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Türk Nöroloji Derneði Nöromüsküler Hastalýklar Çalýþma Grubu Adýna

Amyotrofik lateral skleroz (ALS)’un ilerleyiþini durdurabilmek ve mümkünse iþlev kaybýný geri döndürebilmek için üzerinde çalýþýlan tedavi metodlarýndan biri de kök hücre uygulamasýdýr. Deneysel motor nöron hastalýðý modellerinde bugüne kadar farklý metodlarla kök hücre uygulanmýþ; olumlu veya olumsuz olmak üzere birbirinden farklý sonuçlar elde edilmiþtir. ALS’li hastalara kök hücre uygulamasý ile ilgili, uluslararasý indekslere giren dergilerde yayýmlanmýþ az sayýdaki insan çalýþmalarýnýn sonuçlarý ya olumsuz ya da metodolojik olarak ciddi eksiklikleri bulunan çalýþmalardýr. ALS hastalýðýnda kök hücre uygulamasýnýn tedavi edici etkisi olup olmadýðýnýn insanda araþtýrýlabilmesi için gerekli ve yeterli laboratuvar verisi veya klinik veri bugün mevcut deðildir.

Stem cell application is one of the potential treatment methods for seizing the progression of amyotrophic lateral sclerosis (ALS) and for returning motor function if ever possible. Several different methods of stem cell application have been performed in experimental motor neuron disease models; the beneficial effects of these studies are controversial. There are few stem cell studies on ALS patients reported in the literature. The results of these studies either negative or have serious methodological problems. There is no sufficient laboratory or clinical data for designing a stem cell application trial in ALS patients for today.

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AMAÇ: Bu çalýþmada, Bursa ili Orhangazi ilçesinde yaþayan, 40 yaþ ve üzeri popülasyondaki hareket bozukluklarýnýn prevalans oranlarýnýn bildirilmesi amaçlandý.
YÖNTEMLER: Çalýþmamýz üç fazlý olarak planlandý. Faz I’de; 1256 olgu halk saðlýðý ve nöroloji asistanlarý tarafýndan kapý-kapý, ev ziyaretleri þeklinde kýsa anket formu doldurularak tarandý ve 404 þüpheli hareket bozukluðu olgusu tanýmlandý. Þüpheli olgularýn 131’i faz II’de deðerlendirilebildi ve bu olgular hareket bozukluklarý uzmanlarý tarafýndan görülerek tremor, huzursuz bacak sendromu, hemifasiyal spazm ve distoni tanýlarý için kullandýðýmýz skalalar doldurularak video kayýtlarý alýndý. Faz III’te tüm video görüntüleri hareket bozukluklarý uzmanlarý tarafýndan izlendi ve son taný konusunda fikirbirliðine varýldý.
BULGULAR: Prevalans oranlarý, huzursuz bacak sendromu için; n= 60, %9.71, esansiyel tremor için; n= 21, %3.34, ilerlemiþ fizyolojik tremor için; n= 26, %4.14, Parkinson hastalýðý için; n= 14, %2.23, hemifasiyal spazm için; n= 4, %0.82 ve distoni için; n= 2, %0.41 olarak bulundu.
SONUÇ: Esansiyel tremor, hareket bozukluklarý arasýnda en sýk görülmesine raðmen bizim çalýþmamýzda huzursuz bacak sendromu prevalansýnýn esansiyel tremor prevalansýndan daha fazla olduðu gözlendi.

OBJECTIVE: : In this study we aimed to determine the prevalence of movement disorders among 40 years and older population in Orhangazi district of Bursa, Turkey.
METHODS: This population-based study was planned in three phases. In phase I, door-to-door home interviews were performed on 1256 subjects by residents of departments of neurology and family medicine by using a short questionnaire and 404 subjects with suspected symptoms of movement disorders and Parkinsonism were detected. These subjects were examined and videotaped in phase II. Of the suspected subjects in phase I, 131 did not attend to phase II for various reasons. In phase II, subjects were evaluated by movement disorders specialists by using scales specific to tremor, restless leg syndrome, Parkinson disease, and hemi-facial spasm. In phase III, video recording of all identified patients were reviewed and final diagnoses were made with a consensus of all three specialists.
RESULTS: In this phase, subjects were diagnosed to have restless leg syndrome n= 60, 9.71%, essential tremor n= 21, 3.34%, enhanced physhological tremor n= 26, 4.14%, Parkinson’s disease n= 14, 2.23%, hemifacial spasm n= 4, 0.82%, and dystonia n= 2, 0.41%.
CONCLUSION: Although essential tremor has been reported as the most common movement disorder, in our study restless leg syndrome had higher prevalence than essential tremor.

