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    The diagnostic value of electroencephalography in pediatric patients presenting with syncope
    (2023) Yücel, Gül
    Aim: In the investigation of the diagnosis of pediatric syncope, it was aimed to evaluate the rate of abnormal EEG findings and the diagnostic yield of the EEG in the electroen- cephalography (EEG) taken following their neurological examination. Materials and Methods: EEG records of 332 patients younger than 18 years of age who presented to the pediatric neurology outpatient clinic with syncope were retrospectively analyzed. The EEG results were classified as normal and abnormal. Based on the abnor- mal EEG results, four subgroups were formed as focal epileptiform discharge, generalized epileptiform discharge, focal slowing and generalized slowing. Abnormal EEG results were categorized according to age and gender. Results: Of the cases included in the study, 195 (58.7%) were female and 137 (41.3%) were male. The mean age of the patients was calculated as 12.67±3.21 years. Analysis of the EEG results revealed that 92.5% were normal and 7.53% were abnormal. The most common abnormal EEG finding was focal slowing, which was detected in 12 (3.6%) patients, followed by focal epileptiform discharge which was detected in eight (2.4%) and generalized epileptiform discharge which was detected in five (1.5%) patients. Conclusion: EEG should not be routinely performed to evaluate the diagnosis of pedi- atric syncope. Therefore, EEG should be performed only on patients to be selected based on their medical history and the results of their neurological examination. In this way, it will be possible to derive more benefits out of EEG and to reduce the associated medical costs.
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    Evaluation of neurologically symptomatic and asymptomatic patients in childhood Wilson’s disease with central nervous system involvement: A retrospective observational study
    (2023) Yücel, Gül; Gungor, Sukru
    Aim: The aim was to evaluate the clinical and laboratory characteristics of children with Wilson’s disease (WD) with and without neurological presentation with abnormalities on brain magnetic resonance imaging (MRI) and to describe the relationship of these observations with disease severity and functional outcome and their impact on prognosis. Materials and Methods: Demographic, neuropsychiatric findings, laboratory, disease severity and functional results of 48 children with neurologically symptomatic and asymptomatic WD were evaluated retrospectively. Results: A significant positive correlation was found between the neurologic symptom score and functional outcome in WD with neurological presentation (p<0.001). A significant positive correlation was found between disease severity scores (PELD, MELD, Child Pugh and Dhwin score) and modified Rankin scores (mRS) in WD without neurological presentation (p <0.001, 0.004, <0.001, 0.001, respectively). In addition, a significant positive correlation was found between total bilirubin, direct bilirubin and International Normalized Ratio (INR) values and mRS scores (p= 0.006, 0.012, 0.004, respectively). Kayser-Fleischer Ring sign in the eye was higher in the group with neurological symtomatic WD (p<0.001). The number of patients presenting with clinic of fulminant hepatitis and hepatic encephalopathy was significantly higher in the neurological asymptomatic group (p<0.001). Conclusion: Brain MRI changes may occur even in hepatic WD and presymptomatic cases, although infrequently, regardless of the presence of neurological symptoms. It should be known that neurological symptoms in children and adolescents may occur without significant liver disease. Even without neurological symptoms, all children with WD should have a brain MRI before treatment.
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    The role of serum ferritin, vitamin B12 and vitamin D levels in childhood primary headaches
    (2023) Yücel, Gül
    Aim: In this study, it was aimed to investigate the relationship between headache components and serum ferritin, vitamin B12 and vitamin D levels in pediatric patients with migraine and tension-type headache (TTH). Methods: The data of patients aged 7-17 years who applied to the outpatient pediatric neurology clinic with a complaint of headache and were diagnosed with migraine and TTH based on the International Classification of Headache Disorder (ICHD)-3 beta criteria were evaluated retrospectively. Results: The mean age of the patients was 13.80 ± 3.89 years in the migraine group and 14.10± 4.17 years in the TTH group. In the migraine group, the duration of the attack was longer and the pain intensity was higher. Unilateral headache, throbbing character, nausea, vomiting, discomfort from light and sound were statistically significantly higher in the migraine group. In patients with migraine, low vitamin D and low ferritin levels were associated with a prolongation of the disease duration and an increase in the frequency of attacks. A decrease in serum iron level was associated with an increase in pain severity and a decrease in vitamin D levels was associated with an increase in attack duration. It was observed that there was an increase in the frequency of attacks with a decrease in serum ferritin levels in the TTH group. No statistically significant correlation was found between headache characteristics and vitamin B12. Conclusions: Our study shows the necessity of routine evaluation of vitamin D and ferritin levels in childhood primary headaches.
