Shift Work and Shift Work Sleep Disorders: Definition, Symptoms and Treatment

Today, due to the rapid progress of the global industrial economy, the use of new technologies and the economic competition environment, the necessity of 24 hour interrupted job production has increased and this has caused the obligation to work with the shift system. Approximately 20% of the population is working on shifts and turns apart from the standard working hours. While the shift system has many positive effects on work and manufacture life, it also has negative effects on the life quality of employees and it brings many comorbid health and sleep problems. Shift work sleep disorder is categorized as a subgroup of circadian rhythm sleep disorders family. The primary symptoms of shift work sleep disorder are insomnia and excessive daytime sleepiness. The goal of shift work sleep disorder treatment is to improve the quality of life and work efficiency while improving the current symptoms related to sleep disturbances, and to minimize accidents by increasing attention and alertness. The goal of this review is to determine the clinical findings, diagnostic criteria, systemic outcomes, and treatment methods of shift work sleep disorder and the associated sleep disorders

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

Neuromuscular Effects of Acute Organophosphate Poisoning

Amaç: Organofosfat zehirlenmelerinin nöromusküler etkileri ile ilgili bilgiler sınırlı yayın ve olgu sunumlarına dayanmaktadır. Bu çalışmada akut organofosfat zehirlenmelerinde organofosfatın nöromuskuler etkilenimini araştırmayı ve bunun acil yaklaşım ve tedaviye katkısını belirleyerek organofosfat zehirlenmesine bağlı gelişen olası sakatlıkların azaltılması amacıyla sonraki yapılacak çalışmalara yol gösterici olmayı hedefledik. Materyal ve Metod: İleriye dönük olarak yapılan bu çalışmada 2 yıl boyunca Organofosfat zehirlenmesini düşündüren kolinerjik zehirlenme bulgularıyla Acil Servise başvuran 15 yaş üstü 20 hasta değerlendirildi. Uygun ilk değerlendirme ve tedavi sonrası hastaların nöromuskuler etkilenimi değerlendirmek için Elektromyogarfi, Görsel uyarılmış potansiyel, Somatosensöriyel uyarılmış potansiyel incelemeleri yapıldı. Bulgular: Çalışmamıza 12'si (%60) kadın, 8'i (%40) erkek toplam 20 hasta alındı. Yirmi hastaya yapılan Elektromyografi incelemesinde sinir ileti çalışmaları normal bulundu. Olgular hepsinde motor son plak işlevleri normal olarak değerlendirildi. Dört (%20,0) hastada görsel uyarılmış potansiyel, 3 (%15,0) hastada somatosensöriyel uyarılmış potansiyel incelemelerinde latans ve/veya amplitüd asimetrisi saptandı. Hastalar tam iyilik haliyle taburcu edildi. Sonuç:.Organofosfat zehirlenmesinde elektronörografi, repetetif çalışma ve P300 çalışmaları olmasına rağmen uyarılmış potansiyel çalışmalarına rastlanmamıştır.Organofosfat zehirlenmesinde kardiyak ve nöromuskuler etkilenimi göstermek için daha geniş çalışmalara ihtiyaç vardır.Purpose: The knowledge about neuromuscular effects of organophosphate poisoning depends on limited publications and case reports. In thıs study, we aimed to determine the neuromuscular effects of organophosphate poisoning and the influence of these information in clinical approach and treatment modalities that will guide further studies to prement disability. Materials and Methods: In this prospective study conducted for 2 years with the approval of ethical comittee, 20 patients older than 15 years old who were admitted with cholinergic complaints with suspected organophosphate poisoning were evaluated. After proper primary assesment and treatment Electromyography, Visuel evoked potential, Somatosensory evoked potential were performed to evaluate the neuromuscular affect. Results: Twenty patients, 12 (60%) females and 8 (40%) males were included in our study. Electromyograhy of 20 patients were normal with normal neuromuscular junction functions. Latancy and/or amplitude asymmetry were found in 4 (20%) patients in Visuel evoked potential and 3 (15%) patients in Somatosensory evoked potential. All of the patients were discharged without sequela. Conclusion: There is no evoked potential studies performed in organophosphate poisoning althoung electroneurography repetitive and P300 studies exist in literatüre. More further studies are needed to evaluate the cardiac and neuromuscular effects of organophosphate poisoning

