Multi-inflammatory index as a new predictive and prognostic marker of acute symptomatic seizures in patients with cerebral venous sinus thrombosis

BACKGROUND

The multi-inflammatory index (MII) is a novel marker that indicates the diagnosis, prognosis, and clinical severeness of inflammation-associated diseases. It is indicated that inflammatory biomarkers may help predict the occurrence of acute symptomatic seizures(ASS) after ischemic stroke.

OBJECTIVE

Our goal was to search the predictive and prognostic capability of the MII-1 and MII-2 for ASS in cerebral venous sinus thrombosis (CVST) patients.

METHOD

91 patients with CVST were retrospectively analyzed from the medical records of patients between 2010 and 2023 and divided into the ASS group and non-ASS group. The MII-1 and MII-2 levels on admission, demographic and clinic features, predisposing risk factors, radiological characteristics involving thrombotic cerebral veins, and the type of parenchymal lesions were documented. Modified Rankin Scale (mRS) on admission and at the 3rd month were evaluated to determine the disability.

RESULTS

MII-1 and MII-2 were statistically significantly higher in the ASS group and predictors for the occurrence of seizures with CVST in multivariate analysis. The area under the curve (AUC) of the receiver operating characteristics (ROC) curve for MII-1 was 0.791 (95 %CI = 0.691-0.891, p < 0.001), and AUC for MII-2 was 0.761 (95%CI = 0.660-0.861, p < 0.001). When the clinical variables that were included in the multivariate analysis and MII-1 and MII-2 were combined, the predictive power was greater with the AUC of 0.959. A significant positive correlation was found between mRS at the 3rd month and MII-1 and MII-2 in the ASS group.

CONCLUSION

MII-1 and MII-2 can be used as new predictive and prognostic markers of ASS in patients with CVST.

The relationship between sleep disorders with patients' demographic-clinical characteristics and quality of life in patients with multiple sclerosis

OBJECTIVES

In this study, the effect of sleep disturbance on the quality of life in MS patients and its relationship between demographic and clinical characteristics of the patients were investigated.

METHODS

67 MS patients and 51 healthy individuals were included in our study. The patient group consisted of 43 women and 24 men. The control group consisted of 32 women and 19 men. Demographic and clinical characteristics of the patients; age, gender, duration of illness, annual number of attacks, treatments, and medical history were recorded and neurological examinations of all patients were performed and disability was determined for each patient with Kurtzke's expanded disability status scale (EDSS). Evaluations were made using demographic data, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Expanded Disability Status Scale (EDSS), Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Berlin Questionnaire and Multiple Sclerosis Quality of Life (MSYK) - 54 Instrument.

RESULTS

We found that the quality of life was significantly impaired in MS patients compared to healthy controls (p < 0.001). And we found that this was related to the presence of progressive MS and chronic fatigue among the clinical features of the patient, sleep-disordered breathing among sleep disorders, poor sleep quality, comorbid anxiety and depression (p = 0.001, p:0.009, p = 0.022, p = 0.007, p < 0.001 and p = 0.001, respectively).

CONCLUSION

All these findings show that sleep disorders in patients with MS are a condition that should be questioned and treated in the follow up of the disease, otherwise it may affect the quality of life of patients negatively.

COVID-19 and post-poliomyelitis syndrome: coincidence?

Although severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel virus, many central and peripheral nervous system manifestations associated with coronavirus disease-19 (COVID-19) infection have been reported. Beyond the neurologic manifestations, we may still have much to learn about the neuropathologic mechanism of SARS-CoV-2 infection. Here we report a case of post-poliomyelitis syndrome (PPS) related to COVID-19 and attempt to predict the possible pathophysiologic mechanism behind this association.

Interleukin-33 and oxidative stress in epilepsy patients

OBJECTIVE

İnflammation and oxidative stress plays an important role in the etiology of epilepsy. Interleukin-33 (IL-33), a new member of the cytokine family associated with interleukin-1 (IL-1), has been found to play a role in pathogenesis of central nervous system diseases and cause the production of proinflammatory cytokines and oxidative stress molecules. Our aim was to investigate IL-33 and oxidative stress values (total antioxidant capacity (TAS), total oxidant capacity (TOS), and oxidative stress index (OSI)) in patients with epilepsy and to evaluate their relationship with each other.

