Ideggyogyaszati Szemle-Clinical Neuroscience最新文献

Background and purpose: Combined epilepsy (with generalized and focal seizures) is a recently accepted and yet underreported epilepsy type. We intended to review the literature of combined epilepsy and to report the individual findings of the 31 combined epilepsy patients in our database. Thereafter, we investigated the characteristics of the patients at the group level.

Methods: The individual findings of the 31 patients were tabulated. We characterized the group with special reference to epidemiology, timing and the sequence of generalized and focal seizures, family history of seizures and severity of the electro-clinical phenotype. The variables were compared to those of the generalized epilepsy and the focal epilepsy groups of our database. We carried out statistical analyses by the two-sided Fishers's exact test and the Kruskal-Wallis and post-hoc Dunn tests.

Results: The prevalence of combined epilepsy was 1.56% within the total sample of the classifiable epilepsy patients. Females were affected more often than males (67.7% and 32.3%, respectively). Statistically significant associations emerged firstly between the "short interval" subgroup (where the generalized and focal seizures occurred with short time difference) and the lack of other cerebral abnormality, and secondly between the "long interval" subgroup (where 4 to 37 years elapsed between the occurrence of the two seizure types) and the presence of other brain abnormality (p = 0.02). The proportion of patients with positive family history of seizures was greater in the combined epilepsy- than in the generalized epilepsy group (p = 0.03) and the focal epilepsy group (p < 0.0001) of the database. The electro-clinical phenotype of the absence seizures showed more atypical findings (indicating poor prognosis) in combined epilepsy than in the generalized absence epilepsy patients of the database (p < 0,0001). Despite dissimilar patient selection and study design, our main findings were in accord with those of prior studies. The dissection of the combined epilepsy group into the "long interval" and "short interval" subgroups was a novel approach that highlighted the dissimilar pathogenetic and clinical correlates of each.

Conclusion: The case reports might facilitate the spread of information about combined epilepsy in the medical community. Analyses of the patients at the group level resulted in clinically useful pieces of evidence.

Background and purpose: Stroke is a serious health problem that has a significant impact on health-related quality of life. Despite the increasing popularity of measuring quality of life among patients, it is not routinely measured in clinical practice, and therefore little is known about how well clinical measures reflect quality of life after stroke. The aim of this study was to investigate the quality of life of patients with acute ischaemic stroke.

Methods: For the prospective study, patients diagnosed with acute ischemic stroke at the Neurology Clinic of the Clinical Center of the University of Pécs were selected through convenience sampling between June 2022 and May 2023. Based on the treatments, patients were divided into three groups: mechanical thrombectomy (MT), intravenous thrombolysis (IVT), and standard care (SC). Modified Rankin Scale (Pre-mRS, Follow-up mRS), NIH Stroke Scale (NIHSS), and European Quality of Life 5 Dimensions Scale (EQ-5D-5L) were used in the research. Descriptive statistics, paired T-tests, Wilcoxon tests, McNemar tests and Pearson correlation analysis were applied for the analysis (SPSS 25.0; p <0.05).

Results: A total of 198 participants (115 males, 83 females) took part in the study (MT: 50, IVT: 69, SC: 79). The Pre-mRS and follow-up mRS values indicate that the majority of patients in all three groups fell into the mild category (Pre-mRS: 176 participants; 88%, follow-up mRS: 158 participants; 80%). There was a significant improvement in NIHSS scores in all three groups (IVT: 4.36 vs. 1.57, p<0.001; MT: 8.98 vs. 4.50, p<0.001; SC: 4.38 vs. 2.84, p<0.001). The EQ-5D-5L value also significantly increased for all groups (IVT: 0.82 vs. 0.88, p<0.001; MT: 0.63 vs. 0.73, p<0.001, SC: 0.76 vs. 0.80, p=0.014). Patients admitted with lower NIHSS values reported better quality of life at the end of our study (r: -0.43451).

Conclusion: At 30 days, significant improvement was observed in MT, IVT and SC groups when measured with EQ-5D-5L, but the extent of improvement was highest in the MT group.

Background and purpose: Mechanical thrombectomy is the most important treatment modality in acute stroke; despite successful thrombectomy, good functional outcome is not achieved in a significant proportion of patients. This study examined the effect of neutrophil lymphocyte ratio (NLR) values at admission on functional outcomes in successfully recanalized patients.

