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Atalar AÇ, Özge A, Türk BG, Ekizoğlu E, Kurt Gök D, Baykan B, Ayta S, Erdoğan FF, Yeni SN, Taşdelen B, Velioğlu SK, Midi İ, Serap S, Ulufer Ç, Sarıca Darol E, Ağan K, Ayç S, Gazioğlu S, Vildan Okudan Z, Görkem Şirin N, Bebek N, Dericioğlu N, Güçlü Altun İ, Destina Yalçın A, Sürmeli R, Osman Erdinç O, Erdal A, İlhan Algın D, Kutlu G, Bek S, Erdal Y, Övünç Özön A, Reyhani A, Güldiken B, Baklan B, Oğuz Genç B, Aykutlu Altindağ E, Karahan G, Koç G, Mısırlı H, Öztura İ, Aslan-Kara K, Merve MÇ, Türkmen N, Bulut O, Ömer K, Kesim Çahin Ö, Ferik S, Mehmet TP, Topaloğlu P, Üstün Özek S, Düzgün Ü, Yayla V, Gömceli Y, Ünlüsoy Acar Z. Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria. Front Neurol 2023; 13:1103541. [PMID: 36703639 PMCID: PMC9872152 DOI: 10.3389/fneur.2022.1103541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Background Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert. Methods In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis. Results Longer headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone. Conclusion Longer headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.
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Affiliation(s)
- Arife Çimen Atalar
- Department of Neurology, Istanbul Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye,*Correspondence: Arife Çimen Atalar ✉
| | - Aynur Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - Bengi Gül Türk
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Esme Ekizoğlu
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Duygu Kurt Gök
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Semih Ayta
- Child Neurology Unit, Department of Pediatrics, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Füsun Ferda Erdoğan
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Seher Naz Yeni
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin University, Mersin, Türkiye
| | | | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Department of Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
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Yerlikaya D, Hünerli-Gündüz D, Fide E, Özbek Y, Kıyı İ, Öztura İ, Yener GG. The reliability of P300 and the influence of age, gender and education variables in a 50 years and older normative sample. Int J Psychophysiol 2022; 181:1-13. [PMID: 35988895 DOI: 10.1016/j.ijpsycho.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The present study aims to investigate the effects of age, gender, and level of education on P300 in a healthy population, aged 50 years and over; and determine the reliability metrics for different conditions and measurement methods. METHOD Auditory and visual oddball recordings of 171 healthy adults were investigated. A fully automated preprocessing was applied to elicit ERP P300. Maximum peak amplitude, latency and mean amplitudes were measured. Data were stratified by age, gender, and education to determine group-level differences by using repeat measures of ANOVA. The internal consistency of P300 was calculated by a split-half method using odd-even segments. Test-retest reliability was assessed by calculating the intraclass correlation coefficient (ICC). RESULTS Maximum peak P300 amplitudes were higher in the 50-64 years age group compared to the >65 years age group; and females showed increased P300 amplitudes compared to males. P300 measures showed fair to good internal consistency and poor to good test-retest reliability. CONCLUSION Age and gender should be taken into account when designing ERP studies with elderly individuals. P300 showed good internal consistency in general, between gender groups and age groups. Long-term test-retest reliability was lower but acceptable. These findings can be interpreted as the strength of P300 by being an objective and reliable method independent of cultural differences. Here we underline several factors that may affect P300 measures and discuss other possible factors that should be standardized for P300 to be used in clinical settings.
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Affiliation(s)
- Deniz Yerlikaya
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - Duygu Hünerli-Gündüz
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - Ezgi Fide
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - Yağmur Özbek
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - İlayda Kıyı
- Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey; Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, 35340 Izmir, Turkey.
| | - Görsev G Yener
- Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, 35340 Izmir, Turkey; İzmir University of Economics, Faculty of Medicine, 35330 Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylul University, Izmir, Turkey.
