Selda Keskin Güler

Serum glutathione peroxidase, xanthine oxidase, and superoxide dismutase activities and malondialdehyde levels in patients with Parkinson's disease.

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by loss of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNpc). Oxidative stress has been hypothesized to play a major role in the development of PD in various studies. This study assessed to investigate oxidative and anti-oxidative status in PD patients. We evaluated oxidant/antioxidant status by measuring serum malondialdehyde (MDA) levels, xanthine oxidase (XO) activities, and activities of antioxidant enzymes, namely, glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD). The study included 29 patients with PD and 32 healthy subjects as controls. Comparison of oxidative parameters in the patient and control groups revealed significantly higher GSH-Px and XO activities in the patient group. Serum MDA and SOD activities in PD patients were not significantly different from the controls. MDA was negatively correlated with duration of the PD and positively with age of onset. There was a negative correlation between SOD and Hoehn and Yahr (H&Y) stage. According to these results, we suggest that oxidative stress may contribute to the development of PD.

Serum oxidant and antioxidant status of patients with chronic tension-type headache: possible effects of medical treatment

Tension-type headache (TTH) is one of the most common and costly primary types of headache in clinical practice, with an unknown etiology. This study assessed to investigate oxidative and antioxidative status in patients with chronic tension-type headache (CTTH), and to evaluate possible effect of medical treatment. The study included 41 CTTH patients and 19 age- and sex-matched healthy subjects without headache as controls. The CTTH group comprised 20 patients receiving treatment and 21 untreated patients. We evaluated oxidant/antioxidant status by measuring serum malondialdehyde (MDA) levels and activities of antioxidant enzymes, namely glutathione peroxidase (GSH-Px) and catalase (CAT). Comparison of oxidative parameters in the patient and control groups revealed significantly lower CAT activities and higher MDA level and GSH-Px activities in the patient group. In the CTTH group, serum CAT activities were found to be significantly decreased in patient groups, while serum MDA levels and GSH-Px activities were found to be higher in the untreated CTTH patients. These findings suggest that oxidative stress is increased in the patients with CTTH, and medical treatment abolishes the stress in part. It has been concluded that antioxidant support might be helpful for the patients with CTTH to prevent oxidant stress and peroxidation damages further.

Clinical associations, biological risk factors and outcomes of cerebral venous sinus thrombosis.

Objective Cerebral venous sinus thrombosis (CVST) is a rare cerebrovascular disease affecting young adults. The majority of the patients are female. The aim of this study is to assess the clinical associations, risk factors and outcomes of the patients with CVST. Methods The data of 75 patients with CVST admitted to our hospital between 2006 and 2016 were reviewed. Demographic and clinical features and the thrombophilic risk factors of the patients were recorded. The localizations of the thrombi were determined and modified Rankin score at the time of onset and discharge were calculated. Results The majority of our patients (78.7%) were female. Median age was 35 years (16–76). The most common symptom was headache (86.7%). In 82.6% of our patients, inherited or acquired risk factors for thrombosis were detected. Transverse sinus was the most common site of thrombosis followed by sigmoid and superior sagittal sinuses. Two thirds of the patients had involvement of multiple sinuses. The patients with the involvement of sagittal sinus had better disability at the time of admittance (p = 0.013) while the number of involved sinuses was correlated worse disability (p = 0.015). The neurologic states in the majority of the patients were improved by the end of the hospitalization period (p = 0.001). There was no significant difference in disability score at discharge between men and women (p = 0.080). No patient with CVST died in the hospitalization period. Conclusions This study is one of the largest cohort studies on CVST in our region. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.

Validation of the Revised Illness Perception Questionnaire in Turkish epilepsy patients and the effects of earthquake experience on perception of disease

Objective The aims of this study were to investigate the reliability of the Revised Illness Perception Questionnaire (IPQ-R) in Turkish patients with epilepsy (PWE) and to determine the effects of earthquake experience on the perception of disease in patients. Materials and methods The sample was composed of 48 PWE, who were affected by the 2011 earthquake (n=21) or who had never had any earthquake experience (n=27). The interview form, IPQ-R, and Beck Depression Scale (BDS) were applied. Results The study was carried out on PWE whose mean age was 20.9 years (±8.1 years) and who had been diagnosed within the last 10 years (±6.9 years). IPQ-R consisted of three parts: illness identity, attributions concerning the disease, and probable causes. In the part of illness identity, the most frequently met manifestations were fatigue (76.6%) and headache (72.9%). Regarding attributions concerning the disease and probable causes, the test was determined to be reliable (reliability coefficient 0.715–0.814). In terms of personal control, timeline (acute/chronic), emotional representations, illness coherence, consequences, treatment control, and timeline sub-scales, which were investigated at the dimension about attributions concerning the disease, and psychological causal attributions, risk factors, and immunity subscales, which were investigated at the dimension about probable causes, no significant differences were found between groups (P>0.05). No difference was determined in terms of BDS scores (z=−0.895, P>0.05). Conclusion The results of this study demonstrated that IPQ-R could be used reliably in the Turkish PWE. A severe life event such as an earthquake did not change IPQ-R scores in PWE.

