Caner Feyzi Demir

Serum ghrelin levels are enhanced in patients with epilepsy

PURPOSE In patients with epilepsy, although many changes in the physiology of hormones in the neuroendocrine system can occur (especially in the sex hormones, for example), the causes of these changes have not been fully elucidated. There are also relations between seizure activity and stages of sleep. Ghrelin is the peptide hormone, which has been shown to affect both endocrine function and sleep. The purpose of this study was to evaluate serum levels of ghrelin in epilepsy patients. METHODS A total of 35 patients currently receiving antiepileptic drug therapy (of these patients, 20 had primary generalized seizure and 15 had partial seizure) were studied. The control group consisted of 30 healthy volunteers matched for age and gender. In all participants, serum levels of ghrelin, cholesterol and triglycerides were measured and body mass index (BMI) was determined. Patients with endocrine, immune or any other chronic diseases were excluded. RESULTS In the epilepsy patients, the mean serum ghrelin level was 158.81+/-55.97 pg/ml, and this was significantly higher than the control groups level of 93.43+/-21.33 pg/ml (p<0.001). In terms of serum cholesterol, triglycerides and BMI, no significant differences were found between the epilepsy patients and the control group (p>0.05). CONCLUSIONS The origin of higher serum ghrelin levels in epilepsy and their relation to seizures are not completely known. However, this elevation of serum ghrelin could contribute to the lengthening of NREM sleep in epilepsy patients, thereby playing a role in seizure occurrence. From another direction, high serum ghrelin levels could cause changes and/or dysfunction in hormone secretion and physiology via its effects on growth hormone, and thereby play a facilitating role in seizure occurrence.

Clinical and Radiological Management and Outcome of Pregnancies Complicated by Cerebral Venous Thrombosis: A Review of 19 Cases

BACKGROUND We sought to determine the risk factors and clinical outcomes of pregnant women with cerebral venous thrombosis (CVT). METHODS Nineteen pregnant patients with a diagnosis of CVT were followed in the neurology unit between 2009 and 2012. Patients with central nervous system infection and with CVT secondary to invasive procedures were excluded. Magnetic resonance imaging and magnetic resonance venography were performed for all patients. RESULTS There were 19 pregnant women ranging in age from 18 to 38 years (mean 27.5 years). The follow-up period ranged from 11 to 24 months (mean 19 months). Symptoms and signs that suggested a rise in intracranial pressure were present nearly in all cases, including headache, vomiting with or without nausea, disturbances of consciousness, and papilledema. Seizures and status epilepticus (with or without preeclampsia) were present in 8 cases. The rate of CVT was higher in the third trimester. The superior sagittal and transverse sinuses were the most commonly affected cerebral sinuses in our patients, and parenchymal involvement was present in 7 patients. There was no maternal mortality, and 20 infants were still alive and healthy. CONCLUSIONS If magnetic resonance imaging is available, it should be used for the detection of CVT in all pregnant patients instead of computed tomography. Patients with parenchymal lesions, thrombophilia, and antiphospholipid syndrome had a greater risk of being left with neurologic sequelae. For pregnant patients with CVT, low molecular weight heparin in full anticoagulant doses should be continued throughout the pregnancy. Anticoagulant therapy did not appear to predispose patients to further intracranial hemorrhage.

Investigation of Vaspin Level in Patients with Acute Ischemic Stroke

BACKGROUND Cerebrovascular event is a clinical condition characterized by symptoms and findings pertaining to loss of focal cerebral function because of the vascular causes. Atherosclerosis has a forefront role in the pathogenesis of stroke. Inflammation has an important place in the formation of atherogenesis and atherosclerosis. Visceral adipose tissue-derived serpin (vaspin) is a new adipokine, which is identified recently, associated with obesity and diabetes and also has a proinflammatory characteristic. This study was intended to investigate the relation between vaspin and stroke and stroke and other risk factors. METHODS A total of 50 patients with stroke, as 28 men (56%) and 22 women (44%), and a total of 50 healthy individuals, as 25 men (50%) and 25 women (50%), were enrolled in the study. Blood samples were taken in the acute period (first 48 hours) in the patient group, and serum vaspin levels were measured. Vaspin level was also measured in the control group. The association of vaspin with the lipid parameters, gender, and the severity of internal carotid artery (ICA) stenosis in the patient group was evaluated. Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion. RESULTS No statistically significant difference was found between 2 groups in terms of age and gender (P > .05). Vaspin levels were found to be significantly higher in the patient group (164.73 ± 153.76 ng/mL) compared with the control group (116.21 ± 34.60 ng/mL) (P < .05). However, no relation was established between vaspin level and the severity of ICA stenosis. CONCLUSIONS Vaspin levels have been shown to increase in acute ischemic stroke patients. The increased vaspin levels may vary depending on several factors in acute period of ischemic stroke.

