Publications by authors named "István Fekete"

36 Publications

Resting-state EEG theta activity reflects degree of genetic determination of the major epilepsy syndromes.

Clin Neurophysiol 2021 Sep 3;132(9):2232-2239. Epub 2021 Jul 3.

University of Debrecen, Faculty of Medicine, Department of Neurology, Hungary.

Objective: To explore relationship between EEG theta activity and clinical data that imply the degree of genetic determination of epilepsy.

Methods: Clinical data of interest were epilepsy diagnosis and positive / negative family history of epilepsy. Study groups were: idiopathic generalized epilepsy (IGE), focal epilepsy (FE); FE of unknown etiology (FEUNK), FE of postnatal-acquired etiology (FEPA); all patients with positive / negative family history of epilepsy (FAPALL, FANALL, respectively), disregarding of the syndrome; FAP patients with 1st degree affected relative (FAP1) and those with 2nd degree epileptic relative only (FAP2). Quantitative EEG analysis assessed amount of theta (3.5-7.0 Hz) activity in 180 seconds of artifact-free waking EEG background activity for each patient and group. Group comparison was carried out by nonparametric statistics.

Results: Differences of theta activity were: FAPALL > FANALL (p = 0.01); FAP1 > FAP2 (p = 0.2752). IGE > FE (p = 0.02); FEUNK > FEPA (p = 0.07).

Conclusions: This was the first attempt to explore and quantitatively ascertain relationship between an EEG variable and clinical data that imply greater or lesser degree of genetic determination in epilepsy.

Significance: Theta activity is endophenotype that bridges the gap between epilepsy susceptibility genes and clinical phenotypes. Amount of theta activity is indicative of degree of genetic determination of the epilepsies.
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http://dx.doi.org/10.1016/j.clinph.2021.06.012DOI Listing
September 2021

A modified in vitro clot lysis assay predicts outcomes and safety in acute ischemic stroke patients undergoing intravenous thrombolysis.

Sci Rep 2021 Jun 16;11(1):12713. Epub 2021 Jun 16.

Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, Kálmán Laki Doctoral School, University of Debrecen, 98 Nagyerdei krt., Debrecen, 4032, Hungary.

The outcome of intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA) is only favorable in ≈ 40% of acute ischemic stroke (AIS) patients. Moreover, in ≈ 6-8% of cases, intracerebral hemorrhage (ICH) develops. We tested whether a modification of clot lysis assay (CLA), might predict therapy outcomes and safety. In this prospective observational study, blood samples of 231 AIS patients, all receiving intravenous rt-PA, were taken before thrombolysis. Cell-free DNA (cfDNA), CLA and CLA supplemented with cfDNA and histones (mCLA) were determined from the blood samples. Stroke severity was determined by NIHSS on admission. ICH was classified according to ECASSII. Short- and long-term outcomes were defined at 7 and 90 days post-event according to ΔNIHSS and by the modified Rankin Scale, respectively. Stroke severity demonstrated a step-wise positive association with cfDNA levels, while a negative association was found with the time to reach 50% lysis (50%CLT) parameter of CLA and mCLA. ROC analysis showed improved diagnostic performance of the mCLA. Logistic regression analysis proved that 50%CLT is a predictor of short-term therapy failure, while the AUC parameter predicts ICH occurrence. A modified CLA, supplemented with cfDNA and histones, might be a promising tool to predict short-term AIS outcomes and post-lysis ICH.
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http://dx.doi.org/10.1038/s41598-021-92041-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8208992PMC
June 2021

A Modified Clot Lysis Assay Predicts Outcomes in Non-traumatic Intracerebral Hemorrhage Stroke Patients-The IRONHEART Study.

Front Neurol 2021 20;12:613441. Epub 2021 Apr 20.

Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, Kálmán Laki Doctoral School University of Debrecen, Debrecen, Hungary.

Non-traumatic intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and results in a higher rate of mortality as compared to ischemic strokes. In the IRONHEART study, we aimed to find out whether a modified clot lysis assay method, that includes the effect of neutrophil extracellular traps (NETs) might predict ICH outcomes. In this prospective, observational study, 89 consecutive non-traumatic ICH patients were enrolled. Exclusion criteria included aneurysm rupture, cancer, liver- or kidney failure or hemorrhagic diathesis. On admission, detailed clinical and laboratory investigations were performed. ICH volume was estimated based on CT performed on admission, day 14 and 90. A conventional clot lysis assay (CLA) and a modified CLA (mCLA) including cell-free-DNA and histones were performed from stored platelet-free plasma taken on admission. Clot formation and lysis in case of both assays were defined using the following variables calculated from the turbidimetric curves: maximum absorbance, time to maximum absorbance, clot lysis times (CLT) and area under the curve (CLA AUC). Long-term ICH outcomes were defined 90 days post-event by the modified Rankin Scale (mRS). All patients or relatives provided written informed consent. Patients with more severe stroke (NIHSS>10) presented significantly shorter clot lysis times of the mCLA in the presence of DNA and histone as compared to patients with milder stroke [10%CLT: NIHSS 0-10: median 31.5 (IQR: 21.0-40.0) min vs. NIHSS>10: 24 (18-31.0) min, = 0.032]. Shorter clot lysis times of the mCLA showed significant association with non-survival by day 14 and with unfavorable long-term outcomes [mRS 0-1: 36.0 (22.5.0-51.0) min; mRS 2-5: 23.5 (18.0-36.0) min and mRS 6: 22.5 (18.0-30.5) min, = 0.027]. Estimated ICH volume showed significant negative correlation with mCLA parameters, including 10%CLT ( = -0.3050, = 0.009). ROC analysis proved good diagnostic performance of mCLA for predicting poor long-term outcomes [AUC: 0.73 (0.57-0.89)]. In a Kaplan-Meier survival analysis, those patients who presented with an mCLA 10%CLT result of >38.5 min on admission showed significantly better survival as compared to those with shorter clot lysis results (=0.010). Parameters of mCLA correlate with ICH bleeding volume and might be useful to predict ICH outcomes.
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http://dx.doi.org/10.3389/fneur.2021.613441DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8093390PMC
April 2021

Prognostic Value of Various Hemostasis Parameters and Neurophysiological Examinations in Spontaneous Intracerebral Hemorrhage: The IRONHEART Study Protocol.

Front Neurol 2021 17;12:615177. Epub 2021 Mar 17.

Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Stroke is one of the leading causes of death in all developed countries. In Hungary, more than 10,000 patients die annually due to cerebrovascular diseases according to the WHO Mortality Database. Of these patients, 10-15 % suffer non-traumatic intracerebral hemorrhage (ICH). ICH results in a higher rate of mortality as compared to ischemic stroke and outcomes are difficult to predict. In the IRONHEART study, we aim to test various hemostasis parameters and clinical neurophysiological examinations in evaluating outcome in ICH. In this prospective, observational study, we plan to enroll consecutive patients with non-traumatic spontaneous ICH admitted to a single Stroke Center (Department of Neurology, University of Debrecen, Hungary). The protocol of the IRONHEART study includes the investigation of detailed clinical, laboratory investigations, and various neurophysiological examinations. Stroke severity is quantified based on the National Institutes of Health Stroke Scale (NIHSS) on admission and day 7, 14, and 90 after the onset of stroke. Cranial CT is performed on admission, day 14, and 90 to estimate the ICH volume. Modified Rankin Scale (mRS) is used for evaluating the long-term outcome (90 days post-event). Blood is drawn immediately on admission for specific hemostasis tests. Digital and quantitative EEG techniques and motor evoked potential (MEP) are performed to evaluate the prognosis of cerebral hemorrhage on admission (within 24-48 h), immediately before discharge (~10-14 days later), and 3 months after the event. The following outcomes are investigated: primary outcomes: mortality by day 14 and day 90, secondary long-term outcome at 90 days post-event where mRS 0-2 is defined as favorable long-term outcome. If associations between outcomes and the investigated parameters (hemostasis and neurophysiological examinations) are confirmed, results might aid prognosis assessment in this subtype of stroke with particularly high mortality. Improving clinical grading systems on ICH severity and outcomes by including the investigated parameters could help to better guide the management of these patients in the future.
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http://dx.doi.org/10.3389/fneur.2021.615177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010310PMC
March 2021

The Outcome of Status Epilepticus and Long-Term Follow-Up.

Front Neurol 2019 26;10:427. Epub 2019 Apr 26.

Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

This study was to investigate the outcome of status epilepticus (SE) associated with antiepileptic therapy during SE and in follow-up period, risk factors including age, co-morbidities, pre-existing epilepsy, and etiology in the East-Hungarian region. A prospective cross-sectional database was compiled from outpatient files between 2013 and 2017. Follow-up ended on 30.06.2018. One hundred and thirty five episodes (male: 68, 50.4%) were evaluated, mean age and follow-up time being 64.1 ± 13.9 years and 39.9 ± 14.2 months, respectively. Of the 89 patients with pre-existing epilepsy, 34 failed to visit the outpatient unit regularly. Case fatality rate was 25.2% and 31 patients (30.7%) died after discharge due to co-morbidities; their mean survival time was 10.44 ± 8 months. Focal, generalized and combined type epilepsies were diagnosed in 67 patients (49.6%), 47 patients (34.8%), and 21 patients (15.6%) of SE, respectively. Nine patients had non-convulsive SE (NCSE). Mean seizure-free period was 6.8 ± 6.9 months. Patients taking carbamazepine (20.9%; OR: 0.37, 95%CI: 0.16-0.82; = 0.018), levetiracetam (27.5%; OR: 0.51, 95%CI: 0.27-0.97; = 0.041), or valproate (11.1%; OR: 0.18, 95%CI: 0.05-0.61; = 0.0043) were expected to achieve seizure freedom after SE. The worst outcome was linked to advanced age, etiology, new onset status epilepticus, NCSE, and focal status epilepsy. This study highlights the importance of regular care and patient follow-up.
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http://dx.doi.org/10.3389/fneur.2019.00427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498966PMC
April 2019

EEG-based connectivity in patients with partial seizures with and without generalization.

Ideggyogy Sz 2019 Mar;72(3-4):99-109

University of Debrecen, Medical Center, Department of Neurology, Debrecen.

Background And Purpose: To investigate the neurophysiological basis of secondary generalization of partial epileptic seizures.

Methods: Inter-ictal, resting-state EEG functional connectivity (EEGfC) was evaluated and compared: patients with exclusively simple partial seizures (sp group) were compared to patients with simple partial and secondary generalized seizures (spsg group); patients with exclusively complex partial seizures (cp group) were compared to patients with cp and secondary generalized seizures (cpsg group); the collapsed sp+cp group (spcp) was compared to those who had exclusively secondary generalized seizures (sg group). EEGfC was computed from 21-channel waking EEG. 3 minutes of waking EEG background activity was analyzed by the LORETA Source Correlation (LSC) software. Current source density time series were computed for 23 pre-defined cortical regions (ROI) in each hemisphere, for the 1-25 Hz very narrow bands (1 Hz bandwidth). Thereafter Pearson correlation coefficients were calculated between all pairs of ROI time series in the same hemisphere. Z-scored correlation coefficients were compared at the group level (t-tests and correction for multiple comparisons by local false discovery rate, FDR).

Results: Statistically significant (corrected p<0.05) EEGfC differences emerged at specific frequencies (spsg > sg; cpsg > cp), and at many frequencies (sg > spcp). The findings indicated increased coupling between motor cortices and several non-motor areas in patients with partial and sg seizures as compared to patients with partial seizures and no sg seizures. Further findings suggested increased coupling between medial parietal-occipital areas (structural core of the cortex) and lateral hemispheric areas.

Conclusion: Increased inter-ictal EEGfC is associated with habitual occurrence of secondary generalized seizures.
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http://dx.doi.org/10.18071/isz.72.0099DOI Listing
March 2019

What Machine Learning Can Tell Us About the Role of Language Dominance in the Diagnostic Accuracy of German LITMUS Non-word and Sentence Repetition Tasks.

Front Psychol 2018 30;9:2757. Epub 2019 Jan 30.

Department of Dutch, University of Oldenburg, Oldenburg, Germany.

The present study investigates the performance of 21 monolingual and 56 bilingual children aged 5;6-9;0 on German LITMUS-sentence-repetition (SRT; Hamann et al., 2013) and non-word-repetition-tasks (NWRT; Grimm et al., 2014), which were constructed in accordance with the -principles (anguage mpairment esting in ultilingual ettings; Armon-Lotem et al., 2015). Both tasks incorporate phonologically and syntactically complex structures shown to be cross-linguistically challenging for children with Specific Language Impairment (SLI) and aim at minimizing bias against bilingual children while still being indicative of the presence of language impairment across language combinations (see Marinis and Armon-Lotem, 2015; for sentence-repetition; Chiat, 2015 for non-word-repetition). Given the great variability in bilingual language exposure and the potential effect of language experience on language performance in bilingual children, we examined whether background variables related to bilingualism, particularly, the degree language dominance as measured by relative amount of use and exposure, could compromise the diagnostic accuracy of the German LITMUS-SRT and NWRT. We further investigated whether a combination of the two tasks provides better diagnostic accuracy and helps avoid cases of misdiagnosis. To address this, we used an unsupervised machine learning algorithm, the Partitioning-Around-Medoids (PAM, Kaufman and Rousseeuw, 2009), for deriving a clinical category for the children as ± language-impaired based on their performance scores on SRT and NWRT (in isolation and combined) while withholding information about their clinical status based on standardized assessment in their first (home language, L1) and second language (societal language, L2). Subsequently, we calculated diagnostic accuracy and used regression analysis to investigate which background variables (age of onset, length of exposure, degree of language dominance, socio-economic-status, and risk factors for SLI) best explained clinical-group-membership yielded from the PAM-analysis based on the children's NWRT and SRT performance scores. Results show that although language-dominance clearly influences the performance of bilingual typically developing children, especially in the SRT, the diagnostic accuracy of the tools is not compromised by language dominance: while risk factors for SLI were significant predictors for clinical group membership in all models, language dominance did not contribute at all to explaining clinical cluster membership as typically developing or SLI based on any of the combinations of the SRT and NWRT variables. Additionally, results confirm that a combination of SRT scored by correct target structure and the structurally more complex language-dependent part of the NWRT yields better diagnostic accuracy than single measures and is only sensitive to risk factors for SLI and not to dominance levels or SES.
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http://dx.doi.org/10.3389/fpsyg.2018.02757DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363680PMC
January 2019

