Hulusi Kececi

Habituation and dishabituation of P300.

ObjectiveWe aimed to see the consequences of habituation and posthabituation by means of repeatedly measuring the effects over a longer period. MethodThe study was performed on 27 healthy volunteers. The event-related potentials were recorded from the Fz, the Cz, and the Pz electrode sites. The rare tone-frequent tone probability ratio was 20%. All subjects were asked to press a button when they heard a rare tone. The test was continued until 20 artifact-free rare tones were averaged, which was accepted as 1 trial block. After 10 trial blocks were obtained in a sequential manner, the test was completed. ResultThis study has indicated that P300 amplitudes decrease with repeated stimulations, that is, there is a habituation period. As the test continues, the speed of amplitude decrease slows down and after a while it even starts to increase: that is, a dishabituation occurs. ConclusionsIt is very likely that this habituation relates to a period of learning and dishabituation relates to a period of mental fatigue. In these processes, changes of amplitude and latency values reflect changes in amount of neuronal activation.

Quantitative EEG and cognitive evoked potentials in anemia

OBJECTIVEnThe anemic status may alter brain functions and electrogenesis, as reflected by EEG and cognitive EPs (CEPs). This study aims to evaluate CEPs and EEG power spectra in adult patients with iron-deficiency anemia and to determine the effects of appropriate iron therapy on electrodiagnostic findings.nnnMETHODSnFifty-one patients with iron-deficiency anemia underwent CEP and EEG recording. All patients were re-assessed after three months of oral-iron therapy.nnnRESULTSnAll patients had recovered from their anemia through the three-month iron therapy. Central N1 amplitude and parietal P2 amplitude was increased. N2 latencies were shortened in frontal and central regions. P3 latencies were shortened in frontal, central and parietal areas and P3 amplitude was increased in the parietal region. Except in the gamma-band, all pretreatment and post-treatment mean-power values were significantly lower at the temporal, parietal and occipital regions.nnnCONCLUSIONSnThis study indicates that in iron-deficiency anemia, appropriate iron therapy can improve brain electrogenesis, as reflected by P300 and EEG power spectra.

Effects of topiramate on neurophysiological and neuropsychological tests in migraine patients

Topiramate (TPM) is a antiepileptic drug that has multiple mechanisms of action. It is effective as a monotherapy for migraine prophylaxis. Unfortunately, TPM can frequently cause adverse effects, such as cognitive dysfunction. The present study examines the neuropsychological and neurophysiological effects of TPM in 35 consecutive migraine patients above 18years of age. The TPM dose was started at 25mg/day and increased by 25mg/week, until reaching the maximum dose of 50mg twice daily in the fourth week. Patients were evaluated for development of side effects of the medication and for its effectiveness on migraine. The Wechsler memory scale was used for neuropsychological evaluation and cognitive evoked potentials were used for neurophysiologic evaluations. Analyses of repeated measures show that visual analog scale pain values, as well as migraine attack frequency and headache duration, were decreased significantly during the study. The amplitudes and latencies of P300 did not change. The results of this study show that 100mg TPM is effective in the prevention of migraine headache and in reducing severity of attacks. Patients cognitive complaints are frequent in the first month and decrease in the following month. Despite these complaints, only the attention section of the visual memory section of the Wechsler memory scale was affected - other sections were not affected. Also, P300 study did not reflect changes appropriate to these cognitive complaints.

Susac's syndrome: A case of simultaneous development of all three components of the triad

Susacs syndrome is characterized by the clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing loss. We here report a case of 46 year old woman with a sudden diminution in visual acuity at the left eye, headache and decreased hearing at the right ear with mild confusion considered as Susacs syndrome with complete triad. Although its a relatively rare entity, it should be kept in mind in differential diagnosis of the neurological disorders, especially in women in 20- to 40-year of age presenting with acute hearing loss.

A case of ischemic stroke after bonzai: syntetic cannabinoid from Turkey.

Synthetic cannabinoids (SCs) are the substances created in the laboratories, mimicking the effects of natural, endogenous cannabinoids. In recent years, SCs have been frequently observed in seized materials all over the world. As SCs are easily available and cheap, they have also an increasing use in Turkey, as marijuana substitutes. Due to the effects and complications of cannabinoids, cannabinoid receptors CB1 and CB2 produce a wide range of responses throughout the body. Previous studies suggest that cannabis might produce stroke through direct effects on the cerebral circulation, orthostatic hypotension, central nervous system vasculitis, vasospasm, and atrial fibrillation [1–4]. SCs have many of these effects, since they interact with the same CB1 and CB2 receptors as natural cannabinoids. However, they act faster and are more potent leading to severe complications, due to the changes in their structures. Despite the well-known relationship between the stroke and cannabinoids [4, 5], there are limited reports about SCs and stroke in the last few years [6, 7]. Since SC use is gradually increasing among young people in today’s world, it is important to remember them in the differential diagnosis of stroke, especially in young patients who present to emergency services with aphasia and/or unconsciousness. Thus, we presented a 48-year-old man who presented to our emergency clinic with loss of consciousness. History taken from his siblings revealed that he was found lying unconsciousness at home, with second-degree burns on his hands. In his initial neurological examination, he was lethargic, cranial nerves were intact, had no neck stiffness, meningeal irritation signs. He had no motor deficit and had increased tendon reflexes with no plantar responses. Magnetic resonance imaging of the patient demonstrated an increased signal in diffusion-weighed sequences and an apparent diffusion coefficient reduction in the left cerebellar hemisphere, bilateral occipital and frontal lobes with millimetric, multifocal lesions (Fig. 1). Regarding these findings, we hospitalized the patient to our neurology clinic. Routine blood tests, complete blood count, thyroid function tests with toxicology analyses including ethanol, markers of vasculitis (serum C-ANCA, anti-nuclear antibody, antidsDNA antibody, anti-SM antibody, anti-Jo1 antibody, anti-SCL70 antibody and anti-gliadin antibodies were negative), coagulopathy (homocystein = 15.8 lmol/l, antithrombin III activity = 76, protein C = 77 %, protein S = 103 %, anticardiolipin and antiphospolipid antibodies were negative) panel were normal. Biochemical screening revealed abnormal kidney and liver functions. Cranial magnetic resonance angiography imaging of the patient was normal. There were no abnormalities in the cardiac examination of the patient including normal cardiac enzymes, electrocardiography and echocardiography findings. Intravenous hydration was ordered after the evaluation of the patient by gastroenterology and nephrology clinics. Anti-edematous and antiplatelet treatments were registered for the treatment of acute ischemic stroke. On the second day of his hospitalization, liver and kidney function tests turned to normal, he gained his consciousness, and declared the usage of substance called ‘‘Bonzai’’ via smoking hours before cerebrovascular accident. He had a history of ‘‘Bonzai’’ use since 1 month. Since the psychiatric assessment of the patient revealed an anxious emotional state with decreased attention, concentration, & Yildiz Degirmenci ydegir@gmail.com

Habituation of auditory event-related potentials in patients with Behcet's disease.

Behcet’s disease is a progressive and/or relapsing-remitting multisystem inflammatory disorder. Involvement of the central nervous system occurs in 10%–29% of cases with Behcet’s disease. The aim of the present study was to assess the effect of repetitive auditory stimulations on event-related potentials (ERP) in patients with Behcet’s without neurologic manifestations. The study was performed in 14 patients with Behcet’s disease and 14 healthy volunteers. ERPs were recorded from Fz, Cz and Pz. The auditory ERPs test was continued until 20 artefact-free rare tones were averaged, which was accepted as one trial block. After six blocks were obtained in a sequential manner, the test was completed. According to the results of the present study, P300 latency changed in different manners over trial blocks in the two groups. P300 latency values showed a progressive increase in the controls; however this was not determined in the Behcet’s group. Thus, habituation was not observed in the patient group. Because of the lack of habituation related to P300 latency, it may be thought that there is an insidious pathologic process in Behcet’s disease without neurologic manifestation.

Two foreign language automatisms in complex partial seizures

Ictal speech manifestations with or without loss of consciousness can frequently occur in TLE in which sometimes the patient may remain responsive, even in conjunction with automatisms. Foreign language ictal speech automatism (FLISA) is a rare ictal sign in temporal lobe epilepsy arising from the non-dominant hemisphere. While our literature review revealed no report of CPSs with two foreign language ictal speech automatisms, we here represented a rare case of a Turkish woman with TLE experiencing two foreign language ictal speech automatisms.

Delayed habituation in Behcet's disease

BACKGROUNDnThe autonomic nervous system in Behcets patients may be affected due to various reasons. This entity may be detected with the measurement of the electrodermal activities, heart rate variability and pupillometric methods. Habituation is one of the implicit forms of learning and memory and the loss of habituation can reveal pathological changes in the synaptic regions.nnnAIMnTo determine whether there is a functional decrease in the synaptic effectiveness (habituation) of the pathways to sympathetic neurons that had been repeatedly activated in Behcets.nnnMATERIALS AND METHODSnTwelve patients with Behcets disease and 12 healthy controls were included in the study. Sympathetic skin potential (SSP) records were taken at normal room temperature in a quiet place within a Faraday cage. Sixteen square wave single shock impulses (duration: 1200 ms, strength: 5 mA) were applied on each case.nnnRESULTSnAfter the 1st stimulus, the SSP amplitudes were lower in the patients compared to the controls (P<0.001, t value=7.69). There was no significant differences among the SSP amplitudes after the 13th impulse in the patients (P>0.05). Whereas there was no significant differences among the SSP amplitudes after the 9th impulse in the controls (P>0.05). The habituation rate of the SSP after consecutive impulses was slowest in the patients compared to controls (P<0.001, t value=12.39).nnnCONCLUSIONSnThere is a delayed habituation in Behcets disease and that may due to pathologic changes with vasculitis through their peripheral nerves.

Can paroxysmal hemicrania be bilateral? A case report.

Paroxysmal hemicrania (PH) is a rare primary headache disorder classified in the trigeminal autonomic cephalgias. It can be described as headaches localized in the orbital, supraorbital, temporal or in any combination of these sites, lasting 2–30 min and occurring several or many times a day, associated with ipsilateral autonomic symptoms and respond absolutely to indomethacin. The frequently reported autonomic symptoms during the attacks are lacrimation, conjunctival injection, nasal congestion, rhinorrhea, while eyelid edema, ptosis, miosis and facial sweating are less common [1]. Since PH is a strictly unilateral headache in the majority of patients, and side shift or bilateral headache with bilateral autonomic symptoms been rarely reported [2, 3], we reported a case of shortlasting, bilateral, indomethacin-responsive headache with cranial autonomic features including eyelid edema, lacrimation, conjunctival injection, nasal congestion fulfilling the diagnostic criteria of episodic PH according to the IHS criteria (Beta version) [1]. A 48-year old woman presented to our neurology outpatient clinic with a 30-year history of headache. Her headaches began when she was 17, and she had several treatments with the diagnosis of migraine without any relief. She had no family history of headache. She was suffering from daily attacks of short, severe headache episodes occurring on an almost hourly basis, and lasting 2 or 3 days, two times a year. However, the frequency of headache cycles, as well as the duration of headaches gradually increased after the age of 25. While she had two episodes, lasting 2 or 3 days a year, she began to experience 3 or 4 episodes lasting 1 week in a year. After her pregnancy at the age of 30, the headache episodes recurred in typical manner. During the episodes, she was suffering from bouts of throbbing or stabbing headache localized around the orbital region bilaterally, with a sidedominance of left periorbital region. She had headache attacks lasting about 30 min to 1 h, with a frequency of 10–15 attacks/day. She had bilateral conjunctival injection, eye tearing and eyelid edema, as accompanying symptoms. Pain intensity and frequency of the single episodes increase slowly over the first few days of an episode until they reach a plateau, when attacks occur hourly and visual analogue scale (VAS; 0 = no pain, 10 = worst pain ever experienced) of the single attack is reported to be between 8 and 9. She describes pain-free periods more than 1 month, suggesting the term ‘‘episodic’’, and the features of headache with accompanying autonomic features were diagnosed as PH, according to the IHS criteria of beta-version [1]. To evaluate the symptomatic causes of PH, the performed routine blood tests including complete blood count, erythrocyte sedimentation test, vasculitis markers including anti-nuclear antibody, anti-cardiolipin and anti-phospholipid antibody evaluations were normal. Cranial magnetic resonance imaging of the patient was normal. We started her 25 mg of indomethacin three times a day in combination with a proton pump inhibitor (PPI, lansoprazole 30 mg). The morning following the first dose she was completely headache free and stayed so. At the follow-up visit after 2 weeks, she was pain free still. Presented as poster presentation in the 51st Turkish National Neurology Congress, Antalya, 2015.

Prolonged Todd Paralysis: A Rare Case of Postictal Motor Phenomenon

Todd paralysis (TP) is a relatively rare postictal phenomenon characteristic with weakness of the limbs in various degrees, following epileptic seizures. Since it is a reversible phenomenon in general, the reported duration of TP varies between half-an-hour to 36 hours. However, there is limited data in the literature about TP which persists more than 36 hours. On this aspect, we presented this rare patient with epilepsy who was suffering from prolonged TP persisting since 1 month without any evidence of acute cerebrovascular or structural lesions.