Faculty of Medicine

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    Incidence, risk factors and management practices in post-viral encephalitis epilepsy: A long-term, nationwide population-based study and review of literature
    (Elsevier BV, 2026-03)
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    Adjami, Bekim
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    Boshkovski, Bojan
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    Babunovska, Marija
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    Objective: We investigated the incidence, risk factors, and management of post-viral encephalitis epilepsy (PEE) in a nationwide cohort in North Macedonia. Additionally, we conducted a comprehensive literature search on PEE. Methods: Data were obtained from the electronic National Health System (eNHS), encompassing all patients diagnosed with viral encephalitis (VE) in 2016. Patients with pre-existing epilepsy diagnoses were excluded. Clinical, neuroimaging, and EEG data were collected and analyzed, and participants were followed for seven years. Results: Of 1660,584 individuals registered in the eNHS in 2016, 68 were confirmed to have VE (incidence: 4.1/100,000). Among these, six patients died during hospitalization, and the remaining 62 were included in the study cohort. Acute symptomatic seizures (ASyS) occurred in 39 % of patients, with focal to bilateral tonic-clonic seizures (FBTCS) being the most common seizure type. Over the seven-year follow-up period, 11 patients (18 %) developed PEE, with 73 % of cases diagnosed within the first year. Significant risk factors for PEE included ASyS, younger age, and epileptiform abnormalities on EEG. By the end of the follow-up, seven patients with PEE (64 %) remained on antiseizure medications (ASMs). Conclusions: Our results confirm ASyS and highlight acute electro-clinical findings and young age as risk factors for PEE. There is a need for evidence-based clinical pathways and care protocols for patients at risk.
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    BEYOND SEIZURES: BONE MINERAL DISORDERS IN CHRONIC EPILEPSY-A CROSSSECTIONAL STUDY
    (Macedonian Neurological Society, 2025-10)
    Babunovska, Marija
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    Boshkovski, Bojan
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    Kostovska, Irena
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    EXPANDING THE NEUROLOGICAL SPECTRUM OF VAN MALDERGEM SYNDROME: EPILEPSY WITH MYOCLONIC SEIZURES.
    (Macedonian Neurological Society, 2025-10)
    Mechkaroska Blazheska, Elena
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    Babunoska, Marija
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    Boshkovski, Bojan
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    Kostovska, Irena
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    DOUBLE TROUBLE: DCX MUTATION-ASSOCIATED SUBCORTICAL BAND HETEROTOPIA – A CASE REPORT
    (Macedonian Neurological Society, 2025-10)
    Babunovska, Marija
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    Boshkovski, Bojan
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    Kostovska, Irena
    Background: Patients with epilepsy have an increased risk of fractures, partly due to antiepileptic therapy (AET) through reduced bone mineral density (BMD). Although bone loss is multifactorial, AET may play a significant role, but the exact mechanisms remain unclear. Aim: To investigate the association between AET use and decreased BMD in an unselected population of Macedonian patients with epilepsy. Internationally accepted guidelines for bone health monitoring in epilepsy are lacking, and in our country there are no standardized recommendations. Identifying highrisk groups is essential for the prevention of osteoporosis and fractures. Methods: A cross-sectional study was conducted on 95 patients older than 20 years, treated with AET for more than 2 years, who attended the Epilepsy Outpatient Department at the University Clinic of Neurology between January 1st, 2021 and January 31st, 2024. Data included DXA scan results and demographic information. Logistic regression and other statistical analyses were applied. Results: Osteopenia was present in 50.5% and osteoporosis in 20.0% of patients. Independent risk factors for reduced BMD were female sex, polytherapy with AET, comorbidities, menopause, older age, and longer epilepsy duration. Age >50 years and depression were significant in univariate analysis but not confirmed in multivariate analysis. Conclusion: Independent risk factors such as female sex, menopause, older age, lower BMI, polytherapy, epilepsy duration, and comorbidity were associated with decreased BMD in epilepsy patients. These findings emphasize the importance of using known risk factors as guidance to identify patients at high risk of osteoporosis and fractures.
