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Hemifacial Spasm is often described as a chronic disease that occurs unilaterally with periodic clonic or tonic contractions of the facial muscles. Carbamazepine, clonazepam, nerve block, myectomy, facial nerve neuroctomy, neurosurgical microvascular decompression and botulinum toxin application may be listed as the preferred methods and agents for treatment. Botulinum toxin application is preferred more than medical treatment because it has longer duration of effect, easier to apply and better side effect profile. Botulinum toxin causes paralysis in muscles. This effect is dose-dependent by inhibiting the release of acetylcholine from the terminal membrane. A rare side effect of botulinum toxin application is atrophy, which occurs in applied muscles. Although there is no definitive data on the mechanisms of atrophy development, it is known that this effect occurs with chronic applications. In addition, muscle fiber type, schwann and satellite cell count, mitochondrial mechanisms, and blood perfusion in the muscle were evaluated for the risk of developing atrophy. In this case, a patient who developed atrophy in the facial muscles after chronic botulinum toxin administration was discussed., Hemifasial Spazm sıklıkla tek taraflı olarak, fasial kasların periyodik klonik ya da tonik kasılmalarıyla seyreden, kronik bir hastalık olarak tanımlanmaktadır. Tedavisinde karbamazepin, klonazepam, sinir bloğu, miyektomi, fasial sinir nöroktomi, nöroşirurjik mikrovaskuler dekompresyon ve botulinum toksin uygulaması sık tercih edilen yöntem ve ajanlar olarak sıralanabilir. Botulinum toksin uygulaması; etki süresinin daha uzun olması, uygulanması kolay ve yan etki profilinin daha iyi olması sebebiyle medikal tedaviye göre daha fazla tercih edilmektedir. Botulinum toksini kaslarda paralizi meydana getirir. Bu etkisini doz bağımlı olarak terminal membrandan asetilkolin salınımını inhibe ederek gösterir. Botulinum toksin uygulamasının nadir görülen bir yan etkisi de uygulanan kaslarda meydana gelen atrofidir. Atrofi gelişim mekanizmaları hakkında kesin bir veri olmamakla birlikte bu etkinin kronik uygulamalar ile gerçekleştiği bilinmektedir. Bunun yanında kas lifi tipi, schwann ve satellit hücre sayısı, mitokondriyel mekanizmalar, kastaki kan perfüzyonu gibi faktörler atrofi gelişim riski açısından değerlendirilmiştir. Sunmuş olduğumuz bu olguda kronik botulinum toksin uygulamaları sonrasında yüz kaslarında atrofi gelişen bir hasta ele alınmıştır.

WOS: 000438988100003 Objectives: Epilepsy and headache are common paroxysmal neurological disorders. Headache can occasionally be the sole symptom of a seizure. In addition, postictal headaches frequently occur after complex partial and generalized tonic-clonic seizures. The objective of this study was to determine the prevalence of interictal headache in patients with epilepsy presenting at an outpatient epilepsy clinic. Methods: This prospective study included 86 adult patients who were diagnosed with epilepsy and followed up at a neurology clinic. Results: A total of 86 patients with epilepsy (54 females, 32 males) were included. The type of headache in 41 (47.6%) patients was a tension-type headache (TTH) (n=14, 16.3%), migraine with aura (n=12, 13.9%), migraine without aura (n=11, 12.8%), TTH + stabbing headache (n=1, 1.2%), cluster headache (1.2%), and other primary headaches (n=2, 2.4%). Conclusion: Patients with epilepsy often have headaches, particularly a migraine headache. Headache in patients with epilepsy may be overlooked during follow-up in the outpatient clinic setting, and this can adversely affect the quality of life of these patients.