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AMAÇ: Optik nörit (ON), optik sinirin çoðunlukla geçici görme kaybýna neden olan inflamasyonudur. Tek taraflý ON, multipl skleroz (MS)’un sýk görülen baþlangýç bulgusudur; ancak klinik izole sendrom (KÝS) olarak kalabilmektedir. Bu çalýþmada, izole ON geliþtiren hastalarýn MS’e dönüþmesi ile iliþkili faktörlerin tanýmlanmasý amaçlanmýþtýr.
YÖNTEMLER: Ýstanbul Týp Fakültesi Nöroloji Anabilim Dalý, Multipl Skleroz Birimi Polikliniðinde 1987-2003 yýllarý arasýnda görülen 2836 hastanýn dosyasý gözden geçirilmiþ ve ilk baþvuruda, ON tanýsý alan 90 hasta (61 kadýn, 29 erkek) 2008 yýlýnda birimimize davet edilerek, yeniden deðerlendirilmiþtir. Klinik ve demografik özellikler, görsel uyarýlmýþ potansiyeller, beyin omurilik sývýsýnýn (BOS) özelikleri, manyetik rezonans görüntüleme (MRG) incelemeleri ve McDonald kriterlerine göre MS’e dönüþme tarihi tekrar gözden geçirilmiþtir.
BULGULAR: ON’un ortalama baþlangýç yaþý 109 ± 82 aydý. MS’e dönüþen hastalarýn %50’sinin 13 ay içinde (%95 güven aralýðý; 4.4-19.6) kesin MS geliþtirdiði gözlendi. Yirmi dokuz erkek hastanýn dokuzu, 61 kadýn hastanýn altýsý bilateral ON ile baþvurdu (ki-kare; p= 0.012). Ýki hastanýn izlemi sýrasýnda nöromiyelitis optika geliþti. MS geliþtirme riskinin T2/Flair lezyonlarýnýn varlýðý (p= 0.001), BOS’ta oligoklonal bandlar (OKB)’ýn saptanmasý (p= 0.002), papilödem olmamasý (p= 0.027), ileri düzeyde görsel kaybýn olmamasý (p= 0.016) ve görsel kaybýn subakut (> 1 gün) geliþmesi (p= 0.005) ile anlamlý olarak arttýðý belirlendi (log-rank testi). Cox orantýlý hazard regresyon modeline göre incelenen parametrelerden MS’e dönüþümü en iyi þekilde öngören etmenlerin T2/Flair lezyonunun (hazard oraný 4.8, %95 güven aralýðý 1.5-15.4) veya OKB’nin (hazard oraný 3.6, %95 güven aralýðý 1.1-11.5) varlýðý olduðu bulundu.
SONUÇ: Daha önceki çalýþmalarda da belirtildiði gibi, T2 lezyonu ve BOS’ta OKB saptanmasý durumunda MS geliþtirme riski belirgin derecede fazladýr. Son zamanlarda MS patogenezinin erken dönemlerini daha iyi anlamamýzý saðlayan çalýþmalar, MS tedavisine erken baþlamanýn aksonal hasarý ve uzun dönemde nörolojik sekeli azaltmak gibi fayda saðlayacaðýna yönelik tartýþmalar baþlatmýþtýr. Bu sonuçlarýn göz önünde bulundurulmasý erken tedavi için hasta seçimi ve prognozun belirlenmesi bakýmýndan yol gösterici olabilir.

