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   Table of Contents - Current issue
Coverpage
April-June 2021
Volume 38 | Issue 2
Page Nos. 81-145

Online since Tuesday, June 15, 2021

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REVIEW ARTICLE  

Migraine and frontostriatal circuit disorders: What have we learned until now? p. 81
Aynur Ozge, Hamit Genç, Gülen Güler Aksu, Derya Uludüz
DOI:10.4103/nsn.nsn_9_21  
Even though there is a recognized association, the causation between chronic migraine (CM) and frontostriatal circuit (FSC) disorders that were commonly presented as anxiety disorders, depression, tic disorders, and attention-deficit hyperactivity disorders in routine headache outpatient is yet to be fully disclosed. Medication-overuse headache (MOH) and CM recognizedly affect complex neural systems, including the FSC. Referenced circuits constitute a part of a circle that consists of the cortex, striatum, and thalamus regions and they transmit the data from the cerebral cortex to the subcortex. The above-mentioned circles end up once again in the determined region of the cerebral cortex. Five different FSCs have been described above which circulate among the specific parts of the cortex, namely supplementary motor area, frontal eye fields, dorsolateral prefrontal cortex, lateral orbitofrontal cortex, and anterior cingulate cortex with various subconnections and serve to various functions. Based on the scientific data with an emphasis on the clinical perspective, this paper aims to show the potential causative relationship between common FSC disorders and CM with or without MOH. The results also highlighted the importance of psychiatric comorbidities, as being far from a coincidence, and promoted the application of preventive medicine and interventions including lifestyle changes, cognitive–behavioral treatment, and neuromodulation. Integrative and multidisciplinary management strategies are essential for a comprehensive migraine coping approach in the society.
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ORIGINAL ARTICLES Top

