M. Said Berilgen

Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study

In patients with migraine with or without aura the prophylactic effect of amitriptyline (AMT) and venlafaxine (VLF) was compared in a randomized double-blind crossover study. Intolerable side effects resulted in drop out of five patients on AMT (due to hypersomnia, difficulty in concentration and orthostatic hypotension) and one patient on VLF (because of nausea and vomiting). Following the run-in period the patients (n = 52) were randomly treated with one of the study medications for 12 weeks. After a wash-out period lasting 4 weeks the patients were treated with the other drug for further 12 weeks. Both drugs had significant beneficial effect on pain parameters. Total number of side effects of VLF was low when compared with the side effect profile of AMT. In conclusion, it is suggested that VLF may be considered for the prophylaxis of migraine because of its low and/or tolerable side effect properties.

Serum ghrelin levels are enhanced in patients with epilepsy

PURPOSE In patients with epilepsy, although many changes in the physiology of hormones in the neuroendocrine system can occur (especially in the sex hormones, for example), the causes of these changes have not been fully elucidated. There are also relations between seizure activity and stages of sleep. Ghrelin is the peptide hormone, which has been shown to affect both endocrine function and sleep. The purpose of this study was to evaluate serum levels of ghrelin in epilepsy patients. METHODS A total of 35 patients currently receiving antiepileptic drug therapy (of these patients, 20 had primary generalized seizure and 15 had partial seizure) were studied. The control group consisted of 30 healthy volunteers matched for age and gender. In all participants, serum levels of ghrelin, cholesterol and triglycerides were measured and body mass index (BMI) was determined. Patients with endocrine, immune or any other chronic diseases were excluded. RESULTS In the epilepsy patients, the mean serum ghrelin level was 158.81+/-55.97 pg/ml, and this was significantly higher than the control groups level of 93.43+/-21.33 pg/ml (p<0.001). In terms of serum cholesterol, triglycerides and BMI, no significant differences were found between the epilepsy patients and the control group (p>0.05). CONCLUSIONS The origin of higher serum ghrelin levels in epilepsy and their relation to seizures are not completely known. However, this elevation of serum ghrelin could contribute to the lengthening of NREM sleep in epilepsy patients, thereby playing a role in seizure occurrence. From another direction, high serum ghrelin levels could cause changes and/or dysfunction in hormone secretion and physiology via its effects on growth hormone, and thereby play a facilitating role in seizure occurrence.

Effects of epilepsy on autonomic nervous system and respiratory function tests.

We have investigated autonomic nervous system function during the interictal period in epileptic patients and the possible effects of autonomic dysfunction on respiratory functions. A total of 32 epileptic patients (23 generalized, 9 partial epilepsy) and 32 healthy volunteers were involved. Sympathetic skin response (SSR), for evaluating the sympathetic nervous system, and RR interval variation (RRIV) were measured at the beginning and third month of antiepileptic treatment, and respiratory function tests (RFTs) were performed. In patients with partial epilepsy, SSR latency in the upper extremity (1.3+/-0.2 s) was longer than that of controls (1.2+/-0.3 s) at baseline (P=0.05), and was significantly reduced (1.1+/-0.3 s) after treatment (P<0.05). RRIV values of patients with generalized epilepsy were statistically significantly lower than those of controls (P<0.01). However, deep breathing RRIV values (32.6+/-15.3%) of patients were lower than those (43.0+/-18.2%) of controls (P<0.05). Sympathetic dysfunction was determined in patients with partial epilepsy and parasympathetic dysfunction in patients with generalized epilepsy. No abnormality was observed on RFTs for both patients with partial epilepsy and patients with generalized epilepsy.

A new type of headache, headache associated with airplane travel: Preliminary diagnostic criteria and possible mechanisms of aetiopathogenesis

Background: In recent years, there has been an increase in the reports indicating a form of headache that occurs during commercial aircraft travel. This headache, called airplane headache by some authors, is believed to be a new type of headache. The headache has very specific characteristics and all of the cases exhibited very stereotypical symptoms. Methods: The headache starts suddenly during the ascent and/or descent of the commercial aircraft. It has a mean duration of 20 minutes, which is usually unilateral and commonly localized to periorbital region. The headache is described to be severe, and has a stabbing or jabbing nature, and generally subsides in a short time. In some cases, an organic cause can be identified whereas in others no organic pathology could be found. Results and conclusion: We described the clinical features of 22 cases who suffered from a headache that occurred during airplane travel. We examined other cases with similar features reported in the literature and proposed preliminary diagnostic criteria for this new form of headache. We also discussed the possible patholophysiological mechanisms that may cause this headache.

