The strategies for coping with stress of epilepsy patients.

OBJECTIVE: This study aims to compare the styles of coping with stress between patients with epilepsy and healthy individuals and to examine the effects of clinical features on methods of coping with stress. METHODS: The study enrolled 120 patients diagnosed with epilepsy. Forty healthy individuals were included as control group. Sociodemographic and clinical characteristics of the patients were recorded. The patients and controls completed the Coping Strategies with Stress Inventory (COPE), which comprises 60 items distributed into 15 scales. The COPE scores of the patients and controls were compared. RESULTS: Comparing the COPE scores of the patients and controls, the substance use score was higher in the controls. In terms of gender, seeking instrumental social support, active coping, seeking emotional social support, acceptance, and emotion-focused total coping scores were higher in women among patients. In terms of marital status, the positive reinterpretation and growth score of single patients was significantly higher than that of married patients. In patients with a history of febrile convulsions, the active coping, seeking emotional social support, and denial scores were higher. In terms of treatment, for the patients receiving polytherapy, the suppression of competing activities, focus on and venting of emotions, and dysfunctional total coping scores were higher than in patients receiving monotherapy. CONCLUSION: Epilepsy and stress are intertwined conditions. Epilepsy patients, confronted with stress, avoided using alcohol and substances compared to healthy individuals. There were differences among epilepsy patients according to gender, marital status, febrile convulsion history, number of medications, and approaches to coping with stress.

The inflammatory markers and prognosis of cervicocephalic artery dissection: a stroke center study from a tertiary hospital.

OBJECTIVE: Cervicocephalic artery dissection (CeAD) is the most common cause of ischemic stroke in young adults. Although the exact cause is unknown, inflammation is thought to have a role. Here, we investigated the relationship between CeAD and inflammation. METHODS: Patients diagnosed with CeAD in our stroke center were evaluated retrospectively, and their demographic and clinical features were recorded. The C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell, neutrophil and lymphocyte counts, platelet/lymphocyte ratio (PLR), and neutrophil/lymphocyte ratio (NLR) were recorded on admission. Modified Rankin scores (mRS) were noted on admission and at 6 months to evaluate the dependency status and functional outcome of each patient. RESULTS: Of the 95 patients in the study, 70 (73.7%) were male, and the mean age was 44.4 ± 9.8 years. Patients with high WBC count, ESR, PLR, and NLR frequently had mRS scores of 3-6 at admission; these differences were significant (p = 0.04, p = 0.02, p = 0.04, and p = 0.02, respectively). At 6 months, patients with high CRP and ESR at admission also had significantly poorer prognoses (p < 0.001, p = 0.002, respectively). PLR and NLR values were higher in patients with mRS of 3-6. But there were no significant differences between the good and poor prognosis groups regarding PLR and NLR (p = 0.22, p = 0.05, respectively). CONCLUSION: Inflammation may have a role in the prognosis of CeAD, and inflammatory markers can be evaluated as auxiliary tests for determining prognosis.

Metabolic syndrome and obstructive sleep apnea syndrome among patients with epilepsy on monotherapy.

OBJECTIVES: The study aimed to determine the frequency of metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) in patients with epilepsy receiving monotherapy and the relationship between these syndromes and antiepileptic drugs (AEDs). METHODS: Two hundred and ninety-seven patients with epilepsy between the ages of 18-65 years receiving monotherapy for at least one year and 50 healthy participants were enrolled. Body mass indices and waist circumferences were measured. Serum fasting glucose levels, high-density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol (TC), triglyceride, and serum AED concentrations were noted. The frequency of MetS in patients with epilepsy was calculated. The snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender (STOP-Bang) questionnaire was used to determine the risk of OSAS. The relationship between these two syndromes and seizure type, disease duration, AED dosage, and treatment duration was analyzed. RESULTS: Metabolic syndrome was more frequent in patients with epilepsy compared with healthy participants (32.6% vs. 12.0%), and it was diagnosed in 37.8% of patients receiving valproic acid (VPA), 36.1% of patients receiving carbamazepine (CBZ), 34.9% of patients receiving oxcarbazepine (OXC), and 30.5% of patients on levetiracetam (LEV). There was a positive correlation between VPA treatment duration and MetS existence (p < 0.05). However, MetS frequency did not change because of seizure type, disease duration, or AED dosages in patients with epilepsy receiving monotherapy. The risk for OSAS was higher in patients with epilepsy compared with healthy participants (24.6% vs. 12%), and it was calculated high in 27.7% of patients receiving CBZ, 32.2% of patients receiving LEV, and 30.2% of patients receiving OXC. The OSAS risk was higher in patients who have focal seizures than generalized seizures (p = 0.044). There was no relationship between OSAS risk and duration of epilepsy, duration of treatment, drug doses, and serum drug levels (p > 0.05). CONCLUSION: Higher frequency of MetS and OSAS risk should be kept in mind on clinical follow-up of patients with epilepsy receiving monotherapy.

