Multipl skleroz'da izlenen okkult ve nadir semptom: Patolojik ağlama ve gülme

Pathological laughing and crying (PLC) has an approximately prevelance of 7%-10% among patients with multiple sclerosis (MS). Various damages of prefrontal, temporal cortex, internal capsule, hypothalamus, thalamus, brainstem and the cerebellar pathways may cause pathological laughing or crying. We interviewed 160 MS patients for PLC. Only 5 of our 160 cases complained about pathological laughing or crying. All 5 patients had PLC defined as sudden, involuntary displays of laughing or crying or both, without associated subjective feelings of depression or euphoria. Patient group, consisting 2 women and 3 men had a mean age of 41, mean Expanded Disability Status Scale (EDSS) score of 4.8, disease duration of 12.8 years. In our patients PLC was not associated with disease exacerbations. All PLC patients had numerous brainstem and cerebellar relapses, which caused obvious disabilities including gait ataxia, intention tremor, dysmetria, dysarthria, nystagmus and other cerebellar dysfunctions. All of our patients had so many lesions especially in brainstem because of this we think that the brainstem lesions have crucial role in PLC. This hypothesis needs further investigation especially in functional imaging which may add further information to pathogenesis of PLC. Before the investigation of PLC none of our patients informed us about their complaints of PLC so the physician must be aware of this symptom.Patolojik ağlama ve gülme (PLC), multipl skleroz (MS) hastalarında yaklaşık %7-10 oranında görülür. Prefrontal, temporal korteks, internal kapsül, hipotalamus, talamus, beyinsapı ve serebellar yolaklarda gelişebilecek çeşitli nedenli hasarlar patolojik ağlama ve gülmeye neden olabilir. 160 MS hastasını PLC açısından sorguladık. 160 hastanın sadece 5’i PLC’den yakındı. 5 hastada da PLC; depresyon ya da öfori olmadan, koşullarla uyumsuz, ani, istemsiz ağlama, gülme ya da ikisinin birden varlığı olarak tanımlandı. Hasta grubunda 2 kadın, 5 erkek olmak üzere toplam var olan 5 hastanın ortalama yaşı 41, ortalama EDSS skoru 4.8, ortalama hastalık süresi 12.8 yıldı. Hastalar atak döneminde değildi. Çalışmamızdaki tüm PLC hastalarında ataksi, intansiyonel tremor, dismetri, dizartri, nistagmus ve diğer serebellar system disfonksiyon bulgularına neden olan çeşitli sayıda beyin sapı ve serebellar system atak öyküsü mevcuttu. PLC tanımlanan tüm hastalarda özellikle CMJ Cumhuriyet Medical Journal beyin sapında çok sayıda lezyon mevcuttu, bu nedenle beyin sapının anatomic olarak PLC’de önemli olduğu düşünüldü. Ancak bu hipotez daha fazla sayıda hastada yapılacak olan fonksiyonel görüntüleme çalışmaları ile desteklenmesi gerektiği düşünüldü. Hastaların hiçbiri sorgulama öncesi PLC’den yakınmadığı için klinisyenbu semptomun farkında olmalıdır. Anahtar sözcükler: Multipl skleroz, patolojik gülme ve ağlama, MR

IVIg-induced headache: prospective study of a large cohort with neurological disorders

Background: Intravenous immune globulin (IVIg) is frequently used in some neurological diseases and is also the first-line therapy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. We aimed to evaluate the frequency and characteristics of headaches, which is one of the most common side effects of IVIg treatment. Methods: Patients who received IVIg treatment for neurological diseases were prospectively enrolled in 23 centers. Firstly, the characteristics of patients with and without IVIg-induced headaches were analyzed statistically. Then, patients with IVIg-induced headaches were classified into three subgroups determined by their history: no primary headache, tension-type headache (TTH), and migraine. Results: A total of 464 patients (214 women) and 1548 IVIg infusions were enrolled between January and August 2022. The frequency of IVIg-related headaches was 27.37% (127/464). A binary logistic regression analysis performed with significant clinical features disclosed that female sex and fatigue as a side effect were statistically more common in the IVIg-induced headache group. IVIg-related headache duration was long and affected daily living activities more in patients with migraine compared to no primary headache and TTH groups (p = 0.01, respectively). Conclusion: Headache is more likely to occur in female patients receiving IVIg and those who develop fatigue as a side effect during the infusion. Clinicians’ awareness of IVIg-related headache characteristics, especially in patients with migraine, may increase treatment compliance

The effect of sleep disorders on quality of life in patients with epilepsy: A multicenter study from Turkey

Objective: We aimed to investigate sleep disorders in patients with epilepsy (PWE) and to investigate the effects of sleep disorders on quality of life. Methods: In our multicenter study conducted in Turkey, 1358 PWE were evaluated. The demographic and clinical data of the patients were recorded. The Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and Quality of Life in Epilepsy Inventory-10 (QOLIE-10) were administered. Results: The mean age of 1358 patients was 35.92 ± 14.11 (range, 18–89) years. Seven hundred fifty-one (55.30 %) were women. Some 12.7 % of the patients had insomnia (ISI > 14), 9.6 % had excessive daytime sleepiness (ESS > 10), 46.5 % had poor sleep quality (PSQI > 5), and 354 patients (26.1 %) had depressive symptoms (BDI > 16). The mean QOLIE-10 score was 22.82 ± 8.14 (10–48). Resistant epilepsy was evaluated as the parameter with the highest risk affecting quality of life Adjusted odds ratio (AOR = 3.714; 95 % confidence interval (CI): [2.440–5.652] < 0.001)). ISI (AOR = 1.184; 95 % CI: [1.128–1.243]; p < 0.001), ESS (AOR = 1.081; 95 % CI: [1.034–1.130]; p < 0.001), PSQI (AOR = 0.928; 95 % CI: [0.867 – 0.994]; p = 0.034), BDI (AOR = 1.106; 95 % CI: [1.084–1.129]; p < 0.001), epilepsy duration (AOR = 1.023; 95 % CI: [1.004–1.041]; p = 0.014), were determined as factors affecting quality of life. Significance: Sleep disorders are common in PWE and impair their quality of life. Quality of life can be improved by controlling the factors that may cause sleep disorders such as good seizure control, avoiding polypharmacy, and correcting the underlying mood disorders in patients with epilepsy