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    Valproat kullanan epileptik çocuklarda serum insülin,leptin, ghrelin, GH, IGF-1 ve IGFBP-3 düzeyleri
    (İnönü Üniversitesi, 2006) Yücel, Gül
    VPA çocuklarda ve erişkinlerde epilepsi tedavisinde sık kullanılan antiepileptik bir ilaçtır. Ancak ağırlık artışı gibi istenmeyen yan etkileri bulunmaktadır. VPA'a bağlı ağırlık artışının patogenezi henüz yeterince aydınlatılamamıştır. Ghrelin besin alımı ve tokluğun önemli bir düzenleyicisidir. Besin alımı ve iştahı uyarır. Enerji tüketimini azaltır. Karbonhidrat kullanımını artırırken, yağ kullanımını azaltır. Leptin ve insülin salınımını düzenler. Ghrelinin bu etkileri, insülin rezistansı ve aşırı kilo artışı ile ilişkili görünmektedir. Bu çalışmada VPA ilişkili ağırlık artışında ghrelinin rolü araştırıldı. Ayrıca epileptik çocuklarda VPA tedavisinin büyüme üzerine olan etkisi araştırıldı. Gereç ve Yöntem: Bu çalışmaya İnönü Üniversitesi Tıp Fakültesi Çocuk Nöroloji Polikliniği'nde ILAE-1989 sınıflamasına göre idiyopatik jeneralize veya idiyopatik parsiyel epilepsi tanısı alarak VPA tedavisi başlanan, yaşları 3-15 yıl (ortalama 7,85 ± 3,9 yıl) arasında (17 kız,18 erkek; 20 pubertal,15 prepubertal) olgu alındı. Tedavi öncesinde ve -70 oC' de tedavinin altıncı ayında sabah açlık döneminde serum örnekleri alındı ve muhafaza edildi. Bu örneklerden açlık kan glikozu, insülin, c-peptid, leptin, ghrelin, GH, IGF-1, IGFBP-3 düzeyleri çalışıldı. Serum ghrelin, leptin, GH, IGF-1, IGFBP-3 düzeyleri ELISA yöntemle ölçüldü. Tedavi öncesi ve tedavinin 6. ayındaki değerler karşılaştırıldı. Bulgular: Olguların tedavi öncesi ile tedavinin altıncı ayında ağırlık, boy, vücut kitle indeksi, boy SDS değerlerinde anlamlı bir artış gözlendi. Serum ghrelin düzeylerindeki artış ile serum IGF-1 ve IGFBP-3 düzeylerindeki azalma istatistiksel olarak anlamlıydı. Prepubertal ve pubertal grupta ağırlık, boy, vücut kitle indeksi ve boy SDS değerlerinde 58 anlamlı bir artış vardı. Prepubertal grupta ghrelin düzeyindeki artış ile IGF-1 ve IGFBP-3 düzeylerindeki düşme istatistiksel olarak anlamlı iken, pubertal grupta istatistiksel olarak anlamlı değildi. Sonuç: VPA kullanan epileptik çocuk hastalarda kilo artışı, tedavinin başlangıç döneminde ghrelin düzeyindeki artış ile ilişkili olabilir. VPA tedavinin başlangıç döneminde artmış ghrelin düzeyi iştah artışı, besin alımı ve kilo artışının tetikleyicisidir. Ayrıca VPA tedavisi sırasında artan ghrelin düzeyi IGF-1 düzeyinde azalmaya neden olarak büyümeyi de olumsuz etkileyebilir. Ancak VPA ilişkili ağırlık artışının mekanizmasını ve büyüme üzerine olan olumsuz etkilerini daha iyi aydınlatabilmek için hastaların daha uzun dönem izlenmesi gerekmektedir. Bu amaçla yeni çalışmalara ve daha uzun dönem sonuçlara ihtiyaç duyulmaktadır.