In the article “Early development of intractable epilepsy in children: A prospective study” by Berg et al. ( Neurology 2001;56:1445–1452), several errors appeared in the …

Early development of intractable epilepsy in children: A prospective study

In the article “Levetiracetam in pregnancy: Results from the UK and Ireland epilepsy and pregnancy registers” by E. Mawhinney et al. ( Neurology® 2013;80:400–405), there is an error in the body of the abstract and in table 1. The polytherapy major congenital malformations (MCM) rate should read 5.56% (3.54%–8.56%) rather than 6.47% (4.31%–9.60%). The authors regret the errors.

https://n.neurology.org/content/neurology/80/7/691.full.pdf

Levetiracetam in pregnancy: Results from the UK and Ireland epilepsy and pregnancy registers

Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.

/pdf/pathophysiological-bases-of-comorbidity-in-migraine-3abd9vw6p2.pdf

Pathophysiological Bases of Comorbidity in Migraine.

Bidirectional relationships of sleep and epilepsy in adults with epilepsy.

Background
Yawning is considered to be a symptom that reflects dopaminergic activity, although its pathophysiological mechanism is not yet fully understood Interestingly, repetitive yawning is seen in some patients during migraine attacks The aim of this cross-sectional study is to investigate the frequency of yawning during migraine attacks and its association with different characteristics of migraine

Methods
Patients with migraine with or without aura were evaluated using questionnaires and diaries to determine the characteristics of headache and accompanying symptoms Repetitive yawning in the premonitory phase and/or during headache were determined

Results
Three hundred and thirty-nine patients were included in the study One hundred and fifty-four patients reported repetitive yawning (454%) during migraine attacks Repetitive yawning was reported in the 112% of the patients in the premonitory phase, 242% during headaches, and 10% both in the premonitory phase and during headaches Migraine with aura (468 vs 319%; P = 005), accompanying nausea (896 vs 751%; P = 001), vomiting (487 vs 378%; P = 044), osmophobia (667 vs 523%; P = 024), and cutaneous allodynia (582 vs 46%; P = 032) were more common in patients with yawning than without Other dopaminergic-hypothalamic premonitory symptoms (416 vs 265%; P = 003), especially sleepiness (175 vs 59%; P = 001), irritability/anxiety (214% vs 114%; P = 019), nausea/vomiting (104 vs 43%; P = 03), and changes in appetite (182 vs 97%; P = 024), were also more frequent in patients with yawning than without After being adjusted for all other relevant covariates, the odds of repetitive yawning were increased by the presence of nausea (OR 288; 95% CI 1453-5726; P = 002) and migraine with aura (OR 166; 95% CI 1035-2671; P = 036)

Conclusions
Our results demonstrated that yawning is a common self-reported symptom leading or accompanying migraine attacks and is associated with aura, nausea and/or vomiting, osmophobia, and cutaneous allodynia in patients with migraine Although yawning is a rather frequently seen behavior, it is a unique and reliable symptom in patients with migraine that may offer an opportunity for early treatment of migraine attacks

Migraine and Yawning

Epilepsy and headaches: Further evidence of a link

Sleep quality and related clinical features in patients with epilepsy: A preliminary report.

Amaç: Epileptik gebeliklerde nöbetlerin kontrolü ile anti epileptik ilaçların (AEİ) olası teratojen etkileri arasında dengenin sağlanması esastır. Bu çalışmada epilepsi tanısı ile izlenen gebelere ait demografik ve klinik verilerin sunulması, AEİ kullanımı ile oluşabilecek potansiyel komplikasyonların belirlenmesi amaçlandı. Gereç ve Yöntem: Elli beş epileptik gebe kadına ait 101 gebelik verisi geriye dönük olarak incelendi. Hastaların demografik özellikleri, epilepsi süreleri, nöbet sıklıkları, kullandıkları AEİ’ler ve dozları, doğum yöntemleri, infantların doğum ağırlıkları, fetal malformasyonlar, abortuslar, erken doğum ve ölü doğumlar değerlendirildi. Bulgular: Yüz doksan hastanın 55’inin (%28.9) gebelik yaşamış olduğu ve toplam gebelik sayısının 101 olduğu tespit edildi. Hastaların yaş ortalaması 30.7±9.7, ortalama epilepsi süresi 14.5±10.8 yıl idi. Yüz bir gebeliğin 50’sinde (%61.7) gebelik süresince en az bir kez nöbet geçirildiği saptanırken, 31 gebelikte ise (%38.3) nöbet gözlenmemişti. Gebeliklerin %19.8’i spontan abortus, %72.3’ü miadında canlı doğum, %4.9’u erken doğum, %2’si ölü doğum ve %1’i ise prematüre ölü doğum olarak sonuçlanmıştı. Gebeliğinde AEİ kullanmayan, monoterapi kullanan ve politerapi kullanan hastaların yenidoğanlarının ortalama doğum ağırlıkları sırasıyla 3065.4 gr, 2941.3 gr, 2696.6 gr olarak saptandı.Yenidoğanlarda görülen doğumsal malformasyonlar; dekstrokardi, hipospadias ve at nalı böbrek idi. Sonuç: Epileptik gebelikler sıklıkla sağlıklı bebek doğumu ile sonuçlanmaktadır. Antiepileptik tedavinin prekonsepsiyonel dönemde planlanması, hastaların politerapiden kaçınılarak, nöbet tipine uygun, en düşük doz AEİ ile takip edilmesi bu hedefe ulaşılmasında önem taşımaktadır.

