Sevki Sahin

Coagulation status and biochemical and inflammatory markers in multiple sclerosis.

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system and is the most common cause of neurologic disability in young adults. In this study, the coagulation status and biochemical and non-specific inflammatory markers in patients with MS were investigated. Plasma prothrombin time, activated partial thrombin time, fibrinogen, D-dimer, serum high sensitive C-reactive protein, homocysteine, blood urea nitrogen, creatinine, calcium, total protein, albumin, total cholesterol, vitamin B12, folate levels and erythrocyte sedimentation rate were measured in 42 patients with MS and 31 healthy subjects as a control group. There was a positive correlation between homocysteine and D-dimer levels (r=0.84, p<0.01). However, there was no significant correlation between homocysteine, vitamin B12 (r=0.18) and folate (r=0.23) levels. Serum total protein, albumin and calcium levels of MS patients were lower than the control group. There are some alterations in the coagulation and biochemical status in MS patients. These findings may contribute to better understanding of the etiopathogenesis and clinical characteristics of this disease.

Cutaneous drug eruptions by current antiepileptics: case reports and alternative treatment options.

Serious cutaneous drug eruptions due to antiepileptics have been defined for many drugs like carbamazepine, diphenylhydantoin, phenytoin and valproate. In recent years, adverse cutaneous reactions due to the current antiepileptic drugs have also been reported. In this paper, two cases are presented: a 48-year-old female receiving gabapentin for postherpetic neuralgia who developed leukocytoclastic vasculitis after 8 weeks and a 23-year-old male receiving lamotrigine for epileptic seizures who developed toxic epidermal necrolysis (TEN) in 15 days. Alternative therapy approaches with practical suggestions are also discussed.

Increased plasma homocysteine levels in multiple sclerosis

Sir The pathophysiology of multiple sclerosis (MS) is strongly related to inflammation. In recent years, it has become particularly important to investigate the relationship between the immune and neurohormonal systems [1]. Homocysteine (Hcy) is a neurotoxic amino acid, which accumulates in various neurodegenerative disorders, including stroke and dementia [1,2]. In the current medical literature, only a few authors have reported that there is an elevation of Hcy levels in MS [2 4]. For this reason, we aimed to investigate the plasma Hcy levels in a sample of Turkish MS patients. We studied 30 consecutive patients with relapsing-remitting (RR) MS (12 females, aged 22 48 years, mean: 309/6.3; and 18 males, aged 22 46 years, mean: 429/4.2) with MS, and 21 healthy subjects (10 females and 11 males, aged 21 46 years, mean 309/5.7) as a control group. The diagnosis of MS was based on the McDonald criteria. Duration of the disease from the first symptom was mean 99/5 years. None of the patients had a new attack in the previous six months and no patient was on current steroid or other immunomodulatory therapy. Patients who had major depressive illness, current septic illness, epilepsy and other inflammatory diseases were not included in the study. None of the patients and controls had received vitamin B12 and folate supplementation for at least eight months. This study was approved by the Institutional Ethics Committee, and written informed consent was obtained from each subject. Vitamin B12 and folate levels were measured in serum samples and Hcy levels were measured in plasma samples. The Hcy levels were detected by fluorescence polarisation immunoassay (IMX; Abbot, USA). Vitamin B12 and folate levels were measured by immunoassay chemiluminescence (Access-Beckman-Coulter, USA). Results were statistically analysed by using ordinary ANOVA, and a P value B/0.05 was regarded as statistically significant. The non-parametric Spearman rank correlation test was used for the regression analysis to compare the individual parameters with each other. We found that there was no correlation between Hcy and vitamin B12 (r /0.18) and folate (r /0.23) levels. Vitamin B12 and folate levels were not statistically different for both genders in the patient groups when compared to control groups (P /0.66). Hcy was significantly higher in both male and female MS patients when compared to the control groups. Mean and standard deviation (SD) values of biochemical parameters, including Hcy, vitamin B12 and folic acid, from male subjects are shown in Table 1, and from female subjects are shown in Table 2. The mean Expanded Disability Status Scale (EDSS) score of the patients was 3.169/2.9, and there was no correlation between EDSS score and Hcy (r /0.20), vitamin B12 (r /0.18), folate (r / 0.14) levels. In our study, serum vitamin B12 and folate levels, being in the reference limits according to the age and sex groups, were not correlated with the Hcy levels. However, there are some other studies reporting low correlation between vitamin B12 and Hcy levels [2,5]. We studied 12 female and 18 male consecutive patients with RRMS. Turk Boru et al . have investigated the prevalence of MS in the district of Maltepe, Turkey in a previous study, and they found that high prevalence rates in females (average 2-fold), similar to like other countries [6]. The excess number of male patients in our current study seems to be completely incidental. In the present study, mean age of male MS patients was 10 years more than the male control group. Although Hcy levels are known to vary with age, especially due to the age-related changes in vitamin B12 [7], the difference between the patient and the control group was so high, it cannot be explained solely by age. Moreover, statistically there was no difference between the two groups in vitamin B12 levels. We did not find a correlation between Hcy levels and EDSS scores. This finding is concordant with the study of Ramsaransing et al . [4]. Our results demonstrate that Hcy levels in MS patients of both genders were significantly higher than healthy subjects. The multisystem toxicity of Hcy is attributed to its spontaneous chemical reaction with many biologically important

