian domicile female-farmer with a history of headache, weakness, and vomiting for a period of three months. Also, she had significant papilledema. We diagnosed rare co-morbidity of neurobrucellosis (confirmed after ELISA-test in serum samples and CSF analysis of pleocytosis/increase in protein/decrease in glucose level) in the setting of cerebral venous thrombosis developed in left sigmoid/left transverse sinus (confirmed after MRV of brain). Favorable outcome was achieved by applying protracted polymicrobial antibiotic therapy and heparin. Discussion: It may be challenging to diagnose neurobrucellosis, especially in patients with atypical presentation and abortive clinical forms. The co-morbidity of neurobrucellosis and cerebral venous sinus thrombosis is uncommon. However, it provides a possibility of brucella-colonization in cerebral venous sinuses as a potential hidden link between them. Conclusion: Patients with severe and persistent headache, as well as other neurological symptoms/signs should be considered for neurobrucellosis in endemic, but also in brucella non-endemic regions due to migrations. According to literature survey, this co-occurrence of neurobrucellosis and cerebral venous sinus thrombosis is third one reported from Europe.