In Case Sleep Related Bruxism is Resistant to Treatment…

The diagnosis of sleep-related bruxism is easily established clinically. When there is no identifiable underlying cause, it is classified as primary or idiopathic. However, secondary-symptomatic-forms are much more commonly observed and should therefore be questioned. In this case report, a 17 year-old boy was presented who admitted to our Sleep and Disorders Unit complaining of bruxism in his sleep but diagnosed as having secondary sleep related bruxism associated with arousals secondary to periodic leg movements in sleep. Especially in cases resistant to treatment, secondary conditions and possible underlying sleep disorders should be well-questioned and polysomnography should be performed even it is not necessary for the clinical diagnosis of sleep related bruxism

Comparison of triptans, NSAID and combination in migraine attack treatment

Amaç: Migren atağında baş ağrısı aynı atak içinde rekürrens gösterebilmektedir. Çalışmamızın amacı migren atağını sonlandırmak için yaygın kullanılan nonsteroid antienflamatuvar ilaçlar (NSAİİ) ve triptan gruplarından seçilen birer ajanın ve bunların kombine kullanımının migren atağını sonlandırma üzerindeki etkilerini göstermek ve karşılaştırmaktır.Gereç ve Yöntem: Altmış yedi migren hastasına ait 201 atak değerlendirildi. Hastalar sıra ile üç ayrı tedavi grubuna bire birer alındılar. Birinci grup hastanın baş ağrısı atağı başladığında rizatriptan 10 mg, ikinci grubun tenoksikam 20 mg, üçüncü grubun rizatriptan 10 mg ve ek olarak tenoksikam 20 mg alması sağlandı. Hastalar ağrıyı hissettikleri ve ilaçlarını aldıkları anda, 30 dakika, 60 dakika, bir saat, iki saat, dört saat, sekiz saat sonra ve ertesi gündeki baş ağrısı şiddetlerini Vizüel Analog Skalası'nda (VAS) işaretlediler. Her hasta için toplam üç ayrı atak değerlendirildi. Ataklar, her tedavi alternatifi için ayrı ayrı değerlendirilerek karşılaştırıldı.Bulgular: Tedavi gruplarının VAS değerleri atak başlangıcında farksız iken, Rizatriptan grubunda ve kombinasyon grubunda 30. dakikadan itibaren VAS puanları tenoksikama göre daha düşük bulundu. Rizatriptan grubunda ve kombinasyon grubunda 60. dakikada VAS ortalama değeri 4'ün altına düştü. Tenoksikam grubunda ise 60. dakika VAS değeri dördün üzerinde kaldı ve bu gruptaki VAS ortalaması hem rizatriptan hem de kombinasyon grubundan anlamlı olarak daha yüksek bulundu. Yirmi dördüncü saat değerlendirmesinde ise kombinasyon ve tenoksikam gruplarının VAS puanları birbirine eşi, rizatriptan grubunun VAS ortalaması diğer iki gruptan yüksek bulundu.Sonuç: Tek ilaç ile yeterli kontrol sağlanamayan ataklarda hızlı etkili triptan ve uzun etkili NSAİİ uygun bir tedavi seçeneği olarak görünmektedir.Objectives: Headache during migraine attack may recur during a single attack. The present study evaluated efficacy of both individual and combined use of agents from nonsteroidal anti-inflammatory drug (NSAID) and triptan groups widely used in treatment of migraine attacks.Methods: A total of 201 attacks in 67 migraine patients were evaluated. Patients were divided into 3 study groups: those receiving rizatriptan 10mg, tenoxicam 20 mg, and rizatriptan + tenoxicam (combination). Patients evaluated severity of headache based on visual analogue scale (VAS) at moment of drug delivery, after 30 minutes, and after 1, 2, 4, 8 and 24 hours. Attacks were evaluated separately for each treatment alternative, and results were also compared.Results: VAS values were the same at onset of attack, but were lower in rizatriptan and combination groups than in tenoxicam group at 30 minutes and onward. VAS score was above 4 at 60 minutes in tenoxicam group and mean VAS value in this group was found to be significantly higher than values in rizatriptan and combined groups. At 24 hours, VAS scores were similar in combination and tenoxicam groups, while rizatriptan group had higher mean VAS score than the other 2 groups.Conclusion: When single drug use fails to provide adequate control, combined use of a rapid-acting triptan and a long-acting NSAID appears to be a suitable treatment option

