Introduction: This study aims to investigate obstructive sleep apnoea syndrome (OSAS), quality of sleep, excessive daytime sleepiness (EDS) and quality of life in patients with epilepsy. Methods: One hundred and eleven epilepsy patients, diagnosed with ILAE (international league against epilepsy) criteria, were included in this study. The mean age of the patients was 37.6 +/- 13.1 (19-77) years. Fiftyfour of the patients were (48.6%) men and 57 were (51.5%) women. Age, gender, education level, body mass index, seizure frequency, types of seizures, electroencephalography (EEG) findings, seizures during sleep, and number of anti-seizure drugs were recorded. Berlin Questionnaire (BQ) was used to screen OSAS. Sleep and quality of life were assessed with Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Quality of Life in Epilepsy-31(QOLIE-31) scales. Results: Thirty-six percent of the patients' quality of sleep was poor and 20.7% had mild EDS. Low risk of OUAS was found in 89.2% of the patients. Quality of life was poor according to QOLIE-31. QOLIE 31 and PSQI total score had a statistically significant low negative correlation with BQ. PSQI total score had a statistically significant, low negative correlation with QOLIE-31. Poor sleep quality, EDS, OUAS and quality of life showed no correlation with demographic features, duration of disease, types of seizures, seizure frequency, number of anti-seizure drugs. Conclusion: The poor quality of sleep was 36% in our study. Poor quality of sleep, excessive daytime sleepiness and obstructive sleep apnoea syndrome had no correlation with the demographic and clinical features of the patients with epilepsy but showed low correlation with quality of life.

Background and purpose:The role of synaptic dysfunction in focal epilepsy of unknown cause is not well understood. Neurogranin is a post-synaptic protein used as a biomarker of synaptic disintegration in patients with dementia. Methods:To evaluate the association between synaptic loss, cognitive impairment and seizure activity in epilepsy, we collected sera of 51 patients with focal epilepsy of unknown cause, 26 with frontal lobe epilepsy (FLE) and 25 with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLEHS), and 25 healthy controls. Serum neurogranin levels were measured by ELISA and we sought for potential correlations between neurogranin levels versus clinical features, cognitive test and quality of life scores of the patients. Results:Neurogranin levels were significantly reduced in MTLE-HS patients as compared to FLE patients and healthy controls but were not correlated with any of the clinical and cognitive variables. Both FLE and MTLE-HS patients with treatment resistance showed significantly reduced neurogranin levels. Conclusion:Our results suggest that MTLE-HS patients suffer from reduced synaptic protein production rather than increased synaptic breakdown. Reduction of neurogranin is associated with resistance to anti-epileptic treatment implying the role of this protein in the control of seizures. Neurogranin might serve as a biomarker for monitorization of seizure activity in focal epilepsies.

Aim Reproductive adverse events may be observed in patients with epilepsy associated with antiepileptic drugs. This study aimed to evaluate changes in sex hormone levels in patients receiving antiepileptic treatment as monotherapy and polytherapy. Method In this case-control study, the sex hormone levels and free androgen indexes were evaluated in 83 patients and 40 controls. In the hormone evaluations, measurements were performed for dehydroepiandrosterone sulfate, sex hormone-binding globulin, follicle-stimulating hormone, luteinizing hormone, total and free testosterone, prolactin and estradiol levels. Results A total of 83 patients (42 males, 41 females) with a mean age of 28±7.2 years and a control group of 40 healthy subjects (14 males, 26 females) with a mean age of 33±8.7 years were included. In the patient group, 45 were receiving monotherapy and 38 polytherapy, 13 (15.7%) patients had focal onset seizures, 68 (81.9%) had generalized onset seizure and 2 (2.4%) had seizure type of unknown origin. In the males of the study group, no difference was determined in the hormone levels. In the females of the study group, the free androgen index was determined to be significantly low in the carbamazepine group compared to the control group (p=0.04) and the sex hormone-binding globulin values were significantly high (p=0.01). In males, a significant positive correlation was determined between serum carbamazepine and follicle-stimulating hormone (p=0.046) and prolactin (p=0.035) and a significant negative correlation was determined with the free androgen index (p=0.032). In females, a statistically significant positive correlation was determined between carbamazepine and prolactin (p=0.036). Conclusion The use of antiepileptic drugs creates changes in the sex hormone levels in males, and associated reproductive side-effects may be seen. In the management of patients with epilepsy, an awareness of these side-effects and individual evaluation could have a positive effect on treatment compliance and patient satisfaction.

