Nebil Yildiz

The prevalence of neuropathy and relationship with risk factors in diabetic patients: a single-center experience.

Objective: To determine the rate of distal symmetrical polyneuropathy (DSP) in patients with type 2 diabetes mellitus, to evaluate the role of history, neurological examination and the electrodiagnostic methods in the diagnosis of DSP, and to determine the association between electromyography-supported neuropathy (ESN), neuropathic complaints (NCs) and risk factors. Subjects and Methods: A total of 191 type 2 DM patients (109 female, 82 male; mean age 58.7 ± 10 years) were recruited. The NCs were recorded. All patients had electromyographic (EMG) examinations. The relationship between ESN, NCs and risk factors were evaluated. Results: Of the 191 patients, 83 (43.5%) had DSP on EMG examinations and 92 (48.2%) patients suffered from NCs. Among the ESN patients, a significant relationship existed with HbA1c level, illness duration, smoking, male gender or insulin usage (p < 0.05) but not with age, hypertension, hypercholesterolemia or hypertriglyceridemia. The frequency of NCs was higher in patients with ESN. There was also a significant association between NCs and ESN (p < 0.05). The presence of NCs was not related to age, gender, smoking, hypertension, hypercholesterolemia and hypertriglyceridemia (p > 0.05) but NCs were correlated to HbA1c level, illness duration and insulin usage (p < 0.05). Conclusion: Our data show that a strong association exists between the presence of DSP and illness duration, HbA1c, smoking, thereby indicating that cessation of smoking and near normal glycemic control would be additional precautions to delay the beginning or progression of polyneuropathy.

Corticonuclear innervation to facial muscles in normal controls and in patients with central facial paresis

Abstract Recently it has been proposed that corticobulbar innervation of the lower facial muscles is bilateral, that is from both right and left sides of the motor cortex. The objectives of this study were, i) to evaluate the corticonuclear descending fibers to the perioral muscles and, ii) to determine how central facial palsy (CFP) occurs and often recovers rapidly following a stroke. Eighteen healthy volunteers and 28 patients with a previous history of a stroke and CFP (mean ages: 51 and 61 years) were investigated by TMS (transcranial magnetic stimulation) with a figure of eight coil. Intracranial facial nerve and cortical motor evoked potentials (MEPs) were recorded from the perioral muscles. The periorbital MEPs were also studied. The absence of MEPs in both perioral muscles with TMS of the affected hemisphere was the most obvious abnormality. Also, central conduction time was significantly prolonged in the remaining patients. The mean amplitude of the affected hemisphere MEPs was diminished. The amplitudes of the unaffected hemisphere MEPs recorded from the intact side were enhanced especially in the first week following the stroke. During TMS, only the blink reflexes were elicited from the periorbital muscles due to stimulus spreading to trigeminal afferent nerve fibers. It is concluded that perioral muscles are innervated by the corticobulbar tract bilaterally. CFP caused by a stroke is generally incomplete and mild because of the ipsilateral cortical and multiple innervations out of the infarction area, and recovers fast through cortical reorganisation.

Salivary alpha amylase activity in migraine patients

OBJECTIVE Salivary alpha amylase levels were measured to investigate sympathetic nervous system activity in migraine patients during attack, post-attack and interval periods of headache since salivary alpha amylase levels have been suggested as a potential indirect marker of sympatho-adrenal medullary activity in recent studies. METHODS 50 patients with migraine headache (13 patients in attack, 26 patients in post-attack and 11 patients in interval period) and 60 healthy volunteers were taken into the study. In all participants, the presence of anxiety was measured by using Hamilton Anxiety Rating scale. The visual analog scale scores for pain level estimation were obtained in the attack group. RESULTS The salivary alpha amylase levels were significantly lower in attack period (p<0.01) and higher in post-attack period (p<0.01) when compared with the control group. There was not any significant difference in salivary alpha amylase levels between interval period and control group (p>0.05). There was a weak negative correlation between the salivary alpha amylase levels and the visual analog scale scores. CONCLUSIONS This is the first study showing the dynamic nature of sympathetic nervous system activity by evaluating the salivary alpha amylase levels-a noninvasive, reliable and an easy method-in different periods of migraine headache.

