The EEG Profile of an Outpatient Adult EEG Laboratory of one of the Reference Epilepsy Center in Turkey

Objectives:EEG training can be provided during neurology residency and in PhD, observership or fellowship programmes after residency in Turkey. In this study, we aim to reveal the EEG profile of a reference epilepsy center which provides EEG training in Turkey, by evaluating our patients’ clinical data and EEG findings within three months.Methods:The patients’ clinical data and EEG findings were retrospectively assessed and categorized in groups. EEG recordings that have multiple EEG findings (both focal slowing and interictal epileptic abnormality) were added into each group. EEGs with NCSE, clinical or subclinical ictal recordings, PNES and arrhythmias were noted.Results:Most of the 867 EEGs (56.2%) were performed for epilepsy. Three hundred thirty-six of the EEG recordings (39%) had normal findings while the rest had minimum one abnormal findings. One hundred ninety of the EEG’S (22%) had interictal epileptic discharges, 198 EEGs (23%) had focal or hemispheric slowing, 358 EEGs (41%) had non-specific findings. Fifteen (2%) EEGs had ictal recordings and 19 (2%) had NCSE. NCSE was found in 26% of patients presenting with altered consciousness. Habitual seizures were present with verbal induction in 3/11 patients diagnosis with PNES. Arrhythmia was found 4%.Conclusion:The most common reason to perform a routine EEG is epilepsy. The NCSE, ictal recordings, PNES and arrhythmias are not rare in an outpatient EEG laboratory. NCSE can be observed in 1/4 of patients who underwent EEG recording due to altered consciousness. This study reveals a cross-sectional profile of the reference hospital. EEG training would be provided with experienced specialists by interpreting quantitatively and qualitatively adequate EEGs

Leptomeningeal enhancement as a sole magnetic resonance imaging finding of secondary central nervous system vasculitis: A case report

The main radiological findings of central nervous system (CNS) consist of multiple subcortical infarcts, parenchymal and leptomeningeal enhancement, petechial hemorrhages on MRI and multifocal caliber changes of the vessels on MRA and DSA. Solely or prominent leptomeningeal enhancement is rarely seen as an isolated manifestation of CNS. We report a case of intracerebral vasculitis secondary to inflammatory bowel disease (IBD) showing leptomeningeal enhancement as a unique finding in routine contrast-enhanced cranial MRI and aimed to emphasize the importance of these finding in diagnosing CNS

The REM-sleep-related characteristics of narcolepsy: a nation-wide multicenter study in Turkey, the REMCON study

Introduction: Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)