Objectives: The study aimed to investigate the rate of unplanned pregnancies, changes in seizure frequencies during the 6 months before the pregnancy, during the pregnancy, and the 6 months after the pregnancy, and antiseizure medication (ASM) compliances in women with epilepsy (WWEs). Materials and Methods: The study retrospectively evaluated WWEs who were followed up in the epilepsy outpatient clinic of a training and research hospital between 1997-2021 and had used ASMs for at least 6 months prior to their pregnancy. Results: The study assessed a total of 158 pregnancies for 77 WWEs, with 112 pregnancies resulting in live births, 71.4% of which were unplanned pregnancies. Unplanned pregnancies are more common in less educated women (p = 0.02). Of the women, 35 self-discontinued their ASMs during pregnancy, and these women were younger than the WWEs who continued taking their ASMs (p = 0.003). In addition, folic acid supplement use was lower in women who self-discontinued their ASMs (p = 0.031). The rate of increase in seizure frequency during postpartum period compared to pregnancy was higher in women who self -discontinued ASMs (p = 0.032). Conclusion: Self–discontinuation of ASM during pregnancy is related to an increase in postpartum seizure frequency. WWEs should be given advice on how to minimize the risk of seizure during the postpartum period.

Aim: Antiepileptic drugs (AEDs) can have an effect on hormone metabolism and function, and alter serum levels of some hormones. This study aimed to determine the effects of AEDs on thyroid function test results in epilepsy patients. Methods: The study included 82 epilepsy patients aged 18-45 years. Serum free thyroxin (fT4), free triiodothyronine (fT3), and thyroid-stimulating hormone (TSH) levels were measured in all the participants. Thyroid hormone levels in subgroups were investigated. In addition, Serum AED and thyroid hormone levels and duration of AED use and thyroid hormone levels were analyzed. Results: Although there were differences in thyroid hormone levels among patient subgroups, the differences did not reach statistical significance. There was no significant correlation between the duration of AED use and thyroid function parameters in the monotherapy subgroup. The only correlation observed between serum AED levels and thyroid function test results was that decreased serum fT4 level was associated with decreased carbamazepine level in blood. Conclusion: In this study, we found a significant decrease in fT4 level with only increased serum carbamazepine level. Different results in our study and similar studies in the literature showed that there could be many different physiological and environmental factors affecting thyroid hormone levels.

Objectives: Epilepsy is defined as a chronic neurological disease that results from increased excitability of nerve cells in the brain and requires prolonged or lifelong treatment. Epilepsy is the most common disease seen in neurology practice in childhood and adolescence, and is the second most common disease after cerebrovascular disease in the elderly. In recent years, quality of life for patients with many diseases has gained importance, to increase patient satisfaction and standard of living, but also to reduce costs, and a number of assessment scales have been developed. The aim of this study was to evaluate the quality of life of epilepsy patients and related factors in order to determine the appropriate treatment methods to improve psychosocial findings. Methods: Patients aged 18 to 65 years who had experienced a complex partial or generalized epileptic seizure in the previous year and had been definitively diagnosed with epilepsy were included in the study. Demographic data were noted and evaluated. The Quality of Life in Epilepsy-31 (QOLIE-31) inventory and the Hamilton Depression Rating Scale were administered to all of the patients, as well as the Arizona Sexual Experience Scale. The statistical analysis was performed using NCSS 2007 and PASS 2008 statistical software (NCSS, LLC, Kaysville, UT, USA). Results: A total of 72 patients were included in the study; 45 were female. The mean age was 28.93 +/- 10.72 years and the mean duration of treatment was 8.14 +/- 8.40 years. In all, 34 patients (47.2%) had multiple seizures per year. The Hamilton Depression Rating Scale scores and QOLIE-31 measurement of anxiety related to seizures, total quality of life, emotional well-being, energy/fatigue, cognitive status, and social function were analyzed. There was a negative correlation between the total scores of 52.8% (p <= 0.005). Sexual dysfunction negatively affected all subscales of quality of life in female patients, while total quality of life subscores were negatively affected in males (p<0.005). Conclusion: pilepsy patients and their families should be well informed about the disease and trained extensively about living with seizures beginning at the diagnosis stage. A multidisciplinary approach to treatment that includes the various factors that can affect quality of life will lead to more effective treatment and follow-up.

