Non-ketotic hyperglycaemia presenting as epilepsia partialis continua

AbstractEpilepsia partialis continua (EPC) is a rare epileptic syndrome, observed in various cortical lesions and also in metabolic disorders. We report the case of a 57-year-old patient with EPC as the first manifestation of hyperosmolar non-ketotic hyperglycaemia (NKH) of diabetes mellitus. Computed tomography (CT) and magnetic resonance imaging (MRI) were normal. Initial laboratory data revealing serum glucose 1540mg/dl, and serum osmolality 391mOsm/l confirmed the diagnosis. Electroencephalography (EEG) showed ictal discharges in the ipsilateral hemisphere during focal seizures. Seizures are resistant to anticonvulsant treatment and respond best to insulin and rehydration. Focal motor seizures or EPC are commonly a symptom of NKH in the elderly patients. We recommend that in such cases a metabolic disorder such as diabetes mellitus be ruled out

Long-term outcomes in patients with West syndrome: An outpatient clinical study

AbstractPurposeNearly half of all patients with seizure onset in the first year of life suffer from West syndrome (WS). The prognosis of epilepsy and psychosocial outcomes in children with WS are variable. This study was performed to examine the factors influencing the outcome of this patient population.MethodsA total of 109 patients with WS followed up regularly for at least 3 years were included in the study. Relevant clinical, laboratory, and imaging data were collected.ResultsThe male/female ratio was 65/44 (59.6%/40.4%). The mean age at onset of infantile spasm (IS) was 6±6 (1–36) months. With regard to neuro-developmental and social conditions during the final evaluation, 29.4% of the patients were socially dependent on caregivers, 61.8% needed assistance, and 8.8% were normal. Among the patients, 5.9% were free of epilepsy and antiepileptic drugs (AED) for at least 2 years, 49.0% had no seizures with AEDs, and 45.1% had uncontrollable seizures. Parameters with significant negative effects on the long-term outcomes included symptomatic etiology, presence of developmental retardation before the onset of IS, persistence of active epilepsy, and male gender.ConclusionIn this study, 37 (33.9%) patients had severe consequences as a result of WS. The majority of the rest could cope with daily life with varying degrees of assistance. Eight percent of the patients had a normal development. These results draw attention to the two-thirds of patients with WS who have the chance of an acceptable quality of life (QoL) with early diagnosis and therapeutic measures

Epilepsy in vacuolating megalencephalic leukoencephalopathy with subcortical cysts

AbstractVacuolating megalencephalic leukoencephalopathy with subcortical cysts (MLC) is a disorder characterised by acquired macrocephaly, developmental motor delay of varying degrees, slowly progressive cerebellar and pyramidal signs, and initially preserved intellectual function. More than 60% of the published cases had epileptic seizures.In this study, we analysed the seizures and EEG findings of nine patients with MLC. Six patients (66.6%) with moderate to severe neurological impairment had epilepsy, four with partial and two with generalised seizures. The EEG of five epileptic patients revealed epileptogenic foci over the temporal, frontal and parietal regions with variable predominance during waking and sleep. The facilitation of spike-and-wave paroxysms by eye closure, by intermittent photic stimulation and by hyperventilation were determined in four patients. Four patients also showed abnormalities in the background activity. In conclusion, we think that epilepsy is a significant component of MLC compared to the other leukodystrophies. The elucidation of the underlying molecular defect may explain the unusual pathogenetic relation between this leukoencephalopathy and the associated seizures

