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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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: Epileptogenesis is still not clearly understood. Therefore, there is an inevitable need for research that investigates triggers for reflex seizures and neuropsychological activation (NPA) methods using electroencephalography (EEG) in different epileptic syndromes. In this regard, we aimed to examine the characteristics and frequency of triggers for reflex seizures as well as changes in the frequency of epilepti-form discharges (EDs), according to the stimulus in patients with generalized genetic epilepsy (GGE) and drug- resistant focal epilepsy (FE) by performing a comparative study with a survey and a neuropsychological EEG activation method, besides routine EEG.Methods: A detailed and structured survey questioning seizure triggers was applied to patients with FE and GGE. Afterward, the changes in EDs in juvenile myoclonic epilepsy (JME), absence epilepsy (AE), and resistant FE groups were examined using NPA methods with EEG.Results: The most frequently reported triggers in all patient groups (n=66) were sleep deprivation (68.2%), stress (65.3%), fatigue/physical stress (53%), awakening (42.4%), and light stimuli (25.8%). There was no significant difference between the JME (n=34), AE (n=16), and resistant FE (n=16) groups in terms of either the triggering or inhibition of EDs in EEG by conventional activation and NPA methods. While the triggering of EDs occurred in 24% of patients by hyperventilation and in 18.1% of patients by intermittent photic stimulation, a similar triggering rate was detected in 21.2% of patients by NPA methods. In addition, while the results of the conventional EEG activation methods were negative, a triggered ED was observed in six patients during NPA (11%). Only two patients showed an inhibition by the NPA methods. Four patients had EDs on their EEGs during the NPA methods associated with triggers reported in the questionnaire.Conclusion: In 11% of patients, while an ED was not seen in conventional methods, we observed that ED triggering occurred with the NPA methods. Planning the NPA methods for specific triggers during EEG recordings by prior questioning on the seizure triggers of the patients and applying NPA as an additional triggering method, especially for patients who do not have EDs in EEG with standard activation methods, may be beneficial in terms of the correct diagnosis.
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Objectives: We aimed to investigate the effects of the coronavirus disease 2019 (COVID-19) outbreak on the quality of life (QOL) of patients with epilepsy. Methods: A total of 104 epilepsy patients admitted to our hospital during October and November of 2019 were evaluated for their QOL using the QOL in Epilepsy-31 questionnaire. These assessments were repeated in July 2020 and August 2020 to evaluate the impact of the epidemic on the QOL of epilepsy patients in the same group. The data of the patients were analyzed in SPSS. Results: During the pandemic period, overall score values decreased significantly compared to the pre-pandemic period (p=0.049). Although most of the subscores worsened with the pandemic, the most significant deterioration was observed in emotional well-being (p=0.021). There were six patients (5.8%) whose seizure frequency increased during the pandemic period. In the multivariate analysis, the only parameter that predicted an increase in seizure frequency during COVID-19 was the overall score. Overall score had a positive correlation with educational level. Disease duration, age, marital status, and number of drugs used were found to be negatively correlated with the overall score of the patients. Conclusion: The COVID-19 epidemic causes a significant deterioration in QOL in patients with epilepsy. During epidemics such as COVID-19, clinicians should consider psychosocial factors. In patients with epilepsy, measures should be taken not only to control seizures but also to prevent deterioration in mental health and QOL.
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Amaç: Uzun süreli antiepileptik ilaç kullanımı kemik mineral dansitesinde azalma, osteoporoz ve kırık riski ile ilişkisi bulunmuştur. Kemik mineral metabolizması üzerindeki etkileri tam olarak bilinmemekle beraber ana mekanizma, antiepileptiklerin neden olduğu D vitamini eksikliğineodaklanmış görünmektedir. Bu çalışmanın temel amacı karbamazepin, valproik asit, okskarbazepin, levetirasetam ve lamotrijin monoterapilerinin epilepsi hastalarının kemik sağlığı durumuna etkilerini araştırmaktır.Gereç ve Yöntem: Bu çalışmaya en az bir yıl boyunca monoterapi olarak karbamazepin (n=75), valproik asit (n=75), okskarbazepin (n=37), levetirasetam (n=54) veya lamotrijin (n=29) kullanan 270 epilepsi hastası ve 71 sağlıklı kontrol dahil edildi. Cinsiyet, yaş, günlük ilaç dozu, serumilaç seviyesi ve hastalık süresi gibi hastaların demografik ve klinik özellikleri kaydedildi. Ek olarak, katılımcıların D vitamini, kalsiyum, iyonizekalsiyum ve total protein düzeyleri ileriye yönelik olarak değerlendirildi.Bulgular: Kontrol grubunda D vitamini eksikliği %47.9 oranında saptanırken, epilepsi hastalarının tümüne bakıldığında %78.5 oranında bulundu. Karbamazepin, valproik asit, okskarbazepin ve levetirasetam gruplarının D vitamini düzeyleri kontrol grubuna kıyasla anlamlı olarakdüşük ve D vitamini eksiklik sıklıkları da kontrol grubuna göre anlamlı derecede yüksek bulundu. Valproik asit ve levetirasetam gruplarında ilaçkullanım süresi ile D vitamini düzeyi arasında negatif bir korelayon saptandı.Sonuç: D vitamini eksikliği uzun süreli antiepileptik ilaç kullanan epilepsi hastalarında sıktır ve bu popülasyonda kırık riskinin artmasına kısmenkatkıda bulunabilir. Çalışmamızın sonuçları, epilepsi hastalarının D vitamini seviyelerinin düzenli olarak değerlendirilmesi gerektiğini göstermektedir.
