Risk factors and clinical characteristics of cerebellar infarctions

Amaç: Serebellar infarktlar beyin infarktları arasında % 1.5- 4.2, posterior dolaşım infarktları arasında ise % 47 oranında görülür. Bu çalışmada, superior serebellar arter (SSA), posterior inferior serebellar arter (PİSA) ve anterior inferior serebellar arter (AİSA) alanında serebellar infarktların klinik seyir ve prognozu etkileyen faktörleri incelemeyi planladık. Gereç ve Yöntem: Haseki Eğitim ve Araştırma Hastanesi Nöroloji kliniğinde 2007-2011 tarihleri arasında yatarak tedavi görmüş olan inmeli hastaların kayıtları incelendi. Çalışmaya AİSA, SSA ve PİSA damar alanlarında serebellar infarktı olan 106 hasta dahil edildi. Hastaların başvurudaki şikayetleri, nörolojik muayeneleri, özgeçmişleri, etyolojik amaçlı yapılmış olan tetkikleri ve taburculuktaki nörolojik muayeneleri incelendi. Bulgular: Çalışmamızda hastaların %45.3’i kadın, %54.7’si erkek olup yaş ortalaması 62.64±12.82 idi. Olguların damar alanına göre dağılımı %50’si PİSA, %46.2’sı SSA, %3.8’i AİSA idi. AİSA’ da ataksi, SSA’ da ataksi, dismetri-disdiadokinezi, PİSA’ da ise dizartri, ataksi ve dismetri-disdiadokinezi öne çıkan bulgular idi. En sık görülen risk faktörü hipertansiyon olarak saptandı. Ölümle sonuçlanan infarktların SSA alanında olduğu görülmüştür. Taburculuktaki bağımsız olarak hayatını idame ettirebilecek durumda olan hastalarımızın PİSA grubunda daha sık olduğu gözlenmiştir. Sonuç: Serebellar infarktlar tutulan damar alanına göre etyolojik ve prognostik farklılıklar gösterebilmektedir.Objective: Cerebellar infarcts are seen in 1.5-4.2% of brain infarcts and 47% of the posterior circulation infarcts. In this study, we aimed to investigate the clinical course and prognosis of infarcts in the territory of superior cerebellar artery (SCA), posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA). Material and Methods: We analysed the records of patients with stroke treated in Haseki Educational and Research Hospital between 2007-2011. 106 patients with cerebellar infarcts in the territory of AICA, SCA and PCA were included the study. We evaluated the complaints, neurological findings, history and etiological examinations. Results: In this study, 45.3% of the patients were female, 54.7% of them were male. Mean age of the patients was 62.64±12.82. Of all patients, in 50% PICA, in 46.2% SCA, in 3.8% AICA infarcts were found. Most frequent findings were; ataxia in AICA, ataxia and dysmetriadysdiadakokinesia in SCA, dysartria, ataxia and dysmetriadysdiadakokinesia in PICA. Most frequent risk factor was hypertension. Fatal infarcts were seen in SCA territory. Patients who could sustain life as an independent group were more frequently observed in PICA. Conclusion: Etiologic and prognostic factors may vary between cerebellar infarcts according to the affected arterie

Risk factors and clinical characteristics of cerebellar infarctions

Amaç: Serebellar infarktlar beyin infarktları arasında % 1.5- 4.2, posterior dolaşım infarktları arasında ise % 47 oranında görülür. Bu çalışmada, superior serebellar arter (SSA), posterior inferior serebellar arter (PİSA) ve anterior inferior serebellar arter (AİSA) alanında serebellar infarktların klinik seyir ve prognozu etkileyen faktörleri incelemeyi planladık. Gereç ve Yöntem: Haseki Eğitim ve Araştırma Hastanesi Nöroloji kliniğinde 2007-2011 tarihleri arasında yatarak tedavi görmüş olan inmeli hastaların kayıtları incelendi. Çalışmaya AİSA, SSA ve PİSA damar alanlarında serebellar infarktı olan 106 hasta dahil edildi. Hastaların başvurudaki şikayetleri, nörolojik muayeneleri, özgeçmişleri, etyolojik amaçlı yapılmış olan tetkikleri ve taburculuktaki nörolojik muayeneleri incelendi. Bulgular: Çalışmamızda hastaların %45.3’i kadın, %54.7’si erkek olup yaş ortalaması 62.64±12.82 idi. Olguların damar alanına göre dağılımı %50’si PİSA, %46.2’sı SSA, %3.8’i AİSA idi. AİSA’ da ataksi, SSA’ da ataksi, dismetri-disdiadokinezi, PİSA’ da ise dizartri, ataksi ve dismetri-disdiadokinezi öne çıkan bulgular idi. En sık görülen risk faktörü hipertansiyon olarak saptandı. Ölümle sonuçlanan infarktların SSA alanında olduğu görülmüştür. Taburculuktaki bağımsız olarak hayatını idame ettirebilecek durumda olan hastalarımızın PİSA grubunda daha sık olduğu gözlenmiştir. Sonuç: Serebellar infarktlar tutulan damar alanına göre etyolojik ve prognostik farklılıklar gösterebilmektedir.Objective: Cerebellar infarcts are seen in 1.5-4.2% of brain infarcts and 47% of the posterior circulation infarcts. In this study, we aimed to investigate the clinical course and prognosis of infarcts in the territory of superior cerebellar artery (SCA), posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA). Material and Methods: We analysed the records of patients with stroke treated in Haseki Educational and Research Hospital between 2007-2011. 106 patients with cerebellar infarcts in the territory of AICA, SCA and PCA were included the study. We evaluated the complaints, neurological findings, history and etiological examinations. Results: In this study, 45.3% of the patients were female, 54.7% of them were male. Mean age of the patients was 62.64±12.82. Of all patients, in 50% PICA, in 46.2% SCA, in 3.8% AICA infarcts were found. Most frequent findings were; ataxia in AICA, ataxia and dysmetriadysdiadakokinesia in SCA, dysartria, ataxia and dysmetriadysdiadakokinesia in PICA. Most frequent risk factor was hypertension. Fatal infarcts were seen in SCA territory. Patients who could sustain life as an independent group were more frequently observed in PICA. Conclusion: Etiologic and prognostic factors may vary between cerebellar infarcts according to the affected arterie

