Ufuk Emre

Psychiatric comorbidity in medication overuse headache patients with pre-existing headache type of episodic tension-type headache

Background: Medication overuse headache (MOH) mostly evolves from migraine and episodic tension‐type headache (ETTH). Chronic tension‐type headache (CTTH) is another headache type that evolves over time from ETTH. It is well known that psychiatric comorbidity is high in MOH patients.

Evaluation of common mutations in the Mediterranean fever gene in Multiple Sclerosis patients: Is it a susceptibility gene?

PURPOSE Multiple Sclerosis (MS) is a disease of the central nervous system characterized by multiple areas of inflammation and demyelination in the white matter of the brain and spinal cord. MEFV gene, which is the main factor in familial Mediterranean fever, is an intracellular regulator of inflammation. This study was designed to determine if known mutations in pyrin domain of MEFV gene are involved in MS and associated with MS morbidity. METHODS Fifty-three patients with MS and 66 healthy subjects, who were all Turkish, were included in this study. Five pyrin gene mutations (E148Q, M680I, M694V, M694I and V726A) were detected in the patients and controls by using the PRONTO FMF Basic Kit according to the manufacturers instructions. RESULTS Pyrin gene mutations were found in 20 of the 53 MS patients (38%) and in seven of the 66 healthy subjects (11%). The frequency of total pyrin domain mutations was significantly higher in the MS patients than in the healthy subjects (p<0.0001). The frequencies of M694V, E148Q and V726A mutations were significantly higher in the patients than in the healthy subjects (p=0.02, p=0.013, p=0.004 respectively). The mean time to reach EDSS score 3.0 was earlier in the patients with MEFV gene mutation (p=0.02) and the relapse rate was slightly higher among the MS patients carrying MEFV gene mutation (p=0.04). CONCLUSION The results of this study supported the hypothesis that MS patients with MEFV mutation seem to have the susceptibility to develop a more progressive disease. Moreover, these data suggest that MEFV mutations may increase the risk of MS development.

Unnoticed dysautonomic syndrome of the face: Harlequin syndrome

Harlequin sign and harlequin syndrome, which are used interchangeably in the literature, are characterized by sudden onset of hemifacial sweating and flushing, induced by exercise and heat. Hemifacial sweating and flushing with normal ocular sympathetic innervation, known as harlequin syndrome, is rarely associated with tonic pupils, parasympathetic oculomotor lesion and pre- or postganglionic sudomotor sympathetic deficit. In the literature, hemifacial sweating and flushing in patients with apparently abnormal ocular sympathetic innervation has been defined as harlequin sign. To date, a few reports of excessive hemifacial sweating and flushing in structural lesion have been documented. Herein, we report five patients with excessive hemifacial sweating and flushing, two of whom had a syrinx. In presenting the patients, we have attempted to distinguish harlequin syndrome from harlequin sign. With this in mind, Case 1 can be described as harlequin syndrome resembling Ross syndrome, Case 2 as harlequin syndrome with normal ocular sympathetic innervation, Case 3 as harlequin sign with congenital Horner syndrome, Case 4 as harlequin sign with sympathetic and parasympathetic denervation sensitivity, and Case 5 as harlequin syndrome associated with occult sympathetic denervation sensitivity. These cases are discussed together with a review of the literature.

Low Income and Education Levels May Cause Medication Overuse and Chronicity in Migraine Patients

Background.—Frequent analgesic drug intake, especially in migraine patients, may induce the risk of medication overuse headache (MOH). The various conditions that may affect the development and the features of MOH have not been determined yet.

Peripheral nervous system involvement in patients with Behçet disease.

Background:Central nervous system involvement in Behçet disease (BD) has been well documented, but studies evaluating peripheral nervous system involvement are relatively uncommon. Objective:The aim of this study is to evaluate the frequency and characteristics of peripheral nervous system involvement in BD. Methods:Sixty-nine BD patients (36 women, 33 men) followed by neurology and dermatology outpatient clinics between October 1999 and October 2004 were enrolled into study. A careful history was taken and physical and neurologic examinations were done. All other medical causes that may be related to peripheral nervous system involvement were studied. All patients underwent nerve conduction studies using standard electrophysiologic procedures. Results:Peripheral nervous system involvement was detected in 13 patients. There was no sign and symptom related to peripheral nervous system involvement in these patients. Causes other than BD were found in 5 patients with polyneuropathy. Asymptomatic delay in conduction velocities of the median nerves was detected in 3 patients. In 5 patients with clinically evident peripheral nerve involvement due to BD, 3 had sensorimotor and 2 had sensory axonal neuropathies. Conclusion:Axonal type polyneuropathy may be seen in BD patients. Peripheral involvement may be detected by electrophysiological examinations in asymptomatic BD patients.

Validity and reliability of Turkish translation of Migraine Disability Assessment (MIDAS) questionnaire in patients with migraine.

