Çağdaş Erdoğan

Turkish Version of the painDETECT Questionnaire in the Assessment of Neuropathic Pain: A Validity and Reliability Study

OBJECTIVES The aim of this study was to develop a Turkish version of the painDETECT questionnaire (PD-Q) and assess its reliability and validity. METHODS Two hundred and forty patients who were diagnosed by expert pain physicians in daily clinical practice and classified as having either neuropathic, nociceptive, or mixed pain for at least 3 months were enrolled in this study. After the usual translation process, the Turkish version of the PD-Q was administered to each participant twice with an interval of 48 hours. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), Douleur Neuropathique en 4 questions (DN4) and a pain visual analog scale were assessed along with the PD-Q. Chronbachs α was calculated to evaluate internal consistency of the PD-Q. Intraclass correlation coefficient was calculated to examine test-retest reliability. Convergent validity was assessed by correlating the scale with LANSS and DN4. Discriminant statistics-sensitivity, specificity, Youden index, positive predictive value, negative predictive value-were also assessed. RESULTS A total of 240 patients with chronic pain, 80 patients in each neuropathic, nociceptive, and mixed pain group, were included in this study. Mean age of the patients was 54.1 years, and majority of the patients were female (52.9%). Chronbachs α of the Turkish version of the PD-Q was 0.81. The test-retest reliability of the Turkish version of the PD-Q was determined as 0.98 for the total score and ranged from 0.86 to 0.99 for individual items. The Turkish version of the PD-Q was possitively and significantly corralated with LANSS (r 0.89, P < 0.001) and DN4 (r 0.82, P < 0.001). When the two cutoff values in the original version were used, sensitivity was found 77.5% for a cutoff value ≤19, and specificity was 82.5%. Sensitivity and specificity were 90% and 67.5%, respectively, for the other cutoff value ≤12. Scores ≤12 represents a negative predictive value = 87%, and scores 19≤ represents a positive predictive value = 82%. When mixed pain patients were included in the neuropathic pain group, discriminant values were reduced as expected. CONCLUSIONS The Turkish version of the PD-Q is a reliable and valid scale to be used to determine neuropathic component of chronic pain in Turkish patients.

Correlation between blink reflex abnormalities and magnetic resonance imaging findings in patients with multiple sclerosis

This study investigates the correlation between brain magnetic resonance imaging findings and blink reflex abnormalities in patients with relapsing remitting multiple sclerosis. Twenty-six patients and 17 healthy subjects were included in this study. Blink reflex test (BRT) results were obtained using right and left stimulations; thus, 52 BRT results were recorded for the patient group, and 34 BRT results were recorded for the control group. The magnetic resonance imaging (MRI) findings were classified based on the existence of brainstem lesions (hyperintense lesion on T2 weighted (W) and fast fluid-attenuated inversion recovery MRI or contrast-enhancing lesion on T1W MRI). Correlation analysis was performed for the BRT and MRI findings. The percentage of individuals with abnormal BRT results (including R1 latency, ipsilateral R2 latency, and contralateral R2 latency) was significantly higher in the patient group as compared to the control group (p values: 0.015, 0.001, and 0.002, respectively). Correlation analysis revealed significant correlations between contralateral R2 latency abnormalities and brainstem lesions (p value: 0.011). Our results showed significant correlation correlations between contralateral R2 latency abnormalities and brainstem lesions and these results may be explained the effects of multiple demyelinating lesions of the brain stem of patients with relapsing remitting multiple sclerosis.

Effects of topiramate on peripheral nerve excitability.

Purpose: Antiepileptic drugs are generally used to control the cortical hyperexcitable states. But some of them are also effective on the peripheral nervous system, so they may be used in some states like neuropathic pain. Several recent reports suggest the possible effects of antiepileptic drugs on peripheral nerve excitability. Strength duration time properties gives an indirect idea about the persistent, paranodal sodium (Na) channels and may indirectly reflect the peripheral nerve excitability. Topiramate suppresses the cortical hyperexcitability, but previous studies could not prove a significant effect of topiramate on peripheral nerves. The aim of this study is to investigate the probable nerve excitability changes caused by topiramate. Methods: Forty migraine patients and 40 controls were included in the study. Median motor and sensory conduction parameters were recorded. Strength duration properties were also recorded from abductor pollicis longus muscle, with the stimulation of median nerve. The electrophysiological studies were repeated 4 weeks after the initiation of topiramate in the treatment group. Results: Nerve conduction parameters were not significantly affected by 4-week topiramate treatment. But the strength duration time constant decreased significantly, reflecting a reduction in the excitability. This decrement seemed to be more obvious in those in whom topiramate was also clinically useful. Conclusions: The method used demonstrated a probable effect of topiramate on the peripheral nerve excitability.

