Ferah Kizilay

Evaluation of the lateral instability of the ankle by inversion simulation device and assessment of the rehabilitation program

OBJECTIVES To assess the correctibility of the muscle atrophy, proprioceptive loss, and slowing of the reflex arc around the ankle after ankle sprain with rehabilitation. METHODS The study group consisted of 20 cases with chronic instability who had at least two episodes of ankle sprains (mean 20.6 years, range 16-32 years); control group consisted of 20 patients with same demographic characteristics but without instability. Isokinetic muscle strength measurements and proprioceptive evaluations were made using the Cybex device before and 1.5-month after rehabilitation period. Additionally, the inversion simulation device, which was developed together with the mechanical engineering department of our university, was correlated with the EMG device, and response periods of muscles to stimulation were measured. RESULTS The proprioceptive loss present in all cases with ankle instability before treatment significantly improved after effective rehabilitation (p=0.001). It was detected that lengthened peroneal latent periods shortened with effective rehabilitation (p=0.001). Cross-interaction of rehabilitation was shown with the preservation of the difference between the pathologic and normal sides regarding proprioception and peroneal latent periods before and after treatment, without any difference between the control group and the pathologic sides. CONCLUSION After ankle sprains, especially in patients with chronic instability, strengthening of the muscles around the ankle with well-planned proprioceptive exercises helps the patients return to normal living and sports activities, and prevents unnecessary surgery, especially in cases with functional instability.

Electrophysiologic and Neuropsychologic Evaluation of Patients with Centrotemporal Spikes

The present study was designed to evaluate neurocognitive functions with endogenous potentials and neurophysiologic tests in patients with centrotemporal spikes who were not on any medication. Of the patients, 85.7% had seizures, 9.5% had pavor nocturnes, and 4.8% had atypical headache. The patients, especially who had atypical seizures or left-sided epileptic activity, were found to have significant visuomotor function impairment (p <.05). In P300 test, N2P3 amplitude was lower in the patients, particularly who had left sided epileptic activity (p <.05). MMN and LDN results were normal. Serial evaluations of such patients with endogenous potentials and neuropsychological tests may be helpful to show development of neurocognitive impairment.

VEGF polymorphisms and serum VEGF levels in Parkinson's disease

Accumulated data within the recent years demonstrate that reduced levels of VEGF which is a well known angiogenic molecule might cause neurodegeneration in part by impairing neural tissue perfusion, vasoregulation and normal functioning of perivascular autonomic nerves. Additionally, VEGF has been reported to support neuroprotection in dopaminergic neurons by indirect and direct mechanisms and suppress apoptosis in dopaminergic neurons in vitro. The aim of the current study is first to demonstrate whether there is an association between the three common VEGF polymorphisms (-2578C/A, -634C/G and 936C/T) in the VEGF gene and idiopathic Parkinsons disease (IPD) which is a neurodegenerative disease caused by the progressive degeneration of nigrostriatal dopaminergic neurons, and second to see if the serum levels of VEGF is reduced in the patients with IPD. We screened the genotype and allele frequencies of three common functional polymorphisms of VEGF, namely -2578C/A, -634C/G and 936C/T in DNA samples of 126 patients with IPD and healthy control subjects and also we compared the median serum levels of VEGF between these two groups. No association was found between the inspected VEGF polymorphisms and IPD and also no difference was found between the serum VEGF levels of both groups. The current study failed to support the hypothesis that VEGF polymorphisms and/or reduced serum VEGF levels are likely contributors to the neurodegenerative process in IPD.

The interaction between breathing and swallowing in healthy individuals

In this article, we aimed at investigating the interaction between breathing and swallowing patterns in normal subjects. Ten healthy volunteers were included in the study. Diaphragm EMG activity was recorded by a needle electrode inserted into the 7th or 8th intercostal space. Swallowing was monitored by submental EMG activity, and laryngeal vertical movement was recorded by using a movement sensor. A single voluntary swallow was initiated during either the inspiration or expiration phases of respiration, and changes in EMG activity were evaluated. When a swallow coincided with either inspiration or expiration, the duration of the respiratory phase was prolonged. Normal subjects were able to voluntarily swallow during inspiration. During the inspiration phase with swallowing, diaphragmatic activity did not ceased and during the expiration phase with swallowing, there was a muscle activity in the diaphragm muscle.

Sensorimotor polyneuropathy in patients with SMA type-1: electroneuromyographic findings.