Determination of nerve conduction abnormalities in patients with impaired glucose tolerance

Recent studies have shown that impaired glucose tolerance (IGT) is associated with dysfunction in the peripheral and autonomic nerves. The aim of this study was to determine the electrophysiological abnormalities of IGT. To determine electrophysiological abnormality in the large sensorimotor and sudomotor autonomic nerves with IGT patients, 43 patients and 34 healthy subjects have been studied. Subjective neuropathy symptoms, neurological examination and the electrophysiological findings were evaluated. When conduction of large somatic fibers only was evaluated, the ratio of electrophysiological abnormality was found to be 21%. In addition, where sympathetic skin response was evaluated the sudomotor autonomic abnormality ratio was 28% in upper extremities, 53% in lower extremities, and 16% in upper and lower extremities together. The percentages of abnormal electrophysiological parameters in different motor and sensory nerves were 39.5% in the peroneal motor nerve, 20.9% in the median motor and sural sensory nerves, 18.6% in the median sensory nerve, 16.3% in the tibial motor nerve, 14% in the ulnar sensory nerve, and 2.3% in the ulnar motor nerve. While distal motor latency was the most frequent abnormal parameter in the median and tibial motor nerves, the amplitude changes in the peroneal and ulnar motor nerves were also prominent. In sensory evaluation, the onset latency in the median-ulnar sensory nerves and the amplitude in the sural sensory nerve were found to be evident abnormalities.

An unusual cause of cardioembolic stroke: isolated left ventricular noncompaction.

Background:Isolated left ventricular noncompaction (ILVNC) is a rare congenital condition that is the result of an intrauterine developmental arrest, which stops the compaction of the loose myocardial fiber meshwork of the left ventricle. This condition is recognized by an excessively prominent trabecular meshwork and deep intertrabecular recesses of the left ventricle. Although these intertrabecular recesses are prone to thrombus formation, with resulting embolic sequelae, the literature describes only 1 adult case of a stroke caused by ILVNC. Case Report:We describe a case of cerebral cardioembolism in a 33-year-old man due to ILVNC. Because of echocardiography (ECHO) findings in this case, cardiac magnetic resonance imaging (cMRI) was performed, which allowed a definite diagnosis to be obtained. Conclusion:This case should highlight the importance of performing cMRI especially in younger patients with embolic stroke, if the ECHO suggests a suspected myocardial disorder.

Neurophysiological and morphological responses to treatment with acetyl-l-carnitine in a sciatic nerve injury model: preliminary data

We investigated the effects of acetyl-L-carnitine (ALCAR) on the recovery of sciatic nerve injuries in rats. Sprague Dawley rats were randomized to two groups: ALCAR treated (for 14 days) and control. Each group was divided into three subgroups: distal transection, proximal transection, and grafted. Distal latencies, amplitudes, and motor nerve conduction velocities were measured. In the third month, biopsies were taken and examined under light microscopy. Electrophysiological measurements demonstrated that regeneration occurred earlier and was better in the ALCAR group, particularly in the distal transection subgroup. Better results were obtained in the distal transection subgroup in terms of axonal regeneration compared with the proximal transection and grafted subgroups because the regenerating segment was shorter. ALCAR enhanced the quality of neural recovery at the different levels and in different types of repair, and led to a decline in nerve death.

