Pervin Iseri

Posttraumatic stress disorder and major depressive disorder is common in parents of children with epilepsy

OBJECTIVE The purpose of the study was to determine the prevalence of posttraumatic stress disorder (PTSD), posttraumatic stress symptoms (PTSS), and major depressive disorder (MDD) in parents of children with epilepsy. METHODS Parents (77 mothers and 3 fathers) of children with epilepsy were administered the Structured Clinical Interview for DSM-IV (SCID), PTSD and MDD modules, and the General Health Questionnaire (GHQ). RESULTS The prevalence of both PTSD and MDD was 31.5%. Fifty-six percent (n = 14) of the participants with PTSD had a diagnosis of MDD. PTSD symptom clusters were very prevalent in the parents of children with epilepsy. Reexperiencing and arousal symptom clusters were more frequent (88.8 and 80% respectively) than the avoidance and numbing symptom cluster (32.5%). CONCLUSION These findings suggest that a significant proportion of parents of children with epilepsy experience PTSD and MDD. Increased awareness of the clinical presentations of these disorders may help clinicians to develop preventive and intervention strategies for parents of children with epilepsy.

The effect of memantine in harmaline-induced tremor and neurodegeneration

Essential tremor (ET) is one of the most common and most disabling movement disorders among adults. The drug treatment of ET remains unsatisfactory. Additional therapies are required for patients with inadequate response or intolerable side effects. The current study aims to investigate the anti-tremogenic and neuroprotective effects of memantine (NMDA receptor antagonist) on the harmaline model of transient action tremor. The effects of memantine were further compared with ethanol. Three separate groups of male Wistar rats were injected either with saline, ethanol (1.5 gr/kg), or memantine (5 mg/kg) 15 min prior to a single intraperitoneal injection of harmaline (20 mg/kg). Tremor and locomotion were evaluated by a custom-built tremor and locomotion analysis system. After 24 h of harmaline injection, cellular viability, and apoptosis were assessed using crystal violet staining, and caspase-3 immunostaining, respectively. Harmaline caused neuronal cell loss and caspase-3 mediated apoptosis in cerebellar granular and purkinje cells as well as the inferior olivary neurons. Despite a reduction in tremor intensity and duration with ethanol, this compound resulted in cell loss in cerebellum and olivary nucleus. Memantine exhibited neuroprotective efficacy on cerebellar and inferior olivary neurons albeit weaker anti-tremor effect compared to ethanol. In conclusion, anti-tremogenic and neuroprotective effects do not necessarily overlap. Memantine is a potential treatment for ET particularly given its neuroprotective efficacy.

Linking a compound-heterozygous Parkin mutant (Q311R and A371T) to Parkinson's disease by using proteomic and molecular approaches

Parkin is an E3-protein ubiquitin ligase, which plays an important role as a scavenger in cell metabolism. Since the discovery of the link between Parkin and Parkinsons disease, Parkin was placed in the center of Parkinsons disease research. Previously, we isolated a mutant form of the Parkin protein (Q311R and A371T) from a Parkinsons disease patient. In this study, we aimed at characterizing this mutant Parkin protein by using biochemical and proteomic approaches. We used neuroblastoma cells (SH-SY5Y) as our model and created two inducible cell lines that expressed the wild type and the mutant Parkin proteins. We first investigated the effect of expressing both the wild type and the mutant Parkin proteins on the overall proteome by using 2D-DIGE approach. The experiments yielded the identification of 22 differentially regulated proteins, of which 13 were regulated in the mutant Parkin expressing cells. Classification of the identified proteins based on biological process and molecular function revealed that the majority of the regulated proteins belonged to protein folding and energy metabolism. Ingenuity Pathway Analysis predicted the presence of a link between the regulated proteins of the mutant Parkin expressing cells and Parkinsons disease. We also performed biochemical characterization studies on the wild type and the mutant Parkin proteins to make sense out of the differences observed at the proteome level. Both proteins displayed biological activity, had similar stabilities and localized similarly to the cytoplasm and the nucleus in SH-SY5Y cells. The mutant protein, however, was cut by a protease and subjected to a post-translational modification. The observed differences at the proteome level might be due to the differences in processing of the mutant Parkin protein. Overall, we were able to create a possible link between a pair of Parkin mutations to its pertinent disease by using 2D-DIGE in combination with biochemical and molecular approaches.

