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

GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture

Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment

In vitro cytotoxicity of all-ceramic substructural materials after aging

Periodontitis oral bakterilerin sebep olduğu dişi &ccedil;evreleyen destek kemik ve yumuşak dokuları etkileyen kronik enflamatuar bir hastalıktır. Bu kronik enflamatuar s&uuml;recin sonunda destek dokudaki harabiyet diş kaybına kadar giden sorunlara yol a&ccedil;abilmektedir. Patojen mikroorganizmaların n&ouml;tralizasyonu i&ccedil;in l&ouml;kositlerce reaktif oksijen t&uuml;rlerinin aşırı salınması kronik periodontitisin konak kaynaklı yıkıma sebep olabilecek patolojik &ouml;zelliklerindendir. Şarap, &uuml;z&uuml;m ve &uuml;z&uuml;m &ccedil;ekirdeği ekstratı monomerik flavanol, kateşin, epikateşin ve oligomerik proantosiyanit gibi antioksidan olan polifenolik bileşenlerin ana kaynağıdır. Bu &ccedil;alışmanın amacı ratlarda ligat&uuml;rle ind&uuml;klenen periodontitiste &uuml;z&uuml;m &ccedil;ekirdeği ekstratının alveoler kemik yıkım seviyesi ile plazma total antioksidan durum, total oksidan durum ve osteokalsin seviyelerine etkisini değerlendirmektir. Bu sayede periodontitise bağlı olarak ger&ccedil;ekleşen, reaktif oksijen t&uuml;rlerindeki artışın etkilenme derecesi, ratlara &uuml;z&uuml;m &ccedil;ekirdeği verilerek, antioksidan &ouml;zelliğin alveol kemikteki yıkımla ilişkisi incelenecektir. &Ccedil;alışma Erciyes &Uuml;niversitesi Tıp Fak&uuml;ltesi Hakan &Ccedil;etinsaya Deneysel ve Klinik Araştırma Merkezinde(DEKAM) ger&ccedil;ekleştirilecektir. DEKAM?dan temin edilecek erkek Sprague-Dawley ratlar 4 gruba ayrılacaktır. 1. grubu ligat&uuml;rle ind&uuml;klenen periodontitis + 100 mg/kg &uuml;z&uuml;m &ccedil;ekirdeği gavaj 2. grubu ligat&uuml;rle ind&uuml;klenen periodontitis + 50 mg/kg &uuml;z&uuml;m &ccedil;ekirdeği gavaj 3. grubu &uuml;z&uuml;m &ccedil;ekirdeği verilmeksızın ligat&uuml;rle ind&uuml;klenen periodontitis 4. grubu kontrol ratları oluşturacaklardır. &Ccedil;alışmanın 14 g&uuml;n s&uuml;resinde uygulama kısımının tamamlanması planlanmaktadır. Hayvanlar uyutulup 1., 2. ve 3. grubun maksiller 1. molar dişlerine 5.0 ipek s&uuml;tur bağlanarak periodontitis ind&uuml;klenecektir. 1. gruba 14 g&uuml;n boyunca her g&uuml;n 100 mg/kg &uuml;z&uuml;m &ccedil;ekirdeği gavaj, 2. gruba ise 14 g&uuml;n boyunca 50 mg/kg &uuml;z&uuml;m &ccedil;ekirdeği gavaj yapılacaktır. 14. g&uuml;n sonunda t&uuml;m hayvanlardan plazma total antioksidan durum, total oksidan durum ve osteokalsin seviyelerindeki değişimin takibi i&ccedil;in kan &ouml;rnekleri alınıp hayvanlar kurban edilecektir. Alınan plazma &ouml;rneklerinin biyokimyasal analizi hizmet satın alımı ile &ouml;zel bir firmaya yaptırılacaktır.Hayvanların &uuml;st &ccedil;enesi &ccedil;ıkarılıp stereo mikroskop altında maksiller 1. ve 2. molar dişlerin mine-sement hududu alveol kemik kenarı arası mesafe &ouml;l&ccedil;&uuml;mleri ger&ccedil;ekleştirilecektir.&nbsp;In this study, we evaluated the effects of two different regimens of dietary supplementation with grape seed extract (GSE)based on serum total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) and osteocalcin (OC) inexperimental periodontitis. The investigation was performed at the Department of Animal Experimentation at Erciyes University,Kayseri, Turkey, from May 2011 to June 2011. Experimental periodontitis was induced by placing 5.0 silk sutures around themaxillary first molars. Twenty-seven adult male wistar rats were divided into four study groups as follows: Healthy control(HC; N = 7); Ligature only (LO; N = 6); Ligature-induced periodontitis plus GSE 50 mg/kg (GSE 50; N = 8); Ligature-inducedperiodontitis plus GSE 100 mg/kg (GSE 100; N = 6). GSE administration was performed for 14 days following induction ofexperimental periodontitis. On day 15, serum samples were obtained and rats were sacrificed. Serum samples were analyzed forTAS, TOS, OSI and OC. Defleshed jaws were analyzed morphometrically for alveolar bone loss. The results showed that placing5.0 silk sutures around maxillary first molars resulted in statistically significant bone loss compared to the HC group (P &lt; 0.05).None of the GSE administrated groups showed evidence that GSE was effective in preventing ligature-induced alveolar boneloss. The GSE 100 and GSE 50 groups had a significantly higher TAS compared to the HC group. No significant differences wereseen in TOS, OSI and OC levels. As a whole, GSE administration does not seem to influence TAS, TOS and OC. The lack of atherapeutic benefit of GSE in this study is difficult to explain, and further studies are required to fully assess the potential role ofGSE in periodontal treatment.</div