Behcet's disease without neurological manifestations

WOS: 000230994800001PubMed: 16082149

Visual Hallucinations Due to Rivastigmine Transdermal Patch Application in Alzheimer's Disease; The First Case Report

Rivastigmine is a well-known dual acting acetylcholinesterase and butyrylcholinesterase inhibitor, which is effective on behavioral and psychiatric symptoms including hallucinations, as well as cognitive symptoms of dementia. The most common adverse effects of rivastigmine related to cholinergic stimulation in brain and peripheral tissues are gastrointestinal, cardiorespiratory, extrapyramidal, genitourinary, musculoskeletal symptoms, sleep disturbances, and skin irritations with the transdermal patch form in particular. Despite to the previous reports revealing the improving effects of the drug on hallucinations, we presented a-80 year old women with Alzheimer's disease suffering from visual hallucinations whose complaints began with rivastigmine treatment. Since the patient had recent memory disturbance without any behavioral and/or psychiatric symptoms before rivastigmine administration, and visual hallucinations disappeared with the discontinuation of the drug, visual hallucinations were attributed to rivastigmine

Ergotamine tartrate in migraine attack and tolerance development

ÖZET Bilimsel zemin: Migren, nörolojik, otonomik ve gastrointestinal değişikliklerin çeşitli kombinasyonlarının eşlik ettiği primer epizodik bir baş ağrısı bozukluğudur..Bireyin yaşam kalitesinde ve sosyoekonomik düzeyinde düşüşe yol açan ciddi migren ataklarının akut tedavisinde nonsteroid antiinflamatuar ilaçlar, basit veya kombinasyon analjeziklerinin yetersiz kalması nedeniyle triptan, dihidroergotamin ve ergotamin gibi migren spesifik ajanlar önerilmektedir. Amaç: Bu çalışmanın amacı migren tanısı almış ve ergotamin tartarat kullanmış hastaların retrospektif olarak değerlendirilerek, ergotamin kullanımına bağlı görülebilecek olası yan etkilerin ve tolerans gelişiminin incelenmesidir. Gereç ve yöntemler: Fakültemiz baş ağrısı polikliniğinde IHS kriterlerine göre migren tanısı almış ve hayatlarının bir döneminde ergotamin tartarat kullanmış olan 205 hasta retrospektif olarak değerlendirilmiştir. Bu hastalarda ergotamin tartarat kullanımına bağlı tolerans gelişimi, aşırı kullanım ve yan etkiler incelenmiştir. Sonuçlar: Hastaların ortalama hastalık süreleri 10.835.02 yıl (3-30 yıl), ortalama ergotamin tartarat kullanım süreleri 2.461.29 yıldır (1-10 yıl). Hastaların 118'inde (%57.5) ortalama 1.961.04 (1-7) yılda tolerans geliştiği saptanmıştır. Bu hastaların 76'sının (%64.4) kullandıkları dozu artırırken, geri kalan 42' sinin (%35.6) ise ihtiyaç duymalarına rağmen kullandıkları dozu artırmadıkları görülmüştür. Doz artışına giden hastaların başlangıçta kullandıkları ortalama doz 5.922.12 (1-10) tablet iken, tolerans gelişimi sonrası kullandıkları ortalama doz 20.638.21 (8-30) tablet olarak bulunmuştur. Hastaların 87'si (%42.5), ortalama 1.961.10 yılda (1-5 yıl) yan etkiler nedeniyle, doz artışı yapmaksızın ergotamin tartarat kullanımını bırakmışlardır. Saptanan yan etkileri bulantı-kusma (%14.6), sedasyon (% 10.2), hipertansiyon (%6.3), miyalji (%4.8), miyokard infarktüsü (%2.9), diyare (%2.4) ve bradikardi (%1.3) olarak özetlemek mümkündür. İzlenimler: Migren tekrarlayan baş ağrısı atakları ile seyreden kronik bir hastalıktır. Atak tedavisi gereksinimi olan ve basit analjeziklere yanıt vermeyen hastalarda tedaviye direnç, rekürren baş ağrıları ve kronik günlük baş ağrısına dönüşüm daha sıktır. Bu tür potansiyel risk altında olan hastalarda atak tedavisi planlarken, sık kullanıma bağlı olarak tolerans gelişimi ve yan etki riskinin artabileceği göz önünde bulundurulmalıdır. Triptanların kullanımından önceki dönemlerde iyi bir tercih olan ergotaminlerin, özellikle sık hekim kontrolü olmayan hastalarda geri dönüşü zor karmaşık tablolara neden olabileceğini göz önünde bulundurmak önemlidir.ABSTRACT Use of Ergotamine Tartarate in Migraine Attack and Tolerance Development Background: Migraine is a primary headache disorder with accompanying combinations of neurological, autonomic and gastrointestinal manifestations. Migraine spesific agents such as triptans, dihydroergotamine and ergotamine are recommended in the acute treatment of severe migraine attacks that cause a decline in individual's quality of life and socioeconomic level, in which nonsteroid antiinflammatory drugs, simple or combination analgesics are insufficient. Objective: The aim of this study is to evaluate the patients with the diagnosis of migraine that used .ergotamine tartrate retrospectively, and to investigate the possible side-effects, tolerance development due to ergotamine tartrate. Material and Methods: Two hundred and five patients who attended to the headache polydinic of our faculty with the diagnosis of migraine due to IHS (International Headache Society) criteria who used ergotamine tartrate once in their lifetimes were evaluated retrospectively. Tolerance development, overuse and side-effects were investigated in these patients. • . Results: Mean illness duration of the patients was 10.83±5.02 years (3- 30 years) and the mean duration of ergotamine tartrate usage was 2.46±1.29 years (1-10 years). Ergotamine tartrate tolerance wasdetermined in the 118 (57.5%) of the patients at the mean duration of 1.96±1.04 years (1-7 years). Seventy six (64.4%) of these patients increased the ergotamine tartrate dosage, while the remaining 42 (35.6%) did not increased the dosage despite its necessity. The mean initial ergotamine tartrate dosage of the patients who increased the dosage was found to be 5.92±2.12(1-10) tablets, while the mean dosage was found to be 20.63±8.21 (8-30) tablets after tolerance development. Eighty seven (42.5%) of the patients withdrew ergotamine tartrate without dose increasement due to its side-effects, on an average of 1.96± 1.10 years (1 -5 years). It is possible to summarize the side-effects as nausea-vomiting (14.6%), sedation (10.2%), hypertension (6.3%), myalgia (4.8%), myocardial infarction (2.9%), diarrhea (2.4%) and bradycardia (1.3%). Conclusions: Migraine is a chronic disease coursing with recurrent headache attacks. Resistance to treatment, recurrent headaches and transformation to chronic daily headache is more frequent at the patients in need of attack treatment and unresponsive to simple analgesics. While planning the attack treatment of the patients under such potential risk, tolerance development and the increased risk of side-effects due to drug abuse has to be considered. It is important to consider that ergotamines which were a good.choice in the times prior to the usage of triptans, may lead to-complex, irreversible situations, particularly in the patients without frequent doctor control

