[Show abstract][Hide abstract] ABSTRACT: 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 (AHİ≥30), low OSAS (5≤AHİ<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.
[Show abstract][Hide abstract] ABSTRACT: Background:
The HLA-DQB1*06:02 allele across all ethnic groups and the rs5770917 variation between CPT1B and CHKB genes in Japanese and Koreans are common genetic susceptibility factors for narcolepsy. This comprehensive genetic study sought to assess variations in CHKB and CPT1B susceptibility genes and HLA-DQB1*06:02 allele status in Turkish patients with narcolepsy and healthy persons.
CHKB/CPT1B genes were sequenced in patients with narcolepsy (n=37) and healthy persons (n=100) to detect variations. The HLA-DQB1*06:02 allele status was determined by sequence specific polymerase chain reaction.
The HLA-DQB1*06:02 allele was significantly more frequent in narcoleptic patients than in healthy persons (p=2×10(-7)) and in patients with narcolepsy and cataplexy than in those without (p=0.018). The mean of the multiple sleep latency test, sleep-onset rapid eye movement periods, and frequency of sleep paralysis significantly differed in the HLA-DQB1*06:02-positive patients. rs5770917, rs5770911, rs2269381, and rs2269382 were detected together as a haplotype in three patients and 11 healthy persons. In addition to this haplotype, the indel variation (rs144647670) was detected in the 5' upstream region of the human CHKB gene in the patients and healthy persons carrying four variants together.
This study identified a novel haplotype consisting of the indel variation, which had not been detected in previous studies in Japanese and Korean populations, and observed four single-nucleotide polymorphisms in CHKB/CPT1B. The study confirmed the association of the HLA-DQB1*06:02 allele with narcolepsy and cataplexy susceptibility. The findings suggest that the presence of HLA-DQB1*06:02 may be a predictor of cataplexy in narcoleptic patients and could therefore be used as an additional diagnostic marker alongside hypocretin.
[Show abstract][Hide abstract] ABSTRACT: Subependymal nodular heterotopia (SNH) is a cortical development malformation that is commonly associated with medically resistant epilepsy. Cases of SNH are challenging to treat surgically because there are typically multiple nodules, which may be involved in epileptogenesis. Moreover, dual pathology may exist in these patients. Here, we present a case with unilateral subependymal heterotopic nodules associated with ipsilateral hippocampal atrophy. Invasive and non-invasive work-ups revealed that the hippocampus was the actual ictal onset zone and that the SNH was not involved. An anterior temporal lobectomy was carried out, and postoperative seizure outcome was class Ia at the end of 2 years. The case demonstrates that SNH may not play a major role in patients with dual pathology. However, direct electroencephalography (EEG) recording from areas of SNH and other possible epileptogenic regions is indispensable in defining the ictal onset zone and avoiding poor surgical outcomes.
[Show abstract][Hide abstract] ABSTRACT: Paraneoplastic limbic encephalitis (PLE) associated with small cell lung cancer (SCLC) often presents with antibodies to intracellular antigens and a poor outcome even after tumor resection and immunotherapy. We report a PLE patient presenting with generalized seizures, shortterm memory impairment and medial temporal lobe hyperintensity in MRI. Initial screening revealed significantly elevated thyroid antibody levels suggesting Hashimoto's encephalopathy. Following methylprednisolone treatment, her seizures ceased, MRI findings disappeared and memory impairment showed a partial resolution in 5 months. Two months later, she developed further generalized seizures. Chest X-ray showed a mass lesion, which was demonstrated by needle biopsy to be a small cell lung carcinoma (SCLC). The panel of onconeural antibodies including cell-membrane antigens was negative. However, the patient's serum and cerebrospinal fluid IgG, obtained during both exacerbations, immunolabeled cytoplasm and dendrites of Purkinje cells, cerebellar and hippocampal molecular layers, basal ganglia, thalamus, and the surface of cultured hippocampal neurons, in a manner distinct from previously identified neuropil antibodies associated with SCLC. These neuropil antibodies appear to be associated with a favorable response to treatment. Further studies are required for determination of the target antigen.
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to assess the effect of breathing and physical exercise on pulmonary functions, apnea-hypopnea index (AHI), and quality of life in patients with obstructive sleep apnea syndrome (OSAS).
Twenty patients with mild to moderate OSAS were included in the study either as exercise or control group. The control group did not receive any treatment, whereas the exercise group received exercise training. Exercise program consisting of breathing and aerobic exercises was applied for 1.5 h 3 days weekly for 12 weeks. Two groups were assessed through clinical and laboratory measurements after 12 weeks. In the evaluations, bicycle ergometer test was used for exercise capacity, pulmonary function test, maximal inspiratory-expiratory pressure for pulmonary functions, polysomnography for AHI, sleep parameters, Functional Outcomes of Sleep Questionnaire (FOSQ), Short Form-36 (SF-36) for quality of sleep and health-related quality of health, Epworth Sleepiness Scale for daytime sleepiness, and anthropometric measurements for anthropometric characteristics.
