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   Table of Contents - Current issue
January-March 2023
Volume 40 | Issue 1
Page Nos. 1-58

Online since Wednesday, March 29, 2023

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Electrophysiological investigations in diabetıc patients: Root stimulation and autonomic investigations p. 1
Tulay Kurt Incesu, Aysel Çoban Taşkın, Yaprak Seçil, Sehnaz Arici, Nevin Gürgör, Figen Tokuçoglu, Galip Akhan, Cumhur Ertekin
Introduction: The aim of the study is to search proximal nerve involvement by using proximal root stimulation and possible autonomic neuropathy in type 2 diabetic patients with and without distal symmetric sensorimotor polyneuropathy (DSPN). Patients and Methods: Forty patients with type 2 diabetes and ten volunteers who had no history of diabetes and neuropathy were included. Diabetic patients were equally distributed into two groups according to nerve conduction studies (NCSs): First group comprised of with electrophysiologically confirmed DSPN and second group with normal NCSs. Electrophysiological tests included motor and sensory nerve conduction, needle electromyography, F-response, H-reflex, R-R interval, and sympathetic skin responses (SSRs) studies as well as lumbar root stimulation and cauda equina motor conduction time (CEMCT) calculation. Results: The patients with DSPN had significantly longer F-response latencies and had no H-reflex while H-reflex was observed in 35% of the patients in second group. In the first group, SSRs could not be obtained from both upper and lower limbs in 45% of the patients; however, in the second group, they were absent only in 10% of patients in lower limbs. R-R interval variability was significantly lower in both diabetic groups than volunteers. When compared to the volunteers, cauda equine motor conduction time was significantly prolonged in all diabetic patients, but there was no significant difference between the patient groups. Conclusions: CEMCT prolongation, absence of H-reflex, and decreased R-R interval abnormalities indicating dysautonomia were the most important findings of our study. These results show that early electrophysiological examinations using these methods are important in diabetic patients without polyneuropathy.
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The relationship between transversus abdominis and internal oblique thickness and disease-related characteristics in Parkinson's disease: An ultrasound-based study p. 9
Burcin Aktar, Seher Ozyurek, Evrim Goz, Berril Donmez Colakoglu, Birgul Balci
Background and Aim: The core muscles are essential for spinal stability during functional activities. Trunk muscle function is affected by specific neurodegenerative processes of Parkinson's disease (PD). This study aimed to investigate whether changes in transversus abdominis (TrA) and internal oblique (IO) thickness during the abdominal drawing-in maneuver (ADIM) were associated with clinical manifestations, core endurance, and functional mobility in patients with PD. Materials and Methods: We included patients with a modified Hoehn and Yahr staging of 3 or lower. TrA and IO muscle thickness were measured using ultrasound both at rest and during ADIM, and the percent change (%) was calculated to assess TrA and IO activation. Patients performed core endurance (prone bridge and sit-ups) and functional mobility tests (timed “up and go” [TUG] and five times sit-to-stand [FTSTS]). All assessments were conducted during the “on” phase. Results: Five female and 17 male patients were included in this study. We found a statistically significant correlation between ultrasound parameters of IO and the clinical manifestations of PD (P < 0.05). Correlations were observed between TrA percent change and prone bridge, sit-ups, TUG, and FTSTS (P < 0.05). Conclusion: To the best of our knowledge, this is the first ultrasound imaging-based study to demonstrate the relationship between TrA and IO muscle thickness and clinical outcomes, and functional performance in patients with PD. Percentage changes in IO were associated with the clinical manifestations of PD. Increased activation of TrA during ADIM was associated with improved core endurance and mobility. The results suggest that a trunk-specific exercise program may be the cornerstone in the treatment of PD-related changes.
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Gray zones in the trigeminal autonomic cephalalgias p. 15
Nevra Oksuz, Aynur Özge
Background: Limited data are available about the importance of migrainous features of the trigeminal autonomic cephalalgias (TACs). Methods: We enrolled 99 patients with TACs including 71 cluster headaches, 11 with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, 10 with paroxysmal hemicrania, and seven with hemicrania continua. The presence of diagnostic migraine criteria such as throbbing headache, nausea and/or vomiting, photophobia, phonophobia, and aggravation by physical activity was questioned in these patients as well as autonomic features. Furthermore, supportive features of migraine including motion sickness, atopy and allergy, exacerbation during menstrual periods, irregular sleep, dizziness, and family history of any primary headache were noted. Results: The most common cranial autonomic symptom was lacrimation (87.9%) and the most common migrainous features were throbbing headache (51.5%), phonophobia (41.4%), nausea (39.4%), and photophobia (34.3%). Family history of any primary headache (25.3%) and atopy and allergy (13.1%) was the most common supportive features. Conclusion: We found higher percentages of migrainous features in patients with TACs; phonophobia, throbbing headache, and nausea frequently accompanied TACs. Aggravation by physical activity, which is one of the diagnostic migraine criteria, and motion sickness, which is one of the supportive features of migraine, were much lower in patients with TAC compared with migraineurs.
