Sibel Karsidag

Cutaneous drug eruptions by current antiepileptics: case reports and alternative treatment options.

Serious cutaneous drug eruptions due to antiepileptics have been defined for many drugs like carbamazepine, diphenylhydantoin, phenytoin and valproate. In recent years, adverse cutaneous reactions due to the current antiepileptic drugs have also been reported. In this paper, two cases are presented: a 48-year-old female receiving gabapentin for postherpetic neuralgia who developed leukocytoclastic vasculitis after 8 weeks and a 23-year-old male receiving lamotrigine for epileptic seizures who developed toxic epidermal necrolysis (TEN) in 15 days. Alternative therapy approaches with practical suggestions are also discussed.

Patients with Mild Cognitive Impairment Display Reduced Auditory Event-Related Delta Oscillatory Responses

Background. Event-related oscillations (ERO) may provide a useful tool for the identification of cognitive deficits in mild cognitive impairment (MCI) and Alzheimers disease (AD). In the present study, we investigate peak-to-peak amplitude of auditory event-related delta oscillations of MCI subjects. Method. The study included twenty-two consecutive patients with MCI recruited in neurology clinic and 21 age- and education-matched normal elderly controls. A classical auditory oddball paradigm was used in the experiments. EEG was recorded from F3, Fz, F4, C3, Cz, C4, P3, Pz, P4, O1, Oz, and O2 locations. The maximum peak-to-peak amplitudes for each subjects averaged delta response (0.5–2.2 Hz) were measured. Results. The amplitudes between groups differed significantly at the frontal and mid-centroparietal locations. ANOVA on delta responses revealed a significant effect for groups (F(1.41) = 4.84, P = 0.033), indicating a larger delta response for healthy controls than MCI subjects. Post hoc comparisons revealed that peak-to-peak delta response was significantly larger for healthy controls than for MCI over electrode sites F3, Fz, F4, Cz, C4, and Pz. Discussion. Event-related delta frequency band seems to be the most affected oscillatory response in cognitive impairment due to AD. Therefore, it deserves to be investigated as a candidate electrophysiological biomarker in further studies.

Increased plasma homocysteine levels in multiple sclerosis

Sir The pathophysiology of multiple sclerosis (MS) is strongly related to inflammation. In recent years, it has become particularly important to investigate the relationship between the immune and neurohormonal systems [1]. Homocysteine (Hcy) is a neurotoxic amino acid, which accumulates in various neurodegenerative disorders, including stroke and dementia [1,2]. In the current medical literature, only a few authors have reported that there is an elevation of Hcy levels in MS [2 4]. For this reason, we aimed to investigate the plasma Hcy levels in a sample of Turkish MS patients. We studied 30 consecutive patients with relapsing-remitting (RR) MS (12 females, aged 22 48 years, mean: 309/6.3; and 18 males, aged 22 46 years, mean: 429/4.2) with MS, and 21 healthy subjects (10 females and 11 males, aged 21 46 years, mean 309/5.7) as a control group. The diagnosis of MS was based on the McDonald criteria. Duration of the disease from the first symptom was mean 99/5 years. None of the patients had a new attack in the previous six months and no patient was on current steroid or other immunomodulatory therapy. Patients who had major depressive illness, current septic illness, epilepsy and other inflammatory diseases were not included in the study. None of the patients and controls had received vitamin B12 and folate supplementation for at least eight months. This study was approved by the Institutional Ethics Committee, and written informed consent was obtained from each subject. Vitamin B12 and folate levels were measured in serum samples and Hcy levels were measured in plasma samples. The Hcy levels were detected by fluorescence polarisation immunoassay (IMX; Abbot, USA). Vitamin B12 and folate levels were measured by immunoassay chemiluminescence (Access-Beckman-Coulter, USA). Results were statistically analysed by using ordinary ANOVA, and a P value B/0.05 was regarded as statistically significant. The non-parametric Spearman rank correlation test was used for the regression analysis to compare the individual parameters with each other. We found that there was no correlation between Hcy and vitamin B12 (r /0.18) and folate (r /0.23) levels. Vitamin B12 and folate levels were not statistically different for both genders in the patient groups when compared to control groups (P /0.66). Hcy was significantly higher in both male and female MS patients when compared to the control groups. Mean and standard deviation (SD) values of biochemical parameters, including Hcy, vitamin B12 and folic acid, from male subjects are shown in Table 1, and from female subjects are shown in Table 2. The mean Expanded Disability Status Scale (EDSS) score of the patients was 3.169/2.9, and there was no correlation between EDSS score and Hcy (r /0.20), vitamin B12 (r /0.18), folate (r / 0.14) levels. In our study, serum vitamin B12 and folate levels, being in the reference limits according to the age and sex groups, were not correlated with the Hcy levels. However, there are some other studies reporting low correlation between vitamin B12 and Hcy levels [2,5]. We studied 12 female and 18 male consecutive patients with RRMS. Turk Boru et al . have investigated the prevalence of MS in the district of Maltepe, Turkey in a previous study, and they found that high prevalence rates in females (average 2-fold), similar to like other countries [6]. The excess number of male patients in our current study seems to be completely incidental. In the present study, mean age of male MS patients was 10 years more than the male control group. Although Hcy levels are known to vary with age, especially due to the age-related changes in vitamin B12 [7], the difference between the patient and the control group was so high, it cannot be explained solely by age. Moreover, statistically there was no difference between the two groups in vitamin B12 levels. We did not find a correlation between Hcy levels and EDSS scores. This finding is concordant with the study of Ramsaransing et al . [4]. Our results demonstrate that Hcy levels in MS patients of both genders were significantly higher than healthy subjects. The multisystem toxicity of Hcy is attributed to its spontaneous chemical reaction with many biologically important