In the control group, the outcomes prior to and following 12-weeks follow-up period were found to be similar. In the exercise group, no change was found in the anthropometric and respiratory measurements (P > 0.05), whereas significant improvements were found in exercise capacity, AHI, and FOSQ and SF-36 (P < 0.05). After the follow-up period, it was shown that improvement in the experimental group did not lead to a statistically significant difference between the two groups (P > 0.05).
Exercise appears not to change anthropometric characteristics and respiratory functions while it improves AHI, health-related quality of life, quality of sleep, and exercise capacity in the patients with mild to moderate OSAS.
Sleep And Breathing 11/2009; 15(1):49-56. DOI:10.1007/s11325-009-0311-1 · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present a case of mesencephalic cavernoma, which caused various interesting clinical symptoms. A 58-year-old man was admitted to the emergency unit with a history of sudden, bilateral ptosis. Neurological examination revealed bilateral ptosis-limited elevation of both eyes, limited depression and adduction of the left eye, and a monocular abducting nystagmus in the right eye. Computed tomography showed a small hematoma in the mesencephalon and magnetic resonance imaging revealed a cavernoma with a hemorrhage. The patient was treated conservatively. Three months later, his bilateral ptosis had resolved and both the depression and the adduction of the left eye had improved. A year later, ocular motility had normalized. He subsequently presented with obstructive hydrocephalus, which was resolved with endoscopic third ventriculostomy.
[Show abstract][Hide abstract] ABSTRACT: Introduction. Several co-morbid diseases have been shown to affect sexual functions in both genders. In the literature, sexual function status in men with obstructive sleep apnea syndrome (OSAS) has been studied; however, sexual functions in women with OSAS have not yet been studied. Aims. In this prospective study, we aimed to determine sexual function status in women with OSAS and its relationship with the disease parameters of OSAS. Methods. Women, who were diagnosed with OSAS with polysonmography performed in the sleep center of our university hospital, formed the study population. Women with any genital deformity, postmenopausal women, and women without a regular partner were excluded from the study. General demographic properties, medical histories, polysomnography parameters, and frequency of intercourse per month were noted for each patient. Patients completed the Sexual Function Questionnaire Version 2 (SFQ-V2) and Epworth Sleepiness Scale. The patients were grouped as mild, moderate, and severe OSAS according to the level of respiratory disturbance index (RDI). Main Outcome Measures. Scores of sexual function domains were determined from SFQ, and their relationships with parameters of polysomnography and demographics were studied. Results. Twenty-five patients were included in the study. Mean age was 48.1 +/- 2.7 years. All were married with a mean marriage duration of 25.6 +/- 3.3 years. Mean frequency of intercourse per month was 3.3 +/- 1.8. All domains of sexual functions except pain and enjoyment significantly decreased with increasing severity of OSAS. When we controlled for factors of age and co-morbid diseases, correlation analyses showed significant negative correlation between levels of RDI and all domains of sexual functions except pain and enjoyment (P < 0.05). Conclusions. Obstructive sleep apnea syndrome negatively impacts sexual function in women independent of age and associated co-morbid diseases.
Journal of Sexual Medicine 09/2007; 4(5):1352-1357. DOI:10.1111/j1743-6109.2006.00302x · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper introduces a three-stage procedure based on artificial neural networks for the automatic detection of epileptiform events (EVs) in a multichannel electroencephalogram (EEG) signal. In the first stage, two discrete perceptrons fed by six features are used to classify EEG peaks into three subgroups: 1) definite epileptiform transients (ETs); 2) definite non-ETs; and 3) possible ETs and possible non-ETs. The pre-classification done in the first stage not only reduces the computation time but also increases the overall detection performance of the procedure. In the second stage, the peaks falling into the third group are aimed to be separated from each other by a nonlinear artificial neural network that would function as a postclassifier whose input is a vector of 41 consecutive sample values obtained from each peak. Different networks, i.e., a backpropagation multilayer perceptron and two radial basis function networks trained by a hybrid method and a support vector method, respectively, are constructed as the postclassifier and then compared in terms of their classification performances. In the third stage, multichannel information is integrated into the system for contributing to the process of identifying an EV by the electroencephalographers (EEGers). After the integration of multichannel information, the overall performance of the system is determined with respect to EVs. Visual evaluation, by two EEGers, of 19 channel EEG records of 10 epileptic patients showed that the best performance is obtained with a radial basis support vector machine providing an average sensitivity of 89.1%, an average selectivity of 85.9%, and a false detection rate (per hour) of 7.5.
