Serpil Demirci

Assessment of outcome of carpal tunnel syndrome: a comparison of electrophysiological findings and a self-administered Boston questionnaire.

The relationship between nerve conduction studies and the self-administered Boston Questionnaire that measures the severity of symptoms and functional status in carpal tunnel syndrome was assessed in 44 patients with idiopathic carpal tunnel syndrome. The patients were examined preoperatively and 3 and 6 months postoperatively. Although both the clinical outcome and electrophysiological findings improved significantly after surgery, we observed no correlation between improvements in nerve conduction and the questionnaire scores.

Comparison of open carpal tunnel release and local steroid treatment outcomes in idiopathic carpal tunnel syndrome

Abstract. To compare the efficacy of local steroid injection and open carpal tunnel release, a symptom and functional status questionnaire (Boston Questionnaire) and sensory and motor nerve conduction studies were performed in 90 patients with electrophysiologically proven idiopathic carpal tunnel syndrome, of whom 44 were treated surgically and 46 by two-dose steroid injection. Electrophysiologic studies and the Boston Questionnaire were applied before and at the 3rd and 6th months after treatment. Both groups showed significant improvement at first follow-up. The surgically treated group showed a significant and further improvement of symptoms and conduction values between the 3rd- and 6th-month evaluations, whereas no significant change was observed in the patient group treated by steroid injection. By the end of follow-up, 5% of the hands in the open carpal tunnel release (OCTR) group and 13% of the hands in the local steroid injection (LSIG) group showed electrophysiological worsening, and 5% of the hands in the OCTR group and 22% of the hands in the LSIG group showed symptomatic worsening. Our results show that steroid injection provides an improvement comparable with that from surgical release of the median nerve at a 3-month interval. However, this improvement is not long-lasting.

The auditory event related potentials in episodic and chronic pain sufferers

To examine the cognitive processing differences in chronic and episodic pain sufferers, auditory event‐related potentials (P300 or P3) were recorded in two consecutive trials from 23 chronic lower back pain patients, 22 episodic tension‐type headache sufferers, and from 23 age‐and sex‐matched healthy persons. P3 latency and amplitude showed no difference between groups at first trial. Considering P3 latency habituation, healthy controls and episodic tension‐type headache sufferers showed a significant change of P3 latency whereas lower back pain sufferers failed. Comparing the amount of habituation lower back pain sufferers stood clearly apart from healthy controls. Although there was a remarkable increase of P3 latency in episodic tension‐type headache sufferers, the amount of habituation was not statistically different than it was in lower back pain sufferers. Significant P3 amplitude habituation was observed only in healthy controls. Actually, episodic tension‐type headache sufferers also showed some degree of habituation, which was not statistically remarkable. The amount of amplitude habituation was not different between groups. No correlation was observed between P3 habituation and age, disease duration and symptom severity. These results may point to a disturbed attentional processing in chronic pain sufferers. Our findings suggest that in spite of a similar cortical information processing, the neurocognitive networks related with decision making and memory processing seem to work differently in chronic pain sufferers from those in episodic pain sufferers in repeating tasks. Taking into consideration the reported P3 habituation abnormalities in chronic migraine patients we can say that not the location of pain but rather its temporal pattern may have a role in disturbed attentional processing.

The clinical significance of the neutrophil-to-lymphocyte ratio in multiple sclerosis

Multiple sclerosis (MS) is one of the main chronic inflammatory diseases of the central nervous system that causes functional disability in young people. The aim of this study was to investigate the neutrophil-to-lymphocyte ratio (NLR) in patients with MS and the relationship between the NLR and the severity of the disease. One hundred and two MS patients (31 patients were in relapse; 71 patients were in remission) and 56 healthy controls were included. Complete blood counts as well as demographic and clinical data from MS patients were evaluated retrospectively. The NLRs were calculated for all participants and were compared; the cut-off value was also determined for the NLR and Expanded Disability Status Scale (EDSS). MS patients had a significantly higher NLR (p < 0.001) than the control group. The NLR levels were significantly higher in patients who were in relapse than patients in remission (p = 0.039). The cut-off value for the NLR to predict an MS diagnosis and activity were determined to be 2.04 and 3.90, respectively. The NLRs were directly correlated with erythrocyte sedimentation rate levels (r = 0.795, p < 0.001). Logistic regression analysis with dichotomous EDSS score showed that a high NLR was an independent predictor of the progression of disability. The NLR may be a biomarker that has simple, quick, inexpensive and reproducible properties in MS to predict patients prognosis.

