Optical Coherence Tomography Angiographic Follow-Up in a Case of Subacute Sclerosing Panencephalitis and Unilateral Necrotising Retinitis.

We present a 20-year-old woman who was diagnosed with subacute sclerosing panencephalitis (SSPE) 20 months after presenting with unilateral retinitis. At presentation, the patient had two inferotemporal macular lesions in her left eye. Corresponding to these areas, optical coherence tomography (OCT) showed hyporeflective spaces with loss of nearly all of the retinal layers. OCT-angiography (OCTA) demonstrated some flow deficit areas with a reduction in the vessel density. Her serum measles antibody titre was high (IgG >5000.0 mIU/ml). Twenty months later the macular lesions had diminished in size, and there was some focal retinal thinning with interruption of the ellipsoid zone. OCTA showed that the flow deficit areas were diminished in size together with the relatively improved perfusion density. Neurological examination disclosed myoclonic jerks. Neuropsychological assessment demonstrated impaired executive function, attention, and narrowed lexical fluency. Measles IgG antibody was high in the cerebrospinal fluid (>230.0 U/ml). Brain magnetic resonance imaging demonstrated bilateral, non-specific, small foci of T2 hyperintensity in the frontoparietal subcortical white matter and centrum semiovale. The present case is the first where OCTA findings of SSPE-related retinal lesions have been described.

The test-retest reliability and minimal detectable change of the six-minute walk test, timed up and go test, and 30-second chair stand test in people with epilepsy.

BACKGROUND: The available evidence suggests that people with epilepsy have reduced cardio-respiratory fitness and muscle strength endurance, and impaired balance and mobility. The 6-minute walk test (6MWT), Timed Up and Go (TUG), and 30-second chair stand test (30CST) are physical performance tests frequently used in clinical practice. OBJECTIVE: To establish the test-retest reliability and minimal detectable change of the 6MWT, TUG, and 30CST in people with epilepsy. METHODS: The study was designed as an observational study. Forty-one people with epilepsy (23 females, 18 males; mean age 34.7 ± 10.4 years) participated. The 6MWT, TUG, and 30CST were tested by a trained physiotherapist during two sessions, which were conducted 7-14 days apart. The test-retest reliability of measures was assessed using the intra-class correlation coefficients (ICC) using two-way random effects and absolute agreement methods. The 95% limits of agreement, standard error of measurement (SEM), and minimal detectable change (MDC95) were calculated. RESULTS: The 6MWT (ICC = 0.92, SEM = 15.8, MDC95 = 43.8), TUG (ICC = 0.95, SEM = 3.2, MDC95 = 0.5) and 30CST (ICC = 0.92, SEM = 1.0, MDC95 = 2.8) performance measurements demonstrated excellent test-retest reliability. The 95% limits of agreement was calculated, as illustrated in a Bland-Altman plot. CONCLUSION: The 6MWT, TUG, and 30CST are reliable for measuring physical performance. The findings of this study can support researchers and clinicians to decide if a change score of a person with epilepsy is likely to be measurement error or true change.

Yoga and aerobic exercise in epilepsy: Study protocol for a randomized controlled trial.

BACKGROUND: There has been a growing interest in demonstrating the health benefits of exercise among people with epilepsy in recent years. Although exercise is recommended for people with epilepsy, there is uncertainty concerning the effects of yoga and aerobic exercise on multiple health outcomes in epilepsy. PURPOSE: The aim of this trial was to examine the effects of yoga and aerobic exercise training on physical activity, seizure frequency, health-related physical fitness, mental, emotional, and psychological health status, and quality of life. METHODS: This study was designed as a single-center, 8-week, randomized controlled trial in a three-arm parallel group. Participants will be randomly allocated to yoga, aerobic exercise, or wait-list control groups. The primary outcome is physical activity/sedentary behavior measured by the ActiGraph GT9X accelerometer and seizure frequency. Secondary outcomes include functional capacity, lower extremity strength, balance, body composition, waist and hip circumference, cognition, depression, anxiety, perceived stress, fatigue, sleep quality, and quality of life. The outcomes will be evaluated at baseline and at 8 weeks of follow-up. IMPLICATIONS OF PHYSIOTHERAPY PRACTICE: This study is the first randomized controlled trial comparing the effects of yoga and aerobic exercise among people with epilepsy. The findings of this study could provide important information about the effects of yoga and aerobic exercise training on a variety of health conditions in people with epilepsy. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05066880, registered October 4, 2021.

Normalized Theta but Increased Gamma Activity after Acetylcholinesterase Inhibitor Treatment in Alzheimer's Disease: Preliminary qEEG Study.

Acetylcholinesterase inhibitors (AChE-I) are the core treatment of mild to severe Alzheimer's disease (AD). However, the efficacy of AChE-I treatment on electroencephalography (EEG) and cognition remains unclear. We aimed to investigate the EEG power and coherence changes, in addition to neuropsychological performance, following a one-year treatment. Nine de-novo AD patients and demographically-matched healthy controls (HC) were included. After baseline assessments, all AD participants started cholinergic therapy. We found that baseline and follow-up gamma power analyzes were similar between groups. Yet, within the AD group after AChE-I intake, individuals with AD displayed higher gamma power compared to their baselines (P < .039). Also, baseline gamma coherence analysis showed lower values in the AD than in HC (P < .048), while these differences disappeared with increased gamma values of AD patients at the follow-up. Within the AD group after AChE-I intake, individuals with AD displayed higher theta and alpha coherence compared to their baselines (all, P < .039). These increased results within the AD group may result from a subclinical epileptiform activity. Even though AChE-I is associated with lower mortality, our results showed a significant effect on EEG power yet can increase the subclinical epileptiform activity. It is essential to be conscious of the seizure risk that treatment may cause.

Hyperconnectivity matters in early-onset Alzheimer's disease: a resting-state EEG connectivity study.

OBJECTIVES: The aim of this study was to differentiate individuals with early-onset Alzheimer's disease (EOAD) and identify differences of functional connectivity in resting-state EEG between individuals with EOAD and late-onset AD (LOAD) in comparison with both healthy young and elderly individuals. METHODS: Forty EOAD and 56 LOAD patients were included along with 51 demographically matched young, and 54 elderly healthy individuals as controls to the EOAD and LOAD groups. Four minutes of resting-state EEG were recorded during the eyes-closed condition. The absolute value of imaginary coherence (ICoh) was measured for connectivity. The maximum values of ICoh were measured at delta (0.5-3.5 Hz), theta (4-7.5Hz), alpha (8-13 Hz), alpha-1 (8-10 Hz), alpha-2 (10.5-13 Hz), beta (13-30 Hz), beta-1 (13-20 Hz), and beta-2 (20.5-30 Hz) frequency bands. RESULTS: Individuals with EOAD showed higher coherence values in all frequency bands than LOAD patients. Compared to young healthy controls (YHC), EOAD had increased ICoh values in theta and beta-2 bands, whereas LOAD had lower ICoh values in the alpha-1 band than elderly healthy controls (EHC). Lastly, patients with EOAD demonstrated negative moderate correlations between language domains and beta-1 ICoh values. CONCLUSION: To the authors' knowledge, this is the first study evaluating coherence alterations among early-and late-onset AD patients and the diagnostic value of coherence measures. It was suggested that EOAD patients had more severe pathological changes compared with LOAD.

The reliability of P300 and the influence of age, gender and education variables in a 50 years and older normative sample.

OBJECTIVES: The present study aims to investigate the effects of age, gender, and level of education on P300 in a healthy population, aged 50 years and over; and determine the reliability metrics for different conditions and measurement methods. METHOD: Auditory and visual oddball recordings of 171 healthy adults were investigated. A fully automated preprocessing was applied to elicit ERP P300. Maximum peak amplitude, latency and mean amplitudes were measured. Data were stratified by age, gender, and education to determine group-level differences by using repeat measures of ANOVA. The internal consistency of P300 was calculated by a split-half method using odd-even segments. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC). RESULTS: Maximum peak P300 amplitudes were higher in the 50-64 years age group compared to the >65 years age group; and females showed increased P300 amplitudes compared to males. P300 measures showed fair to good internal consistency and poor to good test-retest reliability. CONCLUSION: Age and gender should be taken into account when designing ERP studies with elderly individuals. P300 showed good internal consistency in general, between gender groups and age groups. Long-term test-retest reliability was lower but acceptable. These findings can be interpreted as the strength of P300 by being an objective and reliable method independent of cultural differences. Here we underline several factors that may affect P300 measures and discuss other possible factors that should be standardized for P300 to be used in clinical settings.