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Objective: In this study, psychogenic-nonepileptic seizure (PNES) frequency was investigated in epileptic patients; weexplored the association between the disease duration, population / clinical data and the prevalence of depression fear.Method: The study included 108 patients with definitive epilepsy. Video EEG and medical records were treated for PNESin patients. Demographic features, duration of illness, seizure frequency, type of seizures, all treatments have beendocumented. All patients earned the Beck Depression and Anxiety Scale. Patients were divided into two groups along withepileptic (Group1) and PNES (Group2). Patients were divided into two groups.Results: The mean age of the patients was 48 ± 12.31years. Fifty-six of all patients (51.8%) were female. Psychiatricnonepileptic-seizures had been shown in 41(37.9%) of 108 epileptic patients.25 of 41 patients (60.9%) were female. Ofthe 41 patients with non-epileptic seizures, 23(56%) were observed to have epileptic seizures under control. Depressionand anxiety scores were significantly higher in Group 2 compared to Group 1 (p≤0.005).Conclusion: In patients with long-term and depressed/anxiety symptoms, PNES should be challenged, particularly in thepresence of various forms of seizures treatment resistance, even under control.
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Amaç: Obstrüktif Uyku Apne sendromunda (OUAS) ağrı, depresyon ve yorgunluk ilişkisinin sosyoekonomik açıdan önemli toplumsal yükler getirdiği gösterilmiştir. Çalışmamızda OUAS hastalarda ağrı semptomlarının prevalansını, demografik ve klinik özelliklerini analiz etmeyi amaçladıkGereç ve Yöntem: Tüm gece polisomnografi çekimi ile OUAS tanısı almış olan 84 hastaya Kısa Ağrı Envanteri, Beck Depresyon ölçeği (BDS), Pittsburgh Uyku Kalitesi indeksi (PSQİ), Epworth Uykululuk ölçeği (ESS), Yorgunluk Şiddet ölçeği (FIS) ve Yorgunluk Etki ölçeği (FSS) uygulandı.Bulgular: Yaş ortalamaları 54,37±11,03 yıl, 62 erkek, 22 kadın toplam 84 hasta çalışmaya dahil edildi. Yirmi beş hasta (%43,1) baş ağrısı, 22 hasta (%37,9) miyofasiyal ağrı ve 11 hasta ise diğer tip (%19) ağrılar tanımladı. Ağrısı olan hastaların FSS, FİS toplam ve bilişsel, sosyal ve fiziksel alt gruplarının ve ESS puanlarının ortalamaları ve ağrısı olmayan hastalardan anlamlı derecede yüksek bulundu. OUAS şiddetine göre ağrı varlığı anlamlı bir farklılık göstermedi, hafif, orta ve ağır OUAS olguları arasında minimum O2 satürasyonu dışında hiçbir parametrede anlamlı farklılık saptanmadı. Son 1 haftada hissedilen ağrının şiddeti ile BDS puanları arasında pozitif yönlü orta düzeyde, PSQİ puanları ile uygulanan tedavi sonucu ağrının azalma oranı arasında negatif yönlü zayıf düzeyde, FIS-bilişsel alt puanı ile anket yapıldığı esnadaki ağrı şiddeti puanları arasında ise pozitif yönlü zayıf düzeyde istatistiksel olarak anlamlı bir korelasyon bulundu.Sonuç: Çalışmamızda ağrısı olan hastalarda gündüz aşırı uykululuk ile yorgunluğun etki ve şiddeti ağrısı olmayanlara göre yüksek bulundu. En belirgin farkın bilişsel ve sosyal yorgunluk açısından olduğu görüldü. Bizim verilerimize göre beklenenin aksine OUAS şiddetinin ağrı üzerine etki etmediği izlendi.