Acute alcohol intoxication may cause delay in stroke treatment - case reports.

BMC Neurol 2019 Jan 29;19(1):14. Epub 2019 Jan 29.

Department of Neurology, Faculty of Medicine, University of Debrecen, Moricz Zs. krt 22, Debrecen, 4032, Hungary.

Background: The signs and symptoms of acute alcohol intoxication resemble those of vertebrobasilar stroke. Due to their shared symptoms including double vision, nystagmus, dysarthria, and ataxia, the differential diagnosis of alcohol intoxication and vertebrobasilar stroke may pose a challenge. Moreover, if alcohol intoxication and stroke occur simultaneously, the signs and symptoms of stroke may be attributed to the effects of alcohol, leading to delayed stroke diagnosis and failure to perform reperfusion therapy.

Case Presentations: Three cases of alcohol intoxication and stroke are presented. The first patient (female, 50 years old) had dysarthria, nystagmus and trunk ataxia on admission. Her blood alcohol level was 2.3‰. The symptoms improved after forced diuresis, but 5.5 h later progression was observed, and the patient developed diplopia and dysphagia in addition to her initial symptoms. Angiography showed occlusion of the basilar artery. Intraarterial thrombolysis was performed. The second patient (male, 62 years old) developed diplopia, dysarthria and trunk ataxia after consuming 4-units of alcohol, and his symptoms were attributed to alcohol intoxication. Two hours later, neurological examination revealed dysphagia and mild right-sided hemiparesis, which questioned the causal relationship between the symptoms and alcohol consumption. Cerebral CT was negative, and intravenous thrombolysis was administered. The third patient (male, 55 years old) consumed 10 units of alcohol before falling asleep. Three hours later, his relatives tried to wake him up. He was unresponsive, which was attributed to alcohol intoxication. When he woke up 8 h later, right-sided hemiparesis and aphasia were observed, and cerebral CT already revealed irreversible ischemic changes.

Conclusions: Our cases show that alcohol consumption may interfere with stroke diagnosis by mimicking the signs and symptoms of vertebrobasilar stroke. Moreover, attributing the symptoms of stroke to alcohol intoxication may delay stroke diagnosis resulting in failure of reperfusion therapy. Based on our observations we conclude that stroke should be considered in the case of worsening symptoms, dysphagia, hemiparesis and disproportionately severe signs that cannot be attributed to the amount of alcohol consumed. In the case of ambiguity, ambulance should be called, and if stroke cannot be excluded, specific therapy should be administered.
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http://dx.doi.org/10.1186/s12883-019-1241-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6350361PMC
January 2019

Inter-ictal network of focal epilepsy and effects of clinical factors on network activity.

Clin Neurophysiol 2019 02 16;130(2):251-258. Epub 2018 Dec 16.

University of Debrecen, Medical Center, Department of Neurology, Móricz Zsigmond krt. 22., 4032 Debrecen, Hungary.

Objective: Aim of the study was to explore the inter-ictal, resting-state EEG network in patients with focal epilepsy (FE) and to specify clinical factors that influence network activity.

Methods: Functional EEG connectivity (EEGfC) differences were computed between 232 FE patients (FE group) and 77 healthy controls. EEGfC was computed among 23 cortical regions within each hemisphere, for 25 very narrow bands from 1 to 25 Hz. We computed independent effects for six clinical factors on EEGfC in the FE group, by ANOVA and post-hoc t-statistics, corrected for multiple comparisons by false discovery rate method.

Results: Robust, statistically significant EEGfC differences emerged between the FE and the healthy control groups. Etiology, seizure type, duration of the illness and antiepileptic treatment were independent factors that influenced EEGfC. Statistically significant results occurred selectively in one or a few very narrow bands and outlined networks. Most abnormal EEGfC findings occurred at frequencies that mediate integrative and motor activities.

Conclusions: FE patients have abnormal resting-state EEGfC network activity. Clinical factors significantly modify EEGfC.

Significance: Delineation of the FE network and modifying factors can open the way for targeted investigations and introduction of EEGfC into epilepsy research and practice.
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http://dx.doi.org/10.1016/j.clinph.2018.11.022DOI Listing
February 2019

Structural and Computational Assessment of the Influence of Wet-Chemical Post-Processing of the Al-Substituted Cubic LiLaZrO.

ACS Appl Mater Interfaces 2018 Oct 17;10(43):37188-37197. Epub 2018 Oct 17.

Department of Physical Geography and Informatics, Soil- and Water Analysing Laboratory , University of Szeged , Egyetem u. 2 , 6722 Szeged , Hungary.

LiLaZrO (LLZO) and related compounds are considered as promising candidates for future all-solid-state Li-ion battery applications. Still, the processing of those materials into thin membranes with the right stoichiometry and crystal structure is difficult and laborious. The sensitivity of the Li-ion conductive garnets against moisture and the associated Li/H cation exchange makes their processing even more difficult. Formulation of suitable polymer/ceramic hybrid solid state electrolytes could be a prosperous way to reach the future large scale production of solid state Li-ion batteries. In fact, solvent mediated and/or slurry based wet-processing of the LLZO, e.g., tape-casting, could result in irreversible Li-ion loss of the pristine material due to Li/H cation exchange. The concomitant structural changes and loss in functionality in terms of Li-ion conductivity are the results of the above process. Therefore, in the present work a systematic study on the chemical stability and structural retention of Al-substituted LLZO in different solvents is reported. It was found that Li/H exchange in LLZO occurs upon solvent immersion, and its magnitude is dependent on the availability of -OH functional groups of the solvent molecules. As a result, a larger degree of Li/H exchange causes higher increase of the lattice parameter of the LLZO, determined by synchrotron diffraction analyses. The expansion of the cubic unit cell was ascertained, when Li was replaced by H in the host lattice, by ab initio computational studies. The application of the most common solvent as dispersion medium, i.e., high purity water, causes the most significant Li/H exchange and, therefore, structural change, while acetonitrile was proven to be the best suitable solvent for wet postprocessing of LLZO. Finally, computational calculations suggested that the Li/H exchange could result in diminished ionic, i.e., mixed Li-H, conductivity due to the insertion of protons with lower mobility than that of Li-ions.
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http://dx.doi.org/10.1021/acsami.8b09789DOI Listing
October 2018

The detrital input and removal treatment (DIRT) network: Insights into soil carbon stabilization.

