Headache in idiopathic/genetic epilepsy: Cluster analysis in a large cohort.

OBJECTIVE: The link between headache and epilepsy is more prominent in patients with idiopathic/genetic epilepsy (I/GE). We aimed to investigate the prevalence of headache and to cluster patients with regard to their headache and epilepsy features. METHODS: Patients aged 6-40 years, with a definite diagnosis of I/GE, were consecutively enrolled. The patients were interviewed using standardized epilepsy and headache questionnaires, and their headache characteristics were investigated by experts in headache. Demographic and clinical variables were analyzed, and patients were clustered according to their epilepsy and headache characteristics using an unsupervised K-means algorithm. RESULTS: Among 809 patients, 508 (62.8%) reported having any type of headache; 87.4% had interictal headache, and 41.2% had migraine. Cluster analysis revealed two distinct groups for both adults and children/adolescents. In adults, subjects having a family history of headache, ≥5 headache attacks, duration of headache ≥ 24 months, headaches lasting ≥1 h, and visual analog scale scores > 5 were grouped in one cluster, and subjects with juvenile myoclonic epilepsy (JME), myoclonic seizures, and generalized tonic-clonic seizures (GTCS) were clustered in this group (Cluster 1). Self-limited epilepsy with centrotemporal spikes and epilepsy with GTCS alone were clustered in Cluster 2 with the opposite characteristics. For children/adolescents, the same features as in adult Cluster 1 were clustered in a separate group, except for the presence of JME syndrome and GTCS alone as a seizure type. Focal seizures were clustered in another group with the opposite characteristics. In the entire group, the model revealed an additional cluster, including patients with the syndrome of GTCS alone (50.51%), with ≥5 attacks, headache lasting >4 h, and throbbing headache; 65.66% of patients had a family history of headache in this third cluster (n = 99). SIGNIFICANCE: Patients with I/GE can be clustered into distinct groups according to headache features along with seizures. Our findings may help in management and planning for future studies.

Investigation of the Albumin/Globulin Ratio as a Biomarker in Restless Legs Syndrome.

Background Measurement of serum/plasma levels of inflammatory factors in restless legs syndrome (RLS) has been the subject of a few studies, as various inflammatory diseases may demonstrate an association with RLS. The albumin/globulin ratio (AGR) is a parameter that considers two proteins that are indicators of inflammation and has been shown to increase in some inflammatory diseases. No study has evaluated the relationship between RLS and AGR yet. In our study, we examined the usability of AGR as a diagnostic biomarker in RLS patients. Methodology A total of 88 patients and 89 control individuals were included in the study retrospectively. The two groups were compared in terms of AGR levels. RLS patients were divided into four groups according to the International Restless Legs Syndrome Study Group Rating Scale score and the relationship between disease severity and AGR values ​​was examined. Results Albumin levels of the study group were higher than the control group. There was no statistically significant difference between the groups regarding globulin and AGR levels. Conclusions Serum albumin levels could be useful in RLS compared to globulin or AGR values. This needs to be supported by new studies with larger patient series, multicenter design, and including multiple parameters such as patients' muscle mass, nutritional habits, and exercise status.