Relation of Apathy to Motor and Non-motor Findings in Parkinson’s Disease

Aim:It has been shown that motor symptoms, as well as non-motor symptoms, significantly affect the quality of life of patients with idiopathic Parkinson’s disease. In our study, the association of apathy, one of the NMS, with motor and non-motor symptoms was investigated.Methods:Patients with stage 1-3 IPH according to the Hoehn-Yahr Scale (H&Y) were included in the study. Patients who received dementia diagnosis according to the DSM IV criteria were excluded from the study. The patients were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS), non-motor symptoms Questionnaire (NMSQ), Geriatric Depression Scale (GDS), and the revised diagnostic criteria for apathy.Results:Apathy was found in 26 of 68 patients who were included in the study. Patients with and without apathy were compared in terms of age, clinical and demographic characteristics, L-dopa equivalent doses, depression, and NMSQ scores. The group of patients with apathy consisted of nine females and 17 males and the mean age was 64.3±7.7 years. The non-apathy group included 25 females and 17 males and the mean age was 66.8±9.1 years. There was no statistically significant difference between the groups in terms of age, education, age at onset, duration of illness and L-dopa equivalent doses. The male-to-female ratio was significantly higher in the apathy group. The mean GDS and NMSQ scores in the apathy group were significantly higher than in the non-apathy group. There was a statistically significant difference between the groups in H&Y stage and total UPDRS and subscales scores. It was noteworthy that the rate of stage 3 patients was higher in the group of patients with apathy. The number of patients having bradykinesia in the apathy group and the number of patients having tremor in the group without apathy was higher.Conclusion:Our study showed that apathy, one of the non-motor symptoms, was more prominent in male gender, associated with UPDRS scores, clinical stage and bradykinesia, and accompanied by depression

Gender Issues in the Management of Epilepsy

The management of epilepsy differs between men and women in many aspects. Gender-related issues need consideration in both women and men with epilepsy. For example, the hormonal changes of menstruation, pregnancy, and the perimenopousal period are unique concerns. The effect of hormonal status on seizures and of seizures on hormonal status, as well as the endocrinological side effects of antiepileptic drugs need to be considered. In addition, comorbidities such as low self-esteem, anxiety, depression, and other psychiatric disorders that are more commonly observed in women need attention

Risk factors and clinical characteristics of cerebellar infarctions

Amaç: Serebellar infarktlar beyin infarktları arasında % 1.5- 4.2, posterior dolaşım infarktları arasında ise % 47 oranında görülür. Bu çalışmada, superior serebellar arter (SSA), posterior inferior serebellar arter (PİSA) ve anterior inferior serebellar arter (AİSA) alanında serebellar infarktların klinik seyir ve prognozu etkileyen faktörleri incelemeyi planladık. Gereç ve Yöntem: Haseki Eğitim ve Araştırma Hastanesi Nöroloji kliniğinde 2007-2011 tarihleri arasında yatarak tedavi görmüş olan inmeli hastaların kayıtları incelendi. Çalışmaya AİSA, SSA ve PİSA damar alanlarında serebellar infarktı olan 106 hasta dahil edildi. Hastaların başvurudaki şikayetleri, nörolojik muayeneleri, özgeçmişleri, etyolojik amaçlı yapılmış olan tetkikleri ve taburculuktaki nörolojik muayeneleri incelendi. Bulgular: Çalışmamızda hastaların %45.3’i kadın, %54.7’si erkek olup yaş ortalaması 62.64±12.82 idi. Olguların damar alanına göre dağılımı %50’si PİSA, %46.2’sı SSA, %3.8’i AİSA idi. AİSA’ da ataksi, SSA’ da ataksi, dismetri-disdiadokinezi, PİSA’ da ise dizartri, ataksi ve dismetri-disdiadokinezi öne çıkan bulgular idi. En sık görülen risk faktörü hipertansiyon olarak saptandı. Ölümle sonuçlanan infarktların SSA alanında olduğu görülmüştür. Taburculuktaki bağımsız olarak hayatını idame ettirebilecek durumda olan hastalarımızın PİSA grubunda daha sık olduğu gözlenmiştir. Sonuç: Serebellar infarktlar tutulan damar alanına göre etyolojik ve prognostik farklılıklar gösterebilmektedir.Objective: Cerebellar infarcts are seen in 1.5-4.2% of brain infarcts and 47% of the posterior circulation infarcts. In this study, we aimed to investigate the clinical course and prognosis of infarcts in the territory of superior cerebellar artery (SCA), posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA). Material and Methods: We analysed the records of patients with stroke treated in Haseki Educational and Research Hospital between 2007-2011. 106 patients with cerebellar infarcts in the territory of AICA, SCA and PCA were included the study. We evaluated the complaints, neurological findings, history and etiological examinations. Results: In this study, 45.3% of the patients were female, 54.7% of them were male. Mean age of the patients was 62.64±12.82. Of all patients, in 50% PICA, in 46.2% SCA, in 3.8% AICA infarcts were found. Most frequent findings were; ataxia in AICA, ataxia and dysmetriadysdiadakokinesia in SCA, dysartria, ataxia and dysmetriadysdiadakokinesia in PICA. Most frequent risk factor was hypertension. Fatal infarcts were seen in SCA territory. Patients who could sustain life as an independent group were more frequently observed in PICA. Conclusion: Etiologic and prognostic factors may vary between cerebellar infarcts according to the affected arterie

