Gokcen Gozubatik-Celik

The Prevalence of Migraine in Restless Legs Syndrome

While previous studies have investigated the prevalence of restless legs syndrome (RLS) in patients with migraine, we aimed to explore the prevalence and characteristics of migraine in adult patients diagnosed with RLS.

CAP characteristics differ in patients with arousal parasomnias and frontal and temporal epilepsies.

Summary: Arousal parasomnias (AP) and frontal and temporal epilepsies consist of pathologic arousals originating in abnormal thalamocortical circuits, reflecting increased sleep instability and arousal oscillations—the cyclic alternating pattern (CAP). In this study, the authors aim to investigate the CAP characteristics in 27 patients with AP, 22 patients with frontal and temporal epilepsies, and age- and gender-matched 20 healthy subjects. The mean CAP sequence and cycle was significantly higher in patients than in control subjects (P < 0.003). The total CAP duration was always higher in the patients with AP than in those with frontal and temporal epilepsies, reaching statistically significant level at the first (P = 0.044), second (P = 0.024), third (P = 0.010), and sixth (P < 0.001) sleep cycles. The duration of A1 in descending branch (P = 0.062) and trough phase of sleep cycles (P = 0.038) was longer in the patients with AP. The duration of A2 subtype of CAP in ascending branch (P = 0.039) and the number (P = 0.036) and duration (P = 0.050) of A3 subtype of CAP in descending branch of sleep cycles were higher in the patients with frontal and temporal epilepsies. This difference in CAP parameters might suggest that AP are associated with milder activation in specific brain areas, showing a similar evolution with physiologic homeostatic decrease in sleep synchronization. Frontal and temporal epilepsies, however, is associated with a moderate-to-powerful activation in wider brain networks.

Pregnancy Data in a Turkish Multiple Sclerosis Population

Background: To conduct the first retrospective clinical study investigating pregnancy in Turkish multiple sclerosis (MS) patients. Summary: We evaluated 558 pregnancies in 199 MS patients and results were compared with general Turkish populations data. The fertility rate in the MS group was found to be lower than that in the general population, even before MS diagnosis was established. Our study suggests that the higher number of pregnancies may have a favorable effect on transition from relapsing-remitting MS to secondary progressive MS, although no effect has been shown regarding the possibility to reach EDSS 6.0 as a milestone. Key Messages: Our data support the conclusion that MS does not have a negative effect on the MS course and disability.

Should HAS-BLED scoring be revised for better risk estimation in patients with intracerebral hemorrhage?

Many efforts have been made to develop decision-support tools and bleeding prediction schemes to start or resume anticoagulation after intracerebral hemorrhage, related with anticoagulation use or not, such as CHA2DS2-VASc or HAS-BLED scoring. HAS-BLED is a validated scoring system to predict the risk of major bleeding in a patient with atrial fibrillation; some current scientific guidelines suggest its use in ‘risk–benefit’ reasoning when deciding whether to start long-term oral anticoagulation. Here the authors present a patient with atrial fibrillation and intracerebral hemorrhage, and aim to discuss the use of HAS-BLED, suggesting that some revisions may help better management of these patients for major bleeding risk.

Natural course of neuromyelitis optica (NMO) in patients with no long-term treatment

OBJECTIVE:To show the natural course of disease in NMO patients with not receiving long term treatment(LTT). BACKGROUND:Neuromyelitis optica(NMO) is an inflammatory disorder of the central nervous system(CNS) presenting with severe optic neuritis(ON) and transverse myelitis(TM).According to current guideline, early diagnosis and aggressive treatment is critical for preventing disability. Some NMO cases in our series didn’t accepted to receive LTT and making comparison between treated and non-treated NMO patients became possible. DESIGN/METHODS:Sixty one patients followed with a diagnosis of NMO/NMO Spectrum Disorder were included in this study. The patients were divided into four subgroups:Group 1:Classical NMO, Group 2:Single or recurrent attacks of transverse myelitis with longitudinally extending spinal cord lesions(LETM), Group 3:Recurrent optic neuritis(ON) with normal brain MRI or cranial MRI lesions not compatible with multiple sclerosis(MS),Group 4:Optico-spinal MS(OSMS).The age at disease onset,gender,type of attacks,clinical presentation,number of attacks,analysis of the cerebrospinal fluid,serum anti-AQP4 antibodies,Expanded Disability Status Scale(EDSS), annual progression index were assessed. RESULTS:Twenty two of the patients were on LTT(19 male,3 male) and 39 patients were not receiving any LTT (32 female,7 male).The mean age at disease onset was 31.58+11.79(between 12-65) in non-treated and was 30.45+12.36(between13-62) in treated group.The mean disease duration was 68.07+64.02 months in non-treated and 58.76+29.59 in treated group.Mean annual progression index (PI) was found to be higher in the non-treated group with respect to treated group (1.27+1.40 and 0.52+0.94 respectively). CONCLUSION:NMO and NMOSD are both considered to be disabling diseases of the central nervous system.Acute clinical relapses are treated with intravenous IV corticosteroids and plasma exchange.However there are still controversies regarding with long term treatment due to lack of randomized double blind studies.Our results verified that immunosuppressive therapy should be started immediately when the diagnosis of NMO is revealed. Disclosure: Dr. Altintas has received research support from The Scientific and Technological Research Council Of Turkey. Dr. Nalbantoglu has nothing to disclose. Dr. Uygunoglu has nothing to disclose. Dr. Gozubatik-Celik has nothing to disclose. Dr. Saip has nothing to disclose. Dr. Siva has nothing to disclose.

Contents Vol. 74, 2015

Basel • Freiburg • Paris • London • New York • Chennai • New Delhi • Bangkok • Beijing • Shanghai • Tokyo • Kuala Lumpur • Singapore • Sydney Founded 1897 as ‘Monatsschrift für Psychiatrie und Neurologie’, continued 1957–1967 as ‘Psychiatria et Neurologia’ Founders: C. Wernicke and Th. Ziehen. Successors: K. Bonhoeffer (1912–1938), J. Klaesi (1939–1967), E. Grünthal (1953–1967), H.E. Kaeser (1968–1993)

The diagnosis of band heterotopia.

Patient 1: A 6-year-old girl was admitted with a 1 year history of atonic seizures (head drops). Her motor and mental development had been normal until age 5 years, but her family had noted behavioral changes about 2 months after the onset of seizures. Her past medical history was remarkable for febrile seizures. Physical and neurological examinations were unremarkable. Electroencephalography (EEG) demonstrated multifocal spike and wave paroxysms generalizing during sleep and bilateral widespread pseudo-periodic slowwave paroxysms with high amplitude (Fig 1). Atonic-myoclonic seizures were recorded. Brain magnetic resonance imaging (MRI) revealed no abnormalities but was performed under suboptimal conditions. Subacute sclerosing panencephalitis was first considered, but no cells or antimeasles antibodies were detected in cerebrospinal fluid. Further testing for metabolic disorders was unremarkable. Her repeat MRI revealed diffuse band heterotopia (Fig 2). Patient 2: A 7-year-old girl was admitted with atonicmyoclonic seizures manifested by dropping of the head, falling, jerking, and dropping objects. Motor and mental development had been normal until the seizure onset at the age of 4 years, but subsequently her family noted behavioral changes. Her EEG findings included spike and wave paroxsyms propagating from both occipital regions, bilateral pseudo-periodic slowwave and sharp wave discharges, and atonic seizures. Subtle MRI changes suggested band heterotopia, and bilateral band heterotopia was confirmed on her second MRI.