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Background: Management of a heavily calcified atherosclerotic occlusive disease involving the common femoral artery (CFA) and external iliac artery (EIA), poses a surgical challenge. Though the current guidelines recommend open surgical therapy for such lesions, this approach is neither easy nor represents the current real-life practice. Purpose: To describe tips and tricks facilitating the hybrid technique for the management of distal iliofemoral atherosclerotic disease, where classic endarterectomy is inadequate or ill-performed. Technique: A contralateraly inserted guidewire reaches the distal iliac artery via the crossover technique and is directly retrieved from the femoral arteriotomy immediately after removal of the anterior plaque segment. The retrieved and secured guidewire enables extensive retrograde CFA endarterectomy over the wire with avusion proximally to the inguinal ligement, followed by patch arterioplasty. Externalizing the guidewire from the patch enables traction on it and facilitates advancement of the stent through tortuous or stenosed iliac vessels as well as accurate stent deployment to cover the margin of the EIA residual plaque. Moreover, this manipulation enables ipsilateral placement of a sheath and passage of a second, retrograde guidewire to perform kissing stenting in the common iliac vessels. Chronic thrombotic lesions require covered stents to avoid thrombus propagation and meticulous flushing before completion of the femoral patching. Conclusions: The combined iliofemoral endarterectomy with stenting does not require advanced endovascular skills and prevents complications associated with incomplete femoral endarterectomy. Extensive avulsion endarterectomy proximal to the inguinal ligament is efficiently and safely performed over a retrieved crossover guidewire, enabling precise residual stenting above the flexion site. [ABSTRACT FROM AUTHOR]

This report describes the unique case of a completely patent Double Aortic Arch (DAA) combined with Kommerell diverticulum (KD), absence of celiac trunk, and congenital asplenia. The anatomical variants described were identified and assessed in a 51-year-old female from computed-tomography angiography (CTA) images with 3D-volume rendered reconstructions during her follow-up after hysterectomy. The reconstructed CTA images showed a DAA with the left common carotid artery stemming from the hypoplastic left aortic arch while the left subclavian artery originated from a KD in the descending thoracic aorta. A symmetric arrangement of the aortic arch branches was demonstrated, comprising a full vascular ring. Since the patient had been completely asymptomatic and with no symptoms of compression of the oesophagus or trachea, no surgical management was advised. The abdomen CTA imaging revealed absence of the celiac trunk with direct origin of the common hepatic and the left gastric artery from the superior mesenteric artery as well asplenia. The authors present a case of asymptomatic DAA of completely patent arches with the right vertebral artery branching separately of and the left SCA originating from KD in the descending aorta. The term KD can be identified also in arch anomalies other than the one originally described. Because anatomical anomalies can frequently be combined, thorough imaging inspection with CTA of both the thorax and abdomen is suggested [ABSTRACT FROM AUTHOR]

The case of a middle-aged man who had intraventricular hemorrhages secondary to Moyamoya disease (MMD), and initially, presented with psychiatric symptoms which did not respond to treatment is described. Neuropsychological assessment showed underlying significant cognitive deficits, mostly of complex attention and speed of information processing, visuospatial and constructional abilities, verbal and nonverbal memory, and executive functions. These deficits remained stable or slightly improved in follow-up assessments. Cognitive dysfunction should be suspected in case of psychiatric or psychiatric-related symptoms in MMD patients. This case study in Greece highlights the range of preserved and impaired cognitive functions in adult MMD by means of repeated neuropsychological evaluations in which a broad range of cognitive abilities were assessed. DOI 10.2466/02.13.l5.22.PR0.107.6.727-732

Abstract Background The aim of the study was to assess the plasma levels of homocysteine in patients with multiple sclerosis (MS) and to investigate whether an association with depression exists. Methods Plasma homocysteine (Hcy), vitamin B12 and plasma folate were measured in 65 moderately disabled patients with relapsing/remitting MS (RR-MS) and 60 healthy controls. All subjects were assessed with the Beck Depression Inventory (BDI). Results Hcy levels were significantly increased in MS patients compared to controls (13.5 ± 4.7 μmol/l vs 8.5 ± 3.1, p < 0.001). A significant correlation was found between Hcy levels and BDI scores (Pearson r = 0.3025, p < 0.05). Plasma Hcy was not related to Extended Disability Status Scale (EDSS) score, age, disease duration or vitamin B12 and folate. Conclusion Moderately disabled MS patients with elevated Hcy levels are particularly prone to develop depressive symptomatology. Further study is warranted in order to elucidate the prognostic and therapeutic implications of this novel finding.

