Serpil Bulut

Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity

Multiple sclerosis (MS) is a chronic disease and a major cause of disability in young adults. The aims of this study were to assess bone mass in patients with MS in comparison to healthy age- and sex-matched controls, and to evaluate factors influencing bone mineral density (BMD), and the relationship of the pain threshold at peripheral and axial sites with BMD in MS. Thirty-one patients with MS and 30 matched healthy controls participated in the study. The Kurtzke expanded disability status scale (EDSS) and the functional independence measure (FIM) were used to scale disability, mobility, and functional status. Serum 25(OH) vitamin D levels were measured. BMD was measured using dual X-ray absorptiometry (DXA). MS patients had significantly lower BMD at the lumbar spine (L2-L4) and femur trochanter compared to the matched controls. BMD of the lumbar spine was nearly 1 SD lower in MS patients compared with the healthy reference population (Z scores). MS patients had significantly lower vitamin D levels (17.3 ng/ml vs 43.1 ng/ml; P < 0.001) compared to controls, and 19 patients (61%) had a serum level of vitamin D that was less than 20 ng/ml. EDSS scores in the patients were inversely correlated with proximal femur BMD but not with spinal BMD. There was a negative correlation with the cumulative steroid dose and BMD only for femur trochanter BMD. Total myalgia scores for paravertebral muscles correlated significantly with spinal BMD. In conclusion, BMD is significantly lower in MS patients than in healthy controls, vitamin D deficiency is prevalent in MS, and ambulatory status is a determinative factor for osteoporosis in MS. Patients should be encouraged to have adequate sunlight exposure and to increase their mobility. Specific strengthening exercises for hip and back muscles in MS patients would have a substantial impact on bone density, osteoporosis, fracture risk, and mobility.

Venlafaxine versus amitriptyline in the prophylactic treatment of migraine: randomized, double-blind, crossover study

In patients with migraine with or without aura the prophylactic effect of amitriptyline (AMT) and venlafaxine (VLF) was compared in a randomized double-blind crossover study. Intolerable side effects resulted in drop out of five patients on AMT (due to hypersomnia, difficulty in concentration and orthostatic hypotension) and one patient on VLF (because of nausea and vomiting). Following the run-in period the patients (n = 52) were randomly treated with one of the study medications for 12 weeks. After a wash-out period lasting 4 weeks the patients were treated with the other drug for further 12 weeks. Both drugs had significant beneficial effect on pain parameters. Total number of side effects of VLF was low when compared with the side effect profile of AMT. In conclusion, it is suggested that VLF may be considered for the prophylaxis of migraine because of its low and/or tolerable side effect properties.

Antioxidant Enzyme and Malondialdehyde Levels in Patients with Panic Disorder

There is evidence of an etiopathogenetic role of free radicals (FRs) in some neuropsychiatric disorders. The aim of the present study was to determine whether the activity levels of some antioxidant enzymes [glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) and catalase (CAT)] and malondialdehyde (MDA), a product of lipid peroxidation, were associated with panic disorder (PD). Twenty patients diagnosed with PD and 20 healthy controls were enrolled in this study. A clinical evaluation and measurements of GSH-Px SOD, CAT and MDA were performed. Additionally, all patients were assessed by the Panic Agoraphobia Scale (PAS). The mean GSH-Px, SOD and MDA levels of the patient group were significantly higher than those of the controls. There was a significant positive correlation between PAS scores and GSH-Px, SOD and MDA levels and between the duration of illness and SOD, CAT and MDA levels in the patient group. In conclusion, our results suggest that FRs may be involved in PD.

Effects of exercise on visual evoked potentials.

The aim of this study was to investigate the effects of acute or habitual exercise on visual evoked potentials (VEP). The study group consisted of 9 female and 7 male volleyball players and the control group contained 9 female and 7 male students who were not involved in any sportive activity. The N75, P100, and N145 latency and amplitudes were measured before and after exercise. Intragroup comparison was made to evaluate the acute effects and intergroup comparison for the chronic effects of exercise. Significant differences were noted between athletes and the sedentary subjects in terms of pre-exercise left-N145 latencies and amplitudes and left -P100 amplitudes. Right-eye N145 latencies of inactive female subjects obtained before and after exercise were also statistically different. The results suggest that acute and habitual exercise affects the VEP responses independent from the body temperature and other physiological parameters. Small sized pre-exercise P100 amplitudes in the athletes can be attributed to the effect of rapid visual-activity-demanding sports on the central nervous system. Visual evoked potentials maybe used as neurophysiological criteria in defining the performance of an athlete.

