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

Mapping of Posidonia oceanica (L.) Delile Meadows Using Geographic Information Systems: A case study in Ufakdere - Kaş (Mediterranean Sea)

Posidonia oceanica (Linnaeus) Delile 1813 is an endemic and the most widespread seagrass species of the Mediterranean Sea. Seagrass meadows are one of the most productive ecosystems on Earth, providing habitat to numerous organisms. Therefore, mapping of seagrass meadows is of crucial importance for conservation and coastal management purposes. Here we present an integrated geographic information system approach with SCUBA diving, providing a cost effective method to monitor seagrass beds at shallow coastal habitats. In this case study P. oceanica meadows were mapped in Ufakdere region of Kaş (Antalya) coastal area between April – September 2015. A total of 25000 m2 are were screened to create seagrass coverage maps. Results indicate that P. oceanica meadows cover 21200 m2 and we estimated that 520 m2 of this area is highly damaged. This integrated approach provided one of the most detailed small-scale Posidonia mapping in Turkey and this time and cost effective methodology can be applied to any seagrass meadow with great ease to increase our knowledge on this important habitat

Mapping of Posidonia oceanica (L.) Delile Meadows Using Geographic Information Systems: A case study in Ufakdere - Kaş (Mediterranean Sea)

Posidonia oceanica (Linnaeus) Delile 1813 is an endemic and the most widespread seagrass species of the Mediterranean Sea. Seagrass meadows are one of the most productive ecosystems on Earth, providing habitat to numerous organisms. Therefore, mapping of seagrass meadows is of crucial importance for conservation and coastal management purposes. Here we present an integrated geographic information system approach with SCUBA diving, providing a cost effective method to monitor seagrass beds at shallow coastal habitats. In this case study P. oceanica meadows were mapped in Ufakdere region of Kaş (Antalya) coastal area between April – September 2015. A total of 25000 m2 are were screened to create seagrass coverage maps. Results indicate that P. oceanica meadows cover 21200 m2 and we estimated that 520 m2 of this area is highly damaged. This integrated approach provided one of the most detailed small-scale Posidonia mapping in Turkey and this time and cost effective methodology can be applied to any seagrass meadow with great ease to increase our knowledge on this important habitat