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Fide E, Yerlikaya D, Öz D, Öztura İ, Yener G. Normalized Theta but Increased Gamma Activity after Acetylcholinesterase Inhibitor Treatment in Alzheimer's Disease: Preliminary qEEG Study. Clin EEG Neurosci 2022; 54:305-315. [PMID: 35957592 DOI: 10.1177/15500594221120723] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Acetylcholinesterase inhibitors (AChE-I) are the core treatment of mild to severe Alzheimer's disease (AD). However, the efficacy of AChE-I treatment on electroencephalography (EEG) and cognition remains unclear. We aimed to investigate the EEG power and coherence changes, in addition to neuropsychological performance, following a one-year treatment. Nine de-novo AD patients and demographically-matched healthy controls (HC) were included. After baseline assessments, all AD participants started cholinergic therapy. We found that baseline and follow-up gamma power analyzes were similar between groups. Yet, within the AD group after AChE-I intake, individuals with AD displayed higher gamma power compared to their baselines (P < .039). Also, baseline gamma coherence analysis showed lower values in the AD than in HC (P < .048), while these differences disappeared with increased gamma values of AD patients at the follow-up. Within the AD group after AChE-I intake, individuals with AD displayed higher theta and alpha coherence compared to their baselines (all, P < .039). These increased results within the AD group may result from a subclinical epileptiform activity. Even though AChE-I is associated with lower mortality, our results showed a significant effect on EEG power yet can increase the subclinical epileptiform activity. It is essential to be conscious of the seizure risk that treatment may cause.
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Affiliation(s)
- Ezgi Fide
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey
| | - Deniz Yerlikaya
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey
| | - Didem Öz
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, 37508Dokuz Eylül University Medical School, Izmir, Turkey.,Global Brain Health Institute, 8785University of California San Francisco, San Francisco, CA, USA.,Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurosciences, Institute of Health Sciences, 37508Dokuz Eylül University, Izmir, Turkey.,Department of Neurology, 37508Dokuz Eylül University Medical School, Izmir, Turkey.,Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey
| | - Görsev Yener
- Brain Dynamics Multidisciplinary Research Center, 37508Dokuz Eylül University, Izmir, Turkey.,Faculty of Medicine, 605730Izmir University of Economics, Izmir, Turkey.,Izmir Biomedicine and Genome Center, Izmir, Turkey
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Okyay RE, Çetintaş B, Akdöner A, Öztura İ, Eryaşar Yildirim G, Çağliyan E, Yavuz O, Şişman AR. The effect of oral contraceptive use on sympatic nerve activity in patients with polycystic ovary syndrome. Gynecol Endocrinol 2022; 38:592-597. [PMID: 35670515 DOI: 10.1080/09513590.2022.2082403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE High sympathetic nerve activity, is thought to be a cardiovascular risk factor, has been shown to correlate with circulating high testosterone levels. However its role on the pathophysiology of the polycystic ovarian syndrome has not been clearly established. The aim of our study is to compare the sympathetic nerve activity between polycystic ovarian syndrome and control group and to determine whether the use of oral contraceptives for contraception has any effect on this activity. MATERIALS AND METHODS Our study has designed as a prospective, case-control study including patients diagnosed with polycystic ovarian syndrome. Antropometric measurements were calculated, hormone levels were measured and sympathetic skin response and heart rate variability measurements were performed in the laboratory to assess sympathetic activity before starting oral contraceptive pill therapy and at the end of 1 month follow up. RESULTS In the baseline condition LH/FSH ratio, LH, DHEAS, and total testosterone levels were significantly higher in women with PCOS. After 1 month of treatment, reductions in Ferriman-Gallwey score, ovarian volumes, number of follicles, LH/FSH ratio, LH, and androgen hormone levels were statistically significant. The mean values of sympathetic skin response amplitude and R-R analysis-Valsalva test were higher in PCOS group as compared to the control group. However, these differences were not statistically significant. Similarly, no statistically significant difference in SSR latency and R-R analysis-standup test were demonstrated between PCOS and control groups. CONCLUSION In conclusion, our study supports the increased sympatovagal activity in patients with polycystic ovarian syndrome.
