Maternal and paternal quality of life in children with epilepsy: Who is affected more?

INTRODUCTION: This study aimed to evaluate and compare parental quality of life (QoL), anxiety, and depression in mothers and fathers of children with epilepsy (CWE). MATERIAL AND METHODS: Thirty-three mothers and 33 fathers of 33 CWE (aged 1-16 years) completed the World Health Organization Quality of Life-Brief Form (WHOQOL-BREF), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) questionnaires. Scores for the questionnaires were compared for 36 mothers and 36 fathers of 36 healthy children (aged 1-16 years). The control group consisted of hospital staff who had healthy children. RESULTS: Mothers of CWE had significantly lower scores for the environmental domain of the WHOQOL-BREF, BDI, and BAI questionnaires compared with mothers of healthy children (p < 0.05), while fathers showed no significant difference (p > 0.05). Furthermore, mothers of CWE had significantly lower scores for the psychological domain of the WHOQOL-BREF compared with fathers (p < 0.05). The environmental domain of the WHOQOL-BREF questionnaire was negatively correlated with the number of children for all parents (r = -0.342, p = 0.005), and the BAI and BDI scales were positively correlated with the number of children (r = 0.386, p = 0.001; r = 0.395, p = 0.001, respectively). CONCLUSION: Mothers of CWE showed lower scores for the psychological domain in QoL analysis compared with fathers of CWE, as well as decreased emotional wellbeing and lower QoL compared with mothers of healthy children. These results reveal that parents of CWE with a larger family size are more affected and that mothers of CWE are more affected. The reasons for these findings and possible interventions that might improve QoL, particularly in mothers with CWE, require further research.

Effects of continuous theta burst transcranial magnetic stimulation on cortical excitability in patients with idiopathic generalized epilepsy.

INTRODUCTION: Transcranial magnetic stimulation (TMS) is a noninvasive technique for investigating cortical physiologic functions in the brain. In this study, the effects of continuous theta burst stimulation (cTBS) on motor evoked potential (MEP) parameters in patients with idiopathic generalized epilepsy (IGE) were investigated. MATERIALS AND METHODS: Fifteen patients with IGE were included. Motor threshold (MT) and cortical silent period (CSP) were determined before cTBS application. Next, cTBS was applied to the dominant (left) hemisphere M1 hand area as the first application. After 1 day, cTBS was applied first to the left M1 hand area and then to the right lateral cerebellar area as the second application. Parameters were again determined after the applications. RESULTS: There was no difference in resting MT values before and after cTBS application (p>0.05). Although CSP increased after stimulation (p<0.05), it was not significantly different between applications (p>0.05). CONCLUSION: For patients with epilepsy, cTBS is a safe technique when applied at a low intensity. The inhibitory effect of cTBS, a noninvasive technique, on cortical excitability in patients with IGE was determined using MEP parameters. The effect lasted at least 1 h. To our knowledge, this is the first study to assess the effect of cTBS on cortical excitability in patients with IGE. Our findings indicate that cTBS decreases cortical excitability in patients with IGE.

Acute lymphoblastic leukemia presenting with oculomotor nerve palsy.

A 48-year-old man presented with left ptosis and double vision. Laboratory test findings indicated acute lymphoblastic leukemia (ALL). Lymphoblastic infiltration of both cavernous sinuses was observed on pituitary gland magnetic resonance imaging. Leukemias may present by many clinical conditions, but isolated cranial nerve palsy is very rare. To our knowledge, this is the first case of ALL presenting with oculomotor nerve palsy. Clinicians should consider oculomotor nerve palsy as the first ALL indication.

A Clinical Analysis of Microvascular Decompression Surgery with Sacrification of the Superior Petrosal Venous Complex for Trigeminal Neuralgia: A Single-Surgeon Experience.