Normative Values of Transcranial Magnetic Stimulation-Evoked Parameters for Healthy Developing Children and Adolescents p. 90
Hasan Tekgul, Ulas Saz, Muzaffer Polat, Nurdan Tekgul, Timur Kose
DOI:10.4103/NSN.NSN_94_20  
Context: Normative data-containing transcranial magnetic stimulation (TMS) evoked parameters are essential for correctly interpreting healthy development and assessing neuroplastic changes in certain neurologic disorders. Aims: The aim is to investigate corticospinal pathways by applying TMS to healthy developing children and adolescents. Settings and Design: In this cross-sectional study, we measured TMS evoked parameters associated with cortical and spinal stimulation obtained from the four extremities of 46 healthy children and adolescents (21 boys and 25 girls; mean ± standard deviation age: 6.4 ± 1.2 years; range: 3.0–20.5 years). Statistical Analysis: Spearman's correlation coefficients were calculated for each variable (weight and height) as a function of motor evoked potential (MEP) response latency and central motor conduction time (CMCT). Pearson's Chi-square test was used to determine the inter-variable correlations. Results: Latencies of MEPs were correlated with age (P < 0.001, r = 0.6948) and height (P < 0.006, r = 0.7994). Amplitudes of active-state MEPs were significantly higher than those of resting-state MEPs associated with the upper and lower extremities. The mean values for active-state MEP latencies were lower than those for resting-state MEPs. The CMCT and magnitudes of latency jumps were calculated using reliable MEP data for children and adolescents. Additionally, the unresponsiveness rates were significantly higher for children aged below 7 years. Conclusion: The TMS evoked parameters investigated in this study are necessary to accurately assess corticospinal pathway development in healthy children and adolescents.
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Evaluation of the ascending utricular and descending saccule pathway using cervical vestibular evoked myogenic potential and ocular vestibular evoked myogenic potential in diabetic polyneuropathy p. 97
Onur Akan, Güler Berkiten, Belgin Tutar, Semih Karaketir, Ömür Biltekin Tuna, Semih Karaketir, Ömür Biltekin Tuna
DOI:10.4103/nsn.nsn_155_20  
Background: Chronic hyperglycemia can affect the vestibular system by causing injury in cells and neural structures. In addition to alterations in the microvasculature and connective tissues, changes in inner ear fluid metabolism can also contribute to otolithic damage in patients with diabetes. We aimed to evaluate the effects of neurovascular degeneration occurring in diabetic polyneuropathy (DPN) on the vestibular system. Methods: Thirty-five patients with DPN (n = 70 ears) and 34 (n = 68 ears) healthy controls were enrolled. Patients were classified into two subgroups as sensorial axonal PNP and sensory-motor axonal PNP. To assess vestibular functions, cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) testing were bilaterally performed. Results: Bilateral cVEMP and oVEMP P1 latency and N1 latency were significantly prolonged, whereas amplitude values were significantly decreased in patients with DPN compared with the controls (P = 0.001). The cVEMP amplitude asymmetry ratio (AAR) was statistically higher in the DPN group than in controls (P = 0.001); oVEMP AAR was not significant between the patient and control groups (P = 0.095). The cVEMP AAR values were found to be increased in both patient subgroups, and oVEMP AAR was elevated in the sensorineural PNP subgroup. In the DPN group, the nonresponse rate was 48.6% (n = 17) in cVEMP and 51.4% (n = 18) in oVEMP, significantly higher compared with the controls (P < 0.05). In cVEMP, nonresponse rates were found to be lower in both DPN subgroups. In oVEMP, the nonresponse rate was found to be higher in the sensory-motor PNP subgroup when compared with the sensorial PNP subgroup (P = 0.008 and P = 0.003, respectively). Conclusion: In diabetes mellitus with multisystemic effects, particularly in patients with polyneuropathy, vestibular testing before the onset of vestibular symptoms may be an early and beneficial diagnostic method for detecting the presence or degree of neurovascular degeneration.
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Changes in the blink reflex during migraine with aura and the inter-attack period p. 105
Mehlika Panpalli Ates, Sevgi Ferik, Leyla Das Pektezel, Hayat Guven, Selim Selcuk Comoğlu
DOI:10.4103/nsn.nsn_176_20  
Introduction: This study aimed to investigate the possible excitability changes in the trigeminovascular system based on blink reflex (BR) in patients experiencing migraine and to compare migraine aura attacks and attack-free period. Materials and Methods: A total of 56 patients diagnosed with migraine headache with aura and 20 healthy individuals without migraine were evaluated electrophysiologically using the BR test. The BR test was repeated twice in patients with migraines during attacks with aura and attack-free period. Results: During the migraine attack with aura, R1 latencies were shorter, and R2 latencies were longer than in the interictal period. Likewise, R1 latencies were shorter, and R2 latencies were longer, in the interictal period compared to normal values obtained in the control group. Conclusion: The detected BR abnormalities have been thought to be able to reflect migraine-related dysfunction in the brainstem and trigeminovascular connections. Significance: It has been concluded that the detected BR abnormalities might reflect migraine-related dysfunction in the brainstem and trigeminovascular connections, indicating increased neuronal excitability in migraine.
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Data mining analysis of demographic and clinical factors in turkish amyotrophic lateral sclerosis patients p. 111
Nesrin Celik Gulay, Hilmi Uysal, Pervin Aliyeva, Uğur Bilge
DOI:10.4103/NSN.NSN_69_20  
