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

The Coexistence of Generalized and Lateralized Periodic Discharges: Report of Two Adult Cases with SSPE and MELAS Syndrome

Generalized and lateralized periodic discharges have not been reported previously in the same EEG simultaneously. Here, we report two adult patients who suffered from rare clinical conditions [subacute sclerosing panencephalitis (SSPE) and nitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome]. Their EEGs showed the same pattern consisting of generalized periodic discharges and lateralized periodic discharges in the same EEG simultaneously. Although the appearances of the EEG were very similar, discharges became more prominent after intravenous diazepam injection in the case with SSPE but were suppressed in the case with MELAS. Lesions in the magnetic resonance imaging (MRI) were located posteriorly in both patients, involving mainly subcortical white matter in the case with SSPE, but mainly the cortical area in the case with MELAS. Generalized periodic discharges are also reported in MELAS for the first time. The underlying mechanisms of the genesis of periodic discharges are still not known, and these two patients may help us to learn more about these rare patterns

Cortical dysplasia and epilepsy in a patient with Thrombocytopenia-Absent Radii (TAR) syndome

Thrombocytopenia - absent radii (TAR) syndrome is characterized by bilateral absence of the radii in the presence of both thumbs and thrombocytopenia. Lower limb involvement, cardiac, gastrointestinal, renal and genital abnormalities may also be seen in the patients with TAR syndrome. Although epilepsy, learning difficulties, intracranial vascular malformations, sensorineural hearing loss, hypoplasia of the corpus callosum and cerebellar dysgenesis as a neurological abnormalities have been reported in a few patients, there is no previous report of a patient with TAR syndrome and cerebral cortical dysplasia. Here we report a patient with TAR syndrome who suffered from focal epilepsy due to right parietal dysplasi

The Coexistence of Generalized and Lateralized Periodic Discharges: Report of Two Adult Cases with SSPE and MELAS Syndrome

Generalized and lateralized periodic discharges have not been reported previously in the same EEG simultaneously. Here, we report two adult patients who suffered from rare clinical conditions [subacute sclerosing panencephalitis (SSPE) and nitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome]. Their EEGs showed the same pattern consisting of generalized periodic discharges and lateralized periodic discharges in the same EEG simultaneously. Although the appearances of the EEG were very similar, discharges became more prominent after intravenous diazepam injection in the case with SSPE but were suppressed in the case with MELAS. Lesions in the magnetic resonance imaging (MRI) were located posteriorly in both patients, involving mainly subcortical white matter in the case with SSPE, but mainly the cortical area in the case with MELAS. Generalized periodic discharges are also reported in MELAS for the first time. The underlying mechanisms of the genesis of periodic discharges are still not known, and these two patients may help us to learn more about these rare pattern

Pseudotemporal Epilepsy with Periventricular Nodular Heterotopia

Scientific background: Periventricular nodular heterotopia (PNH) that is one of the subgroups of neuronal migration disorders is associated with intractable epilepsy. However the etiopathogenesis of seizures in PNH patients are still unclear. Heterotopias are not involved in the epileptic network, alone. A complex relation between nodules, hippocampus and neocortex has been reported as the cause. Case: A 20 year-old male patient with intractable seizures is presented with ictal and interictal EEG findings compatible with right temporal lobe seizure. Although his first MRI was reported as hyperintensity in right hippocampus, repeated MRI examination according to epilepsy protocol revealed bilateral PNH, with no signal change in hippocampus. Conclusion: The aim of this case report is to discuss the importance of PNH in the differential diagnosis of intractable seizures, and to mention that neurologists and radiologists can easily miss these lesions, if the walls of ventricles are not checked carefull

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

Long-term effects of vagus nerve stimulation in refractory pediatric epilepsy: A single-center experience

