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Öğe Breath-holding Spells: Etiological Factors, Laboratory Findings, and Rates of Response to Iron Therapy(2021) Hanci, Fatma; Türay, Sevim; Tirink, Omer Faruk; Kabakuş, NimetAim: In this study, we aimed to investigate the etiological factors, electroencephalographic (EEG) findings, rates of response to iron therapy, and factors affecting response to iron therapy in children diagnosed with breath-holding spells (BHS). Methods: The study included 136 children aged 1 to 48 months who received iron therapy after a BHS diagnosis at our pediatric neurology clinic between November 2015 and No¬vember 2019. Patient medical records (physical examination, laboratory and EEG findings, medical history, and effectiveness of iron therapy) were reviewed retrospectively. Results: Of all patents, 81 (59.6%) exhibited partial response (partial remission) to iron therapy (50% decrease in BHS frequency), 52 (39%) responded completely (complete remission), and 2 were unresponsive. Comparison of the patients with complete and partial remission revealed a higher rate of complete remission in girls. In addition, patients with complete remission had higher levels of hemoglobin, MCV, and ferritin than those with partial remission. Complete remission rates were also higher in patients with normal EEG findings. Conclusion: BHS in childhood is a benign, recurring, and non-epileptic disorder and its differentiation from epilepsy is important. Children with BHS respond well to iron therapy, which can be recommended even if the serum iron and ferritin levels are normal.Öğe Cause or consequence the relationship between cerebral venous thrombosis and idiopathic intracranial hypertension(Lippincott Williams & Wilkins, 2019) Türay, Sevim; Kabakuş, Nimet; Hancı, Fatma; Tunçlar, Aslıhan; Hızal, MustafaAim: The aims of our study were to refer to the complex relationship between idiopathic intracranial hypertension (IIHT) and cerebral sinovenous thrombosis (CSVT), and to determine the differences and commonalities between the patients with and without CSVT in their etiology, along with documenting the uncertainties in concluding on the diagnosis and treatment of these patients. Material and Methods: IIHT was diagnosed according to Dandy criteria, while CSVT was screened for by way of a cranial magnetic resonance imaging for all patients and cranial magnetic resonance venography only if the magnetic resonance imaging was nebulous or there was a family history. Results: We retrospectively evaluated a total of 26 patients (9 of whom had CSVT) diagnosed with IIHT between 2014 and 2018. A total of 9 patients with concurrent CSVT were described as suffering from vascular IIHT, while the remaining 17 were described as suffering from other IIHT. Demographic characteristics were similar in both groups (mean age: 12 vs. 11; male/female ratio: 2/7 vs. 5/12 in vascular IIHT and other IIHT, respectively). Clinical findings, cerebrospinal fluid-opening pressure values, and pathologies of etiology were also similar (vitamin D deficiency: 66% vs. 52%; vitamin B-12 deficiency: 11% vs. none; iron deficiency: 22% vs. 11%; obesity: 22% vs. 23%). A mixture of acetazolamide, topiramate, anticoagulant therapy, and acetylsalicylic acid were given according to the diagnoses. Conclusion: CSVT is a common clinical entity among the causes of IIHT, and it should be taken into consideration in this patient group. However, there is a need for a common guideline for laboratory and imaging methods to understand the etiopathogenesis of childhood IIHT and determine the patients at risk.Öğe Childhood facial palsy: Etiologic factors and clinical findings, an observational retrospective study(Sage Publications Inc, 2019) Hancı, Fatma; Türay, Sevim; Bayraktar, Zehra; Kabakuş, NimetThe purpose of this study was to determine the etiologic factors, clinical characteristics, seasonal distributions, family history, response to corticosteroid therapy, recurrence and residual paralysis rates, and factors affecting these in pediatric facial palsy. Patients aged <18 years diagnosed with acute peripheral facial palsy were included in the study. Demographic data and clinical findings were retrieved from patients' records. The study was completed with 113 patients. Causes were idiopathic in 74 (65.4%) cases. Complete healing was not achieved in 6 (5.3%) patients, and recurrence was observed in 11 (9.7%). None of the patients with residual paralysis used corticosteroid, but all the patients with recurrence had employed them. We determined that young age may have an adverse impact on complication development and that corticosteroid therapy may be useful in the healing process in idiopathic facial nerve palsy. In conclusion, age may have an adverse impact in idiopathic facial nerve palsy, whereas corticosteroid therapy has a positive effect.