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Impact of the coronavirus disease 2019 pandemic on the patient profile evaluated in the electromyography laboratory p. 20
Irem Ilgezdi Kaya, Meltem Inci, Nermin Gorkem Sirin, Mehmet Baris Baslo, Elif Kocasoy Orhan
Objective: The objective of this study was to evaluate how the coronavirus disease 2019 pandemic affected the profile of patients admitted to the electromyography (EMG) laboratory and the types of neurophysiologic evaluations. Methods: We included patients who were admitted to our EMG laboratory in the first 6 months of the pandemic period (Period 1) and the same 6 months of the previous year (Period 2). In view of changes in health-care strategies, lockdown, and disease awareness during the pandemic, each group was divided into 3-month periods (early and late). Demographic and clinical characteristics and electrophysiologic data were evaluated retrospectively and compared between the groups. Results: In Period 1, there were 1872 studies of 1829 patients, and in Period 2, there were 625 studies of 607 patients. Electrodiagnoses for cranial neuropathies were more frequent during the pandemic when compared with before the pandemic (P = 0.018). The subgroup analysis revealed that the ratio of segmental anterior horn involvement decreased in the early pandemic period (P = 0.003), myopathies decreased in the late pandemic period (P = 0.001), and cranial neuropathies increased in the late pandemic period (P = 0.005) compared with the same periods in the previous year. Conclusion: During the pandemic, there have been changes in clinical practice approaches in the electrophysiology laboratory. More cranial neuropathies seemed to be diagnosed in the EMG laboratory during the pandemic, including new-onset facial neuropathies, which was the most significant finding of our study.
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In Vitro investigation of insulin-like growth factor-i and mechano-growth factor on proliferation of neural stem cells in high glucose environment p. 27
Tugba Aydintug Gurbuz, Çağri Güleç, Fatih Toprak, Selin Fulya Toprak, Selcuk Sozer
Objective: High glucose levels cause metabolic and vascular complications by affecting the nervous system with an increased risk of stroke and seizures. There are still no effective treatment modalities for the high morbidity and mortality rates detected in such situations. Neural stem cells (NSCs) provide neurogenesis in the nervous system, but high glucose is detrimental to NSCs. This study investigates the intrinsic and extrinsic effects of the growth factors insulin-like growth factor-I (IGF-I) and mechano-growth factor (MGF) on NSCs when exposed to high glucose levels. Thus, the possibility of new treatment options for diabetes patients is explored. Materials and Methods: Rat NSCs grown in cell culture conditions were exposed to a control glucose concentration of 17.5 mM and high concentrations of 27.75, 41.75, and 83.75 mM for 24 h. The high glucose concentrations were designed to recapitulate the in vivo conditions of diabetes mellitus, diabetic ketoacidosis, and hyperglycemia hyperosmolar status. Then, 0.2 μg/ml IGF-I and MGF growth factors were separately added and their expressions in the NCSs investigated by real-time reverse transcription-polymerase chain reaction. The effects of exogenous IGF-I and MGF administration on NSC proliferation under high glucose conditions were measured by BrdU incorporation assay using flow cytometry analysis. Results: A significant increase was detected in the relative gene expression fold changes of IGF-I and MGF in the NSCs. The MGF relative fold change was greater than the IGF-I for each high glucose condition. NSCs exposed to 27.75 mM glucose revealed a 17-fold and 40-fold increase in the IGF-I and MGF gene expressions, respectively; the 41.75 mM glucose similarly revealed 68-and 161-fold increases and the 83.75 mM glucose 75-and 137-fold increases. Exogenous IGF-I administration increased its expression profile, while the administration of MGF lowered its expression. The NSC was in the growth (G0/G1) phase of the cell cycle during the 24 h culture time. The percentage of proliferated NSC decreased to 89% (17.5 mM), 85% (27.75 mM), 50.30% (41.75 mM), and 28.97% (83.75 mM). Surprisingly, the increase in both IGF-I and MGF saved the NSCs from cell death. Conclusion: Exogenous IGF-I and MGF administrations via high glucose environments increased NSC proliferation at the time of injury and protected the NSCs from cell death. The neuroprotective effect of MGF was greater than that of IGF-I. Thus, due to their neurogenesis potential, exogenous IGF-I and MGF could be applied in the treatment of diabetes patients to relieve neural damage.
