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Balal M, Demir T, Erdem M, Demirkiran M. Postural stability in blepharospasm: the effects of dual-tasking and botulinum toxin therapy. BMJ Neurol Open 2023; 5:e000403. [PMID: 36919159 PMCID: PMC10008225 DOI: 10.1136/bmjno-2023-000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
Background Blepharospasm is a focal dystonia that presents as involuntary, intermittent, continuous contractions of the eyelids. Abnormal eyelid contractions in blepharospasm are expected to cause balance problems, but there is no clear information. Objective This study was designed to evaluate the effect of blepharospasm on postural stability (PS) in patients with blepharospasm. As a secondary endpoint, the efficacy of botulinum toxin type-A (BoNT-A) treatment on static balance in patients with blepharospasm was investigated. Methods Twenty-four patients with blepharospasm receiving regular BoNT-A injections and 20 age-matched and sex-matched healthy controls were included in the study. All subjects were evaluated on a static posturography force platform performing four tasks (eyes open (EO), eyes closed (EC), tandem Romberg (TR) and verbal cognitive task (COGT)). Evaluations of the patients were repeated 4 weeks after the injection. Results Pretreatment lateral and anterior-posterior sways, sway area and velocities of the sways were significantly higher in patients than controls during the COGT and TR (p<0.05). In the patient group, with EO and EC, a few parameters improved after BoNT-A injection. On the other hand, in the TR and COGT, most of the sway parameters and velocities improved significantly after treatment (p<0.05). Conclusions Blepharospasm may cause functional blindness in patients. This study demonstrated that PS worsens in patients with blepharospasm under dual-task conditions. BoNT-A injection treats the disease itself and, thus, markedly improves PS under dual-task conditions in blepharospasm.
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Affiliation(s)
- Mehmet Balal
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
| | - Turgay Demir
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
| | - Miray Erdem
- City Hospital of Neurology, University of Health Sciences, Adana, Turkey
| | - Meltem Demirkiran
- Department of Neurology, Çukurova Üniversitesi Tıp Fakültesi, Sarıçam, Turkey
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Sevim S, Demirkiran M, Terzi M, Yüceyar N, Taşdelen B, Idiman E, Kürtüncü M, Boz C, Tuncel D, Karabudak R, Siva A, Özcan A, Neyal M, Göksel BK, Gazaloğlu GB, Balal M, Şen S, Baklan MA, Gündüz T, Tuncer A, Uygunoğlu U. Coexistence of restless legs syndrome and multiple sclerosis aggravates anxiety and depression. Arq Neuropsiquiatr 2022; 80:168-172. [PMID: 35195221 DOI: 10.1590/0004-282x-anp-2020-0400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/11/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS. OBJECTIVE To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey. METHODS Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D). RESULTS Out of the 1,068 participants, 173 (16.2%) were found to have RLS [RLS(+)] and 895 (83.8%) did not [RLS(-)]. The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p<0.001 for all variables). CONCLUSIONS According to our data, the presence of RLS in PwMS may increase the occurrence of both anxiety and depression symptoms. Awareness and treatment of RLS in PwMS could possibly reduce the symptoms of psychiatric comorbidities originating from RLS.
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Affiliation(s)
- Serhan Sevim
- Mersin University, School of Medicine, Department of Neurology, Mersin, Turkey
| | | | - Murat Terzi
- Ondokuz Mayıs University, Department of Neurology, Samsun, Turkey
| | - Nur Yüceyar
- Ege University, Department of Neurology, İzmir, Turkey
| | - Bahar Taşdelen
- Mersin University, Department of Biostatistics, Mersin, Turkey
| | - Egemen Idiman
- Dokuz Eylül University, Department of Neurology, İzmir, Turkey
| | - Murat Kürtüncü
- İstanbul University, Department of Neurology, İstanbul, Turkey
| | - Cavit Boz
- Karadeniz Technical University, Department of Neurology, Trabzon, Turkey
| | - Deniz Tuncel
- Sütçü İmam University, Department of Neurology, Kahramanmaraş, Turkey
| | - Rana Karabudak
- Hacettepe University, Department of Neurology, Ankara, Turkey
| | - Aksel Siva
- İstanbul University, Cerrahpaşa School of Medicine, Department of Neurology, İstanbul, Turkey
| | | | - Münife Neyal
- Sanko University, Department of Neurology, Gaziantep, Turkey
| | | | | | - Mehmet Balal
- Çukurova University, Department of Neurology, Adana, Turkey
| | - Sedat Şen
- Ondokuz Mayıs University, Department of Neurology, Samsun, Turkey
| | | | - Tuncay Gündüz
- İstanbul University, Department of Neurology, İstanbul, Turkey
| | - Aslı Tuncer
- Hacettepe University, Department of Neurology, Ankara, Turkey
| | - Uğur Uygunoğlu
- İstanbul University, Cerrahpaşa School of Medicine, Department of Neurology, İstanbul, Turkey
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Sen S, Tuncer A, Ozakbas S, Uzunkopru C, Baba C, Demir S, Beckmann Y, Gumus H, Arslan G, Kilic AK, Altintas A, Yuceyar N, Turan OF, Tutuncu M, Terzi M, Acar P, Bunul SD, Balci BP, Bir LS, Koseoglu M, Mungan S, Gunduz T, Dogan IG, Kotan D, Uygunoglu U, Ekmekci O, Demirkiran M, Kamisli O, Kabay SC, Tamam Y, Omerhoca S, Sevim S, Guler S, Kurtuncu M, Efendi H, Karabudak R, Siva A. The Turkish experience of COVID-19 infection in people with NMOSD and MOGAD: A milder course? Mult Scler Relat Disord 2021; 58:103399. [PMID: 35216782 PMCID: PMC8655726 DOI: 10.1016/j.msard.2021.103399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/30/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022]
Abstract
Background COVID-19 is a multisystemic infection with variables consequences depending on individual and comorbid conditions. The course and outcomes of COVID-19 during neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) are not clearly known. Objective/methods The aim of this study was to examine the features and outcomes of COVID-19 infection in NMOSD and MOGAD patients. The patients' demographic and clinical factors, disease modifying treatment (DMT) used and disease information of COVID-19 infection were recorded. Conditions leading to hospitalization and severe exposure to COVID-19 infection were also analyzed. Results The study included 63 patients from 25 centers. Thirty-two patients (50.8%) belong to AQP-4 seropositive group, 13 (20.6%) and 18 (28.6%) were in MOG-positive and double-seronegative groups, respectively. Risk factors for severe COVID-19 infection and hospitalization were advanced age, high disability level and the presence of comorbid disease. Disease severity was found to be high in double-seronegative NMOSD and low in MOGAD patients. No statistically significant effect of DMTs on disease severity and hospitalization was found. Conclusion In NMOSD and MOGAD patients, advanced age, high disability and presence of comorbid disease pose risks for severe COVID-19 infection. There was no direct significant effect of DMTs for COVID-19 infection.