Parkinson hastalığı ile kemik yoğunluğunu ilişkisi

Amaç: Parkinson hastalığı tanısıyla takipli hastalar artmış fraktur; özellikle femur başı frakturu riskiyle karşı karşıyadır. Bu risk artışının hastalığa özgü postural instabilite, nörolojik hasar ya da kemik mineral yoğunluğundaki azalmaya bağlanabileceği öne sürülmüştür. Parkinson hastalığında düşme sıklığı ve komplikasyonlarının artışı nedeniyle Parkinson hastalığı ve osteoporoz ilişkisi önemini korumaktadır. Bu nedenle Türk toplumundaki Parkinson hastalığıyla osteoporoz varlığı arasındaki ilişki incelemeye değer bulunmuştur. Gereç ve Yöntem: 65 idiyopatik parkinson hastasının dahil olduğu hasta grubu ile cinsiyet ve yaş aralığı uyumlu, bilinen sistemik hastalığı olmayan 30 bireyi kontrol grubu olarak kabul ederek kemik mineral yoğunluklarını karşılaştırdık. Kemik metabolizmasına etkisi olabilecek elektrolit ve metabolik hastalığa sahip bireyler çalışma dışı tutulmuştur. Parkinson hastalığı UPDRS ve Hoehn &Yahr skalalarına göre evrelendirilerek incelenmiştir. Bulgular: Çalışmanın sonucunda Parkinson hastaları grubunda anlamlı olarak kemik mineral yoğunluklarında kontrol grubuna göre azalma; ayrıca hastalık evresi Hoehn&Yahr skalasına göre arttıkça; hastaların immobilitesi arttıkça, kemik mineral yoğunluğunda azalma saptandı (p:0.037). Sonuç: Bu sonuçlar ışığında Parkinson hastalığı tanısıyla takipli bireylerde primer ve sekonder koruma tedavilerini planlarken osteoporoz ve olası komplikasyonların göz önünde bulundurulması gerektiğini vurgulamaktayız.Objective: Patients with a diagnosis of Parkinson's disease face an increased risk of bone fracture, especially fracture of the head of the femur. This increased risk has been attributed to the postural instability characteristic of the disease, to neurological damage or to a reduction in bone mineral density. Because of the increased frequency of falling and its complications, the link between Parkinson's disease and osteoporosis demands attention. For this reason, we thought it of value to investigate the relationship between Parkinson's disease and the incidence of osteoporosis in the Turkish population. Materials and Methods: We compared a group of 65 idiopathic Parkinson's patients with a control group of 30 individuals, who were matched for age and sex, and who had no known systemic diseases, for bone mineral density. Individuals with electrolyte and metabolic diseases which might affect bone metabolism were excluded from the study. The stage of Parkinson's disease was determined according to UPDRS and Hoehn and Yahr scores. Results: Results of the study showed a significant reduction in bone mineral density in Parkinson's patients compared to the control group; also, as the stage of the disease advanced according to the Hoehn and Yahr score, and as immobility increased, so bone mineral density decreased (p:0.037). Conclusion: In the light of these results, we emphasize that osteoporosis and its possible complications should be taken into account when planning primary and secondary care treatments for Parkinson's patients

The clinical significance and electrophysiologic findings of fixation-off and closure of the eyes sensitivity: Data from a prospective unselected population

© 2020 Elsevier B.V.Purpose: Electroencephalography (EEG) findings related to the eye-closing motion can be defined in two ways: ‘sensitivity to eyes closed’ (SEC) and ‘eye closure sensitivity (ECS).’ Fixation-off sensitivity (FOS) is a different phenomenon induced by the elimination of central vision/fixation. The purpose of our study was to determine the frequencies of SEC, ESC, and FOS, and to analyze the relationship between eyes closure and the fixation-off phenomenon and clinical importance in an unselected population. Methods: We prospectively evaluated 200 routine interictal EEGs by adding a standardized FOS examination protocol between June and September 2015. Goggles covered with semitransparent tape were used to evaluate FOS. We determined SEC when the epileptiform discharges appeared during eye closure and continued during the eye closed state, whereas ECS was defined as transient epileptic abnormalities following the closure of the eyes lasting for 1−4 sec. The patients were evaluated in terms of demographic characteristics, clinical features, and the relationship between SEC, ECS, and FOS. Results: We detected SEC in 9 (4.4 %) and ECS in 11 (5.4 %) patients. FOS was detected in four (44.4 %) of the patients who showed SEC, all of whom had occipital epileptiform discharges. A statistically significant correlation was found between FOS and treatment resistance in the SEC group (p < 0.001). In logistic regression analysis, occipital lobe epilepsy (p < 0.001) and age under 20 years (p = 0.004) were found as risk factors for SEC. Another interesting finding was the suppression of epileptic discharges with fixation-off in three of 11 patients with ECS. Conclusions: According to the results of our study, FOS is related to treatment resistance. Therefore, FOS should be evaluated in patients with SEC

JUVENILE CHRONIC ARTHRITIS IN A TURKISH POPULATION

The clinical characteristics of 147 Turkish patients with juvenile chronic arthritis seen between 1980 and 1988 were analyzed retrospectively. There was a male predominance (1.3:1), and a relatively low occurrence of early onset pauciarticular disease (16%), chronic anterior uveitis (7%) and positive antinuclear antigens (6%), but a high incidence of secondary amyloidosis (10%) was seen