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

Investigation of Outdoor Gamma Dose Rates in Yalova, Turkey

Radioactivity measurements were performed, at the Yalova (Turkey), part of the Marmara Sea, for natural radiation using ascintillation detector SP6 (via using portable counter ESP2, Eberline). Based on the measurement results, the lowest outdoor gammaconcentration was calculated to 27.70 nGy/h while the highest one calculated to 66.00 nGy/h. And, the average of the measuredgamma dose rates calculated to 48.13 nGy/h while the annual effective dose equivalent was calculated to 59.02 ?Sv/y. Mean value ofexcess lifetime cancer risk also obtained 2.07 $10^{-4}$from using measurement area. The results checked against the world averagedetermined by UNSCEAR. It was concluded that the calculated gamma dose values in Yalova are below the world average

Late-Onset Generalized Myoclonic Seizure: Case Report

Most of the epileptic seizures that begin at an advanced age are focal onset seizures due to an underlying structural lesion. Generalized myoclonic seizures, usually seen in adolescence, are very rare in elderly patients without a history of epilepsy. In this study, we present a 60-year-old patient with generalized myoclonic seizures with electrophysiological findings. Because of the late-onset, myoclonic jerks were first evaluated with the diagnosis of non-epileptic psychogenic attack in an external health center. The patient was diagnosed with seizure recordings in Electroencephalography-video monitoring. The patient responded well to the antiepileptic treatment and became seizure-free

A Case of Autoimmune Encephalitis with Refractory Status Epilepticus

Refractory status epilepticus is usually caused by a severe brain injury and has a high rate of mortality and morbidity despite the infusion of antiepileptic drugs and anesthetic agents. Autoimmune encephalitis is one cause of refractory status epilepticus and status epilepticus may be the initial symptom. The seizures are generally resistant to standard treatment and may require immunotherapeutics. This is a description of a patient who had refractory status epilepticus despite appropriate doses of antiepileptic and general anesthetic drugs, but responded to intravenous immunoglobulin therapy. Examinations revealed an ovarian teratoma with a negative serum N-methyl-D-aspartate receptor antibody

Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort

Objective The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. Methods Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. Results Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, >= 5 headache attacks, duration of headache >= 24 months, headaches lasting >= 1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with >= 5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). Significance Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies