The Profile of Guillain-Barré Syndrome Before and During COVID-19 Pandemic: A 5-Year Experience.

Introduction: We aimed to evaluate and compare the clinical and electrophysiological features of post-COVID-19 Guillain-Barré syndrome (GBS) and non-COVID-19 GBS patients over the last five years. Methods: We retrospectively analyzed patients diagnosed with GBS between October 2016 and September 2021. They were divided into five groups according to the flu season and the COVID-19 pandemic. Groups 1-4 were identified as non-COVID-19 groups, whereas Group 5 constituted the post-COVID-19 group. At the sixth month the Hughes functional grading scale score (HFGSS) was noted. Clinical and electrophysiological findings were compared between the groups. Results: Fifty-nine GBS patients were enrolled in this study. Post-COVID-19 GBS patients had more facial diplegia than non-COVID-19 GBS patients. Except for facial diplegia, post-COVID-19 GBS patients did not differ from non-COVID-19 GBS patients regarding the need for mechanical ventilation, loss of ambulation, type of GBS, response to treatment, and patient outcomes. In 67% of post-COVID-19 GBS patients, HFGSS was ≤2. Acute inflammatory demyelinating polyneuropathy (AIDP) was the most common subtype in post-COVID-19 GBS patients. The 2018-2019 flu season saw more ambulation loss than other flu seasons. The 2017-2018 influenza season had the highest number of patients (39%). Conclusion: The clinical and electrophysiological features of GBS may differ according to year, infectious etiology, and severity of seasonal viral infections. Post-COVID-19 GBS patients mostly had the AIDP subtype with frequent facial diplegia. The prognosis of post-COVID-19 GBS patients was good. The patients responded well to treatment with intravenous immunoglobulin and plasma exchange.

Comparison of clinical features in patients with vestibular migraine and migraine.

Vestibular migraine (VM) is accepted as the most common cause of spontaneous episodic vertigo. In most patients, vestibular symptoms follow migraine headaches that begin earlier in life. The aim of this multicenter retrospective study was to find out the differences between migraine patients without any vestibular symptoms (MwoV) and VM patients and to delineate the specific clinical features associated with VM. MwoV and VM patients were compared regarding demographic features, migraine headache years, headache attack frequency, intensity, symptoms associated with headache and vertigo attacks, presence of menopause, history of motion sickness and family history of migraine. Four-hundred and forty patients with MwoV and 408 patients with VM were included in the study. Migraine with aura was more frequent in patients with MwoV (p = 0.035). Migraine headache years was longer (p < 0.001) and headache intensity was higher in patients with VM (p = 0.020). Aural fullness/tinnitus was more common in patients with VM (p < 0.001) when all other associated symptoms were more frequent in patients with MwoV (p < 0.001) as well as attack triggers (p < 0.05). Presence of menopause and motion sickness history was reported more frequently by VM patients (p < 0.001). Logistic regression analysis indicated that longstanding history of migraine with severe headache attacks, aural fullness/tinnitus accompanying attacks, presence of menopause, previous motion sickness history were the differentiating clinical features of patients with VM.

Vestibular migraine, demographic and clinical features of 415 patients: A multicenter study.

OBJECTIVE: To evaluate demographic and clinical features of vestibular migraine (VM) patients METHODS: Four hundred fifteen patients with VM were evaluated by using a structured questionnaire in addition to clinical examination. RESULTS: The mean age of headache and vertigo onset was 25 years and 39 years, respectively. In 12.3%, benign paroxysmal positional vertigo (BPPV) was detected during the interictal period. Ten percent had hearing loss on audiometry, in 8.7% it was one-sided low-frequency sensory-neural hearing loss below 2000 Hz and the history was typical for Meniere's disease (MD) in addition to VM. Tinnitus was present in 94.4%, aural fullness in 83.4%, nausea in 72.2% and vomiting in 30.5% of patients with VM/MD. The prevalence of these symptoms was higher in patients with VM/MD than in pure VM. Median attack severity determined by visual analog scale measured in centimeters from 0 to 10 was 8 for headache and 7 for vertigo for the whole group. Severe headache was significantly correlated with age of ≤ 43 years (OR: 6.831, 95% CI: [4.10-11.63]; p < 0.001) and severe vertigo was significantly correlated with age ≥ 41 years (OR: 7.073, 95% CI: [4.55-10.98]; p < 0.001). Motion sickness was revealed from past medical history in 51.8%. Family history of migraine was present in 72.5% and the age of onset of both migraine headaches (p = 0.008) and vertigo attacks (p = 0.004) was lower in these patients. CONCLUSION: Younger patients suffered more severe headache attacks whereas vertigo attack severity was higher in the elderly. BPPV and MD were commonly associated with VM and VM/MD was accompanied by aural and autonomic features more frequently than pure VM. Previous history of motion sickness was detected in more than half of the whole group. Family history of migraine was associated with younger onset of migraine headaches and vertigo attacks.

Characteristics of optic neuropathy in Behçet disease.

