Objectives: Vagal nerve stimulation (VNS) is an appropriate treatment option for refractory patients who are not eligible for resective epilepsy surgery. In this study, the clinical and demographic characteristics of VNS patients were documented and it was aimed to determine the effect of VNS on seizure control. Methods: A retrospective survey was performed for patients who were diagnosed as drug resistant epilepsy and underwent VNS implantation, with at least 1 year of follow-up. Nine patients (eight males and one female) with an average age of 30.11 (18–42), were included. Reduction in seizure frequency prior and in the 3rd, 6th, and 12th months after VNS implantation was compared. Patients were considered responders when a reduction of seizures of more than 50% was reported. Results: The mean time from the onset of the disease to VNS implantation was 17.33±9.75 years and the mean age when VNS was implanted was 24.53 (9–39). Decrease in frequency of seizures from VNS implantation to 3 months and 6 months was statistically significant (p=0.003 and p=0.012, respectively). No statistical significance was found between the frequency of seizures before treatment and at the 12th month (p=0.153). Conclusion: In our study, we observed a decrease in seizure frequency in patients with drug resistant epilepsy with a variety of etiologies, which was similar with the literature data. Although a cumulative effect was reported, we have observed a minimal decrease in frequency after the 3rd month
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Volvular epileptic seizure is characterized by walking repetitively in small circles and it is a rare kind of seizure. It is a result of focal epileptic
activity. It could coexist with adversive seizures but it is considered as a separate seizure semiology. Volvular seizures may occur due to primary
epileptic syndrome or secondary to an intracranial lesion. Volvular seizures are mostly seen in frontal lobe lesions, whereas it can be associated
with temporal, parietal, or occipital lesions. We report a case who has volvular epilepsy started at age of 55 due to an intracranial lesion which
we considered and treated as an autoimmune lesion and controlled his resistant epilepsy. New onset epileptic seizures can be caused by
autoimmune etiology.
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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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Objective: Trigeminal autonomic headaches are the primary headache group that occurs with autonomic stimulation of the cranial nerves. The most common type of this group is cluster headache (CH). This study aimed to report the clinical features and pain characteristics of patients with CH. Materials and Methods: Patients of the outpatient headache center between 2010 and 2020 were retrospectively analyzed. Inclusion criteria were diagnosis of CH and a minimum of 1-year follow-up. Records were reviewed using the International Headache Classification-3β. The sociodemographic characteristics of patients, types of pain, pain characteristics, and treatments that were used were documented. Clinical features were compared with sociodemographic characteristics and factors that could affect the pain features. Results: The mean age of 32 patients (25 male and 7 female) was 41.8 (23-68) years, and the mean age at disease onset was 31.7 (15-65) years. Lacrimation followed by conjunctival injection were the most common autonomic findings. According to gender, no statistical significance was found between pain character (p=0.166), painful side (p=0.572), month of onset (p=0.562), accompanying autonomic findings (p=0.495), pain duration (p=0.650), pain occurrence time during the day (p=0.394), and localization (Retroorbital/orbital, p=0.602; temporal, p=0.650; and forehead p=0.394). Nine patients had migraine-like features (MLF). The pain duration of patients with MLF was found to be 1.14±0.6 months and this period was longer than the results of other patients. No statistically significant difference was found between pain characteristics. Conclusion: The delay in diagnosis due to MLF that may accompany shows the importance of increasing awareness in the definition of CH.
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Objectives: Epilepsy, according to our current knowledge, does not increase the risk of Coronavirus disease 2019 (COVID-19) infection or the
rate of complications related to this infection. However, the COVID-19 pandemic can have adverse effects on patients with epilepsy (PWE) and
affect the mental health of the community in general. This study aimed to evaluate the depression and anxiety of epilepsy patients, the effect
of the epidemic on the frequency of seizures, and the quality of life of the patients in the past 3 months during the pandemic.
Methods: The patients who were referred to an epilepsy outpatient clinic of a tertiary neuropsychiatry center within the past 2 years were retrospectively
evaluated. The data regarding the seizures, quality of life, anxiety, and depression were recorded during follow-up or through an
online platform. Seizure frequency, frequency change during the pandemic (April 2020 to June 2020), medications, admissions were obtained,
and Beck Depression and Anxiety Scale were applied to the patients. The patients’ quality of life was evaluated using the “Quality of Life Scale
Short Form-36 (SF-36)” form.
