Current Overview of Idiopathic Intracranial Hypertension

Pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), is an increment in the intracranial pressure without identifiable causal factors. The disorder is frequently seen in obese women of childbearing age. Due to both permanent vision loss and higher risk of recurrence than previously thought, patients with IIH should be followed closely using a multidisciplinary approach. IIH treatment should be arranged considering the severity of headache and papilledema, presence of vision loss, response to medical treatment, and comorbid conditions, with individual planning for each patient. In patients where weight loss and acetazolamide are insufficient for symptoms' resolution, other medical and surgical treatment options should be evaluated rapidly. Because the pathogenesis of IIH is not fully known, treatment options support different theories. With the increase in clinical experience, the aim is to prevent the risk of developing irreversible complications in patients using different treatments, which have recently been developed. This review aimed to evaluate IIH treatment options using current approaches and help physicians in the decision-making process

Idiopathic intracranial hypertension: Do we diagnose and manage it appropriately in the light of current data?

Background and objective: Idiopathic intracranial hypertension (IIH) is an increase of intracranial pressure without a known cause, which usually presented with headache. This study aimed to evaluate the changing diagnosis and management approaches of neurologists for IIH in light of recent data. Methods: An online questionnaire about IIH was developed covering 28 questions, and five sections: demographic data, diagnosis, examination, treatment, and follow-up. We compared the approach of neurologists with 1-9 years of experience (group-A) with that of neurologists with more than 10 years' experience (group-B). Results: A total of 517 neurologists (group A: n = 252, group B: n = 265) participated in the study. Responder rate of questionarre is 18.3%. The approach to IIH in diagnosis, examination, treatment, and follow-up processes was similar in both groups. The younger group (group A) recognized all neuro-radiologic findings, especially flattening of the posterior aspect of the globe (p = 0.001) and tortuosity of the optic nerve (p < 0.001) at higher rates compared with group B. The most commonly used medical treatment was acetazolamide (99%); corticosteroids were used more frequently by group B (p < 0.001). Optic nerve sheath fenestration (88.3%) was the first-line and ventriculo-peritoneal shunt (70.5%) was the second preferred surgical approach. It was observed that serial lumbar puncture applications (57.0%) were preferred more frequently than venous sinus stenting (19.0%) and bariatric surgery (10.0%). Conclusions: The changing information in the last decade about IIH was more closely followed by younger neurologists despite their lesser experience, but classic methods were preferred in surgical approaches in both groups. Our findings indicated that post-graduate education and guidelines should be disseminated for IIH

Pregnancy and Epilepsy: Monitoring and Treating the Seizures

Objectives:Epilepsy is the second most common neurological disorder after migraine in pregnancy. The most suitable antiepileptic drug (AED) to be chosen in this period would minimize the possible maternal and fetal complications. The present study monitors the pregnancies and prognoses of pregnant patients with epilepsy, who were treated in our clinic, and evaluates the efficiency of the antiepileptic treatment.Methods:In this study, 50 pregnant patients were included who were examined and treated in the epilepsy clinic from January 2000 to May 2018. Seizure types and frequencies, AEDs used, and pregnancy processes of the patients were investigated retrospectively based on their medical file records.Results:Of the 1965 patients with epilepsy, the number of pregnant patients included in this study was 50 (2.54%), while the total number of pregnancies was 68 and 27 pregnant patients had generalized onset seizures. There were not any changes in the seizure frequency in 57.1% of the patients. In this study, 40 patients were treated with monotherapy. The most frequently preferred AED was valproic acid with 10 patients. During the pregnancy, the daily dose was increased for 10 patients, and the drug with the highest increment was lamotrigine with four patients. Considering the births concerning fetal malformation, only one infant had spina bifida, and there were no stillbirths.Conclusion:This hospital-based study showed that the course of seizure frequency during pregnancy is unpredictable. Following-up and monitoring the pregnant patients closely are of critical importance for pregnant women with epilepsy to have a healthier pregnancy with possible lowest complication rates

Is Allodynia a Determinant Factor in the Effectiveness of Transcranial Direct Current Stimulation in the Prophylaxis of Migraine?

Objectives Allodynia, the clinical marker of central sensitization, affects even simple daily living activities and increases the tendency for migraine to be more resistant to treatment and have a chronic course. Migraine that impairs quality of life can often be treated with variable pharmaceutical agents, but with various side effects. Transcranial direct current stimulation (tDCS) is a potential alternative treatment for migraine prophylaxis

Eating attitudes of migraine patients in Turkey: a prospective multi-center study

Background: Migraine is a disease characterized by headache attacks. The disease is multifactorial in etiology and genetic and environmental factors play role in pathogenesis. Migraine can also be accompanied by psychiatric disorders like neurotism and obsessive compulsive disorder. Stress, hormonal changes and certain food intake can trigger attacks in migraine. Previous studies showed that eating attitudes and disorders are prevalant in patients with migraine. Eating disorders are psychiatric disorders related to abnormal eating habits. Both migraine and eating disorders are common in young women and personality profiles of these patient groups are also similar. A possible relationship which shows that migraine and eating habits are related can lead to a better understanding of disease pathogenesis and subsequently new therapeutic options on both entities. Association of migraine in relation to severity, depression and anxiety and eating habits and disorders were aimed to be investigated in this study. Methods: The study was designed as a prospective, multi-center, case control study. Twenty-one centers from Turkey was involved in the study. The gathered data was collected and evaluated at a single designated center. From a pool of 1200 migraine patients and 958 healthy control group, two groups as patient group and study group was created with PS matching method in relation to age, body-mass index, marital status and employment status. Eating Attitudes Test-26 (EAT-26), Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) were applied to both study groups. The data gathered was compared between two groups. Results: EAT-26 scores and the requirement for referral to a psychiatrist due to symptoms related to eating disorder were both statistically significantly higher in patient group compared to control group (p = 0.034 and p = 0.0001 respectively). Patients with migraine had higher scores in both BDI and BAI compared to control group (p = 0.0001 and p = 0.0001 respectively). Severity of pain or frequency of attacks were not found to be related to eating attitudes (r:0.09, p = 0.055). Conclusions: Migraine patients were found to have higher EAT-26, BDI and BAI scores along with a higher rate of referral to a psychiatrist due to symptoms. Results of the study showed that eating habits are altered in migraine patients with higher risk of eating disorders. Depression and anxiety are also found to be common amongst migraine patients