A cerebellar demyelinating lesion following treatment of acne with isotretinoin.

We report the case of a demyelinating lesion located in the left cerebellar region that developed 3 months after the onset of oral isotretinoin treatment. In April 2001, 1 year before admission, the patient underwent cranial magnetic resonance imaging (MRI) because of endocrinological problems. This was found to be completely normal. In January 2002, oral isotretinoin treatment was started to treat severe acne. Three months after the onset of therapy, the patient reported lack of appetite, faintness and tinnitus. Her second cranial MRI scan showed a cerebellar lesion, and oral isotretinoin treatment was stopped (April 2002). One month after the cessation of oral isotretinoin treatment, the lesion became less prominent on the MRI scan, and after 3 months, it had disappeared. Although it is difficult to determine the causal association between the demyelinating cerebellar lesion and isotretinoin treatment, we would like to alert physicians to this possibility, because of the common usage of this drug in daily practice.

Association between APOE polymorphisms and mesial temporal lobe epilepsy with hippocampal sclerosis.

To evaluate the hypothetical link between apolipoprotein E (APOE) polymorphisms and mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) and whether presence of APOE epsilon4 allele shortens the latent period between febrile seizures and epilepsy. A further interest is whether presence of APOE epsilon4 allele has an impact on severity of the disease. Forty-seven patients with MTLE-HS were compared with 62 controls. APOE polymorphisms were determined from lymphocytes by standard methods. Eight patients (17%) and 10 controls (16.1%) were demonstrated to have one APOE epsilon4 allele. There was not any statistically significant difference in APOE epsilon4 frequency between patients and controls (P > 0.05). There was not any difference statistically according to onset age of epilepsy and the presence of APOE epsilon4 allele within patient group. APOE epsilon4 polymorphisms did not influence the severity of epilepsy. APOE epsilon4 polymorphisms had no impact on outcome after surgery. Patients with bilateral memory deficits, bilateral hippocampal atrophy and with bilateral epileptiform interictal EEG transients, were independently compared with patients having unilateral features and there were not any statistically significant differences. This study has found no association between APOE epsilon4 polymorphisms and presentation of MTLE-HS in a group of Turkish patients.

Ictal and interictal SPECT findings in childhood absence epilepsy.

The purpose of this study was to investigate the informative value of single photon emission tomography (SPECT) in relation to the pathophysiological functioning of the brain during absence seizures and the origin of ictal discharges in idiopathic generalized epilepsies (IGEs). Six patients with childhood absence epilepsy (CAE) were selected for the study and two consecutive SPECT sessions were performed concomitant with EEG recordings revealing normal results and during hyperventilation (HV) studies where the ictal discharges were induced either alone or accompanied by clinical absence seizures. All six patients had ictal discharges in their EEGs during HV and two of them also had clinical absences. SPECT findings during HV revealed an overall increase in the cerebral blood flow (CBF) with significantly higher values as compared to the baseline data. There was no indication for any focal origin in either the interictal or the ictal SPECT findings. Results of the study were supportive for the concept of subcortical origin for the absence seizures and they were also promising for the diagnostic value of ictal SPECT in epileptic cases with undetermined origin as to whether they were localization-related or generalized.

Prevalence of epilepsy in Silivri, a rural area of Turkey.

PURPOSE: To learn the prevalence of epilepsy in Silivri, a western town of Turkey, a randomized door-to-door survey was conducted using a standard questionnaire. The method of the study was adopted from the suggestions of the World Health Organization (WHO) for prevalence studies in developing countries, and the criteria were derived from Guidelines for Epidemiologic Studies on Epilepsy proposed by the Commission on Epidemiology and Prognosis, the International League Against Epilepsy (ILAE) 1993. METHODS: From June 1 to October 1, 1994, 4,803 people out of a total population of 70,394 were surveyed. The questionnaire, which was administered by practitioners and intern doctors, consisted of 15 questions, with a sensitivity of 99.9% and a specificity of 76%. After the survey, neurologists examined all of the 415 people suspected of having epilepsy and classified the seizures of the active cases. RESULTS: Of the 415 suspected cases, 49 people (24 women, 25 men) were determined as having epilepsy on the assessment day of October 1, 1994. The crude point prevalence of active epilepsy was 10.2 of 1,000 for the region. The prevalence of active epilepsy among women was 10.01 of 1,000 and among men was 10.39 of 1,000. Of the 49 cases, 40.8% had generalized seizures, 53.1% had partial onset seizures, and 6.1% could not be classified. Only 7.7% of the cases with partial onset seizures were defined as probable symptomatic cases. CONCLUSIONS: Onset of the disease peaked at the first decade of life. On the assessment day, 44.9% of those with epilepsy were receiving treatment, and 65.1% had visited religious figures at the onset or during the course of the disease, a figure that reveals the high prevalence of mystical beliefs about the disease in the study area.