Non-ketotic hyperglycaemia presenting as epilepsia partialis continua

AbstractEpilepsia partialis continua (EPC) is a rare epileptic syndrome, observed in various cortical lesions and also in metabolic disorders. We report the case of a 57-year-old patient with EPC as the first manifestation of hyperosmolar non-ketotic hyperglycaemia (NKH) of diabetes mellitus. Computed tomography (CT) and magnetic resonance imaging (MRI) were normal. Initial laboratory data revealing serum glucose 1540mg/dl, and serum osmolality 391mOsm/l confirmed the diagnosis. Electroencephalography (EEG) showed ictal discharges in the ipsilateral hemisphere during focal seizures. Seizures are resistant to anticonvulsant treatment and respond best to insulin and rehydration. Focal motor seizures or EPC are commonly a symptom of NKH in the elderly patients. We recommend that in such cases a metabolic disorder such as diabetes mellitus be ruled out

Restless legs syndrome and depression-anxiety disorder association in iron deficiency anemia patients

Restless Legs Syndrome (RLS) is a disorder in which the person experiences a strong urge to move their legs or other extremities during rest. This urge to move is associated with tingling, pulling or other unpleasant and uncomfortable feelings; it usually slowly increases in the affected limb and often affects sleep. The incidence in general population is 5-15%. Although the pathophysiology is not fully understood, it was thought to result from the iron and dopamine metabolism irregularities and also has a genetic component. There are publications that show the frequency of disease in patients with iron deficiency or renal failure reaches up to 80%. In this study, we investigated the incidence of restless leg syndrome in anemic patients without any other organic disease or drug use, which can cause restless legs syndrome. We also tried to find out if there is a relation between restless legs syndrome, ferritin levels, anxiety and depression. Our retrospective, cross sectional study was made in The Ministry of Health and family medicine, neurology and psychiatry outpatient clinics of Ordu University Education and Research Hospital. 47 patients who were admitted to above mentioned clinics whose ferritin levels were under 50 ng/ml without any other disease and were not on medication (including those indicated for iron deficiency anemia) was included in to the study. All patients were given the Beck depression inventory and Beck anxiety inventory. The patients were questioned in terms of the basic diagnostic criteria established by International Restless Legs Syndrome Study Group. Definitive diagnosis could be established by the patients that meet the four criterias for the diagnosis. International Restless Legs Scale applied to patients diagnosed with RLS. Of 47 patients, 39 were female and 8 were male. 28 (%59.6) of the patients met the criteria of RLS. 28 patients with a diagnosis of RLS; 4 of them mild, 11 of them moderate, 8 of them severe and 5 of them experienced very severe symptoms of RLS. The relationship between the RLS and ferritin levels were checked and there was no statistically significant difference between them. A significant difference was not found in Beck depression scores between patients with and without RLS, but when the groups were compared in terms of Beck anxiety score, there were a significant difference. There was no significant relationship between RLS severity and Beck depression or Beck anxiety scores. RLS can be seen in %5-15 of general population and it is much more likely to emerge in the presence of an organic problem such as iron deficiency anemia. The diagnosis of the disorder is set clinically and RLS had a different significance because it may cause sleep disturbances and psychiatric disorders. If not questioned, this problem, which is not easily noticeable, can lead to misdiagnosis and misinterpreted as an anxiety disorder or a primary sleep disorder. Therefore the symptoms that could be corrected only by iron deficiency treatment, could be inşamed further by giving antidepressants and hypnotics

Relation of Apathy to Motor and Non-motor Findings in Parkinson’s Disease

Aim:It has been shown that motor symptoms, as well as non-motor symptoms, significantly affect the quality of life of patients with idiopathic Parkinson’s disease. In our study, the association of apathy, one of the NMS, with motor and non-motor symptoms was investigated.Methods:Patients with stage 1-3 IPH according to the Hoehn-Yahr Scale (H&Y) were included in the study. Patients who received dementia diagnosis according to the DSM IV criteria were excluded from the study. The patients were evaluated using the Unified Parkinson’s Disease Rating Scale (UPDRS), non-motor symptoms Questionnaire (NMSQ), Geriatric Depression Scale (GDS), and the revised diagnostic criteria for apathy.Results:Apathy was found in 26 of 68 patients who were included in the study. Patients with and without apathy were compared in terms of age, clinical and demographic characteristics, L-dopa equivalent doses, depression, and NMSQ scores. The group of patients with apathy consisted of nine females and 17 males and the mean age was 64.3±7.7 years. The non-apathy group included 25 females and 17 males and the mean age was 66.8±9.1 years. There was no statistically significant difference between the groups in terms of age, education, age at onset, duration of illness and L-dopa equivalent doses. The male-to-female ratio was significantly higher in the apathy group. The mean GDS and NMSQ scores in the apathy group were significantly higher than in the non-apathy group. There was a statistically significant difference between the groups in H&Y stage and total UPDRS and subscales scores. It was noteworthy that the rate of stage 3 patients was higher in the group of patients with apathy. The number of patients having bradykinesia in the apathy group and the number of patients having tremor in the group without apathy was higher.Conclusion:Our study showed that apathy, one of the non-motor symptoms, was more prominent in male gender, associated with UPDRS scores, clinical stage and bradykinesia, and accompanied by depression

