The assessment of the impact of antiepileptic drugs on cognitive functions via N-200/P-300 potentials and neuropsychological measures.

OBJECTIVE: The effects of antiseizure medications (ASMs) on cognitive functions have not been fully elucidated. The primary aim of this study was to demonstrate potential changes in cognitive functions in patients diagnosed with epilepsy from both neuropsychological and electrophysiological perspectives. Our secondary objective was to assess the effects of administered ASM on cognitive functions by categorizing patients into different monotherapy and polytherapy groups. MATERIALS AND METHODS: A single-center, prospective patient registry study was conducted between May 2022 and June 2023. The inclusion criteria included epilepsy patients aged 18 to 50 years who were receiving ASM) treatment, either as inpatients or outpatients, and who did not have any syndromic diagnosis that may lead to cognitive disfunciton (such as primary progressive myoclonic epilepsies, Down syndrome and so on), and did not diagnosed previously or during examination that could affect dementia or cognitive functions. Patients who were scheduled to initiate new ASM treatment were evaluated using the Montreal Cognitive Assessment (MoCA) scale and Event-Related Potentials (ERP) assessment both before commencing treatment and three months thereafter. RESULTS: A total of 320 participants were included in the study; 20 healthy controls and 300 epilepsy patients were included. Statistically significant differences were observed between the healthy control group and the epilepsy group in terms of average Montreal Cognitive Assessment (MoCA) scores and event-related potentials (ERPs) (n200, p300 latencies, n2p3 amplitudes) (p<0.05). Similarly, statistically significant differences were observed between the monotherapy and polytherapy groups in terms of average MoCA and ERP scores (p<0.05). CONCLUSION: This study demonstrated the detrimental effects of certain ASMs, particularly topiramate and carbamazepine, on cognitive functions. Furthermore, the negative impact on cognitive performance became more pronounced with an increasing number of concurrently used ASMs (polytherapy), with topiramate showing notable effects.

COVID-19 vaccination-related headache showed two different clusters in the long-term course: a prospective multicenter follow-up study (COVA-Head Study).

BACKGROUND: Although acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches. METHODS: A multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination. RESULTS: Among the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 ± 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005). CONCLUSION: The identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care.

Proximal sciatic neuropathy secondary to hamstring tendon avulsion.

We herein present the exceptional case of a patient, who injured a sciatic nerve due to avulsion of proximal hamstring tendon in a motorcycle accident. The 63-year-old man was diagnosed firstly with an incomplete fracture of distal femur. A foot drop on the right side was observed when the full-length cast was removed two months later. The patient was referred to the neurology clinic and was diagnosed with a sciatic nerve lesion at the proximal level of the biceps femoris. Magnetic resonance imaging of the thigh showed a proximal avulsion of hamstring muscles tendon. The patient did not improve by short-term physiotherapy and neurosurgical intervention. Sciatic nerve injury can be a result of proximal hamstring avulsion in events such as motorcycle accidents even in the absence of complete or major femur fracture.

Cluster Analysis Revealed Two Hidden Phenotypes of Cluster Headache.

Objective: To investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis. Methods: A total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences. Results: Cluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) years; p = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95); p < 0.001), and showed a better response to triptans (50.00% vs. 28.00; p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0%; p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0%; p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0%; p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) min; p=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) min; p = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0%; p< 0.001). Conclusions: Cluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH.

EEG changes in intensive care patients diagnosed with COVID-19: a prospective clinical study.

INTRODUCTION: Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was declared a pandemic on March 11th, 2020, by the World Health Organization (WHO). There has been a substantial increase in the epileptic seizures and status epilepticus reported in the pandemic period. In this context, it is aimed with this study to identify the electroencephalography (EEG) features of patients admitted to the intensive care unit with the diagnosis of COVID-19 and to look for any specific patterns in these features. MATERIAL AND METHOD: The material of this study primarily comprised the neurological evaluations and continuous EEG recordings of 87 intensive care patients who were diagnosed with COVID-19. In addition, demographic and clinical features and comorbid conditions of these patients were also analyzed, and any correlation thereof was investigated. RESULTS: The EEG data of 87 patients who were diagnosed with COVID-19 and were followed up in the intensive care unit were recorded and then analyzed. Abnormal EEG findings were detected in 93.1% (n = 81) of the patients, which were found to increase significantly with age (p < 0.001). The mean age of patients with specific epileptiform abnormalities on EEG was found to be significantly higher than those with non-specific abnormalities. Epileptiform discharges were seen in 37.9% (n = 33) of the patients. Nonconvulsive status epilepticus (NCSE) was detected in 5.7% of the patients, and antiepileptic drugs were started in 25 (28.7%) of the patients. DISCUSSION: Statistically significant EEG changes were observed in the continuous EEGs of the patients followed up in the intensive care unit due to COVID-19 infection. However, further studies are needed to associate the EEG changes observed in the COVID-19 patients with the epileptogenesis of COVID-19 infection.

Greater occipital nerve block efficacy in COVID­19 associated headache: a preliminary study.

COVID­19 is an infection caused by the new coronavirus SARS­CoV­2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID­19 patients. Between March and May 2020, 27 patients (with laboratory­confirmed 2019­nCoV infection by next­generation sequencing confirmation of real­time PCR) that had moderate or severe headache associated with COVID­19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre­treatment and post­treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID­19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID­19 associated headache treated with GON blockade". More long term and well­designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.