Figen Gökçay

Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study.

Objectives –  To assess the efficacy of topiramate in the treatment of idiopathic intracranial hypertension (IIH) and to compare it with acetazolamide.

Migrainous vertigo: clinical, oculographic and posturographic findings

Migrainous vertigo (MV) is accepted as a common cause of episodic vertigo. The peripheral or central vestibular localization of the deficit as well as the pathophysiology is unclear. This prospective study was designed to assess the clinical features of MV and to search for the localization of the vestibular pathology. Thirty-five patients with MV, 20 patients with migraine and 20 healthy volunteers were studied. Comprehensive neurotological tests were performed between attacks. None of the normal controls or the patients with migraine had ocular motor deficits or caloric test abnormalities. Three patients in the MV group showed saccadic pursuit (8.6±), in one of whom saccadic hypometria was also present. Caloric test results revealed unilateral caloric hypofunction in seven patients (20±). Static posturography results revealed increased sway velocity when the eyes were closed or the platform was distorted in patients with MV. These findings during the symptom-free period revealed that peripheral vestibular dysfunction was more common than a central deficit.

Clinical assessment of topiramate therapy in patients with migrainous vertigo.

(Headache 2010;50:77‐84)

Headache in primary Sjögren’s syndrome: a prevalence study

Objectives –  To determine the prevalence of headache in patients with primary Sjögren’s syndrome (pSS) and to examine the relationship between headache types and clinical, serologic features of the disease.

Ophthalmoplegic migraine : two patients, one at middle age with abducens palsy

Ophthalmoplegic migraine (OM) had been classified as a form of migraine by the Headache Classification Committee of the International Headache Society in the 1988 classification (1). The classification was revised by the same committee in 2004 and OM was classified under the heading of ‘Cranial neuralgias and central causes of facial pain’ and was defined as consisting of at least two episodes of headache accompanied or followed within 4 days of its onset by paresis of one or more cranial nerves: third, fourth and/or sixth with appropriate investigations having excluded paracellar, orbital fissure and posterior fossa lesions (2). Hansen et al. (3) estimated an annual incidence of 0.7 per million. Although it may have onset at any age, it occurs most frequently in infants and children under 12 years of age. The headache is unilateral and invariably ipsilateral to the side of ophthalmoplegia. It is typically severe and may precede the ophthalmoplegia by several days. In OM there is a predilection for males whereas the preponderance of persons with common migraine is female (4). We report two unusual cases: two women with probable OM, one having an onset at age 16 years and the other at 50, both with abducens palsy.

Visual evoked potentials in children with occipital epilepsies

The objectives of this study are to see if any visual evoked potential (VEP) differences are present in two forms of occipital epilepsy, childhood epilepsy with occipital paroxysms (CEOP) and symptomatic occipital epilepsy (SOE) with respect to etiology, as CEOP is a benign age- and localization-related idiopathic epilepsy while SOE is a symptomatic form. Nineteen patients with CEOP and 13 patients with SOE were included in the study and P100 potential latency and amplitude values obtained from these patients were compared with the values recorded from normal controls. The amplitude values recorded from the patients with CEOP were significantly high (P=0.033). P100 potential latency values recorded in patients with SOE were significantly long (P=0.028). High amplitude VEP responses were mostly attributed to hyperexcitability of the occipital cortical structures whereas prolonged latency P100 responses were attributed to occipital structural changes.

Cognitive functions evaluated by P300 and visual and auditory number assays in children with childhood epilepsy with occipital paroxysms (CEOP)

PURPOSE This study was planned to evaluate cognitive functions, especially attention and immediate recall, in children with childhood epilepsy with occipital paroxysms (CEOP), by using P300 and neuropsychological tests, which included visual and auditory number assays. Thirty patients with CEOP, ages ranging from 5 to 17 years were enrolled in the study. Twenty-five healthy children were taken as the control group. METHODS Oddball paradigm was used in P300 recordings. The latency and the amplitude of the P300 wave recorded from Cz were taken into consideration. The neuropsychological test battery included visual and auditory number assays. RESULTS P300 latency was significantly longer in the CEOP group (p=0.014). The results of the visual and auditory number assay test showed significant decline in the patient group when compared with the normal controls. CONCLUSIONS Attention and immediate recall deficits as well as prolonged P300 latencies in children with CEOP can be due to an ongoing epileptic activity either influencing the whole brain or only the occipital lobe which can also be involved in the neuropsychological organization of the human cortex. Therefore, children with CEOP should be evaluated with more detailed neuropsychological tests for possible cognitive deficits.

