| Abstract | Cilj istraživanja: Usporediti serumske koncentracije anti-NMDAR antitijela kod bolesnika s cervikalnom distonijom prije i poslije injekcije botulinum toksina uzevši u obzir duljinu trajanja bolesti, spol, i subjektivne procjene stanja bolesnika nakon primjene botulinum toksina.
Ispitanici i postupci: Uključilo se jedanaestero oboljelih od cervikalne distonije. Prosječna je dob ispitanika 67,36 ± 11,41. Cervikalna distonija sudionika studije prosječno traje 16,44 ± 14,35. Sedam je ispitanika kontinuirano dulji vremenski interval uzimalo botulinum toksin, dok je dvoje prvi put uzelo botoks za liječenje cervikalne distonije, jedna je osoba primila dvije injekcije botoksa. Netom prije ili poslije neurološkoga pregleda uzimao se serum nakon čega se ispitanicima injicirao botulinum toksin. Sljedeći se uzorak seruma prikupio dva mjeseca poslije botulinum toksina. Serumska se koncentracija anti – NMDAR antitijela izmjerila korištenjem Human GRIN1(Glutamate Receptor, Ionotropic, N-Methyl-D-Aspartate 1) ELISA Kit (ELK5387). Serumske su koncentracije anti – NMDAR antitijela izmjerene prije injekcije botoksa i dva mjeseca poslije injekcije botulinum toksina. Usporedilo se koncentracije među spolovima. Nastojalo se dovesti u korelaciju promjene serumske koncentracije antitijela na
NMDAR i subjektivni dojam bolesnika o bolesti. Također, nastojalo se utvrditi korelaciju koncentracije anti – NMDAR antitijela i duljine cervikalne distonije. Statistički su značajni rezultati ako je P<0,05.
Rezultati: 7 (63,64%) su ispitanika žene, 4 (36,36%) su muškarca od ukupno 11. Omjer žena naspram muškaraca jest 1,75:1. 7 je ispitanika uzimalo botulinum toksin dulji vremenski interval, dvoje je prvi put primilo injekciju botulinum toksina, jedan je ispitanik uzeo injekciju
botoksa dva puta. Nije se dobilo statistički značajnih razlika uspoređivanjem serumske koncentracije anti – NMDAR antitijela prije i dva mjeseca nakon injekcije botoksa kao ni usporedbom po spolu. Serumska je koncentracija anti – NMDAR antitijela prije injekcije botoksa iznosila 5,65 ± 0,97, dva mjeseca poslije injekcije botulinum toksina bila je 8,23 ± 0,97.
Prosječna je serumska koncentracija anti – NMDAR antitijela prije botoksa u žena iznosila 5,9 ± 2,64, a poslije 7,9 ± 7,06. U muškaraca je prije botoksa bila 5,23 ± 450,36 te poslije 9,2 ±
1103,09. Iako nije uočen statistički značajan rezultat za povezanost subjektivnoga dojma oboljelih od cervikalne distonije i promjene serumske koncentracije anti – NMDAR antitijela dva mjeseca nakon injekcije botoksa uvidjelo se da oboljeli s jakim subjektivnim poboljšanjem simptoma nakon injekcije botoksa imaju trend smanjenja serumse koncentracije antitijela.
Uočen je statistički značajan rezultat između duljine bolesti i prve serumske koncentracije antitijela (r=0,653, P=0,04). Isto nije primijećeno za drugu serumsku koncentraciju antitijela.
Zaključak: Koncentracija anti – NMDAR antitijela se ne razlikuje u serumu između ispitanika s cervikalnom distonijom prije i dva mjeseca nakon injekcije botulinum toksina. Ne postoji razlika u serumskoj koncentraciji između žena i muškaraca oboljelih od cervikalne distonije.
