Nonconvulsive Status Epilepticus and Coma

Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5 and 48%. Nonconvulsive status epilepticus (NCSE) is an electroclinical state associated with an altered mental status (AMS) but lacking convulsive motor activity. It is difficult to diagnose in the obtunded/comatose patients. Such patients have often other serious medical conditions, and the diagnosis of NCSE is frequently delayed in these patients. Diagnosing NCSE demands a high degree of clinical suspicion and for that reason likely remains under-recognized. The most important question, however, is whether the treatment of NCSE in coma improves the outcome of these patients or not. In this review, we aimed to summarize the EEG patterns in NCSE to further delineate the borders between comatose forms of NCSE and coma-epileptiform discharges and to evaluate modified EEG criteria for NCSE in a coma

EEG Biomarker for Alzheimer’s Disease

Alzheimer’s disease (AD) is a neurodegenerative disorder that accounts for nearly 70% of the more than 50 million dementia cases estimated worldwide. There is no cure for AD. Currently, AD diagnosis is carried out using neuropsychological tests, neuroimaging scans, and laboratory tests. In the early stages of AD, brain computed tomography (CT) and magnetic resonance imaging (MRI) findings may be normal, but in late periods, diffuse cortical atrophy can be detected more prominently in the temporal and frontal regions. Electroencephalogram (EEG) is a test that records the electrical signals of the brain by using electrodes that directly reflects cortical neuronal functioning. In addition, EEG is noninvasive and widely available at low cost, has high resolution, and provides access to neuronal signals, unlike functional MR or PET which indirectly detects metabolic signals. Accurate, specific, and cost-effective biomarkers are needed to track the early diagnosis, progression, and treatment response of AD. The findings of EEG in AD are now identified as biomarkers. In this chapter, we reviewed studies that used EEG or event-related potential (ERP) indices as a biomarker of AD

Seizures in Adult with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited disorder, with an estimated prevalence of 1 in 3000–4000 people. Seizures occur 4–7% of individuals with NF1, mostly due to associated brain tumors or cortical malformations. Seizures in NF1 are often relatively easy to control with one or more conventional antiseizure drugs; surgical resection of offending lesions is sometimes pursued. Surgery has been most successful for temporal lobe gliomas. However, if you faced the drug-resistant epilepsy you may consider the cortical malformations, tumors and hippocampal sclerosis. In this chapter, it is aimed to explain the types of seizures, EEG features and the properties of drug therapy in NF1

Giant Hydatid Cyst Originating from Psoas Muscle Extending to the Iliac Bone, Inguinal, and Femoral Canals: A Case Report and Current Literature Review

Retroperitoneal hydatid cysts are extremely rare and difficult to distinguish from other intra-abdominal pathologies, such as synovial sarcoma. In this study, we present a rare case of a complicated retroperitoneal hydatid cyst originating from the psoas muscle without any other focus. A 59-year-old male patient presented to the outpatient clinic with complaints of constipation and a feeling of gradually increasing swelling in the left lower quadrant of the abdomen and left groin area, progressing toward the left leg. In the examinations performed, a multiloculated giant hydatid cyst that filled the left pelvis in the retroperitoneal region, deviated the intra-abdominal organs to the right side, and extended to the left femoral and inguinal canals was detected. The patient underwent surgical excision and was followed up during the postoperative period. No evidence of recurrence was found at the patient’s 3rd and 6th month follow-ups. Primary muscle hydatid cysts necessitate a distinct approach to treatment and management when compared with hydatid cysts in other bodily organs. While recurrences remain a potential concern after resection, it is noteworthy that the window for the formation of fertile cysts typically spans up to 10 months. Thus, it is advisable to conduct regular postoperative follow-up examinations during the first year following surgery to ensure comprehensive monitoring and care

Quality of Sleep and Insomny Violence in University Students in the Period of COVID-19

