A Case of Secondary Hypersomnia Associated with Amlodipine

Excessive daytime sleepiness is a symptom which can caused serious problems in patients life and is widely common in general population. It may be occurred depending on drug use and medical conditions. Secondary reasons must be investigated before making the diagnosis of primary hypersomnia in patients with excessive daytime sleepiness. In this case report, a patient who was followed up with the diagnosis of idiopathic hypersomnia, but was diagnosed as hypersomnia associated with amlodipine use along with conditions that Obstructive Sleep Apnea syndrome and delayed sleep phase syndrome may cause excessive daytime sleepiness, was presented

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A Case of Pleiosomnia Following Traumatic Brain Injury

Sleep-wake disturbances are highly prevalent and often become persistent sequelae after traumatic brain injury. The most common disturbances are insomnia, excessive daytime sleepiness, and increased sleep need (pleiosomnia). Circadian rhythm sleep-wake disturbances and parasomnias are more rare disturbances. These disorders can affect the treatment process and exacerbate other problems such as cognitive, and psychiatric problems. Among these sleep disturbances, hypersomnia is the most damaging disorder for the patients functionality. In this case report, a patient who was complaining of increased sleep need after traumatic brain injury was presented

Relationship between apnea-hypopnea index and oxygen desaturation in REM-sleep period and morning headache in patients with obstructive sleep apnea syndrome

Introduction: In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. Methods: Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. Results: In group 1, patients with OSAS and morning headache, apneahypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94%; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93%; TST: 81%, min-max: 50-90%). Conclusion: Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome

Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring

Purpose: Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. Methods: Overall, 84 patients—29 with generalised onset epilepsy and 55 with focal onset epilepsy—were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. Results: The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p= 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p= 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. Conclusions: Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED

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

Epilepsy and Military Service

The prevalence of epilepsy in Turkey was found to be 7 to 12.2 in 1000. If a mean prevalence of 10/1000 is accepted, according to the 2016 Turkish population census, there are about 134,000 epilepsy patients among men of military service age. Suitability for military service of epilepsy patients who are obliged to serve is determined by the Turkish Armed Forces, the Turkish Gendarmerie, and the Turkish Coast Guard Command Health Capability Ordinance (HCO). Men without disease or sequelae; or with disease or sequelae included in the “A” category of a list of diseases and sequelae are considered “fit for service.” Men with diseases or sequelae in the “B” and “D” categories are deemed “not fit for service.” Epilepsy disorders are reviewed in the 12th article of the HCO. In August 2016, military hospitals were assigned to the Ministry of Health. The authorization and responsibility to determine whether or not epilepsy patients and those with other disorders are fit for service now belongs to authorized hospitals affiliated with the Ministry of Health. The aim of this review was to offer some example templates as guidance to our colleagues performing this task

Relationship between white matter lesions and neutrophil-lymphocyte ratio in migraine patients

Objectives: In this study, we aimed to compare the neutrophil/lymphocyte ratio(NLR) levels of migraine patients with and without gliotic lesions on brainmagnetic resonance imaging (MRI).Materials and Methods: The records of the patients who were followed up in the neurology outpatient clinic of Ufuk University, Faculty of Medicine, between 2016 and 2019 with the diagnosis of migraine between the ages of 18 and 50 were reviewed retrospectively. Eightysix patients without systemic, neurological, and infectious diseases between 18 and 50 years of age were included in the study. Patients were divided into two groups: Group 1 – subclinical ischemic/gliotic lesions on MRI and Group 2 – normal MRI. Subparameters and calculated NLRs in whole blood results were compared between the two groups.Results: When the two groups were compared in terms of leukocyte and neutrophil counts, a statistically significant difference was found. The leukocyte and neutrophil counts of the patients in Group 1 were significantly higher than those of Group 2 (P = 0.038/P = 0.004). NLR was higher in patients with gliotic lesions on MRI than in patients with normal MRI and was statistically significant (P = 0.016).Conclusion: This study aimed to evaluate the relationship between NLR and white matter lesions in patients with migraine. We have conducted this study to see if we can confirm this with a parameter in migraine patients with white matter lesions. Despite the small number of patients, leukocyte count, neutrophil count, and NLR were significantly higher in migraine patients with white matter lesions which support our hypothesis

Does Longer Compulsory Education Equalize Schooling by Gender and Rural/Urban Residence?

This study examines the effects of the extension of compulsory schooling from 5 to 8 years in Turkey in 1997-which involved substantial investment in school infrastructure-on schooling outcomes and, in particular, on the equality of these outcomes between men and women, and urban and rural residents using the Turkish Demographic and Health Surveys. This policy is peculiar because it also changes the sheepskin effects (signaling effects) of schooling, through its redefinition of the schooling tiers. The policy is also interesting due to its large spillover effects on post-compulsory schooling as well as its remarkable overall effect; for instance, we find that the completed years of schooling by age 17 increases by 1.5 years for rural women. The policy equalizes the educational attainment of urban and rural children substantially. The urban-rural gap in the completed years of schooling at age 17 falls by 0.5 years for men and by 0.7 to 0.8 years for women. However, there is no evidence of a narrowing gender gap with the policy. On the contrary, the gender gap in urban areas in post-compulsory schooling widens