The effect of etanercept and methylprednisolone on functional recovery of the facial nerve after crush injury.

Objective To establish whether etanercept, a TNF-&agr; antagonist, is an alternative and effective treatment on facial nerve after crush injury. Method Fifty-four rats underwent exposure of the left main trunk of the facial nerve followed by a standard crush injury. Animals were randomly divided into 3 groups: control group, methylprednisolone-treated group, and etanercept-treated group. All these groups were divided into 2 subgroups; animals were sacrificed on the 4th day after facial crush injury in the first subgroup and on the 28th day in the second subgroup. Functional recovery of vibrissae movement, eye blink reflex, and vibrissae orientation was measured on a 3-point scale (1 = no recovery, 2 = partial recovery, and 3 = complete recovery) during the recovery process. Facial nerve, from the main trunk at the stylomastoid foramen to the zygomatic, buccal, and marginal branches, were dissected and postfixed in the same fixative. The paraffin sections were studied with macrophage marker, GAP-43 and T Cell Marker. Results Animals receiving etanercept demonstrated significantly better functional recovery compared with control and methylprednisolone-treated animals. The etanercept-treated group showed highest GAP-43 immunoreactivity in the nerves. After the macrophage marker and T cell marker staining, the etanercept and methylprednisolone groups demonstrated statistically significant difference compared with the control group (p < 0.001). Conclusion The present study demonstrates accelerated functional recovery associated with etanercept treatment after facial nerve crush injury in rats.

Cyclic alternating pattern analysis in REM sleep behavior disorder

ObjectiveRapid eye movement (REM) sleep behavior disorder (RBD) is a type of REM parasomnia characterized by complex motor activity during REM sleep. In this study, cyclic alternating pattern (CAP) in patients with idiopathic RBD was analyzed to evaluate the expression of arousal instability of NREM sleep.MethodsA total of 31 idiopathic RBD patients and age- and gender-matched 21 control subjects were consecutively recruited. Conventional sleep polysomnographic recording parameters and CAP parameters were compared between RBD and the control group.ResultsThe number of CAP cycles (120.13 ± 113.56, p = 0.007), CAP sequences (20.9 ± 18.15, p < 0.001), CAP index (25.14 ± 24.44, p = 0.017), and CAP rate (24.07 ± 13.22, p = 0.016) were all significantly higher in RBD patients compared to the control group. The increase in CAP sequences was observed in phase A2 and A3 subtypes while phase A1 subtype was significantly lower in RBD patients. A significant positive correlation was observed between disease duration with total CAP time (r = 0.289, p = 0.042) and A3 index (r = 0.32, p = 0.024). There was a negative correlation between the age and A1 index (r = −0.4491, p = 0.0001).ConclusionTo our knowledge this is the first polysomnographic clinical study which evaluated CAP parameters in RBD. Increased CAP rate found may be considered as a sign showing that NREM sleep may also be affected in RBD patients. Therefore, CAP analysis may be important to enlighten the pathogenesis of parasomnias.

Isolated abducens nerve palsy associated with retinoic acid therapy: a case report.

Isolated abducens nerve palsy is a rare complication of treatment with various drugs. Here, the authors report the case of a 23-year-old female with isolated left abducens nerve palsy after long-term retinoic acid therapy. The association is based on the temporal relationship and the exclusion of other possible etiologic factors following extensive laboratory and imaging diagnostics. The authors suggest that isolated abducens nerve palsy may be a presenting sign of a toxic neuropathy associated with retinoic acid therapy. After the exclusion of other organic lesions, especially idiopathic intracranial hypertension, and an assessment of the risk-benefit ratio, discontinuation of treatment must be considered in such cases.