Introduction: Generally, spinal muscular atrophy (SMA) is believed to be a pure motor neuron disease. We retrospectively evaluated our electrodiagnostic findings in SMA type 1 patients to demonstrate co‐existence of sensorimotor neuropathies. Methods: Electroneuromyographic (ENMG) studies in 15 patients (11 boys, 4 girls) were reviewed independently by 2 neurophysiologists. Upper extremity findings were compared with normal right arm controls. Results: Patient ages ranged from 1.5 to 26 months. Four SMA patients (26.7%) had decreased sensory nerve action potentials (SNAPs) or sensory nerve conduction velocities. Of them, median SNAPs could not be elicited in 3, and sural SNAPs could not be elicited in 2. Compound muscle action potential amplitudes were severely decreased in 14 (93.3%) and normal in 1. Conclusions: Survival motor neuron 1 (SMN1) gene analysis should be considered if clinical features are consistent with SMA, even if pathological or electrophysiological findings demonstrate peripheral sensorimotor polyneuropathies. Muscle Nerve, 2013

One-minute exercise is best for evaluation of postexercise exhaustion in myasthenia gravis

Introduction: To find the best exercise duration for postexercise exhaustion by decrement (PEE‐D) in myasthenia gravis (MG). Methods: In 32 tests in 32 MG patients, repetitive nerve stimulation was performed in the abductor digiti quinti muscle. The 3 Hz responses for 2 s were obtained with supramaximal stimulation at rest, and immediately after (PE0), 30 s after (PE30s), and 1, 2, 3, and 4 min after 10‐s, 30‐s, and 1‐min exercises. Results: Compared with the decrement at rest, a significantly greater decrement was found at PE2m and PE3m after 30‐s exercise, and at PE2m, PE3m, and PE4m after 1‐min exercise. In 11 patients who showed a decremental response only with exercise, PEE‐D was observed in 5 after 30‐s exercise and in 8 after 1‐min exercise. Conclusions: One‐minute exercise is best for evaluation of PEE‐D in MG. Muscle Nerve 50: 413–416, 2014

Impact of sympathetic dysfunction in the etiology of overactive bladder in women: A preliminary study

We investigated the effects of autonomic sympathetic dysfunction in the etiology of overactive bladder (OAB) in women, by assessing the sympathetic skin response (SSR).

Evaluation of cardiac autonomic functions in myasthenia gravis

Abstract Objective: We aimed to comprehensively evaluate cardiac autonomic function in patients with MG and to investigate the relationship between this disorder and disease duration, thymoma and acetylcholine receptor antibody positivity in cases of cardiac autonomic disorder. Methods: The study included 30 patients with MG and 30 age-matched healthy control subjects. Haemodynamic parameters (heart rate, systolic and diastolic blood pressure) and autonomic parameters (low frequency [LF], high-frequency [HF], sympathovagal balance [LF/HF], baroreceptor reflex sensitivity [BRS]) of the patients were automatically measured at rest and in a tilted position with the Task Force Monitor. Results: The mean systolic and diastolic blood pressure measurements obtained at rest and during the tilt test were higher in patients with MG. Sympathovagal balance has been disturbed in favour of sympathetic tone, and parasympathetic insufficiency has become more prominent. When baroreceptor sensitivity was used as the second parameter to evaluate autonomic heart functions, BRS at rest and during the tilt test was lower in the MG group compared with the control group. Discussion: These results suggest that sympathovagal balance has been disturbed in favour of sympathetic tone and that parasympathetic insufficiency has become more prominent. The current findings support the presence of cardiac autonomic involvement in patients with MG. The determination of cardiac autonomic function via noninvasive methods among patients with MG has high predictive value. The identification of autonomic dysfunction at an early stage and the early treatment of cardiovascular diseases can reduce morbidity and mortality.

P292: Features of patellar pendulum triggered by patella T reflex in rigidity

Parkinson’s disease is a movement disorder characterized by an increase in muscle tone. Rigidity affects motor capacity and daily functions of the patients. Aim of the study is analyzing electrophysiologically and kinesiologically features of the patellar pendulum that was triggered by patella T reflex in the Parkinson patients with rigidity. Method: We stimulated patella T reflex by an electronic triggered reflex hammer and recorded muscle action potenteials by surface electrodes from quadriceps femoris and biceps femoris muscles. We analyzed electrophysiological features of patellar T reflex and also analyzed characteristics of the patellar pendulum during the reflex motion in patients with rigidity and normal subjects. Joint angle changes and instantaneous angular velocity during reflex was measured with a goniometric approach. Results: Twenty five normal subjects included study as a control group. Patella T reflex had 17.9±1.9 milliseconds latency and 6404.1±2860.0 microvolt amplitude. Initial time of joint motion was 51.5±9.9 milliseconds and it was measured with an accelerometer. The pendulum count was 4.8±1.5. Angle of joint motion was 18.3±5.6°; extension time was 317.4±23.4 milliseconds; instantaneous angular velocity was 58.0±16.6 degrees/second; frequency was 1.0±0.1. Damping ratio of the pendulum was calculated as 0.6±0.2. A parameter was developed using by significant kinesiological findings and it was 60.3±16.1 degrees/second*Hz. There were 45 Parkinson’s disease patients in the rigidity group. Patella T

Effects of hyperventilation on axonal excitability parameters in diabetic polyneuropathy