Abstract Background Depression and anxiety are common psychiatric symptoms in patients with epilepsy, exerting a profound negative effect on health-related quality of life. Several issues, however, pertaining to their association with psychosocial, seizure-related and medication factors, remain controversial. Accordingly, the present study was designed to investigate the association of interictal mood disorders with various demographic and seizure-related variables in patients with newly-diagnosed and chronic epilepsy. Methods We investigated 201 patients with epilepsy (51.2% males, mean age 33.2 ± 10.0 years, range 16–60) with a mean disease duration of 13.9 ± 9.5 years. Depression and anxiety were assessed in the interictal state with the Beck Depression Inventory, 21-item version (BDI-21) and the state and trait subscales of the State-Trait Anxiety Inventory (STAI-S and STAI-T), respectively. The association of mood disorders with various variables was investigated with simple and multiple linear regression analyses. Results High seizure frequency and symptomatic focal epilepsy (SFE) were independent determinants of depression, together accounting for 12.4% of the variation of the BDI-21. The STAI-S index was significantly associated with the type of epilepsy syndrome (SFE). Finally, high seizure frequency, SFE and female gender were independent determinants of trait anxiety accounting for 14.7% of the variation of the STAI-T. Conclusion Our results confirm the prevailing view that depression and anxiety are common psychological disorders in epileptics. It is additionally concluded that female gender, high seizure frequency and a symptomatic epilepsy syndrome are independent risk factors for the development of anxiety and/or depression.

Aims Urinary incontinence in general is a major cause of quality of life impairment, morbidity and hospitalization. Its onset is strongly linked to the menopause. Our study aimed to elucidate the possible relationship between endogenous circulating estrogens and the onset and development of stress urinary incontinence (SUI). Methods One hundred and thirty eight peri- and postmenopausal women with SUI were matched 1:1 with continent women based on age and BMI. Morning fasting blood samples were drawn from all subjects for assessment of estradiol (E2), FSH, LH, Testosterone, Δ4-Androstendione (Δ4Α), DHEAS, prolactin, SBHG as well as a biochemical profile (glucose, insulin, triglycerides, cholesterol, HDL, LDL, ApoA1, ApoB). Hormone and biochemical parameters were compared between continent and incontinent women. Results Incontinent women had significantly lower serum estradiol levels compared to those in the control group (17.30 ± 8.16 vs. 24.22 ± 8.99, P < 0.001). Furthermore, the same association was observed for serum Δ4Α (146.07 ± 52.63 vs. 159.99 ± 42.62, P = 0.017). These associations remained significant after controlling for age, menopausal age, BMI, and number of deliveries. Conclusions These results may indicate that within the postmenopausal range, endogenous sex hormones may be associated with the presence of SUI in women not on menopausal hormone therapy. Neurourol. Urodynam. 36:121-125, 2017. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Purpose/Aim of the study: We evaluated possible associations between the severity of multiple sclerosis (MS) and levels of sex hormones as well as biochemical parameters in a sample of ambulatory patients.Material and methods: This cross-sectional study recruited 133 adults (52 men, 66 premenopausal and 15 postmenopausal women), with relapsing-remitting MS. Fasting venous blood samples were drawn for biochemical and hormonal evaluation. These parameters were tested for possible associations with MS severity, assessed using the Expanded Disability Status Scale (EDSS)-scores.Results: Follicle-stimulating hormonecorrelated with mean EDSS scores (r= −0.369,p= 0.038) in the premenopausal subgroup. However, this association became non-significant in the age-adjusted multivariate analysis (p= 0.141; power = 67%, typeαerror 0.10). Free androgen exhibited a borderline negative effect on EDSS-scores in the subgroup of men (r= −0.367,p= 0.093), which was lost after adjusting for age and duration of disease (p= 0.192; statistical power = 93%, typeαerror 0.05). Levels of estradiol tended to affect disability status of postmenopausal women (normal–mild vs. severe impairment: 23.33 ± 11.73pg/mL vs. 14.74 ± 6.30pg/mL,p= 0.095). Levels of sex hormones or indices of glycemic metabolism did not differ between patients presenting with EDSS scores higher or lower than the median value.Conclusion: Sex hormones and indices of glucose metabolism exhibited only a middle effect on EDSS scoring, which was not independent from the presence of confounders like age and duration of MS. The present study highlights the need for additional research, in order to elucidate the role of sex hormones and insulin resistance in the course of MS. [ABSTRACT FROM AUTHOR]

