Banu Özen Barut

Sleep Disturbances in Essential Tremor and Parkinson Disease: A Polysomnographic Study.

OBJECTIVE Sleep problems are a common non-motor complication of Parkinson disease (PD), and patients with essential tremor (ET) share a number of motor and non-motor features of PD. To clarify the relationship between these disorders, we evaluated the sleep problems in patients with ET and PD using assessment scales and objective polysomnographic (PSG) testing. METHOD Twenty-one consecutive patients with PD, 16 with ET, and 14 healthy subjects participated in this study and were compared in terms of sleep related complaints, final sleep related diagnosis, and polysomnographic features. RESULTS The results of our study have shown that patients with PD were more likely than were those with ET to have a history of REM sleep behavior disorders (RBD) (p = 0.001) and excessive daytime sleepiness (p ≤ 0.05). Additionally, PSG data revealed that ET patients had lower mean SpO2 values (p ≤ 0.05) and REM without atonia (RWA) (p = 0.032) than did patients with PD. CONCLUSION This is the first study to use PSG to evaluate sleep problems both in ET and PD patients. The results point out different sleep problems in these two common movement disorders which should be investigated in further studies.

An unusual case of neuro-Behçet’s disease presenting with co-occurence of cerebral venous sinus thrombosis with basilar artery occlusion

Non-parenchymal neuro-Behçet disease generally affects cerebral venous sinuses, whereas intracranial intracerebral arterial involvement has been rarely reported. But co-involvement of both intracranial intracerebral artery and venous vascular systems in a patient at the same time has not been mentioned before. To the best of our knowledge, this case involving a 25-year-old male with a 7-year history of Behçet disease is the first reported of this type of involvement. He developed occlusion of the basilar artery together with thrombosis of the left sigmoid sinus, distal internal jugular vein, and straight sinus. He was successfully treated with a combination of high-dose steroid and cyclophosphamide. Cranial magnetic resonance angiography demonstrated the resolution of these abnormalities.

Elli Beş Yaş Üstü Popülasyonda Subjektif Bellek Yakınması ile Objektif Kognitif Performans Arasındaki İlişkinin Belirlenmesi

INTRODUCTION This study investigated the frequency of forgetfulness in elderly individuals over 55 years of age and examined the association of subjective memory complaints (SMCs) with objective cognitive functions,, depression and other risk factors. METHODS We recruited 405 patients over 55 years of age who were referred to Neurology, Cardiology, or Physical Therapy and Rehabilitation outpatient clinics. All subjects were questioned regarding forgetfulness and then were administered the Subjective Memory Complaint (SMC) Scale, Mini Mental Test (MMT), Verbal Fluency Test (VFT), Clock Drawing Test (CDT) and the Geriatric Depression Scale (GDS). Subjects with SMC were compared with those without SMC in terms of cognition, depression and some laboratory parameters. RESULTS Of the patients, 42.5% complained of forgetfulness. None of these patients had been admitted to hospital for this complaint. Women and patients with low education had more forgetfulness as well as poorer results on the SMC Scale, MMT, VFT, and GDS. Patients with SMC had lower hemoglobin, ferritin and free T4 levels. Female gender and depression was found to be a risk factor for SMCs. CONCLUSION SMCs are common in people over 55 years of age. Being a woman as well as depression was found to be a risk factor for SMC. Since depression is a treatable condition, these people should be assessed carefully in terms of depressive symptoms. Laboratory parameters, such as hemoglobin, ferritin and free T4 levels should be investigated in patients with SMC. Unlike the other cognitive tests, CDT performance is independent of subjective memory complaints. Elderly patients rarely visit hospital with complaint of SMC, therefore, clinicians should be watchful for this problem.

Hastanede Yatan Yaşlılarda Bilişsel İşlevlerin Günlük Yaşam Aktiviteleri, Depresyon, Anksiyete ve Klinik Değişkenlerle İlişkisi