Multiple Sclerosis and Panuveitis: A Rare Association

A 28-year-old right-handed male presented in December 2012 with complaints of numbness in the right arm and leg. Neurological examination revealed right hemiparesis and hemihypoesthesia. He had a history of epilepsy, and his mother had Sjogren syndrome. He reported that the numbness in the right arm and leg had started 2 years ago and he was then diagnosed with vasculitis, and thus, was administered 300 mg/day acetylsalicylic acid. Complete blood count, serum biochemistry, and sedimentation rate were normal. Immunological tests, including antinuclear, antiDNA, and antiphospholipids antibodies; laboratory tests for Lyme disease; ENA screening for Sjogren syndrome, syphilis, toxoplasmosis, hepatitis, HIV, CMV, tuberculosis, and sarcoidosis; and Schirmer’s and pathergy tests were negative. Magnetic resonance imaging of the brain revealed periventricular and pericallosal hyperintense lesions that were typical of MS (Figure 1, 2). Cerebrospinal fluid analysis revealed a cellular count of <3 cells/mm3 and protein level at 0.5 g/L with oligoclonal bands. His visual evoked potential revealed a delayed left P100 latency at 139.5 ms. He did not have any ocular symptoms. On ophthalmological evaluation, no ocular abnormalities were found. His ipsilateral delayed P100 latency was considered to be secondary to optic neuropathy. Immunomodulatory therapy (interferon beta 1-a) was initiated following the diagnosis of MS. He was admitted to our department in June 2013 with a complaint of decreased vision in the right and left eyes since the previous 2 days. Ophthalmoscopic examination of both the eyes revealed bilateral panuveitis. The patient was diagnosed with panuveitis associated with MS, and combination therapy with oral prednisolone at a dose of 64 mg/day and azathiopurine at a dose of 100 mg/day were initiated. The patient is still being followed up at our MS polyclinic without any new attack since 2013.

Tuberculous ventriculitis as a relapse following central nervous system tuberculoma

A 74-year-old female patient was admitted with complaints of memory loss, nausea, loss of balance, and urinary incontinence, all of which started approximately 2 months earlier and increased gradually. These symptoms were so severe that she could no longer take care of herself, and her children had begun to assist her. Her medical history included a diagnosis of central nervous system (CNS) tuberculoma and tuberculous lymphadenitis 3 years prior, which were diagnosed upon complaints of severe headache and treated with isoniazid (300 mg/day), rifampicin (600 mg/day), ethambutol (1,500 mg/day) and pyrazinamide (2,000 mg/day) for 1 year. Cranial MR imaging (MRI) at diagnosis of CNS tuberculoma revealed an intense gadolinium-enhanced mass lesion with lobulated contour in the left basal ganglia (Fig 1), and thoracic computed tomography (TCT) identified paratracheal and subcarinal lymphadenopathies. The diagnosis of tuberculosis was confirmed by biopsy of the mediastinum. Following anti-tuberculosis treatment applied during that period, the patient’s ability to walk and her cognitive capacities recovered, and MRI revealed complete elimination of the tuberculoma. Due to the complaints mentioned above, the patient was hospitalized in the neurology service, where her vital signs and systemic physical examination remained normal. Neurological examination revealed an increased tendency to sleep and limited cooperation, even though she could comply with verbal directions, and her visual orientation was intact. No signs of motor deficit, cranial nerve palsy, or meningeal irritation were observed. DTRs and fundus examination were normal. Laboratory analysis indicated normal complete blood counts, biochemical parameters, thyroid function, and vitamin B12 levels, and an erythrocyte sedimentation rate of 25 mm/h. MRI identified a large ependymal contrast enhancement on the ventricular walls of the third, fourth, and lateral ventricles (Fig 2a–c). Lumbar puncture led to the following findings: protein 2,165 mg/L (150–450), glucose 43 mg/dL (simultaneous blood glucose level was 110 mg/dL), cell count 70 leukocyte/mm (all lymphocytes) and a positive Pandy’s test. A cerebrospinal fluid (CSF) smear showed large numbers of lymphocytes, few plasmocytes, degenerated cells and giant cells similar to Langhans type 1–2, and areas resembling eosinophilic small necroses, which led to a diagnosis of tuberculous meningitis (TBM). The CSF culture was negative. We evaluated albumin and IgG in serum and CSF, and found the patient’s IgG index to be 0.70, indicative of intrathecal IgG synthesis. TCT showed no evidence of tuberculous infection. After initiation of fourdrug antituberculosis treatment (isoniazid 300 mg/day, rifampicin 600 mg/day, ethambutol 1,500 mg/day, and pyrazinamide 2,000 mg/day and dexamethasone 2 mg/ day), she was referred to the Infectious Diseases Clinic where she was treated for 2 months. Upon discharge, the patient had full cognitive function; she could easily follow directions and was well-oriented to her surroundings. Control cranial MRI revealed a decrease in ependymal contrast uptake (Fig 2d–f). S. K. Guler (&) N. Gunes B. G. Cokal T. Yoldas Department of Neurology, Ankara Training and Research Hospital, Şukriye district, Ulucanlar Avenue, No: 89, 06340 Ankara, Altindag, Turkey e-mail: keskinselda@gmail.com

As the first sign of multiple sclerosis, eight-and-a-half syndrome

A47-year-old-woman presented with diplopia looking to right side and dizziness for a week. The patient also had a vertigo attack for 2 days long, 2 years ago. She had diabetes mellitus and hypertension in medical history. Ocular motor examination disclosed total conjugate gaze palsy to left (Fig. 1a) and left internuclear ophthalmoplegia (Fig. 1b) suggestive of oneand-a-half syndrome. She also had left peripheric facial palsy (Fig. 1c). Motor, sensory, and cerebellar system examinations and deep tendon reflexes were normal. Brain MRI revealed multiple periventricular, cerebellar, medullary, and pontine white matter demyelination lesions and contrast enhancement at pons (Fig. 2a–d). Cerebrospinal fluid investigation showed normal protein (23.3 mg/dl) and glucose (91 mg/dl) level. Oligoclonal band was positive and IgG index was 0.8. The patient was diagnosed with multiple sclerosis. After 7-day pulse steroid treatment, her complaints regressed and interferon beta-1a regimen was recommended. Eight-and-a-half syndrome is combination of gaze abnormality one-and-a-half syndrome plus seventh cranial nerve palsy [1, 2]. Involvement of caudal paramedian pontine reticular formation (PPRF), medial longitudinal fasciculus (MLF), and facial nucleus/fascicles in the lower pontine tegmentum

Fetal safety of levetiracetam use during pregnancy

The aim of this study is to evaluate the effect of levetiracetam treatment during pregnancy on fetus.. The pregnant women with epilepsy (PWWE) who were exposed to levetiracetam treatment during pregnancy in the form of monotherapy or polytherapy were retrospectively evaluated. They were compared with the PWWE who did not use the antiepileptic drug (AED) during pregnancy. A total of 102 pregnancies were examined. While 35 patients never used AED during pregnancy, 30 patients received only levetiracetam therapy, and 37 patients received levetiracetam with at least one combined AED. While no major congenital malformation (MCM) was determined in the group of patients who never used AED and who received levetiracetam monotherapy, 2 MCMs were determined in the group receiving multiple AED therapy with levetiracetam. This study showed that the use of levetiracetam as monotherapy during pregnancy was at the same risk level as the group who never used AED and that the risk increased when it was used as a part of polytherapy. In conclusion, these findings support the current understanding that LEV may be a feasible option for PWWE.

Asymmetric sensory nerve action potential amplitudes as an early hint for diagnosing Lewis–Sumner syndrome

Lewis–Sumner syndrome (LSS) is an immune-mediated peripheral nerve disorder characterized by multifocal conduction blocks. LSS is typically associated with distal, asymmetric weakness and sensory impairment, affecting primarily upper limbs [1]. It is still an open question whether LSS and multifocal motor neuropathy (MMN) are a variant of CIDP or whether these conditions represent different entities [2].

Mortal Seyreden Bir Amitriptilin İntoksikasyonu Olgusu

Ozet Trisiklik antidepresanlarin (TCA) asiri alimi, ciddi ilac zehirlenmelerinin en sik sebeplerinden biridir. Gorece dusuk (10 mg / kg) bir dozda amitriptilinin intihar etmek amaciyla icimi sonrasi TCA zehirlenmesine bagli cok siddetli norolojik ve kardiyovaskuler belirtiler gosteren 20 yasinda bir kadin hastayi sunuyoruz. Gastrik lavaj, aktif komur, sistemik alkalinizasyon (pH 7.50 olacak sekilde), destek tedavi ve plazma degisim tedavileri hasta icin yeterli olmadi. Hastanin derin koma durumu ve sok tablosu devam etti ve herhangi bir onlem hastayi hayatta tutmaya yetmedi. Bu vaka, TCA zehirlenmesinin onemini ve bu zehirlenmenin dusuk dozlarda dahi olumcul olabilecegini vurgulamaktadir.