Sympathetic skin responses of the face and neck evoked by electrical stimulation

The sympathetic skin responses (SSRs) were recorded from different facial regions and neck in 25 subjects evoked by electrical stimulation of the median nerve at the wrist. Recordings from all regions were cross-compared with each other and within right and left sides individually. In one subject postauricular SSR, and in another subject upper lip SSR could not be elicited on both sides. Other responses could be obtained in all the remaining subjects. In 11 subjects, the responses did not appear by the first stimulus, and began to appear by repeated stimuli. Mean latencies and the highest amplitudes of the responses were similar for both sides. Gradual amplitude increase was observed in the first three or four set of responses in 20 subjects, although the stimulus intensity was constant. In conclusion, face and neck SSRs are symmetric, can be evoked by electrical stimulation and can be used to investigate the sympathetic innervation of these areas.

Autoantibodies and Vitamin Levels: Is A Player Or Not in Pathophysiology of Multiple Sclerosis Patients?

Introduction and Aim: Multiple sclerosis is a demyelinating autoimmune disease of the central nervous system. ANA, anti-dsDNA, and ENA profiles have been used in the diagnosis and treatment of autoimmune diseases. Low vitamin D and B12, and folate levels, and high homocysteine levels are often detected in autoimmune diseases. In the present study, we aimed to investigate these parameters in patients with Multiple sclerosis and Multiple sclerosis like disease, as diagnosed in accordance with the revised McDonald criteria. Methods: The laboratory results of 161 (53Multiple sclerosis, 108 Multiple sclerosis like) patients who were examined for the differential diagnosis of vasculitis/Multiple sclerosis in the last 14 months were evaluated in this present retrospective, cross-sectional study. ANA, anti-dsDNA, ENA profile, vitamin D and B12, folic acid, and homocysteine levels were recorded. Results: ANA levels in 12 patients with Multiple sclerosis and in 34 patients with Multiple sclerosis like disease were positive; however, ANA levels were negative in 37 patients Multiple sclerosis, and 72 patients with Multiple sclerosis like disease. Anti-dsDNA levels in 4 patients Multiple sclerosis and in 23 with Multiple sclerosis like disease were positive; however, they were negative in 44 patients with Multiple sclerosis and 81 with Multiple sclerosis like disease. The mean vitamin B12 and D, and folate levels of 111 patients were found below the lower normal limit, whereas PTH and homocysteine levels were found over the upper normal limit. Conclusion: The present study was the first to report the autoimmune parameters and vitamin D levels in patients with Multiple sclerosis and Multiple sclerosis like disease in Bolu province in the Western Black Sea region. Although ANA positivity comes to the forefront in the diagnosis of autoimmune diseases, high anti-dsDNA positivity in patients with MS-like disease suggests different underlying mechanisms. In the present study, vitamin D and B12, and folic acid levels were detected at the lower limit of normal, and homocysteine levels were found at the upper limit of normal. Prospective studies including a control group, in addition to retrospective studies are required to elucidate the roles of autoantibodies and vitamins in the pathogenesis Multiple sclerosis.

Vasculitis and neurobrucellosis: Evaluation of nine cases using radiologic findings

Brucellosis is an important multisystemic disease with many different clinical symptoms, and its early diagnosis and treatment are possible. Neurobrucellosis (NB) is a rare but serious finding of brucellosis. Brucella can be seen as meningitis and encephalopathy, and it can cause cranial nerve pathologies, vascular syndromes, myopathy, spinal diseases, and psychiatric disorders. In NB, vascular syndromes secondary to inflammation are rarely seen. Here, we present nine young patients with vascular and nonspecific neuropsychiatric findings who had NB as the etiology of stroke.

Sympathetic Skin Responses from the Neck Area in Patients with Unilateral Migraine

INTRODUCTION In this study, in patients with unilateral migraine headache and in normal controls, it was aimed to assess the sympathetic function during attack, post attack, and interval periods and to compare these findings by recording sympathetic skin responses from the neck area, which was not studied before. METHODS A total of 37 unilateral patients with migraine (30 women, seven men) who fulfilled the criteria of International Headache Society (2004) were recruited from our outpatient clinic. The control group consisted of 21 healthy individuals (16 women, five men) who are employees or students of our Medical Faculty. Mean latency and maximum amplitude values of sympathetic skin responses obtained from neck areas of the patients during attack, post attack, and interval periods were calculated. We compared the mean latency and the maximum amplitude values of the symptomatic side with the data of the asymptomatic side and with the data of the control group. We also compared the responses of the patients with right-sided headache with the responses of the patients with left-sided headache. All statistical analyses were performed using SPSS. RESULTS On the neck area, we observed sympathetic hypo-function in the attack and interval periods and a relative hyper-function in the post attack period bilaterally, regardless of the symptomatic side. CONCLUSION These findings suggest that there is ongoing bilateral sympathetic hypo-function in the neck area and there occurs a temporary increase in the function of sympathetic sudomotor activity in the recovery period of headaches.

