HPA axis function in patients with right and left focal lateralized epilepsy.

OBJECTIVES: There is a complex, reciprocal link between epilepsy and the hypothalami pituitary-adrenal (HPA) axis. This study aimed to evaluate the role of the HPA axis in individuals with focal epilepsy, including those with right- or left-hemispheric lateralized epilepsy. MATERIAL AND METHODS: The study comprised 60 individuals with focal epilepsy, ages 18 to 85, with seizures coming from a single hemisphere, no destructive lesions on cranial magnetic resonance imaging, and 32 healthy persons. Blood was drawn from the patient and control groups at 8.00 for serum cortisol level and at 23.00 for serum melatonin level. The Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale were administered to both the patient and control groups. RESULTS: Patients showed decreased melatonin levels (p < 0.001) and poorer sleep quality (p = 0.035). The cortisol level of the patients was found to be lower than the cortisol level of healthy individuals, although it was not statistically significant (p = 0.107). Cortisol and melatonin levels did not significantly differ between patients with seizures coming from the right or left hemisphere. The patients with seizures originating from the left hemisphere had a longer duration of epilepsy disease (p = 0.013), higher seizure frequency (p = 0.013), lower age of first seizure onset (p = 0.038), and a higher rate of polytherapy (p = 0.05). CONCLUSION: Low cortisol and melatonin levels in patients with focal epilepsy may be an indicator of disruption in the HPA axis. There is no significant difference in the HPA axis function between patients with focal epilepsy according to the epileptic hemisphere.

Comparing neuropsychological functioning in Turkish patients with right and left temporal lobe epilepsy.

We compared neuropsychiatric evaluations in temporal lobe epilepsy according to the lateralized hemisphere. Forty-one (68.3%) left-sided temporal lobe epilepsy (LTLE) were compared to 19 right-sided temporal lobe epilepsy (RTLE) (31.7%) (p < 0.001). RTLE mean age was 37 (22-46) years, and LTLE mean age 38 was (30-42). RTLE disease duration was 10 (6-20) years, and LTLE was 22 (10-33) (p < 0.013). Gender (man/woman) for RTLE was 7/12, and for LTLE was 18/23. LTLE scored poorer on the Wechsler Memory Scale (WMS)-III's Mental Control Months-error, WMS-V's "Forward Number Range" and "Backward Number Range" than RTLE (p < 0.017, p < 0.023, p < 0.004). There were differences between hemispheres for "Number of Items Remembered with a Hint" and "Total number of Recalled Items" (WMS-IV) (p < 0.038, p < 0.045). LTLE had lower scores in the Verbal Fluency -K-A-S letters words and WAIS (Wechsler Adult Intelligence Scale) similarity than RTLE (p < 0.019, p < 0.024, p < 0.033, p < 0.026). Oktem and Boston-number of Self-Named Items Tests were poorer in LTLE than RTLE (p < 0.05, p < 0.043). Mental Control Months-error (WMS-III), "Total Number of Recalled Items", "Number of Items Remembered with Hint" (WMS-IV), forward and backward number range (WMS-V), Oktem, Verbal Fluency -K,-A,-S letters words, WAIS similarity, and Boston-number of Self-Named Items tests, can help identify lateralization, particularly in LTLE.

Reversible Severe Parkinsonism Caused by Extra-Pontine Myelinolysis in a patient with Primary Adrenal Failure.

PURPOSE: Extrapontine myelinolysis (EPM) is a highly uncommon, life-threatening disease, particularly in individuals who initially appear with severe clinical symptoms. Here, we describe a case of EPM caused by the rapid correction of hyponatremia that had severe clinical signs at first but parkinsonism symptoms were fully improved after treatment. CASE REPORT: A 46-year-old female patient was admitted to the hospital due to impaired consciousness. Her medical history reveals that she has PAI, or primary adrenal insufficiency. Initial laboratory measurements showed that the serum's sodium (Na) concentration was 104 mEq/L, chloride (Cl) content was 70 mmol/L, potassium (K) content was 4.95 mEq/L, glucose was 42 mg/dL, hydrogen potential (Ph) was 7.12, and bicarbonate (HCO3) concentration was 10 mmol/l. The adrenocorticotropic hormone (ACTH) level was 21 mg/ml, while the cortisol level was 1.2ug/dl. Her mental state was unclear, she had sluggish hypophonic speech, generalized akinesia/rigidity in both upper and lower extremities, trouble swallowing solid and liquid meals, and sialorrhea were all discovered after the Na level was corrected. Hyperintense lesions were visible in the bilateral putamen and caudate nuclei of the Magnetic Resonance Imaging (MRI) T2 and flair-weighted scans, which indicate EPM. EPM was treated with corticosteroids and dopamine agonists, and she was eventually released after complete recovery. CONCLUSION: Even if there are severe clinical symptoms at first, prompt diagnosis and treatment, such as dopaminergic, corticosteroid, and palliative therapy, can save a patient's life.

Advanced Age and Multiple Comorbidities as Important Factors in Predicting Poor Prognosis in Herpes Zoster Ophthalmicus.

The varicella-zoster virus (VZV) infection results in varicella (chickenpox) and is generally seen in immunocompromised persons. VZV virus remains latent in the ophthalmic branch in the trigeminal ganglion. When reactivated, herpes zoster ophthalmicus (HZO) develops and sometimes leads to chronic ocular complications, among which cranial nerve palsies are rarely seen. Though the third cranial nerve is most frequently involved, the fourth and sixth nerves may also be involved in some cases. Treatment includes systemic antiviral therapy and steroid administration. The prognosis is generally good when treatment is executed. Improvement can also be observed without treatment. In this article, we would like to highlight two such cases in which these two cranial nerves got involved following an episode of HZO. One is a 67-year-old female patient having diabetes mellitus (DM), hypertension (HT), and coronary heart disease with fourth and sixth cranial nerve complete palsy. The other is a 76-year-old male patient with HT, DM, and heart failure with only sixth cranial nerve complete palsy. Despite adequate treatment, both patients had a poor prognosis. Advanced age and the presence of multiple comorbidities are important factors in predicting poor prognosis in HZO cases.