OBJECTIVE: We present the clinical profile, features, and neuroimaging findings of 25 patients with Behçet disease (BD), and optic neuropathy (ON), which has been rarely reported in BD. METHODS: Data from 5 university hospitals were retrospectively reviewed, and patients with BD and ON were evaluated. There were 2 groups: (1) those already diagnosed with BD when ON developed (BD→ON group) and (2) those diagnosed with BD during the evaluation of ON (ON→BD group). RESULTS: There were 25 BD patients with ON (13 males). Among these, 13 had ON→BD, and 12 had BD→ON. Seventeen patients had unilateral ON, and 7 patients had recurrent ON. BD→ON patients were older. Disc edema was seen more in ON→BD than in BD→ON patients (10 vs 3). Fourteen patients also had uveitis, 7 with BD→ON and 7 with ON→BD. There was other neurologic involvement in 8 patients; in the BD→ON group, 4/4 had MS-like disease, in the ON→BD group, 3 had typical parenchymal BD, and 1 had MS-like disease. Twenty of 21 patients received immunosuppressive medications, corticosteroids, or both. Prognosis was favorable in most: vision improved in 20 patients, more often in those receiving combined therapies. CONCLUSION: BD may be diagnosed earlier if it is considered and investigated during the assessment of ON, particularly in high-risk regions. Prognosis of ON related to BD seems to be favorable. Immunosuppressants should be given along with corticosteroids. MS-like presentations should also be kept in mind in patients with BD and ON.

Complete seizure freedom is possible in patients with MTLE-HS after surgery in spite of extratemporal electro-clinical features.

PURPOSE: The aim was to identify the common typical and atypical ictal semiologic and EEG features of patients with mesial temporal lobe epilepsy and hippocampal sclerosis who became seizure-free postoperatively. METHOD: The semiologic and EEG findings of 126 ictal video-EEG recordings of 50 patients who remained seizure-free for at least 2 years (mean=9.46±3.20; range=3-14.5 years) after surgery were reviewed. Statistical analysis was used to determine the frequencies of the most common auras, semiologic features and EEG patterns and to define the symptom clusters. RESULTS: Aura was reported in 82% (n:41) of patients and the most common type was epigastric sensation. Early symptoms were contralateral upper extremity dystonic posturing (66%), oro-alimentary automatisms (50%) and ipsilateral hand automatisms (40%). Ictal EEG findings revealed localized and lateralized activity in 62% of patients. Of the 17 most common early symptoms, there was a tendency toward two clusters. Cluster 2 consisted of findings that were typical for patients with mesial temporal lobe epilepsy whereas Cluster 1 mostly consisted of atypical findings. CONCLUSIONS: This study demonstrated two clusters of the semiologic repertoire, and the most frequent EEG finding was lateralized and localized ictal activity, while other types of EEG patterns were also recorded. Although the presence of atypical findings may suggest a more extended or even extratemporal zone, the seizure-free outcome demonstrated that if the critical amount of tissue can be resected within the epileptogenic network, this may be sufficient for termination of seizures.

Panayiotopoulos syndrome with coincidental brain lesions.

PURPOSE: To describe the clinical and electroencephalographic features of three patients diagnosed with Panayiotopoulos syndrome with different lesions identified by cranial MRI investigation. METHODS: Our study was based on patients from the Epilepsy Outpatient Clinic of Sisli Etfal Education Hospital in Istanbul, where a prospective study of Panayiotopoulos syndrome was initiated in 1995. Records of our Epilepsy Outpatient Clinic revealed 53 patients with Panayiotopoulos syndrome. Among them were three with cranial lesions identified by MRI. RESULTS: The onset of the seizures in our patients ranged between five and eight years. The seizures included mainly autonomic symptoms such as nausea, vomiting, pallor, mydriasis, urinary and fecal incontinence, and rarely hypersalivation. Autonomic partial status was detected in one patient. The personal history of our patients revealed head trauma in two and difficult birth history in one patient. Two patients described simple febrile seizures. All patients had occipital spike or spike-wave complexes in their EEGs. The background activity was normal. From the cranial MRI, one patient had a neuroepithelial cyst, the second patient had a right occipital encephalomalasic lesion and the third patient had an arachnoid cyst located in the cisterna magna associated with colpocephaly. Seizure frequency was low in general. All patients except for one received carbamazepine treatment 450-600 mg/day. None of our patients had seizures under antiepileptic treatment. CONCLUSIONS: Children with Panayiotopoulos syndrome may have static MRI brain findings which are likely to be coincidental and do not affect prognosis.

Hot water epilepsy: clinical and electroencephalographic features of 25 cases.

The aim of this study was to analyze the clinical and electroencephalographic findings for 25 patients with hot water epilepsy. Personal and family history, neurological state, age at onset and types of seizures, provoking factors, bathing habits, EEGs, and neuroimages were all reviewed. Age at onset of seizures ranged from 6 months to 37 years. Twenty patients had complex partial seizures. Eight patients had spontaneous seizures as well; one was a typical case of idiopathic photosensitive occipital lobe epilepsy. One patient described an episode interpreted as nonconvulsive status. In our study group, the pouring of the water over the head and the temperature of the water were the most common triggering factors. A special kind of soap and entry of water into the mouth were determined to be unusual triggering factors. Interictal EEGs revealed epileptogenic abnormalities located over the temporal regions in nine patients. Seventeen patients underwent neuroimaging, mostly cranial magnetic resonance imaging. One had right mesial temporal sclerosis and one cortical atrophy; the others had normal findings. Sixteen patients received antiepileptic drugs, mainly carbamazepine, and remained seizure-free. The high rate of epileptogenic abnormalities localized in the temporal region and the complex partial seizures observed in most of our patients indicate the considerable role of the temporal lobe in hot water epilepsy.