Electrophysiological changes in iron deficiency anemia

WOS: 000298822200001Iron deficiency anemia (IDA) is the most common nutritional problem worldwide. Owing to the role of iron in brain energy metabolism, neurotransmitter function and myelin formation, IDA may lead to behavioral, developmental and cognitive dysfunctions. Iron is an essential element and has an important role in several metabolic and enzymatic processes including NADPH reductase activity and cytochrome oxidase system. Our aim was to investigate the electrophysiological effects of IDA on the peripheral nervous system, and to evaluate whether or not the possible electrophysiological abnormalities are reversible with appropriate doses of iron therapy. Electrophysiological evaluations were performed in 52 patients with newly diagnosed IDA and 30 age-matched healthy controls. Electrophysiological evaluations were repeated after 3 months of oral iron therapy. Normal electrophysiological findings were recorded in 38 (73.07%) patients, while 4 (7.69%) patients had polyneuropathy (PNP) and 10 (19.24%) had carpal tunnel syndrome (CTS) findings. Except for one patient with PNP and CTS findings each, the electrophysiological findings of all patients were found to have returned to normal ranges after 3 months of oral iron therapy. Detection of iron responsive neuropathic processes (PNP and CTS) in IDA patients suggested that IDA may cause peripheral nervous system involvement. It is important to emphasize the examinations for IDA as an etiologic factor on planning treatment for neuropathy patients. In cases where IDA is present, it would be beneficial to treat IDA with iron before applying other treatment options for neuropathy

An uncommon case of transient ischemic attack due to energy drink: central homonymous hemianopic scotoma

WOS: 000400411700009Energy drinks are one of the most popular drinks among adults in today's world. They consist of caffeine with high concentrations, simple sugars or sweeteners, amino acids such as taurine, creatine, carnitine, ginseng, vitamins and other plant-based substances as guarana. Since caffeine is a strong methylxanthine leading to central nervous system exitation and platelet aggregation, it may be a risk factor for cerebrovascular events like stroke, seizure, and transient ischemic attacks, especially patients with prothrombotic basis. Thus, we presented a young male who suffered from transient ischemic attack of bilateral central homonymous hemianopic scotoma hours after energy drink consumption

Electrophysiological changes in ron deficiency anemia: Polyneuropathy

Bilimsel Zemin: Demir eksikliği anemisi (DEA) en sık gıda eksikliği olarak bilinmektedir. Demirin beyin enerji metabolizması, nörotransmitter fonksiyonu ve miyelin formasyonu üzerindeki önemli rolüne bağlı olarak DEA davranışsal, gelişimsel ve kognitif disfonksiyonlara yol açabilmektedir. Amaç: Çalışmamızda DEA’ nin periferik sinir sistemi üzerindeki etkilerini araştırmak ve olası elektrofizyolojik anormalliklerin uygun dozda demir tedavisi ile düzelip düzelmediğini incelemek amaçlanmıştır. Materyal ve Metodlar: Yeni tanı almış 52 DEA hastası ve yaşları eşleştirilmiş 30 sağlıklı kişiye başlangıçta ve 3 aylık oral demir tedavisi sonrasında elektrofizyolojik inceleme yapılmıştır. Bulgular: Dört (%7.69) hastada polinöropatiye ait elektrofizyolojik bulgular saptanmıştır. Üç aylık oral demir tedavisi sonrası polinöropatili 1 hasta dışında, tüm hastaların elektrofizyolojik olarak normale döndüğü görülmüştür. Sonuç: DEA hastalarında demir eksikliğine bağlı nöropatik süreçlerin saptanması, DEA’ nin periferik sinir sistemi tutulumuna yol açabileceğini düşündürmektedir. Bu durum, nöropati hastalarında etyolojik açıdan demir eksikliğinin araştırılmasını vurgulamak açısından önemlidir. Nöropatiyle birlikte DEA’ nin varlığında, nöropatiye yönelik başka tedavi seçenekleri denenmeden önce demir replasmanı uygulaması faydalı olabilir.Background: Iron deficiency anemia (IDA) is known as the most common nutritional problem. Owing to the important role of iron in brain energy metabolism, neurotransmitter function and myelin formation, IDA may lead to behavioral, developmental and cognitive dysfunctions. Objective: To investigate the electrophysiological effects of IDA on the peripheral nervous system, and to evaluate whether the possible electrophysiological abnormalities are reversible with appropriate doses of iron therapy, or not. Materials and Methods: Electrophysiological evaluations were performed on 52 patients with newly diagnosed IDA and 30 age-matched healthy controls. The electrophysiological evaluations were repeated after 3 months of oral iron therapy. Results: Four (7.69%) patients had polyneuropathy due to the electrophysiological evaluations. Except 1 patient with polyneuropathy, the electrophysiological findings of all patients were found to return to normal ranges after 3 months of oral iron therapy. Conclusions: The detection of iron responsive neuropathic processes in IDA patients led us to think that IDA may cause peripheral nervous system involvement. It is important to emphasize the investigation of iron deficiency anemia as an etiological factor while planning a treatment for neuropathy patients. In cases where IDA is present, it would be benefical to treat IDA with iron replacement before applying other treatment options in neuropathy