Öğe Effects of 12-month antiepileptic drug use on thyroid functions in children: A retrospective observational study(GALENOS YAYINCILIK, 2021) Hancı, Fatma; Türay, Sevim; Bala, Keziban Aslı; Tunçlar, Aslıhan; Dilek, Mustafa; Kabakuş, NimetAim: The purpose of this study was to examine the effects of antiepileptics on thyroid function tests and to compare these effects among different antiepileptics. Materials and Methods: Two hundred and twenty patients (102 female and 118 male) aged 1-17 years indicated for antiepileptic drug (AED) therapy for epilepsy were enrolled in this study which was performed in a child neurology clinic between January 2014 and January 2018. Those patients using a single AED and with complete seizure control were included. In this study period, according to the local protocol, we measured free thyroxine (fT4) and thyroid-stimulating hormone (TSH) levels at the beginning of treatment and at the 12th month of AED therapy. Results: The mean age of the patients was 10.2 +/- 4.4 years. TSH elevation was observed in only eight patients. These eight patients' thyroid autoantibodies were negative and their thyroid ultrasonography were normal. Subclinical hypothyroidism (TSH: 5-10, fT4 normal) was present in three of these eight patients, and they were therefore not started on medication. The other five were started on L-thyroxine. Four of these were using valproic acid and one was using carbamazepine. We found no significant difference between TSH and fT4 levels measured before the start and at the 12th month of drug therapy, nor among the different AEDs used. Conclusion: AEDs have no marked effects on thyroid function, and may therefore be safely used from that perspective.Öğe Electroencephalogram abnormalities and epilepsy in autism spectrum disorders: Clinical and electroencephalogram findings(Georg Thieme Verlag Kg, 2021) Hancı, Fatma; Türay, Sevim; Öztürk, Yusuf; Kabakuş, NimetIt has been known for several decades that epilepsy and autism spectrum disorders (ASD) are related to each other. Epilepsy frequently accompanies ASD. The purpose of this study was to investigate relationship between clinical and electroencephalogram (EEG) findings in ASD patients and to identify EEG characteristics that may create a disposition to epilepsy in ASD by examining differences in clinical and EEG findings between patients diagnosed with ASD without epilepsy and ASD with epilepsy. A total of 102 patients aged 2 to 18 years and diagnosed with ASD based on Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic criteria between January 2017 and June 2019 were included in the study. Patients were assigned into two groups: (1) ASD with epilepsy and (2) ASD without epilepsy. Clinical findings were retrieved from patients' files, and EEG findings from first EEG records in the EEG laboratory at the time of diagnosis. EEG findings were defined as central, parietal, frontal, temporal, or generalized, depending on the location of rhythmic discharges. The incidence of epilepsy in our ASD patients was 33.7% and that of febrile convulsion was 4%. Generalized motor seizures were the most common seizure type. Epileptic discharges most commonly derived from the central and frontal regions. These abnormalities, especially frontal and central rhythmic discharges, may represent a precursor for the development of epilepsy in ASD patients.Öğe Epilepsy and drug-resistant epilepsy in children with cerebral palsy: A retrospective observational study(Academic Press Inc Elsevier Science, 2020) Hancı, Fatma; Türay, Sevim; Dilek, Mustafa; Kabakuş, NimetPurpose: The objective of this study was to determine risk factors for epilepsy and drug-resistant epilepsy (DRE) development in children with cerebral palsy. Method: Two hundred twenty-nine patients presenting to the pediatric neurology clinic and diagnosed as having cerebral palsy between November 2016 and November 2019 were included in the study. Medical histories and clinical, laboratory, and radiological findings were examined retrospectively from patient records in the hospital data system. Results: Girls represented 103 patients (45%) and boys 126 (55%). The patients' mean age was 8.39 +/- 4.54 years. Epileptic seizures were present in 120 (52.4%) patients and drug-resistant seizures in 64 (27.9%). The risk of epilepsy was significantly higher in patients with motor or speech impairment, with hearing impairment, or undergoing first seizure in the neonatal period. We also observed a higher risk of epilepsy in patients with psychiatric comorbidity, particularly autism spectrum disorder. The risk of epilepsy was also higher in patients with microcephaly or quadriplegic cerebral palsy and in patients with focal and generalized epileptiform abnormality on electroencephalograms (EEGs). However, no significant difference was identified when all these factors were evaluated in terms of the risk of developing DRE. Conclusion: Patients with cerebral palsy have high comorbid epilepsy rates. We think that the risk of epilepsy may be higher in patients undergoing first seizure in the neonatal period, with microcephaly, with quadriplegic type cerebral palsy, and with additional psychiatric comorbidity. The rate of DRE development was very low in patients with normal EEG findings or with only background rhythm abnormalities on first EEGs during neonatal seizures. This may be regarded as a good prognostic factor for nondevelopment of DRE. (C) 2020 Elsevier Inc. All rights reserved.Öğe Mitochondrial metabolism related markers GDF-15, FGF-21, and HIF-1a are elevated in pediatric migraine attacks(Wiley, 2023) Kılınç, Yasemin Baranoğlu; Kılınç, Erkan; Danış, Aysegül; Hancı, Fatma; Türay, Sevim; Özge, AynurObjective: The purpose of this study was to investigate the serum levels of mitochon-drial metabolism/reactive oxygen species (ROS)- related peptides (hypoxia induc-ible factor- 1a [HIF- 1a], fibroblast growth factor -21 [FGF- 21], growth differentiation factor -15 [GDF- 15]) and key migraine- related neuropeptides (calcitonin gene- related peptide [CGRP], pituitary adenylate cyclase- activating peptide -38 [PACAP- 38], sub-stance P [SP], and vasoactive intestinal peptide [VIP]) during migraine attacks and to evaluate their diagnostic value in pediatric migraine.Background: There is increasing evidence for the important role of impairment in oxidative mitochondrial metabolism in the pathophysiology of migraine. Potential biomarkers that may reflect the relationship between migraine and mitochondrial dysfunction are unclear.Methods: A total of 68 female pediatric migraine patients without aura and 20 fe -male healthy controls aged 8- 18 years, admitted to the hospital, were enrolled in this cross- sectional study. Serum concentrations of these molecules were determined by enzyme- linked immunosorbent assays, and clinical features and their possible diag-nostic value were analyzed.Results: Serum levels of HIF- 1a (252.4 +/- 51.9 [mean +/- standard deviation]) pg/mL), GDF- 15 (233.7 +/- 24.7 pg/mL), FGF- 21 (96.1 +/- 13.1 pg/mL), CGRP (44.5 +/- 11.3), and PACAP- 38 (504.7 +/- 128.9) were significantly higher in migraine patients compared to healthy controls (199.8 +/- 26.8, 192.8 +/- 20.7, 79.3 +/- 4.1, 34.1 +/- 3.5 and 361.2 +/- 86.3 pg/ mL, respectively). The serum levels of these peptides were also higher in patients with chronic migraine than in patients with episodic migraine, and higher in the ictal period than in the interictal period. A positive correlation was found between attack frequency and both HIF- 1a and FGF- 21 levels in migraine patients. Serum levels of VIP and SP were not different between the migraine patients and healthy controls.Conclusion: Migraine attacks are accompanied by elevated HIF- 1a, FGF- 21, GDF- 15, CGRP, and PACAP- 38 in medication -naive pediatric patients with migraine. Elevated circulating mitochondrial metabolism/ROS-related peptides suggest a mitochondrial stress in pediatric migraine attacks and may have potential diagnostic value in monitoring disease progression and treatment response in children. Novel approaches intervening with mitochondrial metabolism need to be investigated.