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   2021| January-March  | Volume 38 | Issue 1  
    Online since March 26, 2021

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Role of sleep and sleep disorders on motor and nonmotor features of Parkinson's Disease
Bektas Korkmaz, Büşra Yıldız, Gülçin Benbir Şenel, Derya Karadeniz
January-March 2021, 38(1):20-27
Purpose of the Study: Sleep problems are frequently encountered in Parkinson's disease (PD), including sleep fragmentation, rapid eye movement (REM) sleep behavior disorder (RBD), excessive daytime sleepiness, and sleep-disordered breathing. In this study, we aimed to examine the relationship between sleep structure and sleep disorders on motor and nonmotor symptoms of PD. Basic Procedures: Seventy-three consecutive patients diagnosed as having PD based on the United Kingdom Brain Bank Criteria were prospectively enrolled. Detailed histories of PD-related symptoms, sleep anamnesis, subjective evaluation of nocturnal sleep, and daytime sleepiness were made. All participants underwent one-night video-polysomnography (PSG) and multiple sleep latency test (MSLT) in a sleep laboratory. Main Findings: A significant correlation was present between female sex and RLS (P = 0.009). Age and body mass index showed no significant correlations with PD-related parameters including Unified Parkinson's Disease Rating Scale (UPDRS) scores and PSG parameters. RLS or RBD showed no significant correlation with PD-related variables. Among PSG parameters, higher REM sleep percentages showed a statistically significant correlation with increased scores of UPDRS part III (P = 0.007). A statistically significant negative correlation was present between apnea–hypopnea index and PD duration (P = 0.005), and the presence of obstructive sleep apnea syndrome (OSAS) was statistically significantly correlated with lower scores of UPDRS part II (P = 0.050). The mean sleep latency in MSLT decreased as the dose of dopaminergic treatment increased (P = 0.016). Principal Conclusions: Our study demonstrated that changes in sleep structure and sleep-related disorders observed in PD could be attributed to intrinsic disease-related properties. The presence of changes in sleep structure as higher REM sleep percentages and sleep-related disorders such as OSAS show correlations with the severity of PD.
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MScanFit motor unit number estimation: A novel method for clinics and research
Hatice Tankisi
January-March 2021, 38(1):1-5
Motor unit number estimation (MUNE) methods have been found to be better suited than any other electrophysiological test to study the degree and time course of lower motor unit loss. However, MUNE methods have not yet been implemented in clinics and research. This may be because an ideal method has not been developed yet. This review aims to give an overview of the strengths and limitations of the existing MUNE methods, why a new method was necessary and how the novel MScanFit MUNE can overcome some of the limitations that the other methods had. In the end, the existing literature MScanFit applied has been summarised.
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The effect of vision on top.down modulation of hand blink reflex
Fatma Zehra Calikusu, Ayşegül Gündüz, Meral Kızıltan
January-March 2021, 38(1):6-11
Objective: The magnitude of hand blink reflex (HBR) increases when a threatening stimulus is positioned in the peripersonal space (PPS) compared with stimulus in the extrapersonal space (EPS). We hypothesized that the reflex increase in PPS might change depending on whether the stimulus was seen. We aimed to investigate the alterations in HBR response to understand the effects of vision on cortical modulation of HBR. Methods: The HBR was recorded from 11 healthy volunteers while the hand was far away from the face (EPS), close to the face with eyes open (PPS-eyes open), and close to the face with eyes closed (PPS-eyes closed). Changes in the response magnitudes were compared between the three conditions. Results: HBR was obtained in all subjects. As expected, there was an increase in the reflex magnitude in the PPS-eyes open condition relative to EPS. In the PPS-eyes closed condition, the duration and latency were shorter and the area under the curve was significantly smaller compared with the PPS-eyes open condition. Conclusion: The enhancement of HBR in PPS is attributed to tonic top-down modulation. Our study provides evidence for the special sensory modulation of the PPS effect on HBR and may suggest cortical modulation of top-down modulation of brainstem neural circuits.
  1,195 178 -
Investigation of oxidative stress in relapse and remission periods of patients with relapsing-Remitting multiple sclerosis
Samet Oncel, Musa Ozturk, Rabia Gokcen Gozubatik-Celik, Aysun Soysal, Sevim Baybaş
January-March 2021, 38(1):67-72
Introduction: Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system. The role of oxidative stress has gained importance in the pathogenesis of free radicals in cells such as protein, lipid, and nucleic acids by showing myelin loss and axonal degeneration. In this study, serum total oxidant level total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase (PON) in patients with relapsing-remitting-MS (RRMS) were examined. The hypothesis was that antioxidants might indicate the attack phase or the progression phase. Methods: Twenty-four patients with RRMS known to have undergone new attacks and 24 healthy controls whose demographic data were appropriate were included. PON and TAS/TOS measurements were performed once in the healthy group and twice in the serum samples of patients during relapse and remission periods. The Number Cruncher Statistical System 2007 and Power Analysis and Sample Size 2008 Statistical Software (Utah, USA) program was used for statistical analysis. Results: TAS, TOS, and PON levels were similar in the patient and control groups during the attack. In remission, only a positive, statistically significant relationship between the duration of the disease and TAS measurements was noted (r = 0.435; P = 0.034). No significant relationship was found between sociodemographic characteristics, illness duration, laboratory/imaging findings, and antioxidant parameters in blood. Conclusion: In this study, TOS, TAS, OSI, and PON serum levels had no role in determining attack and remission periods in RRMS. There were only significant differences between disease duration and TAS results during the remission period. Following TAS results may help in monitoring progression in patients with early MS.
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The effects of melatonin treatment on headache and vasomotor reactivity in patients with chronic tension-type headache
Erdal Eroglu, Bilgin Öztürk, Akçay Övünç Özön, Güray Koç, Ömer Karadaş
January-March 2021, 38(1):28-32
Objectives: Chronic tension-type headache (TTH) is a serious disease that disrupts quality of life. In this study, the effect of prophylactic oral melatonin treatment on headache and cerebral vasomotor reactivity (VMR) was investigated in patients diagnosed with chronic TTH per the International Classification of Headache Disorders criteria. Subjects and Methods: Twenty patients with chronic TTH and 20 healthy individuals were included in the study. The patients were administered a melatonin treatment at 3 mg/day for 12 weeks. The number of monthly painful days and pain severity were recorded with the “Visual Analog Scale” before and after the treatment. Cerebral VMR measurements were performed at baseline in the control group and in patients before and after the treatment. Results: The median number of monthly painful days was 20 (15–27) before the treatment and 10 (4–18) after the treatment; the median pain severity score was 70.00 (45–80) before the treatment and 42.50 (15–75) after the treatment. The difference was statistically significant (P = 0.001). No statistically significant difference between the VMR values was observed (P > 0.05). Conclusions: Melatonin treatment was effective in reducing the pain severity and decreasing the number of monthly painful days in patients with chronic TTH but demonstrated no effect on the cerebral VMR.
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Sensory brain responses and lateralization in nonpainful tactile stimuli during sleep
Gonca Inanc, Murat Özgören, Adile Öniz
January-March 2021, 38(1):12-19
Aims and Objectives: The aim of this study was to investigate the difference between sensory brain responses of nonpainful tactile stimuli applied to the fingers of the right-hand dominant individuals between the hemispheres. Materials and Methods: Nineteen healthy volunteers (9 women, mean age ± standard deviation: 23.00 ± 2.24 years) participated in the study. Electroencephalogram (EEG) recordings were taken from 40 channels polysomnography system. A uniform nonpainful stimulus was applied to two fingers (index and middle fingers) of the right and left hand with a pneumatic stimulator unit. Results: Non-rapid eye movement sleep (NREM) whole night sleep-related potentials were evaluated. When the stimulus was applied to the right hand, central and parietal regions of the P50 response component appeared significantly earlier in the left hemisphere. When the left-hand stimulus was applied, the P50 and N100 response components appeared significantly early in central, parietal, and temporal regions in the left hemisphere. Hence, amplitudes of the right-hand response components (P50 and N100) were found to be greater in the central, parietal, and temporal regions in the left hemisphere. When the stimulus is applied to the left hand, the amplitude of the P50 component was greater in the central and temporal regions in the left hemisphere. Conclusion: P50 and N100 are components related to sensory processing. The difference in latency and amplitude observed in these components between hemispheres indicates the presence of lateralization in sensory processing during sleep.
  945 150 -
Pembrolizumab-induced myasthenia gravis in a patient with thymic carcinoma: A case report and review of the literature
Seyma Ciftci Aykac, Büşra Erkılınç, Burhanetti Uludağ
January-March 2021, 38(1):73-78
Pembrolizumab is an immune checkpoint inhibitor. Most cases of myasthenia gravis (MG) reported with the use of immune checkpoint inhibitors have been in melanomas, and small and non-small cell lung carcinoma, but there are no reported cases in thymic epithelial carcinoma. A 57-year-old male with thymic carcinoma presented with symptoms of diplopia, drooping eyelids, and difficulty in talking and swallowing after a second dose of pembrolizumab. Contrast-enhanced brain magnetic resonance imaging, laboratory tests, and electroneuromyography were normal. Single-fiber electromyography showed increased jitter (six muscle fibers were collected, range of jitter 29–140 μs, mean 75 μs; normal <35 μs) in bilateral orbicularis oculi muscles supporting MG. Serum screening showed no any positivity for acetylcholine receptor and muscle-specific tyrosine kinase autoantibodies. The patient died of bulbar dysfunction related to aspiration pneumonia despite receiving intravenous immunoglobulin and methylprednisolone therapy. Physicians should be alert to possible exacerbations of autoimmune diseases and associated risks, especially during treatment with checkpoint inhibitors in thymic malignancy.
  878 164 1
Balance and gait disturbances and quality of life in patients with idiopathic parkinson's disease and progressive supranuclear palsy
Hatice Eraslan Boz, Aycem Öztürk Kiriş, Koray Koçoğlu, Berril Dönmez Çolakoğlu, Raif Çakmur, Gülden Akdal
January-March 2021, 38(1):45-49
Objective: The objective of this study is to compare the balance, gait, and quality of life of patients with idiopathic Parkinson's disease (PD), progressive supranuclear palsy (PSP), and healthy controls (HCs). Materials and Methods: The present study included 26 patients with PD, 14 patients with PSP, and 22 HCs. The Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and the Turkish version of Mini-Mental State Examination (MMSE) were administered to all participants. The Parkinson 's disease questionnaire (PDQ-39) and Unified PD Rating Scale were evaluated only among patients with PD and PSP. Results: There was a significant difference between PD and PSP in terms of BBS, DGI, and all variables of PDQ-39 except “social support” (P < 0.05). Although a significant difference was found between patients with PSP and HCs in the BBS and DGI, there was no significant difference between patients with PD and HCs in the DGI and BBS. Further, the BBS and DGI were strongly correlated regarding the “mobility” and “activities of daily living” variables of the PDQ-39 and moderately correlated in terms of “total scores of PDQ-39,” “stigma,” and “communication” subscores. The MMSE was moderately associated with “total scores of PDQ-39” and the “mobility” subscore. Conclusion: This study demonstrated a significant deterioration in balance, gait, and the quality of life in patients with PSP compared with PD and HCs. However, there was no difference between patients with PD and HCs.
  880 119 -
Reliability and validity of the Turkish version of the morningness – Eveningness questionnaire
Firat Ozdalyan, Özkan Tütüncü, Hikmet Gümüş, Osman Açıkgöz
January-March 2021, 38(1):50-59
Background: People are divided into different chronotypes in relation to their circadian rhythm features. The Morningness–Eveningness Questionnaire (MEQ), developed by Horne and Östberg, was the first and is the most used questionnaire for determining the chronotype of people. The reliability and validity of MEQ were tested in this study due to some deficiencies and inconsistencies in previous reliability and validity studies for the Turkish versions of MEQ and deficiencies regarding the validity and reliability of other versions of MEQ. Subjects and Methods: MEQ was translated into Turkish based on the opinions of five academics who were experts in their respective fields and the suitability and content validity of the questionnaire were ensured. The Turkish MEQ was administered to 419 undergraduate students aged 18–34 years. Robust minimum rank factor analysis (MRFA) was used to reveal the construct validity of the questionnaire. Results: As a result of the analyses, the questionnaire was examined in three factors. None of the items were excluded from the study and all items were collected under three factors. The explained total variance value was 42.7%, and the factors explained 64% of common (shared) variance in MRFA. According to the reliability analysis, Cronbach's alpha value for the MEQ Turkish version was satisfactory for the overall questionnaire (0.765). Conclusions: The MEQ version developed in this study is more valid and reliable compared with other versions. However, these results support that a more detailed instrument for morningness and eveningness can be developed.