Effects of epilepsy on autonomic nervous system and respiratory function tests.

We have investigated autonomic nervous system function during the interictal period in epileptic patients and the possible effects of autonomic dysfunction on respiratory functions. A total of 32 epileptic patients (23 generalized, 9 partial epilepsy) and 32 healthy volunteers were involved. Sympathetic skin response (SSR), for evaluating the sympathetic nervous system, and RR interval variation (RRIV) were measured at the beginning and third month of antiepileptic treatment, and respiratory function tests (RFTs) were performed. In patients with partial epilepsy, SSR latency in the upper extremity (1.3+/-0.2 s) was longer than that of controls (1.2+/-0.3 s) at baseline (P=0.05), and was significantly reduced (1.1+/-0.3 s) after treatment (P<0.05). RRIV values of patients with generalized epilepsy were statistically significantly lower than those of controls (P<0.01). However, deep breathing RRIV values (32.6+/-15.3%) of patients were lower than those (43.0+/-18.2%) of controls (P<0.05). Sympathetic dysfunction was determined in patients with partial epilepsy and parasympathetic dysfunction in patients with generalized epilepsy. No abnormality was observed on RFTs for both patients with partial epilepsy and patients with generalized epilepsy.

Sociodemographic and clinical characteristics of patients with conversion disorder in Eastern Turkey

Abstract.Background: Conversion disorder (CD) is a common disease and its importance still continues in Turkey and particularly in Eastern Turkey. The aim of this study is to examine sociodemographic and clinical characteristics of CD. Method: Among 198 consecutive patients having CD diagnosed by structured DSM-III-R clinical interview, the psychosocial characteristics of the patients were clinically investigated. Results: The most common subtype of CD was non-epileptic seizure (NES) (41.4 %). The psychosocial stress factors were found in the initiation or at the last episode of the disorder (88.9 %). The most prominent problem related with primary support group was traumatic event (37.9 %) followed by problems associated with migration and related economical problems which are the most important problems of the study area. The incidence of depressive disorders was high in patients with CD, and the histrionic personality disorder was the most prominent personality pathology among the patients. Direct referral to psychiatry clinics appeared to be low (12.1 %). Conclusion: Our findings have shown that traumatic events may have an important role in the occurrence, severity and duration of CD, and most of the patients seek help from religious healers. The study has also revealed that lower education level and socioeconomic and sociocultural problems may play a role in the occurrence of the disorder as well as regarding its course.

The evaluation of cognitive functions with P300 test for chronic obstructive pulmonary disease patients in attack and stable period.

OBJECTIVES Hypoxia, in chronic obstructive pulmonary disease (COPD), leads to a decrease in cerebral perfusion and an impairment of some cognitive abilities. We aimed to investigate the relation between arterial blood gas analysis (ABA) and pulmonary function test (PFT) parameters with cognitive function of COPD patients during attack and stable period. PATIENTS AND METHODS ABA, PFT, P300 tests of 30 patients in stabilized period and 30 patients in attack, and 17 healthy controls were evaluated. RESULTS When both COPD groups and controls were compared, it was seen that latency of P300 was shorter in the control group (p<0.001), but there was no difference between COPD groups (p>0.05). P300 amplitude measures were lower in both COPD groups than control group, but it was not statistically significant (p>0.05). When we compared the measures of attack group, we saw that arterial oxygen tension (PaO(2)), arterial oxygen saturation (SaO(2)), forced expiratory volume in 1s (FEV(1)), FEV(1)/forced vital capacity (FVC) values increased (p<0.001), and P300 latency shortened (p<0.05) in attack group during stable period. P300 latency correlated significantly with PaO(2) (r=-0.557, p<0.001), SaO(2) (r=-0.424, p<0.001), FEV(1) (r=-0.441, p<0.001), FEV(1)/FVC (r=-0.477, p<0.001) values, and age (r=0.329, p<0.05). P300 amplitude is only correlated with PaO(2) (r=0.236, p<0.05). CONCLUSION Longer latency of P300 appears to be an expected sequel of COPD. P300 test can be considered as a potential objective marker of cognitive impairment.