Introduction: Vagus nerve stimulation (VNS) has been used as an adjunctive therapy for both children and adults with refractory epilepsy, over the last two decades. In this study, we aimed to evaluate the long-term effects and tolerability of VNS in the pediatric drug-resistant epilepsy (DRE) and to identify the predictive factors for responsiveness to VNS.Methods: We retrospectively reviewed the medical records of pediatric patients who underwent VNS implantation between 1997 and 2018. Patients with >= 50% reduction of seizure frequency compared with the baseline were defined as "responders". The clinical characteristics of responders and nonresponders were compared.Results: A total of 58 children (male/female: 40/18) with a mean follow-up duration of 5.7 years (3 months to 20 years) were included. The mean age at implantation was 12.4 years (4.5 to 18.5 years). Approximately half (45%) of our patients were responders, including 3 patients (5.8%) who achieved seizure freedom during follow-up. The age of seizure-onset, duration of epilepsy, age at implantation, and etiologies of epilepsy showed no significant difference between responders and nonresponders. Responders were more likely to have focal or multifocal epileptiform discharges (63%) on interictal electroencephalogram (EEG), when compared to nonresponders (36%) (p = .07). Vocal disturbances and paresthesias were the most common side effects, and in two patients, VNS was removed because of local reaction.Conclusion: Our series had a diverse etiological profile and patients with transition to adult care. Long-term follow-up showed that VNS is an effective and well-tolerated treatment modality for refractory childhood onset epilepsy. Age at implantation, duration of epilepsy and underlying etiology are not found to be predictors of responsiveness to VNS. Higher response rates were observed for a subset of patients with focal epileptiform discharges

Evaluation of in vivo DNA damaging and oxidative stress effects of sertraline

49th Congress of the European-Societies-of-Toxicology (EUROTOX) -- SEP 01-04, 2013 -- Interlaken, SWITZERLANDWOS: 000323865800391Sertraline, SSRI group of medicine, is the most frequently prescribed drug and well-known fact that central nervous system medication. In this study, the potential influence of the therapies with the different doses of sertraline on DNA damaging, lipid peroxidation levels and antioxidant enzyme activities were investigated. For this purpose Male Wistar Albino rats were divided into four group: control (n = 6), low (10 mg/kg/day), moderate (40 mg/kg/day), and high dose (80 mg/kg/day). Each treatment group had 6 animals and sertraline were administered by gavage throughout 28 days of the study. The alkaline comet assay and the cytokinesis-block micronucleus (CBMN) assay were used to evaluate DNA damaging potential of sertraline in the peripheral blood lymphocytes (PBLs). There is no statistically significant difference between sertraline treated groups and the negative control group with respect to comet assay results (p > .05). According to the data obtained from the CBMN test, an increase in the micronucleus (MN) frequency was detected only at high dose sertraline treatment. Serum paroxanase (PON), catalase (CAT), and superoxyde dismutase (SOD) activities were determined as well as malondialdehyde (MDA) lipid peroxidation for evaluation of oxidative stress effects of sertraline treatment. Serum SOD activities showed increase, CAT and PON activities decreased in all groups. Lipid peroxidation levels (MDA) increased in all sertraline treated rats (p < 0.05). Based on the data, it can be concluded that high dose sertraline administration enhances oxidative stress. Therefore, dose adjustment in depression patients seems significant as it may help prevention of further prognosis of the diseases.European Soc Toxicol (EUROTOX), ECETOC, Roche, Syngenta, AstraZeneca, Sanofi, Basilea Pharmaceutica, ACEA Biosciences Inc, European Crop Protect, Bioservice Sci Labs GmbH, Oekotoxzentrum Ctr Ecotox, Swiss Confederat, Fed Dept Home Affairs, Fed Off Publ Hlth (FOPH), BASF, SCAHT, Johnson & Johnson, Janssen Pharmaceut Co, Natl Ctr Replacement, Refinement & Reduct Anim Res, ILSI, SERVIER, RCC, Nestle, Suva Pro, Interpharma, Covance, Novartis, Merck, BioRelianc

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