Methods: Patients who underwent mechanical thrombectomy due to anterior system major vessel occlusion were retrospectively analyzed and compared with the admission NLR values and 3-month clinical modified Rankin Scale (mRS) scores of successfully recanalized patients.

Results: Of a total of 126 patients who underwent thrombectomy within the specified period, 97 patients with successful recanalization were included in the study. The overall successful recanalization rate was calculated as 77%. The mean NLR of patients with mRS ≤2 (n=65) was found to be significantly lower than patients with mRS≥3 (n=32) (p<0.001). A weak and significant correlation was found between National Institutes of Health Stroke Scale (NIHSS) value and NLR (r= 0.315, p=.002).

Conclusion: NLR value has been found to be associated with futile recanalization in mechanical thrombectomy patients. Therefore, we think that suppression of inflammation before thrombectomy will increase the chance of successful thrombectomy.

Combined central and peripheral demyelination (CCPD) is a rare disease entity. Onset with the simultaneous central nervous system (CNS) and peripheral nervous system (PNS) involvement and its recurrence are exceptional. Anti-neurofascin antibodies have been shown to be present in up to 70% of cases, yet seronegative patients also exist. We present a case of seronegative recurrent CCPD. The PNS involvement was compatible with two episodes of recurrent Guillain-Barre syndrome (GBS), whereas the CNS involvement pattern was not typical for either multiple sclerosis (MS) or acute disseminated encephalomyelitis. The prognosis was excellent with pulse methylprednisolone, intravenous immunoglobulin, and plasmapheresis. This case highlights the varied clinical presentations of CCPD, extending beyond the realms of MS and chronic inflammatory demyelinating polyneuropathy, and underscores the potential for relapse. Importantly, to the best of our knowledge, this represents the inaugural instance of CCPD featuring PNS involvement in the form of recurrent GBS.

Depression, anxiety and psychotic disorders are common perinatal mental health disorders in the postpartum period. Depressive symptoms that occur postpartum are also present in the prenatal period in 50% of patients. Risk factors for the development of postpartum depression include poor relationship with the partner, lack of social support, mother's low socioeconomic status and multiparity. It has been determined that reproductive hormones change significantly during peripartum. Progesterone is one of these hormones and acts on the central nervous system starting from the fetal period; neurogenesis, neuromodulation, sedation are some of these effects. It has also been observed that progesterone has positive effects on learning, memory and mood. Progesterone exerts its effects on the central nervous system by converting into its metabolite allopregnanolone. Allopregnanolone is one of the neuroactive steroids, and found in similar amounts in the circulation of pregnant women and fetuses. It acts on synaptic and extrasynaptic γ-aminobutyric acid type A (GABAA) receptors and is a positive allosteric modulator of the GABAA receptor. Allopregnanolone increases both the receptor's opening frequency and its open duration and improves GABAergic current. Low serum allopregnanolone levels in the second trimester are predictive of postpartum depression. Each 1 ng/mL increase in serum allopregnanolone level reduces the risk of development of postpartum depression by 63%. Brexanolone and zuranolone are synthetic allopregnanolone preparations approved by the FDA for use in female patients with postpartum depression. They act via positive allosteric modulation on the GABAA receptor. Brexanolone is administered via intravenous infusion at varying infusion rates in a healthcare facility over 60 hours. Its effect starts immediately after treatment and continues until the 30th day of follow-up, and depressive mood does not recur. Zuranolone was developed for oral use, and administered as a single dose of 50 mg after a fatty meal. Their effectiveness has been demonstrated in patients with treatment-resistant depression. The development of other novel agents that act on the GABAA receptor and other pathways for the treatment of postpartum depression is in progress.

Background and purpose: Syringomyelia is a neurological condition in which a longitudinal fluid-filled cavity is formed within the spinal cord. It usually occurs in the cervical region and is associated with Chiari malformation, infections, trauma, and tumors of the spinal cord. However, syringomyelia associated with cervical disc disease (SCD) is very rare and only a few cases have been reported so far. This case report presents the clinical and radiological findings of 13 cases of SCD to describe the properties of SCD and explore the nature of the relationship between syringomyelia and cervical disc disease.

Methods: SCD was diagnosed in 13 using MRI findings, including coexistence of syringomyelia and cervical disc disease, presence of narrowed cervical subarachnoid space secondary to the cervical disc herniation or cervical local kyphosis associated with cervical disc degeneration or herniation, and the cervical disc herniation or segmental kyphosis and syrinx should be located within the same levels. The MRI findings were used to grade the syrinx and determine whether the cervical disc herniation or local kyphosis was located at the proximal or distal end of the syrinx.

Results: All patients had single-level disc herniation or kyphosis, the most common level being C5-6 (n = 6), followed by C6-7(n = 4) and C4-5 (n = 3). Eight patients had a distal type (disc disease located in the proximal end of the syrinx) SCD while five had the proximal variety (cervical disc disease located in the distal end of the syrinx). The average length of the syrinx was two vertebral segments. Surgery was performed in five cases and some degree of syrinx resolution was observed in all of them. Discussion - The main cause of syringomyelia is obstruction of cerebrospinal fluid (CSF) pathways; total obstruction could cause distal syrinx, whereas partial obstruction could cause proximal or distal syrinxes. Restoration of CSF pathways may result in some degree of resolution of syringomyelia. A causal association may exist between cervical disc disease and cervical syringomyelia but needs further exploration.

Conclusion: SCD is a mild form of syringomyelia with symptoms primarily arising due to disc herniation or local kyphosis. The surgical treatment of the cervical disc disease is sufficient and results in a syringomyelia resolution of some degree.

Background and purpose: To determine the risk of hemorrhagic transformation in patients with acute ischemic cerebrovascular disease, we investigated the relationship between Apparent Diffusion Coefficient Magnetic Resonance Imaging values measured within the infarct area and microbleeds observed on Gradient Echo Sequence Magnetic Resonance Imaging.

Methods: A total of 172 patients who were hospitalized to the Neurology Clinic of the Istanbul Provincial Directorate of Health Erenkoy Mental and Nervous Diseases Training and Research Hospital between June 2019 and March 2020 were included in this cross-sectional study. The patients were classified according to their demographic and clinical characteristics, by age, gender, hypertension, diabetes mellitus, smoking, and alcohol use. In the Cranial Magnetic Resonance Imaging taken in the application for the diagnosis of acute ischemic cerebrovascular disease, the infarction area in Apparent Diffusion Coefficient sequences with the Region of Interest value and the relationship between microhemorrhage observed in Gradient Echo hemo-sequence was evaluated in Magnetic Resonance Imaging applied between 3-7 days. While calculating spherical Region of Interest values, 5 Region of Interest values were obtained for lesions larger than 1.5x1.5 cm, and their arithmetic mean was obtained, and single spherical Region of Interest value was taken for smaller ones. Apparent Diffusion Coefficient Magnetic Resonance Imaging Region of Interest mean values were divided into 2 groups as 500x10-6 mm2 /s and 500x10-6 mm2/s.

Results: Patients in the group with Apparent Diffusion Coefficient Region of Interest mean values below 500x10-6 mm2/s, had a significantly higher probability for microhemorrhage observes in Gradient Echo Sequence Magnetic Resonance Imaging (p: 0.001) and also more likely to experience microhemorrhage in other areas, which was statistically significant (p: 0.001).The probability of another micro-bleeding observed in patients with microhemorrhage Gradient Echo Sequence Magnetic Resonance Imaging was also statistically significant (p: 0,001). The risk of microbleeding in areas other than ischemia was also found to be significantly higher in patients with microbleeding in the ischemia area in Gradient Echo Sequence Magnetic Resonance Imaging.

Conclusion: In our study, a statistically significant relationship was found between the microhemorrhage in the infarct area and the Apparent Diffusion Coefficient Region of Interest values. When the literature was reviewed, no such study was found to determine the risk of bleeding.

Background and purpose: To evaluate the long-term effects of the COVID-19 pandemic on seizure frequency and levels of mental distress in individuals with epilepsy and identify potential risk factors associated with increased seizure frequency.