INTRODUCTION Cognitive impairment in elderly patients, which may be a sign of dementia, depression, anxiety or medical diseases, has been determined as a risk factor for functional loss. In this study, we aimed to investigate the frequency of cognitive impairment and to investigate the relationship of cognitive status with sociodemographic variables, daily living activities, anxiety and depression in elderly inpatients. METHOD The sample of this cross-sectional and descriptive study consists of 243 patients aged 65 years and older who were hospitalized in Bülent Ecevit University Hospital. A sociodemographic questionnaire,, the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale, Lawton-Brody Instrumental Daily Activities Scale, Geriatric Depression Scale (GDS) and the Beck Anxiety Inventory were used for data collection. RESULTS One hundred and six (43.6%) patients were female and 137 (56.4%) were male. The patients were divided into two groups according to the Mini-Mental State Examination (MMSE) 23/24 cut-off score. The cognitive decline was statistically significantly more frequent in patients who were older, female, less educated, low socioeconomic status, and living in rural areas. There were more problems in the basic and instrumental activities of daily living and nutrition in patients with cognitive decline. Anxiety and depression scores were higher in this group. In our study, although the frequency of cognitive decline and depression according to GDS were 56% and 48%, respectively; we found that only 10.5% of patients applied to the psychiatrist, and 9.3% of patients received psychiatric treatment. CONCLUSION Cognitive decline may cause deterioration in the daily living activities, nutrition and capacity for independent functioning. Older age, female, low education, low socioeconomic status and living in rural area are important risk factors for cognitive impairment. Cognitive decline in older age may be associated with depression and anxiety. We assume that when cognitive decline, depression and other psychiatric problems are unidentified, it may contribute to deterioration of mental health in medically ill elderly.

Hypoglossal nerve involvement in Lewis–Sumner syndrome: a case report

Lewis–Sumner syndrome (LSS), which is also called multifocal acquired demyelinating sensory and motor neuropathy (MADSAM). The clinical characteristics of LSS are asymmetric and distal upper limb involvement, with the medial and ulnar nerves being mostly affected [1] Cranial nerve involvement may be seen. However, hypoglossal nerve involvement in LSS is rare but can occur during LSS relapse, as observed in our patient [2]. Here, we report on a patient with a chronic relapsing form of LSS who had unilateral hypoglossal nerve involvement that showed marked improvement following intravenous immunoglobulin (IVIG) treatment.

Tipik ve Atipik Antipsikotik İlaç Kullanımına Bağlı EEG Anormallikleri / EEG Abnormalities Associated with the Use of Typical and Atypical Antipsychotics

Amac: Tipik antipsikotikler ve klozapin EEG anormalliklerine ve epileptik nobetlere neden olabilir. Yeni kusak antipsikotiklerin EEG uzerindeki etkileri cok fazla bilinmemektedir. Yapilan bu calismada klozapin, ketiapin, risperidon ve olanzapin gibi atipik antipsikotikler, amisulpirid, aripiprazol, paliperidon gibi yeni diger atipik antipsikotikler ve klorpromazin, haloperidol, zuklopentiksol, pimozid gibi tipik antipsikotiklerin EEG anormallikleri uzerine etkileri arastirilmistir. Gerec ve Yontemler: Şizofreni veya sizoaffektif bozukluk tanili 102 hasta prospektif olarak degerlendirilerek EEG’leri cekildi. Bunlarin 82’si atipik [klozapin (n:16), risperidon (n:20), ketiapin (n:10), olanzapin (n:14), diger yeni atipik antipsikotikler (n:10)] ve tipik [haloperidol (n:5), klorpromazin (n:2), zuklopentiksol (n:3), pimozid (n:2)] antipsikotik kullaniyordu, 20’si ise ilac kullanmiyordu. Bu uc alt grup; cinsiyet ve yas uyumlu saglikli kontrol grubunun (n=29) EEG’leri ile karsilastirildi. Bulgular: Gruplar arasinda demografik ozellikler bakimindan istatiksel olarak anlamli fark saptanmadi. Hem ilac kullanmayan hastalarin hem de saglikli kontrollerin EEG’leri normaldi. Klozapin kullanan hastalarin % 31,3’unde (p 0,05) epileptik aktivite gozlendi. Epileptik aktivite disindaki EEG anormallikleri tipik antipsikotik kullananlarin %58,3’unde (p 0.05). EEG abnormalities other than epileptic activity were observed in 58.3% of the patients under typical antipsychotics (p<0.01) and 35% of the patients under risperidone treatment (p<0.01). EEG was normal in 78–80% of the patients using quetiapine and new atypical antipsychotics, compared to 33.3% of the patients under typical antipsychotic treatment (p=0.012). Discussion and Conclusion: Herein, we found that clozapine was the most epileptogenic antipsychotic and that typical antipsychotics were making the worse EEG changes. Nevertheless, in the psychotic patients under clozapine treatment EEG is a must. Psychotic patients with consequential epilepsy could be given new atypical antipsychotics because it has the least unwanted effects on EEG. Moreover, it should also be emphasized that there is a need for further scientific research to clarify all aspects characterizing the complex link between seizure threshold and psychotropic drugs. Key Words: electroencephalography; typical antipsychotics; atypical antipsychotics; epileptic activity