Who is the bigger stigmatizor?: The loved one or the society

Objective: Epilepsy has long been considered by the society as a dangerous and frightening spiritual possession or even a contagious disease. This results in an unavoidable embarrassment for both the patient and the family leading to social isolation, seclusion, and secretiveness about the diagnosis. The aim of this study was to determine the stigmatizing level of the general Turkish population and to compare these results with the stigmatizing level of the patients' relatives group (PRG)

Short-Term Results of Vagal Nerve Stimulation in Resistant Epilepsy Patients

Objectives:Vagal nerve stimulation (VNS) is an appropriate treatment option for refractory patients who are not eligible for resective epilepsy surgery. In this study, the clinical and demographic characteristics of VNS patients were documented and it was aimed to determine the effect of VNS on seizure control.Methods:A retrospective survey was performed for patients who were diagnosed as drug resistant epilepsy and underwent VNS implantation, with at least 1 year of follow-up. Nine patients (eight males and one female) with an average age of 30.11 (18–42), were included. Reduction in seizure frequency prior and in the 3rd, 6th, and 12th months after VNS implantation was compared. Patients were considered responders when a reduction of seizures of more than 50% was reported.Results:The mean time from the onset of the disease to VNS implantation was 17.33±9.75 years and the mean age when VNS was implanted was 24.53 (9–39). Decrease in frequency of seizures from VNS implantation to 3 months and 6 months was statistically significant (p=0.003 and p=0.012, respectively). No statistical significance was found between the frequency of seizures before treatment and at the 12th month (p=0.153).Conclusion:In our study, we observed a decrease in seizure frequency in patients with drug resistant epilepsy with a variety of etiologies, which was similar with the literature data. Although a cumulative effect was reported, we have observed a minimal decrease in frequency after the 3rd month

Short-term Results of The Add-on Lacosamide Therapy in Patients with Drug-resistant Focal Onset Seizures

Objectives:Lacosamide (LCM) is a new generation amino acid drug that is used in patients with drug-resistant epilepsy, which increases the slow inactivation of voltage-dependent sodium channels. In this study, the short-term results of patients with drug-resistant epilepsy who received add-on LCM therapy were evaluated.Methods:Patients who were at least 16 years old and had focal onset seizures for a minimum period of 1 year were retrospectively assessed. Those who had uncontrolled seizures, despite the use of two appropriate antiepileptic drugs at an effective dose for at least six months, were included in the study. Forty-five eligible patients (11 females, 34 males) underwent further analysis. LCM therapy doses, change in seizure frequency, number of seizures before and after LCM therapy, and the effect of LCM add-on therapy on seizures were analyzed.Results:The mean age of the included 45 patients (11 females, 34 males) was 31.42 (16–56) years. Twenty-six of 45 (57.8%) patients under add-on therapy showed a decrease of 50% or more. It was observed that the seizure frequency decreased to a median of 2 (IQR: 0.5–5), which was statistically significant (p<0.001). The dose was not correlated with the seizure decrease ratio (p=0.216). The decrease in seizure frequency was similar in patients with LCM add-on treatment as the second or third drug, when compared with patients using LCM as the fourth or fifth drug (p=0.231).Conclusion:It was observed that LCM add-on therapy significantly decreased seizure frequency, similar to the current literature. On the contrary, the dose effect or earlier add-on therapy did not show a significant effect on seizure frequency. LCM should be considered as a successful treatment option in patients with drug-resistant focal onset seizures

Clinical, Electrophysiological, Radiological Features and Prognosis of Creutzfeldt – Jakob Disease

Objectives:Creutzfeldt- Jakob Disease (CJD) is a neurodegenerative disease characterized by abnormally-shaped proteins. CJD is the most common type of prion diseases with incidence of 1/100000 per year. In this study, we aimed to review clinical, laboratory, electrophysiological and radiological findings and prognosis of 21 cases with the diagnosis of CJD.Methods:A retrospective review of patient records in a single institution was performed to identify patients with sporadic CJD from 2010 to 2018. January 2017 diagnostic criteria were used for inclusion. In this study, 21 patients were included for analysis. Demographic features, symptoms, clinical findings of neurological examination, disease duration, laboratory findings, electrophysiological test results, findings of magnetic resonance imaging and prognosis were documented.Results:Twelve of the patients included in this study were male and nine were female. The mean age was 64.1 (49–79). All the patients had dementia and changes in personality at admission to the hospital. The duration of complaints was 5.4±4 months. Periodic sharp wave complexes were observed in the electroencephalogram at baseline or follow-up. Twenty patients had undergone lumbar puncture to identify 14.3.3 protein tests in cerebrospinal fluid. In six of twelve patients whose results were received, 14.3.3 protein level was positive, whereas four of them were negative and two were at borderline. Seven patients died of the disease during the follow-up in our hospital within 2.8 (1–6) months from the symptom onset.Conclusion:In patients with rapidly progressive dementia, behavioral changes, hallucinations and myoclonus, CJD should be kept in mind for earlier diagnosis

Hormonal effect on the relationship between migraine and female sexual dysfunction

It is not a well-established finding in migraine that female sexual dysfunction (FSD) emerging as a natural course of disease, as a result of accompanying depression/anxiety, or an underlying endocrinological abnormality. Our aim is evaluating the relationship among frequency and severity of migraine, FSD, depression, anxiety, and related hormones in migrainous women. We examined 80 migrainous female and 62 controls cross sectionally. Beck Depression and Anxiety Inventories, Female Sexual Dysfunction Inventory, Migraine Disability Assessment Test, and hormonal analysis were done. Independent risk factors were identified by logistic regression analysis and cut-off values were measured with Receiver Operating Curve. FSD was not related to frequency or severity of migraine. Although depression and anxiety was related to arousal and lubrication, they had limited effect in FSD. There were correlations between prolactin (PRL), desire and lubrication, follicular-stimulating hormone FSH and orgasm, luteinizing hormone (LH), and pain. Also FSH-LH combination and PRL were found as independent factors for FSD. FSH-LH combination and PRL were found as independent factors which had effect on FSD in migraine. Our study is a precursor study about the effect of several hormones on FSD and migraine relationship. Hormonal effect on FSD in migraine will be clearer with future studies

Cognitive Functioning and Silent Neurological Manifestations in Behcet's Disease with Ocular Involvement

Introduction: Various reports have revealed a cognitive dysfunction in Behcet's disease (BD). In this study, we aimed to assess the silent neurological manifestations, behavioral and neuropsychiological impairments of Behcet's disease patients with ocular involvement

Pregnancy and Epilepsy: Clinical Data and Adverse Outcomes of Pregnant Women with Epilepsy

Objectives:Pregnancy in women with epilepsy carries a higher risk for fetal development complications, including congenital malformations. In this study, data obtained from pregnant epilepsy patients in a tertiary epilepsy center were presented.Methods:In this study, 128 pregnancies of 110 pregnant women followed up in the epilepsy outpatient clinic between April 2011 and April 2021 were examined. Demographic data of the patients, antiepileptic drugs AEDs used, and pregnancy outcomes were reviewed retrospectively.Results:During pregnancy, 101 patients (78.9%) received monotherapy, and lamotrigine was the most commonly used drug in monotherapy. A two-drug combination was used in 18 patients (14.1%), and a three-drug combination was used in 5 patients (3.9%). Although the frequency of seizures did not increase in most patients, the frequency of seizures increased in 18 patients (14.1%) and decreased in 5 patients (3.9%). In our study, the intrauterine fetal loss occurred in five patients, newborn infants with congenital malformations in three patients, and neonatal death during delivery in one patient. The number of AEDs used in multivariate logistic regression predicted adverse outcomes such as intrauterine fetal loss, neonatal death, and newborns with congenital malformations.Conclusion:Management of pregnant patients with epilepsy is difficult for both mother and fetus. In our study, combination therapy was more associated with adverse outcomes for the fetus and newborn. Pregnancy should be planned, and seizure-free pregnancy should be targeted with low-dose monotherapy

Health-Related Quality of Life in Patients with Epilepsy

Objectives:This study aimed to evaluate health-related quality of life in patients with epilepsy and to investigate the role of sociodemographic attributes and clinical features.Methods:Two hundred five patients diagnosed with epilepsy and under the follow-up of epilepsy outpatient clinics of our tertiary center were enrolled. Gender, age, age of epilepsy onset, disease duration, seizure type, epilepsy etiology, frequency of seizures, anti-seizure drugs, electroencephalography, and magnetic resonance imaging findings were noted. The Short Form-36, valid and reliable in our country, was used to assess health-related quality of life. The Short Form-36 physical and mental scores were calculated.Results:All Short Form-36 subscores of patients were low when compared to the normative data of our country. Some physical and mental health scores of women with epilepsy were lower than the scores of men with epilepsy. All Short Form-36 subscores of patients under polytherapy were lower than the ones under monotherapy. Some quality of life scores were negatively correlated with disease duration; yet the range of age, age of epilepsy onset, seizure type, etiology of epilepsy, cranial magnetic resonance imaging, and electroencephalography findings were not significantly correlated with Short Form-36 scores.This study revealed that health-related quality of life of patients with epilepsy was lower than that of healthy individuals. It should be noted that Conclusions:women with epilepsy, patients with longer disease duration, patients suffering from frequent seizures, and the ones under polytherapy could have a lower quality of life. Patients with epilepsy should be supported in means of quality of life and modifiable factors

An invisible cause of disability: Stigma in migraine and epilepsy

Objective Our purpose was to identify the ratio and severity of stigmatization in patients with migraine and epilepsy. We also collected demographic and clinical data to search for possible facilitators. Methods In total, 196 patients with migraine and 60 patients with epilepsy were enrolled. Neuro-QoL Stigma Scale was applied in an office setting by a neurologist in 3 different centers. Stigma scores were calculated as standardized T scores (total, enacted, and internalized). Demographics, clinical characteristics, and treatment status of the patients were also compared in terms of stigma scores. Kruskal-Wallis test or Mann-Whitney U tests were applied for comparisons. Spearman's correlation analysis was used for the evaluation of inter-parameter correlations. Results Eighty-one percent of the patients with epilepsy and 72% of the patients with migraine reported being stigmatized. Total T scores were significantly higher in the epilepsy group (50.78 +/- 9.1) than the patients with migraine (44.9 +/- 7.62), also than the chronic (45.86 +/- 8.76) and episodic (44.7 +/- 7.27) migraine subgroups (p < 0.05). T scores increased as the duration of disease increased; however, this correlation was significant for the epilepsy group only (p < 0.05). Migraine group with prophylactic treatment had significantly higher scores than the migraineurs without preventive therapy (p < 0.05). Enacted T scores were higher than internalized T scores in all analyzed groups and subgroups (p < 0.05). Conclusion Patients with migraine and epilepsy are subjected to stigma. The ratio and intensity can change in different countries. We need to increase the awareness and search for better solutions. The standardized tests are important to compare results between studies