Gülnihal Kutlu

Levetiracetam monotherapy for late poststroke seizures in the elderly

Stroke is the most common cause of seizures in the elderly. Antiepileptic drugs are used to treat most patients with late poststroke seizures. The aim of this study was to evaluate the efficacy and tolerability of levetiracetam (LEV) in patients aged 60 or older with late-onset poststroke seizures. This prospective study evaluated patients 60 years of age or older, who had at least two late-onset poststroke seizures and were given LEV monotherapy. Demographic data and seizure and stroke characteristics were recorded. Outpatient visits were made after 2, 4, 6, 9, and 12 months and every 3 months thereafter, and the effectiveness and tolerability of LEV were investigated. Thirty-four patients with a mean age of 69.76+/-6.41 were included in this study. Average seizure frequency before treatment was 3.61+/-3.02/month. Mean follow-up time was 17.68+/-3.24 months. At daily doses of 1000-2000 mg, 82.4% of the patients were seizure free, and 7 patients (20.6%) had side effects. LEV was discontinued in one patient because of severe somnolence. Two patients were switched to another antiepileptic drug because of uncontrolled seizures despite an increase in dose up to 3000 mg/day. LEV monotherapy can be effective and well tolerated in elderly patients with late-onset poststroke seizures.

Different clinical manifestations of hyperammonemic encephalopathy

Valproate is an effective anticonvulsant. Although it is usually well tolerated, it has been associated with many neurological, hematopoietic, hepatic, and digestive system side effects. Among these side effects, hyperammonemia without clinical or laboratory evidence of hepatotoxicity is rare and is an important clinical consideration. The aim of this article was to evaluate the reasons for the unexpected symptoms observed in seven patients with epilepsy patients during valproate treatment. We evaluated seven adult patients with localization-related epilepsy who presented with different acute or subacute neurological symptoms related to valproate-induced hyperammonemic encephalopathy. Four of the seven patients had acute onset of confusion, decline in cognitive abilities, and ataxia. Two had subacute clinical symptoms, and the other patient had symptoms similar to those of acute toxicity. These unusual clinical symptoms and similar cases had not been reported in the literature before. Serum ammonia levels were elevated in all seven patients. After discontinuation of valproate, complete clinical improvement was observed within 5-10 days. On the basis of our work, we suggest that the ammonia levels of a patient who has new neurological symptoms and has been taking valproate must be checked. Clinicians should be aware that these clinical symptoms may be related to valproate-induced hyperammonemic encephalopathy. The symptoms have been observed to resolve dramatically after withdrawal of the drug.

Peripheral neuropathy and visual evoked potential changes in workers exposed to n-hexane.

The aim of this study was to evaluate patients who had peripheral neuropathy and changes to their visual evoked responses resulting from exposure to n-hexane. Eighteen patients with acute or subacute neuropathy, who were working in a shoe factory, were investigated clinically and electrophysiologically. These evaluations were then repeated 9 months to 12 months after cessation of exposure to n-hexane. Results of the nerve conduction studies predominantly showed a decrease in motor and sensory conduction velocities. Between 9 and 12 months after cessation of exposure to n-hexane, 83.3% of patients had a complete clinical recovery. The electrophysiological studies also revealed improvement to the majority of motor and sensory nerve conduction velocities. The results of the visual evoked potential (VEP) studies were considered normal at admission, however, the P100 latencies at the 9-month to 12-month retest had improved (p < 0.05). As the abnormalities identified with clinical examination and nerve conduction studies, and the subclinical abnormalities revealed through VEP assessment, could be reversed after exposure to n-hexane had ceased, the clinical prognosis was usually good.

Does the seizure frequency increase in Ramadan

During Ramadan, the ninth month of the Islamic lunar calendar, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse between dawn and sunset. In this study, we aimed at discovering alterations in drug regimens and the seizure frequency of epileptic patients during Ramadan (15 October 2004-13 November 2004). In the 3 months following Ramadan in the year 2004, 114 patients with epilepsy who were fasting during Ramadan were examined at our Epilepsy Department. Of the 114 patients who were included in the study, 38 patients had seizures and one of these patients developed status epilepticus during Ramadan. When the seizure frequency of these patients during Ramadan was compared to that in the last 1 year and last 3 months period just prior to Ramadan, a statistically significant increase was observed (p<0.001). Moreover, there was an important increase in the risk of having seizures in the patients who changed their drug regimens compared with those who did not (p<0.05). In the patients who received monotherapy or polytherapy, no difference in the frequency of seizures during Ramadan was seen (p>0.05). During Ramadan, an increase in the seizure frequency of patients with epilepsy was observed. The most important reason for this situation was the alteration in the pharmacokinetics and pharmacodynamics of drugs, and consequently, in their efficacy. We believe that in the patients who received monotherapy and who did not change their drug regimes, the increase in seizure frequency may have been related to the changes in their daily rhythms, emotional stress, tiredness and their day-long fasting.