We examined the contribution of demographics and cognitive background variables (processing speed, visuospatial skill, working memory, and interference control) on derived Trail Making Test (TMT) scores in a large sample of Greek healthy participants. We included 775 participants and administered the TMT (TMT-A and TMT-B) and the Wechsler Intelligence Adult Scale (WAIS). Direct (TMT-A & TMT-B time-to-completion) and derived [difference TMT-(B − A) & ratio TMT-(B/A)] scores were calculated. Demographics (age, age2, education, and gender) and WAIS Full Intelligence Quotient significantly predicted the direct TMT-A (R2 = 0.426) and TMT-B (R2 = 0.593) scores and to a lesser extent, the derived TMT-(B − A) (R2 = 0.343) and TMT-(B/A) (R2 = 0.088) scores. In a subsample of 537 healthy participants who also completed the Stroop Neuropsychological Screening Test (SNST), demographics (age and education), WAIS Digit Symbol, Block Design, Arithmetic, and SNST accounted for 44.8% and 59.7% of the variance on TMT-A and TMT-B, and 32.5% and 9.6% of the variance on TMT-(B − A) and TMT-(B/A), respectively. We found minimal influence of Block Design and Arithmetic on TMT-(B − A) and an absence of significant influence of any cognitive variable on TMT-(B/A) score. Concluding, derived TMT scores are suggested as indices to detect impairment in cognitive flexibility across the adult life span, since they minimize the effect of demographics and other cognitive background variables. [ABSTRACT FROM PUBLISHER]

Objective: We aimed to evaluate the association between thyroid hormones and indices of obesity in a sample of d euthyroid postmenopausal women. Design: Cross-sectional study. Methods: Serum levels of TSH, free triiodothyronine (FT3), and free thyroxine (FT4) as well as BMI and waist:hip ratio (WHR) 1 were evaluated in 194 healthy euthyroid postmenopausal women. Ultrasonography was used to assess abdominal fat layers (subcutaneous fat (SF), preperitoneal fat (PF), and SF:PF ratio). Indices of adiposity were defined as high vs low "<2 depending on the median value of the assessed parameters. Results: After multivariate adjustment for traditional risk factors, lower FT4 levels and a higher FT3:FT4 ratio predicted c higher SF mass (FT4, Exp(&#$946;) = 0.035, P=0.020 and FT3:FT ns 4, Exp(b) = 2.374, P=0.018), whereas higher FT3 predicted higher ti PF mass (Exp(β) = 2.815, P=0.032). Women with FT3:FT4 above the highest quartile had a significantly higher SF mass as compared to women in the lowest quartile (1.81 ±0.62 cm vs 1.54±0.46 cm, P=0.027). BMI had a positive independent association with TSH (Exp(β) = 1.829, P=0.018). Finally, FT3 was significantly associated with SF mass among women with higher BMI (FT3, β = 0.259, P=0.040) and women with higher WHR (β = 0.309, P=0.020) but not among women with lower BMI or WHR values. Conclusion: Thyroid hormone levels, and in particular FT3, were independently associated with SF and PF in euthyroid postmenopausal women, and this association was mainly evident in women with higher BMIs. On the other hand, among traditional indices of adiposity, only TSH was positively associated with BMI. Larger prospective studies are needed to evaluate the significance of the present findings. [ABSTRACT FROM AUTHOR]