Statistički značajna povezanost nije uočena za subjektivni dojam oboljeloga od cervikalne distonije i promjene serumske koncentracije antitijela, iako ispitanici s jakim poboljšanjem imaju trend smanjenja koncentracije antitijela. Dulje trajanje bolesti pozitivno je povezano s prvom serumskom koncentracijom. Isto se ne može reći za drugu. Potrebna su daljnja istraživanja na većim uzorcima za dokazivanje povezanosti duljine trajanja bolesti i koncentracija anti – NMDAR antitijela te promjene koncentracije anti – NMDAR i povezanost s težinom kliničke slike. |
| Abstract (english) | Objective: To compare serum concentrations of anti-NMDAR antibodies before and two months after botulinum toxin injection. To determine the association between changes in antiNMDAR antibody concentrations before and two months after botulinum toxin injection and patients' subjective perception of their cervical dystonia. To compare anti-NMDAR antibody concentrations by sex. To determine the association between the duration of cervical dystonia and anti-NMDAR antibody concentration.
Methods: Eleven patients with cervical dystonia were included. The mean age of the participants was 67.36 ± 11.41 years. The participants' cervical dystonia had lasted an average of 16.44 ± 14.35 years. Seven participants had been taking botulinum toxin for a longer period of time, while two were receiving botulinum toxin for the first time to treat their cervical dystonia, and one person had received two botulinum toxin injections. Serum was collected before or after the neurological examination, and the participants were then injected with botulinum toxin. The next serum sample was collected two months late rafter botulinum toxin injection. Serum concentrations of anti-NMDAR antibodies were measured using the Human GRIN1(Glutamate Receptor, Ionotropic, N-Methyl-D-Aspartate 1) ELISA Kit (ELK5387). Serum concentrations of anti-NMDAR antibodies were measured before botulinum toxin injection and two months after botulinum toxin injection. Concentrations were compared between sexes. An attempt was made to correlate changes in serum anti-NMDAR antibody concentrations with patients' subjective perception of their disease. An attempt was also made to determine the correlation between anti-NMDAR antibody concentration and the duration of cervical dystonia. Statistical significance was set at P<0.05.
Results: Seven (63.64%) of the participants were women and 4 (36.36%) were men, for a total of 11 participants. The female-to-male ratio was 1.75:1. Seven participants had been taking botulinum toxin for a longer period of time, two received botulinum toxin injections for the first time, and one participant received two botulinum toxin injections. No statistically significant differences were found in serum anti-NMDAR antibody concentrations before and two months after botulinum toxin injection, or between sexes. The mean serum anti-NMDAR antibody concentration before botulinum toxin injection was 5.65 ± 0.97, and two months after botulinum toxin injection was 8.23 ± 0.97. The mean serum anti-NMDAR antibody concentration before botulinum toxin injection in women was 5.9 ± 2.64, and after was 7.9 ± 7.06. In men, the mean serum anti-NMDAR antibody concentration before botulinum toxin injection was 5.23 ± 450.36, and after was 9.2 ± 1103.09. While no statistically significant result was observed for the association between patients' subjective perception of cervical dystonia and changes in serum anti-NMDAR antibody concentrations two months after botulinum toxin injection, patients with significant subjective improvement in symptoms after botulinum toxin injection showed a trend towards decreased serum antibody concentrations. A statistically significant result was observed between the duration of illness and the first serum antibody concentration (r=0.653, P=0.04). This was not observed for the second serum antibody concentration.
Conclusion: Serum anti-NMDAR antibody concentrations do not differ between patients before and two months after botulinum toxin injection. There is no difference in serum antiNMDAR antibody concentrations by sex. No statistically significant association was found between patients' subjective perception of cervical dystonia and changes in serum antibody concentrations, although patients with significant improvement showed a trend towards decreased antibody concentrations. Longer duration of illness is positively associated with the first serum concentration. This cannot be said for the second. Further studies on larger samples are needed to prove the association between disease duration and anti-NMDAR antibody concentrations and the changes in anti-NMDAR concentration and the association with the severity of the clinical picture. |