AIM: To report the surgical outcomes in patients with trigeminal neuralgia (TN) who underwent microvascular decompression (MVD) with superior petrosal vein sacrification. MATERIAL AND METHODS: Data from 63 patients, whose information was obtained from a group of 113 patients who underwent surgery from 2008 to 2018, were reviewed retrospectively by the first author who was not part of the surgical team, and the pain conditions were evaluated objectively. RESULTS: Following surgery, pain relief occurred in 84% of patients during the early postoperative period and in 69.8% of patients during long-term follow-up. The major offending vessel was the superior cerebellar artery. CONCLUSION: MVD surgery, in particular for patients with typical pain, is one of the most effective treatment strategies for TN. Superior petrosal vein sacrification is a safe method that helps neurosurgeons to visualise the surgical area and perform a better work-up. Neurosurgeons should not be afraid to carry out superior petrosal vein sacrification.

Latencies to first interictal epileptiform discharges in different seizure types during video-EEG monitoring.

PURPOSE: Interictal epileptiform discharges (IEDs) have high diagnostic value concerning patients with epilepsy and the instances of obtaining IEDs increase with longer recording times. However, the merit of a single, extended electroencephalography (EEG) recording in detecting IEDs has not been substantiated. We aimed to determine the optimal duration of an EEG required to diagnose epilepsy in different seizure types. METHODS: Overall, 84 patients-29 with generalised onset epilepsy and 55 with focal onset epilepsy-were evaluated. Long-term video electroencephalographic monitoring (VEM) was analysed to find the first definite IED besides assessing the first seizure and latency. RESULTS: The median latency of the first IED (12 min, ranging from 1 to 440 min vs. 55 min, ranging from 2 to 7500 min; p = 0.014) and the median duration of a VEM recording (2 d, ranging from 1 to 10 d vs. 3 d, ranging from 1 to 10 d; p = 0.012) were found significantly lower in the generalised epilepsy group compared with that in the focal epilepsy group. CONCLUSIONS: Generalised onset epilepsy showed a significantly shorter latency to IED and VEM duration compared with focal onset epilepsy. In our data set, all the patients with generalised onset epilepsy had interictal IED within 10 h, but the patients with focal onset epilepsy required monitoring for three days to obtain IED.

Long-term follow-up of patients with adult-onset subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a rare infectious central nervous system disease with a poor prognosis. Nineteen patients, 18 males and one female, ranging in age from 18 to 22, mean 19.6+/-1.5 years with SSPE were evaluated. We treated 9 patients with oral isoprinosine and 10 patients with alpha-interferon plus oral isoprinosine and followed up for 16 to 160 months. Of the 9 patients treated with oral isoprinosine, 7 (77.7%) died, one stabilized, and one showed progression. Seven (70%) of 10 patients treated with alpha-interferon plus oral isoprinosine died, one showed progression, and stabilization was observed in two patients. Thus, we suggest that isoprinosine alone or in combination with intraventricular interferon did not change the prognosis in long-term follow-up periods.

Pregnancy and teratogenicity of antiepileptic drugs.

Maternal use of antiepileptic drugs (AEDs) during pregnancy has been associated with an increased risk of congenital abnormalities in the fetus. This is partly attributable to AEDs. We aimed to analyse seizure frequency and the rate and type of any congenital malformation related to pregnancies in women with epilepsy in this prospective study. Eighty four pregnant women with epilepsy on AEDs were followed for congenital malformations. Z test was used for statistical analysis. Pregnancy did not influence the seizure frequency in 64 (76.2%) pregnancies. The seizure frequency increased in 16 (19.04%) pregnancies. In 4 (4.76%) pregnancies the number of seizures decreased during pregnancy. Overall percentage of congenital malformations in infants of mothers with epilepsy treated with AEDs was 10%, versus 3.65% in the general Turkish population. Percentages of malformations in children of pregnancies in women with epilepsy on antiepileptic drugs (AEDs) were; 6.52% (3/46) for carbamazepine (CBZ), 14.28% (2/14) for phenytoin (PHT), 13.33% (2/15)for valproic acid (VPA) and 20% (1/5) for phenobarbital (PB). This comfirms previous reports that all four AEDs (CBZ, PHT VPA, PB) are associated with an increased risk of congenital malformations, although CBZ seems to be the the safest agent in monotherapy.