Parkinson hastalığı demansı’nın tedavisi için uygulanan rivastigmine bağlı gelişen alt ekstremite tremor ekzaserbasyonu

Rivastigmine is one of the approved effective treatments for Parkinson's Disease Dementia (PDD). Increase of upper extremity resting tremor is a common adverse effect seen in patients administered rivastigmine and is usually mild, not leading to treatment withdrawal. Rivastigmine patch was given to both of our patients diagnosed with PDD and they suffered from postural instability and lower extremity tremor that occurred while standing and disappeared with walking after the administration and increase dosage of the drug in a few months time. The lower extremity tremor disappeared markedly in both patients after the dose reduction. Disabling lower extremity tremor due to rivastigmine dosage increase has not been reported before. We want to draw attention to this rare side effect through these patients and mention not to quit the drug.Rivastigmin Parkinson Hastalığı Demansı'nın (PHD) tedavisinde kullanılan etkili bir tedavilerden birisidir. Rivastigmin tedavisi uygulanan hastalarda sıklıkla üst ekstremitelerde istirahat tremor görülür ve genellikle hafiftir, tedavinin kesilmesine neden olmaz. Rivastigmin bant PHD tanısı almış iki hastamıza verdik ve doz artımı sonrası aylar içinde her ikisinde de ayağa kalkınca ortaya çıkan postural instabilite ve alt ekstremite tremoru gelişmiştir. İlacın dozunun azaltılması alt ekstremite tremoru belirgin şekilde kaybolmuştur. Rivastigmin doz arttırılmasına bağlı özürleyici alt ekstremite tremoru daha önce bildirilmemiştir. Bu olgu sunumunda nadir görülen bu yan etkiye dikkat çekmek ve ilacı kesmemek gerektiğini vurgulamak istedik

Parkinson hastalığı demansı’nın tedavisi için uygulanan rivastigmine bağlı gelişen alt ekstremite tremor ekzaserbasyonu

Rivastigmine is one of the approved effective treatments for Parkinson's Disease Dementia (PDD). Increase of upper extremity resting tremor is a common adverse effect seen in patients administered rivastigmine and is usually mild, not leading to treatment withdrawal. Rivastigmine patch was given to both of our patients diagnosed with PDD and they suffered from postural instability and lower extremity tremor that occurred while standing and disappeared with walking after the administration and increase dosage of the drug in a few months time. The lower extremity tremor disappeared markedly in both patients after the dose reduction. Disabling lower extremity tremor due to rivastigmine dosage increase has not been reported before. We want to draw attention to this rare side effect through these patients and mention not to quit the drug.Rivastigmin Parkinson Hastalığı Demansı'nın (PHD) tedavisinde kullanılan etkili bir tedavilerden birisidir. Rivastigmin tedavisi uygulanan hastalarda sıklıkla üst ekstremitelerde istirahat tremor görülür ve genellikle hafiftir, tedavinin kesilmesine neden olmaz. Rivastigmin bant PHD tanısı almış iki hastamıza verdik ve doz artımı sonrası aylar içinde her ikisinde de ayağa kalkınca ortaya çıkan postural instabilite ve alt ekstremite tremoru gelişmiştir. İlacın dozunun azaltılması alt ekstremite tremoru belirgin şekilde kaybolmuştur. Rivastigmin doz arttırılmasına bağlı özürleyici alt ekstremite tremoru daha önce bildirilmemiştir. Bu olgu sunumunda nadir görülen bu yan etkiye dikkat çekmek ve ilacı kesmemek gerektiğini vurgulamak istedik

Is there a difference between Parkinson disease patients and a control group in terms of urinary symptoms and quality of life?

