Association between epilepsy and headache.

OBJECTIVE: Similar clinical characteristics of epilepsy and migraine and the prevalence of their comorbidity have been investigated for years. The present study investigated the relationship between epilepsy and headache. METHODS: A total of 420 epilepsy patients, who visited epilepsy outpatient clinic within 6-month period between January 2016 and June 2016, were questioned whether they have headache. Age, gender, duration of epilepsy, type of seizures, and temporal relationship of headache with seizure were investigated in the patients with headache. RESULTS: Headache was detected in 111 (26%) of 420 epilepsy patients. The prevalence of migraine was 15%. When the temporal relationship of headache with seizure was evaluated, interictal headache was found to be the most common type with a percentage of 74.8%. No significant difference was determined between the patients with migraine and non-migraine headache in terms of age, gender, duration of epilepsy, age at the onset of epilepsy, type of seizure, and electroencephalography findings. The prevalence of interictal headache was statistically significantly higher in migraine patients as compared to that of non-migraine patients (p < 0.001); however, the prevalence of preictal headache and the prevalence of postictal headache were significantly lower (p = 0.001 and p < 0.001, respectively). CONCLUSION: The prevalence of headache and the prevalence of migraine, which are considered to be pathogenetically linked to epilepsy, were not different in epilepsy patients as compared to that of the general population. Different outcomes and percentages in other studies suggest that pathogenesis of headache is multifactorial and that different diagnostic criteria might have been taken into consideration.

Holter Monitorisation Results in Early Period of Acute Ischemic Stroke.

INTRODUCTION: Paroxysmal atrial fibrillation (PAF) has a similar risk with persistent AF for ischemic stroke. Holter monitorization (HM) and other long-term monitorization methods increased the detection of PAF and short-lasting runs of tachyarrhythmias. Their classification as PAF and roles in the etiology of ischemic stroke is controversial. In this study, we aimed to investigate the frequency of any duration of PAF and clinical characteristics of the patients with acute ischemic stroke who have undergone 24-hrs HM. METHODS: Patients with acute ischemic stroke and transient ischemic attack (TIA) hospitalized in the Neurology ward and undergone 24-hrs of HM during their hospital stay were included in the study. HM reports, clinical, and laboratory characteristics were analyzed, retrospectively. Patients were grouped into three based on HM: 1st group, without PAF; 2nd group, PAF >30 seconds (s) and 3rd group, PAF<30s. RESULTS: PAF of any duration was detected in 18.8% (n=49) of 261 patients. The duration of PAF was <30s in 16.1% (n=42) and >30s in 2.7% (n=7) of the patients. The mean age, left atrium diameter and CHA2DS2-VASc scores of the second group were significantly higher than the first group (p<0.001, p<0.001 and p=0.007; respectively). The mean age, left atrium diameter, modified Rankin Scores (mRS), and CHA2DS2-VASc scores of the third group were significantly higher than the first group (p<0.001; for all). There was no difference between the second and the third groups in means of mean age, left atrial diameter, MRS, and CHA2DS2-VASc scores (p<0.017, for all). CONCLUSION: In this study, 24-hrs HM in the early period of acute ischemic stroke results yielded a high frequency of PAF<30s and predictive features were in parallel with the literature.

Ischemic Stroke in the Elderly: Septuagenarians Versus Octogenarians.

INTRODUCTION: Stroke prevalence is known to increase with age. Approximately 50% of acute ischemic stroke patients are aged between 70 and 89 years. METHODS: In this study, records of 770 ischemic stroke patients who were 70-89 years old were retrospectively examined (407 septuagenarians and 363 octogenarians). The demographics, comorbid conditions, ischemic stroke type, and stroke outcome for the two age groups were analyzed. RESULTS: Comorbid hypertension, diabetes mellitus, and HbA1c levels of ≥6.5% more frequently occurred in septuagenarians than in octogenarians (80.6% versus 70.8%, p=0.002; 32.2% versus 21.8%, p=0.001; and 35% versus 23.2%, p=0.003, respectively), whereas atrial fibrillation was significantly higher in octogenarians (49.3% versus 41.5%, p=0.03). Hypercholesterolemia, previous stroke history, and antiaggregant and/or anticoagulant use were not significantly different between the two age groups. Based on the Oxfordshire Community Stroke Project classification, the most common stroke subtype in the septuagenarian group was a lacunar infarction and in the octogenarian group, it was a partial anterior circulation infarct. According to the Modified Ranking Score, the number of patients living independently was higher for septuagenarians (42.8% versus 27.8%, p<0.001). CONCLUSION: The present findings indicate that the clinical characteristics of ischemic stroke differed between septuagenarians and octogenarians. Therefore, elderly stroke patients cannot be accepted as a homogeneous group. Because this is a hospital-based study, our findings need to be tested via additional epidemiological studies.

Forced eye closure-induced reflex seizure and non-ketotic hyperglycemia.

We report an uncommon case of 53-year-old female patient with partial seizure induced by forced voluntary eye closure due to non-ketotic hyperglycemia. The initial laboratory tests showed an elevated blood glucose level of 550 mg/dL but no evidence of ketosis. Brain magnetic resonance imaging was normal. When the blood glucose levels decreased slowly to about 150 mg/dL in five days, the seizures ended completely. No anticonvulsants were used. Since seizures are generally refractory to antiepileptic medication, control of blood glucose is essential.

Wall-eyed bilateral internuclear ophtalmoplegia presenting as monocular alternating nystagmus: a non-epileptic phenomenon in a case of diffuse axonal injury.

A 15-year-old male in a persistent vegetative state due to diffuse axonal injury presented with seizures and spontaneous alternating monocular nystagmus. The cranial MRI revealed diffuse axonal injury involving supratentorial and infratentorial structures, and the splenium of the corpus callosum. The monocular alternating nystagmus was thought to be independent of seizures and occurred as a result of diffuse axonal injury affecting the medial longitudinal fasciculus bilaterally.

Reflex epilepsy and non-ketotic hyperglycemia.

Epileptic seizures are paroxysmal events, and it is likely that many, if not most, of them are precipitated by known or unknown factors acting on a central nervous system that is predisposed to the production of epileptic discharges by the presence of an organic lesion, a genetically determined neuronal hyperexcitability, or both. Known precipitating influences are quite varied. We report the case of a 58 years-old patient, followed for non-ketotic hyperglycemia, who presented with focal seizures exclusively induced by specific, active or passive, postures and movements of the right arm or hand. MRI was normal. Following regulation of glucose blood levels the position-induced seizures stopped and antiepileptics were not prescribed. The seizures are kept under control by regulating blood glucose.