Tularemi bakteriyel zoonotik bir hastalıktır. Etyolojik ajan gram negatif bir kokobasil olan Francisella tularensis’tir. Türkiye’nin de bazı bölgelerinde salgınlar şeklinde ortaya çıkmaktadır. Klinik formları; ülseroglandüler veya glandüler, oküloglandüler, orofaringeal, solunum ve tifoidal formlardır. Nörolojik tutulum nadirdir; literatürde en sık menenjit ve ensefalit kliniği ile bildirilmiş olgular bulunmaktadır.Kırk iki yaşındaki olgumuzda, akut gelişen nörolojik bulgular nedeniyle, öncelikle demyelinizan hastalık, iskemik serebrovasküler hastalık, vaskülit düşünülmüştür. Sistemik muayenede tespit edilen lenfadenopatilerden yola çıkarak tularemi infeksiyonu saptanmıştır. İskemik inmeye neden olabilecek bir etyolojik faktör tespit edilmemiş, demyelinizan hastalık dışlanmıştır. Dijital substraksiyon anjiografide damar duvarlarında kontür düzensizlikleri vaskülitle uyumlu bulunmuştur. Tedavi ile lezyonlar kısmen gerilemiş, tedaviye ara verilmesi ile yeni bir enfarkt gelişmiştir. Tüm bulgular hastada sorumlu etkenin Francisella tularensis olduğunu ves tularemi infeksiyonuna bağlı santral sinir sistemi vasküliti olabileceğini düşündürmüştür.Olgumuz literatürde benzerinin olmaması nedeniyle sunuma değer bulunmuştur.
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Objectives: Lacosamide (LCM) is a new generation amino acid drug that is used in patients with drug-resistant epilepsy, which increases the slow inactivation of voltage-dependent sodium channels. In this study, the short-term results of patients with drug-resistant epilepsy who received add-on LCM therapy were evaluated. Methods: Patients who were at least 16 years old and had focal onset seizures for a minimum period of 1 year were retrospectively assessed. Those who had uncontrolled seizures, despite the use of two appropriate antiepileptic drugs at an effective dose for at least six months, were included in the study. Forty-five eligible patients (11 females, 34 males) underwent further analysis. LCM therapy doses, change in seizure fre-quency, number of seizures before and after LCM therapy, and the effect of LCM add-on therapy on seizures were analyzed. Results: The mean age of the included 45 patients (11 females, 34 males) was 31.42 (16–56) years. Twenty-six of 45 (57.8%) patients under add-on therapy showed a decrease of 50% or more. It was observed that the seizure frequency decreased to a median of 2 (IQR: 0.5–5), which was statistically significant (p<0.001). The dose was not correlated with the seizure decrease ratio (p=0.216). The decrease in seizure frequency was similar in patients with LCM add-on treatment as the second or third drug, when compared with patients using LCM as the fourth or fifth drug (p=0.231).Conclusion: It was observed that LCM add-on therapy significantly decreased seizure frequency, similar to the current literature. On the con-trary, the dose effect or earlier add-on therapy did not show a significant effect on seizure frequency. LCM should be considered as a successful treatment option in patients with drug-resistant focal onset seizures.
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Objective: Migraine is the most common primary headache among the
paediatric population. The frequency of the condition causes a negative
effect on children and parents, affecting the quality of life. Migraine
and other primary headaches may result in sleep interruption, insomnia,
hypersomnia and daytime sleeping. In this study, the quality of life and
sleep disorders of children aged 8-18 years with migraine were assessed
and compared with a healthy cohort.
Materials and Methods: This study included 43 children or adolescents
aged 8-18 years with acute migraine attacks, diagnosed according to
the International Headache Society criteria. Parents completed ‘‘the
children’s sleep habits questionnaire’’ and ‘‘pediatric quality of life
inventory’’ tests. The control group included 48 children and adolescents
without headache and a diagnosis of migraine. The two groups were
compared to assess the negative effects of migraine on children.
Results: The mean ages of the patient (15 boys and 28 girls) and
control groups (25 boys and 23 girls) were 13.81±2.78 and 12.56±3.5
years, respectively. The physical health total score (p=0.000), emotional
functioning score (p=0.019), school functioning score (p<0.000),
psychosocial health total score (p<0.000) and the total scale score
(p<0.000) were significantly lower in the patient group. No significant
difference was noted in the social functioning score (p=0.383).
Additionally, the groups did not differ significantly in terms of sleep
behaviour (p>0.05).
Conclusion: The results of this study were similar to those of previous
studies, with the exception of decreased social functioning score of
the pediatric quality of life inventory. These results substantiate the
importance of administering appropriate treatment for pain control in
children and adolescents. Specialists and parents should be aware of the
potential social problems resulting from migraines.
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