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    Fractures in people with epilepsy: A nationwide population-based cohort study https://doi.org/10.1002/epi4.12776
    (Wiley, 2023-06-19)
    Babunovska, Marija
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    Jovanovski, Aleksandar
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    Boshkovski, Bojan
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    Objective: The objective of this study was to determine the age, gender, and site-specific prevalence of fractures in people with epilepsy (PWE) and matched general population comparators in a nationwide study in North Macedonia between 2015 and 2018.Methods: PWE and matched controls were selected through a systematic search of the electronic National Health System (eNHS). We determined the period prevalence (PP) of all site- specific fractures. We also calculated gender and age- specific incidence rate ratios (IRR) for various fractures. Odds ratios (ORs) and risk ratios(RR) were estimated for the number and type of ASM as well as comorbid conditions.Results: Out of 13 818 prevalent epilepsy cases, 6383 (46.2%) were females, and7435 (53.8%) were males. 109 PWE out of 1000 had at least one fracture during thestudy period and ~8 people out of 1000 in the general population. The most frequentsites in terms of PP both in PWE and controls, were fractures of the lower arm, hipand femur, and lower leg. Significant differences in PP for all fracture locationswere observed between PWE and controls (P < 0.001). The noticeable differences of ∼100 times higher PP were observed for fractures of the skull and jaw in PWE.IRR of any fracture in PWE was 272.84/10000 person-years; higher in the older age groups and among people who received >2 ASM. Fracture risk was increased with the use of >2 ASM (OR: 1.56; 95% CI: 1.32-1.84 and RR: RR: 1.32). The presence of comorbidities also increased fractures risk (OR: 1.24; 95% CI: 1.10-1.38).Significance: This population-based study depicts a higher fracture prevalence in PWE compared to the general population. A higher number of ASM and the presence of comorbidities increase the risk of fractures and targeted prevention might be needed in those subgroups of PWE
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    Levetiracetam-Induced Seizure Aggravation in Patients With Focal Cortical Dysplasia
    (Lippincott, Williams & Wilkins, 2018)
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    Babunovska, Marija
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    Boshkovski, Bojan
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    Aleksovska, Katina
    The choice of antiepileptic drug is typically based on seizure type, and there is no evidence for superior effectiveness or potential deterioration of particular antiepileptic drug in specific etiologic subgroups. The aim of the study was to identify etiological factor(s) associated with increased risk of seizure aggravation with levetiracetam (LEV).
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    Proton Magnetic Resonance Spectroscopy of Brain (H-MRS) in patient with temporal lobe epilepsy
    (League against Epilepsy of Macedonia, 2016)
    Chepreganovska-Changova, Tatjana
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    Kuzmanovski, I
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    Boshkovski, Bojan
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    Myasthenia Gravis and Associated Diseases
    (Scientific foundation SPIROSKI, 2018-03-05)
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    Novotni, Gabriela
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    Sazdova-Burneska, Slobodanka
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    Kuzmanovski, I
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    Boshkovski, Bojan
    BACKGROUND: Myasthenia gravis (MG) is an autoimmune disease caused by the action of specific antibodies to the postsynaptic membrane of the neuromuscular junction, leading to impaired neuromuscular transmission. Patients with MG have an increased incidence of other autoimmune diseases. AIM: to determine the presence of other associated diseases in patients with MG.METHOD: A group of 127 patients with MG followed in 10 years period, in which the presence of other associated diseases has been analysed.RESULTS: The sex ratio is in favour of the female sex, the average age of the initial manifestation of the disease is less than 50 years, 65.4% of the patients with MG have another disease. 15.0% patients have associated another autoimmune disease. Thyroid disease is the most common associated with MG, rarely rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and other autoimmune diseases. Other diseases include hypertension, heart disease, diabetes, respiratory diseases, dyslipidemia. 10.2% of the patients are diagnosed with extrathymic tumours of various origins. CONCLUSION: Associated diseases are common in patients with MG, drawing attention to the possible common basis for their coexistence, as well as their impact on the intensity and treatment of the disease.</jats:p>
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    Item type:Publication,
    Proton Magnetic Resonance Spectroscopy of Brain (H-MRS) in patient with temporal lobe epilepsy
    (League against Epilepsy of Macedonia, 2016)
    Chepreganovska-Changova, Tatjana
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    Kuzmanovski, I.
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    Boshkovski, Bojan
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    Jovanovski-Srceva, Marija