Sci Total Environ 2018 Nov 6;640-641:1112-1120. Epub 2018 Jun 6.

University of Michigan, Department of Ecology and Evolutionary Biology, USA. Electronic address:

Ecological research networks functioning across climatic and edaphic gradients are critical for improving predictive understanding of biogeochemical cycles at local through global scales. One international network, the Detrital Input and Removal Treatment (DIRT) Project, was established to assess how rates and sources of plant litter inputs influence accumulations or losses of organic matter in forest soils. DIRT employs chronic additions and exclusions of aboveground litter inputs and exclusion of root ingrowth to permanent plots at eight forested and two shrub/grass sites to investigate how soil organic matter (SOM) dynamics are influenced by plant detrital inputs across ecosystem and soil types. Across the DIRT network described here, SOM pools responded only slightly, or not at all, to chronic doubling of aboveground litter inputs. Explanations for the slow or even negative response of SOM to litter additions include increased decomposition of new inputs and priming of old SOM. Evidence of priming includes increased soil respiration in litter addition plots, decreased dissolved organic carbon (DOC) output from increased microbial activity, and biochemical markers in soil indicating enhanced SOM degradation. SOM pools decreased in response to chronic exclusion of aboveground litter, which had a greater effect on soil C than did excluding roots, providing evidence that root-derived C is not more critical than aboveground litter C to soil C sequestration. Partitioning of belowground contributions to total soil respiration were predictable based on site-level soil C and N as estimates of site fertility; contributions to soil respiration from root respiration were negatively related to soil fertility and inversely, contributions from decomposing aboveground litter in soil were positively related to site fertility. The commonality of approaches and manipulations across the DIRT network has provided greater insights into soil C cycling than could have been revealed at a single site.
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http://dx.doi.org/10.1016/j.scitotenv.2018.05.388DOI Listing
November 2018

[EEG-based cerebral networks in 14 neurological disorders].

Ideggyogy Sz 2017 May;70(5-6):159-178

Debreceni Egyetem Klinikai Központ, Neurológiai Klinika, Debrecen.

Background - Brain networks have not been systematically investigated yet in most neurological disorders. Purpose - To investigate EEG functional connectivity (EEGfC) networks in 14 neurological disorders. Patients - Potentially eligible patients were collected from clinical and EEG databases. All the available clinical data and EEG records were critically revised. All the patients who suffered of a single neurological disorder (out of the 14) and had a good quality EEG recording entered the study. Confoundig factors as comorbidity and CNS-active drug effects were eliminated as far as possible. EEG analysis - Three minutes of resting-state, waking EEG activity were selected for analysis. Current source density (CSD) values were computed for 2394 cortical voxels by Low Resolution Electromagnetic Tomography (LORETA). Thereafter, Pearson correlation coefficients were computed between all pairs of 23 cortical regions of interest (ROI) in each hemisphere (LORETA Source Correlation, LSC software). Computation was carried out for conventional EEG broad bands and very narrow bands (1 Hz bandwidth) between 1 and 25 Hz as well. Correlation coefficients of each group were statistically compared to our normative EEG (LSC) database by two-talied t-tests. Bonferroni-corrected p<0.05 values were accepted as statistically significant, and were graphically displayed as topographical networks. Results and conclusion - Group-specific networks were demonstrated. However, non-specific networks, charasteristic for most groups, were detected as well. Common finding were: decreased connectivity in the alpha band and increased connectivity in the delta, theta bands and upper-beta band. Decreased alpha-band connectivity presumably reflected primary lesional effects and on the other hand, non-specific vulnerability of "rich club connections". Increased connectivity in the slow bands presumably indicated adaptive-compensatory activity of brain homeostasis.
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http://dx.doi.org/10.18071/isz.70.0159DOI Listing
May 2017

Elevated Factor VIII and von Willebrand Factor Levels Predict Unfavorable Outcome in Stroke Patients Treated with Intravenous Thrombolysis.

Front Neurol 2017 23;8:721. Epub 2018 Jan 23.

Division of Clinical Laboratory Sciences, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Introduction: Plasma factor VIII (FVIII) and von Willebrand factor (VWF) levels have been associated with the rate and severity of arterial thrombus formation and have been linked to outcomes following thrombolytic therapy in acute myocardial infarction patients. Here, we aimed to investigate FVIII and VWF levels during the course of thrombolysis in acute ischemic stroke (AIS) patients and to find out whether they predict long-term outcomes.

Materials And Methods: Study population included 131 consecutive AIS patients (median age: 69 years, 60.3% men) who underwent i.v. thrombolysis with recombinant tissue plasminogen activator (rt-PA). Blood samples were taken on admission, 1 and 24 h after rt-PA administration to measure FVIII activity and VWF antigen levels. Neurological deficit of patients was determined according to the National Institutes of Health Stroke Scale (NIHSS). ASPECT scores were assessed using computer tomography images taken before and 24 h after thrombolysis. Intracranial hemorrhage was classified according to the European Cooperative Acute Stroke Study (ECASS) II criteria. Long-term functional outcome was determined at 90 days after the event by the modified Rankin scale (mRS).

Results: VWF levels on admission were significantly elevated in case of more severe AIS [median and IQR values: NIHSS <6:189.6% (151.9-233.2%); NIHSS 6-16: 199.6% (176.4-250.8%); NIHSS >16: 247.8% (199.9-353.8%),  = 0.013]; similar, but non-significant trend was observed for FVIII levels. FVIII and VWF levels correlated well on admission ( = 0.748,  < 0.001) but no significant correlation was found immediately after thrombolysis ( = 0.093,  = 0.299), most probably due to plasmin-mediated FVIII degradation. VWF levels at all investigated occasions and FVIII activity before and 24 h after thrombolysis were associated with worse 24 h post-lysis ASPECT scores. In a binary backward logistic regression analysis including age, gender, high-sensitivity C-reactive protein, active smoking, diabetes, and NIHSS >5 on admission, elevated FVIII and VWF levels after thrombolysis were independently associated with poor functional outcomes (mRS ≥ 3) at 90 days (immediately after thrombolysis: FVIII: OR: 7.10, 95% CI: 1.77-28.38,  = 0.006, VWF: OR: 6.31, 95% CI: 1.83-21.73,  = 0.003; 24 h after thrombolysis: FVIII: OR: 4.67, 95% CI: 1.42-15.38,  = 0.011, VWF: OR: 19.02, 95% CI: 1.94-186.99,  = 0.012).

