Migraine frequent in patients with epilepsy, a comparison of clinical caracteristics of patients with epilepsy associated with migraine and epilepsy alone

Yazarından yayınlama izni istenecektir.Amaç: Bu çalışmada epilepsili hastalarda migren sıklığının genel popülasyondan daha sık olup olmadığını, migren ve epilepsi birlikteliği gösteren hastaların ortak özelliklerini, varsa bu özelliklerin bize ne gibi ipuçları sağlayabileceğini, bu hastaları tek başına epilepsisi olan hastalarla demografik ve klinik olarak karşılaştırmayı amaçladık. Ayrıca epilepsili hastalarda nöbetle ilişkili başağrılarının sıklığı, klasifikasyonu ve klinik özelliklerini, migren benzeri nöbetle ilişkili başağrısı olan hastalar ve diğer hastaları karşılaştırarak, migren benzeri nöbetle ilişkili başağrısı olan hastalar için risk faktörlerini bulmayı amaçladık. Hastalar ve Yöntemler: Eylül 2005-Mart 2006 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı Epilepsi polikliniğine başvuran, yaşları 13-66 arasında değişen, 60'ı kadın 40'ı erkek toplam 100 epilepsi hastası izinleri alınarak çalışmaya alındı. Semptomatik epilepsisi, mental geriliği olan hastalar ve 13 yaşın altındaki çocuklar çalışma dışı bırakıldılar. Migren ve epilepsi birlikteliği olan hastalar ve tek başına epilepsisi olan hastalar belirlendikten sonra, bunlar demografik ve klinik özellikler açısından karşılaştırıldı. Ayrıca nöbetle ilişkili başağrıları demografik , klinik özellikler ve başağrısı tipleri açısından sorgulandı. Bulgular: Epilepsili hastalarındaki migren prevalansı ile normal popülasyondaki migren prevalansı arasında istatistiksel fark saptanmadı. Epilepsili hastalarda migren riski, epilepsi sendromu, nöbet tipleri, epilepsi süresi, nöbet başlangıç yaşı, nöbet sıklığı, kullandığı antiepileptik sayısı, yaş ve cinsiyet ile ilişkisiz olarak değerlendirildi. Migren ve epilepsi birlikteliği olan hastalarda ailede migren öyküsü, tek başına epilepsisi olan hastalara göre yüksekti. Migren ve epilepsi birlikteliği olan hastalarda auralı migren epidemiyolojik çalışmalara göre daha yüksek oranda gözlendi. Nöbetle ilişkili başağrısı sıklığı literatürlerle uyumlu idi. Nöbetle ilişkili başağrısı tipleri ile epilepsi sendromu, nöbet tipleri, epilepsi süresi, nöbet başlangıç yaşı, nöbet sıklığı, kullandığı antiepileptik sayısı, yaş, cinsiyet arasında ilişki saptanmadı. Nöbetle ilişkili başağrısı olanlarda daha sık olarak migren dışı başağrılarının olduğu gözlendi. Migren benzeri nöbetle ilişkili başağrısı olan hastalarda interiktal migren diğer hastalara göre daha sıktı. Sonuç: Verilerimiz migren ve epilepsi arasında bir bağlantı olabileceğini düşündürmektedir, ancak her iki durumun birlikte bulunduğu olgularda belli bir epilepsi özelliği gösteremedik. Yine de epilepsi ve migren birlikteliği olan hastalarda auralı migren sıklığını daha önce yapılan epidemiyolojik çalışmalardan daha fazla saptadık. Bu da birlikteliğin altında yatan patofizyolojik mekanizma olarak yayılan depresyonun katkısı olabileceği hipotezini desteklemektedir. Migren öyküsünün, migren benzeri nöbetle ilişkili başağrısında daha sık olduğunun gözlenmesi, migrenin, migren benzeri nöbetle ilişkili başağrısına eğilim yarattığını düşündürebilir.Aim: In this study, we aimed to evaluate whether migraine is more frequent in patients with epilepsy compared with general population, to find out common features of patients with migraine and epilepsy togetherness and if there's any, to determine what kind of predictions these features can provide us and to compare patients with migraine and epilepsy together with epilepsy alone in term of demographics and clinical characteristics. And also we tried to reveal frequency, classification and clinical features of seizure related headaches in epilepsy patients and by comparing patients with migraine like seizure related headache with other patients we aimed to find out risk factors for patients with migraine like seizure related headache. Patients and methods: A total of 100 patients with epilepsy who referred to Uludag University Faculty of Medicine Neurology Department Epilepsy Clinic between date of September 2005 and March 2006 included in this study. Of those 60 were females and 40 males and the patients were aged between 13 and 66 years. Patients with symptomatic epilepsy and mental retardation and children under age of 13 years excluded for this study. After patients with epilepsy associated with migraine and epilepsy alone obtained, these were compared according to their demographic and clinical characteristics. Furthermore, seizure-related headaches investigated in term of demographic, clinical characteristics and headache types. Findings: A statistical difference wasn't determined between migraine prevalence in epilepsy patients and migraine prevalence in normal population. In patients with epilepsy migraine risk, epilepsy syndrome, seizure types, epilepsy duration, onset age of seizure, seizure frequency, number of used antiepileptics were evaluated free of age and gender relation. Patients with migraine and epilepsy togetherness had a higher family migraine history than patients with epilepsy alone. Migraine with aura has been more frequently observed in patients with migraine and epilepsy v togetherness according to epidemiologic studies. Seizure related headache frequency was consentient with literature. There wasn't a relation between seizure related headache types and epilepsy syndrome, seizure types, epilepsy duration, onset age of seizure, seizure frequency, number of used antiepileptics, age, gender. In subjects who have seizure related headaches more frequently observed that they have headaches not including migraine. In patients with migraine like seizure related headaches interictal migraine was more often than other patients. Conclusion: Our data suggest that there may be a relation between migraine and epilepsy but we couldn't reveal a certain epilepsy characteristic in cases holding two situations together. But anyway, we determined migraine with aura in patients with epilepsy and migraine togetherness more than previous epidemiologic studies.This supports hypotesis that suggests spreading depression has a contribution to pathophysologic mechanism underlying this togetherness. Due to observation that migraine history is more frequent in migraine like seizure related headache, it can be considered that migraine creates a tendency to migraine like seizure related headache

