Tahir Kurtulus Yoldas

Comparison of neutrophil–lymphocyte ratio (NLR) in Parkinson’s disease subtypes

It has been hypothesized that chronic inflammation may play an important role in the development and progression of the neurodegeneration of Idiopathic Parkinson’s disease (IPD). Neutrophil–lymphocyte ratio (NLR) is a marker that indicates the peripheral inflammation. There is only one study regarding NLR and IPD. In this study, we assessed to investigate NLR in patients with IPD, comparing the results with controls and to determine whether there is a difference in NLR levels in subgroups of IPD (akinetic-rigid and tremor-dominant) differ in their levels of NLR. Medical records of 200 IPD patients and 60 controls reviewed retrospectively. Forty-six IPD patients met the inclusion criteria. NLR was calculated by dividing neutrophil count to lymphocyte count. Thirteen akinetic-rigid (AR-IPD) and thirty-three tremor-dominant (TD-IPD) patients’ and controls results were compared. There was not a statistically difference between the NLR levels of IPD patients, controls, and AR-IPD and TD-IPD patients. This result suggests that cerebral inflammation is in the forefront in the development of neurodegeneration in IPD, and that more evidence is needed for the role of peripheral inflammation in the development progression of disease.

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.

Demansı olmayan Parkinson hastalarında işitsel olaya bağlı potansiyel (P300) ile kognitif fonksiyonların değerlendirilmesi

Evaluation of cognitive functions in Parkinson’s patients without dementia with auditory event related potential (P300) Objective: Idiopathic Parkinson’s disease is a clinical situation characterized by akinesia, rigidity, and tremor, and results from the degeneration of the dopaminergic nervous system. As the disease progresses over time, depression, cognitive dysfunction and alterations in cognitive functions are added to the movement disorder at varying rates. The P300 component is a useful parameter for cognitive processing studies on PD patients, as it is independent from motor skills. The current study aimed to show the effects of the PD on the cognitive functions by evaluating the cognitive functions of IPD patients without dementia with the help of an event related potential component, P300 test. Methods: Thirty-eight patients (25 males and 13 females), ranging in age between 40 and 80 years (mean: 58.8 years), were included to the study and the control group consisted of 39 volunteers (25 males and 14 females), ranging in age between 44 and 84 years (mean: 63.5 years), who did not have a history of cerebrovascular disease, dementia, or depression. The participants were informed about the content and the practice of the study, and informed consent forms were obtained. Neurological examination, standardized mini mental test, Unified Parkinson’s Disease Rating Scale (UPDRS), Hoehn and Yahr Scale, Hamilton Depression Rating Scale (HAM-D), and P300 tests were performed on the patients. Standardized mini mental test (SMMT), HAM-D, and P300 tests were performed in the control group. Results: P300 latencies in Parkinson’s patients were significantly prolonged compared to the control group. There was a decrease in P300 amplitude values with increasing HAM-D. Conclusion: P300 latency reflects the rate of stimuli classification by mental process, attention, and cognitive processing. Even if no dementia is present in PD patients, there is a dysfunction in these functions, and it can be demonstrated by the P300 test, which is independent from motor skills.

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.

Overactive bladder symptoms in patients with multiple sclerosis: Frequency, severity, diagnosis and treatment

Objective: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. Design: Survey study. Setting: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. Participants: Consecutive MS patients scheduled for outpatient follow-up (n = 309). Intervention: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. Results: The mean age ± SD was 39.3 ± 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P < 0.001), upper urinary tract assessment by ultrasound (P < 0.001), urodynamic assessment (P < 0.001), admitted to a doctor for urinary symptoms (P < 0.001), and current or past catheter use (P = 0.002). Conclusion: Urgency was the most common urinary symptom followed by frequency, urge incontinence and nocturia in MS patients. The patients with lower OABSS had detailed urological assessments less frequently than the patients with higher OABSS.

Assessment of both serum S-100B protein and neuropeptide-Y levels in childhood breath-holding spells

OBJECTIVE Breath-holding spells are common paroxysmal events in children. Although the spells have a benign prognosis in the long term, they may be complicated by loss of consciousness, tonic-clonic movements, and occasionally seizures. Hence, this study aimed to measure the levels of serum S-100B proteins and neuropeptide-Y in the blood of children who experience breath-holding spells. METHODS The study groups consisted of 45 patients (13 females, 32 males) with breath-holding spells and a control group of 32 healthy individuals (12 females, 20 males). The serum S-100B levels were measured using commercially available ELISA kits. The neuropeptide-Y levels in the serum were measured with RayBio® Human/Mouse/Rat Neuropeptide Y ELISA kits. RESULTS The mean serum S-100B protein level of the breath-holding spells group was 56.38 ± 13.26 pg/mL, and of the control group, 48.53 ± 16.77 pg/mL. The mean neuropeptide-Y level was 62.29 ± 13.89 pg/mL in the breath-holding spells group and 58.24 ± 12.30 pg/mL in the control group. There were significant differences between the groups with respect to serum S-100B protein levels (p = 0.025), while there was no statistically significant difference in neuropeptide-Y levels between the breath-holding spells group and the control group (p = 0.192). CONCLUSIONS The findings of this study suggest that frequent and lengthy breath-holding may lead to the development of neuronal metabolic dysfunction or neuronal damage which is most likely related to hypoxia. In light of these findings, future studies should be conducted using biochemical and radiological imaging techniques to support these results.

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.

Assessment of voiding dysfunction in Parkinson's disease: Reliability and validity of the Turkish version of the Danish Prostate Symptom Score.

To investigate the reliability and validity of the Turkish version of the Danish Prostate Symptom Score (Dan‐PSS) questionnaire in patients with Parkinsons disease (PD) and to compare the burden of LUTS (Lower urinary tract symptoms) in men and women.