Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification

Objectives: None of the classifications of psychogenic non-epileptic seizures (PNES) have been widely accepted and used by physicians so far. In this study we aimed at classifying PNES on the basis of a modified version of semiological seizure classification (SSC). We also sought to assess the interrater reliability (IRR) of the PNES diagnosis based on SSC

Double Peak Orthodromic Sensory Responses in the Electrophysiological Examination of Pathological Conditions

Objective: Double peak sensory responses elicited with submaximal stimulation is an electrophysiological method that has not been studied previously in pathological conditions. The second peak of the response was claimed to be produced by anodal stimulation and originated from the most distal regions of the nerve fibers. The objective of the study was to test double peak sensory responses in two groups of diabetic patients in two different stages of the disease

Lipofibrohamartoma of the Median Nerve: A Case Report

Herein, we present the case of a patient who had complaint suggestive of carpal tunnel syndrome due to fibrolipoma of the median nerve and macrodactyly. 32-year-old male patient has macrodactyly of the right index finger and coarse skin lines and hyperkeratosis on the volar aspect of the index finger. The patient reported numbness and tingling sensation in his right hand that have woken him at night for 10 years. Electromyography, magnetic resonance imaging (MRI) of the right hand and diagnostic biopsy were performed to the patient. Sensory action potential of the right median nerve was absent. The median motor study on the right showed low amplitude of the compound muscle action potential with a markedly prolonged distal latency. MRI scan demonstrated a lesion that extended from the palm to the forearm and gave cable-like appearance to the median nerve which is pathognomonic for lipofibroma. Biopsy result was consistent with fibrolipoma. Neural fibrolipoma is a rare benign tumor of the median nerve. MRI is the best method for observing the involvement of the nerve. In one-third of the cases, macrodactyly is associated with neural fibrolipoma. In the differential diagnosis of patients with carpal tunnel syndrome symptoms, fibrolipoma of the median nerve should also be kept in mind. (Archives of Neuropsychiatry 2011; 48: 155-7

Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort

Objective The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, >= 5 headache attacks, duration of headache >= 24 months, headaches lasting >= 1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with >= 5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies