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

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

Evaluation of Obstructive Sleep Apnea Syndrome in Epilepsy Patients with Polysomnographic Data

Objectives:Sleep respiratory disorders, which are more common in epilepsy patients, are treatable diseases. We have discussed the diagnosis of sleep apnea syndrome after PSG of epileptic patients with visible apnea and snoring, in light of the findings in the literature.Methods:For this study, from 1120 patients with epilepsy, 32 of them who were diagnosed with OSA in the PSG test were selected. Thirty-two patients with epilepsy that snoring and apnea who consulted sleep center. Patients with simple snoring and upper airway resistance were not selected. Epworth Sleep Scales was applied to all patients and all patients were taken.Results:In this study, the findings showed that the ratio of OUAS in patients with epilepsy was 2.9%. 21 of the 32 cases were male and 11 were female. The mean age was 53 (42–69) years. 72% had partial epilepsies and 28% generalized. The Apne-hypopnea index was 28 (14–48). PAP treatment was performed after the diagnosis of sleep apnea syndrome.Conclusion:Sleep respiratory disorders are more common in patients with epilepsy than the rest of the population and they are treatable diseases. The other study revealed that the frequency of OSAS among epilepsy was10,2%. In this study, the findings showed that the ratio of OSAS in patients with epilepsy was 2.9%.This a risk for OSAS and the medication used for the treatment should be selected appropriately. Clinical screening of OSAS in settings of epileptic patients may be needed to diagnose to find out it maybe a potential and modifiable risk factor for epilepsy

Etiology, Clinical Characteristics and In-hospital Mortality of Status Epilepticus: Single Center Experience

Objective:Status epilepticus (SE) is a serious neurological emergency that can has high morbidity and mortality rates and requires prompt diagnosis and treatment. There are different etiologies and the prognosis varies multifactorially. The aim of this study was to reveal the etiological causes, clinical features and mortality rates of patients diagnosed with SE at our center.Methods:The records of 234 patients with a diagnosis of SE over the age of 18 who were followed up and treated at our center between 01.01.2015-01.01.2022 were evaluated retrospectively. Using the hospital information operating system database, we identified people hospitalized with an International Classification of Diseases 10th Revision code G41 for SE as the primary diagnosis. Demographic information, clinical characteristics, and discharge results were obtained from medical records.Results:One hundred-twenty (51.3%) female and 114 (48.7%) male patients were evaluated. The top 3 most common etiologic causes were: discontinuation of anti-seizure treatments without advice (n=82), cerebrovascular events (n=50), and meningitis or encephalitis (n=39). Motor seizures were detected in 183 (78.2%) patients, and non-motor seizures were detected in 51 (21.8%) patients. Seizures were suppressed by first-line treatment in 24 patients and by second-line treatments in 135 patients. Seventy-five patients whose seizures could not be suppressed were accepted as refractory SE and 9 died. The mean age of all patients was 55, and 63 of the patients died.Conclusion:In this study, clinical and demographic features, the etiological causes and in the hospital mortality rates of SE followed in a single center in the Turkish population were determined. The most common causes of patients diagnosed with SE were discontinuation of anti-seizure treatments without our recommendation, cerebrovascular diseases and central nervous system infections, respectively. In our center, no relationship was found between age and mortality. The in-hospital mortality rate was 3.9% for all patients (n=234) and 12% for patients with refractory SE (n=75)

The Role of Obstructive Sleep Apnea Syndrome as a Cause of Stroke

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent sleep disorder. Stroke is the second leading cause of death and the third leading cause of disability in the world. OSAS and stroke has common risk factors, are associated with each other and are both reported to play an important role in the etiology of each other. OSAS and stroke association was identified in our two cases in whom sleep-related respiratory problems were encountered before stroke. We would like to draw attention to the importance of OSAS being among the risk factors in the etiopathogenesis of stroke

Specificity and sensitivity of the SeLECT score in predicting late seizures in patients undergoing intravenous thrombolytic treatment and the effect of diabetes mellitus and leukoaraiosis

Background Seizures after stroke can negatively affect the prognosis of ischemic stroke and cause a decrease in quality of life. The efficacy of intravenous (IV) recombinant tissue plasminogen activator (rt-PA) treatment in acute ischemic stroke has been demonstrated in many studies, and IV rt-PA treatment has been increasingly used around the world. The SeLECT score is a useful score for the prediction of late seizures after stroke and includes the severity of stroke (Se), large artery atherosclerosis (L), early seizure (E), cortical involvement (C), and the territory of the middle cerebral artery (T). However, the specificity and sensitivity of the SeLECT score have not been studied in acute ischemic stroke patients that received IV rt-PA treatment. Objective In the present study, we aimed to validate and develop the SeLECT score in acute ischemic stroke patients receiving IV rt-PA treatment. Methods The present study included 157 patients who received IV thrombolytic treatment in our third-stage hospital. The 1-year seizure rates of the patients were detected. SeLECT scores were calculated. Results In our study, we found that the SeLECT score had low sensitivity but high specificity for predicting the likelihood of late seizure after stroke in patients administered IV rt-PA therapy. In addition to the SeLECT score, we found that the specificity and sensitivity were higher when we evaluated diabetes mellitus (DM) and leukoaraiosis. Conclusion We found that DM was an independent risk factor for late seizures after stroke in a patient group receiving thrombolytic therapy, and late seizures after stroke were less frequent in patients with leukoaraiosis