Utku Ogan Akyildiz

Epidemiology and clinical characteristics of migraine among school children in the Menderes region.

The goal of this study was to collect and analyse information on the prevalence of childhood migraine and disability due to migraine in primary school children of 4th to 8th grades (ages ranging from 9 to 17 years) in the Aydin urban area. A cross-sectional school-based study was conducted between March and June 2004. There were 76 333 children of 4th to 8th grades in primary schools in Aydin. Nearly 10% of this population (7721 out of 76 333) was evaluated by a multistage clustered sampling procedure. Four questionnaire forms were applied to each child by a study neurologist during class time. Questionnaire A consisted of a single question, ‘Have you ever had a headache?’. To those who responded ‘yes’, questionnaire B was applied as a second step, which consisted of eight questions. Diagnosis of migraine headache was made according to International Classification of Headache Disorders 2004. Migraine disability was measured with questionnaire C, which was originally the Pediatric Migraine Disability Assessment (PedMIDAS). Migraine history, previous migraine diagnosis and pain intensity were measured with questionnaire D. According to questionnaire A, 79.6% of boys and 87.1% of girls suffered from headaches. The prevalence of migraine was 9.7% (7.8% in boys, 11.7% in girls) according to questionnaire B. The male:female ratio was 1:1.5. Total PedMIDAS score was 9.94 ± 8.41 days in boys and 11.50 ± 12.28 days in girls. Only 1.9% of the children had previously been diagnosed with migraine. The average migraine headache history was 2.48 ± 1.18 years in girls and 2.57 ± 1.18 years in boys. Although migraine is a common health problem among school children in Aydin, it is mostly still under-recognized.

Carpal tunnel syndrome and ulnar neuropathy at the wrist: comorbid disease or not?

Summary The aim of this study was to elucidate the possible association between carpal tunnel syndrome (CTS) and ulnar neuropathy at the wrist because of the contradictory results of previous studies. Thus, a retrospective case–control study was arranged with an electromyographic database including patients between 2003 and 2009. Patients were selected according to initial diagnosis and the examiners criteria, and data were plotted by computer. One thousand nine hundred twenty-four patients were evaluated for CTS and 1,024 patients for diabetic CTS or diabetic polyneuropathy. CTS and ulnar neuropathy co-occurrence and CTS alone at the wrist was found in 54/404, 19/50, 20/27 patients, respectively. Logistic regression analysis revealed that having CTS was associated with a doubled risk of ulnar neuropathy at the wrist in both idiopathic CTS and diabetic CTS groups but not in diabetic polyneuropathy. Being male and of advanced age were other risk factors for ulnar neuropathy at the wrist. Correlation analysis (age and sex were controlled) revealed decreased but significant correlations between median and ulnar sensory amplitudes in CTS cases in all groups.

Evoked potentials and disability in multiple sclerosis: A different perspective to a neglected method.

UNLABELLED Evoked potentials and disability in multiple sclerosis: a different perspective to a neglected method. OBJECTIVE Because evoked potentials (EP) are reflections of the functional integrity of sensory-motor systems, they are expected to reflect the abnormality in patients with disabilities and handicaps and also be in correlation with scales. This assumption was tested. METHODS Patients with multiple sclerosis (MS) and myelopathy (M) and normal controls were investigated by EP, Multiple Sclerosis Walking Scale-12, timed 25-foot walk test and extended disability status scale (EDSS). EP results were converted to ordinal values, and correlations of these values with scales were calculated. Sensitivity and specificity analysis of EP parameters was also performed. RESULTS Total EP scores revealed high rates of abnormality in both groups, but MS revealed a different correlation pattern from M. The SEP+MEP summed score showed high sensitivity and specificity for MS and this was also correlated with the MS-related disability-ambulation scales including EDSS. The most specific parameter was the minimum M latency in the MEP study. CONCLUSIONS Four extremity recordings of EP with the use of more parameters than usual and ordinal expression of results seem to be benefical in MS. Although this study was cross sectional in nature, results indicated that EP might be useful in clinical follow up.

Acute motor-sensory axonal neuropathy with hyperreflexia in Guillain-Barré syndrome.

Guillain-Barré syndrome is an acute inflammatory autoimmune polyradiculoneuritis. Progressive motor weakness and areflexia are essential for its diagnosis. Hyperreflexia has rarely been reported in the early healing period of Guillain-Barré syndrome following Campylobacter jejuni infection in patients with acute motor axonal neuropathy with antiganglioside antibody positivity. In this study, we report a 12-year-old girl presenting with complaints of inability to walk, numbness in hands and feet, and hyperactive deep tendon reflexes since the onset of the clinical picture, diagnosed with acute motor-sensory axonal neuropathy type of Guillain-Barré syndrome.