ObjectiveSimilar clinical characteristics of epilepsy and migraine and the prevalence of their comorbidity have been investigated for years. The present study investigated the relationship between epilepsy and headache.MethodsA total of 420 epilepsy patients, who visited epilepsy outpatient clinic within 6-month period between January 2016 and June 2016, were questioned whether they have headache. Age, gender, duration of epilepsy, type of seizures, and temporal relationship of headache with seizure were investigated in the patients with headache.ResultsHeadache was detected in 111 (26%) of 420 epilepsy patients. The prevalence of migraine was 15%. When the temporal relationship of headache with seizure was evaluated, interictal headache was found to be the most common type with a percentage of 74.8%. No significant difference was determined between the patients with migraine and non-migraine headache in terms of age, gender, duration of epilepsy, age at the onset of epilepsy, type of seizure, and electroencephalography findings. The prevalence of interictal headache was statistically significantly higher in migraine patients as compared to that of non-migraine patients (p<0.001); however, the prevalence of preictal headache and the prevalence of postictal headache were significantly lower (p=0.001 and p<0.001, respectively).ConclusionThe prevalence of headache and the prevalence of migraine, which are considered to be pathogenetically linked to epilepsy, were not different in epilepsy patients as compared to that of the general population. Different outcomes and percentages in other studies suggest that pathogenesis of headache is multifactorial and that different diagnostic criteria might have been taken into consideration.

Background: Stroke is one of the causes of CK, CK-MB and troponin elevation except ischemic heart disease which creates a conflict for clinicians in emergency services.

Introduction: Paroxysmal atrial fibrillation (PAF) has a similar risk with persistent AF for ischemic stroke. Holter monitorization (HM) and other long-term monitorization methods increased the detection of PAF and short-lasting runs of tachyarrhythmias. Their classification as PAF and roles in the etiology of ischemic stroke is controversial. In this study, we aimed to investigate the frequency of any duration of PAF and clinical characteristics of the patients with acute ischemic stroke who have undergone 24-hrs HM. Methods: Patients with acute ischemic stroke and transient ischemic attack (TIA) hospitalized in the Neurology ward and undergone 24-hrs of HM during their hospital stay were included in the study. HM reports, clinical, and laboratory characteristics were analyzed, retrospectively. Patients were grouped into three based on HM: 1st group, without PAF; 2nd group, PAF > 30 seconds (s) and 3rd group, PAF<30s. Results: PAF of any duration was detected in 18.8% (n=49) of 261 patients. The duration of PAF was <30s in 16.1% (n=42) and >30s in 2.7% (n=7) of the patients. The mean age, left atrium diameter and CHA2DS2-VASc scores of the second group were significantly higher than the first group (p<0.001, p<0.001 and p=0.007; respectively). The mean age, left atrium diameter, modified Rankin Scores (mRS), and CHA2DS2-VASc scores of the third group were significantly higher than the first group (p<0.001; for all). There was no difference between the second and the third groups in means of mean age, left atrial diameter, MRS, and CHA2DS2-VASc scores (p<0.017, for all). Conclusion: In this study, 24-hrs HM in the early period of acute ischemic stroke results yielded a high frequency of PAF<30s and predictive features were in parallel with the literature.

INTRODUCTIONStroke prevalence is known to increase with age. Approximately 50% of acute ischemic stroke patients are aged between 70 and 89 years.METHODSIn this study, records of 770 ischemic stroke patients who were 70-89 years old were retrospectively examined (407 septuagenarians and 363 octogenarians). The demographics, comorbid conditions, ischemic stroke type, and stroke outcome for the two age groups were analyzed.RESULTSComorbid hypertension, diabetes mellitus, and HbA1c levels of ≥6.5% more frequently occurred in septuagenarians than in octogenarians (80.6% versus 70.8%, p=0.002; 32.2% versus 21.8%, p=0.001; and 35% versus 23.2%, p=0.003, respectively), whereas atrial fibrillation was significantly higher in octogenarians (49.3% versus 41.5%, p=0.03). Hypercholesterolemia, previous stroke history, and antiaggregant and/or anticoagulant use were not significantly different between the two age groups. Based on the Oxfordshire Community Stroke Project classification, the most common stroke subtype in the septuagenarian group was a lacunar infarction and in the octogenarian group, it was a partial anterior circulation infarct. According to the Modified Ranking Score, the number of patients living independently was higher for septuagenarians (42.8% versus 27.8%, p<0.001).CONCLUSIONThe present findings indicate that the clinical characteristics of ischemic stroke differed between septuagenarians and octogenarians. Therefore, elderly stroke patients cannot be accepted as a homogeneous group. Because this is a hospital-based study, our findings need to be tested via additional epidemiological studies.

While epileptic seizures are seen in the course of multiple sclerosis, they are rarely the first symptom. The first epileptic seizure of a 26-year-old woman with multiple sclerosis is described in the present report. The patient presented to the emergency department with generalized tonic-clonic seizure. Neurologic examination was normal except for right-sided hemiparesis and hyperactive deep tendon reflexes. Cranial MRI revealed periventricular, multiple millimetric lesions and a 45x27-mm, semi-ring-enhanced, cortical, T2/FLAIR, hyperintense lesion in the centrum semiovale. IgG index was high, and oligoclonal band was positive in cerebrospinal fluid examination. Electroencephalography showed prominent fronto-temporal activity on the left side and sharp wave paroxysms. Multiple sclerosis was diagnosed, and pulse corticosteroid therapy was initiated. Due to recurrent seizures, antiepileptic drug was added to treatment; seizures were controlled with monotherapy. It is known that patients with multiple sclerosis experience seizures. Multiple sclerosis should be considered in the differential diagnosis of young patients presenting with seizures.