Insecticide imidacloprid influences cognitive functions and alters learning performance and related gene expression in a rat model.

The potential toxic effects of several pesticides, including imidacloprid on non‐target organisms have not been clearly established. Also, the chronic effects of non‐toxic doses on cognitive function in mammals are unknown. In this study, the effects of different doses of imidacloprid on learning and memory of infant and adult rats were evaluated, and the expressions of genes synthesizing proteins known to be associated with learning in brain tissues were also documented. 0.5, 2 and 8 mg/kg doses of imidacloprid were administered to newborn infant and adult Wistar albino rats by gavage. Their learning activities were evaluated, and the expression levels of the inotropic glutamate receptor GRIN1, synoptophysin, growth‐associated protein 43 and the muscarinic receptor M1 in hippocampus were determined by real‐time PCR method. Learning activities were diminished significantly at 2 and 8 mg/kg doses in the infant model groups and at 8 mg/kg dose in adult rats. Also, expression levels of GRIN1, SYP and GAP‐43 were found to be insignificantly altered. Only the expression of M1 were significantly changed in high doses of adult group. Thus imidacloprid in high doses causes deterioration in cognitive functions particularly in infant rats, and this deterioration may be associated with changes in the expressions of related genes.

Is it possible to detect active multiple sclerosis plaques using MR thermometry techniques

Multiple sclerosis lesions or plaques are considered to be the result of an inflammatory process in the brain that leads to attack myelin. Inflammation causes disruption of blood-brain barrier in acute, active plaque areas. This process may lead to increase blood supply that causes increase in temperature in these associated areas. These plaques can be seen by examining the brain using magnetic resonance imaging (MRI). Presence of these plaques plays an important role in indicating dissemination in time within the new diagnostic criteria and in treatment of active MS. Gadolinium-based contrast agents help for quantitative assessment of inflammatory activity and lesion load. However, these agents have serious risks such as anaphylaxis and kidney damage. We wanted to open up a discussion for the feasibility of using noninvasive MR thermometer technique instead of conventional MRI techniques, for evaluating the temperature and the extent of temperature changes of white matter and plaques in MS patients. After successful using of MR thermometer technique with upgraded applications, the time needed to perform the studies in a routine setting can be significantly shortened. With eliminating usage of contrast agent, considerable influx money can be provided along with preventing the adverse effects and risks of contrast agent usage.

Paraplegia in pregnancy: a case of spinal vascular malformation with Klippel-Trenaunay syndrome.

Study Design. A case report. Objective. To present improvement of paraplegia due to spinal vascular malformation after delivery with no intervention. Summary of Background Data. Pregnancy has been reported rarely in patients with Klippel–Trenaunay syndrome (KTS). A combined case of spinal arteriovenous malformations (AVMs) within KTS has not been reported before. Methods. A case report of KTS with paraplegia is presented and the pertinent literature is then reviewed. Results. A pregnant woman who was diagnosed with KTS in childhood presented with newly developed paraplegia due to spinal AVMs. Magnetic resonance image showed a vascular malformation at the T9–T12 levels without evidence of spinal cord hemorrhage. Diagnostic angiography that was performed after delivery revealed a high-flow arteriovenous fistula with AVM. Conclusion. Pregnancy complicated by paraplegia is thought to be secondary to venous engorgement and to the resulting spinal cord ischemia in this case. Her neurological symptoms and signs gradually improved over the few days after cesarean delivery.