This pilot study aimed to investigate the expression of estrogen (ER) and progesterone receptors (PR), as well as their subtypes [alpha (ERα), beta (ERβ)], in the ovaries of postmenopausal women with benign or malignant endometrial pathology. Twenty postmenopausal women (age 66.2 ± 7.4 years) were included, diagnosed with benign (n = 10) or malignant [(serous/papillary (n = 4), endometrioid (n = 6)] endometrial lesions. Higher ERβ and PR ovarian expressions were observed comparing women with endometrioid versus non-endometrioid endometrial carcinoma (p = 0.022 andp = 0.029, respectively). Age, age at menarche and presence of hypertension were negatively associated with ERs and PR expression. The expression of ERα and ERβ was inversely correlated with menopausal age, which was not verified for PR. No significant association was observed between ERs or PR expression and benign or malignant endometrial pathology. Higher expression of ERβ and PR in the postmenopausal ovary is associated with the presence of a less aggressive type of endometrial cancer, comparing women with endometrioid versus non-endometrioid lesions. The expression pattern of ovarian receptors did not differ regarding the development of benign or malignant endometrial lesions. Larger observational studies are necessary to confirm the significance of our findings. 此初步研究的目的是在有良性或者恶性子宫内膜病理的绝经后妇女卵巢中，研究雌激素受体（ER）和孕酮受体（PgR）以及其亚型[alpha (ERα), beta (ERβ)]的表达。二十名绝经后妇女被纳入了此项研究（年龄在66.2 ± 7.4岁），均诊断出了良性(n=10)或者恶性[(浆液性/乳头状 (n=4), 子宫内膜样 (n=6)]子宫内膜病变。比较有子宫内膜样肿瘤的女性和非子宫内膜样子宫内膜癌的女性，可以观察到前者卵巢有更高的ERβ和PR 表达(p值分别为p=0.022 和p=0.029).年龄，初潮年龄和高血压发生与否与ER和PR表达呈负相关. ERα和 ERβ的表达和绝经年龄负相关，但尚未证实与PR是否有关。未观察到ERs或者PR的表达与良性或恶性的子宫内膜病理具有显著关联.将有子宫内膜样瘤的女性与无子宫内膜病变的女性做对比，绝经后卵巢中更高的ERβ和PR表达与一种低危型的子宫内膜癌的出现有关。卵巢受体的表达谱并不随着良性或者恶性子宫内膜肿瘤的病变发展而改变.更大的观察性研究对于确认我们发现的意义是必要的。 [ABSTRACT FROM AUTHOR]

Previous studies have showed that perceived stress (PS) in patients with multiple sclerosis (MS) constitutes an important factor for disease onset, relapse, symptomatology and psychological adjustment. Objectives: The aim of this pilot cross-sectional study was to examine the role of self-esteem in PS, after controlling for sociodemographical characteristics, depression and personality in MS patients. Methods: Sixty-six relapsing-remitting MS patients (66.67% females, mean age of 40 ± 11.1 years old, mean duration of disease 133.6 ± 128.8 months) were studied. Perceived stress, self-esteem, depression and personality type were assessed using self-administered questionnaires. Hierarchical multivariate regression modelling was used. Results: Higher education and depression and lower self-esteem were independently and significantly associated with increased PS, accounting for 40.5% of its variance. Univariate analyses revealed that low extroversion and openness and higher neurotism were associated with higher PS, although no significant after adjusting for other factors. Discussion: Although our findings need further confirmation, psychological interventions targetting self-esteem are strongly encouraged. [ABSTRACT FROM AUTHOR]

The case of a middle-aged man who had intraventricular hemorrhages secondary to Moyamoya disease (MMD), and initially, presented with psychiatric symptoms which did not respond to treatment is described. Neuropsychological assessment showed underlying significant cognitive deficits, mostly of complex attention and speed of information processing, visuospatial and constructional abilities, verbal and nonverbal memory, and executive functions. These deficits remained stable or slightly improved in follow-up asscssmcnts. Cognitive dysfunction should be suspected in case of psychiatric or psychiatric-related symptoms in MMD patients. This case study in Greece highlights the range of preserved and impaired cognitive functions in adult MMD by means of repeated neuropsychological evaluations in which a broad range of cognitive abilities were assessed. [ABSTRACT FROM AUTHOR]

