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BackgroundMigraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert.MethodsIn this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis.ResultsLonger headache duration (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone.ConclusionLonger headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.

Coronavirus disease 2019 (COVID-19) can be spread rapidly and can be seen in a wide section of society at any age, affecting the whole society, as well as patients with epilepsy. A virus may cause neurological involvement, as well as systemic involvement. There is no evidence that COVID-19 disease triggers or worsens existing epileptic seizures. Seizures can be triggered secondary to the disease. Likewise, it is understood that individuals with epilepsy are not more likely to contract COVID-19 disease, and have not had the disease more seriously. Unless there are additional problems that pose a risk for COVID-19, the antiepileptic drugs used by patients do not pose a risk for infection. When it is necessary to use hydroxychloroquine, azithromycin and similar drugs in the treatment of COVID-19, antiepileptic treatment is recommended to be reviewed and properly regulated. Conditions, such as the use of cold medicines can increase the risk of seizures due to the pseudoephedrine they contain, and the risk of infection with immunomodulating drugs should be specially addressed. The risk of contamination is highest in places like hospital units, especially emergency units. Therefore, measures should be taken to prevent situations that may lead to the unnecessary application of people to the hospitals and the emergency units. During the epidemic period, individuals will try to obtain information using media, social media and websites. That is why it is crucial for health institutions and authorities to provide accurate information and guide the people during the epidemic. Informing people will allow patients to see the risks of the COVID epidemic more accurately and help prevent unnecessary anxiety.

Elmali, Ayse Deniz/0000-0001-6380-9550 WOS:000560002600002 Coronavirus disease 2019 (COVID-19) can be spread rapidly and can be seen in a wide section of society at any age, affecting the whole society, as well as patients with epilepsy. A virus may cause neurological involvement, as well as systemic involvement. There is no evidence that COVID-19 disease triggers or worsens existing epileptic seizures. Seizures can be triggered secondary to the disease. Likewise, it is understood that individuals with epilepsy are not more likely to contract COVID-19 disease, and have not had the disease more seriously. Unless there are additional problems that pose a risk for COVID-19, the antiepileptic drugs used by patients do not pose a risk for infection. When it is necessary to use hydroxychloroquine, azithromycin and similar drugs in the treatment of COVID-19, antiepileptic treatment is recommended to be reviewed and properly regulated. Conditions, such as the use of cold medicines can increase the risk of seizures due to the pseudoephedrine they contain, and the risk of infection with immunomodulating drugs should be specially addressed. The risk of contamination is highest in places like hospital units, especially emergency units. Therefore, measures should be taken to prevent situations that may lead to the unnecessary application of people to the hospitals and the emergency units. During the epidemic period, individuals will try to obtain information using media, social media and websites. That is why it is crucial for health institutions and authorities to provide accurate information and guide the people during the epidemic. Informing people will allow patients to see the risks of the COVID epidemic more accurately and help prevent unnecessary anxiety.