Fetal safety of levetiracetam use during pregnancy.

The aim of this study is to evaluate the effect of levetiracetam treatment during pregnancy on fetus.. The pregnant women with epilepsy (PWWE) who were exposed to levetiracetam treatment during pregnancy in the form of monotherapy or polytherapy were retrospectively evaluated. They were compared with the PWWE who did not use the antiepileptic drug (AED) during pregnancy. A total of 102 pregnancies were examined. While 35 patients never used AED during pregnancy, 30 patients received only levetiracetam therapy, and 37 patients received levetiracetam with at least one combined AED. While no major congenital malformation (MCM) was determined in the group of patients who never used AED and who received levetiracetam monotherapy, 2 MCMs were determined in the group receiving multiple AED therapy with levetiracetam. This study showed that the use of levetiracetam as monotherapy during pregnancy was at the same risk level as the group who never used AED and that the risk increased when it was used as a part of polytherapy. In conclusion, these findings support the current understanding that LEV may be a feasible option for PWWE.

Vagal Nerve Stimulation Effects on Generalized-Partial Seizures and Medication in Adult Drug- Resistant Epilepsy Patients.

AIM: The aim of this study was to find out if vagal nerve stimulation (VNS) affect the generalized-partial seizure count and medical treatment in adult drug resistant epilepsy patients. MATERIAL AND METHODS: Twenty adult patients who were diagnosed with drug-resistant epilepsy were investigated retrospectively for vagal nerve stimulator implantation between 2001 and 2010 at the Neurosurgery Departments of Ufuk University and Gulhane Military Medical Academy. The effects of vagal nerve stimulation on generalized-partial seizures and medical treatment was scored and if a significant difference was found, a comparison was made by Wilcoxon Signed Ranks test and Pairwise. For all the group analyses, the statistical significant rank was accepted as a p value < 0.05. Bonferroni correction was made when it was needed during pairwise comparisons. RESULTS: VNS significantly decreased the scores of generalized-partial seizures. There was no decrease in the doses of antiepileptic drugs and the medical treatment was resumed as before the implantation. The results were correlated with the relevant literature. CONCLUSION: VNS is an alternative treatment option for drug resistant epilepsy for patients who are not ideal candidates for surgery or are not healed after epilepsy surgery.

Leucopenia and thrombocytopenia possibly associated with lamotrigine use in a patient.

Haematological side effects are rather exceptional with lamotrigine. We report the case of a 25-year-old woman with epilepsy who developed combined leucopenia and thrombocytopenia eight weeks after starting lamotrigine. Within weeks after lamotrigine was discontinued, all of the haematopoietic abnormalities had disappeared. To our knowledge, this is the first report of combined leucopenia and thrombocytopenia associated with lamotrigine treatment suggesting, in our patient, a causal reaction.

Foot drop due to cranial gunshot wound.

OBJECTIVE: We present a case of foot drop from hemorrhagic contusion after cranial gunshot, which has never been reported. METHODS: A 21-year-old man was admitted with inability of dorsiflexion 1 day after a tangential gunshot wound of the scalp. The scalp skin was cut by the rifle bullet. He had foot drop and his neurological examination was normal except for weakness at dorsiflexion of the right foot. Pathological reflexes and sensation failure were not detected. T1- and T2-weighted magnetic resonance images showed hyperintense contusion at the right superior frontal gyrus and mild subdural hemorrhage. Peripheral nervous system examination was electrophysiologically normal. Motor-evoked potentials showed the location of the lesion at the motor cortex because no electrical record was obtained from the right anterior tibial and extensor digitorum brevis muscles, and there was a normal record on the left. Six months later, the patient's neurological examination was uneventful. CONCLUSION: When a cranial gunshot wound injury victim presents with foot drop, the central causes should be included in the differential diagnosis list.

Effect of pramipexole on cutaneous-silent-period parameters in patients with restless legs syndrome.

OBJECTIVE: The aim of this study was to investigate cutaneous-silent-period (CSP) parameters in patients with restless legs syndrome (RLS) and examine the effects of treatment on CSP which, to our knowledge, have not been investigated till date. METHODS: A total of 25 patients with RLS and 25 healthy volunteers were studied. CSP latency and duration in the upper and lower extremities were examined in the two groups. In RLS patients, the variables were examined before and after pramipexole treatment. RESULTS: Lower-extremity CSP latency was longer (106.22±11.69 ms vs. 91.67±8.53 ms; p<0.001) and CSP duration was shorter (35.50±10.91 ms vs. 49.47±6.43 ms; p<0.001) in patients, compared with controls. In the patient group, CSP durations in the upper (40.88±7.95 ms vs. 46.84±10.22 ms; p=0.006) and lower extremities (35.50±10.91 ms vs. 44.91±6.43 ms; p=0.005) were prolonged after treatment, compared with pre-treatment values. CONCLUSIONS: Small-fibre neuropathy may exist in RLS. In addition, we suggest that pramipexole may regulate cortical and spinal inhibitory mechanisms. SIGNIFICANCE: The use of CSP may aid in the diagnosis of RLS and may be used as a measure of treatment effectiveness.

Effects of topiramate on peripheral nerve excitability.

PURPOSE: Antiepileptic drugs are generally used to control the cortical hyperexcitable states. But some of them are also effective on the peripheral nervous system, so they may be used in some states like neuropathic pain. Several recent reports suggest the possible effects of antiepileptic drugs on peripheral nerve excitability. Strength duration time properties gives an indirect idea about the persistent, paranodal sodium (Na) channels and may indirectly reflect the peripheral nerve excitability. Topiramate suppresses the cortical hyperexcitability, but previous studies could not prove a significant effect of topiramate on peripheral nerves. The aim of this study is to investigate the probable nerve excitability changes caused by topiramate. METHODS: Forty migraine patients and 40 controls were included in the study. Median motor and sensory conduction parameters were recorded. Strength duration properties were also recorded from abductor pollicis longus muscle, with the stimulation of median nerve. The electrophysiological studies were repeated 4 weeks after the initiation of topiramate in the treatment group. RESULTS: Nerve conduction parameters were not significantly affected by 4-week topiramate treatment. But the strength duration time constant decreased significantly, reflecting a reduction in the excitability. This decrement seemed to be more obvious in those in whom topiramate was also clinically useful. CONCLUSIONS: The method used demonstrated a probable effect of topiramate on the peripheral nerve excitability.

Spectrum of surgical complications of temporal lobe epilepsy surgery: a single - center study.

AIM: Although surgery is the most effective means of eliminating or reducing seizures in cases of medically refractory epilepsy, the expected or unexpected surgical complications must also be kept in mind in order not to decrease patients' quality of life. The aim of this present study was to assess the surgical complications of temporal lobe epilepsy surgery and their effects on the disease course in patients with intractable epilepsy arising from the temporo-mesial structures. MATERIAL AND METHODS: The records of 58 patients who underwent temporal lobectomy and/or selective amygdalahippocampectomy at Gülhane Military Medical Academy between January 2000 and August 2010 were reviewed for peri- and post-surgical complications. RESULTS: Post-surgical complications were detected in 7 patients (12%). The most common complication of ES was infection in 2 patients (2.9%). Other complications were hemorrhagic infarction, paresis of the frontal branch of the left facial nerve, subdural effusion, anxiety disorder, depressive disorder and late-onset psychosis. CONCLUSION: The results of our study suggest the importance of post-operative care and long-term follow up in order to achieve favorable seizure outcome after epilepsy surgery.

Evaluating the feasibility of measures of motor threshold and cortical silent period as predictors of outcome after temporal lobe epilepsy surgery.