Multiple symmetrical lipomatosis (MSL) is a rare disorder of unknown etiology defined as the presence of multiple and symmetrical fatty accumulations, usually involving the upper trunk, neck and head. Frequently associated findings include diabetes mellitus, hyperlipidemia, liver disease, hypothyroidism and polyneuropathy of unknown origin, but nevertheless, there are published reports of cognitive disorders in patients with MSL. We describe two unusual cases. (38-year-old and 45-year-old Greek men) of MSL who presented with polyneuropathy and memory disorders. This is the first description of memory disorders in patients with MSL. We propose that Mini-Mental State Examination and assessment of cognitive functions should be performed for all patients with MSL. The underlying mechanism in our patients remains unknown, and this question should be the subject of a future study. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to assess the plasma levels of homocysteine in patients with multiple sclerosis (MS) and to investigate whether an association with depression exists. Methods: Plasma homocysteine (Hcy), vitamin B12 and plasma folate were measured in 65 moderately disabled patients with relapsing/remitting MS (RR-MS) and 60 healthy controls. All subjects were assessed with the Beck Depression Inventory (BDI). Results: Hcy levels were significantly increased in MS patients compared to controls (13.5 ± 4.7 µmol/l vs 8.5 ± 3.1, p < 0.001). A significant correlation was found between Hcy levels and BDI scores (Pearson r = 0.3025, p < 0.05). Plasma Hcy was not related to Extended Disability Status Scale (EDSS) score, age, disease duration or vitamin B12 and folate. Conclusion: Moderately disabled MS patients with elevated Hcy levels are particularly prone to develop depressive symptomatology. Further study is warranted in order to elucidate the prognostic and therapeutic implications of this novel finding. [ABSTRACT FROM AUTHOR]

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PURPOSE: Attentional set shifting refers to the ability to alternate attention between simultaneous tasks or goals and plays an important role in managing everyday activities. We examined impaired attentional set-shifting in middle-aged and older adults referred for neuropsychological evaluation. MATERĠAL and METHODS: We included a mixed clinical group of 4,044 adults (age:30-95) referred for neuropsychological assessment. Attentional set-shifting ability was examined using the part B of the Trail Making Test (TMT-B). In order to minimize the motor effect on TMTB, the difference score [TMT part B minus part A, TMT-(BA)] instead of the traditional TMT-B score was used. The prevalence and degree of impairment was evaluated based on previous reference data for TMT-(B-A) in Greek population and according to the well- accepted cut-off score of -1.5 standard deviation (SD) for cognitive impairment. The total group was divided into three age groups (<50, 50- 69, >70 years) and two levels of education (≤12, >12 years). RESULTS: Mean performance was calculated for each age/education group. We further calculated the percentage of patients whose TMT-(B-A) performance fell within the next categories, (i)<-1.5SD, (ii)≥-1.5SD. The results were as follows: (30-49/≤12): (i)50%, (ii)50%; (30-49/>12): (i)63.2%, (ii)36.8%; (50-69/≤12): (i)36%, (ii)63.9%; (50-69/>12): (i)54.2%, (ii)45.8%; (70-95/≤12): (i)27.1%, (ii)72.9%; (70- 95/>12): (i)49.4%, (ii)50.6%. CONCLUSĠON: The evaluation of attentional set shifting should be primarily examined in clinical neuropsychological practice, since irrespective of the presence of underlying pathology, patients referred for neuropsychological evaluation present high percent of impairment, which is more evident in older and less educated groups. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe a case with unexplained neurological signs and symptoms which was presented as relapse of previously undiagnosed WD. After diagnosis confirmation, the patient was appropriately treated which resulted in improvement of major symptoms. CASE REPORT: A 48-year-old man was admitted to our hospital due to unexplained neurological symptoms. During the last year he progressively presented anorexia and weight loss, myoclonic-like movements of right upper and lower extremes, gait, occulomotor and sleep disturbances, depressive mood, withdrawal, and cognitive impairment. At admission, our patient suffered from insomnia [5] and neurological examination revealed mild ataxic walking, impaired vertical gaze, dysarthria and myoclonic type movements with right predominance. Brain MRI (T2, FLAIR) showed three non-specific hyperintense white matter (WM) lesions in left frontal lobe and one hyperintense WM lesion in right frontal lobe, without gadolinum enhancement. Increased pathological signal intensity was found on the left parahippocampal gyrus and the subiculum (5mm), with mild gadolinium enhancement. After exclusion of all probable causes, molecular detection of the 16SrRNA genes by PCR analysis of CSF, stools and blood was performed [6] which confirmed the diagnosis of Whipple disease.. CONCLUSĠONS: In conclusion, the possibility of Whipple disease should be considered in the diferential diagnosis in patients with atypical and unexplained neurological disorders. [ABSTRACT FROM AUTHOR]