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Affiliation(s)
- Recep Emre Okyay
- Department of Obstetrics and Gynecology, Eylul University School of Medicine, Izmir, Turkey
| | - Buket Çetintaş
- Department of Obstetrics and Gynecology, Eylul University School of Medicine, Izmir, Turkey
| | - Aslı Akdöner
- Department of Obstetrics and Gynecology, Eylul University School of Medicine, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Eylul University School of Medicine, Izmir, Turkey
| | | | - Erkan Çağliyan
- Department of Obstetrics and Gynecology, Eylul University School of Medicine, Izmir, Turkey
| | - Onur Yavuz
- Department of Obstetrics and Gynecology, Eylul University School of Medicine, Izmir, Turkey
| | - Ali Rıza Şişman
- Department of Biochemistry, Eylul University School of Medicine, Izmir, Turkey
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Oz D, Özbek Y, Kiyi İ, Öztürk B, Öztura İ, Yener G. Cognitive evidence on EEG-P300 in healthy individuals with high depression scores. NEUROL SCI NEUROPHYS 2022. [DOI: 10.4103/nsn.nsn_185_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Yerlikaya D, Bircan B, Öztura İ, Yener G. Event related delta and theta oscillations are reduced in severe obstructive sleep apnea as a possible electrophysiologial evidence of subtle cognitive changes. Alzheimers Dement 2021. [DOI: 10.1002/alz.055947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | | | - Gorsev Yener
- International Biomedicine and Genome Institute, Izmır Turkey
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Çakmakcı S, Özgen Alpaydın A, Özalevli S, Öztura İ, İtil BO. The effect of oropharyngeal exercise in patients with moderate and severe obstructive sleep apnea using CPAP: a randomized controlled study. Sleep Breath 2021; 26:567-574. [PMID: 34169482 DOI: 10.1007/s11325-021-02423-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 04/21/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is an important public health problem. Beyond common treatment options, solution-oriented options are needed. Oropharyngeal exercise training may be a research area in this respect. This study aimed to evaluate the effects of oropharyngeal exercise (OPE) in addition to continuous positive airway pressure (CPAP) therapy in patients diagnosed with OSA. METHODS Patients with moderate and severe OSA were screened from the electronic database of our hospital and 41 patients (20: exercise group; 21: control group) were included in the study. Each patient was assessed with CPAP usage time, maximal voluntary ventilation (MVV), maximum inspiratory and expiratory pressure (MIP-MEP), neck circumference, body mass index (BMI), waist-hip ratio, Epworth sleepiness score, Pittsburgh sleep quality index (PSQI), and short-form health survey (SF-36) in the first visit. The OPE was prescribed in addition to CPAP for the exercise group and performed by the patients for 3 months. At the end of the third month, groups were re-assessed with the same parameters. RESULTS Most of the patients were men, and the mean age of the study population was 51.9 ± 7.4; the mean apnea-hypopnea index (AHI) in the last polysomnography report was 53.3 ± 27.4. In the exercise group, MVV (p = 0.003), MIP (p = 0.002), MEP (p = 0.024), and SF-36 energy/fatigue (p = 0.020) were observed to increase while the total PSQI score (p = 0.036) decreased. The neck circumference (p = 0.006) and BMI (p = 0.013) were found to be significantly decreased in the exercise group. CONCLUSIONS We found that OPE training may have improved respiratory muscle strength as well as sleep quality and health-related quality of life in the exercise group. OPE along with CPAP therapy may be recommended in moderate and severe OSA patients who are willing to participate.