Is Headache only Headache? Comorbidity of Headaches and Mental Disorders

Objective: To determine the psychiatric disorders comorbid with headaches and the characteristics of these disorders. Method: Patients who admitted to the neurology outpatient clinic with a main complaint of headache (n=71), and the same number of age and sex matched patients (n=71) who admitted to the psychiatry outpatient clinic and had a non-psychotic diagnose in axis I were included into the study. Socio-demographic data and information about their headaches were obtained from all patients. The Visual Analog Scale and MINI-scan form were obtained and psychiatric diagnoses were made after the assessment by MINI. Results: There was not any difference between headache and psychiatric patients group in terms of socio-demographic data. Headache history was found higher in the families of headache group than the psychiatric patients group. High prevalence of psychiatric comorbidity was found in patients with headache (80.3%). All of the patients with tension-type headache (TTH) fulfilled the criteria for diagnosing a pain disorder by MINI, and also the high prevalence of psychiatric comorbidity (63.4%) was still taking place after excluding the pain disorder. The most frequent diagnose of psychiatric comorbidity was found as depressive disorders (64.8%) which is compatible with the literature. Discussion: The high prevalence of psychiatric comorbidity with headache is remarkable. More common family history of headache in headache patients than the other group suggests that there is a tendency to have headache independent from a psychiatric disorder in these patients. High comorbidity rate in the presence of psychosocial stressors suggests that there is a continuum among psychiatric comorbidity, headache and psychosocial stressors. Among the psychiatric comorbidity, depressive disorders predominate. On the other hand, the higher frequency of psychiatric comorbidity in patients with TTH is remarkable. It is observed that the uncertainty between the diagnostic criteria of pain disorder in DSM-IV and diagnostic criteria of TTH (Tension Type Headache) in ICHD (International Classification of Headache Disorders) causes some problems both in diagnosing and treatment of patients and also in researches.

Sympathetic skin responses from the scalp evoked by electrical stimulation in seborrheic dermatitis.

Although the role of autonomic nervous system in seborrheic dermatitis (SD) is still unclear, seborrhea is sometimes accepted as a sign of autonomic dysfunction in several nervous system diseases. Therefore, we aimed to investigate the sympathetic nervous system (SNS) activity in SD by recording sympathetic skin responses (SSR) from the scalp (S‐SSR). Thirty‐one control subjects and 22 SD patients were studied by evoking right and left S‐SSR with electrical stimulation of the right median nerve at the wrist. Mean latencies and maximum amplitudes were calculated for both sides in each group. In seven out of 31 control subjects and in 13 out of 22 patients, the S‐SSR could not be elicited on either side. There were four subjects with unilateral response in the patient group. There were significantly more non‐responders among the patients with SD (P < 0.000). This study suggests that in SD, the autonomic nervous system may be involved. The S‐SSR is a new site for recording SSR. The responses are relatively symmetrical and can be evoked easily by electrical stimulation, and may be used to evaluate the SNS function in SD patients and also in healthy subjects.

P139 Sympathetic skin responses from frontal region in unilateral migraine headache

reflexes -(C) and negative reflexes -(-)). This testified to deficiency in vagus system reflexes, which main function is regulation of internals and provision of blood distribution in accordance with body needs. The reflexes pathology was connected with clinical neurological preeclampsia symptoms (headache, dizziness, “black flies” in front of the eyes, pain in epigastric zone). The moderate preeclampsia reflexes had the following characteristics: oculocardiac -(+)14, C1, (++)6, (-)2; orbital -(+)15, CO, (++)7, (-)1; celiac-plexus reflex-(+)19, (++)2, (-)2. Accordingly, the severe preeclampsia reflexes had the following characteristics: oculocardiac -(+)9, C4, (++)9, (-)5; orbital -(+)10, C3, (++)8, (-)6; celiac-plexus reflex-(+)11, (++)10, (-)6. Conclusions: Vegetative dystonia syndrome reflects dependence between preeclampsia severity and degree of its neurological manifestations. The increase in preeclampsia severity means poor vegetative reflexes and pronounced imbalance between sympathetic and parasympathetic nervous systems. This should be taken into account during treatment and preparation of pregnant women for delivery, because labor decompensates insufficient adaptation mechanisms through hemorrhage and loss of blood. These complications are realized with participation of nervus vagus system.