METHODS

The study included 60 patients with epilepsy and 35 healthy controls. The group of patients with epilepsy consisted of 21 patients with treatment-resistant epilepsy and 39 patients with well-controlled epilepsy. The patients with epilepsy were also classified as monotherapy and polytherapy group according to the number of antiepileptic drugs they used, and focal and generalized epilepsy group according to the seizure type. Serum IL-33, TAS, TOS and OSI levels were measured in the patients with epilepsy and the control group.

RESULTS

The mean serum TAS level was significantly lower in the all patients with epilepsy group compared to the control group, and the mean serum IL-33, TOS, and OSI levels were significantly higher. The mean serum TOS and OSI levels were significantly lower and TAS levels were significantly higher in the patients with well-controlled epilepsy than the patients with treatment-resistant epilepsy. While there was a positive correlation between serum IL-33 and OSI levels in the all patients with epilepsy group, a negative correlation was shown between IL-33 and TAS levels.

CONCLUSION

The IL-33/ST2 pathway may represent a new promising therapeutic strategy both for the treatment and the prevention of the disease.

Acute motor and sensory axonal neuropathy associated with Sjögren's syndrome

Sjögren's syndrome (SS) is an autoimmune disease with mononuclear cell infiltration and destruction of the lacrimal gland and salivary glands, which cause dryness of the eyes and mouth. The most common neurological condition seen in SS is peripheral neuropathy. Initial manifestation of SS as an acute fulminant peripheral neuropathy is extremely rare. We report a 42-year-old patient presenting with acute motor sensory-axonal neuropathy in the presence of SS. She showed partial response to intravenous immunoglobulin but favourable clinical improvement was seen after initiation of corticosteroid treatment.

The measurement of both carotid intima-media thickness and epicardial adipose tissue thickness in children with epilepsy receiving antiepileptic drug therapy

OBJECTIVE

The aim of this study was to evaluate the carotid intima-media thickness together with the thickness of the epicardial adipose tissue in patients receiving antiepileptic drug therapy and to investigate the presence of increased cardiovascular risk in these patients.

METHODS

The study included a total of 52 patients comprising 32 males and 20 females who were diagnosed as having epilepsy and who were using one or more antiepileptic drugs. The control group consisted of 34 healthy individuals comprising 16 males and 18 females. The individuals selected for the study group were requested to go to the hospital after overnight fasting. After blood sampling for serum lipid value, the carotid intima-media thickness was measured with high resolution B-mode ultrasonography and epicardial adipose tissue thickness with echocardiography in the patients and the control group subjects.

RESULTS

The carotid intima-media thickness was determined as 0.47 ± 0.05 mm in the patient group and 0.44 ± 0.04 mm in the control group (p = 0.028). The carotid intima-media thickness was measured as 0.45 ± 0.05 mm in patients with epilepsy taking monotherapy and 0.49 ± 0.04 mm in those taking polytherapy (p = 0.003). The epicardial adipose tissue thickness was determined as 3.42 ± 0.09 mm in the patient group and 1.72 ± 0.90 mm in the control group (p = 0.000). The epicardial adipose tissue thickness was measured as 3.16 ± 0.87 mm in patients with epilepsy taking monotherapy and 3.77 ± 0.83 mm in those taking polytherapy (p = 0.041).

CONCLUSIONS

It was determined that carotid intima-media thickness and epicardial adipose tissue thickness were significantly high in children with epilepsy taking long-term antiepileptic drugs. These results demonstrate that these patients could be at increased risk of the development of cardiovascular complications. There is a need for more extensive studies on this subject.

Comparison of cytokines and prooxidants/antioxidants markers among adults with refractory versus well-controlled epilepsy: A cross-sectional study

PURPOSE

This study aims to investigate the serum adiponectin, interleukin (IL)-6 and oxidative stress in epilepsy patients who are refractory or non-refractory to treatments.

