In memoriam Dr. Szilárd János András

Kálmán János

2015. október 16-án elhunyt Dr. Szilárd János András, az orvostudományok kandidátusa, emeritus professzor, a Szent-Györgyi Albert Orvostudományi Egyetem rektora, az Ideg- és Elmegyógyászati Klinika korábbi tanszékvezető egyetemi tanára, a Magyar Pszichiátriai Társaság alapító tagja, a pszichiátriai szakma önállósodásának, a szociálpszichiátriai és neuropszichiátriai szemléletmód jeles hazai képviselője.


Editoral in Hungarian

Dániel Bereczki


Neurofarmakológia 2015: Új terápiás lehetőségek és jól bevált régi gyógyszerek

Bereczki Dániel

Magyarországon évente több mint 100 ezer fekvő és több mint 1,3 millió ambuláns esetet látnak el a neurológiai osztályok és szakrendelések (Bereczki és Ajtay, 2009). A neurológiai kórállapotok egy része (akut stroke, epilepsziás rohamok, encefalitisz stb.) sürgős kórházi felvételt és ellátást igényel, de a legtöbb neurológiai betegség esetében tartós, sőt egész életre szóló gondozás szükséges. A gondozás részben neurológiai szakrendeléseken történik, de a szakvizsgálatok közötti időben fontos a háziorvos szerepe is.

Current migraine pharmacotherapy

Éva Csépány, Máté Magyar, Tamás Gyüre, György  Bozsik and Csaba Ertsey


The exact pathomechanism of migraine is still unknown, currently there are no biomarkers for
migraine diagnosis, and current animal models reflect only one aspect of migraine, therefore
future migraine studies are necessary. The current treatment of migraine (both acute and
preventive) is suboptimal. There are no specific preventive drugs for migraine, and current
preventatives may become inefficient during long-term use. Triptans are useful abortive
drugs, but not effective in some of the patients; severe cardio-or cerebrovascular side effects
may occur. Triptans and ergot alkaloids (and also non-specific abortive agents) can cause
medication overuse headache. A number of newly synthesized experimental drugs seem to
be effective and promising for migraine therapy, but at present our experience with these is
limited, therefore further studies are essential.

Keywords: migraine, therapy, triptans, abortive drugs, preventative drugs, ergot alkaloids,
aspirin, paracetamol, non-steroidal anti-inflammatory drugs, antiemetics, newly synthesized

Tricyclic antidepressant therapy in headache

Máté Magyar, Éva Csépány, Tamás Gyüre, György Bozsik, Dániel  Bereczki and Csaba Ertsey


The two most important representatives of the primary headaches are migraine and tensiontype headache. More than 10% of the population suffer from migraine and even a greater
part, approximately 30-40% from tension-type headache. These two headache types have
a great effect both on the individual and on the society. There are two types of therapeutic
approaches to headaches: the abortive and the prophylactic therapy. Prophylactic treatment
is used for frequent and/or difficult-to-treat headache attacks. Although both migraine and
tension-type headache are often associated with depression, for their treatment – in contrast
to the widespread medical opinion – not all antidepressants were found to be effective.
Amitriptyline, which is a tricyclic antidepressant, is used as a prophylactic therapy for headache
since 1968. Its efficacy has been demonstrated in several double-blind, placebo-controlled
studies. Although the newer types of antidepressant, such as selective serotonin reuptake
inhibitors and selective serotonin-norepinephrine reuptake inhibitor, have a more favorable
side-effect profile than tricyclic antidepressants, their headache prophylactic effect has not
been proven yet.

Keywords: migraine, tension-type headache, prophylactic treatment, antidepressant, tricyclic


Cardioembolisation is responsible for 20 percent of ischaemic stroke cases, which most commonly derives from non-valvular atrial fibrillation. Although warfarin is highly effective in
primary and secondary stroke prevention, its use is limited by the high risk of haemorrhagic
complications and a narrow therapeutic range that needs regular monitoring of INR. These
limitations explained the strong need for developing new oral anticoagulants. The so-called
’new oral anticoagulants’ are trying to find new targets for modifying the coagulation cascade. Apixaban, edoxaban and rivaroxaban are direct factor Xa inhibitors, while dabigatran
works as a direct thrombin inhibitor. Recent phase-III clinical trials proved their effectiveness
in stroke prevention and risk reducing of haemorrhagic events as well, so they can already
be found as recommended drugs in new guidelines of European and American societies of
cardiology and stroke. The use of new oral anticoagulants instead of warfarin in patients with
atrial fibrillation or as a secondary prevention after cardioembolic stroke has to be considered.

Keywords: stroke, atrial fibrillation, new oral anticoagulants

Application of levodopa/carbidopa intestinal gel in advanced Parkinson's disease

Adrián Tóth, Helga Nagy, Judit Wacha, Dániel  Bereczki and Annamária Takáts


Parkinson’s disease is the second most common neurodegenerative disorder around the
world. Levodopa has remained the ”gold standard” of the therapy even several decades
after its introduction. Chronic levodopa treatment is associated with the development of
motor complications in most patients. Advanced Parkinson’s disease is characterized by
these complications: motor and non-motor fluctuation and disturbing dyskinesia. Continuous dopaminergic stimulation might reduce these complications. In advanced Parkinson’s
disease levodopa is still effective. In the treatment of this stage there are several advanced or
device-aided therapies: apomorphine pump, deep brain stimulation and levodopa/carbidopa
intestinal gel. Levodopa/carbidopa intestinal gel is an aqueous gel that can be delivered to
the jejunum via a percutaneous gastrojejunostomy tube which is connected to an infusion
pump dosing the levodopa gel continuously to the place of absorption. Levodopa/carbidopa
gel infusion can be used as monotherapy, can be tested, can be used individually and this
therapy is reversible. Several clinical trials demonstrated that levodopa/carbidopa intestinal
gel therapy is of long-term benefit, improves the quality of life of the patients and can reduce
motor fluctuation and dyskinesia.

Keywords: advanced Parkinson’s disease, motor and non-motor fluctuation, dyskinesia,
continuous dopaminergic stimulation, advanced therapy, levodopa/carbidopa intestinal gel

Oral disease-modifying agents in relapsing-remitting multiple sclerosis

Anna Iljicsov, Zsuzsanna  Pál and Magdolna Simó


In relapsing-remitting multiple sclerosis, only parenteral immunomodulatory treatments
existed for 15 years, until 2010. In recent years, novel disease-modifying agents became available with new mechanisms of action and oral application, which expanded therapeutic options.
Thus, when making therapeutic decisions, more and new aspects should be considered, and
the daily practice of patient management has been changed due to the different profile of
possible side-effects. The authors review the mechanism of action, pharmacokinetics, studies
regarding efficacy, side-effects of first- and second line oral disease-modifying treatments and
provide practical guide of their everyday usage.

Keywords: relapsing-remitting multiple sclerosis, disease-modifying treatment, oral therapy