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Of 1300 epileptic patients 76 (5.8%) were found to have juvenile myoclonic epilepsy (JME). These 76 patients were examined at the epilepsy outpatient clinic of Bakirköy State Hospital for Neurological and Psychiatric Diseases between 1991 and 1996 and data obtained were analysed retrospectively. Clinically typical absence seizures were reported in 40.8%, myoclonic jerks in 100%, and generalized tonic-clonic seizures in 82.9% of the patients. Neurological and mental examination was normal for all patients with the exception of three cases; two with essential tremor and one with minimal dysarthria. Precipitating factors were noted in 85.5% of cases. Abnormal EEG was recorded in 73 (6.1%) patients. Abnormalities mainly consisted of generalized discharges of spike/polyspike and slow-wave (86.6%) and generalized paroxysmal theta or delta (9.2%). Fifteen (19.7%) had focal abnormalities and 20 (26.4%) had photoconvulsive discharges. Of the 76 patients, 40 (52.6%) were not diagnosed at the initial interview; definite diagnosis was delayed by a mean of 5.9 years. As a result of misdiagnosis at the initial interview 40 patients had been administered AED except for valproate. After reassessment of clinical and EEG findings, the medication was changed to valproate therapy. As a result, 65 of our JME patients (85.5%) were seizure free after a one-year follow-up period.

Recent studies have demonstrated that central neuronal hyperexcitability has an important role in migraine pathogenesis. Hyperexcitability of occipital cortex has been proposed to be responsible for the elaboration of migraine attacks and visual aura. Motor symptoms in some migraine subtypes have also drawn attention to the hyperexcitability of motor cortex. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Transcranial magnetic stimulation (TMS) is a non-invasive tool to investigate physiology and excitability of both motor-and occipital cortices. 11,[21][22][23][24][25] The changes in motor threshold, latency and amplitude of motor evoked potential, central motor conduction time and cortical silent period after magnetic ABSTRACT: Objective: We evaluated motor and occipital cortex excitability in migraine patients using transcranial magnetic stimulation. Methods: In this study, we included 15 migraine patients with aura (MwA), 15 patients without aura (MwoA) between attacks, and 31 normal healthy controls. Motor thresholds at rest, amplitudes of motor evoked potentials, central motor conduction time and cortical silent period were measured by stimulation of the motor cortex by using 13.5 cm circular coil and recording from abductor digiti minimi muscle. Additionally, phosphene production and the threshold of phosphene production was determined by stimulation of the visual cortex with the same coil. Results: No significant differences were observed between the groups with respect to the motor thresholds, Motor evoked potential max/compound muscle action potential max (MEPmax/Mmax) amplitudes, central motor conduction times and duration of cortical silent period. Although not statistically significant, the proportion of the migraineurs with phosphene generation (90%) was found to be higher than that of normal controls (71%). Phosphene threshold levels in migraine patients, however, were significantly lower than those of the controls with MwA patients having the lowest levels. Conclusion: Our findings indicate that the occipital cortex, but not the motor cortex, is hyperexcitable in migraine patients. RÉSUMÉ: Excitabilité du cortex moteur et du cortex occipital chez les patients migraineux.Objectif: Nous avons évalué par stimulation magnétique transcrânienne l'excitabilité du cortex moteur et du cortex occipital chez des patients migraineux. Méthodes: Nous avons étudié entre les crises 15 patients ayant une migraine avec aura (MaA), 15 patients migraineux sans aura (MsA) et 31 témoins en bonne santé. Les seuils moteurs au repos, les amplitudes des potentiels évoqués moteurs (PÉM), le temps de conduction moteur central et la période de silence cortical ont été mesurés par stimulation du cortex moteur au moyen d'une spirale circulaire de 13,5 cm et enregistrement au niveau du muscle abducteur du petit doigt. De plus, la production de phosphènes et le seuil de production de phosphènes ont été déterminés par stimulation du cortex visuel avec la même spirale. Résultats: Nous n'avons observé aucune...

We evaluated the P300 components of event-related potentials (ERP) in 64 cryptogenic partial epilepsy (CPE) patients, and 52 idiopathic generalized epilepsy (IGE) patients as well as in their age-matched control groups. The P200, N200 and P300 latencies recorded from Cz were significantly longer in CPE patients compared with those of their control group (P = 0.0371, P = 0.0092 and P = 0.0405, respectively). The P200 and N200 latencies recorded from Fz were significantly longer than in their control group (P = 0.0448 and P = 0.0107) while the prolongation in the P300 latencies was not found to be statistically significant (P = 0.0733). All latencies were longer in IGE patients, and the amplitudes of the N200/P300 components of ERP were lower in both epileptic groups compared with their control groups, but these differences were not significant. The prolongation of the P300 latencies was not correlated with the type or serum level of antiepileptic drug or seizure control. Our findings suggest that the prolongation of the P300 latency of ERP is related to the type of epilepsy.

Objective:Motor and sensory nerve conductions, F responses, sympathetic skin responses and R-R interval variations (RRIV) were studied to determine the type of peripheral neuropathy among patients with leprosy.Methods:Twenty-nine consecutive patients with leprosy (25 male, 4 female) hospitalized in the “Istanbul Leprosy Hospital'' between January - December, 1999 were included in this study. Ten patients had borderline lepromatous leprosy, and 19 had lepromatous leprosy. None of the patients studied had the tuberculoid form. The mean age was 55±12 years. The control group consisted of 30 (26 male, 4 female) healthy volunteers (mean age: 58.1±7.8 years). All subjects included in the study underwent neurological examination and electrophysiological evaluation. Standard procedures were performed for evaluating sensory and motor conduction studies. Motor studies were carried out on both left and right median, ulnar, tibial and common peroneal nerves while median, ulnar, sural and superficial peroneal nerves were examined for sensory studies. Sympathetic skin response recordings on both hands and RRIV recordings on precordial region were done in order to evaluate the autonomic involvement.Results:The lower extremity was found to be more severely affected than the upper, and sensory impairment predominated over motor. Of 58 upper limbs examined, no sympathetic skin responses was recorded in 46 (79.3%). Compared with the controls, the RRIVs of the leprosy patients were found to be reduced during both resting and deep forced hyperventilation.Conclusion:Our results indicate that leprosy causes a predominantly axonal polyneuropathy that is more severe in the lower extremities. Sensory nerve damage is accompanied by autonomic involvement.

Objective: To assess the impact of the disease stage and therapy on motor cortical excitability in Parkinson's disease (PD). Methods: Twenty newly diagnosed and medication-free, early stage patients, 20 late stage patients under antiparkinsonian therapy and 20 normal healthy controls were included. Motor threshold (MT), amplitudes of motor evoked potential (MEP), motor evoked potential amplitude/compound muscle action potential amplitude (MEP/CMAP) ratio, central motor conduction time (CMCT) and cortical silent period (CSP) were measured by stimulation of the motor cortex using a 13.5 cm circular coil and recordings from abductor digiti minimi muscle. Following the first study protocol, early stage patients were given therapy and the same protocol was repeated three months later. Results: Motor threshold was lower; and the MEP/CMAP ratio was higher in early and late stage patients than normals. In early stage patients after proper therapy, the MTs became higher than before therapy, but still remained lower than normals. In late stage patients, the CMCTs were shorter than the early stage patients before therapy and normals, but there was no difference between the early stage patients and normals. In early stage patients after therapy, the CMCT became longer than before therapy and this difference was significant in both late stage patients and normals. Although more prominent in late stage patients, the CSP duration in both PD groups was found shorter than normals. In early stage patients, after therapy, the CSP durations became significantly longer compared with before therapy. Conclusion: These findings suggest that the motor cortical excitability increases in PD because of the impairment of the corticomotoneuronal inhibitory system. RÉSUMÉ: Effet du traitement sur l'excitabilité motrice corticale dans la maladie de Parkinson. Objectif : Nous avons évalué l'impact du stade de la maladie et du traitement sur l'excitabilité motrice corticale dans la maladie de Parkinson (MP). Méthodes : Vingt patients dont le diagnostic était récent, qui étaient au début de la maladie et qui ne prenaient pas de médicament, ainsi que 20 patients à un stade avancé de la maladie et qui prenaient des médicaments antiparkinsoniens et 20 sujets témoins en bonne santé ont été inclus dans l'étude. Le seuil moteur (SM), les amplitudes des potentiels évoqués moteurs (PÉM), le ratio amplitude des potentiels évoqués moteurs/amplitude des potentiels d'action musculaire composés (PÉM/PAMC), le temps de conduction motrice centrale (TCMC) et la période de silence cortical (PSC) ont été mesurés par stimulation du cortex moteur au moyen d'une bobine circulaire de 13,5 cm et enregistrement au niveau du muscle abducteur du petit doigt. Après avoir effectué une première fois cette évaluation, les patients qui étaient au début de la maladie ont reçu un traitement et le même protocole a été répété trois mois plus tard. Résultats : Le SM était plus bas et le ratio PÉM/PAMC était plus élevé chez les patients au début et en phase tardive de la m...

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