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Background: The thalamus is known as the central sensory and motor relay station of the brain generally. However, cognitive decline due to thalamic lesions has been previously reported in different studies. Also, it has been observed that different cognitive subdomains are affected according to the localization of the lesion in the thalamus. Objectives and Methods: Detailed neurophysiological tests were performed on 28 patients with thalamic hemorrhage and the control group. Patients were grouped according to lesion localization. The results were compared with both the control group and the hemorrhage groups themselves. Results: The performance of patients in all neuropsychological tests was significantly worse than that of the control group. Of the 28 patients, 15 had anterolateral, 5 had posterolateral, 5 had dorsal, and 3 had an anteromedial thalamic hemorrhage. The anteromedial group had the worst scores of almost all tests. Also, 2 situations came to notice in these tests. First, the posterolateral group achieved a remarkably low mean in the recall subgroup of the MMSE tests and verbal memory process tests. Second, the anterolateral group was found to have a low mean in both the language subgroup of the MMSE tests and the phonemic subgroup of the verbal fluency tests. Conclusion: It was concluded in this study that thalamic hemorrhages affect cognition entirely regardless of the lesion localization. It was also observed that the lateral part of the thalamus was associated with language, the posterior part with memory, and the anteromedial part with the rest of the cognitive subdomains.

ObjectiveTo investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis.MethodsA total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences.ResultsCluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) years; p = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95); p < 0.001), and showed a better response to triptans (50.00% vs. 28.00; p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0%; p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0%; p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0%; p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) min; p=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) min; p = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0%; p< 0.001).ConclusionsCluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH.

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Abstract Background Although acute headache following COVID-19 vaccination is widely acknowledged, the long-term progression of these headaches remains poorly understood. Our objective was to identify various phenotypes of prolonged or worsened headaches associated with COVID-19 vaccination and document any changes in these phenotypes over an extended period. Additionally, we aimed to document the diverse headache presentations among patients with pre-existing primary headaches. Methods A multinational, prospective observational study was conducted to investigate prolonged or worsened headaches associated with COVID-19 vaccination. Questionnaires assessing COVID-19 vaccination-related headaches at three time points (initial visit, 3rd month follow-up, and 6th month follow-up) were developed for the study. Headache specialists/clinicians evaluated patients using these questionnaires in a prospective manner. Repeated K-means cluster analysis was performed to identify patient profiles with prolonged or worsened headaches related to COVID-19 vaccination. Results Among the 174 patients included in the study, there was a female-to-male ratio of 128 (73.6%) to 46 (26.4%). The mean age of the patient group was 45.2 ± 13.3 years, and 107 patients (61.5%) had a pre-existing history of primary headaches. Through the analysis, two major clusters were identified based on headache characteristics at each visit. During the first visit (n = 174), Cluster 1 primarily comprised patients with a history of primary headaches, frontal localization of pain, throbbing pain type, more severe headaches accompanied by symptoms such as nausea, phonophobia, photophobia, and osmophobia, and worsened by physical activity. In contrast, Cluster 2 consisted of patients with longer headache durations (over one month) and a stabbing/pressing quality of pain. Patients in Cluster 1 had a higher prevalence of migraine as the pre-existing primary headache disorder compared to Cluster 2 (90.48% vs. 68.18%, respectively; p = 0.005). Conclusion The identification of two distinct phenotypes of prolonged or worsened headaches related to COVID-19 vaccination can provide valuable clinical insights. Having an awareness of the potential worsening of headaches following COVID-19 vaccination, particularly in patients with a primary headache disorder such as migraine, can help clinicians and headache experts anticipate and adjust their treatment strategies accordingly. This knowledge can aid in preplanning treatment modifications and optimize patient care.