Conclusion: Elevated FVIII activity and VWF antigen levels immediately after lysis and at 24 h post-therapy were shown to have independent prognostic values regarding poor functional outcomes at 90 days.
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http://dx.doi.org/10.3389/fneur.2017.00721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5787073PMC
January 2018

Decrease of global current source density predicts successful treatment in absence and juvenile myoclonic epilepsies.

Epilepsy Res 2017 07 2;133:1-5. Epub 2017 Apr 2.

University of Debrecen, Medical Center, Department of Neurology, Móricz Zsigmond krt. 22., 4032 Debrecen, Hungary.

Objective: To investigate relationship between treatment efficiency and EEG background activity changes in absence epilepsy (AE) and juvenile myoclonic epilepsy (JME) patients.

Patients And Methods: EEGs of 31 patients were analysed before treatment and after six months of treatment. Three minutes of artifact-free waking EEG background activity (without epileptiform potentials) were analysed for each patient in both conditions. All the EEG samples were processed to LORETA (Low Resolution Electromagnetic Tomography). Average of all the voxel-wise current source density (CSD) values within the 0.5-8.0Hz frequency range was computed for each EEG. Fischer's exact test was used to investigate association between the global CSD changes and the therapeutic outcome.

Results: Tight connection was demonstrated between seizure freedom and decreased CSD, and between persisting seizures and increased CSD (p<0.001).

Significance: An EEG-based biomarker that predicts successful drug treatment was described.
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http://dx.doi.org/10.1016/j.eplepsyres.2017.03.006DOI Listing
July 2017

Correlation between prescribed daily dose, seizure freedom and defined daily dose in antiepileptic drug treatment.

Int J Clin Pharm 2017 Apr 2;39(2):459-467. Epub 2017 Mar 2.

Department of Neurology, Faculty of Medicine, University of Debrecen, Móricz Zs. krt. 22., Debrecen, Hungary.

Background Although defined daily doses (DDD) for antiepileptic drugs (AED) have been assigned only in combination therapy, based on the literature, most patients take them in monotherapy. Furthermore, discrepancies between DDD and prescribed daily dose (PDD) were observed. Objective First, to determine PDDs of AEDs and to reveal PDD/DDD ratio among seizure free versus not seizure free patients in everyday clinical practice. Second, to test the applicability of 75% cut-off of DDD to achieve seizure freedom. Furthermore, to find out what factors might influence PDD. Setting Outpatient data files at a Hungarian university hospital were studied. Methods A retrospective, 20-year cross-sectional database was compiled from 1282 epileptic outpatients' files. Main outcome measure Seizure freedom and PDD were used as outcome measures. Results The mean DDD% of all prescribed AEDs increased steadily from monotherapy, through bitherapy towards polytherapy (p < 0.0001). Most seizure free patients took AEDs in doses in the range of ≤75% of DDDs in monotherapy and bitherapy. Older AEDs (carbamazepine and valproate) were given in a significantly higher mean dose in bitherapy in the seizure free group. Among the newer types, only levetiracetam and lamotrigine had a significantly higher DDD% in mono-, bi-, and polytherapy. Confirmed by logistic regression analysis, gender, age, type of epilepsy, and number of AEDs had a significant impact on the value of 75% DDD. Conclusion No significant unfavourable impact of the lower ratio of PDD/DDD on the outcome of achieving seizure freedom has been confirmed. As a measure of seizure freedom, 75% of DDD may be used, although individual therapy must be emphasised. Precisely quantified DDD would provide a more accurate calculation of other derived values.
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http://dx.doi.org/10.1007/s11096-017-0447-1DOI Listing
April 2017

Application of a Stir Bar Sorptive Extraction sample preparation method with HPLC for soil fungal biomass determination in soils from a detrital manipulation study.

J Microbiol Methods 2017 05 24;136:1-5. Epub 2017 Feb 24.

Institute of Environmental Sciences, University of Nyiregyhaza, Sóstói út 31/B, Nyiregyhaza, Hungary.

Ergosterol is a sterol found ubiquitously in cell membranes of filamentous fungi. Although concentrations in different fungal species span the range of 2.6 to 42μg/mL of dry mass, many studies have shown a strong correlation between soil ergosterol content and fungal biomass. The analysis of ergosterol in soil therefore could be an effective tool for monitoring changes in fungal biomass under different environmental conditions. Stir Bar Sorptive Extraction (SBSE) is a new sample preparation method to extract and concentrate organic analytes from liquid samples. SBSE was here demonstrated to be a simple, fast, and cost effective method for the quantitative analysis of ergosterol from field-collected soils. Using this method we observed that soil ergosterol as a measure of fungal biomass proved to be a sensitive indicator of soil microbial dynamics that were altered by changes in plant detrital inputs to soils in a long-term field experiment.
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http://dx.doi.org/10.1016/j.mimet.2017.02.009DOI Listing
May 2017

Long-term effects of climate change on carbon storage and tree species composition in a dry deciduous forest.

Glob Chang Biol 2017 08 3;23(8):3154-3168. Epub 2017 Apr 3.

Institute of Environmental and Earth Sciences, University of West Hungary, Sopron, Hungary.

Forest vegetation and soils have been suggested as potentially important sinks for carbon (C) with appropriate management and thus are implicated as effective tools in stabilizing climate even with increasing anthropogenic release of CO . Drought, however, which is often predicted to increase in models of future climate change, may limit net primary productio (NPP) of dry forest types, with unknown effects on soil C storage. We studied C dynamics of a deciduous temperate forest of Hungary that has been subject to significant decreases in precipitation and increases in temperature in recent decades. We resampled plots that were established in 1972 and repeated the full C inventory by analyzing more than 4 decades of data on the number of living trees, biomass of trees and shrubs, and soil C content. Our analyses show that the decline in number and biomass of oaks started around the end of the 1970s with a 71% reduction in the number of sessile oak stems by 2014. Projected growth in this forest, based on the yield table's data for Hungary, was 4.6 kg C/m . Although new species emerged, this new growth and small increases in oak biomass resulted in only 1.9 kg C/m increase over 41 years. The death of oaks increased inputs of coarse woody debris to the surface of the soil, much of which is still identifiable, and caused an increase of 15.5%, or 2.6 kg C/m , in the top 1 m of soil. Stability of this fresh organic matter input to surface soil is unknown, but is likely to be low based on the results of a colocated woody litter decomposition study. The effects of a warmer and drier climate on the C balance of forests in this region will be felt for decades to come as woody litter inputs decay, and forest growth remains impeded.
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http://dx.doi.org/10.1111/gcb.13669DOI Listing
August 2017

Outcome of Repeated Thrombolysis in Debrecen Thrombolysis Database.

