Eda Derle

Do knowledge of, perception of, and attitudes toward epilepsy affect the quality of life of Turkish children with epilepsy and their parents?

The main goal of this study was to evaluate knowledge of, perceptions of, and attitudes toward epilepsy and then to correlate knowledge with quality of life and stigmatization of children with epilepsy and their families. Specific questionnaires were administered to children aged 8 to 17 with epilepsy (n=220) and their parents (n=313). Poor school performance, less social support, less self-esteem, higher anxiety, greater stigmatization, and more depressive symptoms were documented in children who were less knowledgeable (P<0.05). Parents were found to be more knowledgeable about the antiepileptic drugs used, understanding both the effects and the side effects of the medications (P<0.05). Family activities were less restricted if they were more knowledgeable and these parents reported worrying less about their children (P<0.05). Knowledge about epilepsy is associated with less perceived stigmatization and social isolation, as well as fewer depressive symptoms and misperceptions.

Validation of Montreal Cognitive Assessment and Discriminant Power of Montreal Cognitive Assessment Subtests in Patients With Mild Cognitive Impairment and Alzheimer Dementia in Turkish Population

Montreal Cognitive Assessment (MoCA) is a new cognitive tool developed for screening mild cognitive impairment (MCI). The authors examined validity of MoCA and discriminating power of subtests in a Turkish population comprising of 474 participants (246 healthy controls, 114 subjects with MCI and 114 subjects with dementia). The ANCOVAs showed that age and education had a main effect on MoCA scores. Cut scores were computed according to different education levels. The overall cut-off values for MCI and dementia were found to be lower compared to western studies. MoCA was found to have good internal consistency. The subtests most useful in discriminating MCI from healthy controls were recall, visuospatial and language, while in discriminating dementia from MCI were visuospatial, orientation and attention subtests. The results demonstrated that MoCA is a valid and reliable instrument in screening MCI, and compared with the MMSE, MoCA was proved to have superior sensitivity and specificity in detecting MCI.

Unfavorable outcome of pediatric onset multiple sclerosis: Follow-up in the pediatric and adult neurology departments of one referral center, in Turkey

BACKGROUND The prevalence of MS starting under 18 years of age ranges between 2-10% of the total MS population. OBJECTIVE We aimed to examine the clinical and long term follow-up data of pediatric-onset cases in our institutional MS database. METHOD We evaluated the clinical data from the MS database of the Departments of Neurology and Pediatric Neurology of Hacettepe University Hospital. RESULTS The clinical features of 74 patients who had experienced the first attack before age 18 years comprised 3.9% of our MS population. Median age at onset was 15 (3, 5-17, IQR=3.63) years, and female: male ratio was 2.4. The most frequent symptom at onset was brainstem/cerebellar dysfunction (32.4%). Seventy two patients (97.3%) initially had relapsing remitting course and in the follow-up, 17 (23%) of them developed secondary progressive (SP) course. The median interval to develop SPMS course was 10 (5-21, IQR=8) years. At the last visit, median disease duration was 6.67 (0.83-25, IQR=9.06) years, 41 (55.4%) of them had EDSS of ≥4. CONCLUSION These findings illustrate the profile of our pediatric MS patients: almost all are relapsing-remitting initially; about one fourth become secondarily progressive in 10 years, and about half acquire disability EDSS ≥4 in mean 8 years.

Rare Presentation of Midbrain Infarction: Isolated Medial Rectus Palsy.

A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions.

The prevalence and recognition rate of delirium in hospitalized elderly patients in Turkey

Abstract Objective. Delirium is frequently observed, but generally under recognized in elderly hospitalized patients. The aims of this study were to determine the prevalence of delirium in elderly patients hospitalized at a university hospital, and to determine the recognition rate by hospital staff during hospitalization. Methods. The study included 108 consecutive patients aged ≥ 65 years that were hospitalized in the medical and surgical inpatient departments at Başkent University Hospital, Ankara, Turkey. All the patients were evaluated using the Mini Mental State Examination (MMSE) upon admission and Confusion Assessment Method (CAM) on a daily basis during hospitalization. Written documents and consultation requests from psychiatry and/or neurology departments were reviewed for recognition of delirium by hospital staff. Results. Among the 108 patients in the study, delirium was noted in 18 (16.7%) during their hospital stay. Consultation from psychiatry or neurology departments was requested for 5 of the 18 patients, only 1 with a delirium diagnosis, indicating that 17 of the cases (94.4%) were not recognized by their primary physicians. Conclusions. The delirium non-recognition rate in elderly hospitalized patients was very high. We think that hospital staff must be trained to recognize the symptoms of delirium and identify high-risk patients.

Ipilimumab treatment associated with myasthenic crises and unfavorable disease course

Ipilimumab, a monoclonal antibody targeting the cytotoxic T lymphocyte antigen-4 is a treatment option for metastatic melanoma. This receptor serves as an inhibitor receptor on T lymphocytes and blockage of these results predisposition to autoimmune diseases. The patients with autoimmune disorders were excluded in clinical trials and there is no sufficient data of the treatment on these patients who already have an autoimmune disorder. Here, we report a case of myasthenia gravis who was treated with ipilimumab and we presented the long-term prognosis of the patient after treatment.

Clinical results of carotid artery stenting versus carotid endarterectomy

Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (≥70%) or symptomatic stenosis (≥50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility.

Aspirin resistance in cerebrovascular disease and the role of glycoprotein IIIa polymorphism in Turkish stroke patients.

Aspirin resistance occurs in 5–45% of high-risk patients, with various mechanisms proposed for its development. This study aimed to determine the relationships among aspirin resistance, aspirin dosage, type of aspirin and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. Two hundred and eight (75 symptomatic, 133 asymptomatic) patients with vascular risk factors who were using aspirin for primary or secondary prevention were prospectively included. The symptomatic group was further classified into two groups according to aspirin use at the time of stroke. Aspirin resistance was measured by the PFA-100 system (collagen/epinephrine cartridge) and glycoprotein IIIa P1A1/A2 polymorphism was determined by PCR. The overall prevalence of aspirin resistance was 32.2%. The mean age of patients with aspirin resistance was significantly higher than that in those who did not have resistance (P = 0.009). The prevalence of aspirin resistance was similar for the symptomatic and asymptomatic under aspirin therapy groups. The resistance rate was found to be highest with 100 mg enteric-coated preparation use (39.3%). Increasing the aspirin dosage and/or shifting to uncoated preparations caused a change in aspirin sensitivity of 36–60%. Repeated measurements showed development of aspirin resistance in 14% of patients who were sensitive to aspirin in previous measurements. Glycoprotein IIIaP1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke were not significantly related. The effect of aspirin can change by time, dosage and type of preparation used. There are no relationships among glycoprotein IIIa P1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke.

Relationship between white matter hyperintensities and retinal nerve fiber layer, choroid, and ganglion cell layer thickness in migraine patients:

Aim To compare the relationship between white matter hyperintensities (WMH) on brain magnetic resonance imaging and retinal nerve fiber layer (RNFL), choroid, and ganglion cell layer (GCL) thicknesses in migraine patients and healthy subjects. We also assessed the role of cerebral hypoperfusion in the formation of these WMH lesions. Methods We enrolled 35 migraine patients without WMH, 37 migraine patients with WMH, and 37 healthy control subjects examined in the Neurology outpatient clinic of our tertiary center from May to December 2015. RFNL, choroid, and GCL thicknesses were measured by optic coherence tomography. Results There were no differences in the RFNL, choroid, or GCL thicknesses between migraine patients with and without WMH (p > 0.05). Choroid layer thicknesses were significantly lower in migraine patients compared to control subjects (p < 0.05), while there were no differences in RFNL and GCL thicknesses (p > 0.05). Conclusions The ‘only cerebral hypoperfusion’ theory was insufficient to explain the pathophysiology of WMH lesions in migraine patients. In addition, the thinning of the choroid thicknesses in migraine patients suggests a potential causative role for cerebral hypoperfusion and decreased perfusion pressure of the choroid layer.

Prevalence and Treatment of Neuropathic Pain in Kidney and Liver Transplant Recipients.

OBJECTIVES Neurologic complications are common after kidney and liver transplant. Neurologic complications affect mortality and morbidity in transplant recipients, and neuropathic pain is an important symptom affecting a patients quality of life. The aim of the present study was to provide readers with our experience regarding causes and treatment of neuropathic pain in patients undergoing kidney and liver transplant at our transplantation center. MATERIALS AND METHODS The medical data of 553 kidney transplant recipients and 258 liver transplant recipients who received transplant procedures at the Baskent University Transplantation Center between 2008 and May 2016 were retrospectively reviewed. Fifty-one patients who were examined by an expert neurologist and diagnosed with neuropathic pain on the basis of clinical, neurologic examination, and laboratory findings were included for analyses. RESULTS Among 811 transplant recipients, 51 patients (6.2%) were diagnosed with neuropathic pain. Of these, 22 were female and 38 were male patients, and 42 were kidney transplant recipients and 9 were liver transplant recipients. Causes of neuropathic pain included uremia, diabetes mellitus, ischemic peripheral arterial disease, inflammatory neuropathy, vasculitis, discopathy, postherpetic neuralgia, carpal tunnel syndrome, and multiple myeloma. Patients with symptoms too mild to affect daily life activities were treated conservatively. Plasmapheresis, gabapentin, pregabalin, alpha-lipoic acid, and duloxetine were administered as treatment modalities and medications. CONCLUSIONS Neuropathic pain was lower in our transplant recipients than in the general population. Treatment medications were effective for transplant recipients at lower doses for the management of neuropathic pain impairing quality of life than doses for the general population.