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Affiliation(s)
- Selin Çakmakcı
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.
| | - Aylin Özgen Alpaydın
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Sevgi Özalevli
- Department of Pulmonary Rehabilitation, School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurology Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Bahriye Oya İtil
- Department of Chest Diseases, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
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Mermi Dibek D, Öztura İ, Baklan B. Our reasons for converting to valproic acid treatment in female patients with genetic generalized epilepsy: a retrospective, single-centre study. Neurol Sci 2021; 43:517-523. [PMID: 33890162 DOI: 10.1007/s10072-021-05261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIM Valproic acid (Na valproate) is a broad-spectrum anti-seizure medication used in children and adolescents. It is thought to have fewer adverse effects; however, recent studies have restricted its use in women of reproductive age due to the teratogenic impacts on cognition. Although alternative drugs have been used to treat patients in clinical follow-up, some patients have to return to using valproic acid. Our study aimed to determine the rate of return to valproic acid treatment in female patients with follow-up in our centre and the reasons for the return. MATERIALS AND METHODS Female patients with genetic generalized epilepsy who were followed up in our centre were included in the study. Patient data were retrospectively obtained from file records. The patients were grouped by seizure subgroups, antiepileptic treatment used, electroencephalography characteristics, and seizure treatment response. RESULTS Sixty-three (31.7%) of the 199 patients had to return to VPA treatment. When the reasons for the discontinuation of other drugs were examined, non-response to treatment was found in 80.0% of patients, adverse medication effects in 18.3%, and 1.7% continued voluntarily. Patients who are JAE subtypes were more likely to return to VPA treatment than GTCS alone subtypes. A total of 7.4% of patients converted to VPA therapy had continued myoclonic seizures compared with 20.4% of patients treated with alternative drugs. CONCLUSION VPA treatment is not used as the first choice in females of reproductive age; however, some patients will only achieve seizure control with valproate, especially those with myoclonic seizures and JAE.
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Affiliation(s)
- Dilara Mermi Dibek
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey.
| | - İbrahim Öztura
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Barış Baklan
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine, Dokuz Eylul University, İzmir, Turkey
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Dibek DM, Baba C, Akbulut N, Çoban PT, Öztura İ, Baklan B. Rare Two Findings in Frontal Lobe Epilepsy: Finger Snapping, and Ictal Alpha Activity. Ann Indian Acad Neurol 2020; 24:264-266. [PMID: 34220080 PMCID: PMC8232482 DOI: 10.4103/aian.aian_329_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/23/2020] [Accepted: 09/11/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dilara Mermi Dibek
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine Dokuz Eylul University Balcova, Inciraltı, İzmir, Turkey
| | - Cavid Baba
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine Dokuz Eylul University Balcova, Inciraltı, İzmir, Turkey
| | - Nurcan Akbulut
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine Dokuz Eylul University Balcova, Inciraltı, İzmir, Turkey
| | - Pınar Tamer Çoban
- Department of Neurology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine Dokuz Eylul University Balcova, Inciraltı, İzmir, Turkey
| | - Barış Baklan
- Department of Neurology, Clinical Neurophysiology, Faculty of Medicine Dokuz Eylul University Balcova, Inciraltı, İzmir, Turkey
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Demır N, Öztura İ. New Indices from Polysomnographic Measures for the Severity of Obstructive Sleep Apnea Syndrome -A Different Look at Obstructive Sleep Apnea Syndrome. ACTA ACUST UNITED AC 2020; 57:222-227. [PMID: 32952425 DOI: 10.29399/npa.23118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/29/2018] [Indexed: 11/07/2022]
Abstract
Introduction Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent abnormal respiratory events during sleep and causes oxidative stress which is reported as a major pathogenic mechanism for the development of various cardiovascular disorders. For the diagnosis and management of treatment, disease-related symptoms and the Apnea-Hypopnea Index (AHI) measured from polysomnographic (PSG) recordings are taken together. However, AHI do not sufficiently represent the total hypoxic load, and other indices related to apnea frequency, apnea duration, and desaturation degree should be investigated. Methods In this study, 317 polysomnographic recordings were retrospectively evaluated. Apart from the conventional AHI, apnea and/or hypopnea duration percentage (AHDP) and desaturation area (DesatArea) were calculated using PSG data. Results According to the AHI, 21.8%, 32.8% and 45.4% of cases were grouped as mild, moderate and severe OSAS, respectively. When AHDP was taken into account, 10.4%, 22.1% and 67.5% of the cases were regrouped as mild, moderate or severe OSAS, respectively. When the DesatArea calculation was used, the grouping of cases as mild, moderate or severe OSAS changed in value to 10.7%, 21.1% and 68.1%, respectively. The total group change was found to be 58.4% for both the AHDP and DesatArea formulation. With the AHDP formulation, regrouping was made in 52.2% of the mild OSAS cases and 62.5% of the moderate OSAS cases; by using the DesatArea calculation, 50.7% of mild OSAS cases and 63% of moderate OSAS cases were regrouped. Conclusion Our results show that when another parameters related to abnormal respiratory events are used, the same patients within the same group of disease severity are heterogeneously separated according to severity of hypoxia. It is suggested that grouping the patients based on AHI is insufficient and that using other polysomnographic measurements along with AHI should be considered to represent the severity of the disease.