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Affiliation(s)
- Sedat Sen
- Ondokuz Mayis University School of Medicine Samsun, Turkey.
| | - Asli Tuncer
- Hacettepe University School of Medicine Ankara, Turkey
| | | | | | - Cavid Baba
- Dokuz Eylul University School of Medicine Izmir, Turkey
| | - Serkan Demir
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Yesim Beckmann
- Katip Celebi University School of Medicine Izmir, Turkey
| | - Haluk Gumus
- Selcuk University School of Medicine Konya, Turkey
| | - Gokhan Arslan
- Ondokuz Mayis University School of Medicine Samsun, Turkey
| | - Ahmet Kasim Kilic
- Kartal Dr. Lutfi Kirdar Research and Training Hospital, Istanbul, Turkey
| | | | - Nur Yuceyar
- Ege University School of Medicine, Izmir, Turkey
| | | | - Melih Tutuncu
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey
| | - Murat Terzi
- Ondokuz Mayis University School of Medicine Samsun, Turkey
| | - Pinar Acar
- Hacettepe University School of Medicine Ankara, Turkey
| | | | | | | | - Mesrure Koseoglu
- Bakırkoy Prof. Dr. Mashar Osman Research and Training Hospital, Istanbul, Turkey
| | - Semra Mungan
- Ankara City Hospital, Neurology Clinic, Ankara, Turkey
| | - Tuncay Gunduz
- Istanbul University Istanbul School of Medicine Istanbul, Turkey
| | - Ipek Gungor Dogan
- Sancaktepe Sehit Prof. Dr. Ilhan Varank Research and Training Hospital, Istanbul, Turkey
| | - Dilcan Kotan
- Sakarya Research and Training Hospital, Sakarya, Turkey
| | - Ugur Uygunoglu
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey
| | | | | | | | | | - Yusuf Tamam
- Dicle University School of Medicine Diyarbakir, Turkey
| | - Sami Omerhoca
- Bagcilar Research and Training Hospital, Istanbul, Turkey
| | - Serhan Sevim
- Mersin University School of Medicine, Mersin, Turkey
| | - Sibel Guler
- Trakya University School of Medicine, Edirne, Turkey
| | - Murat Kurtuncu
- Istanbul University Istanbul School of Medicine Istanbul, Turkey
| | - Husnu Efendi
- Kocaeli University School of Medicine Kocaeli, Turkey
| | | | - Aksel Siva
- Istanbul University Cerrahpasa School of Medicine Istanbul, Turkey.
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Eryilmaz IE, Erer S, Zarifoglu M, Egeli U, Karakus E, Yurdacan B, Cecener G, Tunca B, Colakoglu B, Bora Tokcaer A, Saka E, Demirkiran M, Akbostanci C, Dogu O, Kaleagasi H, Kenangil G, Cakmur R, Elibol B. Contribution of functional dopamine D2 and D3 receptor variants to motor and non-motor symptoms of early onset Parkinson's disease. Clin Neurol Neurosurg 2020; 199:106257. [PMID: 33039854 DOI: 10.1016/j.clineuro.2020.106257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023]
Abstract
In the present study, we focused on investigating the contribution of functional dopamine D2 and D3 receptor variants to motor and/or non-motor symptoms of early onset Parkinson's disease (EOPD). Three functional single nucleotide polymorphisms (SNPs), DRD3 rs6280, DRD2 rs2283265 and DRD2 rs1076560, were genotyped in 128 Turkish EOPD patients and then, statistical analysis was conducted for the potential impacts of SNPs on clinical parameters. All three SNPs were found to be statistically significant in terms of PD-related pain: DRD3 [rs6280; risk allele "T" for pain; p = 0.031; odds ratio (OR)=4.25], DRD2 [rs2283265; risk allele "A" for pain; p = 0.001; OR=8.47] and, DRD2 [rs1076560; risk allele "A" for pain; p = 0.022; OR=4.58]. Additionally, bilateral disease [p = 0.011; OR=5.10] and gender [risk group "female"; p = 0.003; OR=8.53] were also identified as significant univariate risk factors for PD-related pain. Based on logistic regression analysis conducted with the significant univariate risk factors, this the first report to clarify that a female patient with bilateral PD and DRD2 rs2283265 polymorphism has a significant risk for PD-related pain. Our findings might contribute to improve life quality by offering treatment options for pain in PD patients with these clinical and genetic features.
