Effects of COVID-19 Infection and Vaccines on Patients with Epilepsy: Real-Life Experiences.

Introduction: The current study evaluates the effects of COVID-19 infection and the safety of vaccines in patients with epilepsy (PWEs). Method: The study was conducted with PWEs who were vaccinated against COVID-19. The sample was separated into two groups as those with drug-resistant epilepsy (DRE) and those with non-resistant epilepsy, and their seizure frequencies, seizure types, development of status epilepticus, changes in doses and/or types of drugs, electroencephalographs (EEGs) before and after COVID-19 infection, and vaccination with mRNA or inactivated vaccines were monitored and compared. Changes in seizure patterns were also inquired about following the administration of vaccines other than COVID-19. Results: Included in the study were 307 PWEs with a mean age of 42.62±14.74, among whom COVID-19 PCR positivity was detected in 97(31.6%). Those who experienced no increase in seizure frequency while infected with COVID-19 were significantly under monotherapy (p=0.031). The mean seizure frequency was 2.70±5.19 per year before vaccination, but increased to 3.20±5.82 after. A significant relationship was identified between abnormal EEG and increased seizure frequency across the entire sample and the mRNA group (p=0.011, p=0.004). The frequency of seizures increased significantly in the DRE patients after receiving the mRNA vaccine (p=0.023). Overall, increased seizure frequencies were observed in 29.9% of the sample during COVID-19 infection, with increases of 16.4% in those who received the mRNA vaccine, 8.6% after inactivated vaccines and 25% after non-COVID-19 vaccines. Conclusion: COVID-19 infection was found to be associated with a higher increased seizure frequency risk than being vaccinated, and COVID-19 vaccines do not differ from other vaccines in terms of the risk to PWEs.

Visual evoked potential and nerve conduction study findings in patients recovered from COVID-19.

OBJECTIVE: COVID-19 infection is associated with peripheral neuropathy. However, subclinical neurological involvement may occur anytime, and diagnostic methods that reveal this subclinical involvement are not well established. We aimed to assess the subclinical neurological involvement by visual evoked potential (VEP) measurements and nerve conduction studies (NCS) and explore the relationship between neurological electrophysiological findings and the severity of COVID-19 infection. METHODS: Seventy-six patients recovered from COVID-19 infection, and 44 healthy controls were enrolled in the study. Patients were assessed for clinical and demographic parameters. NCS and VEP analyses were performed to detect any peripheral neuropathy or optic neuropathy in both groups. RESULTS: None of the COVID-19 patients had electrophysiological evidence of peripheral neuropathy. However, patients with COVID-19 pneumonia had significant abnormalities in several peripheral nerve measurements compared to patients without pneumonia. Although P100 parameters did not differ significantly between patients and controls, 12 patients with COVID-19 had prolonged P100 latencies. CONCLUSIONS: We detected subclinical afferent visual pathway abnormality evaluated by VEP analysis. In addition, we found subtle electrophysiological features in the NCS of the patients presented with COVID-19 pneumonia. However, our findings did not fortify the diagnosis of peripheral neuropathy or optic neuropathy. Further studies are needed to determine the characteristics of COVID-19-related peripheral neuropathy/optic neuropathy whether it has distinct clinical features and disease course.

Relationship between obstructive sleep apnoea syndrome and silent brain infarction.

BACKGROUND: The relationship between obstructive sleep apnea syndrome (OSAS) and ischaemic stroke is less known. OBJECTIVES: This study aimed to investigate the relationship between OSAS and silent brain infarcts (SBI). METHODS: Patients who applied to our clinic with the complaint of snoring, respiratory arrest during sleep, that underwent polysomnography were included. All patients were undergone cranial magnetic resonance imaging to detect SBI. RESULTS: SBI was found in 176 (51.5%) of 270 patients in the group with OSAS and 94 (34.8%) patients without OSAS. The patients were evaluated according to their Apnea-Hypopnea Index(AHI) ratio, and those with were found to be significant in terms of SBI. SBI was detected in 56.56% in the moderate and severe (AHI ˃15) stage group and 39.94% in the normal and mild (AHI ≤15) OSAS group (p=0.009). CONCLUSIONS: SBI was found to be significantly higher in patients with moderate and severe stage OSAS compared to the normal and mild OSAS group. Desaturations during sleep may influence the formation of these infarcts. Therefore, this study reported that patients with moderate and severe sleep apnea syndrome may have a higher risk of developing ischaemic cerebrovascular disease and that the treatment of these patients should be planned in this respect.

Adverse events report of inactivated COVID-19 vaccine from 4040 healthcare workers.

