Emine Genç

Evaluation of cardiac repolarization indices in well-controlled partial epilepsy: 12-Lead ECG findings

PURPOSE To evaluate the cardiac repolarization indices in terms of QT intervals in patients with well-controlled partial epilepsy. METHODS Seventy-six adult patients with well-controlled partial epilepsy and 66 healthy controls were enrolled into the study. 12-Lead ECGs were obtained from all participants. Corrected QT (QTc) intervals including maximum QTc (QTmaxc), minimum QTc (QTminc) and QTc dispersion (QTcd) were calculated. RESULTS QTmaxc and QTcd intervals were significantly longer in the epilepsy group when compared to control group (439+/-27 ms vs. 422+/-25 ms, p<0.001 and 55+/-18 ms vs. 41+/-18 ms, p<0.001). The proportion of patients with pathologically prolonged QTcd intervals (>50 ms) was significantly higher in the epilepsy group (25 of 76 vs. 7 of 66, p=0.002). QTmaxc was significantly correlated with age (beta=0.29, p=0.012) after adjusting for gender, body mass index and duration of epilepsy. No correlation was observed between the duration of epilepsy and any of the QT intervals. There were no significant differences between the subgroups regarding QT intervals according to the etiology of the seizures (symptomatic/cryptogenic), being on mono- or polytherapy and treatment regimens (carbamazepine/non-carbamazepine). CONCLUSION The results highlight the importance of cardiac evaluation even in patients with well-controlled epilepsy. 12-lead ECG recordings might help to uncover serious cardiovascular events.

Pattern‐reversal Visual Evoked Potentials in Patients with Newly Diagnosed Epilepsy

Summary:  Purpose: The possible occurence of evoked potential (EP) abnormalities in patients with newly diagnosed epilepsy has been little investigated. The main purpose of the present study was to investigate possible changes in pattern‐reversal visual evoked potential (P‐VEP) responses in newly diagnosed epilepsy patients.

Ocular Changes Associated with Topiramate

Purpose: To determine the changes in refractive error, and the cornea, anterior chamber, and retina induced by topiramate. Methods: The study included 76 eyes of 38 patients that began to use topiramate due to migraine. Following ophthalmological examination, all of the patients underwent central corneal thickness (CCT), anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement using a Scheimpflug camera, as well as macular thickness, retinal and retinal nerve fiber layer thickness (RNFLT) measurements using optical coherence tomography (OCT). These procedures were repeated 15, 30, and 90 days after the initiation of topiramate therapy. Results: The median refractive error value showed a statistically significant increase from −0.25 diopters (D) to −0.62 D at the 90th day follow-up (P < 0.001). Mean CCT was 570.56 µm before treatment and increased to 573.69 µm at the 15th day follow-up, 575.31 µm at the 30th day follow-up, and 574.56 µm at the 90th day follow-up; however, these changes were not statistically significant. Mean ACV, ACD, and ACA did not exhibit statistically significant changes. Mean retinal thickness (RT) increased during the treatment from 263.46 µm to 271.60 µm, which was not statistically significant. The initial mean RNFLT was 100.56 ± 15.36 µm and significantly increased to 110.2 ± 8.41 µm and 111.03 ± 14.59 µm at the 30th and 90th day follow-ups, respectively (P  =  0.01 and P  =  0.004, respectively). Conclusions: During the 3-month follow-up of patients using topiramate 50 mg d−1 significant myopic shift and an increase in RNFLT were observed. Further studies are warranted in order to assess the effects of topiramate when used long term and at higher doses.

Long-term effects of valproic acid on reproductive endocrine functions in Turkish women with epilepsy.

The long-term effects of valproic acid (VPA) on reproductive endocrine functions in women with epilepsy (WWE) were studied. Serum reproductive hormone concentrations, clinical findings and ovarian morphology were analyzed in 71 WWE who had been receiving antiepileptic drugs (AED) for a minimum of 2 years. Of the 71 WWE, polycystic ovarian syndrome (PCOS) (p = 0.011) and menstrual irregularities (p = 0.009) were found to be more prevalent in women receiving VPA treatment when compared to women on non-VPA treatment. There was no statistically significant dose or duration-related rise of risk for patients who developed PCOS and menstrual irregularities and those who were not on long-term VPA therapy. The lack of a duration-related reproductive dysfunction in this patient population may support the hypothesis of early occurring VPA-associated metabolic and endocrine changes.