Do interictal EEG findings reflect cognitive function in juvenile myoclonic epilepsy?

PURPOSE: This study investigated the relationship between frontal lobe cognitive function and frontal focal electroencephalography (EEG) findings in patients with juvenile myoclonic epilepsy (JME). METHODS: The study enrolled 60 patients diagnosed with JME and followed at the Epilepsy Outpatient Clinic of the University of Health Sciences, Bakirkoy Psychiatric Hospital, and 30 healthy volunteers. Demographic and clinical features were recorded. Frontal lobe cognitive functions were tested in both groups. Video-EEG recordings of patients with JME were evaluated. The presence and duration of generalized discharges, the presence and lateralization of focal findings, and the presence of generalized discharges during hyperventilation and photic stimulation were recorded during EEG. Cognitive function test results were compared between the two groups, and the relationship between the EEG findings and cognitive function was investigated. RESULTS: The study included 35 (58.3%) female and 25 (41.6%) male patients and 17 (56.7%) female and 13 (43.3%) male healthy controls. The mean ages of the group with JME and controls were 28.3 ±â€¯8.6 (16-50) and 31.3 ±â€¯7.9 (17-45) years, respectively. Patients with JME performed more poorly on the frontal lobe cognitive tests than controls (p < 0.05). Patients whose generalized discharges were longer than 1 s performed more poorly on tests evaluating attention and made more perseverative errors (p < 0.05). There was no significant correlation between the presence of focal EEG findings and the scores on frontal lobe cognitive functions tests in the group with JME (p > 0.05). CONCLUSION: Frontal lobe cognitive functions are affected in patients with JME. The cognitive effects were more pronounced in patients with prolonged generalized discharges on EEG.

Does restricted diffusion in the splenium indicate an acute infarct?

OBJECTIVE: Although splenial lesions are rare, they are frequently associated with ischemic infarcts, antiepileptic drug toxicity or abrupt discontinuation, viral encephalitis, and metabolic disturbances. In this study, we evaluated clinical and imaging findings and aetiology in 16 patients with splenium lesions. METHODS: Between 2013 and 2017, patients with splenium lesions were examined. Magnetic resonance imaging (MRI) was performed using a 1.5-T unit with fluid attenuation inversion recovery sequences. Additionally, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps were examined. RESULTS: The patients were 11 males and 5 females; the mean age was 52.3 ± 20.3 (22-87) years. The patients were admitted with the following conditions: consciousness disorder (n = 7, 43.7%), headache (n = 3, 18.7%), seizure (n = 3, 18.7%), ataxia (n = 3, 18.7%), hemiparesis (n = 4, 25%), meaningless speech (n = 2, 12.5%), fever (n = 3, 18.7%), perioral numbness (n = 1, 6.2%), and diplopia (n = 1, 6.2%). Hyperintensity in the splenium was observed in DWI sequences in all patients on MRI. Fourteen patients (87.5%) showed hypointensity in the same region on ADC. In patients with ischemic infarcts, the splenium lesions were most commonly observed in the area of the posterior cerebral artery (n = 4, 25%). MRI showed splenial signal changes in DWI sequences in all patients. Hyperintensity in the splenium was observed in DWI sequences in all patients on MRI. Fourteen patients (87.5%) showed hypointensity in the same region on ADC. The aetiologies were defined as multiple sclerosis (n = 1, 6.2%), ischemic infarction (n = 4, 25%), tuberculous meningitis (n = 3, 18.7%), viral encephalitis (n = 2, 12.5%), hypernatremia (n = 1, 6.2%), brain tumour (n = 1, 6.2%), Marchiafava-Bignami syndrome (n = 1, 6.2%), head trauma (n = 1, 6.2%), substance use (n = 1, 6.2%), and epilepsy (n = 1, 6.2%). CONCLUSION: Not every diffuse restriction observed on MRI indicates an ischemic stroke. Although radiologic images of the splenium may suggest acute ischemic infarction, the actual cause may be another pathology. Therefore, the symptoms and aetiologies of patients with splenium lesions should be considered and investigated from a wide range of perspectives.