WCN 2013 No: 1757 Topic: 36 — Other Topic Effects of hyperventilation on axonal excitability parameters in diabetic polyneuropathy D. Yerdelen, G. Akca, F. Kizilay, M.K. Balci, H. Uysal. Department of Neurology, Baskent University, Adana, Turkey; Department of Neurology, Akdeniz University, Faculty of Medicine, Antalya, Turkey; Internal Medicine and Endocrinology Department, Akdeniz University, Faculty of Medicine, Antalya, Turkey Axonal excitability is a physiological concept connected with the characteristics of myelin and membrane of the peripheral nerve. Evaluation of axonal excitability provides important information about the peripheral nerve. It has not been one of the routine electrophysiological evaluations but suitable for use in experimental studies and helps in understanding pathological conditions and gives important information about pathophysiology. The mechanisms of diabetic polyneuropathy have not been understood clearly. We used the short TROND protocol to measure the axonal excitability parameters in 11 healthy subjects and 7 patients with diabetes mellitus (DM) with polyneuropathy. The short TROND protocol was performed before and at the 20th minute of deep hyperventilation of healthy subjects and diabetic patients. Venous blood pH, pO2, and pCO2 values were recorded before hyperventilation and at the 20th minute of hyperventilation. The “hyperventilation score” was evaluated before and after the hyperventilation by asking the patient the degree of the numbness in the extremities and face or by seeing the carpopedal spasm. Although, significant changes in pH values occurred, the “hyperventilation scale score” of the DM group was lower than the score of the control group. When the values of DM and control group after hyperventilation were compared, Ted (10–20 ms), Ted (40–60 ms), Ted (90–100 ms), Ted (peak) and superexcitability at 5 ms were statistically significant. There was a significant change in the hyperpolarization section of threshold electrotonus during hyperventilation in patients with DM. DM patients have different responses to hyperventilation, and pH changes have different effects on diabetic polyneuropathy when compared with healthy subjects. doi:10.1016/j.jns.2013.07.2252 Abstract — WCN 2013 No: 1703 Topic: 36 — Other Topic A case of Hashimoto encephalopathy: Clinical presentation, neuroimaging and treatment WCN 2013 No: 1703 Topic: 36 — Other Topic A case of Hashimoto encephalopathy: Clinical presentation, neuroimaging and treatment C.P. Hoi, H. Ng, L.R. Jin, M.F. Su. Internal Medicine, Neurology, Centro Hospitalar Conde de Sao Januario, Macau SAR, China; Internal Medicine, Centro Hospitalar Conde de Sao Januario, Macau SAR, China Background: Hashimoto encephalopathy (HE) is a rare encephalopathy with positive antithyroid antibodies and normal thyroid function. Objective: The objective of this study was to describe the clinical presentation, neuroimaging and treatment of Hashimoto encephalopathy. Patients and methods: We report a 62-year-old female patient whose clinical presentation, neuroimaging, and response to steroid therapy fulfilled the diagnostic criteria of HE. Results: The neuroimaging changes in this patient were multiple lacunar infarction in bilateral cerebral hemispheres. She was found with high serum anti-thyroid antibody concentrations. After high doses of corticosteroid therapy, her clinical symptoms were significantly improved. At the same time, the titers of serum antithyroid antibodies obviously decreased after steroid treatment. Conclusion: This case illustrates the importance of considering rare but treatable causes of encephalopathy in a patient presenting with rapidly progressive cognitive dysfunction with/without the history of abnormality of thyroid function. doi:10.1016/j.jns.2013.07.2253 Abstract — WCN 2013 No: 1946 Topic: 36 — Other Topic Cross-border mobility of junior neurologists to and within the European Union: A major challenge for the health care system WCN 2013 No: 1946 Topic: 36 — Other Topic Cross-border mobility of junior neurologists to and within the European Union: A major challenge for the health care system A. Macerollo, E.T. Varga, O. Gyorfi, X. Kobeleva, W. Struhal, J. Sellner. Sobell Department of Motor Neuroscience and Movement Disorders, National Hospital of Neurology and Neurosurgery, Institute of Neurology, University College London, London, UK; Department of Neuroscience and Sense Organs, Aldo Moro University, Bari, Italy; Department of Neurology, University of Szeged, Hungary Institute of Genomic Medicine and Rare Disorders, Semmelweis University, Budapest, Hungary; 2nd Clinic of Neurology, Mures County Emergency Hospital, Targu-Mures, Romania; Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany; Department of Neurology, General Hospital of the City of Linz, Linz, Austria; Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University, Salzburg, Austria; Department of Neurology, Klinikum rechts der Isar, Technische Universitat Munchen, Munchen, Germany Background: There is a dynamic flow of medical doctors within and to Europe, particularly since the entry of more countries to the European Union (EU) in 2004 and 2007. Objective: To assess interest and motives for cross-border mobility among residents and junior neurologists from member states of the EU and neighboring countries. Abstracts / Journal of the Neurological Sciences e629 (2013) e629–e678 e649