J Stroke Cerebrovasc Dis 2017 Jan 23;26(1):132-138. Epub 2016 Sep 23.

Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary.

Introduction: Recombinant tissue plasminogen activator (rtPA) is an efficient therapy of acute ischemic stroke. The risk of a recurrent ischemic stroke is high. This prospective single center study aimed to assess whether or not the repeated rtPA treatment is beneficial for acute stroke patients.

Methods: All thrombolysed patients' data at the Department of Neurology, University of Debrecen have been recorded in the Debrecen Thrombolysis Database (DTD) since 2004. We identified 21 patients with repeated thrombolysis. Stroke severity by the NIH stroke scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early CT Score were evaluated on admission and 1 day later. The modified Rankin Scale score at 3 months and case fatality at 1 year were evaluated. We compared the first and second thrombolyses, and we screened for bleeding and allergic reactions to determine safety.

Results: Within the 27-month median time, 18 patients were thrombolysed twice, with complete follow-up. In recurrent stroke patients, diabetes mellitus, congestive heart failure, and anticoagulation were more common. Admission cholesterol levels were decreased. After the first and second treatments, 24-hour NIHSSS were 3 (1;6) and 7 (1;10), respectively. At 3 months, good outcome was significantly higher after the first treatment than those of DTD, with no differences between the 2 attempts. There was little difference in 3-month and 1-year outcomes, regardless of laterality-ipsilateral or contralateral hemisphere-in recurrent strokes. One patient had nonsymptomatic intracranial bleeding after repeated rtPA treatment.

Discussion: Recurrent rtPA treatment may be safe and effective in patients who have mild or moderate residual symptoms after the index stroke.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.08.044DOI Listing
January 2017

Outcome of antiepileptic drug treatment of 1282 patients with epilepsy, their pharmacovigilance reports and concomitant medication on CNS in an East-Hungarian adult database.

J Neurol Sci 2016 Oct 17;369:220-226. Epub 2016 Aug 17.

University of Debrecen, Faculty of Medicine, Department of Neurology, Móricz Zs. krt. 22., Debrecen, Hungary. Electronic address:

Objective: The aim of this study was to determine the outcome of antiepileptic drug (AED) treatment based on seizure freedom, pharmacovigilance reports and effects of concomitant medication on the central nervous system (CNS) of adult epileptic patients registered in the East-Hungarian Epilepsy Database.

Methods: Prospective cross-sectional database was compiled from outpatient files between 1992 and 2011.

Results: The majority of 1282 treated patients were on monotherapy 894 patients (70%), 286 (22%) on bitherapy and 102 (8%) on polytherapy. Of all treated patients, seizure freedom was achieved by 603 (47%). Among the seizure free patients 464 (77%) were on monotherapy, 115 (19%) on bitherapy and only 24 (4%) on polytherapy. The overall rate of adverse drug reactions (ADRs) was 16.2%. From patients on AED, 279 (22%) took concomitant drugs acting on the CNS. In a logistic regression model, other CNS-related drugs and a number of prescribed antiepileptic drugs had a significant influence on the desired outcome of seizure freedom. On comparing the Proportional Reporting Ratio and 95%CI of older and newer AEDs, no significant superiority of newer AEDs was detected.

Conclusion: Careful drug selection for epileptic patients must be highlighted in order to improve outcome, reduce ADRs and improve patient compliance.
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http://dx.doi.org/10.1016/j.jns.2016.08.039DOI Listing
October 2016

[Angioneuritic edema in ischaemic stroke patients treated with rt-PA].

Ideggyogy Sz 2016 Jul;69(7-8):239-243

BAZ Megyei Kórház, Stroke, Vascularis, Általános Neurológiai, Toxikológiai Osztály, Miskolc.

Data of our 254 patients who were treated with rt-PA between 1st of Jan, 2011 and 31st of Dec, 2014 were processed. We focused on angioneurotic oedema as allergic complication of thrombolysis which caused life threatening respiratory obstruction in two cases. We describe these two patients' history. Out of 254 patients six (2.3%) suffered angioneurotic edema caused respiratory obstruction in two (0.90%) cases. This occurrence is approximately 1.3-5.1% in literature. Five, out of six patients who suffered from angioneurotic oedema, had been treated with ACE inhibitors or ARB before. The role of ACE inhibitors is known in metabolism of bradykinin cascade. Plasmin which present during thrombolysis, precipitates biochemical mechanisms of this potential life threatening complication. Therefore rt-PA alone can be the cause of angioedema, but it can be more frequent together with ACE inhibitors therapy.
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http://dx.doi.org/10.18071/isz.69.0239DOI Listing
July 2016

[INDIVIDUAL EVALUATION OF LORETA ABNORMALITIES IN IDIOPATHIC GENERALIZED EPILEPSY].

Ideggyogy Sz 2016 Mar;69(3-4):107-21

Background: Contemporary neuroimaging methods disclosed structural and functional cerebral abnormalities in idiopathic generalized epilepsies (IGEs). However, individual electrical (EEG) abnormalities have not been evaluated yet in IGE patients.

Methods: IGE patients were investigated in the drug-free condition and after 3-6 month of antiepileptic treatment. To estimate the reproducibility of qEEG variables a retrospective recruited cohort of IGE patients was investigated. 19-channel resting state EEG activity was recorded. For each patient a total of 2 minutes EEG activity was analyzed by LORETA (Low Resolution Electromagnetic Tomography). Raw LORETA values were Z-transformed and projected to a MRI template. Z-values outside within the [+3Z] to [-3Z] range were labelled as statistically abnormal.

Results: 1. In drug-free condition, 41-50% of IGE patients showed abnormal LORETA values. 2. Abnormal LORETA findings showed great inter-individual variability. 3. Most abnormal LORETA-findings were symmetrical. 4. Most maximum Z-values were localized to frontal or temporal cortex. 5. Succesfull treatment was mostly coupled with disappearence of LORETA-abnormality, persistent seizures were accompanied by persistent LORETA abnormality.

Discussion: 1. LORETA abnormalities detected in the untreated condition reflect seizure-generating property of the cortex in IGE patients. 2. Maximum LORETA-Z abnormalities were topographically congruent with structural abnormalities reported by other research groups. 3. LORETA might help to investigate drug effects at the whole-brain level.
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March 2016

Increased resting-state EEG functional connectivity in benign childhood epilepsy with centro-temporal spikes.

Seizure 2016 Feb 7;35:50-5. Epub 2016 Jan 7.

University of Debrecen, Institute of Nuclear Medicine, Debrecen, Hungary.

Purpose: To explore intrahemispheric, cortico-cortical EEG functional connectivity (EEGfC) in benign childhood epilepsy with rolandic spikes (BECTS).

Methods: 21-channel EEG was recorded in 17 non-medicated BECTS children and 19 healthy controls. 180s of spike- and artifact-free activity was selected for EEGfC analysis. Correlation of Low Resolution Electromagnetic Tomography- (LORETA-) defined current source density time series were computed between two cortical areas (region of interest, ROI). Analyses were based on broad-band EEGfC results. Groups were compared by statistical parametric network (SPN) method. Statistically significant differences between group EEGfC values were emphasized at p<0.05 corrected for multiple comparison by local false discovery rate (FDR).

Results: (1) Bilaterally increased beta EEGfC occurred in the BECTS group as compared to the controls. Greatest beta abnormality emerged between frontal and frontal, as well as frontal and temporal ROIs. (2) Locally increased EEGfC emerged in all frequency bands in the right parietal area.

Conclusions: Areas of increased EEGfC topographically correspond to cortical areas that, based on relevant literature, are related to speech and attention deficit in BECTS children.
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http://dx.doi.org/10.1016/j.seizure.2016.01.001DOI Listing
February 2016

Predictors of long-term outcome after intravenous or intra-arterial recombinant tissue plasminogen activator treatment in the eastern Hungarian thrombolysis database.

J Stroke Cerebrovasc Dis 2015 Jan 18;24(1):117-24. Epub 2014 Oct 18.

Department of Neurology, Semmelweis University, Budapest, Hungary. Electronic address:

Background: This prospective single-center study aimed to identify features determining long-term outcome after thrombolysis in a Central European stroke population.

Methods: Between 1 January, 2004, and 31 December, 2010, 415 patients were treated with recombinant tissue plasminogen activator at the Department of Neurology, University of Debrecen. Stroke severity by the National Institute of Health Stroke Scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early Computed Tomography score (ASPECTS) were evaluated on admission and 1 day later. The modified Rankin Scale (mRS) at 3 months and case fatality at 1 year were evaluated. Independent predictors of outcome were identified by multivariate testing.

Results: Data of 369 patients were analyzed. Median NIHSSS was 12 (interquartile range [IQR], 8-17) on admission and 10 (IQR, 5-16) at 24 hours. Arterial occlusion was found in 55%. Symptomatic intracerebral hemorrhage (SICH) was detected in 3.8%. Outcome was significantly worse, and SICH was more frequent in intra-arterially treated patients. At 3 months, one third of the patients were independent (mRS ≤ 2), and 23% were dead. At 1 year 2 of 3 patients were alive. Significant independent predictors of disability at 3 months were 24-hour NIHSSS, admission ASPECTS, admission glucose level, and treatment modality. Only the 24-hour NIHSSS was a significant predictor of case fatality at 1 year.

Conclusions: Although short-term outcome was similar, the 3-month and 1-year outcomes were worse than data from previous reports. A more efficient health care program should be implemented after stroke to maintain the favorable effect of thrombolysis in the long term.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.07.054DOI Listing
January 2015

An optimized HPLC method for soil fungal biomass determination and its application to a detritus manipulation study.

J Microbiol Methods 2014 Aug 8;103:124-30. Epub 2014 Jun 8.

Institute of Environmental Sciences, College of Nyiregyhaza, Sóstói u 31/B, Nyiregyhaza, Hungary.

The goal of this research was to develop modified analytical method for the quantitative analysis of ergosterol, which is highly effective marker for fungal biomass. We suggest that our optimized method for the determination of ergosterol is an effective way to monitor changes in fungal biomass under different environmental conditions.
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http://dx.doi.org/10.1016/j.mimet.2014.05.022DOI Listing
August 2014

Uppermost synchronized generators of spike-wave activity are localized in limbic cortical areas in late-onset absence status epilepticus.

Seizure 2014 Mar 4;23(3):213-21. Epub 2013 Dec 4.

Department of Neurology, Kenezy Gyula Hospital, Bartok Bela ut 2-26, H-4031 Debrecen, Hungary.

Purpose: Absence status (AS) epilepticus with generalized spike-wave pattern is frequently found in severely ill patients in whom several disease states co-exist. The cortical generators of the ictal EEG pattern and EEG functional connectivity (EEGfC) of this condition are unknown. The present study investigated the localization of the uppermost synchronized generators of spike-wave activity in AS.

Method: Seven patients with late-onset AS were investigated by EEG spectral analysis, LORETA (Low Resolution Electromagnetic Tomography) source imaging, and LSC (LORETA Source Correlation) analysis, which estimates cortico-cortical EEGfC among 23 ROIs (regions of interest) in each hemisphere.

Results: All the patients showed generalized ictal EEG activity. Maximum Z-scored spectral power was found in the 1-6 Hz and 12-14 Hz frequency bands. LORETA showed that the uppermost synchronized generators of 1-6 Hz band activity were localized in frontal and temporal cortical areas that are parts of the limbic system. For the 12-14 Hz band, abnormally synchronized generators were found in the antero-medial frontal cortex. Unlike the rather stereotyped spectral and LORETA findings, the individual EEGfC patterns were very dissimilar.

Conclusion: The findings are discussed in the context of nonconvulsive seizure types and the role of the underlying cortical areas in late-onset AS. The diversity of the EEGfC patterns remains an enigma. Localizing the cortical generators of the EEG patterns contributes to understanding the neurophysiology of the condition.
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http://dx.doi.org/10.1016/j.seizure.2013.11.017DOI Listing
March 2014

Computed tomography and transcranial Doppler findings in acute and subacute phases of intracerebral hemorrhagic stroke.

J Neuroimaging 2014 Mar-Apr;24(2):124-30. Epub 2013 Jan 14.

Department of Anesthesiology and Intensive Care, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.

Background And Purpose: The hematoma volume is an important determinant of outcome and a predictor of clinical deterioration in patients with intracerebral hemorrhage (ICH). Our goal was to evaluate alterations in the cerebral circulation, in respect to hemorrhage and edema volume changes, using transcranial Doppler (TCD).

Methods: Twenty patients with acute supratentorial ICH were examined. Brain, hematoma, and edema volumes were calculated from CT scans performed at admission and 2 weeks later. Data were compared with those obtained from bilateral TCD recordings of the middle cerebral arteries.

Results: During TCD examination, blood flow velocities did not change, cerebral perfusion pressure (CPP) and resistance area product (RAP) decreased (P = .006, P = .002) while cerebral blood flow index (CBFI) remained constant on the affected side. Although hemorrhage volume did not correlate with RAP in the acute phase, correlation was found in the subacute phase (r = -.44, P = .04).