WOS:000556540500002 Since December 2019, the disease caused by a new type of coronavirus called “New Coronavirus Disease (COVID-19)” has spread rapidly from Wuhan to other provinces of the Republic of China, and then to the entire world (1). With this pandemic around the world and in Turkey, very strong and shocking changes occurred in the flow of life, lifestyle, habits, education, politics, and the economy. Many issues related to COVID-19 have been discussed in the media, mostly new faces, new opinions, new expressions, mostly of scientists and physicians who have rarely been seen before have started to appear in media. With this fast-developing situation threatening the existence of all humanity, the perception of life, today and the future, has differentiated, and death has been considered more than ever before. In this process, new terms and concepts, which have never been used before or used very little, have started to be used frequently

Subakut sklerozan panensefalit (SSPE), kızamık infeksiyonundan yıllar sonra ortaya çıkan, mental kötüleşme, davranış değişiklikleri, miyoklonus ve nörolojik yıkımla seyreden bir hastalıktır. Biz akut konfüzyon ile başlayıp sıradışı radyolojik özellikler gösteren atipik bir SSPE olgusunu sunmayı amaçladık. Öncesinde sağlıklı olan 10 yaşında bir kız çocuğu bir haftadır devam eden baş ağrısı ve sürekli uyku hali ile başvurdu. Dokuz aylıkken kızamık enfeksiyonu öyküsü mevcuttu. Letarjik olup plantar refleks yanıtları bilateral ekstansördü. Sistemik muayene ve rutin biyokimyasal değerlendirmesi normaldi. Beyin manyetik rezonans görüntülemesinde (MRG) beyin sapından serebellar beyaz cevhere uzanan hiperintens lezyonlar görüldü. Rutin beyin omurilik sıvı incelemesi normal olup oligoklonal bantı pozitif, IgG indeksi> 0,7 idi. BOS kızamık antikor titreleri kuvvetli pozitif idi. Elektroensefalografisinde organizasyon bozukluğu ve jeneralize yavaş dalgaları görüldü. Intravenöz (IV) metilprednizolon 5 gün süre ile verildi. Anlamlı bir klinik yanıt alınamadığından IV immunoglobulin tedavisine geçildi. 2.haftada çekilen beyin MRG kontrolünde önceki lezyonlarında artış gözlendi. 4. haftada hasta ani kardiyak arrest nedeniyle kaybedildi. Sonuç: Akut fulminan seyir, beyin sapı ve serebellum tutuluşu SSPE için nadirdir. Baş ağrısı ve akut bilinç değişikliği ile başvuran, kranial görüntülemelerinde atipik bulgular saptanan olgularda subakut sklerozan panensefalit akılda tutulmalıdır., Subacute sclerosing panencephalitis (SSPE) is a progressive disease characterized by mental-neurological deterioration and myoclonus, occurring after years of measles infection. Herein, we report an atypical SSPE case presented with acute confusion and headache which showed atypical radiological features. Case: A 10-year-old previously healthy girl was admitted with headache and constant sleepiness for a week. She had a history of measles infection at the age of nine months. She was lethargic and plantar reflexes were bilaterally indifferent. Systemic examination and routine biochemical evaluation were in normal limits. Brain magnetic resonance imaging (MRI) showed hyperintense lesions extending from brain stem to cerebellar white matter. Routine cerebrospinal fluid (CSF) examination was in normal limits with positive oligoclonal band and IgG index>0,7. CSF measles antibody titers were strongly positive. Her electroencephalography revealed disorganized back ground and generalized slow waves. Intravenous (IV) metilprednizolone was given for 5 days. Because of no significant clinical response, the treatment was switched to IV immunoglobuline. At the second week, following MRI showed extention of previous lesions. On the 4th week of presentation, myoclonus began, the patient developed sudden cardiac arrest and died. Conclusion: Acute fulminant course and involvement of brainstem and cerebellum is rare in SSPE. Differential diagnosis may be difficult from other acute confusional states. This case report seeks to draw attention to the neccessity of keeping the subacute sclerosing panencephalitis in mind while considering the differential diagnosis in patients with headache and acute altered mental state with atypical findings on the brain imaging