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Predictors of retitration in the sleep laboratory: Experience of a single center p. 37
Utku Ogan Akyildiz, Asli Akyol Gurses
Background: Obstructive sleep apnea syndrome (OSAS) is a serious public health problem that causes a significant economic burden worldwide. Apart from several treatment approaches, positive airway pressure (PAP) therapy remains the gold standard. Performing an optimal manual titration study to explore the beneficial and comfortable pressure for patients is essential, but the process is troublous sometimes, requiring multiple attempts. The objective of this study was to present our single-center experience regarding PAP titration studies in OSAS and identify the clinical and laboratory parameters that might predict repeat titration. Materials and Methods: Medical charts of 248 patients with OSAS who were eligible for PAP therapy were retrospectively reviewed. Age, sex, body mass index, modified Mallampati scores, presence of positive Muller maneuvers, and polysomnographic parameters yielded from diagnostic studies were recorded and compared between patients with single versus repeat titrations. Results: The mean age, the proportion of males, and the rate of patients with positive Muller maneuvers were significantly increased in the retitration group (P = 0.015, P = 0.022, and P = 0.001, respectively). Multivariate regression analysis revealed that age and positive Muller maneuvers were independent associates of repeat titration (P = 0.036 and P = 0.005, respectively). Conclusion: Our results suggest that both aging and the presence of a positive Muller maneuver may predict a troublous titration study, raising the need for recurrent attempts. The final common pathway could contribute to a vulnerable and more collapsible airway during sleep. Recognizing the potential need for retitration at the beginning is favorable regarding adjustment of the laboratory conditions and increases the patients' adherence during the management course. The results also confirm the capability of manual titration in terms of exploring proper PAP pressures in the majority of patients with OSAS.
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Can vestibular-evoked myogenic potentials be used in the assessment of reflex habituation? A preliminary report p. 43
Feray Gulec Uyaroglu, Roza Ucar Sariteke, Nese Celebisoy
Background: Vestibular-evoked myogenic potentials (VEMPs) provide an electrophysiological evaluation of vestibular reflexes. The aim of the study was to search for the habituation of ocular and cervical VEMPs (cVEMPs). Materials and Methods: A total of 20 healthy volunteers (10 men and 10 women), with a mean age of 32.4 years (range: 25–45 years) were included in the study. cVEMP and ocular VEMP (oVEMP) tests were performed using “click stimuli.” In cVEMP and oVEMP tests, the latency and amplitude of the responses recorded with 100 and 250 stimulus sequences were compared. Results: When the traces recorded with 100 repetitions for both tests were compared with the traces obtained with 250 repetitions, it was observed that the latencies increased while the amplitudes decreased with increasing number of stimuli, which was statistically significant. Conclusion: Our results showed that an increase in the number of stimuli in oVEMP and cVEMP tests in healthy individuals led to a decrease in amplitude and an increase in latency. As noninvasive, short, and inexpensive evaluation methods, VEMP tests may be used in evaluating the “habituation response” and may find new areas of investigation.
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Do comorbidities and triggers expedite chronicity in migraine? p. 48
Emel Ur Ozcelik, Ezgi Uludüz, Rahşan Karacı, Füsun Mayda Domaç, Mustafa İskender, Aynur Özge, Derya Uludüz
Background and Aim: Several factors are suggested to be associated with an increased risk of transforming from episodic migraine (EM) to chronic migraine (CM). We aimed to examine whether some specific attack triggers and comorbidities were associated with CM. Methods: Patients followed up with a diagnosis of definite migraine for at least 1 year were divided into two groups, EM (<15 attacks per month) and CM (>15 attacks per month). The demographic and clinical data, attack-triggering factors, and comorbid diseases were compared between the groups. Results: A total of 403 (286 females) patients were analyzed; 227 (56.3%) of the migraineurs had EM and 176 (43.7%) had CM. The mean age was 40.9 ± 11.3 years in EM, and 42.2 ± 11.7 years in CM. Disease duration was longer in CM compared with EM (P = 0.007). Missing meals (P = 0.044), exposure to heavy scents/perfumes (P = 0.012), intense physical activity (P = 0.037), and withdrawal of caffeine (P = 0.012) were reported significantly higher in CM than in EM. Comorbid history of medication overuse (P < 0.001), hypertension (P = 0.048), hyperlipidemia (P = 0.025), depression (P = 0.021), chronic painful health problems (P = 0.003), iron deficiency anemia (P = 0.006), and history of surgery (P = 0.006) were found significantly high in CM. Conclusion: This study demonstrates that attack-triggering factors, vascular comorbidities, depression, medication overuse, and chronic painful health problems pose significant risks for CM. Vascular comorbidities are independent risk factors for chronification in migraine and might increase the patient's lifetime morbidity and mortality. Therefore, prompt diagnosis of migraine before the transformation to chronicity and effective early management have the utmost importance.
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Unusual vessel wall magnetic resonance imaging findings in a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy patient p. 56
Huseyin Nezih Ozdemir, Hanife Karakaya, Figen Gökçay
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