Prevalence and clinical characteristics of headache in juvenile myoclonic epilepsy: experience from a tertiary epilepsy center.

The comorbidity of headache and epilepsy is often seen in neurological practice. The objective of this study was to assess the prevalence, types of, and risk factors for headache in juvenile myoclonic epilepsy (JME). We assessed a total of 200 patients and 100 healthy controls in our study. Headache was classified in participants using a self-administered questionnaire. Demographical, clinical features and headache characteristics were recorded. Seizure and headache temporal profiles were noted. Headache was present in 111 (56%) patients and 50 (50%) healthy participants. From these patients, 47 (42.3%) JME patients had migraine [30 (27%) migraine without aura (MO), 17 (15.3%) migraine with aura (MA)], 52 (46.8%) had tension type headache (TTH), 4 (3.6%) had both migraine and TTH, and 8 (7.2%) had other non-primary headaches. In the healthy control group, migraine was detected in 16 (32%) subjects, TTH in 33 (66%), both migraine and TTH in 1 (2%) subject. A positive migraine family history and symptom relief with sleep were more frequent in JME patients (p = 0.01). Headache was classified as inter-ictal in 82 (79.6%) patients and peri-ictal in 21 (20.4%) patients. In conclusion, the present study revealed that headache frequency was not significantly different between JME patients and healthy controls (p > 0.05). However, migraine frequency was higher in JME patients than healthy controls. Some migraine and TTH characteristics were different in between groups. We suggest that our results support both genetic relationship and shared underlying hypothetical pathopysiological mechanisms between JME and headache, especially migraine.

Dandy-Walker Malformation Presenting with Affective Symptoms.

Dandy-Walker malformation is defined by enlarged posterior fossa, cystic dilatation of the fourth ventricle, and cerebellar hypoplasia. Although developmental delay and mental retardation are common in Dandy-Walker malformation cases, other comorbid psychiatric conditions have been rarely reported. There are limited numbers of case reports about comorbidity of bipolar disorder with Dandy-Walker malformation in the literature. Herein, a Dandy-Walker malformation case presenting affective symptoms is reported, and psychiatric symptoms which might be seen in this rare malformation are discussed along with diagnosis, treatment, and follow-up processes. A 27-year-old male patient, hospitalized for compulsory treatment, had been diagnosed with Dandy-Walker malformation in childhood. First complaints were attention deficiency, behavioral problems, learning difficulties; and manic and depressive episodes have occurred during follow-ups. He recently complained of decreased need for sleep, irritability, and increased speed of thought, and psychiatric examination was consistent with manic episode. Cranial computed tomography (CT) revealed bilateral ventriculomegaly, enlarged third and fourth ventricles with posterior fossa cyst, and cerebellar hypoplasia. His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day biperiden, and 100 mg/month paliperidone palmitate. Beside its traditional role in the regulation of coordination and motor functions, cerebellum is increasingly emphasized for its involvement in the mood regulation. Thus, as seen in Dandy-Walker malformation, cerebellar anomalies are suggested to play a role in the pathophysiology of mood disorders. Further studies are needed to better understand the relationship between mood disorders and cerebellum. Moreover, treatment options should be considered carefully in terms of resistance to treatment and potential side effects, for psychiatric disorders occurring in these cases; and detailed examinations, including cranial imaging, would be beneficial in bipolar cases with early onset, unresponsiveness to treatment, presenting atypical symptoms, mental retardation, and developmental delay as well as neurological symptoms and signs.