Mustafa Ertas

The Efficacy and Safety of Venlafaxine in the Prophylaxis of Migraine

Objective.—To evaluate the efficacy and safety of venlafaxine in the prophylaxis of migraine.

Use of levodopa to relieve pain from painful symmetrical diabetic polyneuropathy

&NA; Levodopa has been used to treat some painful conditions and found to be effective in neuropathic pain due to herpes zoster in a double‐blind study. From our anecdotal observations about the efficacy of levodopa on diabetic neuropathic pain, we designed a double‐blind placebo‐controlled study to test levodopa in painful diabetic neuropathy. Twenty‐five out‐patients with painful symmetrical diabetic polyneuropathy were admitted to the study. Fourteen patients were given 100 mg levodopa plus 25 mg benserazide to be taken three times per day for 28 days. Eleven patients were given identical placebo capsules. A blinded neurologist evaluated the patients clinically and performed Visual Analogue Scale (VAS) measurement every week from day 0 to day 28. The results seemed promising and levodopa may be a choice for the control of pain in neuropathy for which we do not have many alternative treatments.

Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial

Introduction: It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura. Methods: Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19–52 years (mean, 35 ± 10 years). Results: The average count of reactions with abnormally high titre was 24 ± 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 ± 4.4 to 7.5 ± 3.7; P < 0.001) and number of migraine attacks (from 9.0 ± 4.4 to 6.2 ± 3.8; P < 0.001) in the elimination diet period. Conclusion: This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks.

An Electronic Device Measuring the Frequency of Spontaneous Swallowing: Digital Phagometer

A new and protable electronic device called the “Digital Phagometer” is described for the time-based counting of spontaneous swallowing. This device is composed of a piezoelectric sensor and a digital event counter/recorder which can be downloaded to any IBM-compatible PC. The sensor of Digital Phagometer is placed and fixed on the coniotomy region between the cricoid and thyroid cartilage. In this way, it is capable of sensing each upward and downward movement of the larynx produced by spontaneous movement as a function of time. Spontaneous swallowing was measured 1–4 h after lunch in 21 normal subjects and 21 patients with Parkinsons disease (PD). The mean frequency of spontaneous swallowing was 0.8 counts/min in PD patients and 1.18 counts/min in normal subjects (p<0.05). During the intake of 200 ml water, the mean frequency of voluntary swallowing did not differ significantly between the two groups (24.6 counts/min in normals vs. 22.3 counts/min in PD patients), but the time necessary to swallow the same volume of water was longer in the PD group.

Validity and Reliability of the Turkish Migraine Disability Assessment (MIDAS) Questionnaire

Objectives.—The aim of this study is to assess the comprehensibility, internal consistency, patient‐physician reliability, test‐retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache.

The distinct genetic pattern of ALS in Turkey and novel mutations

The frequency of amyotrophic lateral sclerosis (ALS) mutations has been extensively investigated in several populations; however, a systematic analysis in Turkish cases has not been reported so far. In this study, we screened 477 ALS patients for mutations, including 116 familial ALS patients from 82 families and 361 sporadic ALS (sALS) cases. Patients were genotyped for C9orf72 (18.3%), SOD1 (12.2%), FUS (5%), TARDBP (3.7%), and UBQLN2 (2.4%) gene mutations, which together account for approximately 40% of familial ALS in Turkey. No SOD1 mutations were detected in sALS patients; however, C9orf72 (3.1%) and UBQLN2 (0.6%) explained 3.7% of sALS in the population. Exome sequencing revealed mutations in OPTN, SPG11, DJ1, PLEKHG5, SYNE1, TRPM7, and SQSTM1 genes, many of them novel. The spectrum of mutations reflect both the distinct genetic background and the heterogeneous nature of the Turkish ALS population.

ICE TEST AS A SIMPLE DIAGNOSTIC AID FOR MYASTHENIA GRAVIS

It is known that myasthenia gravis is improved by cold. In two previously reported studies performed on a limited number of myasthenic patients and controls, local cold application to the eyelid was suggested for use as a diagnostic test for ocular myasthenia gravis. In this study, ice test to the eyelid was evaluated as a diagnostic test on 12 myasthenic patients and 15 controls with blepharoptosis and the results were compared with those of edrophonium test.

