Paroxysmal Amnesia Attacks due to Hashimoto’s Encephalopathy

Hashimoto’s encephalopathy is a rare disease which is thought to be autoimmune and steroid responsive. The syndrome is characterized by cognitive impairment, encephalopathy, psychiatric symptoms, and seizures associated with increased level of anti-thyroid antibodies. The exact pathophysiology underlying cerebral involvement is still lesser known. Although symptoms suggest a nonlesional encephalopathy in most of the cases, sometimes the clinical appearance can be subtle and may not respond to immunosuppressants or immunomodulatory agents. Here we report a case who presented with drowsiness and amnestic complaints associated with paroxysmal electroencephalography (EEG) abnormalities which could be treated only with an antiepileptic drug

Our Cases of Secondary Narcolepsy with Three Different Etiology: Review of the Literature

Narcolepsy is neurological disorder classified among central hypersomnolences group and characterized by excessive daytime sleepiness, cataplexy, associated symptoms like hypnogogic/hypnopompic hallucinations and sleep paralysis. It is divided into two types on the basis of accompanying cataplexy. In the pathophysiology of this disorder, which is accused an autoimmune process, hypocretin deficiency in the hypothalamus was shown. Narcolepsy is often seen as a primary disease in young population but may also occur with other disorders like cerebrovascular diseases, intracranial tumors, encephalitis, sarcoidosis, multiple sclerosis or after head trauma, infections, and vaccines; in which the disease is accepted as secondary narcolepsy. In this case report, patients presenting with excessive daytime sleepiness and diagnosed as having secondary narcolepsy due to medical causes, and who have Parkinson’s disease (PD), history of interferon use and hypothalamic involvement associated with Langerhans cell histiocytosis (LCH) were reported. Daytime sleepiness complaints should be well questioned in organic pathologies related with hypothalamus-pituitary system such as PD and similar diseases or in patients with history of drug use and secondary narcolepsy should be beared in mind

The Research of Sleep Disorders and Their Effects on Quality of Life in Patients with Chronic Renal Failure and Renal Transplant

Objective End stage renal insufficiency (ESRI) is defined as the irreversible loss of renal functions. In its treatment is used hemodialisis, peritoneal dialisis or renal transplantation. Sleep disorders cause excesive daytime sleepiness, mental problems, dysfunction in general health and functions; and therefore affect the quality of life in patients with ESRI. In this study is evaluated the relationship between sleep quality and the qulity of life in patients with hemodialisis, peritoneal dialisis and renal transplantation. Materials and Methods A total of 117 patients being treated in Uludağ University Faculty of Medicine Dialisis Unit between years 2011-2012 were enrolled. Pittsburg Sleep Quality Index (PSQI) were used to determine sleep quality of patients, and Epworth Sleepiness Scale (EUS) and Rolls Royce Quality of Life Scale were used. Results In PSQI, poor sleep quality was observed in 81.5% of patients with hemodialisis, which was 80.8% in patients with renal transplantation and 82% in patients with peritoneal dialisis. In Rolls-Royce Quality of life scale, general health, physical symptoms and activities were higher in patients with renal transplantation, and sleep disorders were higher in patients with hemodialisis. Conclusion Chronic renal insufficiency is a very common condition. Sleep disorders in these patients may affect self-care and show a negative influence on the quality of life. Fort his reason, sleep disorders should be questioned and treated in these chronically ill patients with ESRI

Obstructive sleep apnea syndrome and cardiovascular diseases; the role of hypertension