ÖZETAyta, Semih. Rett Sendromlu Olgular n Elektrofizyolojik Özellikleri.stanbul Üniversitesi Sa$l k Bilimleri Enstitüsü, Nörolojik Bilimler Anabilim Dal .Yüksek Lisans Tezi. stanbul. 2006.Anahtar Kelimeler: Rett Sendromu, Yayg n Geli2imsel Bozukluk, EEG,Elektroensefalografi, Epileptiform AktiviteBu çal 2mada klinik ve genetik olarak Rett sendromu tan s alm 2 12 k z olgunun,özellikle EEG bulgular n n incelenmesi ve sonuçlar n hastal k hakk ndayay nlanm 2 bilgiler e2li$inde de$erlendirilmesi amaçlanm 2t r.Çal 2maya al nan RS tan l 12 k z olgunun ya2lar 3 y l 1 ay-16 y l 8 ay aras nda,ortalama ya2 7 y l 1 ay bulunmu2tur.Olgular n öykülerinden ö$renilen ba2lama ya2 2-24 ay aras nda (ortalama 15 ay),çocuk nörolojisi poliklini$ine getirilme ya2lar ise 1.8-16.6 aras nda (ortalama 4.5ya2) olarak belirlenmi2tir.Epileptik nöbetlerin varl $ 9 (%75) olguda kaydedilmi2tir. Bu 9 olgudan 6's ndajeneralize konvülsiyonlar, 2'sinde ek olarak absanslar, 1'inde jeneralizekonvülsiyonlar ve miyokloniler tan mlanm 2t r. Nöbet öyküsü olan bu olgular ntümü AE al yordu.Sistemik, nörolojik, psikiyatrik muayene ve de$erlendirmeler ile tüm olgular nk zlarda görülen klasik RS tan kriterlerini kar2 lad klar saptanm 2t r.Gesell geli2im testi veya Denver geli2im tarama envanteri sonuçlar , olgular n dil,sosyalizasyon ve motor alanlarda a$ r düzeyde geri olduklar n göstermekteydi.Tüm olgular n rutin kan ve idrar incelemeleri normal s n rlar içinde, do$umsalmetabolik hastal k (DMH) tarama testleri normal bulundu.Kraniyal MR görüntülemeleri -bir olguda gözlenen kavum septum pelusidumvaryasyonu d 2 nda- normaldi.lk EEG incelemeleri yap ld $ s rada 10 olgunun II. evrede, 2 olgunun III. evredeoldu$u saptand .lk EEG'ler 5 olguda normal s n rlar içinde bulundu; temel aktiviteleri (TA) yeterliolan bu olgular n 4'ü inceleme s ras nda II. evrede, biri III. evredeydi.Ba2lang ç EEG'leri s ras nda 5'i II., biri III. evrede olmak üzere toplam 6 olgudasentral dikenler ve/veya mültipl dikenler saptand . Bu ilk EEG incelemeleridöneminde II. evrede olup sentral dikenler izlenen 5 olgudan 2'inde TA yeterli,3'ünde yetersiz bulundu. lk EEG'de sentral dikenleri olan III. evredeki olguda iseTA yetersizdi.lk EEG'si yap ld $ nda II. evrede olan bir olguda sentral dikenler yoktu.Bu olgunun IV. evredeki EEG'sinde, her iki fronto-sentral bölgelerde mültipl diken-yava2 dalgalar ile ayn bölgelerde 3.5-4 Hz frekans nda yava2 dalga dizilerisaptand . Ayn olgunun farkl iki dönemdeki bu EEG'lerinde TA yetersizdi.zlem süresinde evre II'den evre III'e geçen 4 olguda sentral dikenlerin devametti$i görüldü. Bu olgular n 2'sinde ayr ca seyrek jeneralize epileptiform de2arjlarizlendi.Rett sendromunun kesin tan s günümüzde genetik olarak mutasyonun gösterilmesiile konulmaktad r. Ancak klinisyenlerin genetik incelemeye yönlendirecekleriolgular n seçimi için bu hastal $ n tan kriterlerini ve klinik evrelemesini iyibilmeleri gerekmektedir. Destekleyici tan kriterleri aras nda, bu olgularda %50-90s kl $ nda görülen epileptik nöbetler ile hastal $ n evrelerine göre de$i2en EEGanormallikleri de say lmaktad r. RS'lu olgularda nöbetlerin varl $ veyayoklu$undan ba$ ms z olarak ortaya ç kan EEG bulgular n n saptanmas ,de$erlendirilmesi amac yla elektrografik takiplerin yap lmas n n hem klinik pratikteyard mc olaca$ , hem de bilimsel veri birikimi aç s ndan katk da bulunaca$kan s nday z. ABSTRACTAyta, Semih. Electrophysiological Characteristics in Patients with RettSyndrome. Istanbul University The Institute of Medical Sciences. $stanbul. 2006.Key Words: Rett Syndrome, Pervasive Developmental Disorder, EEG,Electroencephalography, Epileptiform ActivityThis study aims to search the EEG findings of twelve (12) patients clinically andgenetically diagnosed to have Rett syndrome (RS) and to evaluate these resultsunder the scope of latest literature data.The ages of these 12 female patients with the diagnosis of RS ranged between 3years 1 month and 16 years 8 months, the average age was calculated to be 7 years1 month.The first signs of the syndrome develop between the 2nd-24th months, the averagebeing 15 months; and the children first apply to the neurology outpatient clinics atthe age of 1.8- 16.6 yrs, the average age being 4.5 yrs.Epileptic seizures were present in 9 of the 12 cases (%75). Among these 9 patients,6 had generalized convulsions, 2 of them additionally had absence seizures and oneof them had generalized convulsions along with myoclonic seizures. All of thesecases with the history of convulsions were on treatment with AEDs.The systemic, neurologic and physchiatric examinations and evaluations of these12 cases matched with the classical diagnostic criteria of RS in females.Gesell