Seizures in Adult with Neurofibromatosis Type 1

Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited disorder, with an estimated prevalence of 1 in 3000–4000 people. Seizures occur 4–7% of individuals with NF1, mostly due to associated brain tumors or cortical malformations. Seizures in NF1 are often relatively easy to control with one or more conventional antiseizure drugs; surgical resection of offending lesions is sometimes pursued. Surgery has been most successful for temporal lobe gliomas. However, if you faced the drug-resistant epilepsy you may consider the cortical malformations, tumors and hippocampal sclerosis. In this chapter, it is aimed to explain the types of seizures, EEG features and the properties of drug therapy in NF1

Nonconvulsive Status Epilepticus and Coma

Nonconvulsive status epilepticus (NCSE) is common in patients with coma with a prevalence between 5 and 48%. Nonconvulsive status epilepticus (NCSE) is an electroclinical state associated with an altered mental status (AMS) but lacking convulsive motor activity. It is difficult to diagnose in the obtunded/comatose patients. Such patients have often other serious medical conditions, and the diagnosis of NCSE is frequently delayed in these patients. Diagnosing NCSE demands a high degree of clinical suspicion and for that reason likely remains under-recognized. The most important question, however, is whether the treatment of NCSE in coma improves the outcome of these patients or not. In this review, we aimed to summarize the EEG patterns in NCSE to further delineate the borders between comatose forms of NCSE and coma-epileptiform discharges and to evaluate modified EEG criteria for NCSE in a coma

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

KALİTELİ UYKU VE UYKU BOZUKLUKLARI

ÖZET: Uyku sağlık ve yaşamımızın iyi bir şekilde devamı için önemli bir role sahiptir. Kaliteliuyku zihinsel sağlığımızı, fiziksel sağlığımızı, hayat kalitemizı korumamıza yardım eder vegüvenliğimiz için gereklidir. Uykunun başlatılması ve sürdürülmesi kortikal ve subkortikal birçokbeyin bölgesinin işlevi ile gerçekleşir. Uykunun başlatılmasında öncelikle ön hipotalamustan gelendöngüsel girdiler ve endojen kimyasal uyarılar doğrultusunda hipotalamusta ventrolateral preoptikçekirdeğin rol aldığı kabul edilir. Normal uykunun hızlı göz hareketleri (REM) ve hızlı gözhareketlerinin olmadığı (NREM) olarak iki dönemi vardır. REM uykusunda asetilkolin veserotonin, NREM uykusunda ise serotonin ve GABA önemli rol oynayan nörotrasmitterlerdir.NREM ve REM gece boyunca 90-110 dakikalık sikluslar şekinde gecede 5-6 kez tekrarlar. NREMgecenin ilk bölümünde, REM ikinci döneminde belirgin olarak gözlenir. Uyku bozukluklarıgörüldüğü döneme göre 3 grupta incelenebilir: (1) REM döneminde görülenler, (2) NREMdöneminde görülenler, (3) Uykunun herhangi bir döneminde görülenler. Uyku bozukluğu olanhastalar yol veya iş kazaları, sosyal uyumsuzluk, akademik veya mesleki performansta düşmegösterebilirler. Bu yüzden uyku bozukluğu detaylı olarak incelenmesi gereken önemli birdurumdur.&nbsp;&nbsp;ABSTRACT: Sleep plays a vital role in good health and well-being throughout your life. Gettingenough quality sleep at the right times can help protect your mental health, physical health, qualityof life, and safety. Sleep initiation and maintenance take place with the function of a lot of corticaland subcortical region of the brain. In the initiation of sleep, it is accepted that primarily cyclicinputs from the hypothalamus and anterior hypothalamus, ventrolateral preoptic nucleus with thesignals of endogenous chemical. Normal sleep is divided into two states: rapid eye movement(REM) and non-rapid eye movement (NREM).The major neurotransmitter of REM isacetylcholine and of NREM are GABA and serotonine. In a normal individual, NREM and REMsleep alternate cyclically throughout the night. The NREM-REM cycle repeats itself every 90-110min, 5-6 times per night. Typically, NREM sleep predominates in the first part of the night, andREM sleep predominates in the second. Sleep disorders can be divided in three groups accordingto occurence period: (1) Sleep disorders seen in REM, (2) in NREM and (3) in any of REM orNonREM periods. Patients with sleep disorders may effects (road and work accidents), socialmaladjustment, decreased academic and occupational performance. Thus, sleep disorder is aserious condition that requires investigation, diagnosis and treatment</p

The Association Between Epilepsy and Autoimmune Diseases

Objectives:Systemic autoimmune diseases are known to affect the central nervous system not rarely . Many studies have investigated the association between epilepsy and autoimmune diseases. This study aimed to determine the association between the gender/ age and seizures of patients with epilepsy with concomitant autoimmune diseases and to determine the seizure types of these patients and to evaluate the EEG results and their response to antiepileptic drugs. Patient files were retrospectively reviewed to identify those with autoimmune diseases.Methods:A total of 2000 patient files with epilepsy who were admitted to the Eskişehir Osmangazi University Medical Faculty Hospital Neurology Department, Clinicial Neurophysiology Division, between 2007 and 2019 were examined and the patients with concomitant autoimmune diseases were documented.Results:Thirty-six (1.8%) of the 2000 patients with epilepsy had autoimmune disorders, of which 10 (0.5%) had concomitant Hashimoto Thyroiditis, 1 (0.05%) had Celiac disease, 1 (0.05%) had Primary Central Nervous System Vasculitis, 8 (0.4%) had Multiple Sclerosis (MS), 1 (0.05%) had Scleroderma, 4 (0.2%) had Behçet’s disease, 1 (0.05%) had Sjogren syndrome, 8 had (0.4%) both SLE and APS , and 2 (0.1%) had Type 1 Diabetes Mellitus (Type 1 DM).Conclusion:Female sex and focal seizures were seen mostly in patients with epilepsy with concomitant multiple sclerosis. Patients with concomitant SLE+APS were also predominantly females, with the majority having Generalized Tonic-Clonic Seizures and a more successful response to treatment. These results corroborate with previous studies