Autonomic nervous system functions in interictal and postictal periods of nonepileptic psychogenic seizures and its comparison with epileptic seizures

PURPOSE (1) To evaluate autonomic nervous system (ANS) functions during both interictal and postictal periods in a group of cases with nonepileptic psychogenic seizures (NEPS) and a group of epileptic patients to determine whether they have autonomic dysfunction. (2) If a significant difference can be established between epileptic and NEPS groups, to determine whether ANS tests can be used as a clinical helper in the differentiation between epileptic seizures (ES) and NEPS. METHODS ANS functions (sympathetic skin response and R-R interval variation) were measured during both interictal and postictal periods in 25 patients who had NEPS and 30 patients who had primary generalized tonic-clonic seizures (GTCS) and partial seizures with secondary GTCS, as well as once in the healthy control group. RESULTS When the patient group with NEPS both in the interictal and postictal period was compared with the control group, functions of both sympathetic and parasympathetic systems were found normal. This finding implies that patients with NEPS have normal ANS functions. A comparison of the epileptic patient group in the interictal and postictal periods with the control group revealed that the former had dysfunctions in both the sympathetic and parasympathetic systems. When patients with NEPS were compared with the ES, the measurements in sympathetic and parasympathetic nervous system functions during the interictal and postictal periods in the ES group were significantly different than those of the NEPS group. CONCLUSION This finding indicates that measurements of ANS functions may be helpful in differentiating between ES and NEPS.

Do polio survivors have a higher risk of epilepsy

We planned this study to investigate the frequency of epilepsy in paralytic polio survivors. We analyzed the clinical data of 91 paralytic polio survivors. Patients who had been diagnosed with epilepsy were examined by electroencephalography and brain magnetic resonance imaging. 11 of the 91 patients had epilepsy (12%). The mean age at which the patients were exposed to acute poliomyelitis was 5.3±3.8 years (age range: 1-13). The mean age of epilepsy onset was 17±5.6 (age range: 4-25) in the epileptic patients. Our findings suggest that paralytic polio survivors may be at a higher risk for epilepsy compared to normal subjects.

Ureterosygmoidostomy-associated hypokalemia-induced quadriparesis and rhabdomyolysis

Ureterosygmoidostomy is a urological intervention widely performed in various conditions such as bladder extrophy, invasive bladder cancer, vesicovaginal fistula and urethral trauma, and this intervention may lead to some complications. One of these complications is hypokalemia, which can cause muscular paralysis rarely (quadriparesis or paralysis of the respiratory muscles). 1–5 In the past decade, studies have found that hypokalemia, which may arise secondary to many factors, leads to rhabdomyolysis besides muscular paralysis. 5

Increased ghrelin levels in epileptic patients

We appreciate the comments of Suleyman Aydin about our paper published in Seizure 2006;15: 106—11. First of all, they indicated that the levels of ghrelin should have been presented as 100— 150 fmol/ml. However, we analyzed full-length octanoylated human ghrelin using a commercial radioimmunoassay (RIA) kit (Phoenix Pharmaceuticals Inc., Phoenix, AZ, USA) and the results were expressed as pg/ml. Several studies have used this kit and they also reported serum ghrelin levels in a wide range as 60—493 pg/ml, 119.6—827.8 pg/ml and 347—1260 pg/ml, respectively. Measurements done in the morning at fasting state and serums obtained from the antecubital vein were kept at 80 8C until analysis, as mentioned in ‘Material and Method’ section of the paper. The values determined in the study are not at very low levels as alleged by the Suleyman Aydin. Secondly, he claimed that the patients in the epilepsy group might become obese and this might lead to controversy about the results. Nonetheless, when the material and methods of our study are read carefully, it can be seen that all study groups including the epilepsy group that were taking AED had a BMI less than 25. An increase in bodyweight may occur in patients taking AED, however, this was not the case for all the patients. Our study population consisted of epilepsy patients without any body weight-gain due to

Examination of the Effects of Degeneration on Vertebral Artery by Using Neural Network in Cases With Cervical Spondylosis

The scope of this study is to diagnose vertebral arterial inefficiency by using Doppler measurements from both right and left vertebral arterials. Total of 96 patients’ Doppler measurements, consisting of 42 of healthy, 30 of spondylosis, and 24 of clinically proven vertebrobasillary insufficiency (VBI), were examined. Patients’ age and sex information as well as RPSN, RPSVN, LPSN, LPSVN, and TOTALVOL medical parameters obtained from vertebral arterials were classified by neural networks, and the performance of said classification reached up to 93.75% in healthy, 83.33% in spondylosis, and 97.22% in VBI cases. The area under ROC curve, which is a direct indication of repeating success ratio, is calculated as 92.3%, and the correlation coefficient of the classification groups is 0.9234. It is also demonstrated that those medical parameters of age and systolic velocity, which were applied into the neural networks, were more effective in developing vertebral deficiency.