Amaç: Koronavirüs pandemisi (COVİD-19) sürecinde üniversite öğrencilerinin uyku kalitesi ve insomnia şiddeti ve bunları etkileyen etmenlerin belirlenmesidir.Materyal ve Metot: Çalışmamız 15 Mart- 31 Mayıs 2020 tarihleri arasında üniversitemiz Sağlık Hizmetleri Meslek Yüksekokulu öğrencilerine Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Uykusuzluk Şiddet İndeksi (UŞİ) ve Algılanan Stres Ölçeği (ASÖ) kullanılarak eposta aracılığıyla yapılmıştır.Bulgular: Çalışmaya 446 (414 K, 32 E) öğrenci katılmıştır. Katılımcıların uykuya dalma süresi ortalaması 26,19±22 dakika, uyku süreleri ortalaması ise 7,98±2,10 saattir. PUKİ toplam puan ortalaması 15,69±2,96’dir. ASÖ puan ortalaması 30,94±8,46 olarak tespit edilmiştir. UŞİ puan ortalaması 10,87±5,35’tir ve düzeyi alt eşiğin üzerindedir. Sokağa çıkma yasağı olan grubun olmayan gruba göre daha düşük uykusuzluk şiddetine sahip olduğu görülmektedir. Alkol kullanımına göre uyku kalitesi ve algılanan stres farklılık göstermekte, uykusuzluk şiddeti ise farklılık göstermemektedir. Günde 2 fincandan fazla kahve tüketenlerin en kötü uyku kalitesine ve en yüksek uykusuzlukşiddetine sahip olduğu tespit edilmiştir. Hiç egzersiz yapmayan katılımcılar ve sosyal medyada günde 3 saat ve üzeri zaman geçiren katılımcıların en yüksek algılanan stres düzeyine sahip olduğu tespit edilmiştir.Sonuç: COVİD-19 pandemisi sırasında evde kalma şeklinde uygulanan tedbirlerin uyku sağlığı üzerinde olumsuz etkisi olduğu görülmektedir.Aim: To determine the sleep quality and insomnia severity of university students and the factors affecting them during the coronavirus pandemic (COVID-19) process. Materials and Methods: Our study was conducted by e-mail using Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Perceived Stress Scale (PSS) between 15 March and 31 May 2020 at our university's Health Services Vocational School. Results: 446 (414 F, 32 M) students participated in the study. Participants' mean time to fall asleep is 26.19 ± 22 minutes, and their average sleep time is 7.98 ± 2.10 hours. PSQI total score average is 15.69 ± 2.96. The mean PSS score was determined as 30.94 ± 8.46. The mean ISI score is 10.87 ± 5.35 and its level is above the lower threshold. It is observed that the group with the curfew has a lower severity of insomnia than the group without it. Sleep quality and perceived stress differ according to alcohol use, but insomnia severity does not differ. It has been found that those who consume more than 2 cups of coffee a day have the worst sleep quality and the highest severity of insomnia. It was found that the participants who did not exercise at all and those who spent 3 hours or more a day on social media had the highest perceived stress level. Conclusion: It is seen that measures applied as staying at home during the COVID-19 pandemic have a negative effect on sleep health

Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria

BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs

Effects of Lacosamide in Cerebral Tuberculoma-Induced Nonconvulsive Status Epilepticus: Case Report

Nonconvulsive status epilepticus (NCSE) is characterized by unexplained changes in behavior and mental status accompanied with continuous seizure activity seen on electroencephalography (EEG). Treatment is similar to treatment of status epilepticus. Lacosamide is one of the newer antiepileptic drugs (AEDs) that slow inactivation of voltage-dependent sodium channels. It has high oral bioavailability, is low protein binding and is primarily metabolized by the liver enzyme CYP2C19. Central nervous system (CNS) tuberculosis may present with signs of parenchymal lesions instead of meningitis. Presently described is a patient who was diagnosed as CNS tuberculosis a year ago with nonconvulsive status epilepticus. Status could be not be controlled with levetiracetam; however, use of lacosamide successfully resolved nonconvulsive status epilepticus

A Case of CADASIL with NOTCH3 Gene Mutation Presenting with Focal Epileptic Seizure: A Case of CADASIL Presenting with Focal Epileptic Seizure

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary disease of cerebral microvessels with autosomal dominant inheritance due to the NOTCH3 gene mutation. Epileptic seizures were observed in 5-11% of CADASIL cases. Observation of seizures as an initial clinical observation is a rare condition in patients with CADASIL patients. In this report, we present a patient with temporal lobe seizure, whose condition was diagnosed through gene analysis as CADASIL