Nerve excitability properties in early preclinical diabetic neuropathy

Diabetic polyneuropathy can be easily diagnosed when the nerve conduction studies are affected. Strength Duration Time (SDTc) reflects nerve excitability properties and was previously used several times to demonstrate the excitability properties of the nerves in the existence of electrophysiologically developed diabetic polyneuropathy. But as we all know, diabetic patients may experience neuropathic symptoms even though their routine nerve conduction studies are normal. SDTc may be useful in this early stages of developing neuropathy. In this study we aimed to evaluate the SDTc properties of diabetic patients in this early preclinic stage. Recently SDTc was commonly studied in the upper extremities but most of the diabetic neuropathies are predominant in the lower extremities. So here we also studied both upper and lower extremities to demonstrate a possible difference.

Injection of specific amyloid-beta oligomers (beta1-40:beta1-42 = 10:1) into rat medial septum impairs memory retention without inducing hippocampal apoptosis

Abstract Objectives: Because of the well-known neurochemical interactions between the septum and hippocampus during memory processes, we investigated the effect of amyloid-beta (A-beta) injection into the medial septum (MS) on the behavior in Wistar rats. We also assessed whether the observed effects were functional or due to apoptosis. Methods: Specific A-beta oligomers (beta1-40:beta1-42  = 10:1) were injected into MS for seven consecutive days. Behavior was assessed with the Morris water maze task. Results: Compared with the control group, rats that received A-beta oligomers exhibited significant memory retention impairment (P < 0·05) without apoptosis in the cornu ammonis (CA)1 and CA3 regions of the dorsal hippocampus. Discussion: These data indicate that septal injection of A-beta impairs memory retention, even in the absence of hippocampal apoptosis. This result might bring new insight to spatial memory-related disorders like Alzheimer’s disease (AD).

Transient electromyographic findings in serotonergic toxicity due to combination of essitalopram and isoniazid

Here, we report a case of serotonergic toxicity due to combination of essitalopram and isoniazid, which was rarely reported before. Moreover, we observed transient neurogenic denervation potentials in needle electromyography, which disappeared with the treatment of serotonergic toxicity. As to our best knowledge, this is the first case, reporting transient electromyographic changes probably due to serotonergic toxicity.

A database for screening and registering late onset Pompe disease in Turkey

The aim of this study was to search for the frequency of late onset Pompe disease (LOPD) among patients who had a myopathy with unknown diagnosis registered in the pre-diagnostic part of a novel registry for LOPD within a collaborative study of neurologists working throughout Turkey. Included in the study were 350 patients older than 18 years who have a myopathic syndrome without a proven diagnosis by serum creatine kinase (CK) levels, electrodiagnostic studies, and/or muscle pathology, and/or genetic tests for myopathies other than LOPD. Acid alpha glucosidase (GAA) in dried blood spot was measured in each patient at two different university laboratories. LOPD was confirmed by mutation analysis in patients with decreased GAA levels from either both or one of the laboratories. Pre-diagnostic data, recorded by 45 investigators from 32 centers on 350 patients revealed low GAA levels in a total of 21 patients; from both laboratories in 6 and from either one of the laboratories in 15. Among them, genetic testing proved LOPD in 3 of 6 patients and 1 of 15 patients with decreased GAA levels from both or one of the laboratories respectively. Registry was transferred to Turkish Neurological Association after completion of the study for possible future use and development. Our collaborative study enabled collection of a considerable amount of data on the registry in a short time. GAA levels by dried blood spot even from two different laboratories in the same patient may not prove LOPD. LOPD seemed to be rarer in Turkey than in Europe.

Remarkable effect of benzodiazepine in a patient with anti-NMDA receptor encephalitis.