Determination of nerve conduction abnormalities in patients with impaired glucose tolerance

Recent studies have shown that impaired glucose tolerance (IGT) is associated with dysfunction in the peripheral and autonomic nerves. The aim of this study was to determine the electrophysiological abnormalities of IGT. To determine electrophysiological abnormality in the large sensorimotor and sudomotor autonomic nerves with IGT patients, 43 patients and 34 healthy subjects have been studied. Subjective neuropathy symptoms, neurological examination and the electrophysiological findings were evaluated. When conduction of large somatic fibers only was evaluated, the ratio of electrophysiological abnormality was found to be 21%. In addition, where sympathetic skin response was evaluated the sudomotor autonomic abnormality ratio was 28% in upper extremities, 53% in lower extremities, and 16% in upper and lower extremities together. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 39.5% in the peroneal motor nerve, 20.9% in the median motor and sural sensory nerves, 18.6% in the median sensory nerve, 16.3% in the tibial motor nerve, 14% in the ulnar sensory nerve, and 2.3% in the ulnar motor nerve. While distal motor latency was the most frequent abnormal parameter in the median and tibial motor nerves, the amplitude changes in the peroneal and ulnar motor nerves were also prominent. In sensory evaluation, the onset latency in the median-ulnar sensory nerves and the amplitude in the sural sensory nerve were found to be evident abnormalities.

An unusual cause of cardioembolic stroke: isolated left ventricular noncompaction.

Background:Isolated left ventricular noncompaction (ILVNC) is a rare congenital condition that is the result of an intrauterine developmental arrest, which stops the compaction of the loose myocardial fiber meshwork of the left ventricle. This condition is recognized by an excessively prominent trabecular meshwork and deep intertrabecular recesses of the left ventricle. Although these intertrabecular recesses are prone to thrombus formation, with resulting embolic sequelae, the literature describes only 1 adult case of a stroke caused by ILVNC. Case Report:We describe a case of cerebral cardioembolism in a 33-year-old man due to ILVNC. Because of echocardiography (ECHO) findings in this case, cardiac magnetic resonance imaging (cMRI) was performed, which allowed a definite diagnosis to be obtained. Conclusion:This case should highlight the importance of performing cMRI especially in younger patients with embolic stroke, if the ECHO suggests a suspected myocardial disorder.

Neurophysiological and morphological responses to treatment with acetyl-l-carnitine in a sciatic nerve injury model: preliminary data

We investigated the effects of acetyl-L-carnitine (ALCAR) on the recovery of sciatic nerve injuries in rats. Sprague Dawley rats were randomized to two groups: ALCAR treated (for 14 days) and control. Each group was divided into three subgroups: distal transection, proximal transection, and grafted. Distal latencies, amplitudes, and motor nerve conduction velocities were measured. In the third month, biopsies were taken and examined under light microscopy. Electrophysiological measurements demonstrated that regeneration occurred earlier and was better in the ALCAR group, particularly in the distal transection subgroup. Better results were obtained in the distal transection subgroup in terms of axonal regeneration compared with the proximal transection and grafted subgroups because the regenerating segment was shorter. ALCAR enhanced the quality of neural recovery at the different levels and in different types of repair, and led to a decline in nerve death.

Eye-related visual hallucinations: consider 'Charles Bonnet syndrome'.

The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.

Relationship of leukoaraiosis to vascular risk factors and lesion type in stroke patients.

Nonspecific periventricular white matter lucencies on computed tomograms (leukoaraiosis) were found in 49 (55%) of 89 stroke patients. We compared the vascular risk factors and the types of stroke with and without leukoaraiosis. Patients with leukoaraiosis were significantly older than those without it. The duration of hypertension was longer than those without leukoaraiosis. Mean diastolic blood pressure was associated with leukoaraiosis. No association was found with systolic blood pressure, diabetes mellitus, angina pectoris, myocardial infarction, heart failure, valvular disease and intermittent claudication. Patients with leukoaraiosis were significantly more likely to have lacunar infarcts on computed tomograms but were less likely to have cortical infarcts, subcortical infarcts or cerebral hemorrhage.

Effects of Anthropometric Factors on Nerve Conduction An Electrophysiologic Study of Feet

BACKGROUND Previous studies have shown that age, sex, and body mass index (BMI) affect the amplitude of sensory nerve action potentials (SNAPs), but the total effects of multiple factors and the most prominently affected nerves have not been elucidated. We systematically investigated the effects of these factors on motor and sensory nerves of the feet. METHODS The amplitude, latency, and conduction velocity of compound muscle action potential (CMAP), SNAP, and mixed nerve action potential (MNAP) of the posterior tibial, calcaneal, distal posterior tibial, medial and lateral plantar, and sural nerves were measured in 30 healthy individuals (60 feet). The effects of age, sex, height, and BMI on each nerve were estimated by correlation and linear regression analyses. RESULTS The amplitude of posterior tibial CMAP and distal posterior tibial MNAP decreased with BMI. The amplitude of medial plantar MNAP and sural SNAP decreased with height. The conduction velocity of calcaneal SNAP and distal posterior tibial and lateral plantar MNAP decreased with height and BMI. The conduction velocity of medial plantar MNAP decreased only with height. The latency of posterior tibial CMAP increased with age and height. The latency of lateral plantar CMAP and calcaneal SNAP increased with height. The latency of lateral plantar MNAP increased with BMI. CONCLUSIONS The effects of age, sex, height, and BMI in foot nerve conduction studies are not identical. Height and BMI were shown to strongly affect motor, sensory, and mixed nerve conduction. Further investigations are needed.

Balance in essential tremor during tandem gait: Is the first mis-step an important finding?

Essential tremor (ET) is the most commonly diagnosed movement disorder. ET may cause substantial loss of motor skills and balance with advanced age. We compared abnormalities in tandem gait with daily activity and Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) scores in 90 ET patients. All patients performed a 15-step tandem three times. The mean of first mis-steps was accepted as the tandem index (TI). The mean age was 61.4 ± 17 years; the mean duration of tremor was 6.7 ± 4 years; and there were 36 men and 54 women. There was no significant difference for age or sex between patients and controls. Head (24.6%), jaw (5.5%), voice (11%), and tongue tremors (1.5%) were identified in ET patients. Rest (2.5%), postural (95%), and kinetic tremors (54%) were detected in the upper extremities. Postural tremor was found in the lower extremities of 5%. The mean TI was 8.3 ± 4 (median, 8) in ET patients, and 10.6 ± 3.9 (median, 10) in controls (p=0.04). Correlation analysis of TI and FTMTRS scores showed tandem gait was significantly correlated with age, total tremor score, postural and kinetic extremity tremor, writing, drawing, pouring, feeding, and working scores. Linear regression showed a significant effect of age and FTMTRS score on TI. The decrease in balance control is apparent with advancing age. Balance disorders were more pronounced in ET patients. Although first mis-step in tandem gait is not as detailed as dynamic balance tests, it can be a simple method for detecting balance disorders.