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    Are COVID-19 vaccines safe for people with epilepsy? A cross-sectional study
    (Springer-Verlag Italia Srl, 2022) Ozdemir, Huseyin Nezih; Dere, Birgul; Gokcay, Figen; Gokcay, Ahmet
    Background COVID-19 disease was first seen in December 2019 and was declared a pandemic soon after. To fight the pandemic, there is an immense need for effective vaccines. The purposes of our study were to investigate the effect of coronavirus vaccines on seizures in people with epilepsy (PWE) and assess the adverse events of COVID-19 vaccine in PWE. Methods This was a cross-sectional study. We included epilepsy patients who got vaccinated with two or three doses at least 1 month earlier. We gathered the data using a standardized form. The form contained questions about patients' demographic features, clinical features, and information about the vaccination and its adverse events. The questionnaire included questions about epilepsy-related adverse events. Results We included 178 people with epilepsy in our study. The frequency of adverse events was lower than clinical studies of the vaccines. The mean number of seizures in the month before the vaccination was 1.62, between the doses was 1.61, and after vaccination was 1.64. There was no significant difference in the number of monthly seizures before the vaccination, the month between the doses, or the month after the vaccination (p = 0.46). Conclusions The vaccines under consideration in our study were tolerated well by the epilepsy patients. The vaccines did not affect the monthly number of seizures of the PWE. A small number of patients had more seizures than normal after vaccination. We think that benefits of the vaccines outweigh the slightly increased possibility of having a seizure after vaccination.
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    The Clinical and Cognitive Spectrum of Artery of Percheron Infarction: 1-Year Follow-Up
    (Cambridge Univ Press, 2022) Cetin, Fatma Ece; Kumral, Emre; Dere, Birgul
    Objective: Survivors of patients with artery of Percheron infarction (API) often have a prolonged and disabling form of cognitive impairment that remains insufficiently characterized. We aimed to examine the clinical and cognitive features of API in the short and long term after stroke. Methods: We reviewed 6400 patients with a first-ever stroke included in the Stroke Registry between 2011 and 2021. The diagnosis of API was based on clinical diagnosis and imaging confirmation. All patients underwent neuropsychological assessment at hospital stay and 1 year after stroke. A z-score of each patients' cognitive test point was calculated, and a z-score inferior to 2 was considered as pathological. Results: Of the 10 patients enrolled, all had cognitive impairment, consciousness, and behavioral disorders at stroke onset. Six patients had pure bilateral thalamic involvement while four had bilateral thalamic and rostral midbrain involvement. At 12 months, 50% of patients had global mental state scores 2 SD below the population mean (z-score mean +/- SD, -2.17 +/- 0.4). Most of the prefrontal cortex cognitive processes including executive functions such as planning and cognitive control (z-score mean +/- SD, -3.92 +/- 0.3), processing speed (-4.42 +/- 0.5), working memory (-3.97 +/- 0.3) were severely impaired at stroke onset. Especially in patients with thalamic and rostral midbrain involvement, deficiencies in executive function (z-score mean +/- SD, -2.60 +/- 0.4), processing speed (-2.22 +/- 0.5), working (-3.76 +/- 0.4), and episodic memory (-2.23 +/- 0.3) continued 12 months after stroke. Conclusions: The occlusion of the artery of Percheron results in severe behavioral and cognitive disorders in the short and long term after stroke.
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    Location of the contrast extravasation is important in predicting outcome of anterior circulation stroke patients
    (Asean Neurological Assoc, 2024) Ozdemir, Huseyin Nezih; Karaman, Bedriye; Guler, Ayse; Dere, Birgul; Cinar, Celal; Kumral, Dursun Emre; Sirin, Hadiye
    Objectives: Contrast extravasations (CE) are frequently seen on postprocedural computed tomography after endovascular therapy (EVT). This study aimed to investigate the relationship between patients' outcomes and CE after EVT. Methods: Stroke patients who had received EVT between 2019 and 2021 were reviewed retrospectively. The CEs were mapped using MRIcroGL software. The rate of in-hospital mortality and modified Rankin Scale at 90 days were taken as outcome measures. Stepwise logistic regression analyses were performed. Three models were created with and without pure CE to predict the patients' outcomes. Results: There were 126 patients included in the study. According to the univariable analysis, CE (OR = 0.70, 95% CI = 0.18-2.68, P = 0.26) and CE-ASPECTS (OR = 1.21, 95% CI=0.60-2.44, P = 0.57) were not related with in-hospital mortality after EVT. The lesion mapping showed that the most common CE locations among the patients with a poor prognosis was the M6 area. The multivariable logistic regression analysis showed that CE in the M6 area (OR = 6.87, 95% CI = 1.27-144.92, P = 0.006) increased the risk of a 3-month poor outcome. The study showed that adding CE to the well-known risk factors for poor prognosis improves the predictive power of the models (Delta AUC of 0.07, P = 0.02). Conclusion: CE has a prognostic value after EVT in anterior stroke patients. The prognostic value is the highest when present in the M6 area.