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Leading article
DEAR READERS!
We present to you the special issue of the Slovenian
Medical Journal, devoted to Neuroscience, which has
been compiled and edited by members of the Slovene
Neuroscience Association: Mara Bresjanac, Maja Trošt
and Grega Repovš.
Neuroscience has made a remarkable progress in the
last few decades. Despite the age long human curiosi-
ty and interest in the nervous system, many key ques-
tions remain unanswered. When the journal Science
was celebrating its 125th anniversary it published
the top 125 unanswered questions still challenging
scientists. The following two neuroscience-related
questions found their way into the top 25: What is the
neurobiological basis of consciousness? and How are
memories stored and subsequently retrieved? Many
more neuroscience-related questions were among the
other 100 on the list including mechanisms of prion
disease, addiction, Alzheimer disease, schizophrenia,
autism, explaining the need to sleep, to dream ...
Slovenian neuroscientists work in different environ-
ments from the Universities, hospitals to research in-
stitutes, where we employ different methods to study
the nervous system from the molecular to the systems
level, and from isolated neural cells in vitro, experi-
mental animals to human subjects. However, not
many organized forms of collaboration between
different institutions and individual neuroscientists
exist, which undoubtedly contributes to suboptimal
exploitation of the available research resources.
In the past five years, SiNAPSA, Slovenian Neuro-
science Association, has made systematic efforts to
improve communication between Slovenian neuro-
scientists. Two international neurocientific conferen-
ces and a few symposia have been organized under
the auspices of SiNAPSA. These events have always
been accompanied by activities aimed at improved
communication between scientists across disciplina-
ry and geographical borders. SiNAPSA conferences
are strings of independent thematic symposia, orga-
nized by their proponents with financial and organi-
zational help from SiNAPSA. With the intent to diver-
sify program and facilitate international collaboration,
every symposium has at least one presenter who
comes from a country other than Slovenia.
The second SiNAPSA Neuroscience Conference took
place at the Medical Faculty of the University of Ljub-
ljana between October 5 and 7, 2007. It had 5 sympo-
sia: cognitive neuroscience, neurobiology of Alzhe-
imer disease and other conformational disorders of
the brain, pediatric neurology, neurodegenerative
disorders and cerebro-vascular disorders. Selected
presenters were invited to submit their manuscripts
for the special issue of the Slovenian Medical Journal.
In order to reach the widest readership we opted to
publish the selected papers in English. Final selection
and preparation of manuscripts was done by the
guest-editors and a number of Slovenian and foreign
invited reviewers, whom we wish to express our grati-
tude.
Allow us to invite you to reading the issue by present-
ing a short overview of its contents: the introductory
paper by David Vodušek and coworkers follows the
example of the European Brain Council, which recent-
ly published its analysis revealing a huge burden on
the European economies, including Slovenia, posed
by neurological and psychiatric disorders. This leads
to increased requirements of the modern societies for
advances in neuroscientific research and their effica-
cious and timely transfer into clinical practice.
The paper by Currais and coworkers addresses an in-
teresting topic of cell cycle reactivation in neurons –
otherwise highly differentiated, non-dividing cells. It
points to the role this reactivation plays in the patho-
genesis of Alzheimer disease. The review paper by
Eva Žerovnik describes some characteristics of amylo-
idogenic proteins, based on the in vitro studies of
human Stefin B. The use of this model protein allows
insight into amyloid fibril formation, a central process
in the deposition of pathological proteins in the brains
of neurodegenerative disorders’ patients.
Long-term effectiveness of l-DOPA treatment in Par-
kinson disease patiens is hampered by dyskinesias.
The research contribution by Gordana Glavan and
Marko Živin employs experimental animals to test the
hypotesis that dyskinesias are related with dopamin-
ergic hypersensitivity of the striatal neurons dener-
vated through initial dopaminergic injury.
A review paper by Nina Mohorko and Mara Bresja-
nac describes a new classification of neurodegenera-
tive disorders with pathological protein tau deposi-
tion in the brain, and discusses possible new diag-
nostic methods based on detection and recognition
of different forms of tau deposits. Neuroimaging me-
thods which can reveal structural and functional chan-
ges in living brains of patients with dementia are gain-
ing in importance as diagnostic aids. Lojze M. Šmid
and Mara Bresjanac offer a review of the main neuro-
imaging methods and their key findings in neuro-
degenerative dementias.
In a review article by Metka Derganc and Damjan
Osredkar about hypoxic-ischemic brain injury in the
neonatal period different cellular mechanisms respon-
sible for the neuronal death are described and new
treatment approaches are listed. Mental retardation
in early childhood is often caused by infantile spasms,
which have a negative influence on cortical develop-
ment in the critical period of early brain development.
As shown in the review by Zvonka Rener Primec, ear-
ly treatment may have a favorable prognosis on cog-
nitive and behavior impairments.
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Neuronal activity is tightly coupled with regional
cerebral blood flow. This functional link is called
neurovascular coupling. The paper by Marjan Zaletel
explains how the neurovascular coupling can be
measured by visually evoked cerebral blood flow
velocity responses (VEFR) and visual evoked poten-
tials (VEP). Neurovascular coupling could be altered
in older subjects and in migraneurs. Elderly often
suffer from dementia. The most common dementias
are nevrodegenerative; Alzheimer and frontotempo-
ral dementia. A clinical differentiation between
them is often difficult but important. Clinical featu-
res and recent developments in genetics and neuro-
pathology are presented in a review article about the
differentiation between the two dementias by Rajka
Liščić.
Alcohol dependence leaves numerous neuropsycho-
logical deficits even weeks after abstinence. Results
of the neurocognitive study done by Lilijana Šprah
and Tatjana Novak on abstinent alcoholics showed
their specific neuropsychological profile and presen-
ted neurocognitive assessment that proved a useful
approach for evaluation of alcohol abstainers func-
tioning.
Mara Bresjanac, Maja Trošt and Grega Repovš
Guest-editors of the special issue of the Slovenian Medical Journal
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Uvodnik
SPOŠTOVANE BRALKE IN BRALCI!
Pred vami je posebna številka Zdravniškega vestnika,
posvečena nevroznanosti, ki so jo pripravili in uredili
člani SiNAPSE, slovenskega društva za nevroznanost:
Mara Bresjanac, Maja Trošt in Grega Repovš.
Nevroznanost se v zadnjih desetletjih razvija z izjem-
no hitrostjo. Zanimanje za vprašanja povezana z živ-
čevjem so že dolgo v žarišču človeške radovednosti
in številna med temi vprašanji kljub metodološkemu
napredku zadnjih desetletij ostajajo neodgovorjena.
Po zanimivem prispevku revije Science iz leta 2005,
ko je revija praznovala 125. obletnico izhajanja, sta
že med prvimi petindvajsetimi dve nevroznanstveni
vprašanji: Kakšna je (nevro)biološka podlaga zavesti?
in Kako se spomini shranjujejo in ponovno prikliče-
jo? Med nadaljnimi stotimi vprašanji je nevroznan-
stvenih še več in vključujejo mehanizem nastanka pri-
onskih bolezni, odvisnosti, Alzheimerjeve bolezni,
shizofrenije, avtizma, razlago potrebe po spanju, po
sanjanju ...
V Sloveniji smo nevroznanstveniki posejani na Uni-
verzah, v kliničnem medicinskem okolju in na razisko-
valnih Inštitutih, kjer z različnimi metodološkimi pri-
stopi raziskujemo živčevje na vseh ravneh od mole-
kularne do sistemske in od izoliranih celic prek živali
do človeka. Med posameznimi inštitucijami in razisko-
valci v našem okolju ni veliko organiziranih oblik
sodelovanja in obstoječih raziskovalnih potencialov
tudi zato verjetno ne izrabljamo najbolje.
V zadnjih petih letih slovenske nevroznanstvenike iz
različnih okolij v skupnih akcijah sistematično pove-
zuje SiNAPSA, slovensko društvo za nevroznanost.
Pod okriljem SiNAPSE smo izpeljali dve večji med-
narodni nevroznanstveni konferenci in nekaj sim-
pozijev, ki jih vedno spremlja tudi program (npr. okro-
gle mize in panelne razprave) namenjen izboljšanju
komunikacije med raziskovalci iz različnih okolij in
znanstvenih panog na osrednje teme nevroznanosti.
SiNAPSINE konference so zastavljene kot zaporedje
neodvisnih tematskih simpozijev, ki jih organizirajo
njihovi predlagatelji in jim SiNAPSA pri tem pomaga
po finančni in organizacijski plati. Vsak simpozij ima
za popestritev programa in za spodbujanje medna-
rodnega sodelovanja tudi vsaj enega tujega vabljene-
ga predstavljalca.
Druga SiNAPSINA nevroznanstvena konferenca je
potekala na Medicinski fakulteti Univerze v Ljubljani
med 5. in 7. oktobrom 2007. Sestavljali so jo naslednji
simpoziji: kognitivna nevroznanost, nevrobiologija
Alzheimerjeve bolezni in drugih bolezni z odlaganjem
amiloida v možganih, otroška nevrologija, nevrode-
generativne bolezni ter cerebrovaskularne bolezni.
Avtorji vabljenih predavanj na konferenci so imeli
možnost oddaje preglednih ali raziskovalnih prispe-
vkov za posebno številko Zdravniškega vestnika. V
želji, da osrednje strokovno glasilo slovenskih zdravni-
kov doseže najširši krog bralcev, smo se gostujoči
uredniki odločili za izbor prispevkov v angleškem
jeziku. Pri izboru in dokončni podobi člankov so sode-
lovali številni domači in tuji recenzenti, ki se jim za
delo najlepše zahvaljujemo.