and Denver development tests applied to these 12 patients showed thatthese cases were severely retarded in terms of language, socialization and motorareas.The routine blood and urine analysis of our patients were all within normal limits,screening for inborn errors of metabolism were all negative.The cranial MR results of these 12 cases were all normal apart from one with thevariation of cavum septum pellusidum.When the first EEG recordings were obtained, 10 of these cases were evaluated tobe stage II, and the remaining 2 patients were stage III.The first EEG recordings of 5 patients were found to be normal, the backgroundactivity (BA) was appropriate of age. 4 of these patients were stage II and just oneof them was stage III.The remaining 6 patients found to have abnormalities in their first EEG recordingspresented with central spikes and/or multiple spikes. Five of these patients werestage II ,and just one of them was stage III. Among the stage II patients with centralspikes, 2 had appropriate BA and 3 had inappropriate BA of age. The only stage IIIpatient with central spikes had inappropriate BA of age.One of these patients was a stage II patient with no central spikes at the time offirst EEG recording. The EEG was repeated when the patient was at stage IV, bothfronto-central areas showed multiple spikes, slow waves and the same areasshowed 3.5-4 Hz frequency slow wave patterns. Both of the EEG's obtained showedinadequate background although recorded at different stages of the same patient.During the observation period, 4 cases proceeded from stage II to stage III, and thecentral spikes continued to be present. In addition, two of these cases seldomly hadgeneralized epileptiform changes.The definite diagnosis of Rett syndrome can be reached only when the geneticmutation is shown. However, the clinicians need to be aware of the diagnosticcriteria and the staging of this syndrome in order to accurately choose the rightpatient to undergo genetic work-up. The supporting diagnostic criteria is thefrequency (%50-90) of epileptic seizures in these patients and EEG abnormalitiesshowing variations according to the stage of the syndrome. EEG recordings shouldbe obtained in RS patients in spite of the absence or presence of seizures. The EEGfollow-up will be helpful for the clinical management of these patients as well asmaking an important contribution for the gathering of scientific information. 46

Subacute sclerosing panencephalitis SSPE is a progressive disease characterized by mental-neurological deterioration and myoclonus, occurring after years of measles infection. Herein, we report an atypical SSPE case presented with acute confusion and headache which showed atypical radiological features. Case: A 10-year-old previously healthy girl was admitted with headache and constant sleepiness for a week. She had a history of measles infection at the age of nine months. She was lethargic and plantar reflexes were bilaterally indifferent. Systemic examination and routine biochemical evaluation were in normal limits. Brain magnetic resonance imaging MRI showed hyperintense lesions extending from brain stem to cerebellar white matter. Routine cerebrospinal fluid CSF examination was in normal limits with positive oligoclonal band and IgG index>0,7. CSF measles antibody titers were strongly positive. Her electroencephalography revealed disorganized back ground and generalized slow waves. Intravenous IV metilprednizolone was given for 5 days. Because of no significant clinical response, the treatment was switched to IV immunoglobuline. At the second week, following MRI showed extention of previous lesions. On the 4th week of presentation, myoclonus began, the patient developed sudden cardiac arrest and died. Conclusion: Acute fulminant course and involvement of brainstem and cerebellum is rare in SSPE. Differential diagnosis may be difficult from other acute confusional states. This case report seeks to draw attention to the neccessity of keeping the subacute sclerosing panencephalitis in mind while considering the differential diagnosis in patients with headache and acute altered mental state with atypical findings on the brain imaging, Subakut sklerozan panensefalit SSPE , kızamık