An abstract of the article "Reference data for derived Trail Making Test scores in Greek healthy population," by Ioannis Zalonis is presented.

Background Depression and anxiety are common psychiatric symptoms in patients with epilepsy exerting a profound negative effect on health-related quality of life. Several issues, however, pertaining to their association with psychosocial, seizure-related and medication factors, remain controversial. Accordingly, the present study was designed to investigate the association of interictal mood disorders with various demographic and seizure-related variables in patients with newly-diagnosed and chronic epilepsy. Materials and methods We investigated 201 patients with epilepsy (51.2% males, mean age 33.2± 10.0 years, range=16-60) with a mean disease duration of 13.9 ± 9.5 years. Depression and anxiety were assessed in the interictal state with the Beck Depression Inventory, 21 item version (BDI-21) and the State and Trait subscales of the State-Trait Anxiety Inventory (STAI-S and STAI-T), respectively. The association of mood disorders with various variables was investigated with simple and multiple linear regression analyses. Results High seizure frequency and symptomatic focal epilepsy (SFE) were independent determinants of depression, together accounting for 12.4% of the variation of the BDI-21. The STAI-S index was significantly associated with the type of epilepsy syndrome (SFE). Finally, high seizure frequency, SFE and female gender were independent determinants of trait-anxiety accounting for 14.7% of the variation of the STAI-T. Conclusions Our results confirm the prevailing view that depression and anxiety are common psychological disorders in epileptics. It is additionally concluded that female gender, high seizure frequency and a symptomatic epilepsy syndrome are independent risk factors for the development of anxiety and/or depression. [ABSTRACT FROM AUTHOR]

Heart failure (HF) is known to be a major risk factor for first-ever ischemic stroke (IS), and is associated with greater stroke severity and higher rates of early mortality and residual disability. There are limited data regarding the association of HF with stroke recurrence. We sought to evaluate the relationship between HF and recurrent IS using a comprehensive meta-analytical approach. We performed a systematic literature review according to PRISMA guidelines to identify all prospective study protocols (randomized clinical trials or observational cohorts) that reported rates of IS recurrence in patients with concomitant HF. We pooled independently the reported corresponding risk ratios (RRs) and hazard ratios (HRs) from each study protocol using the random effects model. Heterogeneity across included studies was evaluated using Cochran Q and I 2 statistics. Our literature search identified 7 eligible studies including 9173 IS patients (18.2% with HF). The reported mean follow-up period in the included studies ranged from 7 days to 5 years. The pooled estimate of RRs and HRs for recurrent IS was 1.96 (95% CI: 1.49–2.60; p < 0.0001) and 1.93 (95% CI: 1.47–2.53; p < 0.0001). We found no evidence of heterogeneity within studies in both the RR (I 2 = 13.5%, p for Cochran Q statistic: 0.325) and HR (I 2 = 0%, p for Cochran Q statistic: 0.629) analyses. HF is associated with a continuous two-fold increase in the risk of IS recurrence in patients with prior history of cerebral ischemia. The benefit of anticoagulation in this high-risk group of patients may be studied along with additional risk factor modifications. [ABSTRACT FROM AUTHOR]