WOS: 000393331000009PubMed ID: 28081354Background/aim: The aim of this study is to research whether urinary symptoms and disruption of quality of life observed in Parkinson disease patients are different than those of their healthy peers. Additionally, whether these complaints were affected by characteristics such as age at onset of Parkinson disease, sex, disease duration, and severity was investigated. Materials and methods: This study comprised a total of 79 individuals, 39 Parkinson patients and a control group of 40 individuals. Parkinson diagnosis was provided by a neurology expert according to the UK Parkinson's Disease Society Brain Bank Criteria. All patients were evaluated by a urologist with the International Prostate Symptom Score (IPSS) and an overactive bladder (OAB) questionnaire. Results: Compared with the control group, the Parkinson patient group had statistically significantly higher rates of urological complaints (P < 0.001), irritative symptoms (P < 0.001), voiding symptoms (P < 0.001), OAB score (P < 0.001), IPSS total score (P = 0.007), and treatment requirements (P < 0.001). Conclusion: Urologic complaints were observed more frequently in the Parkinson patient group compared to the control group. Another important result of this study is that in the Parkinson patient group there was no difference found between urologic complaints in terms of sex

High cholesterol diet activates ER stress mediated apoptosis in testes tissue: Role of alpha-tocopherol

The seminiferous tubules where spermatogenesis occurs are enveloped and protected by the Sertoli cells to support germ cells undergoing meiosis to produce haploid gametes. Clearly, induction of apoptosis in seminiferous tubules leads to abnormalities in spermatogenesis and male infertility. Studies demonstrated that increased hyperlipidemia impairs male infertility and spermatogenesis by enhancing seminiferous tubules apoptosis. However, molecular mechanisms underlying high-cholesterol-mediated testicular damage remain poorly elucidated. In this scope, we established a rabbit model and investigated the role of endoplasmic reticulum (ER) stress on high cholesterol diet induced seminiferous tubule apoptosis. Histopatological examinations revealed increased seminifer tubule apoptosis in testes of rabbits fed high cholesterol diet. In addition, phosphorylated forms of IRE1 and PERK, two well-identified markers of ER stress, were significantly induced in accordance with high cholesterol diet. High cholesterol diet also exhibited CHOP induction in testes, indicating increased ER stress related apoptosis. Supplementation of alpha-tocopherol significantly attenuated cholesterol mediated ER stress, and restored seminiferous tubules apoptosis. Taken together, our findings suggest that alpha-tocopherol might be capable to reduce testicular damage via ameliorating histopatological features and inhibiting seminiferous tubules apoptosis in hypercholesterolemic rabbits

Erken evre Parkinson hastalığında olfaktör disfonksiyon ve epizodik verbal bellek arasındaki İlişki

WOS: 000348845400013PubMed ID: 28360659Introduction: Olfactory dysfunction is an early and common symptom in idiopathic Parkinson's disease (IPD). Recently, the relation between olfactory dysfunction and cognitive loss in IPD has been reported. In our study, we aimed to investigate the relation between olfactory dysfunction and cognitive impairments in early IPD related with this theory. Methods: In this study, we included 28 patients with stage 1 and stage 2 IPD according to the Hoehn-Yahr (H-Y) scale and 19 healthy participants. The University of Pennsylvania Smell Identification Test (UPSIT) was performed for evaluating olfactory function. For cognitive investigation in participants, the clock drawing test, Stroop test, verbal fluency test, Benton face recognition test (BFR), Benton line judgment orientation test (BLO), and Auditory Verbal Learning Test (AVLT) were performed. Results: We found significantly lower UPSIT scores in the patient group compared to controls (p=0.018). In the neuropsychological investigation, only Stroop test and BLOT test scores were significantly lower in the patient group compared to controls (p=0.003, p=0.002, respectively). We found a negative correlation between UPSIT scores and Stroop time (p=0.033) and Stroop error (p=0.037) and a positive correlation between UPSIT scores and SBST long-term memory scores (p=0.016) in patients. Conclusion: In our study, we found mild cognitive impairment related with visuospatial and executive functions in early-stage IPD compared to controls. But, in the patient group, we detected a different impairment pattern of memory and frontal functions that correlated with hyposmia. This different pattern might be indicating a subgroup of IPD characterized by low performance in episodic verbal memory, with accompanying olfactory dysfunction in the early stage.Giriş: Olfaktör disfonksiyon, İdyopatik Parkinson Hastalığının (IPH) erken ve sık görülen bir semptomudur. Son zamanlarda, olfaktör disfonksiyon ile kognitif kayıp arasında ilişki olduğu bildirilmiştir. Çalışmamızda, bu teori ile ilişkili olarak, erken evre IPH’da olfaktör disfonksiyon ve kognitif bozukluklar arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: Bu çalışmaya, Hoehn- Yahr (H-Y) evrelemesine göre evre 1 ve evre 2 IPH tanısı almış 28 hasta ve 19 sağlıklı birey dahil ettik. Olfaktör fonksiyonu değerlendirmek için University of Pennsylvania Smell Identification Test (UPSIT) uygulandı. Hastalarda kognitif fonksiyonu değerlendirmek için, Saat çizme testi, Stroop testi, verbal akıcılık testi, Benton face recognition testi (BFR), Benton line judgement orientation test (BLO), Sözel bellek süreçleri testi (SBST) uygulandı. Bulgular: Kontroller ile mukayese edildiğinde hasta grubunda UPSIT skorlarını anlamlı olarak daha düşük bulduk (p=0.018). Nöropsikolojik değerlendirmede sadece Stroop testi ve BLOT testi kontroller ile mukayese edildiğinde hasta grubunda anlamlı olarak daha düşüktü (sırasıyla p=0,003, p=0,002). UPSIT skorları ile Stroop zamanı ve Stroop hata skorları arasında negatif korelasyon (p=0,037), UPSIT skorları ile SBST uzun süreli bellek skorları arasında pozitif korelasyon bulduk. Sonuç: Çalışmamızda, daha önceki çalışmalardaki gibi, erken evre IPH’da vizyospasyal ve yürütücü fonksiyonlarla ilişkili hafif kognitif bozukluk saptadık. Fakat hasta grubunda hiposmi ile korele şekilde bellek ve frontal fonksiyonlarda farklı bir bozulma paterni saptadık. Bu farklı patern, IPH’ın erken döneminde koku bozukluğu eşliğinde epizodik verbal bellekte performans düşüklüğü görülmesi şeklinde bir alt gruba işaret ediyor olabili