Multiple sclerosis (MS) is one of the chronic and neurodegenerative diseases of the central nervous system (CNS). It generally affects motor, sensory, cerebellar, cognitive, and language functions. It is thought that identifying MS speech disorders using quantitative methods will make a significant contribution to physicians in the diagnosis and follow-up of MS patients. In this study, it was aimed to investigate the speech disorders of MS via objective speech analysis techniques. The study was conducted on 20 patients diagnosed with MS according to McDonald’s 2017 criteria and 20 healthy volunteers without any speech or voice pathology. Speech data obtained from patients and healthy individuals were analyzed with the PRAAT speech analysis program, and classification algorithms were tested to determine the most effective classifier in separating specific speech features of MS disease. As a result of the study, the K-nearest neighbor algorithm (K-NN) was found to be the most successful classifier (95%) in distinguishing pathological sounds which were seen in MS patients from those in healthy individuals. The findings obtained in our study can be considered as preliminary data to determine the voice characteristics of MS patients.

Aims:Many neurological symptoms and complications, including stroke, may develop during Coronavirus disease-2019 (COVID-19). This study evaluated the risk, timing, prognosis, relationship between stroke and COVID-19, and treatment modalities of stroke due to COVID-19 by examining stroke patients with COVID-19.Methods:This retrospective cross-sectional study included 12 patients aged ≥18 years with acute ischemic stroke and who were hospitalized with a confirmed diagnosis of COVID-19. In this study, demographic findings, clinical and stroke symptoms, stroke time, comorbid conditions that could pose a risk for stroke, inflammatory markers, D-dimer levels, imaging results, cardiologic evaluations, O2 need, administered treatments, intensive care support, and prognosis were recorded retrospectively from patient files.Results:Of the patients, 50% were male and 50% were female. The mean age was 70.6±9.3 (range, 55-84) years. The most common comorbid conditions were hypertension (58.3%) and diabetes mellitus (41.7%). Stroke developed at a median of 10.5 [interquartile range (IQR), 5-19.5] days after symptoms COVID-19. The mean National Institutes of Health Stroke Scale score was 7.8±4.7 (range, 3-18) (1-25). The average D-dimer and IL-6 levels of the patients were measured as 3.7 (IQR, 2.7-7.6) mg/L and 44.1±41.2 (range, 4.0-117) pg/mL, respectively. Most patients (66.7%) required oxygen during their hospitalization.Conclusions:Patients with a stroke due to COVID-19 infection have several risk factors, particularly diabetes mellitus and hypertension. They had increased D-dimer levels, and most patients had severe disease. These results suggested that COVID-19 triggered or facilitated stroke rather than being an independent cause.

Introduction: Coronavirus disease 2019 (COVID-19) is known to have higher morbidity and mortality rates, parallel to the increased risk factors in the elderly. We aimed to define the risk factors related to mortality and morbidity in older patients hospitalized with COVID-19 disease in this study. Materials and Methods: This retrospective cross-sectional study included patients aged ≥65 years who were hospitalized with a confirmed diagnosis of COVID-19. We analyzed their demographic data, clinical findings, comorbidities, laboratory and radiologic findings, treatment protocols, and outcomes. Results: A total of 58 patients were included in the study. A total of eight (13.8%) patients died during the clinical follow-up and treatment, and 50 (86.2%) patients were discharged. The most common comorbidities among all patients were hypertension (HT) (69%) and diabetes mellitus (39.7%). The most common symptoms include fever (51.7%), cough (44.8%), and dyspnea (43.1%), and the most common neurologic findings were headache (27.6%) and impaired consciousness (27.6%). Intensive care unit admission was significantly higher among patients with comorbidities of HT, cerebrovascular disease, atrial fibrillation (AF), and chronic obstructive pulmonary disease. The rate of death was significantly higher in patients with a history of smoking, cerebrovascular disease, AF, and HT. Although there was a statistically significant positive correlation between the death rate and leukocyte, neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer, interleukin-6, and procalcitonin levels, a negative correlation was observed in lymphocyte levels. Conclusion: Age-related comorbid conditions, especially HT, cerebrovascular disease, and AF, caused increased morbidity and mortality rates in older patients with COVID-19.