Relationship between the Empathy of Emergency Personnel and Their Approach to Acute Stroke Patients

Aim: The aim of this study was to investigate the relationship between the empathy level of emergency department physicians and nurses and the referral of patients for intravenous thrombolytic and/or endovascular thrombectomy treatment. Material and Methods: This cross-sectional study was carried out with the emergency department physicians and nurses of hospitals that did not have a stroke clinic in Bursa in July 2019, and included 198 emergency personnel. Participants’ sociodemographic characteristics, professional working conditions, and stroke history in their immediate environment (friends and family) were recorded and empathy level was measured. The health professions version of the Jefferson Scale of Empathy was used in the assessment of empathy status among emergency physicians and nurses. Results: The mean empathy score of the study group, by the Jefferson scale of empathy, was found 98.63±14.83 points. In this study, no significant relationship was found between the empathy score and the number of referrals (p=0.962). The total empathy score did not differ by the role of the participants in the hospital (p=0.161) or observation of stroke cases in their family or their friends (p=0.694). Healthcare professionals who had received emergency education (p<0.001), were older (p<0.001), spent more time in their profession (p=0.005), and had observed stroke cases in their family or friends (p=0.005) transferred more stroke cases. Conclusion: This study suggests that interventions for increasing the empathy levels of emergency medicine specialists and nurses will not have a general effect on the referral of acute stroke cases for intravenous thrombolytic and endovascular thrombectomy treatment

FACTORS AFFECTING THE ARRIVAL TIME TO HOSPITALOF PATIENTS WITH ACUTE ISCHEMIC STROKE

Objective: It is known that intravenous thrombolytic therapy in ischemic stroke is beneficial in selected patients who arrived within the first 4.5 hours after the onset of the symptoms and the effectiveness of the treatment depends on early arrival to the hospital. The more patients arrival to the hospital within this time zone, the more they will have the chance to receive thrombolytic therapy. This study aims to investigate the factors that cause delay in the arrival of patients with ischemic stroke to the hospital. Methods: Patients diagnosed with acute ischemic stroke who applied to the neurology outpatient clinic and emergency room between February and May 2019 were included in the study. A direct interview survey was conducted to investigate the factors that delay the arrival to patients or relatives of the patients arrival to Bursa Yuksek Ihtisas Training and Research Hospital due to acute stroke. According to the time of arrival to the hospital after the onset of stroke symptoms, patients were classified as early (≤ 4.5 hours) and late arrival (> 4.5 hours). Based on this grouping, factors causing delay in patients' access to hospital were compared statistically. Results: A total of 251 patients and / or patient relatives who arrived to the emergency and neurology outpatient clinic were interviewed. Of the 251 patients included in the study, 119 (47.4%) were female and the mean age was 70 (34-94) years. Approximately 72.5% of the patients were arrived in the first 4.5-hour slice after the onset of stroke symptoms. Factors causing late arrival were determined as being female, having low NIHSS score and not using ambulance in transportation. Conclusion: Due to the delay in arrival of 27.5% of the patients, there is no chance to apply thrombolytic therapy to eligible ones. The factors resulting in the delay were discovered as female gender, low severity of the stroke and transportation without ambulance. In this respect, community-oriented trainings are required