Association of baseline dyslipidemia with stroke recurrence within five‐years after ischemic stroke

Background and purpose The association between dyslipidemia (DL) and stroke recurrence is unclear, but may be influenced by different subtypes of stroke. This study aims to explore whether DL contributes to the recurrence of certain subtypes of ischemic stroke. Methods Data from the Ege Stroke Registry was examined, and five-years follow-up data for stroke recurrence was analyzed. Trial of Org 10172 in Acute Stroke Treatment criteria was used to classify the subtypes of all stroke. Recurrent stroke was defined as a new neurological deficit compatible to ischemic stroke or intracerebral hemorrhage. The association between DL and stroke recurrence in patients with different sroke subtypes was analyzed using univariable and multivariable logistic regression models. Survival curves were estimated with Kaplan–Meier methods, and survival analyses were undertaken using Cox proportional hazards models. Results Of the 9940 patients with ischemic stroke, 5838 (58·7%) had DL and 2202 (22·2%) experienced a stroke recurrence within five-years. The frequency of stroke recurrence of patients with DL was unsignificantly higher than those without at five-years of follow-up (18·0% vs. 17·0%; P = 0·21). After stratification by Trial of Org 10172 in Acute Stroke Treatment subtypes, multivariable analysis revealed a significant association between DL and stroke recurrence in all ischemic stroke at five-years (odds ratio, 1·2; 95% confidence interval, 1·02–1·42), and in the large-artery disease subtype (odds ratio, 1·46; 95% confidence interval, 1·12–1·91), but not in the other stroke subtypes (cardioembolic: odds ratio, 1·18; 95% confidence interval, 0·84–1·65; small-artery disease: odds ratio, 1·24; 95% confidence interval, 0·87–1·76; other subtype: odds ratio, 0·79; 95% confidence interval, 0·48–1·31). The probability of stroke recurrence increased in patients with large-artery disease and DL, compared with other subtypes of stroke [log rank test (Mantel–Cox) P < 0·013]. Conclusions Our results showed that DL is related to the recurrent strokes in patients with ischemic stroke within five-years after ischemic stroke, specifically to the large-artery disease subtype.

X-linked spastic paraplegia.

This paper describes a family with 10 males affected by x‐linked spastic paraplegia. X‐linked inheritance is rarely encountered in pure and complicated forms of hereditary spastic paraplegia. The disease was characterized by hyperreflexia, progressive spastic gait disorder, extensor plantar responses and mental retardation in all of the affected members of the family we studied. In addition to these symptoms, the older patients had cerebellar findings, severe disability and contractures. This is the 13th family manifesting x‐linked spastic paraplegia reported in the literature.

Neurological symptoms and signs in Behçet disease: a Western Turkey experience.

AimTo assess the clinical patterns of neurologic involvement and the frequencies and characteristics of different types of headaches in patients with Behçet disease. MethodsTotal 530 patients with Behçet disease were evaluated for the presence of neurologic involvement and/or headache. ResultsOf the 54 patients (10.2%) with neurological involvement, 36 (66.7%) had parenchymal and 16 (29%) had vascular involvement. There was a patient with optic neuropathy and another patient with peripheral nerve involvement. There were 46 patients (8.7%) with headache without any evidence of neurological involvement and 25 of them (4.7%) were diagnosed with migraine. ConclusionsThe prevalence of neurologic involvement in our group was higher than the studies published previously from the same country. Migraine prevalence on the other hand was low.