Optimising needle depth in temporomandibular joint arthrocentesis: a magnetic resonance-based study for safety and efficacy.

The aim of this paper was to determine the optimal needle depth for temporomandibular joint (TMJ) arthrocentesis using magnetic resonance imaging (MRI), with the aim of improving procedural safety and efficacy in clinical practice. A retrospective analysis of 264 TMJ MRIs from 132 patients at Istanbul Medipol Mega University Hospital was conducted. T2-weighted MRI sequences were utilised to measure distances from skin to joint capsules at varying needle entry points, applying the double puncture technique. The study adhered to ethical standards with appropriate approvals. The analysis revealed significant gender-related variations in needle depths (females showing shorter distances than males, p < 0.05). No significant gender differences were found in condylar angles. An inverse correlation between age and condylar angle suggested age-related anatomical changes. Crucially, a 20 mm needle depth was identified as safer and more effective than the previously recommended 25 mm. This study underscores the necessity of revising needle depth to 20 mm in TMJ arthrocentesis. These findings hold significant implications for improving procedural safety and catering to demographic variations.

Metabolic syndrome and obstructive sleep apnea syndrome among patients with epilepsy on monotherapy.

OBJECTIVES: The study aimed to determine the frequency of metabolic syndrome (MetS) and obstructive sleep apnea syndrome (OSAS) in patients with epilepsy receiving monotherapy and the relationship between these syndromes and antiepileptic drugs (AEDs). METHODS: Two hundred and ninety-seven patients with epilepsy between the ages of 18-65 years receiving monotherapy for at least one year and 50 healthy participants were enrolled. Body mass indices and waist circumferences were measured. Serum fasting glucose levels, high-density lipoprotein (HDL), low density lipoprotein (LDL), total cholesterol (TC), triglyceride, and serum AED concentrations were noted. The frequency of MetS in patients with epilepsy was calculated. The snoring, tiredness, observed apnea, high blood pressure, body mass index, age, neck circumference, and male gender (STOP-Bang) questionnaire was used to determine the risk of OSAS. The relationship between these two syndromes and seizure type, disease duration, AED dosage, and treatment duration was analyzed. RESULTS: Metabolic syndrome was more frequent in patients with epilepsy compared with healthy participants (32.6% vs. 12.0%), and it was diagnosed in 37.8% of patients receiving valproic acid (VPA), 36.1% of patients receiving carbamazepine (CBZ), 34.9% of patients receiving oxcarbazepine (OXC), and 30.5% of patients on levetiracetam (LEV). There was a positive correlation between VPA treatment duration and MetS existence (p < 0.05). However, MetS frequency did not change because of seizure type, disease duration, or AED dosages in patients with epilepsy receiving monotherapy. The risk for OSAS was higher in patients with epilepsy compared with healthy participants (24.6% vs. 12%), and it was calculated high in 27.7% of patients receiving CBZ, 32.2% of patients receiving LEV, and 30.2% of patients receiving OXC. The OSAS risk was higher in patients who have focal seizures than generalized seizures (p = 0.044). There was no relationship between OSAS risk and duration of epilepsy, duration of treatment, drug doses, and serum drug levels (p > 0.05). CONCLUSION: Higher frequency of MetS and OSAS risk should be kept in mind on clinical follow-up of patients with epilepsy receiving monotherapy.

EXTREME DELTA BRUSH EEG PATTERN IN A CASE WITH ANTI-NMDA RECEPTOR ENCEPHALITIS.

Anti-N-methyl-D-aspartate receptor NMDA-R encephalitis is caused by antibodies against the NMDA-R and characterized by a severe encephalopathy with psychosis, epileptic seizures and autonomic disturbances. This disorder is often accompanied with malignancies, especially ovarian teratoma. Some patients' EEGs show a different pattern similar to the waveforms of premature infants and this pattern is specifically named as extreme delta brush (EDB). We report a 24-year-old female having anti-NMDA receptor encephalitis and EDB patern.