Riboflavin and Vitamin E Increase Brain Calcium and Antioxidants, and Microsomal Calcium-ATP-ase Values in Rat Headache Models Induced by Glyceryl Trinitrate

The essential use of riboflavin is the prevention of migraine headaches, although its effect on migraines is considered to be associated with the increased mitochondrial energy metabolism. Oxidative stress is also important in migraine pathophysiology. Vitamin E is a strong antioxidant in nature and its analgesic effect is not completely clear in migraines. The current study aimed to investigate the effects of glyceryl trinitrate (GTN)-sourced exogen nitric oxide (NO), in particular, and also riboflavin and/or vitamin E on involved in the headache model induced via GTN-sourced exogen NO on oxidative stress, total brain calcium levels, and microsomal membrane Ca2+-ATPase levels. GTN infusion is a reliable method to provoke migraine-like headaches in experimental animals and humans. GTN resulted in a significant increase in brain cortex and microsomal lipid peroxidation levels although brain calcium, vitamin A, vitamin C, and vitamin E, and brain microsomal-reduced glutathione (GSH), glutathione peroxidase (GSH-Px), and plasma-membrane Ca2+-ATPase values decreased through GTN. The lipid peroxidation, GSH, vitamin A, β-carotene, vitamin C, and vitamin E, and calcium concentrations, GSH-Px, and the Ca2+-ATPase activities were increased both by riboflavin and vitamin E treatments. Brain calcium and vitamin A concentrations increased through riboflavin only. In conclusion, riboflavin and vitamin E had a protective effect on the GTN-induced brain injury by inhibiting free radical production, regulation of calcium-dependent processes, and supporting the antioxidant redox system. However, the effects of vitamin E on the values seem more important than in riboflavin.

The Serum Levels of Resistin and Its Relationship with Other Proinflammatory Cytokines in Patients with Alzheimer’s Disease

Objective The present study aims to analyze the levels of resistin, tumor necrosis factor alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-18, and C-reactive protein (CRP) in patients with Alzheimer’s disease (AD) and also investigate a potential relationship between resistin levels and TNF-α, IL-1β, IL-6, IL-18, and CRP levels in patients with AD. Methods The study included fifty patients with AD and 30 healthy controls with normal cognitive functions. The serum resistin, TNF-α, IL-1β, IL-6, IL-18, and CRP levels were assessed. We performed a Mini-Mental State Examination (MMSE) to evaluate the general cognitive performance. Results The mean serum resistin, IL-1β, IL-18, and TNF-α levels were significantly higher in patients with AD compared with the controls (p=0.026, p=0.002, p=0.003, and p=0.038, respectively). The IL-6 and CRP levels did not differ between the groups (p=0.874 and p=0.941). The resistin levels were positively correlated with the levels of CRP and IL-18 (r=0.526, p<0.001; r=0.402, p=0.004, respectively). MMSE scores and inflammatory markers were not correlated (p>0.05 for all). Conclusion Serum resistin levels were significantly increased and correlated with some inflammatory markers in AD patients, suggesting that resistin might play a role in the inflammatory process of AD.