infeksiyonundan yıllar sonra ortaya çıkan, mental kötüleşme, davranış değişiklikleri, miyoklonus ve nörolojik yıkımla seyreden bir hastalıktır. Biz akut konfüzyon ile başlayıp sıradışı radyolojik özellikler gösteren atipik bir SSPE olgusunu sunmayı amaçladık. Öncesinde sağlıklı olan 10 yaşında bir kız çocuğu bir haftadır devam eden baş ağrısı ve sürekli uyku hali ile başvurdu. Dokuz aylıkken kızamık enfeksiyonu öyküsü mevcuttu. Letarjik olup plantar refleks yanıtları bilateral ekstansördü. Sistemik muayene ve rutin biyokimyasal değerlendirmesi normaldi. Beyin manyetik rezonans görüntülemesinde MRG beyin sapından serebellar beyaz cevhere uzanan hiperintens lezyonlar görüldü. Rutin beyin omurilik sıvı incelemesi normal olup oligoklonal bantı pozitif, IgG indeksi> 0,7 idi. BOS kızamık antikor titreleri kuvvetli pozitif idi. Elektroensefalografisinde organizasyon bozukluğu ve jeneralize yavaş dalgaları görüldü. Intravenöz IV metilprednizolon 5 gün süre ile verildi. Anlamlı bir klinik yanıt alınamadığından IV immunoglobulin tedavisine geçildi. 2.haftada çekilen beyin MRG kontrolünde önceki lezyonlarında artış gözlendi. 4. haftada hasta ani kardiyak arrest nedeniyle kaybedildi. Sonuç: Akut fulminan seyir, beyin sapı ve serebellum tutuluşu SSPE için nadirdir. Baş ağrısı ve akut bilinç değişikliği ile başvuran, kranial görüntülemelerinde atipik bulgular saptanan olgularda subakut sklerozan panensefalit akılda tutulmalıdır.

Objective. Comparison of ultrasound (US)-guided erector spinae plane block (ESPB) and serratus anterior plane block (SAPB) in video-assisted thoracic surgery (VATS) patients. The primary outcome was to compare perioperative and postoperative (48 hours) opioid consumption. Methods. A total of 60 patients were randomized into two groups (N =30): an ESPB group and an SAPB group. All the patients received intravenous patient-controlled postoperative analgesia and ibuprofen 400 mg intravenously every eight hours. Visual analog scale (VAS) scores, opioid consumption, and adverse events were recorded. Results. Intraoperative and postoperative opioid consumption at 0-8, 8-16, and 16-24 hours and rescue analgesic use were significantly lower in the ESPB group (P< 0.05). Static/dynamic VAS scores were significantly lower in the ESPB group (P< 0.05). There was no significant difference between static VAS scores at the fourth hour. There were no differences between adverse effects. Block procedure time and one-time puncture success were similar between groups (P > 0.05 each). Conclusion. US-guided ESPB may provide better pain control than SAPB after VATS. Question. Even though there are studies about analgesia management after VATS, clinicians want to perform the technique that is both less invasive and more effective. Findings. This randomized trial showed that US-guided ESPB provides effective analgesia compared with SAPB. Meaning. Performing single-injection ESPB reduces VAS scores and opioid consumption compared with SAPB.

Purpose: To further evaluate the previously shown linkage of absence epilepsy (AE) to 2q36, both in human and WAG/Rij absence rat models, a 160-kb region at 2q36 containing eight genes with expressions in the brain was targeted in a case-control association study involving 205 Turkish patients with AE and 219 controls. Methods: Haplotype block and case-control association analysis was carried out using HAPLO VIEW 4.0 and inhibin alpha subunit (INHA) gene analysis by DNA sequencing. Key Findings: An association was found between the G allele of rs7588807 located in the INHA gene and juvenile absence epilepsy (JAE) syndrome and patients having generalized tonic-clonic seizures (GTCS) with p-values of 0.003 and 0.0002, respectively (uncorrected for multiple comparisons). DNA sequence analysis of the INHA gene in 110 JAE/GTCS patients revealed three point mutations with possible damaging effects on inhibin function in three patients and the presence of a common ACTC haplotype (H1) with a possible dominant protective role conferred by the T allele of rs7588807 with respective p-values of 0.0005 and 0.0014. Significance: The preceding findings suggest that INHA could be a novel candidate susceptibility gene involved in the pathogenesis of JAE or AE associated with GTCS.