DIAGNOSTIC DIFFICULTIES IN PATIENTS WITH JUVENILE MYOCLONIC EPILEPSY

Objective: In this study, we aim to share the data of patients who were followed-up and treated with a diagnosis of juvenile myoclonic epilepsy (JME), and to draw attention to the difficulties in diagnosis and the problems that may occur in treatment. Method: In this study, seizure types, demographic and EEG characteristics of 75 patients with JME were retrospectively analyzed in our tertiary care center. Results: Of the total 75 cases, 48 patients (64%) were female and 27 patients (36%) were male. The overall female/male ratio was 1.7/1. The age of onset of seizures ranged from 6 to 24 years old. According to seizure types, all patients had myoclonic seizures, 65 patients (86%) had generalized tonic clonic seizures and 17 patients (22.6%) had absence seizures. Of the cases, 13 patients (17.3%) had febrile convulsions, 4 patients (5.3%) had a history of febrile convulsions in their families and 10 patients (13.3%) had a family history of epilepsy. For 63 (84%) patients, seizures were under control with valproic acid alone. When the patients EEGs were examined, 55 patients (73.3%) had generalized epileptiform activity, 11 patients (14.7%) had focal abnormaly and 9 patients (12%) had no abnormality. It was determined that the diagnosis of JME was not established at the onset of the disease and the seizures were not under control for 40% of the patients who were admitted to our outpatient clinic from different centers. Conclusion: Physicians should be very careful in the diagnosis of JME and the presence of myoclonia and absence seizures should be questioned in all patients presenting with generalized tonic-clonic seizures between 8-20 years of age in polyclinic practice

Proton magnetic resonance spectroscopy study of bilateral thalamus in juvenile myoclonic epilepsy

SummaryPurposeTo investigate neuronal dysfunction in the thalami of juvenile myoclonic epilepsy (JME) by using proton magnetic resonance spectroscopy (MRS).MethodsWe performed single-voxel proton MRS over the right and the left thalami of 15 consecutive patients (10 women, 5 men) with JME (mean age 20.3 years) and 16 healthy volunteers (10 women, 6 men) (mean age 24.5 years). All patients had seizure onset in late childhood–teenage, normal neurologic examination, typical electroencephalogram (EEG) of JME and normal magnetic resonance imaging (MRI). We determined N-acetylaspartate (NAA) values and NAA over creatine–phosphocreatine (Cr) values. Mann–Whitney U-test was used to evaluate group differences.ResultsGroup analysis showed that echo time (TE) 270 integral value of NAA over left thalamus were significantly decreased in JME patients as compared with controls (34.6033±15.8386; 48.0362±22.2407, respectively, P=0.019). Also group analysis showed that thalami NAA/Cr ratios were significantly decreased in JME patients (right side, 2.21±1.07; left side 2.00±0.72) as compared with controls (right side, 3.45±1.50; left side, 3.08±1.60; P=0.011 and P=0.030, respectively).ConclusionIn the previous studies, NAA values in patients with JME found that they were not statistically lower in thalami than control group. But, in our study, NAA value was found low as well. It has been known that NAA is a neuronal marker and hence it is a valuable metabolite in the neuron physiopathology. As a result, in the patients with JME we tried to support the theory that the underlying mechanism of the generalized seizures was the abnormal thalamocortical circuity, determining the thalamic neuronal dysfunction in MRS statistically

Development of Psychosis in Two Cases with Epilepsy Diagnosis: Clinical Findings, Magnetic Resonance Imaging Features, and Neuropsychological Assessment

Epilepsy-related psychosis is generally separated into 3 subgroups: postictal, interictal, and bimodal psychosis. However, if the psychosis continues for 1 month or longer, it is defined as chronic schizophrenia-like psychosis. It tends to occur 10 to 15 years after the onset of epilepsy, and cannot easily be distinguished from schizophrenia. In controlled trials, the risk of developing a psychotic disorder was 10-times higher in epileptic patients than in patients with other neurological disorders. In this presentation, 2 patients with epilepsy and chronic schizophrenia-like psychosis were diagnosed according to clinical and radiological findings. In both cases, psychotic symptoms appeared after the onset of epileptic seizures. Delusions and hallucinations were present as positive symptomatology. The intensity and severity of epileptic seizures decreased after the onset of psychotic symptoms in both cases. Forced normalization is an important concept for continued discussion