Diagnostic Criteria of Parasomnias and Other Paroxysmal Events in Sleep

Parasomniler uyku geçişlerinde, uykudan uyanma ya da uyku sırasında ortaya çıkan istenilmeyen fiziksel reaksiyonlardır. Parasomniler uyku evrelerine göre; I) Non-rapid eye movement uykusu ile ilişkili parasomniler, II) Rapid eye movement uykusu ile ilişkili parasomniler ve III) Diğer parasomniler olarak sınıflandırılırlar. Hasta ve hasta yakınının yaşam kalitesini etkilediği dönemde mutlaka tedavi önerilmektedir. Bu nedenle uykunun paroksismal diğer olaylarından ayırt edilmesi ve doğru tanı konulması gerekmektedirParasomnias are undesirable physical reactions occurring during sleep transition, during arousal from sleep, or within the sleep period. Parasomnias are divided into sub- groups according to the stage of sleep; I) parasomnias usually associated with NonRapid eye movement sleep, II) parasomnias usually associated with Rapid eye movement sleep, III) other parasomnias. Parasomnias may significantly affect the patient and the relatives of the patient’s quality of life. The proper treatment is suggested when quality of life is affected. Therefore, proper diagnosis and differantial diagnosis from other paroksismal sleep behavior disorder should be done when these attacks detecte

The Effect of Lacosamide Polytherapy on Seizure Prognosis in Focal Epilepsies

Objectives:What is expected from anti-epileptic treatment is low side effects and drug-drug interactions as well as high efficacy. In this study, the efficacy of lacosamide in polytherapy and its effect on prognosis were evaluated.Methods:Seventy-seven patients with focal epilepsy who were followed up for at least 1 year and using lacosamide were included in the study. The antiepileptic drugs they use, the side effects of the drugs, neuroimaging and electrophysiological examinations were evaluated.Results:A total of 77 patients, including 35 women (44.9%) and 42 men (55.1%), were included in the study. The mean age was 33.9±10.6 (min: 19 max: 67). Average age of seizure onset was 12.6±10.7, and none of the patients were using Lacosamide (LKS) as monotherapy. Although only 3 patients were receiving dual therapy, the remaining 74 patients were receiving 3 or more antiepileptic treatments. While 33 of the patients (42.9%) had a decrease in the frequency of seizures after LKS treatment.Conclusion:Although the percentage of efficacy was obtained as low according to literature information, lacosamide is effective in resistant focal epilepsies with an efficiency of 42.9%. Especially in patients who use drugs other than antiepileptic drugs due to comorbid diseases, the absence of drug-drug interaction and the absence of serious side effects that require termination of treatment may be an indication that it can be used safely

Fibromuscular dysplasia and ıntravenous thrombolytic treatment

Fibromusküler displazi (FMD) ateromatöz ve inflamatuvar özellikte olmayan, genellikle orta ve yaşlı kadınları etkileyen, segmental tutulum gösteren bir anjiopatidir. Kesin tanı klinik özelliklerin varlığı ve dijital subtraksiyon anjiografide ipe dizilmiş tesbih tanesi görünümünün saptanması ile konur. Bu makalede akut gelişimli iskemik inme nedeniyle değerlendirilerek trombolitik tedavi uygulanan ve daha sonraki etiyolojik tarama sırasında FMD saptanan bir olgu ve bu olgu bağlamında FMD’ye bağlı iskemik inme geçiren olgularda trombolitik tedaviye bakış sunulmaktadır.Fibromuscular dysplasia (FMD), which usually affects middle-aged and older women, is a non-atheromatous and non-inflammatory angiopathy. Definitive diagnosis is made only by angiography showing classic string-of-beads appearance. In this article, we present a patient with acute ischemic stroke due to FMD who was successfully treated with thrombolytic therapy as well as to revise the approach to FMD in the light of the literature

Frequency and economic burden of psychogenic non-epileptic seizures in patients applying for disability benefits due to epilepsy

Background Psychogenic non-epileptic seizures (PNES) resemble epileptic seizures and are often misdiagnosed as epilepsy. Objective To investigate the frequency of PNES and to calculate the economic burden of the patients who admitted to video-electroencephalographicmonitoring (VEM) to obtain a diagnosis of epilepsy in order to apply for disability retirement. Methods The present retrospective study included 134 patients who required disability reports between 2013 and 2019 and had their definite diagnoses after VEM. Following VEM, the patients were divided into three groups: epilepsy, PNES, and epilepsy + PNES. Results In total, 22.4% (n = 30) of the patients were diagnosed with PNES, 21.6% (n = 29) with PNES and epilepsy, and 56% (n = 75), with epilepsy. The frequency of PNES among all patients was of 44% (n = 59). In patients with PNES alone, the annual cost of using anti-seizure medication was of 160.67 ± 94.04 dollars; for psychostimulant drugs, it was of 148.3 ± 72.48 dollars a year; and the mean direct cost for diagnostic procedures was of 582.9 ± 330.0 (range: 103.52–1601.3) dollars. Conclusions Although it is challenging to determine the qualitative and quantitative total cost in these patient groups, early diagnosis and sociopsychological support will reduce the additional financial burden on the health system and increase the quality of life of the patients