Dovolite, da vas k branju posebne številke povabimo
s kratkim preletom vsebine:
Uvodni pregledni prispevek Davida Voduška s so-
delavci se zgleduje po analizi Evropskega sveta za
možgane, ki opozarja na izjemno velikost bremena
nevroloških in psihiatričnih bolezni za proračune
evropskih držav, vključno s Slovenijo. Zato se pove-
čujejo tudi potrebe sodobne družbe po napredku v
nevroznanosti in učinkovitem ter pravočasnem pre-
nosu novih raziskovalnih spoznanj v klinično medi-
cino.
Antonio Currais s sodelavci v svojem preglednem
prispevku odpira zanimivo temo reaktivacije celične-
ga ciklusa v nevronih, ki so sicer visoko diferencirane,
nedeleče se celice, in o vlogi te reaktivacije v patologiji
Alzheimerjeve bolezni. Pregledni prispevek Eve Že-
rovnik prikazuje nekatere značilnosti amiloidogenih
beljakovin na temelju in vitro študij človeškega stefi-
na B. Uporaba te modelne beljakovine omogoča po-
droben vpogled v nastajanje amiloidnih fibril, po-
membnega procesa v odlaganju patoloških beljakovin
v možganih pri nevrodegenerativnih boleznih.
Učinkovitost kroničnega zdravljenja Parkinsonove
bolezni z l-DOPA krnijo zapleti v obliki motenj giba-
nja (diskinezij). Raziskovalni prispevek Gordane Gla-
van in Marka Živina na poskusnih živalih preverja
domnevo, da so tovrstni zapleti povezani z dopamin-
ergično preobčutljivostjo striatalnih nevronov, ki je
posledica dopaminergične denervacije.
Pregledni prispevek Nine Mohorko in Mare Bresja-
nac podaja opis in sodobno razvrstitev bolezni, pri
katerih se v možganih odlaga patološko spremenje-
na beljakovina tau ter možnosti za razvoj novih diag-
nostičnih pristopov, temelječih na prepoznavi po-
sameznih tipov odlag tau. V diagnostiki demenc igra-
jo danes vse pomembnejšo vlogo sodobne slikovne
metode, ki lahko prikažejo strukturne in funkcijske
spremebe v možganih bolnikov. Pregled teh metod
in njihovih izsledkov pri nevrodegenerativnih demen-
cah podaja prispevek Lojzeta Šmida in Mare Bresja-
nac.
V preglednem članku Metke Derganc in Damjana
Osredkarja o hipoksično-ishemični okvari možganov
v neonatalnem obdobju so opisani celični mehanizmi
okvare nevronov in predstavljena novejša priporoči-
la glede zdravljenja. Umsko manjrazvitost zgodnje
otroške dobe pogosto povzročajo infantilni spazmi,
saj negativno vplivajo na razvoj možganske skorje v
kritičnem časovnem obdobju zgodnje razvojne faze
možganov. Kot kaže prispevek avtorice Zvonke Re-
Uvodnik
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ner Primec, so kognitivni in vedenjski primanjkljaji
blažji ob hitrejšem začetku zdravljenja.
Aktivnost možganskih nevronov je tesno povezana s
področnim možganskim krvnim pretokom. Tej funk-
cijski povezanosti pravimo živčnožilna sklopitev. V
svojem prispevku Marjan Zaletel predstavi, da živčno-
žilno sklopitev lahko ocenjujemo z merjenjem evo-
ciranih možganskih odgovorov krvnega pretoka
(VEOP) in vidnih evociranih potencialov (VEP). Mot-
nje živčnožilne sklopitve so v tem prispevku opisane
pri starostnikih in bolnikih z migreno. Vedno pogoste-
jša spremljevalka starostnikov je tudi demenca. Naj-
pogostejše demence so nevrodegenerativne demen-
ce; npr. Alzheimerjeva in frontotemporalna. Klinično
razlikovanje je pogosto težko a pomembno. V pre-
glednem članku Rajke Liščić o razlikovanju med ome-
njenima demencama so poleg kliničnih značilnosti
obeh predstavljena tudi najnovejša odkritja moleku-
larne genetike in nevropatologije.
Odvisnost od alkohola pušča številne nevropsiho-
loške primanjkljaje tudi po večtedenski abstinenci.
Rezultati študije nevrokognitivne ocene abstinentov,
ki je predstavljena v prispevku Lilijane Šprah in Tanje
Novak, so prikazali nevropsihološki profil abstinen-
tov in predstavili nevropsihološki instrumentarij za
klinično oceno njihovega funkcioniranja.
Mara Bresjanac, Maja Trošt in Grega Repovš
Gostujoči uredniki posebne številke Zdravniškega vestnika