Öğe An overview of vitamin B12 and iron deficiencies as a risk factors in children with febrile seizure etiology(2021) Türay, Sevim; Hanci, Fatma; Özde, SukriyeAim: To determine serum iron, ferritin, folate, and vitamin B12 deficiency and associated hemoglobin (Hb),hematocrit (Hct), mean corpuscular volume (MCV), and red cell distribution width (RDW) values in childrenundergoing febrile seizure, and thus to reveal their potential etiological role.Method: The serum iron, folate, vitamin B12, and ferritin, and Hb, Hct, MCV, and RDW values of 98 patientsundergoing FS and presenting to the pediatric neurology department and of 64 control patients were retrievedretrospectively and compared. Patient group data were also compared within the group.Results: Serum iron, ferritin, and vitamin B12 values were significantly lower in the patient group than in thecontrol group. Intragroup comparison revealed higher RDW values in patients with more than three FS and inthose with complicated seizures.Conclusion: This is the first study to investigate the relationship between vitamin B12, folate, and irondeficiency and FS. It should be remembered that deficiencies in these micronutrients, which are not routinelyinvestigated in patients presenting with FS, may play a role in the etiology, and that the frequency can decreasewith treatment. It should also not be forgotten that FS patients with high RDW values may be at risk of frequentseizure recurrence.Öğe Probable risk factors for epilepsy development following febrile seizure: A retrospective, observational study(KARE PUBL, 2021) Hancı, Fatma; Kocabey, Hüseyin; Kabakuş, Nimet; Türay, SevimObjectives:The purpose of this study was to investigate the risk factors for epilepsy development following febrile seizure (FS). Methods:This study included 449 patients undergoing first FS between 2014 and 2017. The sociodemographic, clinical, and electroencephalography (EEG) characteristics of the patients were retrieved from hospital records. Patients followed-up for at least 3 years after FS were divided into two groups (epilepsy and FS group; FS only group). Results: Of the 449 patients followed-up due to FS (238 [53.2%] boys and 211 [46.8%] girls), 42 (9.4%) were diagnosed with epilepsy during follow-up. The mean age at the time of the first FS was 21.4 +/- 14.5 months. A positive family history of FS and epilepsy was observed in 217 (48.3%) and 66 (14.7%) patients, respectively. In terms of FS characteristics, the prevalence of complex FS was significantly higher in the subsequent epilepsy group. The presence of a history of perinatal asphyxia and epileptiform or background abnormality findings at first EEG was also significantly higher in the subsequent epilepsy group (p<0.001). Conclusion: The findings of this study show that a history of perinatal asphyxia, complex FS, and epileptiform discharges at initial EEG exhibited an increased association with epilepsy development.Öğe The prognostic evaluation of West syndrome patients: A retrospective observational study(Düzce University, 2021) Türay, Sevim; Hancı, Fatma; Dilek, Mustafa; Kabakuş, NimetObjective: To determine neurodevelopmental and seizure prognoses in our patients with West syndrome receiving adrenocorticotropic hormone (ACTH) therapy, and to identify the factors affecting these. Methods: We determined the demographic factors, previous seizure histories, ACTH use and drug response times, and etiological reasons of 34 patients diagnosed with West syndrome in our clinic at 3-24 months old and receiving ACTH therapy. We also investigated their neurological development and its effect on seizure prognosis. Results: We found a significant relationship between patients experiencing seizures before diagnosis and subsequent seizure prognosis. We also defined a later response to ACTH and poorer neurodevelopment and seizure prognoses in patients with symptomatic etiologies. Global developmental delay was identified in 76% of all cases, and seizures persisted despite antiepileptic drugs in 62%. Conclusions: Symptomatic etiological factors in West syndrome adversely affect the neurodevelopmental process and subsequent seizure prognosis.Öğe Reflex epilepsy with hot water: Clinical and eeg findings, treatment, and prognosis in childhood(Georg Thieme Verlag Kg, 2020) Hancı, Fatma; Türay, Sevim; Balcı, Paşa; Kabakuş, NimetHot water epilepsy (HWE) is a subtype of reflex epilepsy in which seizures are triggered by the head being immersed in hot water. Hot water or bathing epilepsy is the type of reflex epilepsy most frequently encountered in our clinic. We describe our patients with HWE and also discuss the clinical features, therapeutic approaches, and prognosis. Eleven patients (10 boys, 1 girl), aged 12 months to 13 years, admitted to the pediatric neurology clinic between January 2018 and August 2019, and diagnosed with HWE or bathing epilepsy based on International League Against Epilepsy (ILAE)-2017, were