Bilge Piri Cinar

The Turkish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery

BackgroundCognitive impairment may be seen in as many as 43–70% of patients with multiple sclerosis (MS) and may be observed in all MS subtypes. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) battery may be used to evaluate cognition status. The purpose of the current study is to validate the BICAMS battery in Turkish.MethodsPatients with MS attending our clinic between September 2014 and April 2015 were invited to participate. Healthy control participants were matched in terms of age, gender and years of education.ResultsOne hundred seventy-three MS patients and 153 healthy control participants were enrolled in the study. MS patients performed significantly worse in all trials than the members of the healthy control group. In addition, cognitive dysfunction was identified in 78 of the 173 (45.1%) patients. In the MS with cognitive impairment group, 64 out of 151 (42.4%) subjects were RRMS patients, 12 out of 18 (66.7%) were secondary progressive MS patients, and 2 out of 4 (50%) were primer progressive MS patients.ConclusionsThe BICAMS has been proposed for assessing cognitive impairment in MS patients. This study shows that the battery is suitable for use in Turkey.

Evaluation of clinical parameters during and after treatment of attack in patients with clinically isolated syndrome: Comparison of the results with that of multiple sclerosis patients

OBJECTIVES The aim of the present study was to examine the changes in the measurement of functions during and after pulse methylprednisolone (MP) treatment during a clinically isolated syndrome (CIS) attack, using the multiple sclerosis functional composite (MSFC) and Expanded Disability Status Scale (EDSS), and to compare the results with that of MS patients. PATIENTS AND METHOD The present study included 44 patients with CIS and 26 patients with clinically definite multiple sclerosis (MS), as the control group. All patients were having an acute attack and were treated with 1000-mg intravenous methylprednisolone. The scales were administered before-and after-treatment, and at 30 days after treatment. RESULTS A 5-days treatment was adequate in 36.9% of CIS patients and 62.5% of MS patients (p=0.003). A moderate correlation was found between Auditory Consonant Trigram Test (ACT) and paced auditory serial addition test in CIS patients before-treatment. A poor correlation was found between EDSS scores and ACT in CIS patients at all measurement periods. The level of correlation between EDSS and ACT scores was similar in MS patients. CONCLUSION Although MS and CIS patients show similar response to corticosteroid treatment and had similar fatigue characteristics, overall cognitive functioning was better in CIS patients.

Paced auditory serial addition test: National normative data

OBJECTIVES The presence and monitoring of cognitive impairment is frequently overlooked in a disease such as multiple sclerosis (MS), which has the potential to affect the physical, social, and socioeconomic lives of individuals in early adulthood. The purpose of this study was to establish Paced Auditory Serial Addition Test (PASAT) normative data for the healthy Turkish population. PATIENTS AND METHODS Three hundred eighty-five healthy volunteers were enrolled. Thirty-two subgroups were established, comprising four age groups (18-25, 26-35, 36-45, and 46-55), four education groups (5 years of education, 8 years, 11 years and 15 years) and two gender groups (male and female). The PASAT test was applied to the entire study group. RESULTS PASAT score decreased with age, although the difference between the age groups did not achieve statistical significance. Very strong significant correlation was determined between education level and PASAT performance. PASAT scores increased with the number of years of education. CONCLUSION This study provides normal PASAT values in the Turkish population on the basis of age, gender, and level of education. These data can be used as control values in clinical practice.

Monthly methylprednisolone in combination with interferon beta or glatiramer acetate for relapsing-remitting multiple sclerosis: A multicentre, single-blind, prospective trial

OBJECTIVES Multiple sclerosis is usually clinically characterized by repeated subacute relapses followed by remissions. Corticosteroids are used for relapses, and this treatment has been shown to increase the speed of recovery from these. We aimed to evaluate the efficacy and safety of pulsed methylprednisolone given every month as an add-on therapy to interferon beta or glatiramer acetate in patients with relapsing-remitting multiple sclerosis. PATIENTS AND METHODS This was a multi-center, examiner-blinded, prospective study. Absolute annualized relapse rates and Expanded Disability Status Scale scores were calculated. RESULTS 103 patients were given intravenous methylprednisolone (1 dose of 1g IV) once a month for 12 months as add-on therapy and were assessed during this period. The decrease in the absolute annualized relapse rate was 0.69, and 72 patients were relapse-free at the end of the year. Sixty-nine of the 103 patients had the same Expanded Disability Status Scale scores at the end of one year, while 21 were less disabled, and 13 sustained disability progression. Health related quality of life measured using the MS Quality of Life scale improved significantly during the study period. CONCLUSION The addition of monthly pulsed methylprednisolone to subcutaneous interferon beta or glatiramer acetate therapy significantly reduced the relapse rate and may also be beneficial in terms of disease progression. These combinations were also safe, and most patients tolerated methylprednisolone as an add-on to interferon beta or glatiramer acetate.