OBJECTIVE: Optic neuritis (ON) is inflammation of the optic nerve that generally leads to transient loss of vision. Unilateral optic neuritis is quite common upon first presentation in multiple sclerosis (MS) patients, but it may also remain as a clinically isolated syndrome. In this study we aimed to determine what factors are associated with the development of MS in isolated ON patients.
METHODS: Medical charts of patients followed-up at Istanbul University, Faculty of Medicine, Department of Neurology between 1987 and 2003 were screened for patients with isolated ON at first presentation. A cohort of 90 patients was thusly obtained. Clinical and demographic features, visual evoked potential, cerebrospinal fluid (CSF), and magnetic resonance imaging findings, and time to definitive MS according to McDonald’s criteria were recorded.
RESULTS: In all, 50% of the patients developed definitive MS after 13 months (95% CI: 4.4-19.6). Two of the patients developed neuromyelitis optica during the course of their follow-up. The development of MS was significantly associated with the presence of a T2 lesion (p= 0.001), oligoclonal bands (OCBs) in the CSF (p= 0.002), absence of papilledema (p= 0.027), absence of severe visual impairment (p= 0.016), and subacute (> 1 day) visual impairment (p= 0.005), as per log rank testing. According to the Cox proportional hazard regression model, the presence of a T2 lesion (hazard ratio: 4.8; 95% CI: 1.5-15.4) and OCBs (hazard ratio: 3.6; 95% CI: 1.1-11.5) are strongly predictive of the progression to MS.
CONCLUSION: As some previous studies have noted, the risk of developing MS after ON is significantly higher in the presence of a T2 lesion and OCBs in the CSF. We think that this should be taken into account before starting early treatment for MS. Recent studies on the pathogenesis of MS have suggested that early treatment of MS reduces neurological disability in the long term. Our results might aid patient selection for early treatment and the determination of prognosis.

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AMAÇ: Multipl skleroz (MS)’un klinik seyri, baþlangýç semptomlarý ve hastalýðýn seyri boyunca görülebilecek problemler, hastalar arasýnda farklýlýk gösterebilmektedir. Bu nedenle, hastalýðýn taný ve tedavi planýnda farklý uygulamalar ortaya çýkmaktadýr. Türkiye’nin farklý bölgelerindeki nöroloji asistan ve uzmanlarýnýn MS hastalýðýnýn tanýsýnda, takibinde, tedavisinde yaþadýklarý zorluklarýn ortaya konmasý amaçlanmýþtýr.
YÖNTEMLER: Mart 2008-Haziran 2008 tarihleri arasýnda, Türkiye’nin farklý bölgelerinden toplam 11 ilde interaktif toplantýlar düzenlendi. Katýlýmcýlarýn verdiði cevaplar sonunda elde edilen veriler deðerlendirildi.
BULGULAR: Toplam 242 nöroloji uzmaný ve araþtýrma görevlisi katýldý. MS tanýsýnda kullanýlan tetkiklerden görsel uyandýrýlmýþ potansiyellerin %14, beyin omurilik sývýsý (BOS) oligoklonal band incelemesinin %40, manyetik rezonans görüntülemenin %1 oranýnda yapýlamadýðý görüldü. BOS oligoklonal band bakýlabilirliði açýsýndan bölgeler arasýnda anlamlý farklýlýk vardý. Mc Donald taný kriterlerini dolduran, iki atak öyküsü olan tipik relapsing-remitting multipl skleroz hastasýnda katýlýmcýlarýn %61’i immünmodülatör tedavi baþlamayý düþündü.
SONUÇ: MS’in klinik, radyolojik ve laboratuvar özellikleri bakýmýndan oldukça fazla farklýlýðýn olmasý, hastalýðýn taný ve tedavi planýnda, tüm dünyada olduðu gibi Türkiye’de de nöroloji uzmanlarýnýn iþini zorlaþtýrmakta ve farklý uygulamalarýn ortaya çýkmasýna neden olmaktadýr.

OBJECTIVE: The clinical progress of multiple sclerosis (MS), initial symptoms and problems during the course of a disease that can be seen, may vary among the patients. Therefore, different applications occurs in the disease diagnosis and treatment plan. The difficulties of diagnosis, treatment and progress of MS disease, experienced by the neurology residents and experts from different regions of the Turkey is intended to introduce.
METHODS: Interactive meetings was arrenged in total 11 cities from different regions of Turkey, between March 2008 and June 2008. The data obtained as a result of the responses of participants were evaluated.
RESULTS: Neurology specialist and research assistant, total of 242 persons participated. It was observed that 14 percent of visual evoked potential, 40 percent of cerebrospinal fluid (CSF) oligoclonal band review and one percent of magnetic resonance imaging examinations used in diagnosis of MS can’t be done. There was significant differences between regions about feasibility of CSF OCB. Sixty one percent of participants thought to start immunomodulatory treatment to typical relapsing-remitting multiple sclerosis patients, filled in the Mc Donald diagnostic criteria and had two attack story.
CONCLUSION: As all the world, in Turkey being very much difference about clinical, radiological and laboratory features of MS lead to the neurology experts work hard and the emergence of different applications about the disease diagnosis and treatment plan.

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AMAÇ: Bu çalýþma incelenmek üzere elektronöromiyografi (ENMG) laboratuvarýna gönderilen hastalarýn klinik ön taný ile ENMG sonuçlarýnýn tutarlý olup olmadýðýný araþtýrmak amacýyla retrospektif olarak yapýldý.
YÖNTEMLER: ENMG laboratuvarýna çeþitli anabilim dallarýnca yönlendirilen ve çeþitli klinik ön tanýlarla istemleri yapýlan 957 hasta bu çalýþmaya dahil edilmiþtir. Demografik bulgularý, muhtemel klinik taný, istemin yapýldýðý anabilim dalý ve elektrofizyolojik inceleme sonrasýnda elde edilen sonuç kayýt edildi ve istatistiksel olarak deðerlendirildi.
BULGULAR: ENMG incelemesi yapýlan 957 hastanýn 644 (%67.3)’ü kadýn, 313 (%32.7)’ü erkekti ve yaþ ortalamasý 45.40 ± 14.54 idi. Hastalarýn ENMG istemleri nöroloji, ortopedi, nöroþirürji ve fizik tedavi ve rehabilitasyon kliniklerince yapýldý. Hastalara uygulanan elektromiyografi sonucuna göre; hastalarýn %53.6’sýnýn (n= 513) sonucu ön taný ile uyumlu bulunurken, %41.5’inin (n= 397) ENMG’si normal olarak deðerlendirildi, %4.9’una (n= 47) ise ön tanýlardan farklý tanýlar koyuldu. Ön tanýlarýn ENMG ile de desteklenmesi bakýmýndan analiz edildiðinde istem yapýlan klinikler arasýnda istatistiksel bir farklýlýk saptanmadý (p= 0.794). Karpal tünel sendromu, polinöropati, radikülopati-pleksopati, tuzak nöropati ve miyopati ön tanýlarýnýn ENMG ile de desteklenmesi arasýndaki farklýlýk istatistiksel olarak analiz edildiðinde; bu ön tanýlar arasýnda ENMG ile uyum bakýmýndan farklýlýk saptandý (p< 0.001).
SONUÇ: Periferik sinir sistemi tutulumu gösteren hastalýklarýn tanýsýnda önemli rol oynayan ENMG incelemesi nörolojik muayenenin bir devamýdýr. Bu nedenle ENMG istemi klinik olarak koyulan tanýyý desteklemek için olduðu kadar, diðer olasý ön tanýlarý dýþlamak amacýyla da yapýlabilir. Bu da çalýþmamýzdaki ön taný ile ENMG sonrasý tanýlar arasýndaki uyumdaki azlýðýn nedeni olabilir.

OBJECTIVE: The aim of this study was to provide information concerning the impact of electrophysiological tests in the clinical management and diagnosis of patients, and to evaluate the consistency between referring clinical diagnoses and electrophysiological diagnoses.
METHODS: The study included 957 patients referred to the electroneuromyography (ENMG) laboratory from different clinics with different clinical diagnoses in 2008. Demographic data, referring clinical diagnoses, the clinics where the requests wanted, and diagnoses after ENMG testing were recorded and statistically evaluated.
RESULTS: In all, 957 patients [644 (67.3%) female and 313 (32.7%) male] were included in the study. Mean age of the patients was 45.40 ± 14.54 years. ENMG requests were made by different specialists; 578 (60.4%) patients were referred by neurologists, 122 (12.8%) by orthopedics, 140 (14.6%) by neurosurgeons, and 117 (12.2%) by physical treatment and rehabilitation departments. According to the results of ENMG testing, 513 (53.6%) patients’ referrals were related to their referral diagnosis, whereas 397 (41.5%) patients had normal ENMG test results, and 47 (4.9%) patients had a diagnosis that differed from the referring diagnosis. Among the relation between the referral diagnosis and electrophysiological diagnosis according to the clinics where the requests were made, there was no statistical difference (p= 0.794), but there were statistically significant differences between the support of different clinical diagnoses, such as carpal tunnel syndrome, polyneuropathy, radiculopathy-plexopathy, entrapment neuropathy, and myopathy based on ENMG test results (p< 0.001).
CONCLUSION: ENMG is a frequently used neurological examination. As such, referrals for ENMG can be made to either support the referring diagnosis or to exclude other diagnoses. This may explain the inconsistency between clinical referring diagnoses and diagnoses following ENMG.

