Person: OĞUZ AKARSU, EMEL
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OĞUZ AKARSU
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EMEL
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Publication An extraordinary eeg phenomenon misdiagnosed as nonconvulsive status epilepticus: Frequent subclinical periodic discharges terminated by sudden auditory stimuli(Sage Publications Inc, 2022-10-05) Salman, Barış; Uğur-İseri, Sibel; Baykan, Betül; Oğuz-Akarsu, Emel; OĞUZ AKARSU, EMEL; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; 0000-0002-0465-4218; IZQ-0662-2023Triggering or modulation of seizures and rhythmic EEG patterns by external stimuli are well-known with the most common clinical appearance of stimulus induced periodic discharges (SI- PDs) patterns which are elicited by physical or auditory stimulation. However, stimulus terminated periodic discharges (ST-PDs), in other words, the periodic discharges stopped by external stimuli is an extremely rare electroencephalographic (EEG) finding. We report a 20-year-old woman with a marked psychomotor developmental delay of unknown cause, with frequent EEG patterns of long-lasting (10-60 s) bilateral paroxysmal high-voltage slow waves with occasional spikes, misdiagnosed as non-convulsive status epilepticus. However, no apparent clinical change was noted by the technician, physician, and her mother during these subclinical ictal EEG recordings. Interestingly, however, these epileptic discharges were abruptly interrupted by sudden verbal stimuli on the EEG, repeatedly. Whole exome sequencing and genotyping were performed to investigate possible genetic etiology that revealed two sequence variants, a frameshift variant of CACNA1H NM_021098.3:c.1701del;p.Asp568ThrfsTer15 and a missense variant of GRIN2D NM_000836.4:c.1783A>T;p.Thr595Ser as well as a copy number variant part deletion of ATP6V1A gene arr [hg19]3q13.31(113,499,698_113,543,081)x1 as possible pathogenic candidates. The subclinical periodic discharges terminated by verbal stimuli, is a very rare manifestation and needs particular attention. External modulation of ictal-appearing EEG patterns is important to identify stimulus terminated EEG patterns.Publication Clinical characteristics and burden of a large series with cluster headache from Turkey(Bmc, 2021-09-01) Dikmen, P. Yalinay; Ari, C.; Sahin, E.; Ertas, M.; Domac, F. Mayda; Aydinlar, E. Ilgaz; Sahin, A.; Ozge, A.; Ozguner, H.; Karadas, O.; Shafiyev, J.; Vuralli, D.; Karli, N.; Zarifoglu, M.; Bolay, H.; Ekizoglu, E.; Orhan, E. Kocasoy; Baykan, B.; Akarsu, E. Oğuz; OĞUZ AKARSU, EMEL; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; 0000-0001-7112-2142; 0000-0002-2354-2975; 0000-0002-5792-2888; 0000-0002-3334-979X; 0000-0002-3360-659X; IZQ-0662-2023; A-4787-2018; GXV-0461-2022; HRC-1114-2023; AFB-2183-2022; HGA-8185-2022Publication Evaluation of risk factors associated with stroke recurrence in patients with minor ischemic stroke(Türk Nöroloji Derneği, 2022-03-01) Dinç, Yasemin; Akarsu, Emel Oğuz; Hakyemez, Bahattin; Bakar, Mustafa; DİNÇ, YASEMİN; OĞUZ AKARSU, EMEL; HAKYEMEZ, BAHATTİN; Bakar, Mustafa; Tıp Fakültesi; Radyoloji Ana Bilim Dalı; 0000-0002-3425-0740; IUQ-6999-2023; IZQ-0662-2023; IWC-9957-2023; AAI-2318-2021; EKN-8251-2022Objective: Recurrent ischemic stroke (RIS) is a major threat CO patients with IS. The risk of RIS in patients with minor IS (MIS) is 10-13% in the first 3 months. Despite the advanced examination and treatment of the patients, RIS is still common. It is important to know which risk factors cause RIS in order to rake some precautions. The aim of this study is to determine the risky group by determining the demographic, clinical and radiological features associated with RIS in patients with MIS.Materials and Methods: We included 310 patients diagnosed as having acute IS (AIS) by Bursa Uludag University Faculty of Medicine Department of Neurology between 01.01.2019 and 01.01.2020, retrospectively.Results: When clinical, radiological and dermogrophic features were analyzed between patients with and without RIS, there were statistically significant differences between groups in terms of the presence of coronary artery disease (CAD), atherosclerotic vascular disease, anterior circulation stroke, craniocervical atherosclerotic stenosis, atherosclerotic stenosis in the anterior circulation, atherosclerotic stenosis of the symptomatic internal carotid artery (ICA), atherosclerotic stenosis in the