Objective: Obstructive sleep apnea syndrome (OSAS) is a common disorder that results from the collapse of the upper airways during sleep and causes temporary hypoxia. OSAS and hypertension are common and multifactorial diseases. aim This study aimed to determine the clinical, demographic, polysomnographic and prognostic features of OSAS patients with hypertension.Materials and Methods: In this study, 364 patients diagnosed with OSAS in the sleep laboratory of the Department of Neurology, Bursa Uludag University Faculty of Medicine between 2016 and 2021 were retrospectively scanned and included. The patients were analyzed by comparing them with and without hypertension.Results: When patients with and without hypertension were compared according to clinical, demographic and polysomnography data, age (p<0.001), sex (p=0.009), presence of diabetes mellitus (DM) (p<0.001), presence of coronary artery disease (p<0.001), presence of heart failure (p=0.020), presence of atrial fibrillation (p=0.004), ischemic stroke (p<0.001), minimum oxygen saturation (p=0.015), oxygen desaturation index (p=0.034) and body mass index (BMI) (p<0.001) were statistically significantly correlated. When the significant variables were analyzed with binary logistic regression, the most significant variables were age [p<0.001, odds ratio (OR): 1.07], DM (p<0.001, OR: 7.58), coronary artery disease (p=0.003, OR: 4.92), heart failure (p=0.041, OR: 5.53), ischemic stroke (p=0.042, OR: 3.38) and BMI (p<0.001, OR: 1.28).Conclusion: In this study, we found that cardiovascular diseases such as coronary artery disease, heart failure and ischemic stroke are more common in OSAS patients with hypertension, and this is independent of risk factors such as age, DM and BMI. OSAS and cardiovascular diseases may show ethnic and racial differences. For this reason, we suggest conducting multicenter prospective studies examining the effects on blood pressure regulation and cardiovascular diseases in our own population

A Survey Study to Investigate the Relationship of Sleep Disorders, Depression and Anxiety in Headache Patients

Objective: There is a complex relationship among pain, sleep and mood, with boundaries indistinguishable from each other. Pain can disrupt the quality of sleep, disturbance of sleeping pattern can create pain and the reflection of this period can manifest itself as depression and anxiety in people. Materials and Methods: A total of 297 patients, followed up due to headache, were enrolled in the study. Patient study groups were classified as episodic tension-type headache (TTH), migraine, chronic migraine and chronic tension-type headache. Patient assessments were performed by Epworth sleepiness scale, Hamilton Anxiety Rating scale (HAM-A) and Hamilton Depression Rating scale (HDRS). Results: In all groups, excessive daytime sleepiness accompanied the clinical picture. In episodic TTH group, HAM-A was 12.27±3.34 (p0.05), and in group with chronic TTH, HAM-A was 5.71±2.51 (p>0.05); anxiety scores were increased in episodic TTH and migraine groups when compared to other groups and also normal population. In episodic TTH group, HDRS was 8.34±3.85 (p>0.05); in migraine group, 9.01±1.25 (p>0.05); in chronic TTH group, 10.05±3.40 (p<0.001) and in group with chronic migraine HDRS was 11.70±3.25 (p<0.001). The depression scores were increased in chronic migraine group and chronic TTH group when compared to other groups and to normal population. Conclusion: As a conclusion, we suggest that pain, depression, anxiety and disorders of sleep should be considered as a whole and patient approach should be planned according to this concept

Evaluation of Coronavirus Disease 2019-Positive Patients with Febrile Convulsions

Objective:Febrile convulsion is a common seizure type in children between 6 months and 6 years of age and is seen in 2%-5% of children.1 Coronavirus disease 2019 spread rapidly and became a pandemic. As coronavirus disease 2019 can be seen in epilepsy patients, the relationship between coronavirus disease 2019 and seizures is not clear yet.2 This study aimed to evaluate the characteristics of coronavirus disease 2019-positive patients with febrile convulsions and compare them with coronavirus disease 2019-negative patients with febrile convulsions regarding their clinical features.Methods:Forty patients were included in the study. In our country, diagnosing, monitoring, and treating coronavirus disease 2019 are performed according to the Turkish Ministry of Health coronavirus disease 2019 Scientific Committee guidelines.Results:Twelve of the patients were coronavirus disease 2019 positive, whereas 28 were coronavirus disease 2019 negative. While the rate of complex febrile convulsion was 50% in the coronavirus disease 2019-positive group, this ratio was 25% in the coronavirus disease 2019-negative patient group.Conclusions:Seizures occur in the presence of higher-grade fever in coronavirus disease 2019-positive cases. On the other hand, the probability of seizures to occur focally and recur during the same disease period might be higher. Male gender and maternal history of febrile convulsions may be the risk factors

