Nonconvulsive Status Epilepticus and Coma

Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5 and 48%. Nonconvulsive status epilepticus (NCSE) is an electroclinical state associated with an altered mental status (AMS) but lacking convulsive motor activity. It is difficult to diagnose in the obtunded/comatose patients. Such patients have often other serious medical conditions, and the diagnosis of NCSE is frequently delayed in these patients. Diagnosing NCSE demands a high degree of clinical suspicion and for that reason likely remains under-recognized. The most important question, however, is whether the treatment of NCSE in coma improves the outcome of these patients or not. In this review, we aimed to summarize the EEG patterns in NCSE to further delineate the borders between comatose forms of NCSE and coma-epileptiform discharges and to evaluate modified EEG criteria for NCSE in a coma

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

KALİTELİ UYKU VE UYKU BOZUKLUKLARI

ÖZET: Uyku sağlık ve yaşamımızın iyi bir şekilde devamı için önemli bir role sahiptir. Kaliteliuyku zihinsel sağlığımızı, fiziksel sağlığımızı, hayat kalitemizı korumamıza yardım eder vegüvenliğimiz için gereklidir. Uykunun başlatılması ve sürdürülmesi kortikal ve subkortikal birçokbeyin bölgesinin işlevi ile gerçekleşir. Uykunun başlatılmasında öncelikle ön hipotalamustan gelendöngüsel girdiler ve endojen kimyasal uyarılar doğrultusunda hipotalamusta ventrolateral preoptikçekirdeğin rol aldığı kabul edilir. Normal uykunun hızlı göz hareketleri (REM) ve hızlı gözhareketlerinin olmadığı (NREM) olarak iki dönemi vardır. REM uykusunda asetilkolin veserotonin, NREM uykusunda ise serotonin ve GABA önemli rol oynayan nörotrasmitterlerdir.NREM ve REM gece boyunca 90-110 dakikalık sikluslar şekinde gecede 5-6 kez tekrarlar. NREMgecenin ilk bölümünde, REM ikinci döneminde belirgin olarak gözlenir. Uyku bozukluklarıgörüldüğü döneme göre 3 grupta incelenebilir: (1) REM döneminde görülenler, (2) NREMdöneminde görülenler, (3) Uykunun herhangi bir döneminde görülenler. Uyku bozukluğu olanhastalar yol veya iş kazaları, sosyal uyumsuzluk, akademik veya mesleki performansta düşmegösterebilirler. Bu yüzden uyku bozukluğu detaylı olarak incelenmesi gereken önemli birdurumdur.&nbsp;&nbsp;ABSTRACT: Sleep plays a vital role in good health and well-being throughout your life. Gettingenough quality sleep at the right times can help protect your mental health, physical health, qualityof life, and safety. Sleep initiation and maintenance take place with the function of a lot of corticaland subcortical region of the brain. In the initiation of sleep, it is accepted that primarily cyclicinputs from the hypothalamus and anterior hypothalamus, ventrolateral preoptic nucleus with thesignals of endogenous chemical. Normal sleep is divided into two states: rapid eye movement(REM) and non-rapid eye movement (NREM).The major neurotransmitter of REM isacetylcholine and of NREM are GABA and serotonine. In a normal individual, NREM and REMsleep alternate cyclically throughout the night. The NREM-REM cycle repeats itself every 90-110min, 5-6 times per night. Typically, NREM sleep predominates in the first part of the night, andREM sleep predominates in the second. Sleep disorders can be divided in three groups accordingto occurence period: (1) Sleep disorders seen in REM, (2) in NREM and (3) in any of REM orNonREM periods. Patients with sleep disorders may effects (road and work accidents), socialmaladjustment, decreased academic and occupational performance. Thus, sleep disorder is aserious condition that requires investigation, diagnosis and treatment</p

A Case of CADASIL with NOTCH3 Gene Mutation Presenting with Focal Epileptic Seizure: A Case of CADASIL Presenting with Focal Epileptic Seizure

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary disease of cerebral microvessels with autosomal dominant inheritance due to the NOTCH3 gene mutation. Epileptic seizures were observed in 5-11% of CADASIL cases. Observation of seizures as an initial clinical observation is a rare condition in patients with CADASIL patients. In this report, we present a patient with temporal lobe seizure, whose condition was diagnosed through gene analysis as CADASIL

Frontal Lacunar Infarct in the Development of Non-Convulsive Status Epilepticus: Case Report

Nonconvulsive status epilepticus is characterized by altered mental status without convulsive motor activity and symptoms lasting more than 10 minutes or recorded with electroencephalogram (EEG). This clinical presentation is expected to be seen mostly in chronic epilepsy patients and is recognized especially in critically ill patients, recently. Underlying metabolic anomalies, stroke and infections, may precipitate the nonconvulsive status epilepticus. It is demonstrated in 16% of the patients over 60 years old with altered mental status in the emergency department (ED) and the mortality rates increase by 50% among adults. Ischemic stroke has been shown to be associated with an increased risk of nonconvulsive status epilepticus. In ischemic stroke, not only cortical and great vessel infarcts but also lacunar infarcts have the possibility of developing nonconvulsive status epilepticus. In this case report, we aimed to present with literature information that especially frontal region infarcts may be a determining factor in the development of early status epilepticus after stroke

Pharmacoresistant seizures in neurofibromatosis type 1 related to hippocampal sclerosis: Three case presentation and review

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited disorder, with an estimated prevalence of 1 in 3000-4000 people. Seizures occur 4-7% of individuals with NF1, mostly due to associated brain tumors or cortical malformations. Hippocampal sclerosis (HS) in the patients with NF1 has been reported very rarely and only 15 patients were found in review of English literature. We presented here 3 additional patients with NF1 and intractable seizures due to hippocampal sclerosis; in whom one of them underwent epilepsy surgery and he is seizure free for 5 years after right temporal lobectomy.Wo

Dementia and parkinsonism case secondary to giant cystic Virchow-Robin spaces

The perivascular spaces in the brain,called Virchow Robin spaces, are well-defined spaces filled with interstitial fluid accompanying the arteries and arterioles perforating the brain parenchyma. Normally 1 to 2 mm, these spaces can be seen in healthy individuals at almost any age and are usually asymptomatic. When they expand, they may cause different clinical characteristics depending on their localization and frequency. The enlarged giant Virchow-Robin spaces have been associated with hydrocephalus, small vessel diseases, and other neuropsychiatric disorders, but the causes associated with vascular parkinsonism and subcortical dementia are very rare. In this article, we present secondary vascular parkinsonism and subcortical dementia due to multilobule cystic giant Virchow-Robin spaces