asymptomatic ICA and performing carotid artery scenting. When significant variables were analyzed by using binary logistic regression in patients with MIS, it was found that the most significant variables were CAD and asymptomatic ICA stenosis.Conclusion: In our study, the risk factors associated with RIS in patients with MIS were the presence of CAD and asymptomatic ICA stenosis. Atherosclerosis is a systemic disease and therefore craniocervical atherosclerotic stenosis may be multiple. Angiographic evidence has also revealed ethnic and racial differences in patients with AIS. For this reason, more precise information can be obtained with prospective studies to be conducted in our own population.Publication IVIg-induced headache: prospective study of a large cohort with neurological disorders(Springer-Verlag Italia Srl, 2023-03-11) Bayir, Buse Rahime Hasirci; Ünsal, Mirac Aysen; Agircan, Cansu; Sirin, Tuba Cerrahoglu; Akan, Onur; Gursoy, Gizem; Eyigurbuz, Tugba; Dibek, Dilara Mermi; Akdag, Gonul; Elmali, Ayse Deniz; Nazli, Ezgi; Arikan, Fatma Akkoyun; Baslo, Sezin Alpaydin; Agircan, Dilek; Oğuz-Akarsu, Emel; Cetin, Özdem Ertürk; Demir, Tulin Gesoglu; Demirel, Esra Aciman; Vuralli, Doğa; Deveci, Şule; Tanyel, Tuba; Domac, Fusun Mayda; Karlı, Necdet; Velioglu, Sibel; Baykan, Betul; OĞUZ AKARSU, EMEL; KARLI, HAMDİ NECDET; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; IZQ-0662-2023; JDE-9380-2023BackgroundIntravenous immune globulin (IVIg) is frequently used in some neurological diseases and is also the first-line therapy in Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. We aimed to evaluate the frequency and characteristics of headaches, which is one of the most common side effects of IVIg treatment.MethodsPatients who received IVIg treatment for neurological diseases were prospectively enrolled in 23 centers. Firstly, the characteristics of patients with and without IVIg-induced headaches were analyzed statistically. Then, patients with IVIg-induced headaches were classified into three subgroups determined by their history: no primary headache, tension-type headache (TTH), and migraine.ResultsA total of 464 patients (214 women) and 1548 IVIg infusions were enrolled between January and August 2022. The frequency of IVIg-related headaches was 27.37% (127/464). A binary logistic regression analysis performed with significant clinical features disclosed that female sex and fatigue as a side effect were statistically more common in the IVIg-induced headache group. IVIg-related headache duration was long and affected daily living activities more in patients with migraine compared to no primary headache and TTH groups (p = 0.01, respectively).ConclusionHeadache is more likely to occur in female patients receiving IVIg and those who develop fatigue as a side effect during the infusion. Clinicians' awareness of IVIg-related headache characteristics, especially in patients with migraine, may increase treatment compliance.Publication Automatic detection of F waves and F-MUNE in two types of motor neuron diseases(Wiley, 2022-02-01) Oğuz-Akarsu, Emel; Şirin, Nermin Görkem; Artuğ, Tuğrul; Erbaş, Bahar; Orhan, Elif Kocasoy; İdrisoğlu, Halil Atilla; Ketenci, Ayşegül; Baslo, Mehmet Barış; Öge, Ali Emre; OĞUZ AKARSU, EMEL; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; IZQ-0662-2023Introduction/Aims Motor unit number estimation by F waves (F-MUNE) is an uncommonly used MUNE technique. Our aim in this study was to assess the sensitivity of F-MUNE values elicited with newly developed software in motor neuron diseases. Methods F waves were recorded by 300 submaximal stimuli from abductor digiti minimi and abductor pollicis brevis muscles of 35 patients with amyotrophic lateral sclerosis, 18 with previous poliomyelitis, and 20 controls. The software determined the surface motor unit action potentials (sMUAPs) and calculated the F-MUNE values. Compound muscle action potential scans were also recorded to obtain MScanFit. Results The sMUAP amplitudes were higher and F-MUNE values were lower in both muscles of the patients when compared with controls. F-MUNE values could distinguish patients from controls. Significant correlations were found between F-MUNE and MScanFit in the patient groups. Discussion The new F-MUNE software offered promising results in revealing motor unit loss caused by motor neuron diseases.Publication Clinical characteristics and burden of a large series with cluster headache from