Hacer Bozdemir

Vascular parkinsonism: a distinct, heterogeneous clinical entity.

Objectives– The aim of this study was to define the symptoms and signs of suspected vascular parkinsonism (VP) which is still a debatable concept. Material and methods– Patients with parkinsonism were grouped into patients with suspected VP and Parkinsons disease (PD) after other causes for secondary parkinsonism, and parkinsonism‐plus syndromes were excluded. The clinical features of 16 patients with suspected VP to those of 50 diagnosed with PD were compared. All patients were assessed using unified Parkinsons disease rating scale (UPDRS) and all had cerebral MRIs. Results– Patients with VP had significantly older onset age and shorter duration of disease with gait disorder as the most frequent initial symptom. All PD patients had satisfactory response to levodopa treatment, whereas only 38% VP patients had satisfactory response to levodopa treatment. Vascular risk factors were more common in VP (81%) than PD (32%). Postural instability, freezing, gait disturbance, pyramidal signs, and postural tremor were significantly more prevalent in patients with VP than in PD. In VP patients these features were more prominent in the lower limbs. Twenty‐five percent had acute onset VP. All patients with VP had ischemic lesions, mainly in subcortical white matter, to a lesser extent basal ganglia and brainstem, in their cerebral MRIs, while 70% of PD patients had normal MRIs. Conclusion– The differences in the clinical features support the concept that VP is a distinct clinical entity with heterogeneous clinical, MRI, and possibly pathophysiological features.

A Radial Basis Function Neural Network Model for Classification of Epilepsy Using EEG Signals

Epilepsy is a disorder of cortical excitability and still an important medical problem. The correct diagnosis of a patient’s epilepsy syndrome clarifies the choice of drug treatment and also allows an accurate assessment of prognosis in many cases. The aim of this study is to evaluate epileptic patients and classify epilepsy groups such as partial and primary generalized epilepsy by using Radial Basis Function Neural Network (RBFNN) and Multilayer Perceptron Neural Network (MLPNNs). Four hundred eighteen patients with epilepsy diagnoses according to International League against Epilepsy (ILAE 1981) were included in this study. The correct classification of this data was performed by two expert neurologists before they were executed by neural networks. The neural networks were trained by the parameters obtained from the EEG signals and clinic properties of the patients. Experimental results show that the predictions of both neural network models are very satisfying for learning data sets. According to test results, RBFNN (total classification accuracy = 95.2%) has classified more successfully when compared with MLPNN (total classification accuracy = 89.2%). These results indicate that RBFNN model may be used in clinical studies as a decision support tool to confirm the classification of epilepsy groups after the model is developed.

Early left ventricular functional alterations in patients with obstructive sleep apnea syndrome

BACKGROUND The knowledge regarding myocardial alterations in patients with obstructive sleep apnea syndrome (OSAS) in the absence of any known cardiovascular disorders including hypertension is limited. The aim of this study was to assess the early alterations of left ventricular (LV) functions caused by OSAS before the development of hypertension and other cardiovascular manifestations of OSAS. METHODS Eighty consecutive patients who underwent polysomnography (PSG) were enrolled in the study. Patients with hypertension, diabetes mellitus or any other known cardiac diseases were excluded from the study. Subjects were separated into two groups by their apnea/hypopnea index (AHI) (group 1: AHI < 15, and group 2: AHI ≥ 15). Fourty-three patients with normal polysomnographic examination or mild OSAS (group 1) and 37 patients with moderate to severe OSAS (group 2) were compared. After PSG examination, LV functions were assessed by using the conventional and tissue Doppler echocardiographic methods. RESULTS The mean age was similar between the groups. The ratio of male patients was higher in group 2 (male/female: 31/12 in group 1 vs. 34/3 in group 2, p = 0.04). Body mass index was higher in group 2 (p = 0.05). Conventional echocardiography showed that interventricular septum thickness was 9.5 ± 1.1 mm in group 1, and 10.5 ± 1.4 mm in group 2 (p = 0.02). Mean left atrial diameter was 35.6 ± 4.1 mm in group 2, and 33.8 ± 3.1 mm in group 1 (p = 0.04). Ratio of early to late transmitral diastolic velocities was lower in group 2 (p = 0.01), indicating that impairment of diastolic function was more frequent in moderate to severe OSAS patients. Tissue Doppler echocardiography showed that early diastolic myocardial velocity was lower ingroup 2 (21.1 ± 5.6 cm/s in group 1 vs. 18.3 ± 5.3 cm/s in group 2, p = 0.01). CONCLUSIONS Left ventricular diastolic dysfunction, LV hypertrophy and left atrial dilatationoccur in patients with OSAS even before the development of hypertension and other cardiovascular diseases.

Transient parkinsonism: Induced by progesterone or pregnancy?

We report on the development of transient parkinsonism after progesterone injection in a pregnant patient with a risk of abortion. Etiological possibilities are discussed, including pregnancy itself, possible toxic effects of the dead fetus, and progesterone injection. Progesterone‐induced parkinsonism seems the most likely diagnosis in this case.