Methods: This is a cross-sectional study conducted in Türkiye in May 2021 by phone. Information on epilepsy syndromes, antiseizure medications, average seizure frequency, and drug resistance was obtained from medical records. A questionnaire was completed that included demographic and clinical characteristics and Kessler Psychological Distress Scale 10 (K-10). From people with epilepsy (PWE), seizure control in the month before the pandemic and perceived stress, sleep changes, changes in adaptation during this period, and whether there were changes in seizure control after the pandemic were questioned.

Results: A total of 227 patients were included, and the K-10 score of 81.9% (186/227) of PWE was found to be ≥30. An increase in seizure frequency was detected in 34 (15%) patients. The factors affecting the increase in seizure frequency were analyzed using logistic regression analysis. In the univariate model hesitate to go to the emergency room despite having seizures during the pandemic (OR= 8.325; 95% CI: [2.943 - 23.551], p=0.001) was evaluated as the parameter with the highest risk of increased seizure frequency. In multivariate analyses (enter model) only polytherapy (OR= 2.945; 95% CI: [1.152 - 7.532], p=0.024) was detected as the parameter with increased seizure frequency.

Conclusion: One year after the declaration of the pandemic, we found that stress was still common, the frequency of seizures increased. In multivariate analyses, only polytherapy was detected as the parameter with increased seizure frequency.

Background and purpose: Posterior reversible encephalopathy syndrome (PRES) is characterized by vasogenic edema, usually reversible, with the prominent involvement of the parietal and occipital lobes. The exact etiopathogenesis leading to PRES is unknown. Because signs of eclampsia and preeclampsia in neuroimaging often overlap and manifest as PRES, we aimed to evaluate whether demographic, clinical, and laboratory parameters predict PRES in patients with preeclampsia or eclampsia.

Methods: 213 pre-eclampsia or eclampsia patients with cranial imaging were retrospectively examined. We recorded the patients' demographic information, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), hemogram, biochemical indicators, clinical symptoms, and imaging features.

Results: Of all patients, 69% (n = 147) had preeclampsia while 31% (n = 66) had eclampsia, and 24.4% (n = 53) were diagnosed with PRES. The mean age of patients who developed PRES was 25.81 ± 6.07 years and thus significantly less than that of patients who did not develop PRES (p = .000). Patients with PRES had significantly higher mean SBP (p = .015), DBP (p = .009), and MAP (p = .003) than patients without PRES, along with significantly higher aspartate aminotransferase (ASAT; p = .001), alanine aminotransferase (ALAT; p = .001) blood urea nitrogen (BUN; p = .001), white blood cell (WBC; p = .003), neutrophil (p = .001), and hemoglobin (Hb; p = .027) levels, but significantly lower albumin (p = .000) levels.

Conclusion: Age, high blood pressure, and BUN, neutrophil, and WBC levels were predictors of the development of PRES in patients with preeclampsia and eclampsia. Early neuroimaging considering those predictors should be performed to diagnose PRES in patients with preeclampsia and eclampsia.

Background and purpose: Face masks are crucial parts of personal protective equipment (PPE) to reduce the risk of respiratory infections. The COVID-19 outbreak has increased healthcare workers' use of face masks. This study aimed to evaluate changes in cerebrovascular response among healthcare workers using surgical and N95 respirator masks.

Methods: 90 healthcare workers: 30 wearing surgical masks, 30 wearing N95 respirators, and 30 without masks were included. After two-hour of face mask use, the baseline mean flow velocity (MFV) and the mean breath-holding index (BHI) of the bilateral middle cerebral arteries (MCAs) were evaluated with transcranial Doppler ultrasound. The presence of de-novo headache was recorded. BHI values below 0.69 were evaluated as a sign of impaired cerebrovascular reactivity (CVR).

Results: The rate of de-novo headache was significantly higher in the N95 respirator mask group (p = 0.004). Compared to the control and surgical mask groups, the N95 respirator mask group had significantly lower values of the baseline MFV of the right MCA (p = 0.003 and p = 0.021, respectively) and mean BHI (p = 0.003 and p = 0.012, respectively). Still, only one N95 respirator mask user had a mean BHI value below 0.69.

Conclusion: Surgical masks did not significantly affect cerebral hemodynamics. Although N95 respirator mask use significantly decreased BHI values, the CVR is still within normal limits, and the development of de-novo headache is not directly associated with low CVR.