Epilepsy in the elderly

WOS: 000372007900004Amaç: Epilepsi yaşlılarda sık görülen bir hastalıktır, ancak etiyolojisi, klinik sunumu, eşlik eden hastalıkları ve prognozu genç hastalardan farklıdır. Bu çalışmada epilepsi nedenleri, yaşlılarda nöbet tipleri, elektroensefalografi (EEG) bulguları araştırıldı. Gereç ve Yöntem: İlk epileptik nöbetini geçiren ve altmış beş yaş üzerinde 95 hasta retrospektif olarak değerlendirildi. Yaş, epilepsi tipi, EEG bulguları, manyetik rezonans görüntüleme ve/veya kranial tomografi bulguları, etiyoloji, eşlik eden hastalıklar ve verilen antiepileptik tedaviler değerlendirildi. Bulgular: Hastalarımızın yaş ortalaması 75 idi ve 50 (%56) hasta erkekti. Doksan beş hastanın 55’inde (%58) parsiyel tipte nöbet, 36’sında (%38) jeneralize tonik klonik nöbet ve 4’ünde (%4) jeneralize status epileptikus vardı. İnteriktal EEG’de fokal epileptiform aktivite sıklığı %32,6 idi. Nöbetler hastaların %85’inde (81 hasta) monoterapi ile %15’inde (14 hasta) politerapiyle kontrol altında idi. Çalışmamız serebrovasküler hastalıkların, en sık (%63) etyolojik neden olduğunu gösterdi. Yaş ve nöbet sıklığı ve EEG anormallikleri arasında anlamlı bir ilişki saptanmadı. Ancak yaş ve eşlik eden hastalıklar arasında anlamlı bir ilişki saptandı. Sonuç: Sonuçlarımız fokal nöbetlerin yaşlı epilepsinin en sık belirtisi olduğunu desteklemektedir. Serebrovasküler hastalıklar yaşlılarda epilepsinin en fazla rastlanan etiyolojik nedenidir. Monoterapi hastaların çoğunluğunda yeterlidir. Yaşlı nüfusun devamlı büyümesi, doğru tanı ve etkili tedavi gereksinimini arttırmaktadır.Objective: Epilepsy is frequently seen in the elderly, but its etiology, clinical presentation, comorbidities, and prognoses are different than younger patients. In this study, we investigated types of seizures, electroencephalography (EEG) findings and the cause of epilepsy in the elderly. Materials and Methods: We retrospectively analyzed 95 patients who were 65 years old or older, and who had an epileptic seizure for the first time. Type of epilepsy, age, EEG findings, magnetic resonance imaging and/or cranial tomography findings, etiology, comorbidities and antiepileptic medication were evaluated. Results: The average age of our patients was 75, and 50 (56%) patients were male. Among 95 patients, 55 (58%) had focal seizures, 36 (38%) had generalized tonic-clonic seizures and 4 (4%) had convulsive status epilepticus. The frequency of focal interictal epileptiform activity was 32.6% patients. Seizures were responsive to treatment administered as monotherapy in 81 (85%) patients and as politherapy in 14 (15%) patients. Our study showed that cerebrovascular disease was the most common (63%) etiological cause identified. There was no significant relationship between age and frequency of seizures and EEG abnormalities. However, a significant correlation was found between age and comorbidities. Conclusion: Our results supported the focal seizure is the most common manifestation of epilepsy in the elderly. Cerebrovascular disease is the most common etiological cause of epilepsy in the elderly. Monotherapy is sufficient in the majority of patients. Continuous growth of the elderly population is increasing the need for accurate diagnosis and effective treatment