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Affiliation(s)
- Nurhak Demır
- Marmara University, Pendik Education and Research Hospital, Neurology Clinic, İstanbul, Turkey
| | - İbrahim Öztura
- Department of Neurology, Dokuz Eylül University Hospital, İzmir, Turkey
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Yerlikaya D, Emek-Savaş DD, Bircan Kurşun B, Öztura İ, Yener GG. Electrophysiological and neuropsychological outcomes of severe obstructive sleep apnea: effects of hypoxemia on cognitive performance. Cogn Neurodyn 2018; 12:471-480. [PMID: 30250626 DOI: 10.1007/s11571-018-9487-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 05/03/2018] [Accepted: 05/16/2018] [Indexed: 10/16/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder characterized with upper airway obstructions. Some studies showed cognitive and electrophysiological changes in patients with OSAS; however, contradictory results were also reported. The purpose of the present study was twofold: (1) to investigate cognitive changes in severe OSAS patients by using neuropsychological tests and electrophysiological methods together, (2) to investigate influence of hypoxemia levels on cognition. Fifty-four severe OSAS patients and 34 age-, gender- and education matched healthy subjects were participated. OSAS patients were further divided into two subgroups according to minimum oxygen saturation levels. All participants underwent a detailed neuropsychological test battery. A classical visual oddball task was used to elicit ERP P300 and mean P300 amplitudes were measured from Fz, Cz and Pz electrode sites. OSAS patients showed reduced mean P300 amplitudes up to 43-51% on all electrode sites compared to healthy controls. Subgroup analysis revealed significant differences in neuropsychological test scores between healthy controls and high hypoxemia OSAS group, as well as between low and high hypoxemia groups. Moreover, both low and high hypoxemia OSAS groups had lower P300 amplitudes compared with healthy controls. P300 amplitudes showed a gradual decline in parallel with increasing hypoxemia severity; however, the difference between high and low hypoxemia OSAS groups did not reach significance. Moderate correlations were found between sleep parameters, neuropsychological test scores and P300 amplitudes. These results suggest that electrophysiological measures could be better indicators of cognitive changes than neuropsychological tests in OSAS, particularly in mildly affected patients.