What happens in the other eye? Blink reflex alterations in contralateral side after facial palsy.

Alterations in blink reflex excitability may occur in the contralateral side (CLS) and in the symptomatic side after peripheral facial palsy (PFP). In this study, the alterations of blink reflex in CLS were evaluated in cases with PFP who showed “three different types” of recovery. For this purpose, the R2 response area and recovery curve of the blink reflex were evaluated. The study included 51 patients suffering from PFP and 20 age- and sex-matched healthy controls. Cases with PFP were divided into three groups: patients with PFP with partially cured and accompanied by synkinesis (postfacial syndrome), patients with PFP with residual weakness, and patients who suffered from recurrent PFP. All three groups’ R2 values of CLS were compared with the values of controls and patients who had synkinesis. The CLS of all three groups’ R2 area values were found to be significantly higher when compared with controls. These values were found to be highest in patients who suffered from recurrent PFP. Hyperexcitability occurs in CLS after PFP and this is highest in patients who suffer from recurrent PFP. It suggested that the contralateral reorganization caused by peripheral nerve damage correlates with the severity of the lesion and the recurrence of axon damage enhances the excitability of the reflex cycle, which affects the contralateral facial nucleus.

Eye-related visual hallucinations: consider 'Charles Bonnet syndrome'.

The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.

Effects of Anthropometric Factors on Nerve Conduction An Electrophysiologic Study of Feet

BACKGROUND Previous studies have shown that age, sex, and body mass index (BMI) affect the amplitude of sensory nerve action potentials (SNAPs), but the total effects of multiple factors and the most prominently affected nerves have not been elucidated. We systematically investigated the effects of these factors on motor and sensory nerves of the feet. METHODS The amplitude, latency, and conduction velocity of compound muscle action potential (CMAP), SNAP, and mixed nerve action potential (MNAP) of the posterior tibial, calcaneal, distal posterior tibial, medial and lateral plantar, and sural nerves were measured in 30 healthy individuals (60 feet). The effects of age, sex, height, and BMI on each nerve were estimated by correlation and linear regression analyses. RESULTS The amplitude of posterior tibial CMAP and distal posterior tibial MNAP decreased with BMI. The amplitude of medial plantar MNAP and sural SNAP decreased with height. The conduction velocity of calcaneal SNAP and distal posterior tibial and lateral plantar MNAP decreased with height and BMI. The conduction velocity of medial plantar MNAP decreased only with height. The latency of posterior tibial CMAP increased with age and height. The latency of lateral plantar CMAP and calcaneal SNAP increased with height. The latency of lateral plantar MNAP increased with BMI. CONCLUSIONS The effects of age, sex, height, and BMI in foot nerve conduction studies are not identical. Height and BMI were shown to strongly affect motor, sensory, and mixed nerve conduction. Further investigations are needed.

Balance in essential tremor during tandem gait: Is the first mis-step an important finding?

Essential tremor (ET) is the most commonly diagnosed movement disorder. ET may cause substantial loss of motor skills and balance with advanced age. We compared abnormalities in tandem gait with daily activity and Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) scores in 90 ET patients. All patients performed a 15-step tandem three times. The mean of first mis-steps was accepted as the tandem index (TI). The mean age was 61.4 ± 17 years; the mean duration of tremor was 6.7 ± 4 years; and there were 36 men and 54 women. There was no significant difference for age or sex between patients and controls. Head (24.6%), jaw (5.5%), voice (11%), and tongue tremors (1.5%) were identified in ET patients. Rest (2.5%), postural (95%), and kinetic tremors (54%) were detected in the upper extremities. Postural tremor was found in the lower extremities of 5%. The mean TI was 8.3 ± 4 (median, 8) in ET patients, and 10.6 ± 3.9 (median, 10) in controls (p=0.04). Correlation analysis of TI and FTMTRS scores showed tandem gait was significantly correlated with age, total tremor score, postural and kinetic extremity tremor, writing, drawing, pouring, feeding, and working scores. Linear regression showed a significant effect of age and FTMTRS score on TI. The decrease in balance control is apparent with advancing age. Balance disorders were more pronounced in ET patients. Although first mis-step in tandem gait is not as detailed as dynamic balance tests, it can be a simple method for detecting balance disorders.