Hormone replacement therapy in hypothyroidism and nerve conduction study

WOS: 000239795400004PubMed: 16844546Objectives. - To evaluate the electrodiagnostic evidence of peripheral nerve dysfunction in patients with hypothyroidism before and after hormone replacement treatment. Materials and methods. - Forty patients aged above 18 years diagnosed with hypothyroidism were included in our study. Patients with FT4 levels below 11.6 pmol/l and TSH levels above 4.2 IU/ml were accepted as hypothyroidic. Electrodiagnostic evaluation was performed at the onset of the study and after 3 months. Electrodiagnostic evaluation included motor and sensory nerve conduction studies, and F wave. Results. - The differences between pre- and post-treatment FT4, FT3 and TSH values were found to be statistically significant. At the onset, electrophysiological evaluation revealed carpal tunnel syndrome in 15 patients and polyneuropathy in seven patients; whereas 18 patients were found normal in these respects. After treatment, the electrodiagnostic evaluation revealed that 35 patients were normal, while only two patients had carpal tunnel syndrome and three patients had polyneuropathy. The differences between before and after treatment values of median motor distal latency and amplitude, median sensorial nerve conduction velocity, tibia[ motor nerve conduction velocity and sural. sensory nerve conduction velocity were found to be statistically significant. Conclusion. - The results of the control evaluation after treatment demonstrated that the findings related to entrapment neuropathy and polyneuropathy in hypothyroid patients can be reversible in a period of 3 months if appropriate hormone replacement treatment can be obtained. Especially in the treatment of entrapment neuropathy in hypothyroidism, the chance of medical treatment must be given to patients before considering surgical treatment. (c) 2006 Elsevier SAS. All rights reserved

Effects of topiramate on neurophysiological and neuropsychological tests in migraine patients

WOS: 000271917800009PubMed: 19793661Topiramate (TPM) is a antiepileptic drug that has multiple mechanisms of action. It is effective as a monotherapy for migraine prophylaxis. Unfortunately, TPM can frequently cause adverse effects, such as cognitive dysfunction. The present study examines the neuropsychological and neurophysiological effects of TPM in 35 consecutive migraine patients above 18 years of age. The TPM dose was started at 25 mg/day and increased by 25 mg/week, until reaching the maximum dose of 50 mg twice daily in the fourth week. Patients were evaluated for development of side effects of the medication and for its effectiveness on migraine. The Wechsler memory scale was used for neuropsychological evaluation and cognitive evoked potentials were used for neurophysiologic evaluations. Analyses of repeated measures show that visual analog scale pain values, as well as migraine attack frequency and headache duration, were decreased significantly during the study. The amplitudes and latencies of P300 did not change. The results of this study show that 100 mg TPM is effective in the prevention of migraine headache and in reducing severity of attacks. Patients' cognitive complaints are frequent in the first month and decrease in the following month. Despite these complaints, only the attention section of the visual memory section of the Wechsler memory scale was affected - other sections were not affected. Also, P300 study did not reflect changes appropriate to these cognitive complaints. (C) 2009 Elsevier Ltd. All rights reserved

Topiramate response in adult-onset opsoclonus-myoclonus-ataxia syndrome: A case report

WOS: 000404949600009PubMed: 28461028

Quantitative EEG and cognitive evoked potentials in anemia

WOS: 000256122300008PubMed: 18423335Objective. - The anemic status may alter brain functions and electrogenesis, as reflected by EEG and cognitive EPs (CEPs). This study aims to evaluate CEPs and EEG power spectra in adult patients with iron-deficiency anemia and to determine the effects of appropriate iron therapy on etectrodiagnostic findings. Methods. - Fifty-one patients with iron-deficiency anemia underwent CEP and EEG recording. All patients were re-assessed after three months of oral-iron therapy. Results. - All patients had recovered from their anemia through the three-month iron therapy. Central N1 amplitude and parietal. P2 amplitude was increased. N2 latencies were shortened in frontal and central regions. P3 latencies were shortened in frontal, central and parietal areas and P3 amplitude was increased in the parietal region. Except in the gamma-band, all. pretreatment and post-treatment mean-power values were significantly tower at the temporal, parietal and occipital regions. Conclusions. - This study indicates that in iron-deficiency anemia, appropriate iron therapy can improve brain electrogenesis, as reflected by P300 and EEG power spectra. (C) 2008 Publie par Elsevier Masson SAS