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Amaç: İnmeye yaklaşımda toplumun ve sağlık personellerinin farkındalığı hayati önem taşır. Bu çalışmada inme geçiren hasta yakınlarının ve sağlık personelinin (hekim dışı) bu farkındalıkta olup olmadığını ve akut inme sırasında hastaya doğru davranışı ne kadar gösterebildiğini karşılaştırmalı olarak araştırmayı amaçladık.Yöntemler: Ağustos 2018-Kasım 2018 tarihleri arasında hastanemizde çalışan sağlık personeli, servislerimizde inme tanısıyla yatan/poliklinik takibi olan hasta yakınları; inme hastasıyla karşılaşmamış toplum kaynaklı kişiler (kontrol grubu) gönüllük esasıyla çalışmaya dahil edilmiştir. Katılımcıların sosyo-demografik özellikleriyle beraber, araştırmacılarca hazırlanan inme bulguları/acil yaklaşımları/risk faktörleri sorularının değerlendirildiği anket formu katılımcılara uygulanmıştır.Bulgular: Çalışmaya 236 sağlık personeli; 268 hasta yakını, 165 kontrol grubu olmak üzere toplam 669 kişi katıldı. Hasta yakınlarının ve kontrol grubunun sağlık çalışanlarına göre anlamlı düzeyde en sık internetten inme ile ilgili bilgiyi aldıkları saptandı (p=0,001); beklenenin aksine hasta yakınlarının üçüncü sıklıkta sağlık personelinden inme bilgisine ulaştığı izlendi. İnmenin tedavi edilebilir olduğu bilinci, sağlık personelinde mevcutken (p≤0,005), hasta yakını grubunun kontrol grubuyla benzer sayıda yeterli bilinçlilikte olmadığı tespit edildi. İnme hastasına ilk yaklaşım olarak sağlık personeli %77, hasta yakını grubu %46 ve kontrol grubu ise %34 oranlarında ACİL-112’yi arama cevabını verdi. Sağlık personelinin %73,7’si, hasta yakınlarının %38’i, kontrol grubunun %24’ü inme hastasına acil yaklaşım süresinin ilk 4,5 saat içinde olduğu doğru cevabını verdi.Sonuç: İnme farkındalığı açısından üç grupta benzer yüksek bilinçlilikte iken, inmenin tedavi edilebilirliği ile inme hastasına ilk yaklaşımın 112’yi aranması açısından yeterli bilinçlilikte olunmadığı gözlemlend
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Objectives: Transient Ischemic Attack (TIA) is due to a temporary lack of adequate blood and oxygen to the brain. TIAs typicallylast less than 24 hours. 10-15% of ischemic stroke patients have a history of TIA. 18% of them experience an ischemic stroke within90 days, and the ABCD2 scoring system is used to estimate the risk. Our study aims to investigate the risk factors, the etiology, thelesion occurrence on MRI and the near-term risk of stroke of patients on whom TIA was diagnosed.Methods: In this study, 124 patients were included between January 2012 and January 2018. Sixty-eight of the 124 patients weremale. The history of patients was questioned; systemic and neurological examinations were made. The stroke risk factors and TIAduration were noted and ABCD2 scores were calculated. All the patients’ blood samples, including glucose and lipid profile, werestudied. They received CT, DWI MRI, electrocardiography, transthoracic echocardiography, ultrasound and/or MR angiography ofthe cervical arteries.Results: One hundred twenty-four patients were included in this study, and 56 patients were female. The mean age was63.04±16.77. Hypertension was the most common risk factor (50.8%). Twenty-seven patients were on antithrombotic; six patientswere on anticoagulant therapy, while 91 patients were not receiving any antiaggregan therapy. ABCD2 scores were significantlyhigher on the antithrombotic therapy group (p=0.019). In 52 patients ABCD2 score was below 4, and in 72 patients, the score wasgreater than 4. In 67.7% of patients, no etiology was found. An ischemic lesion was detected in 16.9% of the patients. 58 % of thepatients were discharged on anticoagulant therapy. Five patients developed ischemic stroke.Conclusion: The risk factors of ischemic stroke and TIAs are similar factors. The etiology of TIAs cannot be found out in most of thepatients. Thus, the patients are discharged with oral anticoagulant treatment.
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