Mahmut Bilal Çaman

Purpose Obstructive Sleep Apnea (OSA) is the most common sleep-related disorder. Interoception is the collection of sensory and cognitive processes that involve receiving and interpreting physiological signals from internal body structures and conveying the perception of inner sensations. In this study, it was hypothesized that the impairment in cognitive functions associated with chronic hypoxemia and the insular effects due to OSA would negatively affect interoceptive functions. The aim of this study was to evaluate whether interoception in OSA changes consistent with the hypothesis. Methods A total of 102 patients diagnosed with OSA were included in this study. All participants were divided into groups based on their T90 values: desaturated OSA (T90 ≥ 20%) and non-desaturated OSA (T90 < 20%). The Heartbeat Counting Task was used to assess interoceptive accuracy, while the Interoceptive Sense Questionnaire (ISQ) was employed to identify subjective challenges in evaluating interoception. Results Interoceptive accuracy was lower in the desaturated OSA group than in the non-desaturated OSA group (Z = -2.463; p = 0.014). Interoceptive accuracy was negatively correlated with the body mass index (r = -0.228; p = 0.021), T90 (r = -0.269; p = 0.006), and positively correlated with the average SaO2 (r = 0.377; p < 0.001) and SaO2 nadir (r = 0.243; p = 0.014). Conclusion This study examined interoceptive functions in patients with OSA. It was concluded that interoceptive accuracy is affected by the severity of hypoxia as hypothesized.

Hemifasial Spazm sıklıkla tek taraflı olarak, fasial kasların periyodik klonik ya da tonik kasılmalarıyla seyreden, kronik bir hastalık olarak tanımlanmaktadır. Tedavisinde karbamazepin, klonazepam, sinir bloğu, miyektomi, fasial sinir nöroktomi, nöroşirurjik mikrovaskuler dekompresyon ve botulinum toksin uygulaması sık tercih edilen yöntem ve ajanlar olarak sıralanabilir. Botulinum toksin uygulaması; etki süresinin daha uzun olması, uygulanması kolay ve yan etki profilinin daha iyi olması sebebiyle medikal tedaviye göre daha fazla tercih edilmektedir. Botulinum toksini kaslarda paralizi meydana getirir. Bu etkisini doz bağımlı olarak terminal membrandan asetilkolin salınımını inhibe ederek gösterir. Botulinum toksin uygulamasının nadir görülen bir yan etkisi de uygulanan kaslarda meydana gelen atrofidir. Atrofi gelişim mekanizmaları hakkında kesin bir veri olmamakla birlikte bu etkinin kronik uygulamalar ile gerçekleştiği bilinmektedir. Bunun yanında kas lifi tipi, schwann ve satellit hücre sayısı, mitokondriyel mekanizmalar, kastaki kan perfüzyonu gibi faktörler atrofi gelişim riski açısından değerlendirilmiştir. Sunmuş olduğumuz bu olguda kronik botulinum toksin uygulamaları sonrasında yüz kaslarında atrofi gelişen bir hasta ele alınmıştır.

Transient loss of consciousness (LOC) has an important place in emergency applications. Therefore, it is very important to define the etiology of LOC. In this study, we retrospectively analyzed our outpatient electroencephalography (EEG) records to evaluate whether the clinician ordering the test had a fulfilling result. EEG recordings between 01.07.2017 to 01.07.2018 in our outpatient clinic were reviewed. 1015 of EEGs were ordered by general neurologists (70.05%), 355 by epilepsy specialists (24.5%) and 79 by other departments (5.5%). The Department of Psychiatry was leading among other departments by one third. 281 out of 1449 EEGs were abnormal (19.4%). Only three patients had a seizure during EEG recording. Preliminary diagnosis for EEG record request were epilepsy in 829 patients (57.2%), syncope in 257 patients (17.8%), headache in 12 (0.8%), vertigo in 12 (0.8%), cognitive dysfunction in 71 (4.9%), sleep disorder in 16 (1.1%), intracranial mass lesion in 18 (1.0%), cerebrovascular diseases in 54 (3.7%), altered mental status in 26 (73.3%) and encephalitis in 15 patients (1.0%). Normal EEG recording results were 76.5% in the recordings with preliminary diagnosis of epilepsy. Abnormalities found in patients with preliminary diagnosis of epilepsy patients were sharp/spike in 45.1%, focal/generalied slowing in 41.5% and background slowing in 11.8%. Overall abnormality percentage was similar in EEGs requested by either general neurologists (76.0%) or epilepsy specialists (76.9%) but not by other departments (82.1%). As a result; EEG should not be interpreted as a screening test, patients’ details and clinical features during loss of consciousness episode have a priceless importance and preliminary diagnosis should be re- and reevaluated before EEG recording request.