Turkey(Sage Publications, 2021-09-01) Dikmen, P. Yalinay; Ari, C.; Sahin, E.; Ertas, M.; Domac, F. Mayda; Aydinlar, E. Ilgaz; Sahin, A.; Ozge, A.; Ozguner, H.; Karadas, O.; Shafiyev, J.; Vuralli, D.; Bolay, H.; Ekizoglu, E.; Orhan, E. Kocasoy; Baykan, B.; Akarsu, E. Oguz; OĞUZ AKARSU, EMEL; Karli, N.; BAYSAL KAR, BAHAR; Zarifoglu, M.; ZARİFOĞLU, MEHMET; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; 0000-0001-7112-2142; 0000-0002-2354-2975; 0000-0002-5792-2888; 0000-0002-3334-979X; 0000-0002-3360-659X; AFB-2183-2022; HGA-8185-2022; HRC-1114-2023; A-4787-2018; GXV-0461-2022; IZQ-0662-2023Publication Reply: "Spinal nerve pathology in Guillain-Barre syndrome associated withCOVID-19 infection"(Wiley, 2020-08-10) Oğuz-Akarsu, Emel; Özpar, Rıfat; Hakyemez, Bahattin; Karlı, Necdet; OĞUZ AKARSU, EMEL; ÖZPAR, RİFAT; HAKYEMEZ, BAHATTİN; KARLI, HAMDİ NECDET; Tıp Fakültesi; Radyoloji Ana Bilim Dalı; 0000-0001-6649-9287; 0000-0001-6649-9287; 0000-0002-3425-0740; AAI-2318-2021; AAA-8936-2021; AAN-4912-2021; AAH-5062-2021; IZQ-0662-2023Publication Reevaluation of the electroencephalogram recordings of patients with nonconvulsive status epilepticus by using salzburg consensus criteria(Wolters Kluwer Medknow Publications, 2022-04-01) Timer, Emin; Yilgor, Abdullah; Bebek, Nerses; Baykan, Betül; Oğuz-Akarsu, Emel; OĞUZ AKARSU, EMEL; Tıp Fakültesi; Nöroloji Ana Bilim Dalı; IZQ-0662-2023Objective: Nonconvulsive status epilepticus (NCSE) is a challenge to diagnose in some cases, and recently, Salzburg consensus criteria for NCSE (SCC-NCSE) were developed to contribute to clinical practice. We aimed to investigate their validity and usefulness by reevaluating the electroencephalogram (EEG) examinations of our patients in this study. Materials and Methods: We retrospectively evaluated all EEG recordings of patients diagnosed with NCSE by experienced clinical neurophysiologists in our EEG laboratory over a period of 2 years. Two neurologists trained in EEG reanalyzed all EEG data and categorized these patients as NCSE, possible NCSE, or non-NCSE using the SCC-NCSE. Results: Twenty-nine patients with a mean age of 31.5 & PLUSMN; 25.9 were reanalyzed. According to the SCC-NCSE, 24 patients (82.7%) were diagnosed as NCSE. Eighteen patients (62%) who fulfilled all SCC-NCSE were diagnosed as NCSE, whereas six patients (20.7%) were diagnosed only as possible NCSE. Five patients (17.3%) did not fulfill SCC-NCSE; the reasons are the lack of additional secondary criteria in 2 patients with encephalopathy, the absence of full compliance with the criteria in other 2 patients, and a diagnosis of electrical status epilepticus during sleep in the last patient. Conclusion: The results of our study show that SCC-NCSE is highly consistent with clinical practice to decide for the diagnosis of NCSE. The evaluation of NCSE according to a set of new standardized criteria is thought to be difficult in practice, but it provides a more objective assessment. Therefore, we believe that its use should be encouraged to increase experience and the possibility of correct diagnosis.Publication Cluster analysis revealed two hidden phenotypes of cluster headache(Frontiers Media Sa, 2022-05-20) Dikmen, Pınar Yalınay; Arı, Çağla; Şahin, Erdi; Ertas, Mustafa; Domaç, Fusun Mayda; Aydınlar, Elif Ilgaz; Şahin, Ayşenur; Özge, Aynur; Özgüner, Hilal; Karadas, Ömer; Shafiyev, Javid; Vuralli, Doga; Aktan, Cile; Oğuz-Akarsu, Emel; Karlı, Necdet; Zarifoğlu, Mehmet; Bolay, Hayrunisa; Ekizoğlu, Esme; Orhan, Elif Kocasoy; Taşdelen, Bahar; Baykan, Betül; OĞUZ AKARSU, EMEL; KARLI, HAMDİ NECDET; ZARİFOĞLU, MEHMET; Tıp Fakültesi; Nöroloji Bölümü; IZQ-0662-2023; JDE-9380-2023; EHN-5825-2022ObjectiveTo investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis. MethodsA total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences. ResultsCluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) years; p = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95); p < 0.001), and showed a better response to triptans (50.00% vs. 28.00; p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0%; p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0%; p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0%; p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) min; p=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) min; p = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0%; p< 0.001). ConclusionsCluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH.