Recep Aygül

Plasma oxidants and antioxidants in acute ischaemic stroke

Plasma levels of the oxidants xanthine oxidase, nitric oxide and malondialdehyde and the antioxidants superoxide dismutase, glutathione peroxidase and glutathione reductase, together with total superoxide scavenger activity and non-enzymatic superoxide scavenger activity, were determined in 19 patients with acute ischaemic stroke and 20 controls. Compared with controls, superoxide dismutase, total superoxide scavenger activity, glutathione peroxidase and glutathione reductase activities were significantly lower, and nitric oxide and malondialdehyde levels significantly higher, in acute stroke patients. Xanthine oxidase showed a slight but non-significant increase in stroke patients compared with controls. There was no significant difference in non-enzymatic superoxide scavenger activity between the two groups. There was a positive correlation between glutathione reductase levels and Glasgow Coma Scale scores, and a negative correlation between malondialdehyde levels and non-enzymatic superoxide scavenger activity. These findings suggest that oxidative stress in patients with acute ischaemic stroke may be the result of an imbalance in oxidant/antioxidant homeostasis.

Plasma values of oxidants and antioxidants in acute brain hemorrhage : Role of free radicals in the development of brain injury

The levels of oxidants xanthine oxidase (XO), nitric oxide (NO), and malondialdehyde (MDA) and of the antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and glutathione reductase (GRD) were determined in plasma within 24 h after onset of hemorrhagic stroke in 17 patients (9 men and 8 women, aged 60.7±11.5 yr) and in 20 healthy controls (12 men and 8 women, aged 62.5±8.3 yr). Compared to controls, the plasma SOD and total superoxide scavenger activi ties (TSSA) were significantly lower and the NO levels were significantly higher among the stroke patients. XO showed a slight, nonsignificant increase in the patients, but the levels of MDA, NSSA, GRD, and GSH-Px did not show any significant differences between the two groups. The hemorrhage volume was negatively, correlated with the initial score of the Glasgow Coma Scale and a positive correlation with lethal outcome, but it did not correlate significantly with any of the measured parameters. The results suggest that free radicals might play a role in the development of brain injury following brain hemorrhage.

Sensitivities of conventional and new electrophysiological techniques in carpal tunnel syndrome and their relationship to body mass index

The purpose of this study is to evaluate prospectively the sensitivities of conventional and new electrophysiological techniques and to investigate their relationship with the body mass index (BMI) in a population of patients suspected of having carpal tunnel syndrome (CTS). In this study, 165 hands of 92 consecutive patients (81 female, 11 male) with clinical diagnosis of CTS were compared to reference population of 60 hands of 30 healthy subjects (26 female and 4 male). Extensive sensory and motor nerve conduction studies (NCSs) were performed in the diagnosis of subtle CTS patients. Also, the patients were divided into subgroups and sensitivities were determined according to BMI. The mean BMI was found to be significantly higher in the CTS than in the control group (p < 0.001). The sensitivity of the median sensory nerve latency (mSDL) and median motor distal latency (mMDL) were 75.8% and 68.5%, respectively. The most sensitive parameters of sensory and motor NCSs were the difference between median and ulnar sensory distal latencies to the fourth digit [(D4M-D4U), (77%)] and the median motor terminal latency index [(mTLI), (70.3%)], while the median-to-ulnar sensory action potential amplitude ratio (27%) and the median-thenar to ulnar-hypothenar motor action potential amplitude ratio (15%) were least sensitive tests. Sensory tests were more sensitive than motor NCSs. Combining mSDL with D4M-D4U, and mMDL with mTLI allowed for the detection of abnormalities in 150 (91%) and 132 (80%) hands, respectively. Measurements of all NCSs parameters were abnormal in obese than in non-obese patients when compared to the BMI. The newer nerve conduction techniques and combining different NCSs tests are more sensitive than single conventional NCS test for the diagnosis of suspected CTS. Meanwhile, CTS is associated with increasing BMI.

Paraoxonase 1 gene polymorphisms, paraoxonase/arylesterase activities and oxidized low-density lipoprotein levels in patients with migraine

The vascular endothelial dysfunction has been implicated in the pathogenesis of migraine. Oxidized low‐density lipoprotein (ox‐LDL) may impair endothelial function. Paraoxonase‐1 (PON‐1) prevents oxidative modification of LDL cholesterol (LDL‐C). So we investigated serum PON‐1 and arylesterase (ARE) activities, PON‐1 55 L/M and 192Q/R polymorphisms and the serum lipid profile in patients with migraine. Biochemical parameters and PON‐1 polymorphism analyses were assessed in 104 patients with migraine and 86 healthy subjects. Ox‐LDL was detected by ELISA, and polymorphisms were determined using PCR–restriction fragment length polymorphism analysis. Patients with migraine had lower PON‐1 and ARE activities (p < 0·001, for both) and higher ox‐LDL and LDL‐C levels (p < 0·001, for both) and ox‐LDL: LDL‐C ratio (p < 0·005) than the controls. The genotype distribution and the allele frequencies for PON‐1 55 L/M and 192Q/R polymorphisms were not different among the study populations. The results of our current study indicate that migrainous patients have decreased serum PON‐1 and ARE activities and increased serum ox‐LDL levels, which may have a clinical importance in the treatment of migraine. Copyright

Handedness, Eyedness, and Crossed Hand-Eye Dominance in Male and Female Patients with Migraine with and without Aura: A Pilot Study

The possible relationships of migraine to left-handedness and left-eyedness, as well as sex and aura-related differences, were examined. 146 migraine patients (M age = 32.1 yr., SD = 9.5) and 141 controls (M age = 30.0 yr., SD=9.3) participated. Hand preference was assessed by the modified version of the Edinburgh Handedness Inventory. Ocular dominance was measured by means of the near-far alignment test. Migraine diagnoses were made on the basis of criteria provided from the International Headache Society. In the overall sample and in women, left-handedness and left-eyedness were not significantly correlated with migraine. In men, the incidence of left-handedness and left-eyedness were significantly higher in patients than in controls. The presence of aura in patients with migraine was significantly associated with the incidence of left-eyedness and crossed hand-eye dominance, but not handedness, for the total sample and women. These results suggest that there may be a tendency towards anomalous dominance, especially left-eyedness, in migraine patients particularly those with aura.

The clinical properties of a migrainous population in eastern Turkey-Erzurum.

Objectives: The purpose of this study was to determine the clinical and demographic characteristics of patients with migraine headache, in the vicinity of Erzurum, Turkey. Methods: A uniform questionnaire was given to 185 patients diagnosed as having migraine according to the International Headache Society diagnostic criteria between August 2001 and July 2002. One hundred forty five females (78.4%) and 40 males (21.6%) were included in the study. The male to female ratio was 1:3.2. The mean age of the cases was 32.4 ± 10.2 years and the mean age of onset was 22.8 ± 9.1 years. Results: One hundred and thirty seven patients (74.6%) fulfilled the criteria for migraine without aura (MwA) whereas forty-eight patients (25.4%) fulfilled the criteria for migraine with aura (MA). The males had been suffering from migraine headaches for a mean of 8.3 ± 6.3 years versus a mean of 9.3 ± 7.6 years in females. More than half (61.4%) of the females were housewives, and 84.3% of the cases were living in urban areas. About half (48.7%) of them had at least 11 years of education, most (79.5%) reported low or medium income level. Also, 70.8% were married. There was a high rate of headache in family history (72.4%). A majority of patients (75.7%) complained of severe headaches. One fourth (24.9%) had more than three attacks per month. Headache was unilateral in 71.9% and was throbbing in 77.8%. In 117 patients (63.2%) the symptoms were aggravated by physical activity. Attacks were accompanied by nausea in 84.9%, vomiting in 50.3%, photophobia in 80.0%, and phonophobia in 78.4%. In 58% of the cases, the headache was severe enough to disturb daily activities. Conclusions: This study showed that migraine is more commonly seen in urban areas, in females, and is associated with high education plus low income, and is comprised of a wide complex of symptoms.

