BackgroundClinical practice guidelines are systematically created documents that summarize knowledge and assist in delivering high-quality medicine by identifying evidence that supports best clinical care. They are produced not only by international professional groups but also by local professionals to address locally-relevant clinical practice. We evaluated the methodological rigour and transparency of guideline development in neurology formulated by professionals in a local medical community.MethodsWe analyzed clinical guidelines in neurology publicly available at the web-site of the Physicians’ Assembly in Croatia in 2012: 6 guidelines developed by Croatian authors and 1 adapted from the European Federation of Neurological Societies. The quality was assessed by 2 independent evaluators using the AGREE II instrument. We also conducted a search of the Cochrane Library to identify potential changes in recommendation from Cochrane systematic reviews included in guideline preparation.ResultsThe methodological quality of the guidelines greatly varied across different domains. „Scope and Purpose” and „Clarity of Presentation“ domains received high scores (100% [95% confidence interval (CI) 98.5–100] and 97% [77.9–100], respectively), the lowest scores were in “Stakeholder Involvement“ (19% [15.5–34.6]) and “Editorial Independence” (0% [0–19.2]). Conclusions of 3 guidelines based on Cochrane systematic reviews were confirmed in updated versions and one update provided new information on the effectiveness of another antidepressant. Two Cochrane reviews used in guidelines were withdrawn and split into new reviews and their findings are now considered to be out of date.ConclusionNeurological guidelines used in Croatia differ in structure and their methodological quality. We recommend to national societies and professional groups to develop a more systematic and rigorous approach to the development of the guidelines, timely inclusion of best evidences and an effort to involve target users and patients in the guideline development procedures.

to evaluate the relationship between epilepsy, antiepileptic drugs (AEDs) and quality of life (QoL) in patients with epilepsy (PE), and its association with depressive symptoms and sexual dysfunction (SD). QoL was assessed by use of the Quality of Life in Epilepsy-31 Inventory (QOLIE-31), SD by the Arizona Sexual Experiences Scale (ASEX), and depressive symptoms by the Hamilton Rating Scale for Depression (HAM-D17). The study included 108 PE (women 63% and men 37% men), mean age 39.54±15.91 years. Focal type epilepsy was diagnosed in 14.8%, generalized type in 35.2%, and both types were present in 40.7% of study patients. Drug-resistant epilepsy (DRE) was present in 44/108 and vagus nerve stimulation (VNS) was implanted in 27/44 patients. The mean response on QOLIE-31 was 62.88±17.21 with no significant differences according to gender, type of epilepsy, and age. A statistically significantly lower QoL was found in the 'Overall QoL' domain (35-55 vs. <35 age group). Patients taking both types of AEDs had a significantly lower QoL compared to those on newer types of AEDs. Higher QoL was associated with less pronounced depressive symptoms (p=0.000). Significant correlations were found between lower QoL and SD (p=0.001). In 27 patients with DRE having undergone VNS, a favorable effect of VNS implantation on the QoL and mood was observed as compared with 18 patients without VNS (p=0.041).

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In this case report we present a patient with cognitive impairment as a result of primary angiitis of the central nervous system (PACNS). Our patient is male, age 54, with 15 years of education. Patient presented with difficulty in pronauncing, nasal speech and weakness during period of one year. Neurocognitive status showed impairment of episodic memory and concentration, attention verbal, and visual memory deficiency (MMSE 25). Brain CT scan showed no acute hemorrhage or ischemia, but cronic vascular changes in deep white matter of cerebral hemispheres, basal ganglia, thalamus, and pons with lacunar lesion next to the head od left nucleus caudatus. Brain MRI showed intracerebral hemorrhage in right temporal lobe,multiple gliotic/malacion zone paraventricular, predominant in basal ganglia and hemispheres of the cerebellum. Differential diagnose of multiple intracerebral hemorrhage includes vascular malformations, cerebral amyloid angiopathy, ischemic stroke, cerebral venosus sinus, tumor, cerebral vasculitis etc. Medical diagnostic included laboratory tests, prostigmin test, EMNG, AchR and MuSK antibodies test, EEG, cerebrospinal fluid analysis. Trought his medical evaluation, which has been performed to exlude any infections or malignant process, we finally conduted cerebral digital subractional angiography (DSA) to diagnose PACNS. Cerebral DSA showed multiple, non significant stenosis on specific vascular segments, impling high suspected vasculitis. After immunologist being consulted, patient was prescribed with metilprednisolon during 3 next days and cyclophosphamide next 6 month. Control DSA is planned in the future. PACNS is one of the most formidable diagnostic and therapeutic challenges to neurologists. Given the low specificity of cerebral angiogram and not uniform clinical presentation, PACNS is best approached by an organized team with expertise in neurovascular disease, immunology or rheumatology, neuroradiology, and neuropathology.