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   2021| October-December  | Volume 38 | Issue 4  
    Online since December 29, 2021

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The effect of cold on the trigeminal reflexes
Rahsan Inan, Meral Erdemir-Kızıltan
October-December 2021, 38(4):226-233
Objective: Effects of muscle cooling on the spinal stretch and monosynaptic reflexes have been studied to describe the properties of Group I and II afferents of muscle spindles. Masseter muscle differs from extremity muscles in structural and numerical features of the muscle spindles. The aim of this study was to examine the muscle spindle afferent features of masseter muscle by applying cold to understand the role of Group I and II afferents in reflexes of masseter. Patients and Methods: We included 12 healthy subjects (7 females and 5 males) in the study. Masseter inhibitory reflex (MIR), jaw tendon reflex (JTR), trigeminal motor evoked potential (MEP), and trigeminal somatosensory evoked potential (SEP) were studied before and after cold application. Left masseter muscle was cooled down to 18°C. We compared the data obtained before and after cold application. Results: After cold application, the mean total duration of MIR was shortened and it was absent in four subjects. The mean amplitude of JTR was higher after cold application (P = 0.018) without any significant change in latency. The mean latency of MEP was delayed without any change in amplitude (P = 0.003). There was no significant difference in SEPs. Conclusions: Changes observed in MIR, JTR, and MEP could not be ascribed to any specific type of muscle spindle afferents. Delayed mean reflex latencies were attributed to the effect of cold on nerve conduction. Summation of peripheral cold and pain receptor features, spindle afferents, and cortical mechanisms might have caused cold-associated changes.
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COVID 19-Associated headache: Critical review after a scientific webinar
Arife Cimen Atalar, Bengi Gül Alpaslan Türk, Aynur Özge
October-December 2021, 38(4):201-208
Coronavirus disease 2019 (COVID-19)-related headache is the fifth most frequent symptom and the most common neurologic manifestation of the disease with a prevalence of 6.5%–27.9%. Headache related to COVID-19 shows diverse features and can clinically manifest with different phenotypes. The most common clinical presentation is bilateral (mostly frontal or frontotemporal location), long-lasting, pressing/pulsating quality, and partially or completely resistant to analgesic treatment. The activation of the trigeminovascular system by either direct invasion of the virus or indirect mechanisms induced by cytokine storm, excess neuroinflammation, vasculopathy, and ischemia are the possible underlying pathophysiologic mechanisms. Patients with preexisting primary headaches is another important issue that needs to be enlightened to determine whether these patients are more susceptible to COVID-19-related headache. Headache is also an important symptom in patients with long COVID syndrome, which has a serious negative impact on the individuals' quality of life in the long term. Populations such as children, pregnant women, and the elderly are more vulnerable to COVID-19, and it is obvious that COVID-19 affects these populations differently. The headache characteristics and course of headache in these special populations is an important research topic that needs more focused studies. In this review, we attempted to update physicians with the new developments about COVID-19-related headaches and discuss the subject with different aspects in light of the recent “COVID-19-associated headache webinar” organized by the Global Migraine and Pain society (GMPS) in collaboration with the global COVID-19 Neuro Research Coalition and the European Academy of Neurology (EAN).
