Osteonecrosis in the both femoral heads in a patient with Neuro-Behcet's disease

Neuro-Behcet's disease [NBD] is a rare clinical entity that frequently presents neuro-psychiatric symptoms, and mesodiencephalic and pontobulbar lesions. There is only one published report about osteonecrosis in NBD. We report a patient whose first presentation was neurological NBD with presenting bilateral femoral heads osteonecrosis. A 36-year-old male was hospitalized with gait disorder, diplopia and speech disorder. The past medical history of the patient was unremarkable. The MR image showed mesencephalic lesion with oedemaas a hyperintense area. The present case was diagnosed as NBD and treated with methylprednisolone [1g /day] only for five days. One year after, bilateral hip pain developed. MR image of both hips showed well-demarcated areas of osteonecrosis in the bilateral femoral heads. The patient was operated by an orthopedic surgeon. Because early diagnosis and immediate treatment of osteonecrosis is very important, the physician must bear in mind that osteonecrosis might result from impaired microvascular involvement in even NBD

long-term prognosis of epilepsy patients with medically treated over a period of eight years in Turkey

Objective: The aim of this study was to investigate the effect of demographic and clinical characteristics on temporal changes in seizure control and frequency in medically treated epilepsy patients to guide treatment modalities

Methods: We retrospectively analyzed the association between clinical and demographic characteristics and seizure frequency in 1329 epilepsy patients who were followed up at an outpatient clinic for one to eight years, 2008-2015

Results: Younger age at first seizure [p = 0.0465] and a long disease duration [p = 0.0406] had a negative effect on seizure control in all the epilepsy patients. Febrile convulsions [PCs] [p > 0.0001], perinatal risk [PNR] [p > 0.0002], a family history of epilepsy [FHE] [p > 0.0016], antiepileptic drug [AED] use [p > 0.001], mental retardation [MR] [p > 0.001], and psychiatric disorders [p > 0.0478] were prognostic indictors of temporal changes in seizure frequency. The presence of PNR [p = 0.0416], age at onset of epilepsy [p = 0.034], central nervous system infection [CNSI] [p = 0.04], and AEDs number [p = 0.0282] were prognostic indicators of not remaining seizure free for one year. In those with partial epilepsy, a trauma history [p = 0.05], a longer epilepsy duration [p = 0.0057], and FHE [p = 0.0466] increased the frequency of seizures, whereas cerebrovascular event [CVE] history decreased the seizure frequency [p = 0.0413]. In addition, FHE [p = 0.0438] and psychotic disorders [p = 0.0416] increased generalized seizures frequency

Conclusion: In all the epilepsy patients, a younger age at onset and longer duration of epilepsy were associated with a poor prognosis. The presence of PNR, age at onset of epilepsy, CNSI, and AEDs numbers were prognostic indicators of not remaining seizure free for one year. Increasing AEDs number was not effective in controlling seizures in partial epilepsy, but it was effective in controlling seizures in generalized epilepsy