Acquired ocular motor apraxia from bilateral frontoparietal infarcts associated with Takayasu arteritis

The relatively rare syndrome of acquired ocular motor apraxia is characterised by difficulty in initiating saccades to command and to visual targets, usually in all directions.1 ### Case report Our patient was a 52 year old left handed and non-literate man. He was admitted to a local hospital with the complaint of acute and persistent thoracic and epigastric pain radiating to his back. Five days later he developed acute loss of consciousness and was sent to our hospital. Blood pressure was 170/100 mm Hg from the right arm and 160/100 mm Hg from the left, the right femoral artery was pulseless, and the epigastrium was painful on palpation. He was stuporose, disoriented, and his cooperation was limited to simple commands only. He had bilateral ptosis with his eyes fixed in the primary position. Convergence was absent. However, an oculocephalic reflex could be elicited in both vertical and horizontal directions. His left nasolabial sulcus was somewhat reduced. He had paresis of both his arms and his left leg, while the motor strength in his right leg was almost completely normal. Hoffman and Babinski signs were positive on the left side, with hyperreflexia. The tendon reflexes were normal on the right side and no pathological reflexes were elicited. He had urinary incontinence. On the third day of admission he appeared apathetic. Although his thinking was slowed, and his affect was flattened, he could answer simple questions and obey simple commands. He still had difficulty in understanding complex orders. His ptosis had resolved …

Anthropometric indexes, insulin resistance, and serum leptin and lipid levels in women with cryptogenic epilepsy receiving topiramate treatment

We aimed to investigate the effects of topiramate monotherapy on anthropometric indexes, insulin resistance, and serum leptin and lipid levels in 33 premenopausal women (mean age+/-standard deviation: 26.7+/-7.1years) with cryptogenic epilepsy. Body mass index (BMI), waist circumference and serum leptin, insulin and lipid levels were measured at baseline and at 6months after initiation of topiramate. We found reductions in BMI (p<0.001), waist circumference (p<0.001) and serum high-density lipoprotein (HDL) cholesterol levels (p=0.011). We also found significant improvements in insulin resistance (p=0.023), but not in serum leptin levels (p=0.45). Our results suggest that topiramate treatment in women with epilepsy is associated with reduced BMI and waist circumference and improvement in insulin resistance; however, according to our data, topiramate treatment is also associated with lower HDL cholesterol levels, which may substantially increase vascular disease.

A Case With Prepontine (Clival) Arachnoid Cyst Manifested as Trigeminal Neuralgia

Most cases of “idiopathic” trigeminal neuralgia are thought to originate from vascular compression of the trigeminal root entry zone. In this case, we describe a young man presenting with the symptoms of trigeminal neuralgia associated with a prepontine (clival) arachnoid cyst.

Dural carotico-cavernous fistula: pre and postembolization appearances of bone-subtracted CT angiography.

Digital subtraction angiography (DSA) is the best method of evaluating carotid cavernous fistulas (CCF). DSA, however, has the disadvantage of being an invasive procedure. Computerized tomography (CT) angiography which is noninvasive, have been shown to provide more information about the size and location of fistulas. As a new method, Bone-Subtraction CT Angiography (BSCTA), than conventional CT angiography, is a method that improves the detection and interpretation of vascular lesions near to the cavernous segment of carotid artery. In this case report, we report a case of a dural carotico-cavernous fistula (CCF), appearances of pre and postembolization BSCTA images, confirmed by on DSA. As far as we know, CCF demonstrated by BSCTA has not been reported yet.

Neuro-Behçet's syndrome presenting with features mimicking acute tuberculous meningitis

Behçets disease is an inflammatory disease that can involve multiple systems. Here, we describe a case of neuro-Behçets syndrome presenting with features mimicking acute tuberculous meningitis. Behçets disease should be considered in the differential diagnosis of a meningeal syndrome unless a viral or bacterial agent is demonstrated.

Sleep quality, morningness–eveningness preference, mood profile, and levels of serum melatonin in migraine patients: a case–control study

The melatonin as the pineal gland’s secretory product is implicated in the pathophysiology of migraine. Melatonin has critical functions in human physiology, and research underscores the importance of melatonin in circadian rhythm, sleep, and mood regulation. Clinical observations have indicated that migraine attacks have a seasonal, menstrual, and circadian timing, suggesting that chronobiological mechanisms and their alterations may causally involve in the etiology of the disease. However, the topic has received relatively little attention in the migraine literature. Associations between melatonin, circadian preference, sleep, and mood states were investigated in the current study. Fifty-five patients (47 females and 8 males) were compared to 57 gender and age-matched control subjects (40 females and 17 males). A socio-demographical questionnaire, the Beck Depression Inventory, Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Profile of Mood States (POMS), and Morningness–Eveningness Questionnaire were administered to volunteers. Blood samples were taken from all participants at about 1:00 AM in an unlit room not to hamper melatonin secretion, and blood melatonin levels were measured using quantitative ELISA test. In comparison with controls, melatonin levels were significantly lower among migraine patients. Migraineurs reported significantly greater scores on the BAI, confusion-bewilderment subscale of the POMS, and total and sleep latency subscale of the PSQI. Migraine patients who had nausea during the migraine attacks and who reported bouts relevant to certain food consumption, such as cheese or chocolate, had significantly lower levels of melatonin. Contrarily, groups did not reveal statistically substantial difference in circadian preferences.