Migraine is a type of primary headache with recurrent attacks, negatively affects the daily living activities of sufferers because of its severity, and causes a heavy economic burden. The economic, social, and physical burdens of migraine grow with the increasing frequency of headache attacks. Mechanism-based treatments are increasingly needed, especially for those with chronic migraine (CM) or episodic migraine (EM) with frequent attacks. Conventional migraine-preventive medications have been essentially developed for some other diseases and shown to be also effective against migraine headaches. Efficacy, safety, and tolerability issues limit their use for an adequate duration, and most patients are under the risk of medication-overuse headache because of the ineffectiveness of attack treatments. In recent decades, a better understanding of migraine pathophysiology has given a new direction to migraine drug research to fulfill the unmet need for the development of migraine-specific medications. Calcitonin gene-related peptide (CGRP) has attracted attention with its potential role in migraine pathogenesis and has become the focus of drug research in this area as of the 1990s. The first monoclonal antibody developed and approved for the treatment of migraine is erenumab. Being the only therapeutic antibody against the CGRP receptor, erenumab differs from the other monoclonal antibodies for migraine prevention that target the CGRP ligand. Erenumab is a fully human, immunoglobulin G2 class monoclonal antibody with no immunomodulatory effect. It blocks the CGRP receptor with high affinity and selectivity and prevents binding of the CGRP ligand to this receptor. It does not have a significant effect on other receptors in the calcitonin receptor family. Erenumab has been shown to diminish the number of migraine days and the need for attack treatment and to improve patient-reported outcomes in patients with EM and CM.

Abstract Background and aim Pathogenesis of COVID-19 -related headache is unknown, though the induction of the trigeminal neurons through inflammation is proposed. We aimed to investigate key systemic circulating inflammatory molecules and their clinical relations in COVID-19 patients with headache. Methods This cross-sectional study enrolled 88 COVID-19 patients, hospitalized on a regular ward during the second wave of the pandemic. Clinical characteristics of COVID-19 patients were recorded, and laboratory tests were studied. Results The mean ages of 48 COVID-19 patients with headache (47.71 ± 10.8) and 40 COVID-19 patients without headache (45.70 ± 12.72) were comparable. COVID-19 patients suffered from headache had significantly higher serum levels of HMGB1, NLRP3, ACE2, and IL-6 than COVID-19 patients without headache, whereas CGRP and IL-10 levels were similar in the groups. Angiotensin II level was significantly decreased in the headache group. COVID-19 patients with headache showed an increased frequency of pulmonary involvement and increased D- dimer levels. Furthermore, COVID-19 was more frequently associated with weight loss, nausea, and diarrhea in patients with headache. Serum NLRP3 levels were correlated with headache duration and hospital stay, while headache response to paracetamol was negatively correlated with HMGB1 and positively associated with IL-10 levels. Conclusion Stronger inflammatory response is associated with headache in hospitalized COVID-19 patients with moderate disease severity. Increased levels of the circulating inflammatory and/or nociceptive molecules like HMGB1, NLRP3, and IL-6 may play a role in the potential induction of the trigeminal system and manifestation of headache secondary to SARS-CoV-2 infection.

Objectives: Chronic tension-type headache (TTH) is a serious disease that disrupts quality of life. In this study, the effect of prophylactic oral melatonin treatment on headache and cerebral vasomotor reactivity (VMR) was investigated in patients diagnosed with chronic TTH per the International Classification of Headache Disorders criteria. Subjects and Methods: Twenty patients with chronic TTH and 20 healthy individuals were included in the study. The patients were administered a melatonin treatment at 3 mg/day for 12 weeks. The number of monthly painful days and pain severity were recorded with the “Visual Analog Scale” before and after the treatment. Cerebral VMR measurements were performed at baseline in the control group and in patients before and after the treatment. Results: The median number of monthly painful days was 20 (15–27) before the treatment and 10 (4–18) after the treatment; the median pain severity score was 70.00 (45–80) before the treatment and 42.50 (15–75) after the treatment. The difference was statistically significant (P = 0.001). No statistically significant difference between the VMR values was observed (P > 0.05). Conclusions: Melatonin treatment was effective in reducing the pain severity and decreasing the number of monthly painful days in patients with chronic TTH but demonstrated no effect on the cerebral VMR.

Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of migraine headache. In the International Classification of Headache Disorders, CM is defined as a separate entity and the presence of drug overuse headache is removed from being an exclusion criterion. CM accounts for more than 10% of all migraine patients and includes the group with the most prominent disease-related disability. Diagnosis is often overlooked and most patients do not receive appropriate treatment. CM is associated with social and economic burdens such as frequent use of health services, drug overuse, and significant disruption to work and school life. Compared with episodic migraine, more frequent comorbid disorders are important in migraine chronicity, treatment, and course. With appropriate treatment in CM, it is possible to increase the quality of life of the patient and to reduce the social economic burden associated with migraine. In this review, the disease burden of CM, accompanying comorbid diseases, and current treatment options are reviewed.

Objectives:The aim of this study was to retrospectively evaluate the efficacy and safety of lacosamide (200-300-400 mg/day) as adjunct treatment in patients with uncontrolled focal-onset seizures taking 2 or more antiepileptic drugs (AED).Methods:The medical records of patients with uncontrolled focal epilepsy who received lacosamide as add-on therapy for at least 6 months was reviewed retrospectively. The demographic data, the doses of lacosamide, concomitant AED therapy, and seizure activity in first and sixth months were analysed.Results:A total of 83 patients were evaluated. The mean percent reduction in seizure frequency per month was 38.98% in the first month and 33.22% in the sixth month. In all, 53% of the patients had a decrease in seizures of 50% or more in the first month, and 47% saw a similar decrease in the sixth month . The percentage of those taking a sodium channel blocking AED in addition to lacosamide was 97.6%. Dose-related adverse events reported included dizziness, nausea, diplopia, gastroenterological side effects, headache, itchy skin, and blurred vision. It was determined that all of the patients with drug-related side effects were taking a sodium channel blocking AED concomitantly with lacosamide.Conclusion:Adjuvant treatment with lacosamide reduced seizure frequency for patients with uncontrolled focal-onset seizures.

Sleep-wake disturbances are highly prevalent and often become persistent sequelae after traumatic brain injury. The most common disturbances are insomnia, excessive daytime sleepiness, and increased sleep need (pleiosomnia). Circadian rhythm sleep-wake disturbances and parasomnias are more rare disturbances. These disorders can affect the treatment process and exacerbate other problems such as cognitive, and psychiatric problems. Among these sleep disturbances, hypersomnia is the most damaging disorder for the patients functionality. In this case report, a patient who was complaining of increased sleep need after traumatic brain injury was presented.

Objective: Botulinum toxin type-A (BoNTA) has been considered a treatment option for CH. The aim of this study was to assess the effectiveness of BoNTA treatment in patients with medically resistant CH.Materials and Methods: Forty patients with CH were included in the study. Patients in the BoNTA group (n=20) were administered 10 U of BoNTA bilaterally to the frontal muscles, 20 U to the temporal muscles, 15 U to the semispinalis capitis, 15 U to the splenius capitis, and 15 U to the trapezius muscles (total: 150 U). Patients in the placebo group (n=20) received 0.2 mL of saline administrated to the same sites. All participations were evaluated 6 and 12 weeks after treatment; side effects, the number of painful days, severity (by visual analogue scale, VAS) and frequency of pain were evaluated.Results: In the BoNTA group, the severity and frequency of pain 6 and 12 weeks post treatment were significantly lower than pre-treatment levels (p

Conjunctival injection and tearing with unilateral short lasting neuralgiform headache syndrome is called as SUNCT. Even though these headaches are reported seldomly, the prevalence is possibly higher than known. It is of importance to recognize these uncommon disorder, since its management differs from common primary headaches. Until today, it was reported to be treated with different types of drugs. We here reported a 30 years old male patient with normal neurological examination, blood examination and neuroimaging. Our patient gave no response to indomethacin, gabapentine and carbamazepine treatments. This case is an example of SUNCT case treated with steroid