Epilepsy in the elderly

WOS: 000372007900004Amaç: Epilepsi yaşlılarda sık görülen bir hastalıktır, ancak etiyolojisi, klinik sunumu, eşlik eden hastalıkları ve prognozu genç hastalardan farklıdır. Bu çalışmada epilepsi nedenleri, yaşlılarda nöbet tipleri, elektroensefalografi (EEG) bulguları araştırıldı. Gereç ve Yöntem: İlk epileptik nöbetini geçiren ve altmış beş yaş üzerinde 95 hasta retrospektif olarak değerlendirildi. Yaş, epilepsi tipi, EEG bulguları, manyetik rezonans görüntüleme ve/veya kranial tomografi bulguları, etiyoloji, eşlik eden hastalıklar ve verilen antiepileptik tedaviler değerlendirildi. Bulgular: Hastalarımızın yaş ortalaması 75 idi ve 50 (%56) hasta erkekti. Doksan beş hastanın 55’inde (%58) parsiyel tipte nöbet, 36’sında (%38) jeneralize tonik klonik nöbet ve 4’ünde (%4) jeneralize status epileptikus vardı. İnteriktal EEG’de fokal epileptiform aktivite sıklığı %32,6 idi. Nöbetler hastaların %85’inde (81 hasta) monoterapi ile %15’inde (14 hasta) politerapiyle kontrol altında idi. Çalışmamız serebrovasküler hastalıkların, en sık (%63) etyolojik neden olduğunu gösterdi. Yaş ve nöbet sıklığı ve EEG anormallikleri arasında anlamlı bir ilişki saptanmadı. Ancak yaş ve eşlik eden hastalıklar arasında anlamlı bir ilişki saptandı. Sonuç: Sonuçlarımız fokal nöbetlerin yaşlı epilepsinin en sık belirtisi olduğunu desteklemektedir. Serebrovasküler hastalıklar yaşlılarda epilepsinin en fazla rastlanan etiyolojik nedenidir. Monoterapi hastaların çoğunluğunda yeterlidir. Yaşlı nüfusun devamlı büyümesi, doğru tanı ve etkili tedavi gereksinimini arttırmaktadır.Objective: Epilepsy is frequently seen in the elderly, but its etiology, clinical presentation, comorbidities, and prognoses are different than younger patients. In this study, we investigated types of seizures, electroencephalography (EEG) findings and the cause of epilepsy in the elderly. Materials and Methods: We retrospectively analyzed 95 patients who were 65 years old or older, and who had an epileptic seizure for the first time. Type of epilepsy, age, EEG findings, magnetic resonance imaging and/or cranial tomography findings, etiology, comorbidities and antiepileptic medication were evaluated. Results: The average age of our patients was 75, and 50 (56%) patients were male. Among 95 patients, 55 (58%) had focal seizures, 36 (38%) had generalized tonic-clonic seizures and 4 (4%) had convulsive status epilepticus. The frequency of focal interictal epileptiform activity was 32.6% patients. Seizures were responsive to treatment administered as monotherapy in 81 (85%) patients and as politherapy in 14 (15%) patients. Our study showed that cerebrovascular disease was the most common (63%) etiological cause identified. There was no significant relationship between age and frequency of seizures and EEG abnormalities. However, a significant correlation was found between age and comorbidities. Conclusion: Our results supported the focal seizure is the most common manifestation of epilepsy in the elderly. Cerebrovascular disease is the most common etiological cause of epilepsy in the elderly. Monotherapy is sufficient in the majority of patients. Continuous growth of the elderly population is increasing the need for accurate diagnosis and effective treatment