The effect of interferon beta 1B on bone mineral density in multiple sclerosis patients

OBJECTIVE Osteoporosis is a secondary problem in multiple sclerosis (MS) patients. There have been only a few reports about the effect of interferon beta (IFNB) 1b on bone mineral density (BMD). We aimed to determine bone mass in patients using IFNB 1b. METHODS We enrolled 17 patients taking IFNB 1b (group I), 15 patients not taking IFNB (group II). We measured the BMD and T scores values and the patients were distinguished as normal, osteopenia and osteoporosis. RESULTS In the lumbar spine, there was no difference between groups I and II (p=0.3). In the left femur, no significant difference was detected between groups I and II (p=1). There was an inverse correlation between the BMD at the both regions and the Expanded Disability Status Scale score (r= -0.39, p=0.03; r=-0.52, p=0.002, respectively). CONCLUSION IFNB 1b may be used safely in MS patients, even in those undergoing pulse steroid therapies, because IFNB 1b has no effect on BMD.

Acute cerebral ischaemia: Relationship between serum and cerebrospinal fluid orexin-A concentration and infarct volume

Objective Orexins are hypothalamic neuropeptides that are involved in feeding, neuroendocrine regulation, sleep-wakefulness and sleep disorders (such as narcolepsy). This study investigated the relationship between serum and cerebrospinal fluid (CSF) orexin-A concentrations and infarct volume, in patients with ischaemic stroke. Methods Serum and CSF concentrations of orexin-A were determined 48–72 h after the onset of ischaemic stroke in patients, then compared with those of healthy control subjects of comparable age. Infarct volumes were measured using computerized tomography, 48–72 h after hospitalization. Results Mean serum and CSF orexin-A concentrations were significantly lower among ischaemic stroke patients (n = 29) compared with control subjects (n = 13). There was a significant inverse correlation between infarct volumes and CSF orexin-A concentrations in patients with ischaemic stroke. Conclusion These data show that serum and CSF orexin-A concentrations decrease after cerebral ischaemia and may play a role in the development of brain injury. The orexin-A concentration in the CSF might be a useful biomarker for the assessment of progression of brain tissue damage during the early stages of ischaemic stroke.

Familial Fahr disease in a Turkish family.

Fahr syndrome refers to a rare syndrome characterized by symmetrical and bilateral intracranial calcification. We present a 42-year-old woman with Fahr disease, but lacking extrapyramidal symptoms or a metabolic disorder. Her neurological examination was normal. Computed tomographic scans demonstrated symmetrical calcification over the basal ganglia, thalamus and cerebellum. No underlying cause for the bilateral calcification was found. When screening other family members, we detected Fahr syndrome in her two daughters and three brothers, revealing that the disease was an autosomal dominant trait. Fahr disease may be clinically asymptomatic, but have pronounced positive brain imaging findings. Computed tomographic scanning remains the most effective screening tool for adult relatives.

Precipitating factors of migraine attacks in patients with migraine with and without aura

AbstractStudies specifically devoted to precipitating factors in migraine are rare. The aim of the study was to determine the triggers of migraine in a population attending the neurology clinic. One hundred and eighty-five patients who fulfilled the diagnostic criteria for migraine as proposed by the International Headache Society were evaluated by means of a personal interview. The mean age was 32.37 ± 10.16 years, and the mean duration of migraine was 9.30 ± 7.58 years; 74.1% (137 patients) met criteria of migraine without aura and 25.9% (48 patients) of migraine with aura. Stress and mental tension (70.8%) were found to be the most common precipitants of both migraine without aura and migraine with aura. Other common precipitants were lack of sleep (48.4%), noise (42.2%), not eating at right times (41.6%), types of food and drink (32.9%), light (31.9%), menstruation (31%), smell (25.9%), fatigue (21.6%), heat/cold weather (16.8%), smoking (15.7%), travel (9.2%), and sexual activity (1.1%). The distribu...