Valproic acid is a branched-chain carboxylic acid construct used as anantiepileptic agent. Side effects can be listed as nausea, vomiting, alopecia,weight gain, asymptomatic increase in liver function tests, fulminant hepatitis,sedation, ataxia, tremor, pancreatitis, cardiac arrhythmia, thrombocytopenia,hyperammonemia and encephalopathy. Valproate-associated encephalopathy is oftencharacterized by impairment in change of consciousness, apathy, irritability,confusion, and impaired liver function. This table is accompanied with a highlevel of ammonia in the blood. Rarely, encephalopathy may occur withouthyperammonemia and irrespective of serum valproate level. Typical clinicalfindings in this case report were supported by EEG records and serum ammonialevel was found to be normal in our patient. Valproate Encephalopathy withoutHyperammonemia was diagnosed. Clinical improvement after cessation of valproatetreatment was also demonstrated by EEG findings and the diagnosis wassupported., Valproik asit antiepileptik ajan olarakkullanılan dallı zincirli karboksilik asit yapısında bir ajandır. Yan etkileri; bulantı, kusma, alopesi, kiloalımı, asemptomatik olarak karaciğer fonksiyon testlerinde artış, fulminanhepatit, sedasyon, ataksi, tremor, pankreatit, kardiyak aritmi, trombositopeni,hiperammonemi ve ensefalopati tablosu olarak sıralanabilir. Valproat ileilişkili ensefalopati sıklıkla bilinç durumunda bozulma, apati, sinirlilik,konfüzyon, karaciğer fonksiyonlarında bozulma ile karakterize bir tablodur. Butabloya kan amonyak düzeyinde yükseklik sıklıkla eşlik eder. Daha nadir olarakise hiperammonemi görülmeden ve serum valproat düzeyine bağlı olmaksızın daensefalopati tablosu ortaya çıkabilir. Bildirmiş olduğumuz bu olguda tipikklinik bulgular; EEG kayıtları ile desteklenmiş, hastamızda serum amonyakdüzeyi normal bulunmuştur ve Hiperammonemi olmaksızın Valproat Ensefalopatisitanısına ulaşılmıştır. Sonrasında valproat tedavisinin kesilmesinin ardındangörülen klinik iyileşme, yine EEG bulgularıyla da ortaya konmuş, tanıdesteklenmiştir.

Refrakter Epilepsininerken tanısı, alternatif tedavi yaklaşımlarını uygulamak için çok önemlidir.Bununla beraber, refrakter epilepsinin yanlış tanısı sıktır. Yalancı-RefrakterEpilepsi yanlış tanı, yanlış ve/veya düşük doz antiepileptik ilaç kullanımı vehastanın kötü uyumuna bağlı nöbet kontrolündeki yetersizliktir. Bu çalışmanınamacı, gerçek ve yalancı refrakter epilepsi hastalarını incelemektir. Dört yüzkırk dokuz hastanın dosyaları (Mart 2014-Ocak 2017) aynı nörolog tarafındangeriye dönük olarak incelenmiştir ve gerçek refrakter ve yalancı refrakterepilepsi hastaları saptanmıştır. Yetmiş sekiz (%66.1) hastada gerçek refrakterepilepsi tespit edilmiştir. On dört (%11.9) hastada yanlış tanı mevcuttu; oniki (%10.2) hastada uygun olmayan tedavi alıyordu; onbir hasta (%9.3) yetersizdozda antiepileptik ilaç kullanıyordu, monoterapi alan üç hastada yetersiztedavi uyumuna sahipti. Gerçek veyalancı refrakter epilepsinin ayırıcı tanısı yetersiz tedavi yaklaşımlarında vegerçek refrakter epilepsinin gelecek tedavisinde çok önemlidir., Early recognition ofrefractory epilepsy is so important to apply alternative therapeutic approachto the patient. However, misdiagnosis of refractory epilepsy is common.Pseudo-Refractory epilepsy is defined as seizures inadequately treated due toincorrect diagnosis, use of incorrect and/or low dose antiepileptic drug (AED)and poor compliance of patients. The aim of the present paper was toinvestigate the patients with true and pseudo-refractory epilepsy. The files offour hundred and forty-nine patients (March 2014-January 2017) reviewed by thesame neurologist retrospectively and the patients with true andpseudo-refractory epilepsy were determined. Seventy-eight (66.1%) of the patients was with true refractory epilepsy.Fourteen (11.9%) patients had misdiagnosis; twelve (10.2%) patients usedinappropriate medicine; eleven (9.3%) patients was treated with inadequate doseof antiepileptic drug; three patients had poor compliance of treatment receivedmonotherapy. Differentiation of pseudo-refractory and true refractory epilepsyare very important for avoiding unnecessary treatment approaches and futuremanagement of true refractory epilepsy.