Evaluation of sex hormones in epilepsy patients

31st International Epilepsy Congress -- SEP 05-09, 2015 -- Istanbul, TURKEYWOS: 000365756500134

The Effect of Clozapine on Tremor in Patients with Parkinson’s Disease who were Initiated Clozapine For Psychotic Symptoms

Aim: Tremor is one of the initial symptoms of Parkinson’s disease and most of the patients suffer from it along the course of the disease. Levodopa and dopamine agonists are used as first-line therapy. Studies showed that clozapine can be effective on patients who are resistant or insufficiently responsive to these therapies. In this retrospective study, we searched the effect of clozapine on tremor. Methods: We retrospectively analyzed the medical records of patients who have been followed in our Movement Disorders Clinic between the years 2005 and 2012. Fourteen patients using clozapine due to psychotic symptoms were included in the study. The patients were assessed using the Unified Parkinson’s disease rating scale (UPDRS) at the beginning and after 2 months of constant dose of clozapine usage. Two patients were excluded from the study because of non-compliance with the treatment due to excessive sedation. Assessments were done on 12 patients. Results: When the UPDRS scores before and after clozapine treatment examined, a statistically significant decrease was found in UPDRS-total, UPDRS-tremor, UPDRS-motor, and UPDRS-activities of daily living tremor scales after treatment. Conclusion: Since clozapine may have a positive effect on tremor in Parkinson’s disease, it can be considered as a treatment option for treatment-resistant psychotic symptoms. (The Medical Bulletin of Haseki 2013;51:173-7

Insomnia and Dysautonomia with Contactin-Associated Protein 2 and Leucine-Rich Glioma Inactivated Protein 1 Antibodies: A “Forme Fruste” of Morvan Syndrome?

Morvan syndrome (MoS) is typically characterized by neuromyotonia, sleep dysfunction, dysautonomia, and cognitive dysfunction. However, MoS patients with mild peripheral nerve hyperexcitability (PNH) or encephalopathy features have been described. A 46-year-old woman presented with a 2-month history of constipation, hyperhidrosis, and insomnia. Neurologic examination revealed muscle twitching and needle electromyography showed myokymic discharges in all limbs. No clinical or electrophysiological features of neuromyotonia were present. Although the patient denied any cognitive symptoms, neuropsychological assessment revealed executive dysfunction, while other cognitive domains were preserved. Cranial and spinal MRIs were unrevealing and tumor investigation proved negative. Polysomnography examination revealed total insomnia, which was partially reversed upon immune-modulatory therapy. Investigation of a broad panel of antibodies revealed serum leucine-rich glioma inactivated protein 1 and contactin-associated protein 2 antibodies. The features of this case indicate that the presentation of PNH syndromes may show significant variability and that MoS patients may not necessarily exhibit full-scale PNH and encephalopathy symptoms

The comparative effectiveness of fingolimod, natalizumab, and ocrelizumab in relapsing-remitting multiple sclerosis

© 2023, Fondazione Società Italiana di Neurologia.Background: Fingolimod, natalizumab, and ocrelizumab are commonly used in the second-line treatment of relapsing-remitting multiple sclerosis (RRMS). However, these have only been compared in observational studies, not in controlled trials, with limited and inconclusive results being reported. A comparison of their effect on relapse and disability in a real-world setting is therefore needed. Objectives: The objective of this study was to compare the efficacy of fingolimod, natalizumab, and ocrelizumab in reducing disease activity in RRMS. Methods: This multicenter, retrospective observational study was carried out with prospectively collected data from 16 centers. All consecutive RRMS patients treated with fingolimod, natalizumab, and ocrelizumab were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores, and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), time to first relapse, and disability accumulation were compared. Results: Propensity score matching retained 736 patients in the fingolimod versus 370 in the natalizumab groups, 762 in the fingolimod versus 434 in the ocrelizumab groups, and 310 in the natalizumab versus 310 in the ocrelizumab groups for final analyses. Mean ARR decreased markedly from baseline after treatment in all three treatment groups. Mean on-treatment ARR was lower in natalizumab-treated patients (0.09, 95% confidence interval (CI), 0.07–0.12) than in those treated with fingolimod (0.17, 0.15–0.19, p<0.001), ocrelizumab (0.08, 0.06–0.11), and fingolimod (0.14, 0.12–0.16, p=0.001). No significant difference was observed in mean on-treatment ARR between patients treated with natalizumab (0.08, 0.06–0.11) and ocrelizumab (0.09, 0.07–0.12, p=0.54). Compared to fingolimod, the natalizumab and ocrelizumab groups exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients at year 1. No significance differences in disability accumulation were determined between the therapies. Conclusion: Natalizumab and ocrelizumab exhibited similar effects on relapse control, and both were associated with better relapse control than fingolimod. The effects of the three therapies on disability outcomes were similar