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Kizilkilic EK, Karadeniz D, Senel GB. Attention and executive function impairments in obstructive sleep apnea are associated with decreased sleep spindles. Acta Neurol Belg 2024:10.1007/s13760-024-02534-9. [PMID: 38563875 DOI: 10.1007/s13760-024-02534-9] [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: 08/08/2023] [Accepted: 03/13/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Sleep spindles play a key role in sleep-mediated cognitive processes. Cognitive functions are well-known to be affected in obstructive sleep apnea (OSA). Here, we analyzed attention and executive functions in patients with OSA and investigated the relationship between sleep spindles and cognitive abilities. METHODS Sixty patients with OSA (18-65 years, 19 females and 41 males) and a control group (n = 41) including age-and sex-matched healthy individuals were consecutively and prospectively enrolled. All participants had a full-night polysomnography, and sleep spindles were analyzed using a semi-automated program. For the evaluation of short-term memory, attention and executive functions, Stroop test, forward and backward digit span tests were applied to all participants upon awakening following polysomnography. RESULTS Scores of forward and backward digit span and Stroop tests were worse in OSA patients in compared to those in controls. Mean density of sleep spindles was decreased in OSA patients than those in controls (p = 0.044). A positive correlation was found between fast sleep spindle frequency and forward digit span (r = 2.222; p = 0.038) and backward digit span test scores (r = 2,157; p = 0.042) in OSA patients. In patients with moderate to severe OSA, sleep spindle density was positively correlated with forward (r = 2.323, p = 0.029) and backward (r = 2.500, p = 0.016) DSTs, and the duration of sleep spindles had positive correlation with backward DST (r = 2.452, p = 0.010). CONCLUSION Our findings demonstrated that the disturbances in sleep spindle characteristics in OSA are associated with the cognitive impairments in attention, short-term memory, and executive functions, especially in patients with moderate to severe OSA.
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Affiliation(s)
- Esra Kochan Kizilkilic
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey.
| | - Derya Karadeniz
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey
| | - Gulcin Benbir Senel
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey
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Kochan Kizilkilic E, Unkun R, Karadeniz KG, Korkmazer B, Kizilkilic O, Delil S. Delayed Enhancing White Matter Lesions, a Rare Complication After Stent-Assisted Coil Embolization: A Case Report. World Neurosurg 2024; 187:42-45. [PMID: 38548055 DOI: 10.1016/j.wneu.2024.03.110] [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: 02/20/2024] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Delayed enhancing white matter lesions are a rare complication that develops after endovascular treatment of cerebral aneurysms, the etiology of which remains unclear. METHODS AND RESULTS We present a 52-year-old female patient who was symptomatic with a seizure-like condition and showed reversible cranial parenchymal changes with high-dose cortisone treatment after endovascular stent-assisted coil embolization for an unruptured aneurysm in the internal cerebral artery. CONCLUSIONS Clinicians should be alert to this rare complication and should follow patients for a long time due to its fluctuating and long-term course.
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Affiliation(s)
| | - Rumeysa Unkun
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Kağan Gökdeniz Karadeniz
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bora Korkmazer
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Osman Kizilkilic
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Radiology, Istanbul, Turkey
| | - Sakir Delil
- Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey
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Calikusu FZ, Akkus S, Kochan Kizilkilic E, Poyraz BC, Altunç AT, Kiziltan G, Gunduz A. Atypical findings: Atypical parkinsonian syndromes or Atypical parkinsonian syndromes look-alikes. Clin Neurol Neurosurg 2023; 233:107975. [PMID: 37734268 DOI: 10.1016/j.clineuro.2023.107975] [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] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/09/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE In parkinsonian syndromes, presentations other than current diagnostic criteria are considered atypical findings. Our goal was to identify and describe the frequency and features of uncommon manifestations of atypical parkinsonian syndromes within our group. METHODS We retrospectively retrieved the medical records of all patients admitted to our clinic with parkinsonism between January 2011 and January 2022. We only included patients with atypical parkinsonian syndromes, in which the diagnosis was based on current clinical criteria. We retrospectively analyzed neurological, psychiatric, radiological, and electrophysiological characteristics. Typical and atypical features were classified according to the current clinical criteria and previous reports. RESULTS We determined 51 patients with atypical parkinsonian syndromes; 46 were included, whereas five were excluded due to insufficient follow-up. The probable diagnoses were multiple system atrophy (MSA, n = 19), dementia with Lewy bodies (DLB, n = 10), frontotemporal dementia (FTD, n = 10), corticobasal syndrome (CBS, n = 3), progressive supranuclear palsy (PSP, n = 4). The prevalence of atypical findings was similar among different types of atypical parkinsonian syndromes (p = 0.847). Atypical findings were eyelid myoclonus, double vision in MSA; ataxia, myoclonus, and a typical hummingbird sign on MRI in DLB; pyramidal findings and family history in FTD; early onset, family history, and onset with psychiatric findings in PSP-like phenotype. Genetic causes were identified in the FTD-like phenotype with pyramidal findings, whereas symptom onset was early with myoclonus in the PSP-like phenotype. CONCLUSION Atypical findings such as abnormal saccades, myoclonus, and ataxia may be a part of degenerative syndromes. However, family history, onset at an earlier age, and specific neurological findings suggest genetic syndromes.
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Affiliation(s)
- Fatma Zehra Calikusu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Sema Akkus
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Esra Kochan Kizilkilic
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Burc Cagri Poyraz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Psychiatry, Istanbul, Turkey
| | - Ali Tarik Altunç
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Psychiatry, Istanbul, Turkey
| | - Gunes Kiziltan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey
| | - Aysegul Gunduz
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Neurology, Istanbul, Turkey.
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Kizilkilic EK, Kılboz BB, Ucler S. Syndrome of Transient Headache and Neurological Deficits with Cerebrospinal Fluid Lymphocytosis (HaNDL): A Case Report - Is there an Association with the COVID-19 Vaccine? Ann Indian Acad Neurol 2023; 26:310-312. [PMID: 37538407 PMCID: PMC10394446 DOI: 10.4103/aian.aian_1002_22] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/02/2023] [Accepted: 01/31/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Esra Kochan Kizilkilic
- Department of Neurology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Bekir Burak Kılboz
- Department of Neurology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
| | - Serap Ucler
- Department of Neurology, University of Health Sciences, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, Turkey
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Unkun R, Kizilkilic EK, Delil S, Kemerdere R, Ozkara C. Levetiracetam-associated pancytopenia. Acta Neurol Belg 2022:10.1007/s13760-022-02138-1. [DOI: 10.1007/s13760-022-02138-1] [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] [Received: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022]
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Hamid R, Korkmazer B, Kochan Kizilkilic E, Arman GM, Ozogul M, Kargın OA, Arslan S, Kizilkilic O. Potential Association Between COVID-19 Vaccination and Facial Palsy: Three Cases With Neuroimaging Findings. Ear Nose Throat J 2022:1455613221113818. [PMID: 35855585 PMCID: PMC9301354 DOI: 10.1177/01455613221113818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 01/07/2023] Open
Abstract
Acute onset Facial palsy was reported in four vaccinated participants in the BNT162b2 (Pfizer-BioNTech) vaccine clinical trials published on December 10, 2020. So far, few cases of Facial palsy among the mRNA vaccine groups have been previously documented in the literature. Facial palsy is cited as medically attended adverse event following immunization on April 12, 2021, after the first dose of the approved Pfizer-BioNTech COVID-19 vaccines for preventive immunization for SARS-CoV-2 is administrated to the population in Turkey. This study is aimed to describe clinical and magnetic resonance imaging features of three patients, who developed acute onset peripheral facial paralysis after administration of the BNT162b2 vaccine, without any previous medical condition. The first patient presented with right sided facial palsy within the same day following the vaccine was administrated, while the second patient presented with left sided facial palsy 2 months after vaccination. The third patient, on the other hand, presented with right sided facial palsy and abducens nerve (CN VI) paralysis two days after vaccine was administrated.