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Affiliation(s)
- Isil Ezgi Eryilmaz
- Bursa Uludag University, Faculty of Medicine, Medical Biology Department, Bursa, Turkey
| | - Sevda Erer
- Bursa Uludag University, Faculty of Medicine, Neurology Department, Bursa, Turkey.
| | - Mehmet Zarifoglu
- Bursa Uludag University, Faculty of Medicine, Neurology Department, Bursa, Turkey
| | - Unal Egeli
- Bursa Uludag University, Faculty of Medicine, Medical Biology Department, Bursa, Turkey
| | - Ece Karakus
- Bursa Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Beste Yurdacan
- Bursa Uludag University, Faculty of Medicine, Medical Biology Department, Bursa, Turkey
| | - Gulsah Cecener
- Bursa Uludag University, Faculty of Medicine, Medical Biology Department, Bursa, Turkey
| | - Berrin Tunca
- Bursa Uludag University, Faculty of Medicine, Medical Biology Department, Bursa, Turkey
| | - Beril Colakoglu
- Dokuz Eylul University, Faculty of Medicine, Neurology Department, Izmir, Turkey
| | - Ayse Bora Tokcaer
- Gazi University, Faculty of Medicine, Neurology Department, Ankara, Turkey
| | - Esen Saka
- Hacettepe University, Faculty of Medicine, Neurology Department, Ankara, Turkey
| | - Meltem Demirkiran
- Cukurova University, Faculty of Medicine, Neurology Department, Adana, Turkey
| | - Cenk Akbostanci
- Ankara University, Faculty of Medicine, Neurology Department, Ankara, Turkey
| | - Okan Dogu
- Mersin University, Faculty of Medicine, Neurology Department, Mersin, Turkey
| | - Hakan Kaleagasi
- Mersin University, Faculty of Medicine, Neurology Department, Mersin, Turkey
| | - Gulay Kenangil
- BAU Medical Park Goztepe, Neurology Department, İstanbul, Turkey
| | - Raif Cakmur
- Dokuz Eylul University, Faculty of Medicine, Neurology Department, Izmir, Turkey
| | - Bulent Elibol
- Hacettepe University, Faculty of Medicine, Neurology Department, Ankara, Turkey
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5
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Demir T, Aslan K, Demirkiran M. Evaluation of postural balance in patients with obstructive sleep apnoea syndrome. Neurol Neurochir Pol 2019; 54:83-89. [PMID: 31793660 DOI: 10.5603/pjnns.a2019.0059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/08/2019] [Accepted: 11/05/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with obstructive sleep apnoea syndrome (OSAS) can be more prone to accidents due to excessive daytime sleepiness which can lead to attention deficits and thereby cause balance problems. One of the tests evaluating postural balance is static posturography (SPG). In this study, we aimed to evaluate postural balance with SPG in OSAS patients. METHODS Patients who were referred to a sleep disorders outpatient clinic of a tertiary health care centre with snoring, daytime sleepiness or witnessed apnoea were enrolled consecutively in this cross-sectional study. They were grouped as the OSAS group and the control group according to the apnoea-hypopnoea index. Posturographic analyses were carried out in all subjects on a SPG platform under five different conditions: eyes open (EO), eyes closed (EC), head rotated to left (HL), head rotated to right (HR), and tandem Romberg. RESULTS A total of 95 patients and 23 controls were included in the study. In EO conditions, there was no difference between the OSAS group and the control group in any of the posturographic parameters. In EC conditions, change in lateral sway was significantly higher in the OSAS group which also correlated negatively with SaO2(min). HR conditions caused an i ncrease in anterior-posterior (A-P) sway velocity, and HL conditions led to an increase in change in lateral and A-P sways, sway area, and sway area velocity in the OSAS group. CONCLUSIONS Our findings suggest that postural balance in OSAS patients is impaired even in the very first hours of the day, and that the severity of the disease has an impact on postural balance.
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Affiliation(s)
- Turgay Demir
- Cukurova University Facultyof Health Science, Cukurova University Balcalı Kampus Sarıcam, 01330 ADANA, Turkey.
| | - Kezban Aslan
- Cukurova University Facultyof Health Science, Cukurova University Balcalı Kampus Sarıcam, 01330 ADANA, Turkey
| | - Meltem Demirkiran
- Cukurova University Facultyof Health Science, Cukurova University Balcalı Kampus Sarıcam, 01330 ADANA, Turkey
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Eryilmaz IE, Cecener G, Erer S, Egeli U, Tunca B, Zarifoglu M, Elibol B, Bora Tokcaer A, Saka E, Demirkiran M, Akbostanci C, Dogu O, Colakoglu B, Kenangil G, Kaleagasi H. Epigenetic approach to early-onset Parkinson's disease: low methylation status of SNCA and PARK2 promoter regions. Neurol Res 2017; 39:965-972. [PMID: 28830306 DOI: 10.1080/01616412.2017.1368141] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and aim The effect of epigenetic modifications in the genes related to Parkinson's disease (PD) is still unclear. In the present study, we investigated methylation status of SNCA and PARK2 genes in patients with early-onset Parkinson's disease (EOPD). Materials and methods The promoter region methylation status of SNCA and PARK2 genes was evaluated by methylation specific-PCR (MSP) in 91 patients with EOPD and 52 healthy individuals. Results The methylation of SNCA and PARK2 promoter regions were significantly lower in EOPD patients compared to the control group (P = 0.013 and P = 0.03, respectively). We also found that the methylation status of the SNCA might be associated with positive family history of PD (P = 0.042). Conclusion Although it should be supported by further analysis, based on the results of the present study, the methylation status of SNCA and PARK2 genes might contribute to EOPD pathogenesis.
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Affiliation(s)
- Isil Ezgi Eryilmaz
- a Faculty of Medicine, Department of Medical Biology , Uludag University , Bursa , Turkey
| | - Gulsah Cecener
- a Faculty of Medicine, Department of Medical Biology , Uludag University , Bursa , Turkey
| | - Sevda Erer
- b Faculty of Medicine, Department of Neurology , Uludag University , Bursa , Turkey
| | - Unal Egeli
- a Faculty of Medicine, Department of Medical Biology , Uludag University , Bursa , Turkey
| | - Berrin Tunca
- a Faculty of Medicine, Department of Medical Biology , Uludag University , Bursa , Turkey
| | - Mehmet Zarifoglu
- a Faculty of Medicine, Department of Medical Biology , Uludag University , Bursa , Turkey
| | - Bulent Elibol
- c Faculty of Medicine, Department of Neurology , Hacettepe University , Ankara , Turkey
| | - Ayse Bora Tokcaer
- d Faculty of Medicine, Department of Neurology , Gazi University , Ankara , Turkey
| | - Esen Saka
- c Faculty of Medicine, Department of Neurology , Hacettepe University , Ankara , Turkey
| | - Meltem Demirkiran
- e Faculty of Medicine, Department of Neurology , Cukurova University , Adana , Turkey
| | - Cenk Akbostanci
- f Faculty of Medicine, Department of Neurology , Ankara University , Ankara , Turkey
| | - Okan Dogu
- g Faculty of Medicine, Department of Neurology , Mersin University , Mersin , Turkey
| | - Beril Colakoglu
- h Faculty of Medicine, Department of Neurology , Dokuz Eylul University , Izmir , Turkey
| | - Gulay Kenangil
- i Erenkoy Training and Research Hospital for Neurologic and Psychiatric Disease , Istanbul , Turkey
| | - Hakan Kaleagasi
- g Faculty of Medicine, Department of Neurology , Mersin University , Mersin , Turkey
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Abstract
Aphasia is a rare sign of multiple sclerosis (MS). Several different forms of aphasia have been reported in MS. We report, to our knowledge, the first case of a MS patient with crossed aphasia during an attack.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, School of Medicine, Cukurova University, Adana, Turkey.
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8
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Abstract
Objective Sexual dysfunction (SD) severely affects the quality of life in patients with multiple sclerosis (MS). The aim of this study is to investigate the type and frequency of sexual complaints in MS patients, to analyse their relationship to various clinical and psychosocial variables and to clarify the differences between MS patients with and without SD. Methods Thirty-five relapsing-remitting (RR), nine secondary progressive and seven primary progressive MS patients were included in this study. A structured face-to-face interview regarding sexual function and other physical problems which may interfere with sexual functioning was administered to each patient. They also filled out Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), which includes items for primary (direct physical), secondary (indirect physical) and tertiary (psychosocial) causes of SD. Disability, cognitive functions and psychological functioning were also evaluated. Results Forty-one patients (80.4%) reported primary SD; decreased libido was the most frequent complaint (80.5%). These patients were older and more disabled, however 39% had low disability scores. SD was a common problem for both men and women. Patients with RRMS were affected less in all items of primary SD. Several items of secondary SD-problems with memory and concentration, bladder symptoms, bowel symptoms-showed correlation with different items of primary SD; these were altered genital sensation, decreased libido, increased time for arousal, decreased lubrication/difficulties with erection. Total MSISQ-19 scores were correlated with disease duration, age, disability, disease course, Beck depression scale, temporary and long-standing anxiety and low level of education. Conclusion SD is an underestimated, common symptom of MS. It may occur in MS even in the absence of severe disability. Physicians’ awareness of this problem may help to bring about appropriate treatments and management, and improve the quality of life for these patients.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, School of Medicine, Cukurova University, Adana, Turkey.
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Esen E, Sizmaz S, Balal M, Yar K, Demirkiran M, Unal I, Demircan N. Evaluation of the Innermost Retinal Layers and Visual Evoked Potentials in Patients with Multiple Sclerosis. Curr Eye Res 2016; 41:1353-1358. [PMID: 26882356 DOI: 10.3109/02713683.2015.1119283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The present study was conducted to investigate alterations in the innermost layers of the retina using optical coherence tomography (OCT) and to assess potential associations of structural measures with functional markers in patients with Multiple Sclerosis (MS). MATERIALS AND METHODS Ninety-four eyes of 47 MS patients and 60 eyes of 30 healthy individuals were included in the study. All patients underwent complete ophthalmological examination and OCT imaging to analyze peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thickness. Visual evoked potentials (VEPs) and expanded disability status scale (EDSS) score were assessed for MS patients. RESULTS The average RNFL and GCIPL thicknesses were thinner in MS patients (86.2 ± 11.9 µm and 73.6 ± 9.7 µm, respectively) when compared with those of healthy controls (96.7 ± 8.2 µm and 85.9 ± 4.6 µm, respectively, p < 0.001 for both). Within MS patients, the average RNFL and GCIPL thicknesses were lower in eyes with a prior history of optic neuritis (MS ON) than in eyes with no optic neuritis history (MS non-ON) (p = 0.012 and p < 0.001, respectively). RNFL and GCIPL thicknesses were inversely correlated with VEP latency (r = -0.40, p < 0.001 and r = -0.36, p < 0.001, respectively) in MS patient eyes. There was a correlation between GCIPL thickness and VEP amplitude in eyes with previous ON history (r = 0.34, p = 0.035). No significant correlations were found between OCT measurements and EDSS score. CONCLUSIONS Innermost layers of the retina are highly affected by the pathophysiologic process in MS disease, manifesting as a reduction in RNFL and GCIPL thickness. The structural retinal changes show correlation with alterations in potentials showing the optic pathway function.
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Affiliation(s)
- Ebru Esen
- a Department of Ophthalmology, School of Medicine , Cukurova University , Adana , Turkey
| | - Selcuk Sizmaz
- a Department of Ophthalmology, School of Medicine , Cukurova University , Adana , Turkey
| | - Mehmet Balal
- b Department of Neurology, School of Medicine , Cukurova University , Adana , Turkey
| | - Kemal Yar
- a Department of Ophthalmology, School of Medicine , Cukurova University , Adana , Turkey
| | - Meltem Demirkiran
- b Department of Neurology, School of Medicine , Cukurova University , Adana , Turkey
| | - Ilker Unal
- c Department of Biostatistics, School of Medicine , Cukurova University , Adana , Turkey
| | - Nihal Demircan
- a Department of Ophthalmology, School of Medicine , Cukurova University , Adana , Turkey
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Esen E, Sizmaz S, Demir T, Demirkiran M, Unal I, Demircan N. Reply to the Comment by Yolcu et al. on Our Paper Entitled "Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography". Ophthalmologica 2016; 235:122. [PMID: 26727273 DOI: 10.1159/000442954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 11/26/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Ebru Esen
- Department of Ophthalmology, Cukurova University School of Medicine, Adana, Turkey
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Esen E, Sizmaz S, Demir T, Demirkiran M, Unal I, Demircan N. Evaluation of Choroidal Vascular Changes in Patients with Multiple Sclerosis Using Enhanced Depth Imaging Optical Coherence Tomography. Ophthalmologica 2015; 235:65-71. [PMID: 26485541 DOI: 10.1159/000441152] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/14/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the choroidal thickness in patients with multiple sclerosis (MS) using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS In this observational comparative study, 68 eyes of 34 MS patients and 60 eyes of 30 healthy subjects were evaluated. All participants underwent complete ophthalmologic examination and OCT scanning. Choroidal thickness measurements were performed at seven points. RESULTS The mean subfoveal choroidal thickness was reduced significantly in MS patients (310.71 ± 61.85 μm) versus healthy controls (364.85 ± 41.81 μm) (p < 0.001). The difference was also significant at all six measurement points (p < 0.001 for all). Choroidal thickness measurements revealed no significant difference between MS eyes with a prior optic neuritis (ON) history (MS ON) and those without ON history (MS non-ON). Subfoveal choroidal thickness did not correlate with retinal nerve fiber layer and Expanded Disability Status Scale score, but reduced choroidal thickness was associated with longer disease duration (r = -0.28, p = 0.019) in MS patients. CONCLUSION In MS patients, choroidal structural changes occur both in MS ON and MS non-ON eyes. The decreased choroidal thickness might provide evidence to support a potential role of vascular dysregulation in the pathophysiology of MS.
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Affiliation(s)
- Ebru Esen
- Department of Ophthalmology, Cukurova University School of Medicine, Adana, Turkey
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12
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Coskun Benlidayi I, Basaran S, Evlice A, Erdem M, Demirkiran M. Prevalence and risk factors of low bone mineral density in patients with multiple sclerosis. Acta Clin Belg 2015; 70:188-92. [PMID: 26103537 DOI: 10.1179/2295333715y.0000000002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine the prevalence and risk factors of low bone mineral density (BMD) in patients with multiple sclerosis (MS). METHODS Patients with MS who had undergone a BMD evaluation via dual-energy X-ray absorptiometry (DXA) between January 2010 and December 2013 were included in the study. Descriptive data, BMD values, and risk factors for osteoporosis along with the details regarding MS, such as age at onset, duration of disease, clinical type of MS, expanded disability status scale (EDSS) scores, and lifetime steroid intake were obtained from the medical record database and telephone interview. RESULTS The study group comprised 67 patients with a mean age of 41.1 ± 10.2 years. Of the patients, 20.9% revealed low BMD for chronological age. Vitamin D insufficiency (25(OH)D < 20 ng/ml) rate was 86.6%. Comorbidity and EDSS scores of patients with low BMD were significantly higher than those of the remaining patients (P = 0.000 and P = 0.015, respectively). Neck BMD was inversely correlated with comorbidity score, disease duration, relapse number, and lifetime steroid intake (r = - 0.270, r = - 0.263, r = - 0.359, and r = - 0.314, respectively). CONCLUSION The current study revealed that low BMD and vitamin D insufficiency were common in patients with MS. Longer disease duration, higher comorbidity score, and severe disability level led to lower BMD values. In conclusion, it is of paramount importance for clinicians to pay more attention on bone health in MS and to tailor preventative measures meticulously.