Route Learning Impairment Associated with Encephalomalasia Secondary to Traumatic Brain Injury: A Case Report

Topographical disorientation is marked by difficulty finding ones way in familiar or new environments. The present case study reports findings from a 30-year-old male with encephalomalasia of the left parahippocampal region secondary to brain trauma with subsequent difficulty in learning of new routes. His navigation in premorbidly known (familiar) surroundings was intact. Magnetic resonance images revealed left parahippocampal and bilateral occipital encephalomalasia. Neuropsychological screening showed impairment in structuring a representation of the spatial relationships among landmarks with relatively preserved ability to learn visual and verbal information of these landmarks. Decreased visual perception and inappropriate visual inputs due to cervical dystonia and right homonymous hemianopsia also appear to play a role in his disability. The current knowledge about the neuronal systems involved in visual cognition and topographical orientation also are addressed in this report.

The importance of EEG and variability of MRI findings in acute hemorrhagic leukoencephalitis.

Sir, Acute haemorrhagic leukoencephalitis (AHLE) is a lethal haemorrhagic variant of acute disseminated encephalomyelitis (ADEM), a rare demyelinating disorder of central nervous system. A 22-year-old woman was referred to our hospital with status epilepticus. Her seizures were treated with phenytoin infusion. In the next day, neurological examination revealed global aphasia and right-sided hemiplegia. High degree of fever and leukocytosis (22.000/mm) were detected suggesting a preceding infection. Antibiotic and antiviral agents were introduced. Magnetic resonance imaging (MRI) of brain showed large hyperintense areas including some isointense regions on diffusion-weighted signal intensity (DWI). These areas were observed as hypointense on apparent diffusion coefficient (ADC) again including some isointense regions (Fig. 1). T1 and T2-weighted images were completely normal. In spite of mannitol and dexamethasone treatment, total quadriplegia and increased muscle tonus prominent in neck and face muscles were observed during the follow up. Electroencephalogram (EEG) revealed slow background activity and a rhythmic focal delta activity in left hemispheric derivations (Fig. 2). A new MRI scan was performed and large hyperintense lesions scattered in both hemispheres in T1 and T2-weighted images with partial contrast enhancement were detected (Fig. 3). Findings in DWI and ADC mapping were completely reversed. Diagnosis of AHLE was made and 1000 mg/day intravenous methylprednisolone treatment was introduced. All neurological impairments, MRI and EEG findings were resolved within 10 days. Acute disseminated encephalomyelitis typically begins within 6 days to 6 weeks after an infection or vaccination. Long-tract signs and impairment of consciousness are the most common features. Seizures, aphasia and extrapyramidal signs like hemidystonia or rigidity could be occurred infrequently. The diagnosis is usually based on MRI studies. Most common abnormalities are bilateral asymmetric multiple small lesions (<5 mm) and large confluent white matter lesions. AHLE (some degree of

The Effect of Pulse Methylprednisolone Plus Theophylline Treatment on Clinical, Pulmonary and Inflammatory Markers in Relapses of Multiple Sclerosis

OBJECTIVE The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses. STUDY DESIGN Double blind randomized controlled trial. MATERIAL AND METHODS The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5(th) and 30(th) days of the treatment. RESULTS Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5(th) day 2.4±1.6; 30(th) day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level. CONCLUSION There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.

Homonymous Quadrantanopia Secondary to Behçet Disease

The authors describe the case of a 42-year-old woman with a 3-year history of recurrent oral and genital ulceration, optic neuritis, and uveitis. She presented with left sided loss of vision. On neurological examination and perimetric analysis a left superior homonymous quadrantanopia was revealed. Magnetic resonance imaging of the brain demonstrated a typical lesion located at the right lateral geniculate nucleus. One month after systemic corticosteroid treatment, her perimetric analysis showed mild improvement. This is a rare case of neuro-Behçet disease presented with an isolated right lateral geniculate lesion.