Temporal lobe ictal behavioral patterns in hippocampal sclerosis and other structural abnormalities.

Ictal behavioral characteristics may provide clues in determining the nature of the epileptic focus. We defined ictal behavioral characteristics in patients with intractable temporal lobe epilepsy (TLE) who underwent anterior temporal lobectomy (ATL) and lived seizure-free for 2 years of follow-up. Video/EEG data on 282 seizures observed in 48 patients who suffered from TLE and underwent ATL were analyzed. All patients were seizure-free after surgery. We divided the patients into two groups on the basis of the pathological examination. Two hundred and two seizures in 35 patients with hippocampal sclerosis (Group 1) and eighty seizures in 13 patients with other pathological findings, such as tumors, cavernoma, and hamartoma (Group 2), were analyzed. Ictal behavior characteristics were evaluated for each of the seizures recorded in the two groups. Behavioral arrest, bilateral hand automatisms, oral and leg automatisms, and ictal aggression were significantly more frequent in Group 2 (P<0.05), whereas contralateral dystonia of the upper extremity (P<0.05), ipsilateral hand automatisms (P<0.05), ipsilateral hand automatisms in the presence of contralateral dystonia of the upper extremity (P<0.001), contralateral forced head deviation (P<0.05), and secondary generalization (P<0.05) were more significant in Group 1. There was no significant difference in vocalization and ipsilateral nonforced head deviation between the two groups (P>0.05). The number of seizures observed during ictal speech, crying, and postictal nose wiping was not large enough, so differences could not be analyzed. It was concluded that although ictal behavioral characteristics differed between the two groups, certain behavioral patterns may be helpful in differentiating between hippocampal sclerosis and other pathology.

Identification and removal of an epileptogenic lesion using Ictal-EEG, functional-neuronavigation and electrocorticography

PURPOSE Cases with intractable epilepsy may present with multiple lesions in their brains. Ictal-EEG carries a great value in identification of the primary epileptogenic source. On the other hand, removal of low-grade tumors located around the eloquent cortex may be risky with conventional techniques. Functional-neuronavigation (f-NN) is the integration of functional magnetic resonance imaging and stereotactic technologies; and provides interactive data regarding localization of the motor cortex. This report presents a case with dysembryoplastic neuroepithelial tumor (DNET), which was removed using f-NN and electrocorticography (ECoG) techniques. METHODS A 19-year-old patient with intractable complex partial and secondary generalized seizures is presented. MRI revealed a low-grade tumor located in right parietal region just behind the motor cortex, and a contralateral temporal arachnoid cyst. Ictal-EEG demonstrated the right parietal origin of the seizures. The patient underwent a right parietal craniotomy and tumor excision using f-NN and ECoG techniques intraoperatively. ECoG findings correlated with epileptogenicity of the parietal lesion. RESULTS Postoperative course was uneventful. No postoperative deficit was observed. The patient was seizure free in eight months follow-up. Pathological examination reported the lesion as DNET. CONCLUSIONS Ictal-EEG has a very important role in identification of the epileptogenic focus in cases with multiple brain lesions. Preservation of the functional cortex is the most prominent aim during lesional surgery of epilepsy. Intraoperative mapping using f-NN and ECoG supports the orientation of the neurosurgeon to the functional and epileptogenic cortical areas; and thus, increase the safety and efficacy of surgical procedures.

Brucella: A Cause of Peripheral Neuropathy

Brucellosis is a common infectious disease in Mediterranean countries. We evaluated the peripheral nerve involvement in patients with brucellosis. Thirty-eight patients with brucellosis were examined. Four of them were excluded because of B12 deficiency and diabetes mellitus. Thirty-four patients were included. The average age was 43.08 ± 15.3 years. Patients were divided into two groups according to the abnormality in their peripheral nervous system (PNS) examination. All patients underwent nerve conduction and needle electromyography EMG studies. Twenty normal healthy subjects were used as a control group. Axonal sensorimotor neuropathy was determined in 12 patients who also had abnormality in PNS examination. After 6 months of treatment, nerve conduction studies were nearly normal in these patients. The EMG findings of the remaining 22 patients were normal, as well as the clinical examination. However, the motor conduction velocities of median (p < 0.001), peroneal (p < 0.001), and ulnar (p < 0.05) nerves were decreased, F wave latencies were prolonged in the posterior tibial and peroneal nerve, and distal latency was also prolonged in the posterior tibial nerve (p < 0.05) when compared to healthy subjects. Sensory conduction velocities of the median (p < 0.001), ulnar and sural (p < 0.05) nerve were also decreased. Brucellosis may be considered as a cause of clinical or subclinical peripheral neuropathy and should be evaluated especially in endemic areas.