Here, we report a case of anti-NMDA receptor encephalitis with a history of vaccination in which peroral low dosages of benzodiazepines caused reversible episodes of wakefulness. A 42-year-old male patient presented with a reversible attack of blurred vision, paresthesia in his right hand followed by psychiatric symptoms, visual hallucinations, and episodes of disorientation. In the end of the first month, he experienced seizures. He had a history of vaccination just 3 weeks before the symptoms started. Cranial imaging was within normal limits. EEG demonstrated persistent, repeated sharp waves localized to left parietal cortex. Cerebrospinal fluid (CSF) examination revealed an elevated protein level without any cells or microorganism. All infectious markers were negative. Antinuclear antibody profile, lupus anticoagulants were also negative. Whole body 18F-fluorodeoxyglycose positron emission tomograpghy (FDG-PET) demonstrated hyperactivity in bilateral temporoparietal cortex. Treatment with acyclovir and meropenem was initiated. Seizures were under control with levetiracetam treatment (2,000 mg daily). The sharp waves previously observed in the left hemisphere were no longer present after treatment. In his follow-up, the patient progressively became unresponsive and the clinical picture deteriorated to a catatonic state. With the suspicious of nonconvulsive status epilepticus, he received intravenous benzodiazepine (Bz) which caused a period of wakefulness lasting for 15 min. Phenytoin was added to the treatment, but despite an adequate free phenytoin serum level of 22 mg/ml, no beneficial clinical effect was seen, and the patient was still unresponsive. Twenty-four hour EEG monitoring demonstrated mild diffuse slowing (6–7 Hz) without any epileptic discharges. This remarkable clinical effect was observed after diazepam injection but not with other antiepileptic drugs, and the absence of obvious EEG findings suggested a pathology rather than nonconvulsant status epilepticus. Low dosage of peroral lorazepam (1 mg) also caused a 2-h period of wakefulness which also supported another diagnosis rather than status epilepticus. Then, the dosage was increased to 4 9 1 mg daily which provided a day time wakefulness. On the other hand, he returned to his unresponsive status when the drug was delayed. Further investigation demonstrated antibodies to NMDA receptors in CSF. No tumor was found by whole body FDG-PET, testicular ultrasound, or chest tomography. At the end of the second month from symptom onset, all anti-infectious agents were stopped step by step and the patient was put on high dosage (1,000 mg) IV pulse corticosteroid treatment for 5 days followed by a 1-mg/kg oral dose regimen. After 2 weeks of treatment, he was awake but still experienced hallucinations and episodes of disorientation so he received seven cycles of plasma exchange (Pex) on alternate days. After Pex, oral benzodiazepine was gradually stopped, and the patient was still awake and was able to perform daily tasks. Ç. Erdoğan (&) E. Değirmenci A. Oğuzhanoğlu Department of Neurology, Pamukkale University, Kinikli, Denizli, Turkey e-mail: drcagdaserdogan@gmail.com

A Bibliometric Analysis of Optic Coherence Tomography Studies in Multiple Sclerosis

Objective: Optical coherence tomography (OCT) is a non-invasive, non-contact diagnostic tool that provides high-resolution cross-sectional images of the retina that has been used for ten years in multiple sclerosis (MS) related optic neuropathies. The objective of this study is to determine the scientific output in use of OCT in multiple sclerosis between 1982 and 2012 using ISI Web of Knowledge. Methods: The ISI Web of Knowledge was searched for articles on OCT published between 1982 and February 2012 using appropriate terms. Articles were characterized each year by publication type. Results: Search yielded 154 publications after the search for keywords “optical coherence tomography and multiple sclerosis and 167 publications after the search for the keywords “optical coherence tomography and optic neuritis”. After eliminating the conflicting publications total 193 publications were analyzed. A cubic increase in the number of publications over time was observed. Conclusions: The number of scientific publications in the field of OCT in MS has increased significantly over the past years. The United States, England and Spain have dominated the field of OCT in MS.

Nasopharyngeal carcinoma presenting with horner syndrome and carotid-sinus syncope.

Introduction:Nasopharyngeal carcinoma can present with different neurological signs and findings. In this paper, we report a patient presenting with Horner syndrome and syncopal episodes who was finally diagnosed with nasopharyngeal carcinoma. Case Report:A 56-year-old man presented with a history of slowly progressive right upper-eyelid droop for the last 1.5 months and episodes of loss of consciousness. After detailed clinical and laboratory examinations, the patient had the final diagnosis of metastatic nasopharyngeal carcinoma. Conclusions:This is the first case with nasopharyngeal carcinoma presenting with both Horner syndrome and carotid-sinus syncope. The mechanism of Horner syndrome and the syncopal episodes and their relation with the lesion location are discussed.