Parkinson’s Disease and Narcolepsy-Like Sleep Episodes

A fifty one-year-old male patient presented with the complaint of sudden daytime sleep episodes for the last one and a half years. The patient had been diagnosed with Parkinson’s disease for four years and has been administered treatment of ropinirole 4 mg XL and rasagiline 1 mg tablet. The patient reported that his complaints occurred with the addition of pramipexola 0.750 mg/day tablet. Excessive daytime sleepiness occurred as sudden sleep episodes without giving any prior signs and subsided spontaneously after which the patient felt rested. The patient was diagnosed with severe obstructive sleep apnea syndrome and hypersomnia depending on medical disease and drug side effects with polysomnography and multiple sleep latency test

Determinants of the changes in positive airway pressure for the retitration in patients with obstructive sleep apnea syndrome

During long-term follow-up of the patients with obstructive sleep apnea syndrome (OSAS) under the positive airway pressure (PAP) therapy, it waits to be explored whether or when routine retitrations are indicated. We prospectively followed up 133 patients for 10 years to define which demographical or polysomnographic factors should be taken into account to determine the need for retitration. Patients were retitrated at 1st, 2nd, 5th, and 10th follow-up years. A change in pressures >= 2cmH(2)O was present in more than half of the patients at 2nd and 5th years. Changes in weight for at least 10 kg showed a significant correlation with the changes in pressures >= 2cmH(2)O (p = 0.023) and >= 3cmH(2)O (p = 0.047) at 2nd year. OSAS-related complaints, nasal or upper airway surgery, or emergence of cardiovascular diseases were not correlated with the changes in pressures. Apnea-hypopnea index (AHI) at diagnostic night was positively correlated with the changes in pressures >= 3cmH(2)O at 1st and 5th years. The percentage of N3 sleep at first titration night showed positive correlation with changes in pressures >= 3cmH(2)O at 2nd and 5th years. The index of periodic leg movements in sleep (PLMS) and PLMS-arousal index at first titration night was positively correlated with any change in pressures at 2nd and 5th years. Our findings showed that vast changes in weight, high AHI at diagnostic night, increased duration of deep NREM sleep and high PLMS and PLMS-arousal indices at first titration night should be noted as important indicators for retitration within the first 5 years of follow-up

THE RELATIONSHIP BONE MINERAL DENSITY AND HIGH-DOSE SHORT-TERM CORTICOSTEROID THERAPY IN MULTIPLE SCLEROSIS PATIENTS

Introduction: Previous studies were reported that osteoporosis and bone fracture occurs more frequently among Multiple sclerosis patients than the general population. The aim of this study to investigate the affects of total doses of short-term, high dose corticosteroids on bone mineral density and other affecting factors for bone mineral density in Relapsing-remitting type Multiple Sclerosis patients. Material and methods: Fifty-four patients (37 females, 17 males) with relapsing-remitting type Multiple Sclerosis who filled the diagnostic criteria according to McDonald criteria were included in the study. Femoral and lumbar bone mineral density were measured using dual energy X-ray absorptiometry. Expanded Disability Status Scale, disease duration, number of attacks, cumulative corticosteroid dose were recorded. Serum calcium, potassium, phosphorus, vitamin D, parathormone and osteocalcin levels were measured. Patients were divided into two groups: patients who have received at least 20 g intravenous metilprednisolone (Group I) and patients who have received less than 20 g intravenous metilprednisolone (Group II). We analysed association between cumulative corticosteroid dose and each parameters. Results: Osteopenia was present in 46.2% and osteoporosis in 5.5% of the study population according to femoral neck bone mineral density. Femoral bone mineral density was significantly lower among patients. There was no correlation between cumulative dose of corticosteroid and bone mineral density. Conclusion: Low bone mineral density and osteoporosis are common in Multiple sclerosis patients. High-dose steroid therapy is not be the primary cause of osteoporosis in patients with multiple sclerosis

Electroencephalographic features associated with intermittent rhythmic delta activity

Objective. - To investigate the clinical importance of intermittent rhythmic delta activity (IRDA) in terms of accompanying electrophysiological findings on EEG and their association with IRDA

Susceptibility to Juvenile Myoclonic Epilepsy Associated with the EFHC1 Gene: First Case Report in Turkey