The Migraine Disability Assessment (MIDAS) questionnaire is a brief, self-administered questionnaire which is designed to quantify headache-related disability in a 3-month period. We have tested a Turkish version of the MIDAS questionnaire in 60 migraine patients. Sixty of the clinically diagnosed migraine headache sufferers were enrolled in a 90-day diary study and completed the MIDAS questionnaire in the first, 21st and the last day of the 90-day study. The scores taken from the diary and the scores of the MIDAS taken at different times were evaluated by the correlation tests of both Pearson and Spearman for each question and total scores. Cronbachs scores taken from the diary and taken from the test of the MIDAS which was applied at different times were evaluated. Pearsons correlation on the responses in the initial MIDAS questions was between 0.44 (reduced productivity in household chores) and 0.78 (missed work or school days). The correlation of the Spearman was similar to the Pearson values. As a result, we found that the overall score of the MIDAS has a good reliability and its internal consistency is also good (Cronbachs α 0.87). These findings support the use of the MIDAS questionnaire as a clinical and research tool on Turkish patients.

Hand Splinting for Poststroke Spasticity: A Randomized Controlled Trial

Abstract Purpose: To determine the effect of volar and dorsal splinting on the spasticity of the wrist flexor muscles in patients who had stroke. Method: Thirty-nine subjects were prospectively randomized to use a dorsal or volar splint or no splint (control group). All the patients underwent home-based exercise program, and the experimental groups used either dorsal or volar hand splints according to their distribution. The primary outcome measure was spasticity assessed clinically by the Modified Ashworth Scale (MAS) and electrophysiologically by H latency and Hmax:Mmax ratio of flexor carpi radialis. Secondary outcome measure was passive range of motion (PROM) of wrist extension. Results: Spasticity parameters (MAS, H latency, Hmax:Mmax ratio) and wrist PROM were not significantly different among the groups. Conclusions: This study failed to demonstrate any statistically significant difference in spasticity or in wrist PROM of both the volar and dorsal splint groups. These splints could be recommended as part of an integrative approach without expecting a major clinical effect rather than as an alternative to other treatment.

Sleep disorders in Behçet's disease, and their relationship with fatigue and quality of life.

Behçet’s disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet’s disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet’s disease. Fifty‐one patients with Behçet’s disease without any neurological involvement were interviewed regarding sleep disorders. Twenty‐one subjects with no sleep complaints were included as the control group. Sleep‐related complaints were evaluated in a face‐to‐face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea–hypopnea index were higher than in controls (P < 0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet’s disease.

UNUSUAL COMBINATION OF REVERSIBLE SPLENIAL LESION AND MENINGITIS-RETENTION SYNDROME IN ASEPTIC MENINGOMYELITIS

A circumscribed lesion in the splenium of the corpus callosum (SCC) is a rare finding, and little is known about its etiology.1 Reversible splenial lesions in the CC are observed in various diseases (Table 1).1–33 Table 1 Etiologies of isolated reversible lesions in the splenium of the corpus callosum The combination of aseptic meningitis or meningomyelitis and acute urinary retention has been recently acknowledged and, in the absence of accompanying abnormalities, has been referred to as meningitis-retention syndrome (MRS) by some Japanese authors.34,35 Only a few reports of MRS are available to date.34–38 Although the term meningitis was used, some of the reported cases could in fact have been myelitis in view of the presence of fecal incontinence and brisk reflexes.34 To the best of our knowledge, the combination of neurogenic bladder and reversible splenial lesion due to meningomyelitis or to any other condition has not been reported previously. Here, we report a case of an isolated reversible splenial lesion and a neurogenic bladder in a woman with aseptic meningomyelitis.

Upper Limb Tendinitis and entrapment neuropathy in coal miners

BACKGROUND It is well-known that work-related upper limb musculoskeletal disorders, particularly tendinitis and nerve entrapment, remain a difficult and costly problem in industrialized countries. The aim of this study was to evaluate tendinitis and entrapment neuropathy of the upper limb of Turkish coal miners. METHODS Eighty coal miners and 43 age-matched clerical workers were included in the study. The evaluation procedures included collection of personal and clinical data, physical examination and bilateral electrodiagnostic testing. Subjects were examined to diagnose tendinitis and nerve entrapment of the upper limb. Bilateral median and ulnar nerves conduction tests were performed on all subjects. Data were collected between August 2011 and December 2011. RESULTS There were 33 subjects with lateral epicondylitis, 10 with medial epicondylitis, and 22 with De Quervains disease among the coal miners. There were seven subjects with lateral epicondylitis, eight with medial epicondylitis, and four with De Quervains disease in the control group. The two groups significantly differed in the prevalences of lateral epicondylitis and De Quervains disease (P = 0.024 and P =0.029, respectively). Sixteen subjects in the coal miners and 12 subjects in the controls had carpal tunnel syndrome (P = 0.66). Thirty-seven subjects in the coal miners had ulnar neuropathy of the elbow (UNE), while four subjects in the controls had UNE; this difference was statistically significant (P < 0.001). CONCLUSION Lateral epicondylitis, De Quervain disease, and ulnar neuropathy are common work-related upper limb disorders among coal miners.