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13
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Evlice A, Demirkiran M, Aslan K, Bozdemir H. A Case of Cortical Multiple Sclerosis. Noro Psikiyatr Ars 2014; 51:408-409. [DOI: 10.5152/npa.2014.7641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 02/10/2014] [Indexed: 11/22/2022] Open
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15
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Abstract
The association between Amyotrophic Lateral Sclerosis or other Motor Neuron Diseases (MNDs) with Lymphoproliferative Disorders (LPDs) and plasma cell neoplasias (such as Hodgkin's or non-Hodgkin's lymphoma, Waldenstrom's macroglobulinemia, multiple myeloma, chronic lymphocytic leukemia) has been described. It is not clear whether LPDs play a role in the pathogenesis of MND; however it is possible that patients might have antibodies against motor neurons. An association between motor neuron disease and Multiple myeloma (MM) is rarely reported in the literature. This article reports a case of a 75-year-old male with MM and MND. Interestingly, the patient was in complete remission for MM when he was diagnosed as MND and he died due to progressive MND.
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Affiliation(s)
- Filiz Koc
- Department of Neurology, Cukurova University, Faculty of Medical, Adana, Turkey.
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16
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Demirkiran M, özeren A, Bozdemir H. Letter to the Editor. Mult Scler 2006. [DOI: 10.1191/135248506ms1354xx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- M Demirkiran
- Department of Neurology, School of Medicine, Ç ukurova University, Adana, Turkey
| | - A özeren
- Department of Neurology, School of Medicine, çukurova University, Adana, Turkey
| | - H Bozdemir
- Department of Neurology, School of Medicine, Ç ukurova University, Adana, Turkey
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17
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Abstract
Global aphasia is an acquired language disorder characterized by severe impairments in all modalities of language. The specific sites of injury commonly include Wernike's and Broca's areas and result from large strokes--particularly those involving the internal carotid or middle cerebral arteries. Rarely, deep subcortical lesions may cause global aphasia. We present three cases with global aphasia due to a more rare cause: left thalamic hemorrhage. Their common feature was the large size of the hemorrhage and its extension to the third ventricule. HMPAO-SPECT in one of the cases revealed ipsilateral subcortical, frontotemporal cortical and right frontal cortical hypoperfusion. Left thalamic hemorrhage should be considered in the differential diagnosis of global aphasia.
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Affiliation(s)
- Ali Ozeren
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey
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18
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Abstract
We report on the development of transient parkinsonism after progesterone injection in a pregnant patient with a risk of abortion. Etiological possibilities are discussed, including pregnancy itself, possible toxic effects of the dead fetus, and progesterone injection. Progesterone-induced parkinsonism seems the most likely diagnosis in this case.
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Affiliation(s)
- Meltem Demirkiran
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey.
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19
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Eraksoy M, Kurtuncu M, Akman-Demir G, Kilinc M, Gedizlioglu M, Mirza M, Anlar O, Kutlu C, Demirkiran M, Idrisoglu HA, Compston A, Sawcer S. A whole genome screen for linkage in Turkish multiple sclerosis. J Neuroimmunol 2004; 143:17-24. [PMID: 14575909 DOI: 10.1016/j.jneuroim.2003.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Factors exerting recessive effects on susceptibility to complex traits are expected to be over-represented in communities having a higher frequency of consanguineous marriage. Multiple sclerosis, a typical complex trait, is relatively common in Turkey where cultural factors also determine a high rate of consanguineous marriage. Previous genetic studies of multiple sclerosis in Turkey have been confined to the search for associations with candidate genes. In order to exploit the special genetic features of the Turkish population, we performed a whole genome screen for linkage in 43 Turkish multiplex families employing 392 microsatellite markers. Two genomic regions where maximum lod score (MLS) values were suggestive of linkage were identified (chromosomes 13q and 18q23) along with a further 14 regions of potential linkage. Parametric analysis of these data using a recessive model, appropriate for populations with a high frequency of consanguinity, increased the LOD scores in four regions.
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Affiliation(s)
- M Eraksoy
- Department of Neurology, Instanbul Faculty of Medicine, Capa, Istanbul, Turkey.
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20
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Erkek B, Tuzuner A, Genc V, Demirkiran M, Balcy´ D, Demirer S, Aydintug S, Akin M, Ciftci O, Sonyurek P, Gungor E. The differences of CRP and prealbumin levels before and after major abdominal surgery according to nutritional routes. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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21
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Demirer S, Gungor E, Tuzuner A, Aydintug S, Demirkiran M, Genc V, Balcy´ D, Erkek B, Sonyurek P, Akin M. The comparison of standard enteral and immune-nutrition in patients with larynx cancer: A randomized prospective study. Clin Nutr 2003. [DOI: 10.1016/s0261-5614(03)80237-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Bozdemir H, Sarica Y, Demirkiran M. The effects of cold stress test on vasomotor tonus in normal controls. Neurol India 2002; 50:531-4. [PMID: 12577120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
Plethsymographic recordings are used to evaluate changes in peripheral vascular tonus. Twenty-six volunteers (15 men, 11 women) with a mean age 31 years were included in this study. Plethsymographic recordings were done both at baseline and +40C temperatures bilaterally. Significant reductions in systemic blood flow were noted with different maneuvers. Reactive hyperemia occurring after ischemia was local, however local reduction in blood flow after cold test was systemic. As the local temperature increased, the blood flow parameters normalized, too. In normal controls these values normalized in 20 minutes. The changes in vasomotor tonus due to cold test demostrated a parallel pattern.
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Affiliation(s)
- H Bozdemir
- Department of Neurology, Cukurova University Scholl of Medicine, 01330-Adana, Turkey.
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23
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Jankovic J, Demirkiran M. Classification of paroxysmal dyskinesias and ataxias. Adv Neurol 2002; 89:387-400. [PMID: 11968463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
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Abstract
OBJECTIVES The aim of this study was to define the symptoms and signs of suspected vascular parkinsonism (VP) which is still a debatable concept. MATERIAL AND METHODS Patients with parkinsonism were grouped into patients with suspected VP and Parkinson's disease (PD) after other causes for secondary parkinsonism, and parkinsonism-plus syndromes were excluded. The clinical features of 16 patients with suspected VP to those of 50 diagnosed with PD were compared. All patients were assessed using unified Parkinson's disease rating scale (UPDRS) and all had cerebral MRIs. RESULTS Patients with VP had significantly older onset age and shorter duration of disease with gait disorder as the most frequent initial symptom. All PD patients had satisfactory response to levodopa treatment, whereas only 38% VP patients had satisfactory response to levodopa treatment. Vascular risk factors were more common in VP (81%) than PD (32%). Postural instability, freezing, gait disturbance, pyramidal signs, and postural tremor were significantly more prevalent in patients with VP than in PD. In VP patients these features were more prominent in the lower limbs. Twenty-five percent had acute onset VP. All patients with VP had ischemic lesions, mainly in subcortical white matter, to a lesser extent basal ganglia and brainstem, in their cerebral MRIs, while 70% of PD patients had normal MRIs. CONCLUSION The differences in the clinical features support the concept that VP is a distinct clinical entity with heterogeneous clinical, MRI, and possibly pathophysiological features.
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Affiliation(s)
- M Demirkiran
- Cukurova University, School of Medicine, Department of Neurology, Adana, Turkey.
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25
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Demirkiran M, Sarica Y, Ozeren A, Tuncer I. Wegener's granulomatosis : a case with multiple symmetric cranial neuropathy. Neurol India 1998; 46:307-309. [PMID: 29508828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a 47 year-old woman with Wegener's granulomatosis presenting with an atypical onset of multiple symmetric cranial neuropathies. The diagnosis was established by clinical and laboratory data. To our knowledge, this is the first case of Wegener's granulomatosis presenting with bilateral multiple symmetric cranial neuropathy.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey
| | - Y Sarica
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey
| | - A Ozeren
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey
| | - I Tuncer
- Department of Neurology, Cukurova University School of Medicine, Adana, Turkey
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26
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Kantarci O, Siva A, Eraksoy M, Karabudak R, Sütlaş N, Ağaoğlu J, Turan F, Ozmenoğlu M, Toğrul E, Demirkiran M. Survival and predictors of disability in Turkish MS patients. Turkish Multiple Sclerosis Study Group (TUMSSG). Neurology 1998; 51:765-72. [PMID: 9748024 DOI: 10.1212/wnl.51.3.765] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To examine the natural history, survival, and prognostic factors in a sample of Turkish MS patients. METHOD This multicenter study included 1,259 definite MS patients diagnosed according to the criteria of Poser et al. Actuarial analysis of selected disability levels of 3, 6, 8, and 10 achieved with the Expanded Disability Status Scale (EDSS); a multivariate Cox regression analysis for prognostic factors related to time to reach EDSS > or = 6; and Pearson's correlation coefficient for individual factors were performed. RESULTS The survival (+/- SE) at 15 years from onset was 94.6 +/- 2.9%, and at 25 years was 89.0 +/- 5.8%. The disability reached by 15 years was EDSS > or = 3 in 66.4%, EDSS > or = 6 in 41.2%, EDSS > or = 8 in 10.5%, and EDSS = 10 in 5.4%. The most significant unfavorable prognostic factors were progressive course (relative risk [RR], 3.73; CI, 2.71 to 5.13) and sphincter symptoms at onset (RR, 1.86; CI, 1.23 to 2.82), followed by male sex, motor symptoms at onset, and a high attack frequency within the first 5 years. Primary progressive disease was correlated positively with male sex (r = 0.0895, p = 0.001), older age (r = 0.1807, p = 0.000), and motor (r = 0.1433, p = 0.000) or sphincter symptoms (r = 0.1001, p = 0.000) at onset, unlike relapsing-remitting and secondary progressive disease. CONCLUSIONS Although a slightly better prognosis is observed in the Turkish MS population, early prognostic factors are similar to most of the previous Western series. Primary progressive disease, mostly seen in older men with motor and sphincter involvement at onset, has a worse prognosis and may represent a distinct behavioral variant of MS.