Increased Epicardial Fat Thickness Correlates with Aortic Stiffness and N-Terminal Pro-Brain Natriuretic Peptide Levels in Acute Ischemic Stroke Patients

Epicardial fat, a metabolically active tissue, has emerged as a risk factor and active player in metabolic and cardiovascular diseases. We investigated epicardial fat thickness in patients who had sustained an acute ischemic stroke, and we evaluated the relationship of epicardial fat thickness with other prognostic factors. We enrolled 61 consecutive patients (age, ≥18 yr) who had sustained a first acute ischemic stroke and had been admitted to our hospital within 24 hours of the onset of stroke symptoms. The control group comprised 82 consecutive sex- and age-matched patients free of past or current stroke who had been admitted to our cardiology clinics. Blood samples were taken for measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels at admission. Aortic stiffness indices and epicardial fat thickness were measured by means of transthoracic echocardiography within the first 48 hours. In comparison with the control group, the patients with acute ischemic stroke had significantly higher epicardial fat thickness (4.8 ± 0.9 vs 3.8 ± 0.7 mm; P <0.001), lower aortic distensibility (2.5 ± 0.8 vs 3.4 ± 0.9 cm(2) ·dyn(-1); P <0.001) and lower aortic strain (5.5% ± 1.9% vs 6.4% ± 1.8%; P=0.003). We found a significant association between epicardial fat thickness, NT-proBNP levels, and arterial dysfunction in patients who had sustained acute ischemic stroke. Increased epicardial fat thickness might be a novel risk factor and might enable evaluation of subclinical target-organ damage in these patients.

Does positive airway pressure therapy improve olfactory function?: Role of PAP treatment on olfactory dysfunction

Olfactory function deteriorates in patients with severe obstructive sleep apnea syndrome (OSAS). The effect of positive airway pressure (PAP) therapy on olfactory function has not been investigated before. In this study, we aimed to investigate the role of PAP therapy on olfactory impairment in patients with OSAS.

Epilepsi hastalarında huzursuz bacaklar sendromunun retrospektif analizi

Amac: Huzursuz bacaklar sendromu, ozellikle bacaklarda ve ekstremitelerde uyusma ve tanimlamasi zor anormal bir his ile karakterizedir. Calismamizda kronik epilepsi hastalarinda huzursuz bacaklar sendromu sikligini saptamayi amacladik. Yontemler: Toplam 86 epilepsi hastasi calismaya dahil edildi. Calisma hastalarinin epilepsi siniflamasi, 1981 International League Against Epilepsy siniflamasina gore yapildi. Hastalarin demografik verileri toplandi ve diger formlara ek olarak Uluslararasi Huzursuz Bacaklar Sendromu Calisma Grubu (IRLSSG) tarafindan 2014 yilinda yayinlanan 4 soruluk tani kriterlerinden olusan anketin Turkce versiyonu hasta ile yuz yuze gorusulerek dolduruldu. Bulgular: Calismaya dahil edilen hastalarin huzursuz bacaklar sendromu prevalansi % 5.81 (86 hasta uzerinden 5 hasta) bulundu. IRLSSG degerlendirme olcegi ortalamasi 17 ± 6,5 idi. Sonuc: Calismamizin sonuclari, yaygin norolojik bir hastalik olan epilepsi hastalarinda huzursuz bacaklar sendromunun prevalansinin genel populasyona gore daha dusuk oldugunu gosterdiAmac: Huzursuz bacaklar sendromu, ozellikle bacaklarda ve ekstremitelerde uyusma ve tanimlamasi zor anormal bir his ile karakterizedir. Calismamizda kronik epilepsi hastalarinda huzursuz bacaklar sendromu sikligini saptamayi amacladik. Yontemler: Toplam 86 epilepsi hastasi calismaya dahil edildi. Calisma hastalarinin epilepsi siniflamasi, 1981 International League Against Epilepsy siniflamasina gore yapildi. Hastalarin demografik verileri toplandi ve diger formlara ek olarak Uluslararasi Huzursuz Bacaklar Sendromu Calisma Grubu (IRLSSG) tarafindan 2014 yilinda yayinlanan 4 soruluk tani kriterlerinden olusan anketin Turkce versiyonu hasta ile yuz yuze gorusulerek dolduruldu. Bulgular: Calismaya dahil edilen hastalarin huzursuz bacaklar sendromu prevalansi % 5.81 (86 hasta uzerinden 5 hasta) bulundu. IRLSSG degerlendirme olcegi ortalamasi 17 ± 6,5 idi. Sonuc: Calismamizin sonuclari, yaygin norolojik bir hastalik olan epilepsi hastalarinda huzursuz bacaklar sendromunun prevalansinin genel populasyona gore daha dusuk oldugunu gosterdi