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Hereditary spastic paraplegias (HSPs) are neurodegenerative disorders characterized by progressive weakness and spasticity in the lower limbs and are clinically and genetically heterogeneous. They are clinically classified as pure and complicated forms. HSP may be inherited as autosomal dominant, autosomal recessive, X-linked, or mitochondrial disorders. A 61-year-old man presented with progressive stiffness, weakness, ataxia in the lower limbs, dysarthria and asymmetric ptosis. None of the family members had such neurological symptoms. Brain magnetic resonance imaging showed cerebellar atrophy. Genetic analysis with whole exome sequencing revealed a homozygous p.Ala572Val (c.1715C>T) exchange mutation in SGP7 gene. SPG 7 mutation is an important cause of adult-onset undiagnosed ataxia. Although the availability of exome sequencing with targeted analysis helps molecular diagnosis of SPG7 easier, it is important to consider SPG7 in the differential diagnosis of adult onset ataxias. In this paper we report a patient with complicated form of HSP with SPG7 mutation.

Objectives:Coronavirus disease (COVID-19) causes various neurological manifestations such as seizure and alteration of consciousness. The effect of COVID-19 on epilepsy is limited. For this reason, it was aimed to investigate the effect of COVID-19 on seizure frequency and severity of patients with epilepsy and the effect of COVID-19 treatment on seizures.Methods:Patients followed by the epilepsy outpatient unit were evaluated for COVID-19 between April 2020 and April 2021 and the patients who had COVID-19 were undertaken to the study. The age, gender, epilepsy type, duration of epilepsy, seizures in the past year, comorbidity disease, the date of COVID-19, COVID-19 treatment, inpatient care, need of intensive care, seizures in the meantime, treatment of antiepileptic drugs (AED), and seizure frequency and severity after COVID-19 were evaluated retrospectively.Results:A total of 141 patients who were diagnosed with COVID-19 were recruited for the study. When evaluating the factors which affect seizure occurrence risk during COVID-19, it was found that COVID-19 treatment protocol did not affect, but the existence of seizure in the past year increased 4.002 times, need for inpatient care increased 12.481 times, and number of AED increased 1.974 times seizure risk. It was found that having seizure during COVID-19 increased after COVID-19 seizure frequency and severity.Conclusion:As a result, the data of the study showed that the factors which affect having seizure during COVID-19 were inpatient care, the number of AED, and existence of seizure in the past year. The studies which included larger patients and longer follow-up time data are needed to evaluate the longer effect of COVID-19 on epilepsy.

Osteomalacia is a metabolic bone disease characterized by demineralization of the newly formed osteoid in adults. Vitamin D deficiency due to insufficient vitamin D intake, inadequate exposure to sunlight, and malabsorption of vitamin D are the most widespread cause of osteomalacia. Here,we present the case of 18 year old female patient who presented to our hospital with complaints of low back pain. Sacral bone pseudofracture was detected by magnetic resonance imaging due to osteomalacia. Patient was treated with vitamin D.

Objective: In this study, it was aimed to evaluate the relationship between vitamin D level and pain severity, localization and duration in patients with non-specific musculoskeletal pain. Materials and Methods: Patients who applied to physical medicine and rehabilitation outpatient clinics due to non-specific muscle pain in 19 centers in Turkey were retrospectively screened. Three thousand four hundred fourpatients were included in the study, whose pain level was determined by visual analog scale (VAS) and the painful region, duration of pain and vitamin D level were reached. D group was found to be D deficient (group 1) when 25 (OH)D level was 20 ng/mL or less and group D 2 (vitamin D deficiency) was higher than 30 ng/mL (group 3). The groups were compared in terms of pain duration, localization and severity. In addition, the correlations of pain localization, severity and duration with vitamin D levels were examined. Results: D vitamin deficiency was detected in 2202 (70.9%) of 3 thousand four hundred and four registered patients, and it was found that vitamin D deficiency in 516 (16.6%) and normal vitamin D in 386 (12.4%). The groups were similar in terms of age, body mass index, income level, duration of complaint, education level, family type and working status (p>0.05). There was no statistically significant difference between groups in terms of VAS, pain localization and duration scores (p>0.05). Conclusion: Our study shows that vitamin D deficiency in patients with nonspecific musculoskeletal pain is not associated with the severity and duration of pain.