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AMAÇ: Acil servislerde, nörolojik hastalýklarýn tanýsý için erken, hýzlý ve multidisipliner yaklaþým oldukça önemlidir. Bu çalýþmada acil servise baþvuran ve nöroloji konsültasyonu istenen olgularýn özelliklerini deðerlendirmeyi amaçladýk.
YÖNTEMLER: Çalýþmaya toplam 780 hasta dahil edildi. Hastalarýn demografik özellikleri, acil baþvuru ve nöroloji konsültasyon nedenleri, nörolojik tanýlarý, laboratuvar (hemoglobin, beyaz küre, platelet, kan glukoz, üre, kreatinin, eritrosit sedimentasyon hýzý, D-dimer düzeyleri) ve görüntüleme incelemeleri retrospektif olarak hasta dosyalarýndan deðerlendirildi.
BULGULAR: Bilinç bozukluðu, nöroloji konsültasyonlarýnýn en sýk nedeni idi (%19.7). Bu hastalarýn, %27.9’una iskemik inme, %18.2’sine hipoksik ensefalopati, %9.1’ine serebral hemoraji tanýsý konulmuþtu. %11’inde ise nörolojik bir taný düþünülmedi. Diðer sýk nöroloji konsültasyonu istenen nedenler, vertigo, baþ aðrýsý, nöbet ve inme idi. Çalýþma grubunun %43.7’sinde, klinik bulgular diðer sistemik nedenlerle iliþkili bulundu. Fokal nörolojik bulgular özellikle iskemik ve hemorajik inme, epilepsi ve hipoksik ensefalopati tanýlarýnda saptandý.
SONUÇ: Acil servislerde, fokal nörolojik bulgularý bulunmayan bilinç bozukluðu olan hastalarda, ilk olarak metabolik nedenler dýþlanmalýdýr. Fokal nörolojik bulgularýn varlýðýnda ise öncelikle intrakraniyal yapýsal hastalýklarýn deðerlendirilmesi gerekir. Dikkatlice oluþturulacak algoritimler ve nörolojik muayene eðitimleri, hastalarýn tanýsýnda acil servis çalýþanlarý için yararlý olacaktýr.

OBJECTIVE: Early, rapid, and multidisciplinary approaches are very important in the diagnosis of neurological disorders in emergency departments. The present study aimed to investigate the features of patients that presented for neurology consultation in the emergency department.
METHODS: The present study included 780 patients. Patient demographic features, reasons for emergent treatment and neurological consultation, neurological diagnosis by the neurologist, and laboratory (total blood count, serum glucose level, urea, creatine, erythrocyte sedimentation rate, and D-dimer levels) and imaging findings were retrospectively evaluated based on patient charts.
RESULTS: Impaired consciousness was the most frequent reason for neurological consultation (19.7%). Among these patients, ischemic stroke was diagnosed in 27.9%, hypoxic encephalopathy in 18.2%, cerebral hemorrhage in 9.1%, and 11% had no neurological diagnosis. Other common reasons for neurological consultation were vertigo, headache, seizure, and stroke. Clinical findings were related to other systemic causes in 43.7% of the study group. Focal neurological findings were present, especially in patients that presented with ischemic and hemorrhagic stroke, epilepsy, and hypoxic encephalopathy.
CONCLUSION: In emergency departments, metabolic causes should be ruled out in patients with impaired consciousness and the absence of focal neurological signs. Intracranial structural disorders must be evaluated when focal neurological signs are present. Cautiously prepared algorithms and neurological examination training will help improve the accuracy of emergency department diagnoses.

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Hipnik baþ aðrýsý, genellikle ileri yaþlarda ve uyku sýrasýnda görülen, nadir bir primer baþ aðrýsý formudur. Bu olgularýn polisomnografik (PSG) kayýtlamalarý, baþ aðrýsý ataklarýnýn sýklýkla REM fazýnda ortaya çýktýðýný göstermiþtir. Burada, 10 yýldýr süren, hemen her gece birkaç kez uykudan uyandýran baþ aðrýlarý hipnik baþ aðrýsý için Uluslararasý Baþ Aðrýsý Derneði (International Headache Society; IHS) kriterlerini karþýlayan, 69 yaþýnda erkek bir olgu sunulmuþ; lityuma yanýt alýnamamasý üzerine verilen topiramat 100 mg/gün ile tam düzelme elde edilmiþtir. Topiramat tedavisi alýrken yapýlan PSG’de baþ aðrýsý olmamýþ, topiramatý kestiði dönemde tekrarlanan PSG’de, biri REM, diðeri nonREM fazýnda oluþan iki baþ aðrýsý ataðý kaydedilmiþtir. Her iki kayýtta da solunumsal uyku bozukluðu olmadýðý, REM ve non-REM uyku sürelerinin normale göre kýsaldýðý gözlenmiþtir. Ayrýca, topiramatlý PSG’de, hastanýn daha az uyandýðý ve REM uyku oranýnýn tedavisiz PSG’ye göre daha yüksek olduðu tespit edilmiþtir. Bu bulgular, hipnik baþ aðrýsýnýn uykunun evresiyle deðil doðrudan uyku durumuyla iliþkili olduðu görüþünü desteklemektedir. Hipnik baþ aðrýsýnda lityum verilemeyen hastalar için topiramat bir tedavi seçeneði olarak akla gelmelidir.