Uzm. Dr. Belgin Petek Balc›. Haseki E¤itim ve Araflt›rma Hastanesi, Noroloji Klini¤i, Millet Cad., Fatih, 34250, ‹stanbul. e-posta: belginp1@yahoo.com C›kar cak›flmas› / Conflicts of interest: C›kar cak›flmas› bulunmad›¤› belirtilmifltir. / No conflicts declared. www.raeddergisi.org doi:10.2399/raed.15.76486 Karekod / QR code: Sistemik skleroderma (SS) gunumuzde nedeni tam olarak bilinmeyen otoimmun, enflamatuar bir kollagen doku hastal›¤›d›r. Ozellikle cilt, gastrointestinal sistem, akci¤er, kalp ve bobrekleri tutar ve organlar›n ba¤ dokular›nda fibrozise neden olur. Ayr›ca subkutanoz kalsiyum birikimleri, hipotiroidi, tuzak noropatiler ve otonomik disfonksiyon gorulebilir. Di¤er kollajen doku hastal›klar›ndan farkl› olarak, SS’da norolojik tutulum nadir gorulur. Hastal›¤›n patogenezi henuz tam olarak anlafl›lamam›flt›r. SS’de dokularda kollojenden oluflan ekstraselluler matriks birikimi, kucuk arterlerde vaskuler lezyonlar, hastal›¤a ozgu antikor geliflimi gibi hucresel ve humoral immunite de¤ifliklikleri patofizyolojiden sorumlu tutulmaktad›r. Bu makalede ileri yaflta jeneralize tonik-klonik nobetleri bafllayan SS olgusunda; skleroderma-epilepsi-inme birlikteli¤i irdelenmifl ve nadir gorulen bu durum literatur eflli¤inde gozden gecirilerek tart›fl›lm›flt›r.

Summary Systemic sclerosis is a generalized connective tissue disease, characterized by inflammatory, vascular and fibrotic changes of skin and a variety of internal organs. Central nervous system involvement is rare. Scleroderma is a phenomenon known to be presented with right hemiparesis and generalized tonic-clonic seizures. Cranial diffussion MRI showed acute focal infarct in left centrum semiovale. In EEG, sharp waves in left parietal area was detected. Scleroderma affecting the central nervous system rare, due to the association with stroke and epilepsy were examined in the light of the literature.

Objective: Epilepsy is frequently seen in the elderly, but its etiology, clinical presentation, comorbidities, and prognoses are different than younger patients. In this study, we investigated types of seizures, electroencephalography (EEG) findings and the cause of epilepsy in the elderly.Materials and Methods: We retrospectively analyzed 95 patients who were 65 years old or older, and who had an epileptic seizure for the first time. Type of epilepsy, age, EEG findings, magnetic resonance imaging and/or cranial tomography findings, etiology, comorbidities and antiepileptic medication were evaluated.Results: The average age of our patients was 75, and 50 (56%) patients were male. Among 95 patients, 55 (58%) had focal seizures, 36 (38%) had generalized tonic-clonic seizures and 4 (4%) had convulsive status epilepticus. The frequency of focal interictal epileptiform activity was 32.6% patients. Seizures were responsive to treatment administered as monotherapy in 81 (85%) patients and as politherapy in 14 (15%) patients. Our study showed that cerebrovascular disease was the most common (63%) etiological cause identified. There was no significant relationship between age and frequency of seizures and EEG abnormalities. However, a significant correlation was found between age and comorbidities.Conclusion: Our results supported the focal seizure is the most common manifestation of epilepsy in the elderly. Cerebrovascular disease is the most common etiological cause of epilepsy in the elderly. Monotherapy is sufficient in the majority of patients. Continuous growth of the elderly population is increasing the need for accurate diagnosis and effective treatment.

Summary Systemic sclerosis is a generalized connective tissue disease, characterized by inflammatory, vascular and fibrotic changes of skin and a variety of internal organs. Central nervous system involvement is rare. Scleroderma is a phenomenon known to be presented with right hemiparesis and generalized tonic-clonic seizures. Cranial diffussion MRI showed acute focal infarct in left centrum semiovale. In EEG, sharp waves in left parietal area was detected. Scleroderma affecting the central nervous system rare, due to the association with stroke and epilepsy were examined in the light of the literature.