Juvenile myoclonic epilepsy (JME), characterized by predominating myoclonic seizures, is one of the most common forms of generic generalized epilepsy. Generic studies in JME reported susceptibility associated with EFHC1 gene. A 26-year-old male patient was admitted to our epilepsy outpatient clinic unit with one generalized tonic-clonic seizure and with previous myoclonic seizures started at the age of 17 years described as jerky movements. His neurologic examination and neuroimaging studies were normal. The family history was unremarkable. His electroencephalography was recorded under treatment and showed short-lasting paroxysms consisting of 6-7 Hz generalized slow waves and superimposed sharp contoured waves, slightly prominent over the posterior halves of the hemispheres, interpreted as generalized paroxysmal abnormality. After performing whole exom sequencing and investigating epilepsy-related genes, a heterozygous missense variant was found in EFHC1 gene causing amino acid change [rs137852776: NM_018100.4: c.685T>C;p 15 (Phe229Leu)]. His seizures are still under control with valproate 1000 mg/d. Variants in EFHC1 gene are the most commonly observed genetic abnormalities in patients with familial JME in different countries. Our study reported a EFHC1 gene variation in a patient typical JME for the first time in our country. Our finding is important for future clinical studies and genetic counseling in JME

Near-tendon single-fiber electromyography in patients with myopathy

© 2022 Elsevier Masson SASWe investigated how properties of single-fiber action potentials (SFAP) and jitter changed in different recording sites in patients with myopathy and controls. SFAP and jitter were recorded using a disposable single-fiber electrode in the biceps brachii muscle of three patients and controls in two sites: i) near the end-plate zone (EPZ), ii) near the tendon. SFAP and spike duration were longer in patients than in controls. Moving the needle away from the EPZ did not change the electrophysiologic parameters. Longer SFAP duration may reflect slow velocity in muscle fibers and serve as an indicator for small fiber size in myopathy

Rationale and Design of the Turkish Sleep Apnea Database - TURKAPNE: A National, Multicenter, Observational, Prospective Cohort Study

WOS: 000439590300008PubMed ID: 30083405OBJECTIVES: The primary aim of The Turkish Sleep Apnea Database (TURKAPNE) study is to generate a cross-sectional nationwide database for defining the clinical and polysomnographic characteristics of the patients with obstructive sleep apnea (OSA) in Turkey. MATERIALS AND METHODS: In this ongoing project, all consecutive adults with suspected OSA are recruited from the sleep centers of the university and research hospitals in Turkey. Information on anthropometric data, educational status, driving license, smoking habits, alcohol use, comorbidities, drug use, questionnaires, polysomnographic, and/or cardiorespiratory polygraphic findings are recorded in a systematized Web-based report form. Blood glucose, lipids and other biochemical markers, lung function, and echocardiography measurements are optionally included. Follow-up data regarding treatment modality and compliance is assessed. Cross-sectional and longitudinal associations between OSA phenotypes and metabolic, pulmonary, and cardiovascular comorbidities as well as traffic accidents, and the impact of treatment will be further explored. We target a total sample of 10,000 participants. RESULTS: The study was registered with ClinicalTrials.gov (NCT02784977) in May 2016 and the first patient was recruited in October 2017. A total of 1911 participants from 19 centers have been enrolled in the study by May 31, 2018. CONCLUSION: The TURKAPNE study will contribute to a better understanding of the health-related burden of OSA phenotypes and its association with the comorbidities and adverse outcomes, including traffic accidents in Turkey. The results may also contribute to a more personalized approach and better management of varying OSA phenotypes with concomitant disorders.Turkish Thoracic SocietyThe foundation and infrastructure of the database was supported by grants from the Turkish Thoracic Society with no influence on the design of the study, the analysis of the data, the data collection, drafting of the manuscript, or the decision to publish

Atrial Fibrillation Management in Acute Stroke Patients in Türkiye: Real-life Data from the NöroTek Study

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Turkiye. Within the scope of NoroTek-Turkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.Materials and Methods: On May 10, 2018 (World Stroke Awareness Day), 1,790 patients hospitalized at 87 neurology units in 30 health regions were prospectively evaluated. A total of 929 patients [859 acute ischemic stroke, 70 transient ischemic attack (TIA)] from this study were included in this analysis.Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received "effective" treatment [international normalization ratio >= 2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.Conclusion: NoroTekTR revealed the high but expected frequency of AF in acute stroke in Turkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Turkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF