Yuksel Kaplan

Epidemiological and clinical characteristics of headache in university students

OBJECTIVE Epidemiological studies regarding headache are abundant in developed countries; however, the data in developing countries are scarce. This study aims to detect the prevalence and clinical features of headache in Gaziosmanpasa University students in Tokat, Turkey. PATIENTS AND METHODS 2168 subjects were selected with randomized stratified sampling, and 92.5% of them participated in the study (2023 students). Two neurologists from our medical faculty interviewed and examined the students with headache. Assessment was done according to The International Classification of Headache Disorders, 2nd edition. RESULTS In our study, 22.64% of the students had tension-type headache (TTH), 17.89% had migraine headache, 0.29% TTH plus migraine headache, 0.20% had cluster and variants type of headache. Migraine type of headache was more common in females than in males (p=0.0001); however, no significant difference was present between males and females who had migraine with aura and tension-type headache. DISCUSSION The clinical features of tension-type headache and migraine in our university students were similar to the ones of general population and to the studies conducted on university students.

Obesity and Carpal Tunnel Syndrome: Is There a Causal Relationship?

Objectives: Obesity is defined as a risk factor for carpal tunnel syndrome (CTS). In this study, the presence or absence of recovery in median nerve conduction velocities after weight loss in obese patients was assessed in order to determine whether excess weight or other factors influence the higher prevalence of CTS in obese patients. Methods: Patients with body mass indexes (BMIs) ≧30 were included in the study. CTS symptoms, age, gender, height, body weight, and concomitant diseases were evaluated. Nerve conduction studies (NCS) were obtained on one upper extremity. All patients were included in dietetic programs. Three months later, NCS were repeated and compared with the first NCS. Results: BMIs were statistically significantly lower on the second visits 3 months later (p = 0.0001). No statistically significant difference was observed in the second NCS of electromyographically diagnosed cases with CTS (p > 0.05). Conclusion: We expected a recovery in median nerve conduction velocities in patients with CTS after weight loss. In the literature, even in untreated cases with CTS, spontaneous improvements in second NCS have been reported. This finding suggests that factors other than excess body weight may be influential in the higher prevalence of CTS in obese patients. A more detailed, genetic-factor-targeted investigation may prove more beneficial to clarify this issue.

Skewed X inactivation in an X linked nystagmus family resulted from a novel, p.R229G, missense mutation in the FRMD7 gene

Aims: This study aimed to identify the underlying genetic defect of a large Turkish X linked nystagmus (NYS) family. Methods: Both Xp11 and Xq26 loci were tested by linkage analysis. The 12 exons and intron–exon junctions of the FRMD7 gene were screened by direct sequencing. X chromosome inactivation analysis was performed by enzymatic predigestion of DNA with a methylation-sensitive enzyme, followed by PCR of the polymorphic CAG repeat of the androgen receptor gene. Results: The family contained 162 individuals, among whom 28 had NYS. Linkage analysis confirmed the Xq26 locus. A novel missense c.686C>G mutation, which causes the substitution of a conserved arginine at amino acid position 229 by glycine (p.R229G) in exon 8 of the FRMD7 gene, was observed. This change was not documented in 120 control individuals. The clinical findings in a female who was homozygous for the mutation were not different from those of affected heterozygous females. Skewed X inactivation was remarkable in the affected females of the family. Conclusions: A novel p.R229G mutation in the FRMD7 gene causes the NYS phenotype, and skewed X inactivation influences the manifestation of the disease in X linked NYS females.

Carpal tunnel syndrome in postmenopausal women

OBJECTIVE Hormonal changes that accompany menopause have a significant impact on the nervous and other physiological systems. Our objective was to evaluate the relationship between carpal tunnel syndrome (CTS) and the clinical features of menopause in postmenopausal women, in comparison to age-matched healthy controls. METHODS Overall, 6230 women were seen during the study period. Of these, 5587 were not eligible because they were premenopausal or perimenopausal. 537 women did not meet the criteria used in the study for a diagnosis of idiopathic CTS and were excluded. Finally, one hundred and six patients with CTS and 115 controls were examined. The presence of CTS was confirmed both clinically and electrophysiologically. Socio-demographic variables and reproductive histories were evaluated via a structured interview. RESULTS In comparison to healthy controls, patients with CTS showed a significantly greater number of pregnancies and an earlier age at menopause. Regarding the type of menopause, patients and controls showed similar frequencies for natural versus surgical menopause. The frequency of natural menopause was significantly higher than that of surgical menopause in both groups. CONCLUSION Our results suggest that age at menopause may be a significant factor in the development of CTS. Pregnancy-related hormonal changes may have long-term effects that increase the incidence of CTS in postmenopausal women.

Association between restless legs syndrome and Chiari type 1 malformation

Chiari type 1 malformations (CM-1) consist of the downward displacement of the cerebellar tonsils out of the inferior opening of the skull and into the spinal canal. In relation to this, a few studies in the literature have drawn attention to the possible role of the upper brainstem, diencephalon, red nucleus, and cerebellum in the pathogenesis of restless legs syndrome (RLS). Herein, we present five cases of RLS who were also found to have CM-1 malformations. The cases were notable for an early onset of RLS and a poor response to dopaminergic treatment. The patients fulfilled the diagnostic criteria for RLS according to the International RLS Study Group. None of the patients had a family history of RLS or any other condition known to be associated to RLS. The patients ranged in age from 20 to 31 years old. Four of the patients indicated occasional pain in the occipital-suboccipital area upon questioning about CM-1-related symptoms. All cases had used at least two different drugs known to be effective in RLS treatment. Our opinion is that CM-1-related involvement of the cerebellum and/or connections of the cerebellum with the basal ganglia may have contributed to the development of RLS in these cases.

Intra-familial incidence and characteristics of hot water epilepsy.

OBJECTIVE To assess the clinical features of several members of the same family diagnosed with both hot water epilepsy (HWE) and cerebral lesions. METHODS Age at onset and types of seizure, precipitating factors, EEG findings, and neuroimages were evaluated. RESULTS The family consisted of six generations, including one consanguineous parent. Of eight family members diagnosed with epilepsy, seven suffered from HWE. Age at onset of seizures ranged within childhood. Seven patients with HWE experienced complex partial seizures, with or without secondary generalization; one experienced simple partial seizures as well as complex partial seizures. Three patients experienced spontaneous seizures as well as HWE. Interictal EEG revealed abnormalities in two patients. Magnetic resonance imaging revealed cerebral lesions in one patient, probably attributable to ischemic changes. Magnetic resonance images were consistent with findings of ischemic gliosis in two patients, and either demyelinating or ischemic gliosis in one patient. CONCLUSIONS Descriptions of HWE families with different ethnic backgrounds may permit more definite conclusions regarding the mechanisms epileptogenesis, and the genetic defects that underlie this disease.

Epilepsy and kleptomania.

Kleptomania, defined in the American Psychiatric Associations Diagnostic and Statistical Manua of Mental Disorders, Text Revision: DSM-IV-TR, as the inability to resist the impulse to steal objects that are not needed for personal use or for their monetary value, may reflect a form of obsessive-compulsive spectrum disorder and/or affective spectrum disorder. We report on a patient who developed kleptomania and left temporal lobe epilepsy around the same time; both disorders were completely resolved in this patient with topiramate.

Diyabetik Polinöropati için Risk Faktörleri

INTRODUCTION The aim of this study was to investigate the risk factors for distal symmetric sensory-motor polyneuropathy (DSP) in patients with type 2 diabetes mellitus (DM). METHOD Sixty seven patients with type 2 DM (33 males and 34 females) were included in the study. In addition to a detailed neurological examination, the Michigan Neuropathy Screening Instrument was administered to all patients and their total neuropathy scores were calculated. Nerve conduction examinations were performed for all patients. RESULTS The mean age of the patients was 52.83±.87 years. The mean glycosylated hemoglobin (HbA1C) value was 8.56±2.07% (normal: 3-6.5%). The total neuropathy score significantly correlated with diabetes duration, hypertension, retinopathy, and HbA1C. CONCLUSION This study confirms the previous reports regarding the association of neuropathy with poor glycaemic control and duration of the disease. The association of neuropathy with retinopathy and hypertension is important.