The relationship between temperament and depression in Parkinson's disease patients under dopaminergic treatment: Temperament, depression in Parkinson's

The risk factors for depressive symptoms in patients with Parkinsons disease (PD) under dopaminergic drug treatment are unclear. In this study, we examined whether some temperament traits are related to the presence of comorbid depression in PD patients, independent of the characteristics of illness and drug treatment.

Screening Fabry’s disease in chronic kidney disease patients not on dialysis: a multicenter study

Abstract Objectives: Fabrys disease is an X-linked inherited, rare, progressive, lysosomal storage disorder, affecting multiple organs due to the deficient activity of α-galactosidase A (α-Gal A) enzyme. The prevalence has been reported to be 0.15–1% in hemodialysis patients; however, the information on the prevalence in chronic kidney disease not on dialysis is lacking. This study aimed to determine the prevalence of Fabry’s disease in chronic kidney disease. Methods: The patients older than 18 years, enclosing KDIGO 2012 chronic kidney disease definitions, not on dialysis, were enrolled. Dried blood spots on Guthrie papers were used to analyze α-Gal A enzyme and genetic analysis was performed in individuals with enzyme activity ≤1.2 μmol/L/h. Results: A total of 1453 chronic kidney disease patients not on dialysis from seven clinics in Turkey were screened. The mean age of the study population was 59.3 ± 15.9 years. 45.6% of patients were female. The creatinine clearance of 77.3% of patients was below 60 mL/min/1.73 m2, 8.4% had proteinuria, and 2.5% had isolated microscopic hematuria. The mean value of patients’ α-Gal A enzyme was detected as 2.93 ± 1.92 μmol/L/h. 152 patients had low levels of α-Gal A enzyme activity (≤1.2 μmol/L/h). In mutation analysis, A143T and D313Y variants were disclosed in three male patients. The prevalence of Fabry’s disease in chronic kidney disease not on dialysis was found to be 0.2% (0.4% in male, 0.0% in female). Conclusion: Fabry’s disease should be considered in the differential diagnosis of chronic kidney disease with unknown etiology even in the absence of symptoms and signs suggestive of Fabry’s disease.

Psychotic symptoms following sildenafil and panax ginseng treatment in a pramipexole induced manic patient with Parkinson’s Disease: a case report -

Objective: Parkinson’s disease (PD) is a chronic neurodegenerative disease characterized by movement abnormalities. It is well known that dopamine agonists are associated with several psychiatric symptoms during the treatment of PD. Pramipexole with a great affinity for D3 receptors, particularly on mesolimbic regions may induce manic or psychotic symptoms by stimulating mesolimbic dopaminergic neurons, as well as the other dopaminergic agonists. Panax Ginseng is a herbal drug which also contains sildenafil and acts through central cholinergic and dopaminergic mechanisms. Sildenafil is a widely used drug for the treatment of erectile dysfunction and predominantly inhibits the breakdown of PDE5 and thus increases the amount of cGMP. Comorbid psychiatric symptoms should be taken into consideration when different classes of drugs were used during the treatment of PD. Methods: We here report on a male patient who first developed mania while receiving pramipexole, and some additional pscyhotic symptoms further emerged when panax ginseng and sildenafil were added to the ongoing pramipexole treatment because of erectile dysfunctions. Results: A patient with PD was admitted to psychiatry unit with some psychotic symptoms after taking sildenafil and panax ginseng for erectile dysfunction in combination with pramipexole. Conclusion: This case demonstrated that some drugs which were not primarily used in the treatment of PD, might have caused some severe psychotic symptoms due to underlying pschopathology of PD, drug interaction, and the action of mechanisms of the dopaminergic drugs.

Combined surgical treatment for severe sleep apnoea, to improve BiPAP compliance

Positive airway pressure (PAP) devices are used in the treatment of obstructive sleep apnoea syndrome (OSAS). In cases of PAP failure, many different surgical methods can be used for the treatment. The authors present an unusual case of a patient with Bi-level PAP (BiPAP)-intolerant severe OSAS who was treated with combined surgical methods. A 55-year-old man was treated with BiPAP due to OSAS; he was admitted to the clinic with nose stuffiness, respiratory distress and BiPAP adherence with tolerance and compliance problems. Septal deviation, concha hypertrophy, lateral pharyngeal band hypertrophy and Thornwaldt cyst were determined in the examination. Combined surgical methods were administered. The patients apnoea hypopnoea index (AHI) was 72.8 in diagnostic polysomnography. Preoperative AHI was 7.3 and postoperative AHI was 2.3 while using BiPAP and, after the surgery, the BiPAP intolerance was eliminated. The authors suggest that a combination of different surgical methods would be an adjuvant treatment to increase BiPAP compliance.