Objective: In this study, it was aimed to determine the rates of multiple drug use in the patients with osteoporosis as well as the use of drugs affecting bone metabolism and balance. Materials and Methods: We included outpatients from Physical Medicine and Rehabilitation Policlinics diagnosed with primary or secondary osteoporosis between January 2014 and May 2014. Written consent of the participants was obtained. Data of the first 1000 patients who agreed to participate in the study were evaluated. Data regarding age, history, drugs currently being used and newly initiated were recorded. The drugs that affect bone metabolism were determined. The drugs that heva side effects including dizziness, somnolence, distractibility, decrease in the visual acuity, orthostatic hypotension and ototoxicity and were recorded because these can cause a balance disorder. Results: In this study, 64% of the participants were on five or more drugs. The most commonly used drugs were analgesics (65.4%), antihypertensives (52.6%), and drugs for digestive system (37.3%). We found that 65.5% of the participants were using drugs that may have side effects on bone metabolism and 93.7% were using drugs that may have side effects on balance. Conclusion: Multi-drug use and drug interactions should be considered during the treatment of osteoporosis and the drugs used should be recorded. Drugs that affect bone metabolism should only be used over the short term. Also, patients should be informed about side effects that might affect visuality, somatosensorial system and vestibular system and their daily activities should be regulated. (Turkish Journal of Osteoporosis 2015;21: 5-9)

Parallel to the frequent application of anterior segment surgical techniques, the frequency of dry eye disease is increasing. Dry eye is a multifactorial condition that affects the surface of the eye and induces an inflammatory response. Corneal nerves play an important role in the maintenance of a healthy ocular surface. Intact corneal innervation is mandatory for normal blinking and tearing reflexes. Damage to this neural circuit interrupts the normal regulation of lacrimal gland secretion and causes dry eye disease. Anterior segment surgeries damage corneal innervation. Even after a successful cataract or refractive surgery, the occurrence of dry eye leads to discomfort and several complications. Because of these problems, we have to know the risk factors and the triggering mechanisms of dry eye disease, to take precautions during and after the surgery, and to choose the appropriate surgical technique. (Turk J Ophthalmol 2012; 42: 227-34)

Although vascular factors are considered primarily in the etiology of hemichorea among the elderly, chorea related to congenital vascular malformations including cavernous angioma are reported very rarely. We found cavernous angioma to be the cause of persistant, unilateral chorea localized to the right lower extremity in a 83 year-old woman. In this article we would like to highlight the etiology of chorea in patients with late onset movement disorders

Pur po se: To determine the tear osmolarity changes in patients who had undergone phacoemulsification surgery. Ma te ri al and Met hod: Tear osmolarity measurements were performed in 30 eyes of 30 patients who had undergone cataract surgery without any complication. Measurements were performed before surgery and consecutively at 1st month, 3rd month, and 6th month after the surgery. TearLab osmometer (TearLab Corporation, San Diego, CA, USA) device was used for the measurements and paired ttest was used for statistical analysis. Re sults: The mean age of the patients was 72.3±3.7 (67-78) years. Thirteen patients were men and 17 patients were women. The mean osmolarity values were 305.8±6.5 mOsm/L before the surgery and 312.3±6.4 mOsm/L at 1st month, 307.5±5.1 mOsm/L at 3rd month and 305.1±5.7 at 6th month after the surgery. The difference between the values before surgery and at 1st month was found statistically significant (p=0.001). Dis cus si on: The tear osmolarity increases at the first month after surgery but decreases to the levels measured before surgery at the 3rd month. The increase at the first month may be due to the corneal incisions and medication used after the surgery. We think that we have to take into account this similarity increase in all cataract patients, especially in those who also have dry eye disease. (Turk J Ophthalmol 2012; 42: 35-7)