  780 162 -
Renal involvement in children with tuberous sclerosis
Ahmet Keskinoglu, Hasan Tekgül, Caner Kabasakal
January-March 2021, 38(1):33-36
Objectives: Tuberous sclerosis (TS) is a multisystemic disease with a genetic component. The central nervous system is most commonly involved. Renal involvement is also common. In this study, renal involvement was investigated descriptively and analytically in children with TS. Methods: A retrospective cohort study was performed on TS patients followed in a neurology clinic. The result variable is renal involvement. Other demographic, health-related, and family characteristics were examined as independent variables. Other system involvements in children with TS were presented analytically. Descriptive and analytical statistics were performed with SPSS 24.0 software. Results: The total number of children diagnosed with TS was 52. Renal involvement was found in 9 (17.3%) of these children. Frequency of renal involvement was not statistically increased according to independent characteristics which were obtained from patient files (demographic characteristics, presence of neurological problems in the family, weight and height percentiles, and other system involvements in children with TS). Conclusion: In our study, renal involvement was found to be less frequent than the reported in the literature. It may be more relevant to conduct studies with higher number of children with TS for risk assessment of renal involvement.
  713 119 -
Different attitudes in the management of different types of status epilepticus: A survey study among neurologists demonstrating evidence gap
Yasemin Bicer Gomceli, Ebru Aykutlu Altındağ, Betül Baykan
January-March 2021, 38(1):37-44
Purpose: The aim is to identify current diagnostic and therapeutic approach to different types of status epilepticus (SE) including convulsive SE (CSE), non-CSE (NCSE), and epilepsia partialis continua (EPC) to detect unmet needs and problems encountered during the management of these neurological emergencies in our country, Turkey. Methods: The specifically designed SE survey included 31 questions that were related to the incidence, the distribution of etiological causes, the diagnostic process, and the treatment approaches of the neurologists and individual electroencephalography (EEG) facilities of the institutions. Results: The total number of respondents was 152 with a median years of experience in professional practice of 10.8 years (1–39 years). The great majority of the neurologists preferred diazepam plus phenytoin as the first choice drug in the treatment of CSE. Of the respondents, only 55% accepted the SE as refractory after applying the second drug and they monitored these patients in the intensive care unit (ICU). Most of the participants (67.7%) did not provide any treatment except the standard medical approaches, while only 39 (30.7%) had used immunotherapy in the treatment of super-refractory SE. Forty-seven respondents (37%) indicated that they had difficulty identifying NCSE on EEG. While 37% of the participants treated EPC patients with preserved consciousness in ICU by general anesthesia, only 15% were previously applied immunotherapy. Strikingly, 41% of the participants stated that they did not feel themselves as sufficiently competent in terms of practical and theoretical knowledge about the management of SE. Conclusion: We demonstrated that there are no standardized attitudes for the management of different types of SE among neurologists. It is worth to emphasize that the neurologists did not feel themselves sufficiently competent in terms of practical and theoretical knowledge, especially with regard to the subtypes of SE.
  663 104 -
Coexistence of hypokalemic periodic paralysis with central hypersomnolence: An attack of paralysis in polysomnographic recording
Gulcin Benbir Senel, Derya Karadeniz
January-March 2021, 38(1):79-80
  638 104 -
The effects of ozone oxidative preconditioning on subarachnoid hemorrhage via rat cerebral vasospasm model
Hikmet Turan Suslu, Necati Tatarlı, Davut Ceylan, Hüsnü Süslü, Süheyla Uyar Bozkurt, Timucin Avsar, Bülent Güçlü
January-March 2021, 38(1):60-66
Objective: Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a major cause of morbidity and mortality. Inflammation is the major molecular mechanism observed in vasospastic SAH. Ozone (O3) has been used as a therapeutic agent in the treatment of various conditions and diseases for years. The aim of this study was to evaluate the anti-inflammatory effect of ozone oxidative preconditioning (OOP) in a rat model of SAH in order to assess the therapeutic potential of O3 in SAH therapy. Materials and Methods: In the presented study, an experimental in vivo SAH rat model that provided constriction of large cerebral arteries was used. The inflammatory response of cerebral vasospasm after SAH and the effects of OOP were evaluated by comparing the mRNA levels of inflammatory molecules (tumor necrosis factor-α, interleukin-1β, and intercellular adhesion molecule-1) in the serum samples of rats. Results: The level of inflammatory molecules increased in vasospasm at 12 h, 24 h, and 48 h in the posttreatment groups. However, intraperitoneal OOP decreased the level of inflammatory molecules dramatically. Conclusions: Our study indicated that O3 treatment has potential in the management of inflammation created in a rat SAH model. These findings may inform further studies investigating possible uses of O3 in the treatment of vasospasm.
  619 111 -