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Affiliation(s)
- Deniz Yerlikaya
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey
| | - Derya Durusu Emek-Savaş
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey.,2Department of Psychology, Faculty of Letters, Dokuz Eylül University, 35160 Izmir, Turkey.,3Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland
| | - Behice Bircan Kurşun
- 4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey
| | - İbrahim Öztura
- 4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey
| | - Görsev G Yener
- 1Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, 35340 Izmir, Turkey.,4Department of Neurology, Dokuz Eylül University Medical School, 35340 Izmir, Turkey.,5Brain Dynamics Multidisciplinary Research Center, Dokuz Eylül University, 35340 Izmir, Turkey
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Yerlikaya D, Kurşun BB, Gökçeoğlu A, Emek-Savaş DD, Öztura İ, Yener GG. Evaluating cognitive changes in severe OSAS: Neuropsychological tests may not be as efficient as electrophysiological methods. Int J Psychophysiol 2016. [DOI: 10.1016/j.ijpsycho.2016.07.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tapan ÖO, Sevinç C, İtil BO, Öztura İ, Kayatekin BM, Demiral Y. Effect of Nasal Continuous Positive Airway Pressure Therapy on the Functional Respiratory Parameters and Cardiopulmonary Exercise Test in Obstructive Sleep Apnea Syndrome. Turk Thorac J 2015; 17:1-6. [PMID: 29404114 DOI: 10.5578/ttj.17.1.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/17/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nasal continuous positive airway pressure (nCPAP) treatment is the gold standard treatment for obstructive sleep apnea syndrome (OSAS). In this study, we aimed to show that the pulmonary functions, exercise limitation on the cardiopulmonary exercise test (CPET), and the health-related quality of life can be improved after a short treatment period by nCPAP. MATERIALS AND METHODS Our case group with severe obstructive sleep apnea (OSA) performed incremental CPET before and after 8 weeks of nCPAP treatment. All the subjects also underwent physical examination, body composition analysis, simple spirometric measurements, maximal inspiratory pressure (PImax)-maximal expiratory pressure (PEmax), and lung volume tests before and after nCPAP treatment. RESULTS Thirty-one patients (4 female, 27 male) completed the study. The mean age of the patients was 53.41 ± 1.46 years. Sixteen had at least one comorbidity. In addition, 17 of the subjects were ex-smokers. After nCPAP treatment for 8 weeks, higher PImax-PEmax (p< 0.05), peak oxygen uptake (p= 0.001), workpeak (p= 0.000), maximal heart rates (p= 0.000), and short form-36 scores (p< 0.05) were observed. nCPAP treatment helped control the blood pressure (p= 0.005). There was no significant change in body composition analysis, spirometric parameters, and lung volumes. CONCLUSION In a short time period, nCPAP can improve exercise capacity, respiratory muscle strength, and the health-related quality of life scores and help control blood pressure.
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Affiliation(s)
- Özge Oral Tapan
- Department of Chest Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Can Sevinç
- Department of Chest Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Bahriye Oya İtil
- Department of Chest Diseases, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | | | - Yücel Demiral
- Department of Public Health, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Özer Çelik A, Kurt P, Yener G, Alkin T, Öztura İ, Baklan B. Comparison of Cognitive Impairment between Patients having Epilepsy and Psychogenic Nonepileptic Seizures. Noro Psikiyatr Ars 2015; 52:163-168. [PMID: 28360698 DOI: 10.5152/npa.2015.7290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 04/20/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate cognitive impairment in patients having epilepsy or psychogenic nonepileptic seizures (PNESs) using selected neuropsychological tests at different time periods related to the seizure. METHODS In this study, selected neurocognitive tests were administered to the patients. Within 24 h, the previously applied neurocognitive tests were repeated within 24 h following the observation of typical seizures when monitoring and normalizing electroencephalography (EEG) activity. Basal neurocognitive tests were also administered to the healthy control group, and repeat neurocognitive evaluation was performed within 24-96 h. RESULTS The basal neurocognitive evaluation revealed that verbal learning and memory scores as well as Stroop test interference time were significantly lower in the PNES group compared with those in the controls. In the basal cognitive tests administered to the patients with epilepsy, verbal learning and memory scores, long-term memory, and total recognition test scores were significantly lower than those of the controls. Following the repeat cognitive tests, significant progress was found in the verbal categorical fluency score of the PNES group. No significant difference was determined in the epilepsy group. Significant contraction was determined in the Stroop interference time in the control group, but no similar change was recorded in the epilepsy or PNES groups. CONCLUSION While memory problems seemed to be most prominent in the assessed patients with epilepsy, attention and executive function problems were more dominant in the patients with PNESs. These findings are probably related to numerous factors such duration of disease, mood disorders, and specific drug use. No deterioration in attention and executive functions was reported in the early post-seizure period in either patient group.