INTRODUCTION: Although it is well known that ES alters cortical excitability, little is known about the relationship between ES outcome and cortical excitability. Transcranial magnetic stimulation has been successfully used to evaluate cortical excitability in epilepsy patients. The present study aimed to assess the value of the motor threshold (MT) and cortical silent period (CSP) as predictors of the outcome of temporal lobe epilepsy surgery (TLES). MATERIALS AND METHODS: Epileptic foci in the epilepsy patients were identified via video-electroencephalography (v-EEG) monitoring, brain magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), and neurophysiological testing. MT, CSP-150, and CSP-max were measured in 10 epilepsy patients on both the ipsilateral and contralateral side of the epileptic focus 1 week before and 3 months after TLES. Pre- and post-operative MT and CSP measurements were compared, and the results were interpreted based on the clinical outcome of TLES. RESULTS: Mean follow-up period was 28.8 months. In all, 8 patients were seizure-free post TLES, whereas in 2 patients seizures persisted. No significant differences were observed in ipsilateral or contralateral hemisphere MT measurements before and after surgery. Both CSP-150 and CSP-max values in the non-focal hemispheres decreased in the 8 patients that were seizure-free post TLES, whereas no differences were observed in the 2 patients with seizures that persisted post TLES. CONCLUSIONS: The present findings indicate that monitoring pre- and post-TLES CSP changes may be predictive of the early clinical outcome of TLES.

Time-dependent changes in the serum levels of prolactin, nesfatin-1 and ghrelin as a marker of epileptic attacks young male patients.

A relationship between hormones and seizures has been reported in animals and humans. Therefore, the purpose of this study was to investigate the association between serum levels of prolactin, nesfatin-1 and ghrelin measured different times after a seizure or non-epileptic event and compared with controls. The study included a total of 70 subjects, and of whom 18 patients had secondary generalized epilepsy (SGE), 16 patients had primary generalized epilepsy (PGE), 16 patients exhibited paroxysmal event (psychogenic) and 20 healthy males were control subjects. The first sample was taken within 5min of a seizure, with further samples taken after 1, 24, and 48h so long as the patient did not exhibit further clinically observable seizures; blood samples were taken once from control subjects. Prolactin was measured immediately using TOSOH Bioscience hormone assays. Nesfatin-1 and ghrelin peptides were measured using a commercial immunoassay kit. Patients suffering from focal epilepsy with secondary generalization and primary generalized epilepsy presented with significantly higher levels of serum prolactin and nesfatin-1 and lower ghrelin levels 5min, 1 and 24h after a seizure than patients presenting with paroxysmal events (psychogenic) and control subjects; the data were similar but not statistically significant after 48h. The present study suggests that increased serum prolactin and nesfatin-1 concentrations, decreased ghrelin concentrations could be used as markers to identify patients that have suffered a recent epileptic seizure or other paroxysmal event (psychogenic).

Lateralization of cerebral blood flow in juvenile absence seizures.

Cerebrovascular blood flow in absence seizures and flow patterns during the ictal period have not been thoroughly investigated. We aimed to evaluate cerebral blood flow changes in typical juvenile absence seizures during the ictal and postictal phases. Seizures were recorded in three patients (mean age: 21 +/- 1 years) with multiple daily typical absence seizures. Simultaneous video electroencephalography and bilateral middle cerebral artery transcranial Doppler ultrasonography recordings were conducted during seizures. Basal, ictal, and postictal blood flow velocities were recorded bilaterally, and offline analyses were performed in relation with generalized spike and wave discharges. Total of 43 seizures were recorded. Ictal increase and postictal decrease of cerebral blood flow velocities were significant for both sides (P < 0.001). The interhemispheric asymmetry in the ictal velocity increase was significant (P < 0.05). The interhemispheric asymmetry in the postictal velocity decrease was not significant (P > 0.05). The blood flow velocity increase after seizure onset indicates a vascular coupling mechanism. A sudden and then a gradual decrease in blood flow velocity, which lasted even after the seizure ceased, might suggest a preventive mechanism to avoid excessive seizure duration or even an absence status epilepticus. Significant asymmetries in increase and a symmetrical decrease may support the cortical focus theory.