Risk factors and clinical characteristics of cerebellar infarctions

Amaç: Serebellar infarktlar beyin infarktları arasında % 1.5- 4.2, posterior dolaşım infarktları arasında ise % 47 oranında görülür. Bu çalışmada, superior serebellar arter (SSA), posterior inferior serebellar arter (PİSA) ve anterior inferior serebellar arter (AİSA) alanında serebellar infarktların klinik seyir ve prognozu etkileyen faktörleri incelemeyi planladık. Gereç ve Yöntem: Haseki Eğitim ve Araştırma Hastanesi Nöroloji kliniğinde 2007-2011 tarihleri arasında yatarak tedavi görmüş olan inmeli hastaların kayıtları incelendi. Çalışmaya AİSA, SSA ve PİSA damar alanlarında serebellar infarktı olan 106 hasta dahil edildi. Hastaların başvurudaki şikayetleri, nörolojik muayeneleri, özgeçmişleri, etyolojik amaçlı yapılmış olan tetkikleri ve taburculuktaki nörolojik muayeneleri incelendi. Bulgular: Çalışmamızda hastaların %45.3’i kadın, %54.7’si erkek olup yaş ortalaması 62.64±12.82 idi. Olguların damar alanına göre dağılımı %50’si PİSA, %46.2’sı SSA, %3.8’i AİSA idi. AİSA’ da ataksi, SSA’ da ataksi, dismetri-disdiadokinezi, PİSA’ da ise dizartri, ataksi ve dismetri-disdiadokinezi öne çıkan bulgular idi. En sık görülen risk faktörü hipertansiyon olarak saptandı. Ölümle sonuçlanan infarktların SSA alanında olduğu görülmüştür. Taburculuktaki bağımsız olarak hayatını idame ettirebilecek durumda olan hastalarımızın PİSA grubunda daha sık olduğu gözlenmiştir. Sonuç: Serebellar infarktlar tutulan damar alanına göre etyolojik ve prognostik farklılıklar gösterebilmektedir.Objective: Cerebellar infarcts are seen in 1.5-4.2% of brain infarcts and 47% of the posterior circulation infarcts. In this study, we aimed to investigate the clinical course and prognosis of infarcts in the territory of superior cerebellar artery (SCA), posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA). Material and Methods: We analysed the records of patients with stroke treated in Haseki Educational and Research Hospital between 2007-2011. 106 patients with cerebellar infarcts in the territory of AICA, SCA and PCA were included the study. We evaluated the complaints, neurological findings, history and etiological examinations. Results: In this study, 45.3% of the patients were female, 54.7% of them were male. Mean age of the patients was 62.64±12.82. Of all patients, in 50% PICA, in 46.2% SCA, in 3.8% AICA infarcts were found. Most frequent findings were; ataxia in AICA, ataxia and dysmetriadysdiadakokinesia in SCA, dysartria, ataxia and dysmetriadysdiadakokinesia in PICA. Most frequent risk factor was hypertension. Fatal infarcts were seen in SCA territory. Patients who could sustain life as an independent group were more frequently observed in PICA. Conclusion: Etiologic and prognostic factors may vary between cerebellar infarcts according to the affected arterie

Epilepsy in the elderly

WOS: 000372007900004Amaç: Epilepsi yaşlılarda sık görülen bir hastalıktır, ancak etiyolojisi, klinik sunumu, eşlik eden hastalıkları ve prognozu genç hastalardan farklıdır. Bu çalışmada epilepsi nedenleri, yaşlılarda nöbet tipleri, elektroensefalografi (EEG) bulguları araştırıldı. Gereç ve Yöntem: İlk epileptik nöbetini geçiren ve altmış beş yaş üzerinde 95 hasta retrospektif olarak değerlendirildi. Yaş, epilepsi tipi, EEG bulguları, manyetik rezonans görüntüleme ve/veya kranial tomografi bulguları, etiyoloji, eşlik eden hastalıklar ve verilen antiepileptik tedaviler değerlendirildi. Bulgular: Hastalarımızın yaş ortalaması 75 idi ve 50 (%56) hasta erkekti. Doksan beş hastanın 55’inde (%58) parsiyel tipte nöbet, 36’sında (%38) jeneralize tonik klonik nöbet ve 4’ünde (%4) jeneralize status epileptikus vardı. İnteriktal EEG’de fokal epileptiform aktivite sıklığı %32,6 idi. Nöbetler hastaların %85’inde (81 hasta) monoterapi ile %15’inde (14 hasta) politerapiyle kontrol altında idi. Çalışmamız serebrovasküler hastalıkların, en sık (%63) etyolojik neden olduğunu gösterdi. Yaş ve nöbet sıklığı ve EEG anormallikleri arasında anlamlı bir ilişki saptanmadı. Ancak yaş ve eşlik eden hastalıklar arasında anlamlı bir ilişki saptandı. Sonuç: Sonuçlarımız fokal nöbetlerin yaşlı epilepsinin en sık belirtisi olduğunu desteklemektedir. Serebrovasküler hastalıklar yaşlılarda epilepsinin en fazla rastlanan etiyolojik nedenidir. Monoterapi hastaların çoğunluğunda yeterlidir. Yaşlı nüfusun devamlı büyümesi, doğru tanı ve etkili tedavi gereksinimini arttırmaktadır.Objective: Epilepsy is frequently seen in the elderly, but its etiology, clinical presentation, comorbidities, and prognoses are different than younger patients. In this study, we investigated types of seizures, electroencephalography (EEG) findings and the cause of epilepsy in the elderly. Materials and Methods: We retrospectively analyzed 95 patients who were 65 years old or older, and who had an epileptic seizure for the first time. Type of epilepsy, age, EEG findings, magnetic resonance imaging and/or cranial tomography findings, etiology, comorbidities and antiepileptic medication were evaluated. Results: The average age of our patients was 75, and 50 (56%) patients were male. Among 95 patients, 55 (58%) had focal seizures, 36 (38%) had generalized tonic-clonic seizures and 4 (4%) had convulsive status epilepticus. The frequency of focal interictal epileptiform activity was 32.6% patients. Seizures were responsive to treatment administered as monotherapy in 81 (85%) patients and as politherapy in 14 (15%) patients. Our study showed that cerebrovascular disease was the most common (63%) etiological cause identified. There was no significant relationship between age and frequency of seizures and EEG abnormalities. However, a significant correlation was found between age and comorbidities. Conclusion: Our results supported the focal seizure is the most common manifestation of epilepsy in the elderly. Cerebrovascular disease is the most common etiological cause of epilepsy in the elderly. Monotherapy is sufficient in the majority of patients. Continuous growth of the elderly population is increasing the need for accurate diagnosis and effective treatment

Epileptic Seizure as First Presenting Symptom of Multiple Sclerosis: A Case Report

While epileptic seizures are seen in the course of multiple sclerosis, they are rarely the first symptom. The first epileptic seizure of a 26-yearold woman with multiple sclerosis is described in the present report. The patient presented to the emergency department with generalized tonic-clonic seizure. Neurologic examination was normal except for right-sided hemiparesis and hyperactive deep tendon reflexes. Cranial MRI revealed periventricular, multiple millimetric lesions and a 45x27-mm, semi-ring-enhanced, cortical, T2/FLAIR, hyperintense lesion in the centrum semiovale. IgG index was high, and oligoclonal band was positive in cerebrospinal fluid examination. Electroencephalography showed prominent fronto-temporal activity on the left side and sharp wave paroxysms. Multiple sclerosis was diagnosed, and pulse corticosteroid therapy was initiated. Due to recurrent seizures, antiepileptic drug was added to treatment; seizures were controlled with monotherapy. It is known that patients with multiple sclerosis experience seizures. Multiple sclerosis should be considered in the differential diagnosis of young patients presenting with seizures

Tolosa-Hunt Syndrome: A Report of Two Cases

Tolosa-Hunt syndrome (THS) is a painful ophthalmoplegia, characterized by cryptogenic granulomatous inflammation of the cavernous sinus and/or superior orbital fissure. Glucocorticoid treatment is used for both diagnostic and therapeutic purposes. According to the Headache classification subcommittee of international headache society criteria, magnetic resonance imaging (MRI) or biopsy is necessary for demonstration of the granulomatous inflammation. Here, we present two cases of THS with clinical and MRI findings