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Affiliation(s)
- Rauf Hamid
- Department of Radiology, Istanbul University-Cerrahpasa
Cerrahpasa Medical Faculty, Fatih, Turkey
| | - Bora Korkmazer
- Department of Radiology, Istanbul University-Cerrahpasa
Cerrahpasa Medical Faculty, Fatih, Turkey
| | - Esra Kochan Kizilkilic
- Department of Neurology, University of Health Sciences
Istanbul Prof. Dr Cemil Tascioglu City Hospital, Okmeydani, Turkey
| | - Gokce Merve Arman
- Department of Radiology, Karamanoglu Mehmetbey University
Karaman Training and Research Hospital, Karaman, Turkey
| | - Murat Ozogul
- Department of Radiology, University
of Health Sciences, Haydarpasa Numune Training and
Research Hospital, Uskudar, Turkey
| | - Osman Aykan Kargın
- Department of Radiology, Istanbul University-Cerrahpasa
Cerrahpasa Medical Faculty, Fatih, Turkey
| | - Serdar Arslan
- Department of Radiology, Istanbul University-Cerrahpasa
Cerrahpasa Medical Faculty, Fatih, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Istanbul University-Cerrahpasa
Cerrahpasa Medical Faculty, Fatih, Turkey
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Kizilkilic EK, Unkun R, Uygunoglu U, Delil S, Ozkara C. Treatment of COVID-19-induced refractory status epilepticus by tocilizumab. Eur J Neurol 2022; 29:2861-2863. [PMID: 35678591 PMCID: PMC9348353 DOI: 10.1111/ene.15440] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/02/2022] [Indexed: 12/31/2022]
Abstract
Background and purpose COVID‐19 is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in which neurological complications have been increasingly recognized. Acute symptomatic epileptic seizures and status epilepticus are frequently reported neurological complications associated with this infection. The nervous system damage caused by SARS‐CoV‐2 may be mediated by the immune system. Interleukin 6 (IL‐6), an important component of the cytokine storm, is directly correlated with the severity of symptoms. Tocilizumab is an inhibitor of IL‐6 receptors, which blocks IL‐6‐mediated signal transduction and is used in the treatment of COVID‐19 and status epilepticus. Case report A patient with the Unverricht–Lundborg disease is presented who had developed refractory recurrent status epilepticus during COVID‐19 infection, which was finally controlled by treatment with tocilizumab. Discussion Tocilizumab, an IL‐6 inhibitor, may be considered as a treatment option in patients with status epilepticus and refractory seizures.
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Affiliation(s)
| | - Rumeysa Unkun
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sakir Delil
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Cigdem Ozkara
- Department of Neurology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Senel GB, Kochan Kizilkilic E, Karadeniz D. Restless sleep disorder in children with NREM parasomnias. Sleep 2021; 44:6149528. [PMID: 33630032 DOI: 10.1093/sleep/zsab049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/19/2020] [Revised: 02/07/2021] [Indexed: 11/14/2022] Open
Abstract
STUDY OBJECTIVES Restless sleep disorder (RSD) is a newly defined sleep disorder in the pediatric age group. Here, we investigated the frequency of RSD and the sleep characteristics in children with NREM (non-rapid eye movements) parasomnias associated with RSD. METHODS We analyzed all patients with NREM parasomnias for the last 1 year, and investigated the clinical and polysomnographic characteristics. RESULTS Twenty-eight children with NREM parasomnias and age- and gender-matched 20 healthy children were analyzed. The diagnosis of RSD was made in eight children with NREM parasomnias (28.6%), and none of the children had RSD in controls (p = 0.008). The most common diagnosis among children with RSD was somnambulism (six children), but not significantly (p = 0.308). Sleep efficiency was lower in children with RSD than those without RSD (p = 0.033). In cyclic alternating pattern analysis (CAP), CAP rate, durations and the indices of phases A1, A2, and A3 were significantly higher in children with NREM parasomnias in compared to controls. CAP parameters between children with or without RSD; however, were similar, except for higher index of phase A3 in children with RSD, suggesting arousal reactions accompanying RSD. CONCLUSIONS We demonstrated that RSD was present in almost one third of the children with NREM parasomnias. Sleep quality was worse in children with NREM parasomnias and RSD. An increase in sleep instability compatible with NREM parasomnia was present, while an increased phase A3 in RSD was remarkable. RSD is associated with a worse sleep quality and increased arousals, and should be questioned in children with NREM parasomnias.
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Affiliation(s)
- Gulcin Benbir Senel
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Sleep and Disorders Unit, Istanbul, Turkey
| | - Esra Kochan Kizilkilic
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Sleep and Disorders Unit, Istanbul, Turkey
| | - Derya Karadeniz
- Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Neurology, Sleep and Disorders Unit, Istanbul, Turkey
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