Mustafa Ceylan

Serum levels of pentraxin-3 and other inflammatory biomarkers in migraine: Association with migraine characteristics.

Background Several studies have been conducted on the inflammatory aspects of migraine. Pentraxins are a novel and important part of innate immunity as a superfamily of acute phase proteins. In our study, we aimed to demonstrate the relationship between migraine and the serum levels of pentraxin-3 (PTX-3), C-reactive protein (CRP), fibrinogen and D-dimer. Methods We recruited 30 migraine patients (in both the attack and interictal period) and 30 healthy controls. Serum samples were obtained from all participants, and a brain MRI performed in the last six months was assessed regarding the presence of deep white matter lesions. Comparisons between the attack, interictal and control groups regarding the serum levels of PTX-3, CRP, fibrinogen and D-dimer were performed. The association between serum PTX-3 levels and migraine characteristics (disease duration, headache frequency, MRI findings, aura, family history, attack duration, and MIDAS score) was also assessed. Results We found higher serum levels of fibrinogen and PTX-3 in migraine attack patients compared with the interictal and control groups (p = 0.03 and p < 0.001, respectively). Subgroup analysis also showed that patients with a disease duration of more than five years and with an attack duration of more than 12 hours have lower serum levels of PTX-3 than patients who have a relatively new diagnosis and have relatively short-lasting migraine attacks (p = 0.042 and p = 0.038, respectively). Conclusions PTX-3 and fibrinogen exhibit different serum levels in patients undergoing a migraine attack compared with the interictal group and the controls. Participants with longer attacks and disease durations have lower serum levels of PTX-3, suggesting that inflammatory processes change along with disease progression.

Age and gender related prevalence of intracranial calcifications in CT imaging; data from 12,000 healthy subjects

PURPOSE Location and extent of intracranial calcifications have been detected accurately with the use of CT technology and since, many clinical or pathological entities have been linked to these calcifications. Our purpose is to provide data regarding the prevalence of calcifications in various locations in brain. MATERIAL AND METHODS We retrospectively examined 11,941 subjects who underwent non-contrast enhanced brain CT examination. We determined the prevalence of choroid plexus, pineal gland, habenula, dura mater, basal ganglia and vascular calcifications. RESULTS Of 11,941 subjects, 70.2% had choroid plexus calcifications. Calcifications were most frequently seen in pineal gland and 71.6% of the study population had pineal calcifications. Habeluna and dural calcifications were present in 19.2% and 12.5% of the population respectively. Basal ganglia calcifications and vascular calcifications only constituted 1.3% and 3.5% of the study population respectively. Male dominance was present in all calcification types except basal ganglia calcifications. CONCLUSIONS Showing associations and dissociations from the literature, our study provides a baseline data regarding the prevalence of various types of intracranial calcifications.

Serum fetuin-A levels in subjects with and without choroid plexus calcification

Choroid plexus is an intraventricular plexus of tissue which is responsible for secretion of cerebrospinal fluid. Calcification of choroid plexus is found to be associated with age and gender. One of novel and popular glycoprotein that involves in inhibition of mineralization is human fetuin-A. In our study, we investigated plasma levels of fetuin-A in subjects with and without choroid plexus calcification. For this purpose, 41 subjects with choroid plexus calcification and 41 age and gender matched subjects with normal appearing choroid plexus were recruited. Calcified and normal choroid plexus tissue identified on computed tomography images. Overnight fasting venous blood samples were collected to measure serum fetuin-A levels using a human fetuin-A enzyme-linked immunosorbent assay kit. Statistically significant difference concerning the median concentration of fetuin-A was found between subjects with and without choroid plexus calcification (p: 0.040). Significance was also present between male subgroups (p: 0.017) and 18-27 years age subgroups (p: 0.025). Our results suggest that fetuin-A has an potent role in calcification process of choroid plexus.

Clinically and electrophysiologically diagnosed botulinum intoxication

In this case report, clinical and electrophysiological findings of 43-year-old female patient who developed Clostridium botulinum intoxication after consumption of home-made canned food are presented. Following the sudden onset of severe nausea and vomiting, diplopia, blurred vision, bilateral ptosis, weakness, speech and swallowing difficulties have developed and the patient declared that she has just tasted the canned beans after she had rinsed them several times. The case, where serological tests cannot be performed, was diagnosed clinically and treated with antitoxin immediately. During follow-up, consecutive nerve stimulation was performed and significant incremental response was observed. There was an improvement in symptoms within 2 weeks, and in 5 or 6 weeks the symptoms had disappeared completely. Electrodiagnostic studies revealed that the findings turned to normal. The case showed that immediate antitoxin treatment is life-saving even the diagnosis of botulinum intoxication is based on clinical findings.

Serum Prolidase Activity as a Biomarker for Choroid Plexus Calcification

The choroid plexus (CP) performs multiple functions such as secretion and reabsorption. CP also acts as the blood-cerebrospinal fluid barrier. Prolidase plays an important role in collagen metabolism by degrading imidodipeptides, in which proline or hydroxyproline residue is located at the C-terminal end. Serum prolidase activity (SPA) may reflect the degree of fibrosis and inflammation. Choroid plexus calcification (CPC) is considered as the physiological calcification of the brain, and CPC is diagnosed by the presence of calcification in the anatomical region on computed tomography (CT). Here, CPC and non-calcified CP were defined by Hounsfield Units (HU) values of > 150 and < 50, respectively. We aimed to measure SPA in subjects with CPC and those with non-calcified CP. This study included 89 subjects who were admitted to the neurology clinic and underwent CT: 44 subjects with CPC and 45 subjects with non-calcified CP. The neurological examination of all subjects was normal; namely, the subjects with CPC were asymptomatic. The SPA level was significantly higher in the CPC group than that in the non-calcified CP group (p < 0.002), and there was a significant positive correlation between vitamin D and SPA levels in the CPC group. In contrast, the vitamin D and parathyroid hormone levels were higher in the CPC group, but the difference was not statically significant (p > 0.05). These findings indicate that SPA is a biomarker for CPC that may be predictive of future brain disease.

Effects of levetiracetam monotherapy on sperm parameters and sex hormones: Data from newly diagnosed patients with epilepsy

PURPOSE Epilepsy has an impact on the reproductive system. Males with epilepsy have lower fertility rates, hypo-sexuality and reduced potency compared with the general population. Anti-epileptic drugs and epilepsy itself are thought to be responsible for this reduced fertility. LEV is a second-generation anti-epileptic agent with low incidences of both adverse effects and drug-drug interactions. In this study, we have investigated the effects of LEV treatment on sex hormones and sperm parameters in newly diagnosed epilepsy patients. METHODS We recruited 26 males with newly diagnosed epilepsy and introduced LEV monotherapy. Patients were divided into two groups depending on whether they had partial or generalized seizures. We acquired the results of pre- and post-treatment sperm analyses and serum sex hormone levels. We also recorded the maximum dose, daily dose and treatment duration for each individual. Pre- and post-treatment comparisons and correlations between both sperm and sex hormone parameters and both treatment duration and dose were determined. RESULTS Pre- and post-treatment sex hormone levels were not significantly different. The total sperm count, percentage of normal morphology and functional sperm count tested after treatment were significantly lower in both groups compared with pre-treatment values (p<0.05). There was a moderate correlation between daily dose and reduction in functional sperm count (r: 0.41, p: 0.034). CONCLUSIONS Our findings confirm that LEV treatment of newly diagnosed epilepsy patients decreases sperm parameters without altering sex hormone levels. Our results may guide the choice of anti-epileptic drug treatment among men with epilepsy.

Serum pentraxin-3 levels in acute stroke: No association with stroke prognosis

BACKGROUND Stroke is the leading cause of serious disability. Estimating severity of the disease and early risk assessment is crucial. Several studies have been carried on and several biomarkers have been proposed in the literature for risk assessment and to estimate the stroke prognosis. In this study we assessed the association of predictors such as patient age, gender, stroke volume and NIHS scores on prognosis of stroke event. We investigated whether the serum pentraxin-3 levels are linked with stroke prognosis. METHODS Forty-four stroke patients without cardiovascular risk factors were included in this study. Initial NIHS scores, stroke volumes, serum pentraxin-3 levels and the data regarding the risk factors were collected in the first and seventh days of event. Association of predictors with final NIHS scores were investigated using multivariate regression model. RESULTS Initial NIHS score, initial and final stroke volumes were independently associated with final NIHS score whereas serum pentraxin-3 levels, whether acquired at the first or seventh day of stroke, were not associated with final NIHS score. CONCLUSIONS In stroke patients without cardiovascular, cardiopulmonary and infectious diseases, serum pentraxin-3 levels are not associated with stroke prognosis.