OBJECTIVES: Numerous vaccination studies are conducted to protect against COVID-19 infection, and preclinical and clinical studies are still ongoing worldwide. During this extraordinary period, the necessity to perform COVID-19 vaccine studies and immunization programs together has emerged. Vaccine Adverse Effects (VAEs) need to be documented quickly. We aimed to determine the VAEs and to compare the frequency of VAEs between groups according to sociodemographic characteristics after the inactivated vaccine (CoronaVac) was administered to healthcare workers (HCWs) in Turkey. METHODS: An online questionnaire was delivered to 4040 volunteer HCWs across the whole country who were vaccinated with CoronaVac. Sociodemographic characteristics, medical history, history of COVID-19 infection, and VAEs occurring after the first and second doses of the inactivated vaccine were evaluated. RESULTS: The most common local and systemic VAEs after first and second doses of the COVID-19 vaccine were reported as, pain at the injection site (37.9%; 37.6%), headache (21.5%; 16.8%), fatigue (18%; 15%), drowsiness (9.6%; 8.2%), back pain (8.8%; 8.2%), nausea (6.3%; 4.8%), and joint pain (4.7%; 4.7%). Individuals with a history of allergies (generalized or vaccine-related) and females had a higher rate of VAE. Participants aged 60 and over reported less frequent VAEs. CONCLUSION: It is extremely important to identify and document the VAEs occurring in the early postvaccination period in different groups of the community. These initial findings may provide reassurance to healthcare providers and vaccine recipients and promote confidence in the safety of this inactive COVID-19 vaccine, however longitudinal follow-up studies are recommended.

The Evaluation of the Relationship between sTREM-1, VEGF-B, and VEGF Gene Expression Levels with Disease Activity of Behçet's Patients.

BACKGROUND: There is no specific marker that shows the disease activity in Behçet's disease. AIM: In this study, we aimed to investigate VEGF-B and VEGF gene expressions and sTREM-1 levels in association with the activation of Behçet's disease. STUDY DESIGN: Case-control study. METHODS: Clinical features of patients who applied in the rheumatology clinic and were diagnosed with BD according to the international working group's criteria were investigated. 30 healthy volunteers and 30 patients in the active period according to the EBDCAF scoring were studied. VEGF-B and VEGF gene expressions and sTREM-1 levels were studied in the serum samples of the patients and the control subjects. RESULTS: The VEGF-B expressions and sTREM-1 levels were higher in the BD than those in the healthy group, but this difference did not reach statistical significance. VEGF gene expression was statistically significant (p = 0.008). Behçet's disease patients with oral aphthae, genital ulcer, eye, joint, vascular, skin, and neurological involvement were analyzed separately as subgroups. We find that VEGF gene expression level of Behçet's disease patients with joint involvement (arthritis/arthralgia) and also VEGF-B and VEGF gene expression of Behçet's disease with vascular involvement (DVT/thrombophlebitis) were significantly higher (p = 0.035, p = 0.021). Each subgroup was analyzed with the control group. We determined that VEGF gene expression in all subgroups was significantly higher than that in the control group. At the same time, VEGF-B levels of patients with genital ulcer and vascular involvement (DVT/thrombophlebitis) were significantly higher than those in the control group. CONCLUSION: VEGF-B and VEGF gene expressions can be activity indicators for BD. In addition, this study shows that new treatment options should be explored for Behçet's disease patients with joint and vascular involvement. In the following years, new treatment methods are needed to investigate for revealing the role of the etiopathogenesis of BD and the activation and prognosis of VEGF by examining this study and providing much more participation. In our study group, the sTREM-1 levels were high but the results did not reach statistical significance. More studies are needed with larger groups in order the highlight the exact role of STREM-1 in Behçet's disease.

Cognitive Effects of Androgen Deprivation Therapy in Men With Advanced Prostate Cancer.

OBJECTIVE: To evaluate the prostate cancer effects of androgen deprivation therapy (ADT) by using a systematic set of methods to calculate specific cognitive functions in men with locally advanced or metastatic prostate cancer. MATERIALS AND METHODS: From April 2014 to February 2016, a prospective, comparative study was done to evaluate the cognitive effects of hormone therapy. Group 1 consisted of 78 patients with locally advanced or metastatic prostate cancer who received complete ADT treatment continuously for 12 months and group 2 (control group) consisted of 78 patients who underwent radical prostatectomy without any additional treatment. The Montreal Cognitive Assessment (MoCA) test and the Frontal Assessment Battery (FAB) test with Turkish language version were used to evaluate multiple domains of cognitive function. RESULTS: Post-treatment results of both tests revealed that patients in group 1 achieved lower mean total scores than group 2. In MoCA test, the deficits were especially prominent in the areas of language ability and short-term memory capacity (P < .05 and P < .05). No significant differences could be identified between groups in respect to attention, executive functions, visuospatial abilities, abstract thinking, calculating abilities, and orientation. In FAB test, the deficits were especially prominent in the areas of mental flexibility and inhibitory control (P < .05 and P < .05). No significant differences could be identified between groups in conceptualization, motor series, conflicting instructions, and environmental autonomy. CONCLUSION: ADT affects cognitive functions such as language ability, short-term memory capacity, mental flexibility, and inhibitory control. Urologists should keep in mind these side effects and inform the patients and their families for the early symptoms of cognitive dysfunction.