[Show abstract][Hide abstract] ABSTRACT: We studied motor cortical thresholds (TIs) and cortical silent periods (SPs) evoked by transcranial magnetic stimulation (TMS) in 110 epileptic patients. Sixty-two had primary generalised, 48 had partial type seizures. Fifteen out 110 patients were analysed both before and after anticonvulsant medication. Our aims were to evaluate the TI levels and the duration of SPs in patients with epilepsy and to determine the reliability of TMS in patients with epilepsy. There was no negative effect of TMS on the clinical status and EEG findings in patients with epilepsy. TIs obtained from patients with partial epilepsy were higher than those obtained from both controls and primary epileptics. The duration of SP in patients with primary epileptics was more prolonged than those obtained from controls. There was no correlation between EEG lateralisation and both SP duration and TI values. In de novo patient group, SP duration was significantly prolonged after anticonvulsant medication. We concluded that TMS is a reliable electrophysiological investigation in patients with epilepsy. The analysis of SP duration may be an appropriate investigation in monitoring the effect of anticonvulsant medication on the cortical inhibitory activity.
[Show abstract][Hide abstract] ABSTRACT: To find out whether there is a relationship between the headache characteristics and polysomnographic findings in patients with prediagnosis of the sleep apnea syndrome (SAS) and, if there is, to search for its possible cause.
Chronic morning headache is considered by many to be an important part of the SAS. Some reports support this relationship, and some do not.
We questioned 75 patients with SAS about headache. Headaches were classified according to the International Headache Society (IHS-88) system. We evaluated the relationship between headache and polysomnographic findings.
There was no statistically significant relationship between headache and apnea hypopnea index (AHI) or minimal oxygen saturation (P >.05).
We could not demonstrate a statistically significant relationship between headache, AHI, and minimal oxygen saturation in our patients with SAS.
Headache The Journal of Head and Face Pain 06/2004; 44(6):603-6. DOI:10.1111/j.1526-4610.2004.446009.x · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Thyroxine-induced epilepsy is a very rare condition occurring in epileptic patients. Here we report a boy with thyroxine-induced hypermotor seizure (HMS) following thyroxine administration for his central hypothyroidism secondary to surgery and cranial radiation for his brain tumor. After 3 years seizure-free period, he had repeated HMS, seven to eight attacks per day, after initiation L-thyroxine treatment. Following reduction of the daily thyroxine dose, his seizures decreased in frequency. To our knowledge, this is the first reported case of HMS associated with L-thyroxine administration.
[Show abstract][Hide abstract] ABSTRACT: It is well known that multiple sclerosis (MS) is a demyelinating disease of the central nervous system that mostly starts in the second to third decade. In the present study, we reviewed our own observations of the clinical and paraclinical features in the 36 of 890 (4.04%) MS patients whose symptoms started before 16 years of age. The average age at onset of the disease in these 36 patients was 12.9 years. In 18 patients, the disease onset was monosymptomatic. Diplopia and sensory disturbances were the most common initial manifestations and occurred in 27.7% of cases. Twenty-one patients (59%) had a relapsing and 11 patients (30.5%) had a secondary progressive course. On the last evaluation, the EDSS score was above 5 in 11 patients and it was below 5 in 21 patients. As a result of this study, we concluded that childhood onset MS does not significantly differ from that it has been typically seen in adults in terms of major clinical manifestations and course of disease.
Brain and Development 07/2003; 25(4):233-6. DOI:10.1016/S0387-7604(03)00034-2 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 12-year-old male with subacute sclerosing panencephalitis is presented. Magnetic resonance imaging revealed basal ganglia involvement without white matter changes for several months. Basal ganglia changes are not infrequent in subacute sclerosing panencephalitis, but they tend to appear in advanced clinical stages. Prominent basal ganglia involvement may occur very rarely in subacute sclerosing panencephalitis. In our patient, serial magnetic resonance imaging demonstrated the involvement of white matter after 2 years of magnetic resonance imaging follow-up. In contrast with the neuroradiologic progression, our patient's clinical status remained stable.
[Show abstract][Hide abstract] ABSTRACT: Hereditary motor and sensory neuropathy (HMSN) is a heterogeneous group of peripheral neuropathies which are diagnosed on the basis of clinical, electrophysiological and neuropathological findings. Among the hypertrophic demyelinating neuropathies, HMSN III is the most severe. It is often associated with de novo mutations in the genes encoding for peripheral myelin proteins. While peripheral nerve hypertrophy is an expected finding in HMSN III, cranial nerve hypertrophy is exceptional. Here we describe a mutation in the PMP22 gene in a 19-year-old man with infantile onset of sensory motor polyneuropathy without family history and multiple cranial nerve hypertrophy shown by cranial magnetic resonance imaging.
Journal of Neurology 04/2001; 248(3):193-6. DOI:10.1007/s004150170225 · 3.38 Impact Factor