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Long-term surgical outcomes and predictors of surgical treatment in temporal lobe epilepsy
Irem Yildirim, Asli Akyol Gurses, Esra Erkoc Ataoglu, Gokhan Kurt, Umit Ozgur Akdemir, Ali Yusuf Oner, Tugba Hirfanoglu, Lutfiye Ozlem Atay, Ayşe Serdaroglu, Erhan Bilir
October-December 2021, 38(4):209-218
Background: Surgical treatment of epilepsy is a favored modality in the management of refractory temporal lobe epilepsy (TLE) and known to be quite effective. The aim of this study was to evaluate the long-term outcomes in surgical treatment of TLE and to identify prognostic factors influencing postoperative seizure remission. Materials and Methods: The patients who underwent anterior temporal lobectomy (ATL) with the diagnosis of refractory TLE in our center between the years of 2006 and 2020 were included. Preoperative workup process was carried out by a multidisciplinary team and consisted of neuropsychological examination, long-term electroencephalography, brain magnetic resonance imaging (MRI), and fluorodeoxyglucose positron emission tomography (FDG-PET) for each patient. Postoperative assessment of seizure control was repeated every year following surgery and categorized according to Engel's outcome classification. The predictive value of baseline demographic, clinical, laboratory, imaging, and histopathological parameters on postoperative seizure control was also evaluated. Results: One hundred and forty-three patients who underwent ATL with the diagnosis of TLE were included. According to Engel's classification, the seizure freedom rate was found to be 83.2% at the 2nd year, 81.3% at the 4th year, and 79.2% at the 10th year after surgery. In the univariate analysis, febrile seizure (FS) history, unilateral interictal epileptiform discharges (IEDs), hippocampal sclerosis (HS) on MRI, unilateral temporal hypometabolism (HM) on FDG-PET, and HS in histopathology were predictors of seizure control at the postoperative 2nd and 10th years. FS history, unilateral localization of IEDs, and unilateral FDG-PET findings of temporal HM were found to be the independent predictors of postoperative seizure control on multivariate analysis. Conclusions: In the current study, we revealed that epilepsy surgery provides effective seizure control and represents a beneficial therapeutic option in refractory TLE. Our results also suggested that FS history, unilateral IEDs, and unilateral FDG-PET findings of temporal HM were independent predictors of seizure remission in these patients.
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Effects of patient and seizure-related factors on drug load in seizure-free patients with idiopathic generalized epilepsy
Fulya Eren, Günay Gül
October-December 2021, 38(4):219-225
Introduction: Idiopathic generalized epilepsies (IGEs) include four different epilepsy syndromes and IGE have mostly a good response to antiepileptic drugs (AEDs). The most common IGE subgroup is juvenile myoclonic epilepsy (JME). It generally responds well to low doses of AEDs; however, some patients need higher doses of medication. In this study was hypothesized that patient and epilepsy characteristics of seizure-free patients with high drug load might differ from those with low drug load. For this purpose, it was aimed to compare patients with JME and patients with other generalized epilepsies (non-JME IGE) regarding these factors concerning drug load. Patients and Methods: The records of the epilepsy outpatient clinic from 2010 to 2020 were retrospectively evaluated for patients with IGEs. Patients without any epileptic seizures in the last year were accepted as seizure-free. Drug load is calculated by dividing the prescribed daily dose by defined daily dose (PDD/DDD). A total drug load (TDL) equal to one and greater was considered as a high TDL (≥1, high-TDL group), where a drug load of below one was considered as a low TDL (<1, low-TDL group). The high-TDL and low-TDL groups in patients with JME and non-JME IGE were compared in terms of sociodemographic characteristics, personal and family histories, duration of epilepsy, seizure characteristics, epilepsy syndromes, electroencephalography findings, and AEDs and doses. Results: In this study, 119 patients (69 females, 50 males) with a mean age of 30.11 (range, 18–65) years were included. The mean age of onset and duration of the disease was 16.21 (range, 3–47) years and 13.6 (1–45) years, respectively. Sixty-three of the patients were diagnosed as having JME, and 56 patients were diagnosed as having non-JME IGE (39 with generalized tonic-clonic seizures alone, 17 juvenile absence epilepsy). According to the TDL, 35 patients were classified in the low-TDL group and 84 patients in the high-TDL group. The age of disease onset was higher in the non-JME IGE group (P = 0.027). Triple-type seizures were significantly more common in the JME group (P < 0.001). No statistically significant differences were found between the low- and high-TDL groups regarding patient and epilepsy characteristics in the JME and non-JME IGE groups. Conclusion: Most seizure-free patients had low-TDL in the JME and non-JME IGE groups. No association was observed in the JME and non-JME IGE groups regarding the total AED load.