Epilepsi tüm yaş gruplarında görülebildiğinden, doğurganlık çağındaki kadınları da etkileyebilir. Epilepsili bir kadının tedavisi, epilepsili bir erkeğin tedavisinden farklıdır. Çünkü epilepsi ve tedavide kullanılan antiepileptik ilaçlar (AEİ) cinsel gelişimi, menstrual siklusu, kontrasepsiyonu, fertiliteyi, gebeliği, emzirmeyi ve menapozu etkileyebilir. Bu makalede kadın hastada epilepsi yönetimi tartışılacaktır., Since epilepsy can be seen in all age groups, it can also affect women of childbearing age. The treatment of epilepsy in women is very different from the treatment of men with epilepsy. Because epilepsy and antiepileptic drugs (AEDs) used in the treatment can affect sexual development, menstrual cycle, contraception, fertility, pregnancy, lactation and menopause. This article discusses the management of epilepsy in a female patient.

WOS: 000390945900006 Objectives: Demographic and clinical findings of patients with refractory epilepsy receiving treatment at the newly established epilepsy outpatient clinic of Mugla Sitki Kocman University Faculty of Medicine were evaluated. Methods: Records of patients treated at the epilepsy outpatient clinic between June 2014 and March 2016 were examined, and 60 patients with refractory epilepsy were included the study. Results: Mean age was 34.3 years. Of the total, 29 were men and 31 were women. Seizures of 50 patients were partial onset, while those of 3 were generalized. Fourteen patients had psychogenic seizures, and 1 patient was diagnosed with paroxysmal kinesigenic dyskinesia. The electroencephalogram (EEG) recording of 20 patients was normal. Partial epileptiform abnormalities were present in 24 patients, and generalized epileptiform abnormalities were seen in 1 patient. Treatment was modified in 45 patients. Four patients were seizure-free, 13 showed more than 50% reduction in seizure frequency, and 9 patients had less than 50% fewer seizures. It is thought that 34 patients have pharmacoresistant seizures. The cause of uncontrolled seizures was misdiagnosis in 5 patients, improper drug in 3 patients, and insufficient treatment dose in 5 patients. Conclusion: Accurate diagnosis and appropriate treatment with sufficient dose of drug selected according to type of seizure is important for patients with refractory epilepsy.

WOS: 000408863600003 Objectives: The aim of the present study was to evaluate demographic and clinical findings of patients who underwent follow-up at the newly established epilepsy outpatient clinic of the Mugla University Faculty of Medicine. Methods: Included were 208 patients who underwent follow-up at the clinic between March 2014 and September 2015. Results: Mean age was 29.42 +/- 15.86, with a range of 5-84 years. Eighty-three patients were men (39.9%); 125 were women (60.1%). The most common risk factors included head trauma, febrile convulsion, and family history of epilepsy. Seizures of 155 patients (75.5%) were partialonset, those of 22 (10.6%) were generalized, and those of 9 (4.3%) were unclassified. Sixty-seven patients (37.2%) had normal electroencephalogram, 96 patients (53.3%) had partial, and 10 patients (5.6%) had generalized epileptiform abnormalities. Of the 172 patients (28.5%) to whom antiepileptic drugs had been administered, 49 were resistant to medical treatment. Of the patients with modified therapy, 22 (41.5%) were seizure-free, 7 (13.2%) experienced >50% reduction in seizure frequency, and 8 experienced

WOS: 000389890700003 Objectives: The present study aimed to investigate the seasonal variability of AHI values among patients with sleep apnea. Patients and Methods: In order to conduct the retrospective study, we accepted 304 patients (223 male and 81 female) between May 2014 to May 2015 into our study at Mugla Sitki Kocman University Medical faculty of sleep disorders clinic. Patients were divided into four groups according to the timing of the PSG: winter, spring, summer, and autumn. Results: We reviewed the records of patients, including their PSGs, and found that their AHI values were comparable across seasons. The average AHI value for males was 34.95 +/- 29.95 and 21.88 +/- 2.76 for females; we observed no significant statistical difference among the four groups (both males and females) in terms of AHI. Conclusion: Although patient complaints increased due to exacerbation of diseases such as asthma and allergic rhinitis in the winter, this study did not reflect a significant change in AHI values. Therefore, PSG examinations do not need to be repeated in different seasons.