Results: One hundred sixty-four patients (77 men, 87 women) included in the study were analyzed. The median overall seizure frequency
and seizure frequency during pandemic were 0.2 seizures/month (0–1) and 0 seizures/month (0–0.9), respectively. 125(76.2%) of the patients
reported that they had no seizures during that period. No significant difference was found between the frequency of seizures reported by the
patients before and during the pandemic period (p=0.12). Only one patient had a PCR confirmed COVID-19 diagnosis, and the other six patients
were diagnosed clinically and radiologically. No significant relationship was found between COVID-19 diagnosis and seizure frequency
(p=0.671). 105(64.02%) patients were considered to have depressive symptoms with ten or more points according to the Beck Depression
Scale. 116 patients (70.7%) were considered to have anxiety symptoms with nine or more points from the Beck Anxiety Scale.
Conclusion: This study was conducted to evaluate the seizure frequency, psychiatric status, and quality of life of PWE in April, May, and June
2020 during the first peak of the COVID-19 pandemic in our country while the social restrictions were applied at the highest level. We found
that there was no significant increase in the seizure frequency of patients during the pandemic period and depressive symptoms were common
in this patient group and affected their quality of life.
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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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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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Objectives: Pregnancy in women with epilepsy carries a higher risk for fetal development complications, including congenital malformations.
In this study, data obtained from pregnant epilepsy patients in a tertiary epilepsy center were presented.
Methods: In this study, 128 pregnancies of 110 pregnant women followed up in the epilepsy outpatient clinic between April 2011 and April
2021 were examined. Demographic data of the patients, antiepileptic drugs AEDs used, and pregnancy outcomes were reviewed retrospectively.
Results: During pregnancy, 101 patients (78.9%) received monotherapy, and lamotrigine was the most commonly used drug in monotherapy.
A two-drug combination was used in 18 patients (14.1%), and a three-drug combination was used in 5 patients (3.9%). Although the frequency
of seizures did not increase in most patients, the frequency of seizures increased in 18 patients (14.1%) and decreased in 5 patients (3.9%). In
our study, the intrauterine fetal loss occurred in five patients, newborn infants with congenital malformations in three patients, and neonatal
death during delivery in one patient. The number of AEDs used in multivariate logistic regression predicted adverse outcomes such as intrauterine
fetal loss, neonatal death, and newborns with congenital malformations.
Conclusion: Management of pregnant patients with epilepsy is difficult for both mother and fetus. In our study, combination therapy was
more associated with adverse outcomes for the fetus and newborn. Pregnancy should be planned, and seizure-free pregnancy should be
targeted with low-dose monotherapy.
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Objectives: Creutzfeldt- Jakob Disease (CJD) is a neurodegenerative disease characterized by abnormally-shaped proteins. CJD is the most common type of prion diseases with incidence of 1/100000 per year. In this study, we aimed to review clinical, laboratory, electrophysiological and radiological findings and prognosis of 21 cases with the diagnosis of CJD. Methods: A retrospective review of patient records in a single institution was performed to identify patients with sporadic CJD from 2010 to 2018. January 2017 diagnostic criteria were used for inclusion. In this study, 21 patients were included for analysis. Demographic features, symptoms, clinical findings of neurological examination, disease duration, laboratory findings, electrophysiological test results, findings of magnetic resonance imaging and prognosis were documented. Results: Twelve of the patients included in this study were male and nine were female. The mean age was 64.1 (49–79). All the patients had dementia and changes in personality at admission to the hospital. The duration of complaints was 5.4±4 months. Periodic sharp wave complexes were observed in the electroencephalogram at baseline or follow-up. Twenty patients had undergone lumbar puncture to identify 14.3.3 protein tests in cerebrospinal fluid. In six of twelve patients whose results were received, 14.3.3 protein level was positive, whereas four of them were negative and two were at borderline. Seven patients died of the disease during the follow-up in our hospital within 2.8 (1–6) months from the symptom onset. Conclusion: In patients with rapidly progressive dementia, behavioral changes, hallucinations and myoclonus, CJD should be kept in mind for earlier diagnosis.
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