EFFICACY OF TOPIRAMATE AS ADD-ON THERAPY IN TWO DIFFERENT TYPES OF PROGRESSIVE MYOCLONIC EPILEPSY

The present article describes two unrelated cases of progressive myoclonic epilepsy (PME) of the Laforas disease and Unverricht-Lundborg types who were treated with topiramate (TPM) as add-on therapy for their myoclonus. After the initiation of topiramate therapy both cases responded with marked decrease in myoclonic seizure frequency and improvement of quality of life. Topiramate appears to be a useful alternative agent in cases of PME and could be consider for adjunctive therapy.

Do polio survivors have a higher risk of epilepsy

We planned this study to investigate the frequency of epilepsy in paralytic polio survivors. We analyzed the clinical data of 91 paralytic polio survivors. Patients who had been diagnosed with epilepsy were examined by electroencephalography and brain magnetic resonance imaging. 11 of the 91 patients had epilepsy (12%). The mean age at which the patients were exposed to acute poliomyelitis was 5.3±3.8 years (age range: 1-13). The mean age of epilepsy onset was 17±5.6 (age range: 4-25) in the epileptic patients. Our findings suggest that paralytic polio survivors may be at a higher risk for epilepsy compared to normal subjects.

A case of Ross syndrome presented with Horner and chronic cough

Ross syndrome is a rare sweating disorder associated with Adies tonic pupil, decreased or diminished tendon reflex and unknown etiology. Although autonomic disturbances affecting sudomotor and vasomotor functions are seen commonly, they are rarely symptomatic. While Ross syndrome is typically characterized with dilated tonic pupil, it may be rarely manifested with miotic pupils (little old Adies pupil), which can make diagnosis difficult. In this article, we aim to specify the atypical clinical manifestations of syndrome by means of Ross syndrome manifested by autonomic symptoms, Horner syndrome, chronic cough together with bilateral little old Adies pupil.

Auditory P300 Event-Related Potentials in Children with Sydenham?s Chorea

UNLABELLED P300 event-related potentials (ERPs), objective measures related to cognitive processing, have not been studied in Sydenhams chorea (SC) patients. PURPOSE To assess cognitive impairment with P300 ERPs. METHOD Seventeen patients with SC and 20 unaffected healthy children were included. Stanford-Binet test was used for psychometric assessment, and odd-ball paradigm was used for auditory ERPs. RESULTS There was no significant difference in P300 latencies between the SC-pretreatment group, SC-posttreatment group and control group (p>0.05). Mean interpeak latencies in SC-pretreatment group and SC-posttreatment group showed significant prolongation compared with the control group (p<0.05). Mean interpeak latencies in SC-posttreatment group were significantly decreased compared with SC-pretreatment group (p<0.05). Compared to controls, patients did not show significant difference in Stanford-Binet intelligence examination. CONCLUSION This report suggests that interpeak latencies and amplitudes of P300 ERPs could be useful for detecting and monitoring cognitive impairment in SC patients.Os potenciais evento-relacionados a P300 (ERPs), medidas objetivas relacionadas ao processamento cognitivo, nao foram ainda estudados em pacientes com Coreia de Sydenham (CS). Objetivo: avaliar o comprometimento cognitivo atraves dos ERPs P300. Metodo: foram incluidos 17 pacientes com CS e 20 criancas saudaveis. A avaliacao psicometrica foi feita utilizando o teste de Stanford–Binet e, para os ERPs auditivos, foi usado o paradigma odd-ball. Resultados: Nao houve diferenca significativa nas latencias P300 entre os grupos CS pre-tratamento, CS pos-tratamento e grupo controle. (p>0,05). A media das latencias interpicos no grupo CS pre-tratamento e CS pos-tratamento apresentava aumento significativo em comparacao aos pacientes do grupo controle (p<0,05). A media das latencias interpicos no grupo CS pos-tratamento apresentava decrescimo significativo quando comparada aquela do grupo CS pre-tratamento (p<0,05). Comparados aos controles, os pacientes com CS nao mostravam diferenca significativa em relacao aos controles ao teste de Stanford-Binet. Conclusao: Este estudo sugere que as latencias interpicos e as amplitudes dos ERPs P300 podem ser uteis para detectar e monitorar a ocorrencia de comprometimento cognitivo em pacientes com CS.