METHOD

The study comprised 31 refractory epilepsy, 29 well-controlled epilepsy patients and control group including 29 healthy individuals. The serum adiponectin, IL-6, total antioxidant status (TAS), total oxidant status levels (TOS) and oxidative stress index (OSİ) were determined.

RESULTS

The mean serum adiponectin and TAS levels were significantly lower in the refractory epilepsy patients than in the healty controls, and mean IL-6, TOS and OSİ levels were significantly higher. The serum adiponectin, IL-6, TAS, TOS and OSI levels were not significantly different between the well-controlled epilepsy patients and the healthy controls.

CONCLUSIONS

The mean serum IL-6 and oxidative stress levels in refractory epilepsy patients were higher and the serum adiponectin level was lower than the healthy control group. These findings may be associated with an increased risk of seizures, atherosclerosis and cardiovascular disease in refractory epilepsy patients.

Effect of serum inflammatory markers on the prognosis of adult and pediatric patients with Guillain-Barré syndrome

OBJECTIVE

The aim of this study was to evaluate blood neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), C-reactive protein (CRP), and albumin levels for their prognostic value in adult Guillain-Barré syndrome (GBS-A) and pediatric Guillain-Barré syndrome (GBS-P) patients.

PATIENTS AND METHODS

We retrospectively analyzed the medical records of 68 Guillain-Barré syndrome (GBS) patients (36 adults, 32 children) who were treated as inpatients at Harran University Faculty of Medicine, Neurology and Pediatric Neurology Departments. The pretreatment NLR, PLR, CRP, and albumin levels and Hughes scores at hospital admission, discharge, and third-month control were documented.

RESULTS

In GBS-A patients, the mean CRP and NLR levels at admission/discharge and third-month control were significantly higher, and the mean albumin level was significantly lower in the Hughes disability scale (HDS)≥3 group. In GBS-P group, the mean NLR level at third month was significantly higher in the HDS≥3 group. GBS-A patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than GBS-P patients. Both GBS-A and GBS-P patients had higher mean NLR, PLR, and CRP levels and lower mean albumin values than healthy controls. Only the albumin level of the GBS-A group was found to be a significant predictor of prognosis at discharge from hospital.

CONCLUSION

NLR, CRP, and albumin levels in the GBS-A group and NLR levels in the GBS-P group may be helpful in predicting the prognosis of the disease. The albumin level of GBS-A patients is an independent risk factor for prognosis at discharge from hospital.

Surgical treatment of pseudotumor cerebri

AIM

To share our experience with idiopathic intracranial hypertension.

MATERIAL AND METHODS

All patients believed to have pseudotumor cerebri underwent a fundus oculi examination to confirm the existence of papillary stasis and lumbar puncture (LP) to measure cerebrospinal fluid (CSF) pressure. Patients who did not respond to medical treatment underwent fundus oculi examinations at 3-week intervals. Patients with CFS pressures exceeding 240 mm H2O underwent at least three LPs at 3-day intervals. Patients with higher CFS pressures were treated surgically.

RESULTS

The mean patient age was 40.8 (range 31-58) years and the mean body mass index (BMI) was 30.9 (range 28.8-36.4) kg/m2. Papillary stasis was observed in 15 (46.8%) cases. The mean initial CSF pressure was 455.6 (range 360-560) mmHg, and after a mean of 4.3 (range 3-6) repeat measurements, this decreased to 213.4 (range 160-320) mmHg (Table I). Complications in our series included a lumbar pouch in three patients, and an abdominal pouch, meningitis, and abdominal migration in one patient each.

DISCUSSION

Surgical treatment of idiopathic intracranial hypertension is necessary when the intracranial pressure does not decrease despite medical treatment and repeat LP.

CONCLUSIONS

Idiopathic intracranial hypertension is a clinical syndrome of unclear pathogenesis that is closely related to obesity.

KEY WORDS

Cerebrospinal fluid, Idiopathic intracranial hypertension, Pseudotumor cerebri, Obesity.