The effect of oral contraceptive use on sympatic nerve activity in patients with polycystic ovary syndrome.

OBJECTIVE: High sympathetic nerve activity, is thought to be a cardiovascular risk factor, has been shown to correlate with circulating high testosterone levels. However its role on the pathophysiology of the polycystic ovarian syndrome has not been clearly established. The aim of our study is to compare the sympathetic nerve activity between polycystic ovarian syndrome and control group and to determine whether the use of oral contraceptives for contraception has any effect on this activity. MATERIALS AND METHODS: Our study has designed as a prospective, case-control study including patients diagnosed with polycystic ovarian syndrome. Antropometric measurements were calculated, hormone levels were measured and sympathetic skin response and heart rate variability measurements were performed in the laboratory to assess sympathetic activity before starting oral contraceptive pill therapy and at the end of 1 month follow up. RESULTS: In the baseline condition LH/FSH ratio, LH, DHEAS, and total testosterone levels were significantly higher in women with PCOS. After 1 month of treatment, reductions in Ferriman-Gallwey score, ovarian volumes, number of follicles, LH/FSH ratio, LH, and androgen hormone levels were statistically significant. The mean values of sympathetic skin response amplitude and R-R analysis-Valsalva test were higher in PCOS group as compared to the control group. However, these differences were not statistically significant. Similarly, no statistically significant difference in SSR latency and R-R analysis-standup test were demonstrated between PCOS and control groups. CONCLUSION: In conclusion, our study supports the increased sympatovagal activity in patients with polycystic ovarian syndrome.

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.

The effect of oropharyngeal exercise in patients with moderate and severe obstructive sleep apnea using CPAP: a randomized controlled study.

PURPOSE: Obstructive sleep apnea (OSA) is an important public health problem. Beyond common treatment options, solution-oriented options are needed. Oropharyngeal exercise training may be a research area in this respect. This study aimed to evaluate the effects of oropharyngeal exercise (OPE) in addition to continuous positive airway pressure (CPAP) therapy in patients diagnosed with OSA. METHODS: Patients with moderate and severe OSA were screened from the electronic database of our hospital and 41 patients (20: exercise group; 21: control group) were included in the study. Each patient was assessed with CPAP usage time, maximal voluntary ventilation (MVV), maximum inspiratory and expiratory pressure (MIP-MEP), neck circumference, body mass index (BMI), waist-hip ratio, Epworth sleepiness score, Pittsburgh sleep quality index (PSQI), and short-form health survey (SF-36) in the first visit. The OPE was prescribed in addition to CPAP for the exercise group and performed by the patients for 3 months. At the end of the third month, groups were re-assessed with the same parameters. RESULTS: Most of the patients were men, and the mean age of the study population was 51.9 ± 7.4; the mean apnea-hypopnea index (AHI) in the last polysomnography report was 53.3 ± 27.4. In the exercise group, MVV (p = 0.003), MIP (p = 0.002), MEP (p = 0.024), and SF-36 energy/fatigue (p = 0.020) were observed to increase while the total PSQI score (p = 0.036) decreased. The neck circumference (p = 0.006) and BMI (p = 0.013) were found to be significantly decreased in the exercise group. CONCLUSIONS: We found that OPE training may have improved respiratory muscle strength as well as sleep quality and health-related quality of life in the exercise group. OPE along with CPAP therapy may be recommended in moderate and severe OSA patients who are willing to participate.

Our reasons for converting to valproic acid treatment in female patients with genetic generalized epilepsy: a retrospective, single-centre study.

INTRODUCTION AND AIM: Valproic acid (Na valproate) is a broad-spectrum anti-seizure medication used in children and adolescents. It is thought to have fewer adverse effects; however, recent studies have restricted its use in women of reproductive age due to the teratogenic impacts on cognition. Although alternative drugs have been used to treat patients in clinical follow-up, some patients have to return to using valproic acid. Our study aimed to determine the rate of return to valproic acid treatment in female patients with follow-up in our centre and the reasons for the return. MATERIALS AND METHODS: Female patients with genetic generalized epilepsy who were followed up in our centre were included in the study. Patient data were retrospectively obtained from file records. The patients were grouped by seizure subgroups, antiepileptic treatment used, electroencephalography characteristics, and seizure treatment response. RESULTS: Sixty-three (31.7%) of the 199 patients had to return to VPA treatment. When the reasons for the discontinuation of other drugs were examined, non-response to treatment was found in 80.0% of patients, adverse medication effects in 18.3%, and 1.7% continued voluntarily. Patients who are JAE subtypes were more likely to return to VPA treatment than GTCS alone subtypes. A total of 7.4% of patients converted to VPA therapy had continued myoclonic seizures compared with 20.4% of patients treated with alternative drugs. CONCLUSION: VPA treatment is not used as the first choice in females of reproductive age; however, some patients will only achieve seizure control with valproate, especially those with myoclonic seizures and JAE.

New Indices from Polysomnographic Measures for the Severity of Obstructive Sleep Apnea Syndrome -A Different Look at Obstructive Sleep Apnea Syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent abnormal respiratory events during sleep and causes oxidative stress which is reported as a major pathogenic mechanism for the development of various cardiovascular disorders. For the diagnosis and management of treatment, disease-related symptoms and the Apnea-Hypopnea Index (AHI) measured from polysomnographic (PSG) recordings are taken together. However, AHI do not sufficiently represent the total hypoxic load, and other indices related to apnea frequency, apnea duration, and desaturation degree should be investigated. METHODS: In this study, 317 polysomnographic recordings were retrospectively evaluated. Apart from the conventional AHI, apnea and/or hypopnea duration percentage (AHDP) and desaturation area (DesatArea) were calculated using PSG data. RESULTS: According to the AHI, 21.8%, 32.8% and 45.4% of cases were grouped as mild, moderate and severe OSAS, respectively. When AHDP was taken into account, 10.4%, 22.1% and 67.5% of the cases were regrouped as mild, moderate or severe OSAS, respectively. When the DesatArea calculation was used, the grouping of cases as mild, moderate or severe OSAS changed in value to 10.7%, 21.1% and 68.1%, respectively. The total group change was found to be 58.4% for both the AHDP and DesatArea formulation. With the AHDP formulation, regrouping was made in 52.2% of the mild OSAS cases and 62.5% of the moderate OSAS cases; by using the DesatArea calculation, 50.7% of mild OSAS cases and 63% of moderate OSAS cases were regrouped. CONCLUSION: Our results show that when another parameters related to abnormal respiratory events are used, the same patients within the same group of disease severity are heterogeneously separated according to severity of hypoxia. It is suggested that grouping the patients based on AHI is insufficient and that using other polysomnographic measurements along with AHI should be considered to represent the severity of the disease.

Electrophysiological and neuropsychological outcomes of severe obstructive sleep apnea: effects of hypoxemia on cognitive performance.

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized with upper airway obstructions. Some studies showed cognitive and electrophysiological changes in patients with OSAS; however, contradictory results were also reported. The purpose of the present study was twofold: (1) to investigate cognitive changes in severe OSAS patients by using neuropsychological tests and electrophysiological methods together, (2) to investigate influence of hypoxemia levels on cognition. Fifty-four severe OSAS patients and 34 age-, gender- and education matched healthy subjects were participated. OSAS patients were further divided into two subgroups according to minimum oxygen saturation levels. All participants underwent a detailed neuropsychological test battery. A classical visual oddball task was used to elicit ERP P300 and mean P300 amplitudes were measured from Fz, Cz and Pz electrode sites. OSAS patients showed reduced mean P300 amplitudes up to 43-51% on all electrode sites compared to healthy controls. Subgroup analysis revealed significant differences in neuropsychological test scores between healthy controls and high hypoxemia OSAS group, as well as between low and high hypoxemia groups. Moreover, both low and high hypoxemia OSAS groups had lower P300 amplitudes compared with healthy controls. P300 amplitudes showed a gradual decline in parallel with increasing hypoxemia severity; however, the difference between high and low hypoxemia OSAS groups did not reach significance. Moderate correlations were found between sleep parameters, neuropsychological test scores and P300 amplitudes. These results suggest that electrophysiological measures could be better indicators of cognitive changes than neuropsychological tests in OSAS, particularly in mildly affected patients.

Airway and sleep disorders in patients with acromegaly.

OBJECTIVE: Acromegaly is a multisystemic disorder caused by excessive secretion of growth hormone (GH). Sleep-disordered breathing (SDB) such as sleep apnea syndrome (SAS) may occur in acromegaly. The aim of study was to assess the presence of sleep disorders and evaluate the systemic complications on respiratory, cardiovascular, and upper airway systems in acromegalic patients. METHODS: The study group consisted of 30 acromegaly outpatients. GH and insulin-like growth factor 1 (IGF-1) measurements were obtained; body pletysmography, arterial blood gas analysis, tissue-doppler imaging, echocardiography, polysomnography, otorhinolaryngologic examination, and head-neck computed tomography were performed. RESULTS: Sixteen female (53.3%) and 14 male (46.7%) acromegalic patients had a mean age of 51.1 ± 13.2. GH was supressed in 19 patients (63.3%) when 11 had active acromegaly (36.7%). There were 17 patients with SAS (62.9%) (7: mild, 3:intermediate, 7:severe SAS) and average AHI was 16/h. Sixteen patients had predominantly obstructive SAS while one patient had predominantly central SAS. SAS was statistically more frequent in males than females (P = .015). The mean neck circumference was significantly longer in patients with SAS (P = .048). In SAS patients,the soft palate was elongated and thickened,which was statistically significant (P = .014 and P = .05).Vallecula-to-tongue distance was statistically longer in acromegalic patients with SAS (P = .007).There was a positive correlation between tonsil size,vallecula-to-tongue distance and AHI (r = 0.432, P = .045 and r = 0.512, P = .021, respectively). CONCLUSION: SDB seems to be common and clinically important in patients with acromegaly, particularly in men. The most frequent type of apnea in acromegalics is obstructive. Hormonal activity of acromegaly does not seem to have an effect on the development of SAS. Despite its high prevalence, SAS is frequently under-assessed in patients with acromegaly. Systemic complications and SDB should be researched in acromegalics.

Effect of Nasal Continuous Positive Airway Pressure Therapy on the Functional Respiratory Parameters and Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome.

OBJECTIVES: Nasal continuous positive airway pressure (nCPAP) treatment is the gold standard treatment for obstructive sleep apnea syndrome (OSAS). In this study, we aimed to show that the pulmonary functions, exercise limitation on the cardiopulmonary exercise test (CPET), and the health-related quality of life can be improved after a short treatment period by nCPAP. MATERIALS AND METHODS: Our case group with severe obstructive sleep apnea (OSA) performed incremental CPET before and after 8 weeks of nCPAP treatment. All the subjects also underwent physical examination, body composition analysis, simple spirometric measurements, maximal inspiratory pressure (PImax)-maximal expiratory pressure (PEmax), and lung volume tests before and after nCPAP treatment. RESULTS: Thirty-one patients (4 female, 27 male) completed the study. The mean age of the patients was 53.41 ± 1.46 years. Sixteen had at least one comorbidity. In addition, 17 of the subjects were ex-smokers. After nCPAP treatment for 8 weeks, higher PImax-PEmax (p< 0.05), peak oxygen uptake (p= 0.001), workpeak (p= 0.000), maximal heart rates (p= 0.000), and short form-36 scores (p< 0.05) were observed. nCPAP treatment helped control the blood pressure (p= 0.005). There was no significant change in body composition analysis, spirometric parameters, and lung volumes. CONCLUSION: In a short time period, nCPAP can improve exercise capacity, respiratory muscle strength, and the health-related quality of life scores and help control blood pressure.

[Anxiety disorder due to epilepsy: a case report]. / Epilepsiye Bagli Anksiyete Bozuklugu Olgusu.

Epileptic patients present with psychiatric disorders more frequently than the general population and patients with other chronic medical conditions. Psychiatric disorders can co-occur with epilepsy and can be caused by epilepsy. Personality changes, as well as psychosis, and mood or anxiety disorders can occur in association with epilepsy. Anxiety disorders due to epilepsy can manifest as generalized anxiety disorder, panic disorder, phobias, or obsessive-compulsive disorder. The risk of an anxiety disorder is higher in patients with focal epilepsy, especially those with temporal lobe epilepsy, but an anxiety disorder can also occur in patients with frontal lobe epilepsy or generalized tonic-clonic epilepsy. Herein we present a 41-year-old female patient with comorbid anxiety disorder and epilepsy that improved following initiation of antiepileptic medication. The patient's EEG showed abnormalities, particularly in the frontal lobe. Epileptic activation-associated anxiety disorder presented as phobia of swallowing and the patient exhibited features of generalized anxiety disorder. Following initiation of antiepileptic medication, the seizures stopped and the symptoms of anxiety disappeared in two weeks. The patient was receiving psychotherapy once every 2 weeks. The patient remained asymptomatic during 2-years of follow-up. This case highlights the importance of differential diagnosis of underlying epilepsy in patients with acute severe anxiety and the efficacy of proper medical treatment, which was given in the presented case for the underling pathology of anxiety.