Movement disorders may appear after cerebrovascular events. Chorea is the most common movement disorders seen after the basal ganglia and the thalamic lesions. The sudden onset of the chorea suggests vascular events (ischemia, hemorrhage, vascular malformations ). A 75 -year-old female patient, who had acute choreiform movements on the right hand which had a spontaneous remmision in 24 hours after globus pallidus infarction is presented in this case., Hareket bozuklukları serebrovasküler olaylar sonrası karşımıza çıkabilir. Bazal gangliyonlar ve talamusu tutan lezyonlarda kore en sık karşılaşılan hareket bozukluğudur. Korenin ani başlangıçlı olması vasküler olayları (iskemi, hemoraji, vasküler malformasyonlar) düşündürür. Bu makalede globus pallidus infarktı sonrası akut olarak sağ elde koreiform hareketleri ortaya çıkan, 24 saat içinde kendiliğinden gerileyen 75 yaşındaki kadın olgu sunulmaktadır.

Amaç: Epilepsi iş gücü kaybı ve özürlülüğe yol açan kronik nörolojik bir hastalıktır. Uygun tıbbi ve cerrahi tedavilere rağmen sık nöbet geçiren hastaların sosyal açıdan korunması önemlidir. Bu çalışmada epilepsi hastalarının maluliyet değerlendirmesinde demografik ve klinik özelliklerin araştırılması amaçlandı. Gereç ve Yöntem: Bu çalışmada Antalya Eğitim ve Araştırma Hastanesi Sağlık Kurulu Bölümü’ne Ocak 2014-Ocak 2015 tarihleri arasında malulen emeklilik isteği ile başvuran hastalar geriye dönük olarak incelendi. Bulgular: Otuz biri (%79.5) erkek, sekizi (20.5) kadın olmak üzere toplam 39 hasta incelendi. Yaş ortalaması 41.8 olan hastaların ortalama epilepsi süreleri 20.4±12.6 (minimum 6 ay - maksimum 46 yıl) yıl idi. Sonuçta yedi (%17.9) hastanın emeklilik için uygun olduğuna karar verilirken 16 hastanın (%41) ise uygun kriterleri taşımadığı sonucuna varılmıştır. On dört (%35.9) hasta başvuru sonrası kontrollere gelmezken iki (%5.1) hastanın ise epilepsi hastası olmadığı saptanmıştır. Sonuç: Epilepsi hastalarının takibinde sadece tıbbi tedavi ile yetinmeyip hastaların sosyal hakları konusunda bilinçlenmelerine katkıda bulunmak ve yaşam kalitelerini artırmak uygun bir yaklaşımdır. Objectives: Epilepsy is a chronic disease resulting in the loss of labor and disability. Despite appropriate medical and surgical treatments, patients experiencing frequent seizures should be protected socially. This study aimed to investigate the demographic and clinical characteristics of disability in epilepsy patients. Methods: According to the decisions of the Health Board of Antalya Education and Research Hospital, patients followed-up by second stage hospitals or who had no follow-ups would be followed-up for at least three months with appropriate and adequate treatment than final decision would be given. Results: Thirty-nine patients (31 male, 8 female) were included into the study. The mean age was 41.8 years, duration of epilepsy was 20.4 ± 12.6 years (min. 6 months- max. 46 years). Ultimately, seven patients were suitable for disability retirement and 16 were not. Fourteen patients withdrew applications. Finally, it was understood that two patients had syncope attacks rather than epilepsy. Conclusion: During the follow-up of the patients with epilepsy, the management of medical therapy is not enough alone, we must educate the patients about their social benefits. Patients, who have frequent seizures that obstacle working, should be promoted socially and financially by the social state. However, this issue is open to abuse, people who deserve social benefits should be determined objectively.