Two Cases of Lafora Disease Diagnosed By Genetical Tests

Epilepsy develops related to a complex genetic heredity as many diseases in society. Lafora disease (LD) is an autosomal recessive inheritance. It is localized at EPM2A gen 6q23-25 and encodes tyrosine phosphatase (Laforin protein). About 80% of the patients have mutations in this gene. In a case of LD, rapid and progressive dementia and frequent occipital seizures are clinical symptoms. For definitive diagnosis, through genetical study, EPM2A and EPM2B genes should be analyzed. A male at the age of 18, with a medical history of meningitis and seizures with high temperature. Starting from the age of 10, there have been symptoms such as generalized tonic-clonic (GTC) seizures, startles in the whole body, and forgetfulness. In genetical tests, homozygote deletion of adenine nucleotide in the position of 468 at codon 156 and guanine nucleotide in the position of 469 at codon 157 is found. In other words, there has been dinucleotide deletion which is compatible with LD. A 20-year-old male was examined because of such symptoms as forgetfulness, myoclonia, hallucinations, and GTC clonic seizures. He was diagnosed with LD because of the heterozygote transformation of CCC to CTC at codon 111. Even though genetic disorders have many different reasons, it is advised that every society should have their own advanced studies on gene mutation. In Turkish cases, both of these genes were found mutated, each in different patients through various studies

Nonconvulsive status epilepticus cases arising in connection with cephalosporins

Cephalosporins, particularly cefepime, exert neurotoxic side effects that can lead to status epilepticus. These neurotoxic side effects include myoclonus, dystonic movements, tremor, asterixis, seizure, status epilepticus, encephalopathy, and sometimes coma. Status epilepticus, particularly nonconvulsive status epilepticus (NCSE), is a well-known but unusual complication in patients with altered renal function who were receiving treatment with intravenous cephalosporins, especially cefepime. We reviewed the clinical and electroencephalographic (EEG) characteristics of 7 patients with renal failure who developed consciousness alterations with changes in EEG activity while being treated with cephalosporins. All patients developed renal failure: six patients had chronic renal failure, one patient had acute renal failure, and two patients were administered hemodialysis. Nonconvulsive status epilepticus was observed between 2 and 8 days (average of 5.6 days) after initiation of cephalosporins. Cephalosporins are epileptogenic drugs, especially when used in excessive doses or when renal function is impaired. Critically ill patients with chronic kidney disease are particularly susceptible to cefepime neurotoxicity. Clinical and electrophysiological results of patients guide the diagnosis of NCSE by healthcare providers. (C) 2016 Published by Elsevier Inc

The evaluation of psychogenic non-epileptic seizures (PNES) cases with saline injection method in video-EEG monitorization unit

Background: It has been reported that 10 to 30% of patients sent to epilepsy centers with a diagnosis of refractory epilepsy are diagnosed with psychogenic non-epileptic seizure (PNES). A wide variety of provocative methods are used to assist PNES diagnosis. Objective: To investigate the effect of seizure induction on the diagnosis and prognosis of PNES. Methods: We retrospectively examined 91 patients with PNES complaints in our video-EEG laboratory. Intravenous saline was administered to all patients for induction of seizures. Results: Saline injection was performed in 91 patients referred to our EEG lab with PNES initial diagnosis, 57 of whom were female and 34 male. Saline injection triggered an attack in 82 patients (90%). Conclusions: In this study we have concluded that provocative methods are practical, cheap and, most of all, effective for patient diagnosis. In clinical practice, explaining the diagnosis is the first and most important step of the treatment, and careful patient-doctor communication has a positive impact on patient prognosis