Screening for Electrophysiological Abnormalities in Chronic Hepatitis C Infection: Peripheral Neuropathy and Optic Neuropathy.

INTRODUCTION: To investigate the existence of peripheral and optic neuropathies in asymptomatic individuals with hepatitis C infection. METHODS: Thirty consecutive patients who were followed in a hepatitis C outpatient clinic were recruited for electrophysiological evaluation together with 30 age- and gender-compatible healthy controls. All patients had a detailed neurological examination. The information regarding the disease duration and management with interferons were collected. Nerve conduction studies and visual evoked potentials (VEP) were recorded in all subjects. The results of the patient and control groups were statistically compared. RESULTS: Of the patients with hepatitis C infection, 16 were females and 14 males. The mean age was 57.5 years, and the average disease duration was 6.43 years. The P100 latencies in the patient group were within normal limits, while the amplitudes were meaningfully small by comparison with the controls. There were some abnormalities in the nerve conduction studies of 15 patients. Sensorial neuropathy was detected in two patients, sensorimotor polyneuropathy in four, carpal tunnel syndrome in seven, and carpal tunnel syndrome and sensorimotor polyneuropathy as comorbid states in another two patients. The nerve conduction studies and VEP parameters were entirely normal in the control group. CONCLUSION: Hepatitis C-related neurological abnormalities may occur both in the central and peripheral nervous system. Mononeuritis multiplex, sensorial axonal neuropathy, and multiple mononeuropathies are some of the presentations of the peripheral nervous system involvement. The mode of infection is considered to be via vasculitic mechanisms. In addition, optic neuropathy is a known complication of interferon treatment. Autoantibodies, cytokines, chemokines, and cryoglobulins are accused to play roles in the pathogenesis. In this study, we investigated the involvement of the peripheral nervous system and optic nerves in a group of patients with hepatitis C. The results were in favor of peripheral nerve injury of various types and optic neuropathy of the axonal type.

Evaluation of the Adherence to Immunmodulatory Treatment in Patients with Multiple Sclerosis.

INTRODUCTION: In this article, we report the data regarding treatment adherence of a group of patients with multiple sclerosis (MS) and relapsing-remitting or secondary progressive disease who were followed in the MS outpatient clinic of Bozyaka Education and Research Hospital, Izmir. METHODS: We collected the demographic data of 219 patients with MS who were treated with immunomodulatory drugs and the documentary data on the disease characteristics from the patient' files. Each patient was provided a detailed questionnaire regarding treatment adherence in addition to the Beck depression scale (BDS) and Paced Auditory Serial Addition Test (PASAT). Nonadherence was defined as the discontinuation of the drug, i.e., more than one dose a month for intramuscular interferon, six doses a month for glatiramer acetate, and four doses a month for subcutaneous interferons. Statistical analyses were performed using Medcalc statistics package. For those parameters with an even distribution, the paired samples t-test was used to compare the results. RESULTS: Of the 219 [183 relapsing remitting multiple sclerosis (RRMS) and 36 secondary progressive multiple sclerosis (SPMS)] patients included in the study, 143 patients were women and 76 were men. The mean age of the patients was 40.77±10.36 years. The mean expanded disability status scale (EDSS) score was 2.90±1.88, and mean annualized attack rate (ARR) was .65±.55. Of the 219 patients, 75.1% continued the immunomodulatory treatment. Thirty-three patients in the RRMS group and 23 patients in the SPMS group abandoned the immunomodulatory treatment. Treatment adherences were similar between patients with RRMS and SPMS (53%). Adherence revealed no correlation with age, ARR, PASAT score, and disease duration. However, higher EDSS and depression scores had significant positive correlation with adherence. Moreover, treatment adherence was noted to be lower in the group with higher education levels. Treatment discontinuation did not correlate with age, ARR, BDS, or PASAT scores. The disease duration and EDSS scores were found to be significantly correlated with treatment discontinuation. CONCLUSION: In this extensively followed up patients' group with multiple sclerosis, the ones with extended disease duration, higher disability, and more educated had higher rates of treatment discontinuation and lower levels of treatment adherence. The patient-reported outcomes and well-documented treatment adherence data will contribute to the neurologists' understanding of the patients' inclinations regarding the injectable treatments and help in better management of the immunomodulatory treatments.