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

A Patient with Anti-LGI1 Related Autoimmune Limbic Encephalitis who had Frequent and Drug Resistant Seizures

Anti-LGI1 auto-antibody related limbic encephalitis is characterized by memory deficits, various neuro-psychiatric symptoms, behavioral disorders and temporal lobe seizures that point to involvement of the limbic system. Neuro-imaging studies reveal abnormal signal intensity in the mesial temporal structures and/or basal ganglia. Seizures are frequently resistant to antiepileptic medications. However they can be dramatically controlled by immunological treatment modalities. A 29-year-old male patient was admitted to our medical center due to long lasting frequent seizures that could not be controlled with four different antiepileptic drugs. However soon after the diagnosis of anti-LGI1 related autoimmune limbic encephalitis, he received IV pulse steroid treatment that lead to complete and rapid cessation of his seizures. Based on this case report, the presenting features, diagnosis and treatment of anti-LGI1 related autoimmune limbic encephalitis are once more stressed

Nistagmus Downbeat Nystagmus Due to Oxcarbazepine Intoxication

Downbeat nystagmus is associated primarily with structural lesions of the central nervous system and may be observed as a manifestation of drug intoxication. Herein we present an epileptic patient that presented with downbeat nystagmus related to oxcarbazepine intoxication and completely recovered following dose reduction. To the best of our knowledge this is the first report of downbeat nystagmus related to oxcarbazepine intoxication. Moreover, clinicians should be aware that downbeat nystagmus could be a manifestation of antiepileptic drug intoxicatio

Refractory Lesional Parietal Lobe Epilepsy: Clinical, Electroencephalographic and Neurodiagnostic Findings

Introduction: Specialized centers, in the management and surgical treatment of medically refractory epilepsy, emphasize the importance of differentiating the varieties of localization related epilepsies. There has been considerable recent interest in temporal and frontal lobe epileptic syndromes and less attention has been paid to parietal and occipital lobe epilepsies. Methods: Here we report the clinical, electroencephalographic and neuroimaging characteristics of 46 patients with medically refractory lesional parietal lobe epilepsy who have been followed up for 1-10 years. Results: In this study auras were reported in 78.3% of the patients and included sensory symptoms (72.2%), headache (36.1%), nausea and vomiting (36.1%), psychic symptoms (36.1%) and visual symptoms (16.6%). The most common ictal behavioral changes were paresthesia (69.6%) and focal clonic activity (39.1%). Tonic posture, various automatisms, head deviation, staring, sensation of pain and speech disturbances occurred to a lesser extent. Simple partial seizures were present in 69.6%. Complex partial seizures occurred in 43.5% and secondary generalized tonic clonic seizures were reported in 58.7% of the patients. Interictal routine EEG disclosed abnormal background activity in 1/3 of the patients. Nonlocalising epileptiform abnormalities were found in 34.8% of the patients. EEG findings were normal in 34.8% of the patients. The most common presumed etiologic factors were as follows: posttraumatic encephalomalacia, stroke, tumor, malformation of cortical development, atrophy, and arteriovenous malformation. Conclusion: Clinical, electrophysiological and neuroimaging features of the lesional symptomatic partial epilepsy patients may help us to localize the seizure focus in some patients with cryptogenic partial epilepsy. So that, the timing decision of the parietal lobe sampling with more invasive techniques like intracranial electrodes prior to epilepsy surgery would be easier.Wo

A Detailed Evaluation of Centers that Use Video-Electroencephalogram Monitorization and Epilepsy Surgery in Turkey

Objectives: The aim of this study was to collect data through the Epilepsy Surgery Commission of the Turkish Epilepsy Society to obtain a comprehensive assessment of the status of epilepsy patients in Turkey, to identify the existing infrastructure-service potential of video-electroencephalogram (EEG) monitoring (VEM) centers and epilepsy surgery, to initiate standardization activities, to create awareness of the data, and to ensure that the necessary precautions are taken by the health authorities

Nöroloji Staj Notları

Nöroloji Staj NotlarıBu kitap, Dönem V Nöroloji Stajı boyunca öğrencilerin elinde temel bir rehber olmasını sağlamak amacıyla hazırlanmıştır. Hastaya, hikayesine ve bulgularına bir bilmece gibi yaklaşmak, lezyon “nerededir?” ve “nedir?” sorularının yanıtını aramak nörolojiyi zevkli kılan özelliklerdir. İyi bir hikaye almanın önemi hemen her bölümde vurgulanmıştır. Klinik nörolojinin temel ve güncel kavramlarını içermekle birlikte tüm bilgiyi 200 sayfalık bu kitapçığa sığdırmak mümkün değildir. Eksik konular için önerilen kaynaklar kitabın sonunda verilmiştir. Bu ikinci baskıda öğrencilerden ve öğretim üyelerinden gelen görüşler doğrultusunda düzeltmeler yapılmış, nöroanatomik kısa bilgiler ve güncel kavramlar eklenmiştir. Bilgiye ulaşmak için çok çeşitli kaynakların var olduğu bir dönemde, elde temel bir kitabın var olmasının, öğrencinin araştırmacı yönünü azaltmayacağını, aksine artıracağını umuyoruz

Nöroloji Ders Kitabı

Değerli meslektaşlarımızın okuduğu ilk nöroloji kitabı olacağı düşüncesiyle yazılmış ve Hacettepe stajyer ders notlarını kapsayan bu kitabın tüm ülkeye yararlı olması dileğiyle. H.Ü.T.F. Nöroloji Öğretim Üyeler

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