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Reversing the deconditioning effects of the pandemic in the elderly via telerehabilitation
Melis Bagkur, Tuba Yerlikaya, Gonca Inanc, Adile Oniz
October-December 2021, 38(4):250-255
Objective: To investigate the effect of a structured home-based interactive telerehabilitation program on physical activity (PA) level, sleep, and quality of life (QoL) in older individuals who were in home confinement during the pandemic. Materials and Methods: A total of 23 participants in the age range of 65–90 (mean: 72.47 ± 5.58) years (15 females) were included in the study. A telerehabilitation exercise program was administered three times per week for 8 weeks. PA levels and sleep parameters were evaluated (using the Sensewear Armband) at baseline and at the end of the 8th week. In addition, the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale were used for self-reported evaluation of sleep, and the World Health Organization QoL Instrument-Older Adults Module was administered to evaluate the QoL. Results: Comparing pre- and postexercise evaluation results demonstrated a significant increase in PA levels and significant improvements in sleep duration, sleep latency, and daytime sleepiness. In addition, a significant increase was observed in the total QoL scores. Conclusion: The telerehabilitation exercise program seems to be an effective method to increase PA levels, improve sleep-related parameters, and enhance QoL in older adults affected by home confinement during the pandemic.
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Value of boston questionnaire in carpal tunnel syndrome
Ayse Caglar Sarilar, Duygu Kurt Gök
October-December 2021, 38(4):245-249
Objectives: The Boston Carpal Tunnel Questionnaire (BCTQ) is a patient-based outcome measure that has been developed for patients with Carpal tunnel syndrome (CTS). The purpose of this study was to investigate the association between BCTQ scores and electrophysiological findings in patients with CTS. Subjects and Methods: This study included 174 individuals (control group [n = 68] and patient group [n = 106]) admitted to Erciyes University Hospital Department of Neurology between August 2019 and November 2019 with complaints of pain, numbness, and paresthesia in the unilateral or bilateral median nerve trace and diagnosed with idiopathic CTS or normal after electrophysiological testing. The Turkish version of the BCTQ was applied to these patients. Results: The mean age of the participants was 46.6 (standard deviation ± 11.9). One hundred and fifty-seven (90.2%) of all the participants were female. Among patients, 29.9% (n = 52) had mild, 21.8% (n = 38) had moderate, and 9.2% (n = 16) had severe CTS. Both the Symptom Severity Scale (SSS) and functional status scale (FSS) scores were evaluated between the groups, and there was a significant difference between the groups (P < 0.001 and P = 0.001, respectively). Although there was a significant difference between the groups, the huge overlap in the distribution of the scores indicated that discrimination of an individual according to FSS/SSS scores is unrealistic in the clinical setting. Conclusion: The BCTQ will not be sufficient and objective in the diagnosis and management of CTS. Today, electrophysiological tests are still the gold standard for the diagnosis of CTS, and referring the patient to the electromyography EMG laboratory is necessary for early diagnosis and determining the effective treatment method.
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Asymptomatic median neuropathy in patients with diabetic polyneuropathy
Murat Alemdar
October-December 2021, 38(4):234-244
Aim: This study aims to investigate whether asymptomatic median neuropathy (AMN) in patients with diabetic peripheral polyneuropathy (DPNP) is a result of polyneuropathic involvement of median nerve (MN) or its true entrapment. Subjects and Methods: We determined the grades of the Michigan severity scale and the rates of peripheral nerve conduction abnormalities in study subgroups, including patients with carpal tunnel syndrome (CTS), AMN, and normal MN conductions to highlight if the severity of polyneuropathic involvement was different between them. In addition, the results of conventional and comparative nerve conduction studies (NCSs) were compared between these study subgroups. Results: Distributions of Michigan grades and rates of abnormalities in peroneal and sural NCSs were similar between the subgroups (P > 0.05 for all analyses). Abnormality rates of ulnar NCSs were higher in the AMN group than in the other groups, whereas those of comparative transcarpal NCSs were higher in the CTS group. The mean distal sensory latency (DSL) and motor latency (DML) of MN were longer, sensory conduction velocity (SCV) was slower in the CTS group than AMN group, whereas MN motor conduction velocity (MCV) was slower, UN DSL was longer, SCV was slower, SNAP amplitude was smaller, DML was longer, and MCV were slower in the AMN group (P < 0.05 for all analyses). Discussion: Our findings reveal that grade of polyneuropathic involvement is more prominent in AMN, whereas transcarpal MN conduction delay is greater in CTS. The results of the study suggest that the prominence of polyneuropathic impairment in addition to a lesser degree of MN sheet compression obscures the clinical signs in patients with diabetes with AMN.
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Protective effects of oxytocin and progesterone on paclitaxel-induced neuropathy in rats
Mehmet Ekici, Muharrem Balkaya1
October-December 2021, 38(4):262-270
Objective: Paclitaxel (Ptx), used to treat cancer, still causes neuropathic pain and peripheral neuropathy today. This study was conducted to evaluate the effects of progesterone (Pg) and oxytocin (Oxy) on peripheral neuropathy rat model induced by Ptx. Materials and Methods: A total of 38 male Sprague–Dawley rats were randomly divided into five groups, e.g., control (n = 6), Ptx (n = 8), Ptx + Oxy (n = 8), Ptx + Pg (n = 8), and Ptx + Oxy + Pg (n = 8). The rats were monitored daily for body weight change throughout the experiment. To evaluate peripheral neuropathy, electroneuromyography measurements (latency, amplitude, and motor nerve conduction velocity (MNCV)) were recorded from the sciatic nerve innervating the gastrocnemius muscle. Sciatic nerve tissue samples were collected for histopathological evaluation. Results: Ptx led to significant reductions in body weight from day 6 (P < 0.05). There was no difference between groups in the distal latency and amplitudes (P > 0.05). Proximal latency was prolonged in Ptx group rats than in other groups (P < 0.05). Importantly, it was found that MNCV was higher in the Ptx + Pg group than Ptx, Ptx + Oxy, and Ptx + Oxy + Pg groups (P < 0.05). Furthermore, Pg-administered rats had the lowest nerve degeneration compared to rats administered Oxy and Oxy + Pg (P < 0.05). Conclusions: The present findings suggest that Pg has a protective effect on peripheral neuropathy induced by Ptx in rat.
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Cerebrospinal fluid level of phosphorylated neurofilament heavy chain is higher in converting clinically isolated syndrome and correlates with CAMP response element-binding protein concentration
Mehmet Gencer, Gizem Koral, Elif Sanli, Selen Cirak, Ece Akbayir, Hande Yuceer, Tugce Kizilay, Ruziye Erol Yildiz, Sibel Penbe Yentur, Vuslat Yilmaz, Erdem Tuzun, Recai Turkoglu
October-December 2021, 38(4):256-261
Introduction: Prevision of conversion from clinically isolated syndrome (CIS) to multiple sclerosis (MS) is required to avoid unnecessary use of immunomodulating agents and to recognize patients with high disease activity. Our aim was to evaluate the value of phosphorylated neurofilament heavy chain (pNFH, a marker for neuroaxonal degeneration) and Cyclic adenosine monophosphate response element-binding protein (cAMP response element-binding protein [CREB], a marker for neuroregeneration) levels in the prediction of conversion from CIS to MS. Methods: Twenty-three consecutively recruited treatment-naïve CIS patients were followed for 36 months. pNFH and CREB levels were measured in the first episode cerebrospinal fluid (CSF) and the serum of 12 converting (CIS-MS) and 11 nonconverting CIS patients (CIS-CIS) by enzyme-linked immunosorbent assay. Results: Baseline CSF but not serum samples of CIS-CIS patients displayed significantly lower pNFH levels compared to patients with CIS-MS. The analysis of receiver operating characteristic curve presented a high specificity for the prediction of MS conversion for the CSF pNFH cut-off level of 730.9 pg/ml. CSF pNFH levels significantly correlated with serum and CSF CREB levels. Higher baseline CSF pNFH and CREB levels were associated with more rapid progression to MS or increased disability scores. Conclusion: CSF pNFH measurement may potentially determine MS patients with unfavorable clinical progression after the first attack. pNFH and CREB appear to be increased in parallel in CSF of CIS patients with higher disease activity. These results suggest that neurofilaments are not only indicators of axonal degeneration but also partly a marker of neuronal differentiation and new axon regeneration mediated by CREB signaling pathway.
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