Hypnic headache is a primary, rare headache disorder of the elderly, which occurs during sleep. Polysomnography (PSG) studies have shown that hypnic headache occurs with much gretaer frequency during REM sleep than during non-REM sleep. We present a 69-year-old male that had been waking from sleep due to headaches that have occurred every night for 10 years and was diagnosed as hypnic headache according to International Headache Society (IHS) criterion. He did not benefit from lithium treatment. After taking topiramate 100 mg/day his headaches disappeared. PSG recordings made while he was taking topiramate showed that he had no headaches. He discontinued topiramate on his own and his headaches returned. Subsequently, three weeks after he stopped taking topiramate, two hypnic attacks were recorded during a second PSG-1 during REM and 1 during non-REM sleep. In two records, both the duration of REM and non-REM sleep were reduced. PSG while the patient was taking topiramate showed a higher proportion of REM sleep and fewer awakenings than did the second PSG. Our findings support the view that hypnic headache attacks arise directly from sleep, not from sleep stages. Changes in sleep physiology in the elderly may contribute to hypnic headache. Topiramate may be an effective alternative treatment for hypnic headache in cases unresponsive to lithium or in those that experience intolerable side-effects.

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Konjenital dermal sinüs ciltten derin dokulara açýlan epitelize kanallardýr. Bu sinüsler erken embriyolojik geliþim sýrasýnda kütanöz ektoderm ile nöroektodermin bilinmeyen bir nedenle ayrýþmasýný tamamlayamamasý sonucu oluþur. Ellerde beceriksizliðin ön planda olduðu, el kaslarýnda kuvvetsizlik yakýnmasýyla müracaat eden iki olguya muayene, elektrofizyoloji ve görüntüleme yöntemleri ile servikal dermal sinüs tanýsý koyuldu. Ýntrensek el kaslarýnda atrofi ve kuvvetsizlik olmasý nedeniyle polinöropati ve motor nöron hastalýðý ön tanýlarý ile takip edilmiþ olan bu iki hastanýn bulgularý ve hastalýðýn patofizyolojisi tartýþýlmýþtýr.

Department of Neurology, Gulhane Military Medicine Academy, Ankara, Turkey
Congenital dermal sinuses are epithelium-lined tracts that extend from an opening in the skin through deeper tissues. These sinuses consist of incompletely separated cutaneous ectoderm from the neuroectoderm due to embryological maldevelopment. We present two cases of cervical dermal sinus that presented to our outpatient clinic with diminished hand muscle strength. These two cervical dermal sinus cases were followed-up with the diagnosis of polyneuropathy and motor neuron disease based on atrophy and weakness of the intrinsic hand muscles. The pathophysiology of the cases is discussed.

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Aþaðý vurucu nistagmus santral sinir sisteminin yapýsal lezyonlarýna baðlý olarak veya ilaç intoksikasyonlarýyla iliþkili olarak ortaya çýkabilen bir nistagmus tipidir. Burada okskarbazepin intoksikasyonuna baðlý aþaðý vurucu nistagmusu olan ve ilaç dozunun azaltýlmasý sonrasý bulgularý tamamen düzelen bir epilepsi hastasý sunulmaktadýr. Okskarbazepin intoksikasyonuna baðlý aþaðý vurucu nistagmus daha önce bildirilmemiþtir. Antiepileptik ilaç kullanan hastalarda aþaðý vurucu nistagmusun bir intoksikasyon belirtisi olabileceði akýlda tutulmalýdýr.

Downbeat nystagmus is associated primarily with structural lesions of the central nervous system and may be observed as a manifestation of drug intoxication. Herein we present an epileptic patient that presented with downbeat nystagmus related to oxcarbazepine intoxication and completely recovered following dose reduction. To the best of our knowledge this is the first report of downbeat nystagmus related to oxcarbazepine intoxication. Moreover, clinicians should be aware that downbeat nystagmus could be a manifestation of antiepileptic drug intoxication.

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