The Relationship Between Illness Severity, Anxiety and Depressive Symptoms in Obstructive Sleep Apnea Syndrome Patients

Objective: Obstructive Sleep Apnea syndrome (OSAS) is a disease commonly seen in the community, causing labor loss and neuropsychiatric symptoms. The aim of the study is to compare the symptoms of depression and anxiety with those of healthy controls in patients with OSAS and to investigate the relationship between OSAS severity with anxiety and depression. Materials and Methods: Two hundred and thirteen patients with OSAS who underwent polysomnographic examination and 116 healthy controls were included in the study. The patient group was classified as mild, moderate and severe OSAS. Beck Anxiety and Beck Depression Scales were administered to the patients and healthy controls. Results: There was a significant difference between the patient group and the control group in the mean scores of Beck Depression and Beck Anxiety Scales. The mean scores of depression of the OSAS group were 11.16±8.87 (mild depression); 6.85±6.15 of the control group (p0.05). Conclusion: In our study; although there was a significant difference between depression and anxiety mean scores in patient and control group; there was no significant difference in anxiety and depression mean scores among mild, moderate and severe OSAS patients. Patients with OSAS were found to have mild anxiety and depressive symptoms. In these patients, there was no correlation between AHI values and depression and anxiety scores

Effects of obstructive sleep apnea on retinal microvasculature

AIM: To detect retinal microvascular variations in obstructive sleep apnea syndrome patients. METHODS: This prospective, observational case-control study included healthy controls and patients with mild, moderate, and severe obstructive sleep apnea syndrome. Vascular parameters, foveal avascular area, and flow areas in macula-centered, 6.00×6.00 mm2 scan size optical coherence tomography angiography images were compared. RESULTS: The control group had the highest whole image, parafoveal, and perifoveal vessel density among the groups in both superficial and the deep capillary plexus (all P<0.05). Rapid eye movement sleep apnoea-hypopnoea index was reversely correlated with whole (Rho=-0.195, P=0.034), parafoveal (Rho=-0.242, P=0.008), perifoveal (Rho=-0.187, P=0.045) vessel density in the superficial capillary plexus, and whole (Rho=-0.186, P=0.046), parafoveal (Rho=-0.260, P=0.004), perifoveal (Rho=-0.189, P=0.043) vessel density in the deep capillary plexus, though the mean and non-rapid eye movement sleep apnoea-hypopnoea index related with only parafoveal vessel density in the superficial capillary plexus (Rho=-0.213, P=0.020; Rho=-0.191, P=0.038) and the deep capillary plexus (Rho=-0.254, P=0.005; Rho=-0.194, P=0.035). CONCLUSION: This study shows decreased vessel density and its reverse correlation with the apnoea-hypopnoea index in patients with obstructive sleep apnea syndrome

Restless Legs Syndrome in Patients with Epilepsy Under Levetiracetam Monotherapy

Objective: Restless Legs syndrome (RLS) is a frequent neurological disease. Levetiracetam (LEV) is an effective and broad-spectrum anticonvulsant drug. The aim of this study is to investigate the frequency of RLS in patients diagnosed with epilepsy who took LEV monotherapy. Materials and Methods: Two neurologists were reviewed the files of 1680 patients, who were followed in epilepsy outpatient clinic. One hundred seven patients under LEV monotherapy for at least six months and 120 healthy controls were included in the study. The criteria for the International Restless Legs Syndrome Study Group were taken into consideration for the assessment of RLS. Results: The mean age of patient group was 38.26±17.39 years, while the mean age of healthy controls was 39.17±16.12 years. There were no statistically significant differences in terms of age and sex between each two groups. The mean duration of LEV usage was 28.34 months. The LEV usage dose was between 500-3000 mg/day. RLS was seen in 7 (5.83%) healthy controls, whereas 4 patients (3.73%) had RLS in patient group before LEV treatment. The symptom of RLS in two patients disappeared after LEV treatment started and this rate decreased to 1.87%. The biochemical parameters were normal in all patient groups, after LEV treatment, peripheral neuropathy was detected in one patient whose symptoms were not relieved. Conclusion: LEV may have therapeutic effect on RLS. It may be preferred especially in comorbid situations where epilepsy and RLS are seen together. Longitudinal and prospective studies are needed to manifest better the therapeutic effects of LEV on RLS

Comparision of clinical and electrophysiological staging in Carpal Tunnel Syndrome