Conclusions: TCD monitoring sensitively demonstrates the hemodynamic change caused by ICH but the severity of the changes does not correlate with the volume of the ICH in acute stage. The CPP, RAP, and CBFI values are more sensitive parameters than the absolute velocity values, therefore they contribute more to the understanding of hemodynamic changes developed after spontaneous ICH.
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http://dx.doi.org/10.1111/j.1552-6569.2012.00776.xDOI Listing
April 2015

[Advances in the prevention, diagnosis and therapy of vascular diseases].

Orv Hetil 2012 Apr;153(13):483-98

Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Neurológiai Klinika Debrecen Nagyerdei krt 98. 4032.

Atherosclerosis is a systemic disease affecting the coronary, carotid, intracerebral, renal and peripherial arteries. The early morphological and functional impairments could be detected in the second or third decades of life and their progression depend on the number and severity of risk factors and individual susceptility. Although the vascular risk factors (smoking, overweight, age, unhealthy diet, lack of physical exercise, hypertension, diabetes mellitus, chronic kidney disease and dyslipidemia) are the same and common in the different vascular diseases, the present clinical routine artificially classifies the diagnosis and therapy of different vascular diseases into different subfields of medicine with the negative impact of possible polypragmasia. Recently, worldwide health surveys (e.g. REACH registry) have proven the usefulness of a holistic approach in the diagnosis and therapy of multiorgan-affected vascular patients. This review summarizes the multidisciplinary advances and future perspective of vascular diseases.
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http://dx.doi.org/10.1556/OH.2012.29340DOI Listing
April 2012

The electrophysiological "delayed effect" of focal interictal epileptiform discharges. A low resolution electromagnetic tomography (LORETA) study.

Epilepsy Res 2009 Aug 12;85(2-3):270-8. Epub 2009 May 12.

Kenézy Hospital Ltd., Department of Neurology, Debrecen, Hungary.

Unlabelled: Collating the findings regarding the role of focal interictal epileptiform discharges (IEDs) on CNS functions raises the possibility that IEDs might have negative impact that outlasts the duration of the spike-and-wave complexes. The aim of this study was the electrophysiological demonstration of the "delayed effect" of the IEDs. 19-channel, linked-ears referenced, digital waking EEG records of 11 children (aged 6-14 years, eight with idiopathic, three with cryptogenic focal epilepsy, showing a single spike focus) were retrospectively selected from our database. A minimum of 20 (preferably, 30), 2-s epochs containing a single focal spike-and-wave complex were selected (Spike epochs). Thereafter, Postspike-1 (Ps1), Postspike-2 (Ps2) and Postspike-3 (Ps3) epochs were selected, representing the first and second seconds (Ps1), the third and fourth seconds (Ps2) and the fifth and sixth seconds (Ps3) after the Spike epoch, respectively. Interspike epochs (Is) were selected at a distance at least 10s after the Spike epoch. Individual analysis: the frequency of interest (FOI=the individual frequency of the wave component of the IEDs), and the region of interest (ROI=the site of the IEDs) were identified by reading the raw EEG waveform and the instant power spectrum. Very narrow band LORETA (low resolution electromagnetic tomography) analysis at the FOI and ROI was carried out. Age-adjusted, Z-transformed LORETA "activity" (=current source density, amperes/meters squared) was compared in the Spike, Ps1, Ps2, Ps3 and Is epochs.

Findings: the greatest (uppermost pathological) Z-scores and the greatest spatial extension of the LORETA-abnormality were always found in the Spike epochs, followed by the gradual decrease of activity in terms of severity and spatial extension in the Ps1, Ps2, Ps3 epochs. The lowest (baseline) level and extension of the abnormality was found in the Is epochs. Group analysis: average values of activity across the patients were computed for the temporal decrease of the abnormality.

Findings: a clear tendency for the decrease of abnormality was demonstrated.

Conclusion: the "delayed effect" of the IEDs was demonstrated electrophysiologically and quantified. The method may be utilized in the individual assessment of the effect of IEDs on cortical activity, the degree and temporo-spatial extension of the abnormality.
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http://dx.doi.org/10.1016/j.eplepsyres.2009.03.022DOI Listing
August 2009

Prior transient ischemic attack is independently associated with lesser in-hospital case fatality in acute stroke.

Psychiatry Clin Neurosci 2008 Dec;62(6):705-12

Department of Neurology, University of Debrecen, Hungary.

Aim: Ischemic preconditioning has been well established in healthy human hearts, but limited information is available about its occurrence or its integrity in the brain. The aim of the present study was therefore to investigate whether a prior cerebral ischemic episode (stroke or transient ischemic attack [TIA]) is able to confer protection against ischemic stroke, reflected by in-hospital case fatality.

Methods: A total of 2874 acute stroke patients included in the prospective, hospital-based Debrecen Stroke Database were studied, of whom 673 had previous stroke and 195 had prior TIA.

Results: Following adjustment for active confounders, TIA but not stroke in the history was associated with decreased odds for in-hospital case fatality (odds ratio, 0.53; 95% confidence interval: 0.29-0.98; P = 0.041). The fitness of the final multiple regression model was good (Hosmer-Lemeshow goodness-of-fit chi(2) statistic (P = 0.328).

Conclusion: TIA may have an ischemic preconditioning effect in the human brain.
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http://dx.doi.org/10.1111/j.1440-1819.2008.01874.xDOI Listing
December 2008

Effects of vinpocetine on the redistribution of cerebral blood flow and glucose metabolism in chronic ischemic stroke patients: a PET study.

J Neurol Sci 2005 Mar 8;229-230:275-84. Epub 2005 Jan 8.

National Stroke Center, Department of Vascular Neurology, Semmelweis University, H-1085 Budapest, Hungary.

The pharmacological effects of the neuroprotective drug vinpocetine, administered intravenously in a 14-day long treatment regime, on the cerebral blood flow and cerebral glucose metabolism in chronic ischemic stroke patients (n=13) were studied with positron emission tomography in a double-blind design. The regional and global cerebral metabolic rates of glucose (CMRglc) and cerebral blood flow (CBF) as well as vital physiological parameters, clinical performance scales, and transcranial Doppler parameters were measured before and after the treatment period in patient groups treated with daily intravenous infusion with or without vinpocetine. While the global CMRglc values did not change markedly as a result of the infusion treatment with (n=6) or without (n=7) vinpocetine, the global CBF increased and regional CMRglc and CBF values showed marked changes in several brain structures in both cases, with more accentuated changes when the infusion contained vinpocetine. In the latter case the highest rCBF changes were observed in those structures in which the highest regional uptake of labelled vinpocetine was measured in other PET studies (thalamus and caudate nucleus: increases amounting to 36% and 37%, respectively). The findings indicate that a 2-week long intravenous vinpocetine treatment can contribute effectively to the redistribution of rCBF in chronic ischemic stroke patients. The effects are most pronounced in those brain regions with the highest uptake of the drug.
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http://dx.doi.org/10.1016/j.jns.2004.11.053DOI Listing
March 2005
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