The effect of cigarette smoking on retinal nerve fiber layer thickness in patients with migraine

Abstract Context: Migraine is a frequent and disabling chronic neurological condition with complex pathophysiology. Both cigarette smoking and migraine may cause damage to the optic nerve. Objective: The primary objective of this study was to investigate the effect of cigarette smoking on retinal nerve fiber layer (RNFL) thickness in patients with migraine. Materials and methods: Eighty-four consecutive patients diagnosed with migraine (34 smokers and 50 nonsmokers) and 66 age- and gender-matched healthy non-smoker controls were enrolled for this observational cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography (OCT) and then RNFL thickness in patients with migraine who smoke was compared to nonsmoking patients with migraine and healthy subjects. Results: The average, superior, nasal and inferior RNFL thicknesses were significantly thinner in patients with migraine compared to the control group (p < 0.001, p = 0.02, p < 0.001 and p = 0.04, respectively). The average and inferior RNFL thicknesses were significantly reduced in smoker patients with migraine compared to the nonsmokers (p = 0.011, p = 0.045, respectively). Nonsmoker patients with migraine had significantly thinner average and nasal RNFL thicknesses than the control group (p = 0.001, p = 0.001, respectively). Conclusion: Cigarette smoking may cause significant RNFL thinning in patients with migraine. OCT may be a feasible technique for determination of smoking-induced ocular damage in patients with migraine.

Is Retinal Nerve Fiber Layer Thickness Change Related to Headache Lateralization in Migraine

Purpose To evaluate retinal nerve fiber layer (RNFL) thickness in migraine patients with unilateral headache. Methods A total of 58 patients diagnosed with migraine headache consistently occurring on the same side and 58 age- and sex-matched healthy subjects were evaluated in this cross-sectional study. RNFL thickness was measured using spectral-domain optical coherence tomography, and the side with the headache was com-pared with the contralateral side as well as with the results of healthy subjects. Results The mean patient age was 33.05 ± 8.83 years, and that of the healthy subjects was 31.44 ± 8.64 years (p = 0.32). The mean duration of disease was 10.29 ± 9.03 years. The average and nasal RNFL thicknesses were significantly thinner on the side of headache and on the contralateral side compared to control eyes (p < 0.05, for all). Thinning was higher on the side of the headache compared to the contralateral side; however, this difference was not statistically significant. Conclusions The RNFL thicknesses were thinner on the side of the headache compared to the contralateral side in the migraine patients with unilateral headache, but this difference was not statistically significant.

Pheochromocytoma presenting with bithalamic infarction, dementia, and increased intraocular pressure.

The anatomic response to intravitreal bevacizumab injection in three patients with aggressive, posterior retinopathy of prematurity is described. In all cases, the worse eye was treated with a single intravitreal injection of 0.75 mg of bevacizumab as monotherapy or complementary to laser therapy. In 24 hours, all injected eyes showed regression of the tunica vasculosa lentis and iris vessel engorgement and disappearance of iris rigidity. In addition, plus disease and retinal proliferation began to regress. None of the eyes required additional treatment. Follow-up of up to 10 months

The Effect of Type D Personality on Quality of Life in Patients with Multiple Sclerosis

INTRODUCTION The Type D personality was reported as an important indicator of adverse clinical outcomes and quality of life in various diseases. The objective of this study was to investigate the relationships between the Type D personality and clinical features and the effect of Type D personality on quality of life in patients with multiple sclerosis (MS). METHODS Seventy-four patients with MS participated in this study. Clinical parameters of the patients were recorded and disability was assessed using the Expanded Disability Status Scale (EDSS). Patients were examined with the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Type D Scale (DS14), and 36-Item Short-Form Health Survey (SF-36). RESULTS BDI and BAI scores were significantly higher and mental subscale of the SF-36 scores were significantly lower in Type D compared to nonType D (p<0.001, p=0.001, and p<0.001, respectively). The total DS14 scores were found to be positively correlated with EDSS, BDI, and BAI and negatively correlated with SF-36 mental subscale (p=0.02, p<0.001, p<0.001, and p<0.001, respectively). Multivariate linear regression analysis indicated that the total DS14 score was independently associated with the mental component of SF-36 (p<0.001). CONCLUSION The Type D personality traits may worsen the quality of life, particularly the mental component, in patients with MS. Consequently, the assessment of MS patients by brief and valid DS14 may be valuable for clinical practice.