Erratum: The Effectiveness of Diet Restriction in Elderly with Migraine.

[This corrects the article on p. 217 in vol. 58, PMID: 34526845.].

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.

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.

The Effectiveness of Diet Restriction in Elderly with Migraine.

INTRODUCTION: Migraine type headache is a type of pain with a high socioeconomic burden that limits the activities of daily life of individuals of all ages. The pathogenesis is not fully understood. There are a lot of migraine's trigger factors and foods are one of them. The purpose of this study was to specify the effect of migraine triggering on the migraine attacks prevention in the elderly population. METHOD: The study consisted of patients over the age of 65 with a diagnose of migraine without aura according to International Headache classification. Thirty-one migraine patients with migraine attacks were included in the study. Triggering foods were expelled from the diets of migraine patients. This diet and pre-diet 2 months after the application, the frequency of attack within a month, attack duration and visual analog scale (VAS) pain intensity, the number of analgesics and triptans used were recorded. RESULTS: A total of 31 patients (8 male and 23 female) were evaluated. In the second month after dieting, the frequency of attack, attack duration, pain severity, and analgesic and triptan counts were statistically significantly lower than the pre-treatment level (p<0.05). CONCLUSION: Results of the study; In migraine-aged elderly patients, it can be concluded that migraine attacks may be an effective and reliable treatment in reducing the number of analgesics and triptans used in migraine attacks.

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.

Efficacy of Diet Restriction on Migraines.

INTRODUCTION: Migraine is a common type of headache, but its pathogenesis is still not fully understood. Triggering factors may vary in migraine patients with a particular importance of certain food intake. In this study, the efficacy of limiting certain migraine- triggering foods in the prevention of migraine attacks was investigated. METHODS: Patients diagnosed with migraine without aura according to the International Classification of Headaches were enrolled. Fifty migraine patients stating that migraine attack started after the intake of certain foods were evaluated. The patients were randomly divided into 2 groups. The migraine-triggering foods identified by the patients were excluded from the diet in both groups 1 (n=25) and 2 (n=25). Monthly attack frequency, attack duration, and attack severity (using the visual analogue scale) were recorded before starting the diet restriction and 2 months after the diet restriction. Diet restriction was relaxed in group 1 after the second month and continued in group 2. In the fourth month, the monthly attack frequency, attack duration, and attack severity (using the visual analogue scale) were determined in both groups. RESULTS: A total of 50 patients comprising 9 males and 41 females were evaluated in this study. In both the groups, in the second month after diet implementation, monthly attack frequency, attack duration, and attack severity were found to have decreased to a statistically significant extent compared to those in the period before diet implementation [group 1 (p=0.011, p=0.041, and p=0.003, respectively) and group 2 (p=0.015, p=0.037, and p=0.003, respectively)]. In the evaluation in the fourth month, it was observed that this significant decrease was maintained only in group 2. CONCLUSION: The results of the study reveal that if migraine-triggering foods are identified by migraine patients, restricting their intake can be an effective and reliable method to reduce migraine attacks.

Progression in acute ischemic stroke: Is widespread atherosclerotic background a risk factor?

OBJECTIVES: In this study, we aimed to investigate the causes and conditions related with progression and outcome of progressive acute ischemic stroke. PATIENTS AND METHODS: In this prospective study, a total of 78 acute ischemic stroke patients (32 males, 46 females; mean age 70±12.8 years; range 34 to 95 years) were included between February 2006 and October 2010. The patients were classified into two groups as those with and without progression according to the National Institute of Health Stroke Scale (NIHSS). Risk factors for ischemic stroke, stroke subtypes, and radiological investigations and prognosis were compared between the progressive and non-progressive patients. RESULTS: Neurological deterioration occurred in 12 patients (15%). Progressive acute ischemic stroke patients had carotid stenosis compared to non-progressive patients (50% vs 19%), and ischemic cardiac disease (33% vs 6%) more common in the patients with progression. Mortality during hospital stay and long term-outcomes were similar between the groups. CONCLUSION: Our study results suggest that widespread atherosclerotic diseases may induce neurological progression.

Intravascular lymphoma masquerading as multiembolic stroke developing after coronary artery by-pass surgery.

BACKGROUND: Intravascular lymphoma (IVL) is a very rare non-Hodgkin type lymphoproliferative disorder characterized by neoplastic growth of lymphoid cells within the lumen of capillaries, small veins, and arterioles. The neoplastic cells cannot reach the parenchyma because of the loss of adhesion molecules during malignant transformation. Multifocal vascular occlusions caused by proliferation of malignant lymphocytes in the lumen result in diffuse thrombosis and tissue infarction. The clinical symptoms of the disease are dependent on the specific organ involvement which most often includes the central nervous system and skin. Neurologic presentation includes focal sensory or motor deficits, altered sensorium, rapidly progressive dementia, seizures, ataxia, and vertigo. CASE REPORT: We report a patient with IVL whose symptoms developed on the second postoperative day of coronary artery-bypass surgery imitating a multiembolic stroke. Magnetic resonance imaging showed widespread ischemic subcortical lesions. The patient's clinical status worsened irrespective of supportive medical treatment. The diagnosis was established by autopsy. CONCLUSION: IVL may mimic ischemic stroke. IVL is not often diagnosed before death because of the intravascular growth pattern of the tumor cells and a fulminant clinical course. IVL may be considered in the differential diagnosis of ischemic stroke patients with progressive worsening despite medical management.