Amaçlar: Karpal tünel sendromu teshis edilen hastalarda klinik ve elektrofizyolojik evrelemeler arasındaki iliskinin arastırılmasıdır. Gereç ve yöntemler: Karpal tünel sendromu saptanan 127 el (90 hasta) incelendi. Hastalar klinik olarak ve elektrofizyolojik olarak evrelendi. Her iki evreleme arasındaki iliski incelendi. Karpal tünel sendromu tanısı, medyan sinir trasesindeki, parestezi, agrı, medyan sinir innervasyonlu alanlarda duyu kaybı, medyan sinir innervasyonlu kaslarda motor güçsüzlük ve atrofi olması, Phalen testi veTinel testi pozitifligi ile konuldu. Bulgular: Hastaların klinik evrelemesi ile elektrofizyolojik evrelemesi arasında anlamlı bir iliski saptandı (p=0.000). Hastaların klinik evreleri arttıkça elektrofizyolojik olarak da agır derecelerde karpal tünel sendromu ile uyumlu bulgular elde edilmekteydi. Sonuç: Pratikte klinik ve elektrofizyolojik olarak uyumsuz vakalara rastlansa da hastaların medyan sinir kompresyonunun derecesi klinik muayeneler ile tahmin edilebilir düsüncesindeyiz.Objectives: The aim of the study was to investigate the relationship between the clinical and electrophysiological stages in patients diagnosed with carpal tunnel syndrome. Material and methods: One hundered twentyeight hands (90 patients) with carpal tunnel syndrome were investigated. Patients were staged clinically and electrophysiologically. The relationship between these stages was investigated. Diagnosis of carpal tunnel syndrome was made according to the presence of paresthesia, pain in the innervation area of the median nerve, weakness and atrophy in the median nerve innervated muscles, positive Phalen and Tinnel tests. Results: A significant correlation was found between clinical and electrophysiological staging of patients. The electrophysiological findings were more severe as the clinical stage progressed. Conclusions: We suggest that although there may sometimes be a discordance between clinical and electrophysiological stages in clinical practice, the severity of the compression of the median nerve can usually be estimated by clinical examination

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 (&lt;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

Demographic and Clinical Findings of Patients with Refractory Epilepsy at Epilepsy Outpatient Clinic of Muğla Sıtkı Koçman University Faculty of Medicine

Objectives:Demographic and clinical findings of patients with refractory epilepsy receiving treatment at the newly established epilepsy outpatient clinic of Muğla Sıtkı Koçman University Faculty of Medicine were evaluated.Methods:Records of patients treated at the epilepsy outpatient clinic between June 2014 and March 2016 were examined, and 60 patients with refractory epilepsy were included the study.Results:Mean age was 34.3 years. Of the total, 29 were men and 31 were women. Seizures of 50 patients were partial onset, while those of 3 were generalized. Fourteen patients had psychogenic seizures, and 1 patient was diagnosed with paroxysmal kinesigenic dyskinesia. The electroencephalogram (EEG) recording of 20 patients was normal. Partial epileptiform abnormalities were present in 24 patients, and generalized epileptiform abnormalities were seen in 1 patient. Treatment was modified in 45 patients. Four patients were seizure-free, 13 showed more than 50% reduction in seizure frequency, and 9 patients had less than 50% fewer seizures. It is thought that 34 patients have pharmacoresistant seizures. The cause of uncontrolled seizures was misdiagnosis in 5 patients, improper drug in 3 patients, and insufficient treatment dose in 5 patients.Conclusion:Accurate diagnosis and appropriate treatment with sufficient dose of drug selected according to type of seizure is important for patients with refractory epilepsy

Relationship Between Hormones and Epilepsy

The relationship between hormones and epilepsy is very complex. Hormones affect epilepsy, while epilepsy affects hormones. In addition, antiepileptic drugs have effects on seizures and hormones. In patients with epilepsy, menstrual disorders, hypothalamic amenorrhea, polycystic ovary syndrome, premature menopause, decreased fertility, sperm motility disorder, decreased sexual desire, problems in ejaculation, and orgasmic difficulty are more common than in the normal population. In this article, the relationship between epilepsy and hormones is discussed

Peri-ictal Water Drinking and Temporal Lobe Epilepsy: A Case Report

Summary Peri-ictal water drinking has been defined as the action of drinking during or within 2 minutes of a seizure. It can be seen in childhood or adulthood epilepsy. It is usually seen in adults with temporal lobe epilepsy. Peri-ictal water drinking is a rare vegetative symptom and has clinical significance in terms of being a lateralizing sign for the non-dominant hemisphere