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Affiliation(s)
- Ayşegül Özer Çelik
- Clinic of Neurology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Pınar Kurt
- Department of Psychology, İstanbul Arel University, İstanbul, Turkey
| | - Görsev Yener
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Tunç Alkin
- Department of Psychiatry, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Barış Baklan
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Evlice A, Uğurel B, Baklan B, Öztura İ. Neuropathy and Dysautonomia in Patients with Obstructive Sleep Apnea Syndrome. Noro Psikiyatr Ars 2015; 52:24-28. [PMID: 28360671 DOI: 10.5152/npa.2015.7288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 12/19/2013] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of our study is to search for the existence of neuropathy, dysautonomia and to identify the correlations of sickness level of patients with Obstructive Sleep Apnea Syndrome (OSAS). METHODS The research is based on the real cases at Dokuz Eylul University of Medicine Sleep and Epilepsy Center, observed during September 2008-May 2009. The patients were selected by polysomnography samples based on 20 persons at same ages with following criteria; high leveled OSAS (AHİ≥30), low OSAS (5≤AHİ<30) and healthy participants. Classical ENMG protocol, symphatic skin response and R-R interval variation test were performed on these samples. RESULTS High and low leveled OSAS patients had a statistically significant (p<0.05) decrease in the average velocity of motor conduction in right tibialis posterior when compared to the control group. Besides we observed an statistically significant (p<0.05) increase in the average amplitud of symphatic skin responses in high leveled OSAS patients than control group. CONCLUSION OSAS indicates a risk of possible peripheral neuropathy and autonomic dysfunction risk increases in positive correlation with level of OSAS.
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Affiliation(s)
- Ahmet Evlice
- Department of Neurology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Burcu Uğurel
- Department of Neurology, Yeditepe University Faculty of Medicine, İstanbul, Turkey
| | - Barış Baklan
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - İbrahim Öztura
- Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Özyurt G, Öztura İ, Alkın T, Özerdem A. [Anxiety disorder due to epilepsy: a case report]. Turk Psikiyatri Derg 2015; 26:71-75. [PMID: 25742040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Epileptic patients present with psychiatric disorders more frequently than the general population and patients with other chronic medical conditions. Psychiatric disorders can co-occur with epilepsy and can be caused by epilepsy. Personality changes, as well as psychosis, and mood or anxiety disorders can occur in association with epilepsy. Anxiety disorders due to epilepsy can manifest as generalized anxiety disorder, panic disorder, phobias, or obsessive-compulsive disorder. The risk of an anxiety disorder is higher in patients with focal epilepsy, especially those with temporal lobe epilepsy, but an anxiety disorder can also occur in patients with frontal lobe epilepsy or generalized tonic-clonic epilepsy. Herein we present a 41-year-old female patient with comorbid anxiety disorder and epilepsy that improved following initiation of antiepileptic medication. The patient's EEG showed abnormalities, particularly in the frontal lobe. Epileptic activation-associated anxiety disorder presented as phobia of swallowing and the patient exhibited features of generalized anxiety disorder. Following initiation of antiepileptic medication, the seizures stopped and the symptoms of anxiety disappeared in two weeks. The patient was receiving psychotherapy once every 2 weeks. The patient remained asymptomatic during 2-years of follow-up. This case highlights the importance of differential diagnosis of underlying epilepsy in patients with acute severe anxiety and the efficacy of proper medical treatment, which was given in the presented case for the underling pathology of anxiety.
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Evlice A, Uğurel B, Baklan B, Öztura İ. OBSTRUKTİF UYKU APNE SENDROMUNDA NÖROPATİ VE DİSOTONOMİ. Noro Psikiyatr Ars 2014. [DOI: 10.4274/npa.y7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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