Introduction: Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that affects nerve cells in the brain and spinal cord, controlling voluntary muscle movement. Data mining is a discipline that provides meaningful conclusions from databases or implicit data. In this study, we examine the relationship between the clinical and demographic characteristics of ALS patients and a control group, using data mining techniques. Methods: In the study, data belonging to 235 patients diagnosed with ALS and a control group of 117 people consisting of relatives of ALS patients were used. The dataset contains 121 features that include clinical and demographic information for each patient. The patient group and the control group were examined together and separately to examine the relationship between the features. In the study the data mining methods of classification and clustering were used on R and WEKA software packages. Results: There were no significant differences between ALS patients and the control group in terms of environmental factors such as location, gender, smoking, exercise status, and clinical factors such as genetics, ALS involvement, course of the disease, disease in the family. The results also showed that there was no relationship between demographic and clinical features such as gender, occupation, age group, and concomitant disease between groups or within groups.
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Investigation of the complex structure between the severity of alzheimer's disease and influencing factors using latent class cluster analysis p. 120
Didem Derici Yildirim, Mumine Bozdag Kiraz, Bahar Tasdelen, Aynur Ozge
DOI:10.4103/NSN.NSN_92_20  
Objective: The cognition of Alzheimer's disease (AD) has a heterogeneous pattern. It is useful to obtain more information about specific subgroups of patients to prevent disease progression. For better identification of the population, we aimed to detect latent groups based on cognitive test scores using latent class (LC) cluster analysis and influencing factors of latent severity groups to assist practitioners in outpatient departments who have restricted time and instrumentation. Materials and Methods: Data for 630 patients with AD in the Mersin University Dementia Outpatient Unit were collected, and cognitive test scores, demographic variables, and other factors such as comorbidities and family history of dementia were obtained. Initially, LC cluster analysis was performed to distinguish subgroups considering clinical dementia scores, age, and sex as covariates. Second, univariate analysis was used to detect the relationship between latent subgroups and influencing factors. Finally, multinomial logistic regression was performed to identify the magnitude of risk for significant factors. Results: Four severity groups were defined as mild, moderate, severe, and very severe cases of AD, and severity was significantly related to educational level, hyperlipidemia, diabetes mellitus, and sarcopenia (P < 0.001, P = 0.001, P = 0.043, and P < 0.001, respectively). Family history also influenced severity (P = 0.024). Disease severity increased with decreased education levels. Family history predicted a 1.555-fold increase in the risk of being in the moderate group versus the mild group. Moreover, diabetes mellitus predicted a 3.690-fold increase of being in the very severe group versus the mild group. Conclusion: LC cluster analysis is effective for determining severity groups for AD, and study results will help prepare a guide for an optimum evaluation tool for the disease.
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Late-onset myasthenia gravis: Is it a different clinical entity? p. 127
Hulya Tireli, Gulbun Yuksel, Kemal Tutkavul
DOI:10.4103/nsn.nsn_201_20  
Objective: The increase in the average life expectancy of humans has resulted in an increased occurrence of late-onset myasthenia gravis (LOMG). It is noticeable that the clinical, immunologic, and prognostic features of patients with LOMG are different than those of the patients with early-onset myasthenia gravis (EOMG). The present study aimed to establish the dissimilar features of patients with EOMG and LOMG. Subjects and Methods: The study retrospectively compared 93 patients with EOMG and LOMG in terms of clinical and immunologic features and response to medical treatment and thymectomy. Results: Of the 93 patients with MG, 56 had EOMG and 37 had LOMG. The EOMG group was dominated by female patients and generalized MG, whereas male patients and ocular MG were predominant in the LOMG group. Both groups tested positive for acetyl choline receptors antibodies. The number of patients undergoing thymectomy was higher in the EOMG group than in LOMG group. Responses to thymectomy and immunosuppressive treatment in LOMG group were lower compared with the EOMG group. Conclusion: The present study concludes that the clinical prognosis of patients with LOMG is better, and thymectomy may not be quite necessary for patients in this group who do not have thymomas (nonthymomatous patients).
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Effects of cellular phone electromagnetic field exposure on the hippocampi of rats in childhood and adolescence p. 135
Zeynep Hatice Okur, Dilek Sağir
DOI:10.4103/nsn.nsn_206_20  
Objective: The effects of the electromagnetic fields (EMFs) emitted from cell phones on living organisms and human health have become one of the most important topics for research because cell phones are widely used, even at early ages, all over the world. In this study, it was aimed to reveal the effects of exposure to EMFs emitted from cell phones on the hippocampus region of the brain during childhood and adolescence. Materials and Methods: In the study, newborn rats were divided into six groups as control 1–21, EMF 1–21, control 21–60, EMF 21–60, control 1–60, and EMF 1–60. The rats in the EMF groups were exposed to an EMF emitted from cell phones placed in cages every day. No procedure was performed in the control (C) groups. Sections taken from the brain tissues were evaluated using histopathologic, stereologic, and immunohistochemical methods. Results: According to the stereologic analysis results we obtained from the study, there was a significant decrease in the number of pyramidal cells and hippocampus volume in the EMF 1–60 group (P < 0.05). In the histopathologic examinations of the brain sections, it was observed that there were many damaged neurons with darkly stained cytoplasms among normal pyramidal cells in all age groups exposed to EMF. In addition, caspase 3 immunoreactivity was found to be statistically significantly increased in the EMF 1–60 group compared with all other groups (P < 0.05). Conclusion: Chronic cell phone exposure from birth to the end of adolescence causes neuronal damage and volume reduction in the developing hippocampus.
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LETTER TO EDITOR Top

Anti-Myelin Oligodendrocyte Glycoprotein-Associated Disease with Recurrent Tumefactive Demyelinating Lesions p. 143
Hüseyin Nezih Ozdemir, Cenk Eraslan, Ahmet Gökçay, Figen Gökçay
DOI:10.4103/nsn.nsn_161_20  
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