Sleep Structure in Children With Attention-Deficit/Hyperactivity Disorder.

The authors evaluated basic sleep architecture and non-rapid eye movement (NREM) sleep alterations in drug-naïve attention-deficit/hyperactivity disorder (ADHD) children without psychiatric or other comorbidities. This cross-sectional case-control study included 28 drug-naïve children with ADHD and 15 healthy controls. This subjective studies revealed that children with ADHD had a worse sleep quality and increased daytime sleepiness. Polysomnography data showed that the sleep macrostructure was not significantly different in children with ADHD. Sleep microstructure was altered in ADHD children by means of reduced total cyclic alternating pattern rate and duration of cyclic alternating pattern sequences. This reduction was associated with a selective decrease of A1 index during stage 2 NREM. SpO2 in total sleep was slightly decreased; however, the incidence of sleep disordered breathing showed no significant difference. The authors suggest that cyclic alternating pattern scoring would provide a further insight to obtain a better understanding of the sleep structure in children with ADHD.

Neuropathy and Dysautonomia in Patients with Obstructive Sleep Apnea Syndrome.

INTRODUCTION: The aim of our study is to search for the existence of neuropathy, dysautonomia and to identify the correlations of sickness level of patients with Obstructive Sleep Apnea Syndrome (OSAS). METHODS: The research is based on the real cases at Dokuz Eylul University of Medicine Sleep and Epilepsy Center, observed during September 2008-May 2009. The patients were selected by polysomnography samples based on 20 persons at same ages with following criteria; high leveled OSAS (AHI≥30), low OSAS (5≤AHI<30) and healthy participants. Classical ENMG protocol, symphatic skin response and R-R interval variation test were performed on these samples. RESULTS: High and low leveled OSAS patients had a statistically significant (p<0.05) decrease in the average velocity of motor conduction in right tibialis posterior when compared to the control group. Besides we observed an statistically significant (p<0.05) increase in the average amplitud of symphatic skin responses in high leveled OSAS patients than control group. CONCLUSION: OSAS indicates a risk of possible peripheral neuropathy and autonomic dysfunction risk increases in positive correlation with level of OSAS.

Comparison of Cognitive Impairment between Patients having Epilepsy and Psychogenic Nonepileptic Seizures.

INTRODUCTION: The aim of this study was to evaluate cognitive impairment in patients having epilepsy or psychogenic nonepileptic seizures (PNESs) using selected neuropsychological tests at different time periods related to the seizure. METHODS: In this study, selected neurocognitive tests were administered to the patients. Within 24 h, the previously applied neurocognitive tests were repeated within 24 h following the observation of typical seizures when monitoring and normalizing electroencephalography (EEG) activity. Basal neurocognitive tests were also administered to the healthy control group, and repeat neurocognitive evaluation was performed within 24-96 h. RESULTS: The basal neurocognitive evaluation revealed that verbal learning and memory scores as well as Stroop test interference time were significantly lower in the PNES group compared with those in the controls. In the basal cognitive tests administered to the patients with epilepsy, verbal learning and memory scores, long-term memory, and total recognition test scores were significantly lower than those of the controls. Following the repeat cognitive tests, significant progress was found in the verbal categorical fluency score of the PNES group. No significant difference was determined in the epilepsy group. Significant contraction was determined in the Stroop interference time in the control group, but no similar change was recorded in the epilepsy or PNES groups. CONCLUSION: While memory problems seemed to be most prominent in the assessed patients with epilepsy, attention and executive function problems were more dominant in the patients with PNESs. These findings are probably related to numerous factors such duration of disease, mood disorders, and specific drug use. No deterioration in attention and executive functions was reported in the early post-seizure period in either patient group.