followed up prospectively for similar to 18 months. Patients' clinical and electroencephalography (EEG) findings and treatment details were noted. All 11 patients' seizures were triggered by hot water. Age at first seizure was between 2 months and 12 years. Seizure types were generalized motor seizures, absence, and atonic. EEG was normal in two patients, but nine patients had epileptiform discharges. Magnetic resonance imaging of the brain was performed and reported as normal (except in one case). Histories of prematurity were present in two patients, unprovoked seizures in one, and low birth weight and depressed birth in the other. Patients with HWE have normal neuromuscular development and neurological examination results, together with prophylaxis or seizure control with a single antiepileptic drug, suggesting that it is a self-limited reflex epilepsy.Öğe The role of obesity and vitamin D deficiency in primary headaches in childhood(Springer Heidelberg, 2020) Hancı, Fatma; Kabakuş, Nimet; Türay, Sevim; Bala, Keziban Aslı; Dilek, MustafaThis study evaluates the role of obesity, overweight and vitamin D deficiency in primary headaches in childhood. This retrospective observational study included pediatric patients aged 5-17 years admitted to the pediatric neurology clinic with headaches between January 2015 and August 2018 and diagnosed with primary headache based on ICHD III-beta criteria. The control group consisted of healthy children without headache admitted to the pediatric outpatient clinic for check-ups before engaging in athletic or school activities. The control and patient groups were at the same risk of low 25(OH)D3 levels. The study population was divided into three groups-patients with migraine (group A), patients with tension-type headache (TTH) (group B) and the control group (group C). Participants' demographic data, medical histories, physical examination findings and laboratory results were retrieved retrospectively from the patient charts. BMI was significantly higher in patients with primary headache, the risk of primary headache increasing in patients with a BMI in excess of 25. Comparison of the patients with primary headache and the control group revealed lower 25(OH)D levels in the primary headache group, although the difference was not statistically significant. Girls with primary headache had significantly lower 25(OH)D levels than boys. A relationship may be present between overweight, obesity and primary headache, while female gender may be suggested as a negative factor for primary headache. Patients should be advised to lose weight if BMI indicates overweight or obesity.Öğe Sydenham's chorea; clinical and magnetic resonance imaging findings, a retrospective observational study in children(Georg Thieme Verlag Kg, 2020) Hancı, Fatma; Hızal, Mustafa; Türay, Sevim; Kalaycıoğlu, Oya; Kabakuş, NimetThe purpose of this study was to evaluate the correlation between magnetic resonance imaging (MRI) findings and demographic and clinical characteristics, response to treatment times, and recurrence rates of Sydenham's chorea (SC), the most common of the acquired pediatric choreas. The clinical and radiological findings of 12 patients presenting to the pediatric neurology clinic in the previous 4 years and diagnosed with SC on the basis of the modified Jones criteria were investigated retrospectively from the hospital files. In addition, we measured the maximum prefrontal cortex and basal ganglia (globus pallidus, putamen, and caudate nucleus) thicknesses in the axial plane from patients' cerebral MRIs and compared these values with prefrontal cortex and basal ganglia thicknesses of a healthy control group measured using the same technique. Patient and control groups' cranial and basal ganglia MRIs were found to be normal. However, patients' globus pallidus thicknesses were significantly lower than those of the healthy control group. Additionally, the globus pallidus values of patients with recurrent SC and a prolonged healing time were lower than average. However, we determined no significant difference in terms of prefrontal motor cortex, caudate nucleus, or putamen thicknesses between the patient and control groups. Low globus pallidus thicknesses in patients with SC may indicate atrophy associated with globus pallidus involvement. Further experimental and prospective and long-term studies are needed for a better understanding of the factors affecting the pathophysiology, recurrence, and healing time of SC.