Comparison of magnetic coil stimulation and needle electrical stimulation in the diagnosis of lumbosacral radiculopathy

Electrical stimulation (ES) of lumbosacral nerve roots using a needle electrode inserted to the laminar level at the midline of Th12-L1 or L1-2 intervertebral interspace, was compared with magnetic stimulation using a 9-cm diameter coil (MCS) at the L3-4 or L4-5 spine levels, Compound muscle action potentials (CMAP) were superficially recorded from homologous muscles in both sides in 15 normal control subjects and in 20 patients with lumbosacral radiculopathy. Soleus muscles were used for S1, tibialis anterior (TA) for L5, and rectus femoris (RF) muscles for L4 roots. According to the clinical or radiological diagnosis (CAT, MRI and/or myelography) conventional needle EMG was capable to localise the root lesion in 16 of 20 patients (80%) and ES localised the root involvement in 18 of 20 patients (90%); the diagnostic value of MCS was lower, about 65% (13 of 20 patients). Although ES is uncomfortable and invasive, it is superior to needle EMG in localising unilateral or multiple lumbosacral root involvement. At present, MCS is not suitable for the diagnosis of lumbar radiculopathy.

Motor-evoked potentials from various levels of paravertebral muscles in normal subjects and in patients with focal lesions of the spinal cord.

Study Design. This prospective study includes normal control subjects and patients with focal lesions of the spinal cord investigated by transcranial magnetic stimulation. Objectives. To establish a stable method to elicit motor evoked potentials from cervical to lumbar segmental levels and to apply the method that would allow the localization in patients with restricted cord lesion. Thirty‐four healthy subjects (10 women, 24 men) and 17 patients with focal spinal lesions were admitted to this study. Summary of Background Data. The focal cord lesions and injuries were previously evaluated by the records of lower limb muscles after cortical stimulation, but this method did not demonstrate the vertebral levels at which the lesions were located. Methods. The paravertebral myotomal‐evoked potentials were recorded in different segmental levels (T1, T6, T12, and L3) from paravertebral muscles, using surface and needle electrodes by transcranial magnetic stimulation in normal control subjects and patients. Results. In normal control subjects, paravertebral myotomal‐evoked potentials were obtained from T1, T6, T12, and L3 paravertebral muscles with both recording techniques (surface and needle electrode). From T1 to L3 latencies of paravertebral myotomal‐evoked potentials increased gradually (from 10 msec to 17 msec) in normal control subjects. The levels of spinal cord lesions were obtained reliably in 14 of 17 patients with thoracic‐lumbar spinal cord lesions, by using both electrophysiologic methods. In 11 of 14 patients, the lesions produced total conduction block, at and below the lesion level. In the remaining 3 patients slowing of intersegmental conduction was observed along the focal cord lesion. Conclusions. The paravertebral myotomal‐evoked potentials obtained by surface electrode from paravertebral muscles and by midline needle electrode in the intrinsic rotatory muscles of the spine were useful in localizing lesions in the spinal segments in most of the patients with thoracic‐lumbar cord lesions.

Diagnostic value of electrical stimulation of lumbosacral roots in radiculopathies

Needle electrical stimulation of the lumbosacral roots at the laminar level of the Th12‐L1 or L1‐2 intervertebral spaces were performed in 24 normal subjects and 58 patients with various kinds of lumbar radiculopathy (unilateral L4, L5 and S1 herniated nucleus pulposus and lumber stenosis). The root stimulation method was compared with conventional needle EMG. Lumber electrical stimulation showed root abnormalities objectively in 80% of patients while the diagnostic value of needle EMG was 65%. Therefore, electrical root stimulation is superior to routine EMG for localizing lumbar root involvement. However, the only needle EMG demonstrated the root pathology in 7 cases (12%) and single electrophysiological abnormality was found by the root stimulation in 16 cases (27%). Thus, both electrophysiological methods should be complementary to each other in evaluation of the lumbar radiculopathy.