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Affiliation(s)
- O Kantarci
- Department of Neurology, Istanbul University, Cerrahpaşa School of Medicine, Turkey
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27
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Abstract
Transesophageal echocardiography (TEE) is more sensitive than transthoracic echocardiography (TTE) in detecting the potential source of emboli in cardioembolic strokes (CES). To establish the prevalence of a potential cardiac source of embolism detectable on TEE and its relationship to vascular risk factors, an unselected ischemic stroke population was evaluated. Twenty-six age and sex-matched cases with normal cardiological and neurological examinations as well as normal CT-scans, TTE and ECGs were included in the study as the control group. One hundred and eight patients with cardioembolic stroke (53 patients), atherothrombotic stroke (36 patients), and lacunar stroke (19 patients) were investigated by TTE and TEE. Seven of the 26 (26.9%) controls had thoracic atherosclerotic plaques on TEE examinations. The prevalence of abnormal TEE findings in patients was higher compared to the controls (p < 0.001). TEE revealed more specific findings in every etiological group when compared to TTE (74.0% vs 10.2%, p < 0.001). Atrial fibrillation correlated with the abnormalities of TEE (p < 0.05) while other risk factors did not. Left atrial spontaneous echo contrast was the most common finding on TEE of cases with cardioembolic stroke while atherosclerotic aortic plaques were mostly encountered in patients with atherothrombotic stroke. No specific findings by TEE were seen in patients with lacunar stroke. TEE is capable of detecting definite etiologies in cardioembolic stroke and associated cardiac pathologies in atherothrombotic stroke and lacunar stroke. These observations suggest that TEE is a useful tool to guide the physician for the treatment of ischemic stroke patients.
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Affiliation(s)
- A Ozeren
- Department of Neurology, School of Medicine, Cukurova University, Balcali, Adana, Turkey
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28
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Abstract
A 41-year-old woman presented with a 6-month history of gradually progressive postural instability and dysarthria associated with cerebellar and extrapyramidal signs. No Kayser-Fleischer (K-F) rings were observed on biomicroscopic examination of each cornea. The only evidence of hepatic dysfunction was a modest elevation of alanine-aminotransferase. The diagnosis of Wilson disease (WD) was based on low serum ceruloplasmin, abnormal serum copper and urinary copper excretion, and DNA marker segregation analysis. WD should be considered in the presence of characteristic neurologic and laboratory features, regardless of age at onset, evidence of hepatic dysfunction, or absence of K-F rings.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Abstract
3,4-Methylenedioxymethamphetamine (MDMA), also known as "ecstasy" is a popular recreational drug with potential for abuse. Although its neurotoxic effects have been established in animal studies, the acute and long-term effects of this serotonergic agent in humans are still unknown. We describe a 19-year-old woman with overlapping symptoms of neuroleptic malignant syndrome and serotonin syndrome after a single exposure to MDMA. We also review 15 other cases reported in the literature to draw attention to the serious neurotoxicity, including fatal outcomes, caused by the use of this increasingly popular, illicit drug.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, Baylor College of Medicine, Houston, TX 77030, USA
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Ozeren A, Sarica Y, Mavi H, Demirkiran M. Bromocriptine is ineffective in the treatment of chronic nonfluent aphasia. Acta Neurol Belg 1995; 95:235-8. [PMID: 8553797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The effect of bromocriptine on chronic nonfluent aphasia was investigated in 4 patients suffering from a stroke 24 to 35 months before the onset of this study (average 29 months). Two patients had Broca, one had global and the other transcortical motor aphasia. CT-scans demonstrated anterior-posterior infarctions in 3 patients and anterior infarction in one. Bromocriptine was given initially at a dosage of 10 mg/day, and of 25 mg/day during the follow ups. By means of aphasia tests, bromocriptine was found to be ineffective for the treatment of any symptoms of chronic nonfluent aphasia.
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Affiliation(s)
- A Ozeren
- Department of Neurology, School of Medicine, Cukurova University, Balcali, Adana, Turkey
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31
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Abstract
We studied 46 patients with paroxysmal dyskinesia and classified them according to phenomenology, duration of attacks, and etiology. There were 13 patients, 7 females, who had paroxysmal kinesigenic dyskinesia (PKD), 10 with attacks lasting 5 minutes or less (short lasting) and 3 with attacks lasting longer than 5 minutes (long lasting). Twenty-six patients, 18 females, had paroxysmal nonkinesigenic dyskinesia (PNKD), 9 with short-lasting and 17 with long-lasting PNKD. Five patients, 3 females, had paroxysmal exertion-induced dyskinesia (PED), 3 with short-lasting PED and the other 2 with long-lasting PED. In addition, there was 1 patient with paroxysmal hypnogenic dyskinesia (PHD) and 1 with paroxysmal superior oblique myokymia. Only 2 patients, 1 with PKD and 1 with PHD, had family history of paroxysmal dyskinesias. No specific cause could be identified in 21 patients; in the other 23 patients the etiologies included the following: psychogenic (9 patients), cerebrovascular diseases (4), multiple sclerosis (2), encephalitis (2), cerebral trauma (2), peripheral trauma (2), migraine (1), and kernicterus (1). Nine of 10 (90%) patients with PKD improved with medications, mostly anticonvulsants, compared with only 7 of 19 (37%) with PNKD. This new classification, based chiefly on precipitating events, allowed appropriate categorization of the attacks in all our patients with paroxysmal dyskinesias.
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Affiliation(s)
- M Demirkiran
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
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