Coexistence of Symptoms Associated with Trigeminal Pathways in Chronic and Episodic Migraine and the Effects on Quality of Life

Objective The functional impairment in migraine greatly depends on the chronicity of the disease. Patients with migraine suffer from sleep difficulties and concentration problems. Cranial autonomic symptoms, vertigo, dizziness, and cutaneous allodynia are also frequent in patients with migraine. In this paper, we aim to investigate the coexistence of these symptoms and their effects on the quality of life of patients with chronic and episodic migraine. Methods The study included 1,080 patients with migraine. The presence of cranial autonomic symptoms, vertigo/dizziness, cutaneous allodynia, concentration-related impairment in function, and abnormal sleep latency was sought in patients with questionnaires, and comparisons were made between episodic and chronic migraine groups. Results Abnormal sleep latency and concentration-related impairment in function were more frequent in patients with chronic migraine compared with those with the episodic form (P < 0.001 for both). Furthermore, these two symptoms were significantly more frequent in separate patient groups with cranial autonomic symptoms, vertigo/dizziness, and cutaneous allodynia than patients without (P < 0.005). Conclusion Abnormal sleep latency and concentration-related impairment in function were more frequent in patients with chronic migraine than those with the episodic form. Cranial autonomic symptoms, vertigo/dizziness, and cutaneous allodynia were significantly coexisting in migraine patients.

Episodic Migraine and White Matter Hyperintensities: Association of Pain Lateralization

Background Migraine pathophysiology involves a neuronal mechanism that is closely associated with the neuronal activation of peripheral trigeminal nociceptive pathways. It also involves a vascular mechanism that is supported by studies concerning the presence of migraine with aura in various vascular diseases. Migraine is associated with silent infarct-like lesions and white matter hyperintensities (WMHs) that can be encountered during magnetic resonance imaging. In this study, we aimed to demonstrate the migraine-WMH link based on pain lateralization. Methods We recruited 628 episodic migraine patients and examined their cranial magnetic resonance images regarding the presence of deep, subcortical, and periventricular WMHs. We sought to identify an association between lesion occurrence and pain side. Results We found that the patients had more deep/subcortical hyperintensities in the cerebral hemisphere that was ipsilateral to the pain side (ƙ = 0.421). Periventricular hyperintensities were not associated with the pain side (P = 0.768). Conclusions Based on our study results, we concluded that pain in episodic migraine is associated with the occurrence of WMHs in the cerebral hemispheres.

Serum NT-pro CNP levels in epileptic seizure, psychogenic non-epileptic seizure, and healthy subjects

PurposeEpileptic seizure is the result of uncontrollable neural excitation in the brain. The C-type natriuretic peptide is a member of natriuretic peptide hormone family and is synthesized by brain and blood vessels in CNS. NT-pro CNP is an amino-terminal fragment of C-type natriuretic peptide and is more stable compared to its predecessor. In this study, we aimed to evaluate the role of NT-pro CNP in psychogenic non-epileptic seizures, epileptic seizures, and normal subjects.MethodsThirty-three patients with epilepsy and 43 patients with psychogenic non-epileptic seizures were enrolled in this study. The control group consisted of 28 healthy subjects. Post-ictal serum levels of NT-pro CNP were acquired from all participants. Statistically significant differences between patient groups and controls regarding serum levels of NT-pro CNP were sought.ResultsNT-pro CNP levels were significantly lower in the epilepsy group than the psychogenic non-epileptic seizure group and control group with no significant difference between the psychogenic non-epileptic seizure and control group (p < 0.05).ConclusionPost-ictal serum NT-pro CNP levels were lower in epileptic seizures compared to psychogenic non-epileptic seizures as well as healthy controls. We think that such a difference is associated with C-type natriuretic peptide-related neural mechanisms such as altered microcirculation, increased brain-blood barrier permeability, and synaptic stabilization.