Mental retardation associated with Brown‐Vialetto‐Van Laere syndromeSirs

(2003). Mental retardation associated with Brown‐Vialetto‐Van Laere syndromeSirs. Amyotrophic Lateral Sclerosis and Other Motor Neuron Disorders: Vol. 4, No. 1, pp. 52-53.

Cerebral responses elicited by stimulation of the vesico-urethral junction (VUJ) in diabetics

To investigate the involvement of the visceral afferent nerves in diabetes mellitus, we enrolled 46 male patients in a study, examining the cerebral potentials evoked by stimulation of the vesico-urethral junction (VUJ CEP) and the pudendal (penile CEP) and posterior tibial nerves (tibial CEP). The age range was 23-67 (mean 45.8) years. The epithelial surface of the vesico-urethral junction was stimulated bipolarly with an electrode attached to a specially produced Foley catheter. Cerebral responses were recorded bipolarly at vertex. VUJ CEPs were absent (27 patients) or protracted and/or of low amplitude (4 patients) (total 31 patients; 67.8%). Penile CEP and/or tibial CEP could be obtained in all cases; however, protracted P1 peak latencies were detected in 15 (32.8%). The abnormalities of VUJ CEP did not correlate with the presence of peripheral neuropathy, while the abnormalities of penile CEP and/or tibial CEP invariably coincided with the presence of peripheral neuropathy. Although neither age nor the duration of diabetes correlated with abnormal CEPs as determined by any of the tests, insulin dependence correlated with abnormal penile CEP and to a lesser extent with VUJ CEP. We conclude that VUJ CEP is informative in evaluating the physiological condition of visceral afferents, and can be used in diagnosis of the early involvement of visceral afferents in diabetes mellitus.

Epileptic seizures triggered by the use of a powered toothbrush

BACKGROUND Reflex epilepsy is characterized by seizures that are triggered in response to a specific stimulus and tooth-brushing epilepsy is an extremely rare form of reflex epilepsy in which the seizures are mainly induced by the act of tooth brushing. In this report, we describe an epilepsy patient whose seizures were exclusively triggered by the use of a powered toothbrush. METHODS AND RESULTS A 31-year old female had been treated for partial epilepsy of left temporal or frontal lobe for 20 years and she did not have seizures for the last 3 years. However, she experienced periods of auras, partial complex seizures, and nocturnal generalized seizures after she started using a powered toothbrush. The interictal electroencephalography revealed slow wave paroxysm over the left temporal or frontal lobe. CONCLUSIONS This case report is, to our knowledge, the first report of reflex epilepsy in which the seizures were triggered by the use of a powered toothbrush. Possible mechanisms to explain the novel type of this rare disorder are discussed.

The application of neural networks in classification of epilepsy using EEG signals

Epilepsy is a disorder of cortical excitability and still an important medical problem. The correct diagnosis of a patients epilepsy syndrome clarifies the choice of drug treatment and also allows an accurate assessment of prognosis in many cases. The aim of this study is to evaluate epileptic patients and classify epilepsy groups by using Multi-Layer Perceptron Neural Networks (MLPNNs). 418 patients with epilepsy diagnoses according to International League against Epilepsy (ILAE, 1981) were included in this study. The correct classification of this data was performed by two expert neurologists before they were executed by MLPNNs. The MLPNNs were trained by the parameters obtained from the EEG signals and clinic properties of the patients. We classified the epilepsy into two groups such as partial and primary generalized epilepsy and we achieved an 89.2% correct prediction rate by using MLPNN model. The parameters of the loss of consciousness in the course of seizure, the duration and ritmicity of abnormal activities found in EEG constituted the most significant variables in the classification of epilepsy by using MLPNN. These results indicate that the classification performance of MLPNN model for epilepsy groups is satisfactory and we think that this model may be used in clinical studies as a decision support tool to confirm the classification of epilepsy groups after they are developed.

Crossed aphasia in multiple sclerosis.

Aphasia is a rare sign of multiple sclerosis (MS). Several different forms of aphasia have been reported in MS. We report, to our knowledge, the first case of a MS patient with crossed aphasia during an attack.

Can Neural Network Able to Estimate the Prognosis of Epilepsy Patients Accorrding to Risk Factors

The aim of this study is to evaluate the underlying etiologic factors of epilepsy patients and to predict the prognosis of these patients by using a Multi-Layer Perceptron Neural Network (MLPNN) according to risk factors. 758 patients with epilepsy diagnosis are included in this study. The MLPNNs were trained by the parameters of demographic properties of the patients and risk factors of the disease. The results show that the most crucial risk factor of the epilepsy patients was constituted by the febrile convulsion (21.9%), the kinship of parents (22.3%), the history of epileptic relatives (21.6%) and the history of head injury (18.6%). We had 91.1 % correct prediction rate for detection of the prognosis by using the MLPNN algorithm. The results indicate that the correct prediction rate of prognosis of the MLPNN model for epilepsy diseases is found satisfactory.