Vasculitides comprise a heterogeneous group of autoimmune disorders, occurring as primary or secondary to a broad variety of systemic infectious, malignant or connective tissue diseases. The latter occur more often but their pathogenic mechanisms have not been fully established. Frequent and varied central and peripheral nervous system complications occur in vasculitides and connective tissue diseases. In many cases, the neurological disorders have an atypical clinical course or even an early onset, and the healthcare professionals should be aware of them. The purpose of this brief review was to give an update of the main neurological disorders of common vasculitis and connective tissue diseases, aiming at accurate diagnosis and management, with an emphasis on pathophysiologic mechanisms. [ABSTRACT FROM AUTHOR]

Objective Regulations and guidelines regarding driving privileges of patients with epilepsy vary greatly worldwide. The aim of our study was twofold: firstly, to evaluate disobedient drivers in Greece and to elucidate their awareness of the law, emotional responses, and seizure profile and, secondly, to identify determinants of disobedience regarding driving among patients with epilepsy. Methods All consecutive patients with epilepsy who visited the epilepsy outpatient clinic of two tertiary epilepsy centers were invited to participate in the study. One hundred ninety patients met our inclusion criteria. Results Fifty-two percent of our study population was aware of the driving restrictions. More than one out of three patients were disobedient (35.8%). Being a male was associated with a 6.07-fold increase in the odds of being disobedient (95% CI: 2.73–13.47, p < 0.001); being employed was associated with a 4.62-fold increase in the odds of being disobedient (95% CI: 2.20–9.68, p < 0.001); and each extra antiepileptic drug (AED) was associated with a decrease in the odds of disobedience by a factor of 0.41 (95% CI: 0.26–0.63, p < 0.001). Conclusion Male gender, employment, and number of AEDs are important determinants of disobedience regarding driving among patients with epilepsy. [ABSTRACT FROM AUTHOR]

The case of a middle-aged man who had intraventricular hemorrhages secondary to Moyamoya disease (MMD), and initially, presented with psychiatric symptoms which did not respond to treatment is described. Neuropsychological assessment showed underlying significant cognitive deficits, mostly of complex attention and speed of information processing, visuospatial and constructional abilities, verbal and nonverbal memory, and executive functions. These deficits remained stable or slightly improved in follow-up asscssmcnts. Cognitive dysfunction should be suspected in case of psychiatric or psychiatric-related symptoms in MMD patients. This case study in Greece highlights the range of preserved and impaired cognitive functions in adult MMD by means of repeated neuropsychological evaluations in which a broad range of cognitive abilities were assessed. [ABSTRACT FROM AUTHOR]

Enzyme-inducing antiepileptic drugs AEDs have adverse effects on bone mineral density (BMD), whereas studies on levetiracetam (LEV), a nonenzyme-inducing agent, have showed conflicting results. The aim of this study was to further elucidate the role of LEV in bone health. A sample of forty-six patients with epilepsy (mean age: 35.7 years, range: 20.2–64.2 years, 39.1% males) on LEV monotherapy for at least one year (range: 1.5–14.5 years, median 5.5 years) underwent femoral neck (FN) and lumbar spine (LS) BMD measurements. The T- and Z-scores were calculated. Results showed that 15.2% of the patients were identified with osteopenia and none with osteoporosis. Pearson's correlations revealed a negative but not significant association of LEV duration with bone-related measurements (range of rhos: from − 0.004 to − 0.23), except for LS T-scores. In terms of FN BMD measurements, Z-scores, and T-scores, longer LEV therapy duration had adverse but not significant effects on bone health after adjusting for age and gender. With regard to LS BMD measurements, Z-scores, and T-scores, men taking LEV for at least 5.5 years had better, although not significant, bone health compared with men with shorter LEV exposure, after adjusting for age. The opposite was found in women, although differences did not reach significance. These preliminary results are indicative of a differential effect of LEV therapy duration in men and women, which could presumably account for the incongruity of the already published studies. Also, LS assessments were more sensitive to these gender differences. Future larger studies should validate these results. [ABSTRACT FROM AUTHOR]