Are COVID-19 vaccines safe for people with epilepsy? A cross-sectional study.

BACKGROUND: COVID-19 disease was first seen in December 2019 and was declared a pandemic soon after. To fight the pandemic, there is an immense need for effective vaccines. The purposes of our study were to investigate the effect of coronavirus vaccines on seizures in people with epilepsy (PWE) and assess the adverse events of COVID-19 vaccine in PWE. METHODS: This was a cross-sectional study. We included epilepsy patients who got vaccinated with two or three doses at least 1 month earlier. We gathered the data using a standardized form. The form contained questions about patients' demographic features, clinical features, and information about the vaccination and its adverse events. The questionnaire included questions about epilepsy-related adverse events. RESULTS: We included 178 people with epilepsy in our study. The frequency of adverse events was lower than clinical studies of the vaccines. The mean number of seizures in the month before the vaccination was 1.62, between the doses was 1.61, and after vaccination was 1.64. There was no significant difference in the number of monthly seizures before the vaccination, the month between the doses, or the month after the vaccination (p = 0.46). CONCLUSIONS: The vaccines under consideration in our study were tolerated well by the epilepsy patients. The vaccines did not affect the monthly number of seizures of the PWE. A small number of patients had more seizures than normal after vaccination. We think that benefits of the vaccines outweigh the slightly increased possibility of having a seizure after vaccination.

Panayiotopoulos syndrome and Gastaut syndrome are distinct entities in terms of neuropsychological findings.

BACKGROUND: Although the courses of self-limited focal epilepsies of childhood are considered as benign, a handful of studies suggested that these children may suffer from cognitive problems. Implementing tailor-made educational strategies would aid these children to reach their full potentials. Therefore, it is crucial to understand and differentiate the complete neuropsychological and behavioral profiles of these rather common syndromes. We aimed to examine the distinct cognitive and behavioral profiles of the Panayiotopoulos syndrome (PS) and the Gastaut syndrome (GS), comparatively. METHOD: Twenty patients with PS, 20 patients with GS, and 20 healthy controls have been recruited. The testing protocol included Wechsler Intelligence Scale for Children-Revised, Conner's Continuous Performance Test, Verbal Fluency Test, Stroop Color and Word Test, Color Trails Test, Tower of London Test, Symbol Digit Modalities Test, California Verbal Learning Test-Children's Version, Rey Complex Figure Test, Benton Face Recognition Test, Benton Judgment of Line Orientation, Peabody Picture Vocabulary Test, Reading and Writing Test, Child Behavior Checklist, Conner's Parent Rating Scale-48, and Behavior Rating Inventory of Executive Function. Demographical, clinical, electrophysiological data, and imaging findings have also been evaluated. RESULTS: With regard to intelligence, the patients with PS scored less in all scales compared to the healthy controls. However, only the performance IQ (intelligence quotient) scores differed significantly between the patient groups, with the patients with PS scoring lower than the patients with GS. Verbal memory problems were eminent in both of the patient groups; whereas, visual memory was impaired only in the group with PS. Psychomotor speed was affected in both groups. Reading problems were prominent only in the patients with PS. Writing and arithmetic skills were defective in both patient groups. There were no noteworthy behavioral problems in comparison to healthy subjects. CONCLUSION: Using neuropsychological profiles, this study demonstrated that the GS and the PS are two distinct entities. Cognitive dysfunction is a more prominent and widespread feature of the patients with PS; whereas, the patients with GS suffer only from milder and isolated cognitive problems.

[Subacute sclerosing panencephalitis cases diagnosed by increased CSF/serum measles antibody indices]. / Yüksek BOS/Serum Kizamik Antikor Indeksi ile Tanimlanan Subakut Sklerozan Panensefalit Olgulari

Subacute sclerosing panencephalitis (SSPE) caused by persistent defective measles virus strains, is a progressive neurological disorder of children and adolescents. The aim of this letter was to share the data from SSPE-suspected cases who were definitely diagnosed by the detection of increased antibody index in serum and cerebrospinal fluid (CSF) samples. A total of 11 patients (mean age: 14.3 years) with suspected SSPE between February 2006 to August 2008, were included in the study. Simultaneously obtained serum and CSF samples from patients were analyzed in terms of albumin, total IgG and measles-specific IgG levels (Measles Virus IgG ELISA for CSF Diagnostics, Euroimmun, Germany). The value of CSQrel (relative CSF/serum quotient) ≥ 1.5 was accepted indicative for intrathecal measles antibody synthesis. Seven (63.6%) of the 11 patients' diagnosis were confirmed with the demonstration of elevated CSF/serum indices (CSQrel range: 2.3-36.9; mean: 12.9). Mean age of those seven cases was 12.3 years (age range: 7-21) and four of them were male. The history of patients with high antibody indices indicated that three of four patients who had measles infection had not been vaccinated against measles. These three unvaccinated patients had measles infection at 3rd, 8th and 30th months of age, respectively, and the period of SSPE development were 15, 6 and 4.5 years, respectively. With this letter we would like to emphasize once more that effective measles vaccination is the only way for the prevention of measles and SSPE and the demonstration of increased measles antibody index in simultaneously obtained serum and CSF samples is crucial for the diagnosis of SSPE.

Cervical vestibular evoked myogenic potentials in patients with the first episode of posterior canal benign paroxysmal positional vertigo before and after repositioning.

BACKGROUND: Cervical vestibular evoked myogenic potentials (cVEMPs) are used to assess the sacculo-collic pathways. Benign paroxysmal positional vertigo (BPPV) is mainly a utricular disorder. OBJECTIVES: To investigate cVEMPs in BPPV patients before and after repositioning maneuvers. METHODS: Forty patients with posterior canal BPPV with new onset symptoms underwent cVEMP testing at the time of diagnosis and a month after successful repositioning maneuver. p13, n23 latency and amplitude ratio values were compared with the results of 40 healthy controls. RESULTS: p13 and n23 latencies of the affected side were significantly longer than the healthy controls more prominent for the p13 latency. Comparison of the affected side with the non-affected side revealed delayed p13 latency on the affected side. Though a significant improvement in p13 latency was observed after repositioning, it was still prolonged when compared with the healthy controls. An abnormality regarding amplitudes was not present. CONCLUSIONS AND SIGNIFICANCE: cVEMP abnormalities in patients with BPPV indicate saccular dysfunction accompanying utricular dysfunction which seems to be confined to the symptomatic side at least in the early phase of the disease. Partial recovery can be seen after treatment with residual findings following even the first attack.

Primary Sjögrens syndrome presenting as neuromyelitis optica.

This report presents a patient with Devics neuromyelitis optica associated with primary Sjögrens syndrome. Her first attack was right-sided optic neuritis at age 10 years. Attacks involving both optic nerves and medulla spinalis were recorded during the ensuing years. The diagnosis of Sjögrens syndrome could not be made until the second decade because it was not suspected.

Cognitive functions evaluated by P300 and visual and auditory number assays in children with childhood epilepsy with occipital paroxysms (CEOP).

PURPOSE: This study was planned to evaluate cognitive functions, especially attention and immediate recall, in children with childhood epilepsy with occipital paroxysms (CEOP), by using P300 and neuropsychological tests, which included visual and auditory number assays. Thirty patients with CEOP, ages ranging from 5 to 17 years were enrolled in the study. Twenty-five healthy children were taken as the control group. METHODS: Oddball paradigm was used in P300 recordings. The latency and the amplitude of the P300 wave recorded from Cz were taken into consideration. The neuropsychological test battery included visual and auditory number assays. RESULTS: P300 latency was significantly longer in the CEOP group (p=0.014). The results of the visual and auditory number assay test showed significant decline in the patient group when compared with the normal controls. CONCLUSIONS: Attention and immediate recall deficits as well as prolonged P300 latencies in children with CEOP can be due to an ongoing epileptic activity either influencing the whole brain or only the occipital lobe which can also be involved in the neuropsychological organization of the human cortex. Therefore, children with CEOP should be evaluated with more detailed neuropsychological tests for possible cognitive deficits.

Atypical EEG findings in subacute sclerosing panencephalitis.

OBJECTIVE: To evaluate atypical electroencephalographic features in subacute sclerosing panencephalitis (SSPE) and to detect its relation to clinical features. METHODS: Twenty-two patients aged 2-17 years (mean 9.4 years) with definite diagnosis of SSPE were studied. Their clinical data and EEG records were reviewed retrospectively. All EEG records were analysed for features of periodic complexes (PCs) in relation to age, age at onset, clinical stage and the rate of progression as well as duration of the disease. RESULTS: Classical periodic complexes of SSPE were found in EEGs of 13 patients (group I). Atypical patterns were observed in EEGs of nine patients (group II). Two new atypical findings were identified: prolonged discharges which include sharp waves and slow waves for 4-7 s followed by suppression for 1-4s; and periodic complexes which consist of four or five sharp waves in every 2 s. We observed atypical EEG patterns were more frequently in Stage III, acute form, and the disease duration was longer than in the typical group. CONCLUSIONS: Atypical EEG patterns in SSPE might be related to the progression of the disease, but this theory needs further longitudinal studies. SIGNIFICANCE: We suggest atypical EEG patterns might be observed more frequently in patients with severe neurologic disability, more rapidly progressive disease and longer duration of disease.

Evaluating cognitive functions with visual and auditory number assays and P300 in children with epilepsy.

This study was planned to evaluate cognitive functions, especially attention and immediate recall, in children with epilepsy by using P300 and neuropsychological tests, which included visual and auditory number assays. Fifty five patients with partial seizures, 45 patients with generalized seizures and 20 patients with intractable seizures were enrolled in the study. Twenty five healthy children were taken as the control group. The results were as follows: 1. P300 latencies were significantly longer in the intractable and partial groups when compared with the control subjects. 2. The duration of epilepsy, seizure frequency, cerebral imaging pathologies were not significantly correlated with delayed P300 latencies. 3. The results of the visual and auditory number assays test showed significant abnormalities when each of the three groups were compared with the normal controls. 4. Though some subgroups of the neuropsychological tests were correlated with the P300 latencies, an overall significant correlation was not present between them. So, we suggest that neuropsychological tests are more convenient for the assessment of cognitive functions in children with epilepsy than the P300 recordings.

Occipital epilepsies in children.

Occipital lobe seizures, as defined by subjective symptoms and objective signs, can be recognized by clinical seizure characteristics in most cases. Visual symptoms such as hallucinations and amaurosis are the most common occipital lobe seizure symptoms. The patients must be classified in order to be able to define the prognosis. In this study, we classified patients with occipital epilepsy as childhood epilepsy with occipital paroxysms (19 patients), idiopathic photosensitive occipital epilepsy (10 patients) and symptomatic occipital epilepsy (25 patients). They were evaluated according to clinical, electrographic and neuroimaging characteristics.

Visual evoked potentials in children with occipital epilepsies.

The objectives of this study are to see if any visual evoked potential (VEP) differences are present in two forms of occipital epilepsy, childhood epilepsy with occipital paroxysms (CEOP) and symptomatic occipital epilepsy (SOE) with respect to etiology, as CEOP is a benign age- and localization-related idiopathic epilepsy while SOE is a symptomatic form. Nineteen patients with CEOP and 13 patients with SOE were included in the study and P100 potential latency and amplitude values obtained from these patients were compared with the values recorded from normal controls. The amplitude values recorded from the patients with CEOP were significantly high (P=0.033). P100 potential latency values recorded in patients with SOE were significantly long (P=0.028). High amplitude VEP responses were mostly attributed to hyperexcitability of the occipital cortical structures whereas prolonged latency P100 responses were attributed to occipital structural changes.

Four novel and two recurrent NHLRC1 (EPM2B) and EPM2A gene mutations leading to Lafora disease in six Turkish families.

Lafora disease (LD) is a type of autosomal recessive, progressive myoclonus epilepsy resulting mostly from mutations in the EPM2A and NHLRC1 genes. Mutational analysis in both genes was initiated with the aim of establishing LD DNA diagnosis in Turkey. Four novel NHLRC1 (p.G131X, p.P69S and p.D82H) and EPM2A (p.V7A) and two recurrent NHLRC1 (p.D146N) and EPM2A (p.R241X) mutations were identified in six families. The delineation of causative mutations in patients provided early disease diagnosis for other family members and contributed to the knowledge of LD pathogenesis.

Neurological symptoms and signs in Behçet disease: a Western Turkey experience.

AIM: To assess the clinical patterns of neurologic involvement and the frequencies and characteristics of different types of headaches in patients with Behçet disease. METHODS: Total 530 patients with Behçet disease were evaluated for the presence of neurologic involvement and/or headache. RESULTS: Of the 54 patients (10.2%) with neurological involvement, 36 (66.7%) had parenchymal and 16 (29%) had vascular involvement. There was a patient with optic neuropathy and another patient with peripheral nerve involvement. There were 46 patients (8.7%) with headache without any evidence of neurological involvement and 25 of them (4.7%) were diagnosed with migraine. CONCLUSIONS: The prevalence of neurologic involvement in our group was higher than the studies published previously from the same country. Migraine prevalence on the other hand was low.

Sydenham chorea and Hashimoto thyroiditis: an unusual association.

Sydenham chorea is an immune-mediated neuropsychiatric disorder associated with group A beta-hemolytic streptococci infection. The authors present a 12-year-old female patient with Sydenham chorea and Hashimoto thyroiditis. Although Hashimoto thyroiditis has been associated with other autoimmune disorders, the association of Sydenham chorea and Hashimoto thyroiditis has not been previously reported. Immunological processes are suggested to be implicated in the pathogenesis of this association; however, the exact mechanism remains unclear.