Epilepsy and Pregnancy: A Retrospective Analysis of 101 Pregnancies

Fatigue is a frequently reported symptom in patients with epilepsy (PWE) while the pathophysiology, causes and effects on the disease are not yet fully understood. Fatigue may occur as a side effect of antiepileptic drugs (AEDs); however, it varies greatly depending on both the characteristics of the patients and the AEDs used. The aim of this study was to investigate the relation between fatigue, clinical features and AEDs and doses used in monotherapy in PWE. Ninety consecutive patients with the diagnosis of epilepsy, treated as monotherapy were included in the study. Demographic data, seizure type and frequency, AEDs and their doses were recorded. Fatigue severity scale (FSS) was used in the evaluation of fatigue. Cases of fatigue were defined by a FSS score ≥ 4. The mean age of the patients (57 females, 33 males) was 33 ± 12.7 years and the mean disease duration was 11.7 ± 9.1 years. Used as monotherapy, AEDs included carbamazepine (n = 29, 32.2%), valproic acid (n = 28, 31.1%), levetiracetam (n = 23, 25.6%) and lamotrigine (n = 10, 11.1%). Fatigue was reported by 52.2% of patients (FSS score ≥ 4). It was found that patients with fatigue had more seizures in the last year than those without (p = 0.031). There was no relation between fatigue and AEDs. The doses of carbamazepine and levetiracetam were significantly correlated with the scores of FSS (p = 0.042 and p = 0.023, respectively), and there was no correlation between the doses of valproic acid and lamotrigine and the scores of FSS. The results of our study showed that; approximately half of the patients with epilepsy had fatigue. Although the relation between AEDs and fatigue was not detected, it was pointed out that AED doses may play a role in the development of fatigue.

Inter-ictal fatigue and antiepileptic drugs in patients with epilepsy.

Aim: Status epilepticus (SE) is an important and distinct problem with its high morbidity and mortality. The need for early identification of SE to predict the course and prognosis of epilepsy have led us to investigate the clinical features associated with SE in patients with epilepsy in this study.Material and Methods: The information of the patients with epilepsy recorded comprised demographic features, type and etiology of seizures, age of onset of epilepsy, frequency of seizures, mono- or polytherapy treatment, history of convulsive SE, triggering factors for SE and brain magnetic resonance imaging findings. The data also included patients’ family history of epilepsy and history of febrile seizures, mental retardation.Results: A total of 610 patients with epilepsy (291 men, 319 women) were included in the study. It was found that 49 (8%) of the patients had at least one convulsive SE. Univariate logistic regression analysis showed that earlier onset of epilepsy, symptomatic/cryptogenic etiology, mental retardation, frequency of seizures ≥1/month, treatment with polytherapy, and abnormalities in neuroimaging are associated with SE (p=0.001, p0.001, p0.001, p0.001, p0.001 and p0.001, respectively). In multivariate logistic regression analysis; mental retardation (SE 0.380; 95% CI 0.186-0.825; p=0.014) and polytherapy (SE 0.392; 95% CI 0.158-0.735; p=0.006) were found to be independent factors related with SE. It was determined that 69% of patients had a triggering factor for SE and infection (65%) was the most common among these.Conclusion: The results of this study showed that there is a clear relationship between the occurrence of SE and mental retardation and treatment with polytherapy in patients with epilepsy. Symptomatic/cryptogenic etiology, early onset of epilepsy, high frequency of seizures and presence of abnormalities in neuroimaging are also associated with SE. Identification of these risk factors of SE will be helpful to initiate the appropriate treatment within a short time after diagnosis.

Aslı Ece Çilliler

Papers

Epilepsy and headaches: Further evidence of a link

Sleep quality and related clinical features in patients with epilepsy: A preliminary report.

Epilepsy and Pregnancy: A Retrospective Analysis of 101 Pregnancies

Inter-ictal fatigue and antiepileptic drugs in patients with epilepsy.

Clinical features associated with convulsive status epilepticus in patients with epilepsy