Sudden unexpected death in epilepsy (SUDEP) is one of the most devastating complications of epilepsy, posing a significant challenge for clinicians, geneticists, and forensic specialists. It is defined as a sudden, unexpected, nontraumatic, and nondrowning death in individuals with epilepsy, with no identifiable toxicological or anatomical cause found during postmortem examination. It accounts for a significant portion of epilepsy-related mortality. The heterogeneous nature of SUDEP complicates accurate diagnosis, classification, and epidemiological assessment, particularly in cases lacking comprehensive death scene investigation or autopsy. Emerging evidence suggests that SUDEP is a multifactorial phenomenon involving complex interactions between seizure-induced respiratory dysfunction, autonomic instability, and cardiac arrhythmogenesis. Findings from monitored cases indicate that terminal apnea often precedes cardiac arrest, underscoring the central role of postictal respiratory failure. However, conventional autopsy often fails to reveal specific structural abnormalities, making SUDEP a diagnosis of exclusion in forensic practice. The integration of molecular autopsy has significantly advanced the understanding of SUDEP by identifying pathogenic variants in genes associated with cardiac channelopathies and epilepsy syndromes. Next-generation sequencing technologies have enabled comprehensive genetic screening in autopsy-negative cases, linking neuronal excitability and cardiac electrophysiology. These findings highlight the shared molecular mechanisms underlying epilepsy and sudden cardiac death and offer opportunities for family-based risk assessment and preventive interventions. A multidisciplinary approach that combines clinical evaluation, standardized forensic investigation, and genomic analysis is essential to improve diagnostic accuracy and risk stratification. Continued research integrating genetic, physiological, and epidemiological data is crucial to advancing precision medicine strategies and reducing the global burden of SUDEP.
Objectives: This study aimed to evaluate the efficacy of swallowing disorder rehabilitation in patients with schizophrenia experiencing dysphagia and hypersalivation. Patients and methods: A quasi-experimental pretest-posttest design was used. Forty-seven patients with schizophrenia with dysphagia were screened between April 2018 and January 2020. After exclusions due to noncompliance, seven patients (4 males, 3 females; mean age: 44.28 +/- 21.81 years; range, 19 to 79 years) completed the study. Swallowing was assessed with the Eating Assessment Tool (EAT-10), salivary issues with the Saliva Control Severity and Frequency Scale, and mouth opening with trismus measurement before and after a 12-session rehabilitation program (3 sessions a week). The program included chewing training, oral motor exercises, laryngeal mobilization, thermal tactile stimulation, and neuromuscular electrical stimulation. Results: After treatment, EAT-10, saliva severity, saliva frequency, and trismus scores significantly improved compared to baseline (p < 0.05). Disease history, education, and physical activity did not affect outcomes (p > 0.05). Conclusion: Swallowing disorder rehabilitation effectively improves swallowing and saliva control in dysphagic patients with schizophrenia.
This historical review addresses the development of debates on the cellular unit of the nervous system and functional localization in the brain from the 19th century to the present. The first section summarizes the disagreements between the reticular theory and the neuron doctrine, based on the contributions of Remak, Gerlach, Deiters, Golgi, His, Forel, Nansen, Cajal, Waldeyer, and Sherrington. The second section evaluates discussions on phrenology, holistic cortical approaches, and cortical localization through the work of Gall, Flourens, Broca, Wernicke, Jackson, Hitzig, Fritsch, Ferrier, and Goltz. The final section emphasizes the transition of modern neuroscience from a strictly centralized localization concept to distributed, connectional network models. Historical evidence suggests that brain functions cannot be reduced to single centers nor fully explained within a homogeneous cortical area. The current approach accepts that specific functions emerge through anatomically distinguishable but strongly interconnected networks.
Individuals with aphasia experience limitations in participating in life and daily activities. Contemporary traditional therapy approaches primarily focus on the individual’s neurological, linguistic, and cognitive impairments. The main goals of activity and participation-based approaches are to eliminate the communication barriers caused by aphasia, include individuals with aphasia and their communication partners in the intervention process, and create the necessary environmental conditions. In this review, we provide speech and language therapists with an informative review of the effectiveness of activity and participation-based intervention approaches at national and international levels by conducting a literature review and presenting compensatory strategies that would improve the quality of life of individuals with aphasia and their communication partners. In this context, national and international publications related to activity-participation-based approaches in aphasia were reviewed, information about these approaches was given, and the findings of effectiveness studies were compiled. The results of the review indicate that activity and participation-based approaches are effective in revealing the existing language competencies of individuals with aphasia, enabling them to be more active participants in communication and to develop methods, reducing the stress, depression symptoms, and caregiving burdens of their communication partners, facilitating more effective communication with the individual with aphasia, and enhancing the quality of life for both the individual with aphasia and their communication partner.