Effects of exercise on somatosensory-evoked potentials.

The aim of this study was to investigate the effect of acute and regular exercise on somatosensory-evoked potentials (SEP). The study group was designed as 9 female and 7 male volleyball players, and the control group as 9 female and 7 male sedentary students. The P1 and P2 latency and amplitude values were measured by tibial nerve stimulation on both lower extremities in the study groups before and after exercise on a treadmill. Intra-group comparison was made to evaluate the acute effects of exercise, and inter-group comparison for the chronic effects of it. Statistically significant difference was determined in pre-exercise right P2 amplitudes and post-exercise left P2 latencies of female volleyball players and sedentary girls. There was significant difference between only the pre-exercise left P2 latency when comparison was made between the sportsmen and sedentary male subject groups. There were significant differences between the pre-exercise left P1 and P2 latency values of sportswomen and right P2 amplitudes of sedentary female subjects. There was no significant difference between left P2 latency values of sportsmen and sedentary male subjects. In conclusion, it was determined that acute and regular exercise shortened the latency of sensory-evoked potentials while decreasing their amplitudes. When evaluating the sensory-evoked potentials in electrophysiology laboratories, the exercise capacity and physical activity levels of the subjects should be considered.

Investigation of Vaspin Level in Patients with Acute Ischemic Stroke

BACKGROUND Cerebrovascular event is a clinical condition characterized by symptoms and findings pertaining to loss of focal cerebral function because of the vascular causes. Atherosclerosis has a forefront role in the pathogenesis of stroke. Inflammation has an important place in the formation of atherogenesis and atherosclerosis. Visceral adipose tissue-derived serpin (vaspin) is a new adipokine, which is identified recently, associated with obesity and diabetes and also has a proinflammatory characteristic. This study was intended to investigate the relation between vaspin and stroke and stroke and other risk factors. METHODS A total of 50 patients with stroke, as 28 men (56%) and 22 women (44%), and a total of 50 healthy individuals, as 25 men (50%) and 25 women (50%), were enrolled in the study. Blood samples were taken in the acute period (first 48 hours) in the patient group, and serum vaspin levels were measured. Vaspin level was also measured in the control group. The association of vaspin with the lipid parameters, gender, and the severity of internal carotid artery (ICA) stenosis in the patient group was evaluated. Stenotic plaques in ICA were classified as normal, mild (stenosis under 50%), moderate (stenosis 50%-69%), severe (stenosis 70%-99% to preocclusion), and occlusion. RESULTS No statistically significant difference was found between 2 groups in terms of age and gender (P > .05). Vaspin levels were found to be significantly higher in the patient group (164.73 ± 153.76 ng/mL) compared with the control group (116.21 ± 34.60 ng/mL) (P < .05). However, no relation was established between vaspin level and the severity of ICA stenosis. CONCLUSIONS Vaspin levels have been shown to increase in acute ischemic stroke patients. The increased vaspin levels may vary depending on several factors in acute period of ischemic stroke.

Spinal subarachnoid hemorrhage complicating oral anticoagulant therapy.

Spinal subarachnoid hemorrhage (SAH) is rare clinical entity possible owing to the diluting and fibrinolytic effects of cerebrospinal fluid (CSF). When it occurs, it is most commonly encountered in the thoracic segment of the subarachnoid space. We present a case of a 50-year-old man who sustained spinal SAH in the cervical and thoracic segments related to anticoagulant therapy. He progressed to significant neurological deficit since he was inoperable, an observation that supports the need for decompression surgery. We should be aware of potential hematomyelia should a patient on anticoagulant therapy develop neurological symptoms localized to the spinal cord. When available, magnetic resonance (MR) imaging is the modality of choice to diagnose and follow-up spinal SAH.