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We compared copeptin levels in relapsing-remitting multiple sclerosis (RRMS) patients with controls and investigated how plasma copeptin levels were changed with the disease period. Thirty patients with RRMS without a prior attack in the last twelve months, and 19 RRMS patients with a clinical acute attack and 30 healthy individuals were included into the study. Copeptin levels were significantly higher in all RRMS patient groups than healthy controls. Plasma copeptin levels were higher in patients in remission period compared with relapse period of 19 RRMS patients with an acute attack. We consider copeptin can be used as a potential biomarker for RRMS.

Restless legs syndrome (RLS) is a common sensorimotor disorder that, in case of severe symptoms, can be very distressing and negatively interfere with quality of life. Moreover, increasing evidences associate RLS with higher risk of cerebrovascular and cardiovascular disease (CVD). The purpose of this study was to quantify two proteins, previously identified by proteomics and potentially linked with CVD risk, namely kininogen-1 (KNG1) and alpha-1-antitrypsin (A1AT), in primary RLS patients at high severity grade (HS-RLS) in comparison to healthy control subjects. Proteins were quantified through enzyme-linked immunosorbent assay (ELISA) in plasma samples from 14 HS-RLS patients and 15 control individuals. The two groups were closely matched for age and gender. The expression level of KNG1 resulted significantly higher (p

Objectives Copeptin, the C-terminal fragment of antidiuretic hormone, is a new biomarker that has been found to be elevated in several disorders and could be related with prognosis. This study aimed to compare plasma copeptin levels in patients with restless legs syndrome (RLS) with healthy individuals and to investigate whether plasma copeptin levels were associated with the severity of disease. Material and methods 41 patients with primary RLS, who were followed in Bakirkoy Psychiatry and Neurology Research and Training Hospital and 41 age- and sex-matched healthy individuals were included into the study. RLS patients were divided into subgroups as mild-moderate, severe, and very severe according to the severity of symptoms. Sleep quality and excessive daytime sleepiness were determined according to Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale, respectively, and sleep quality scores were analyzed statistically among the groups divided according to disease severity. Copeptin levels in all the patients were compared to the controls. RLS subgroups were compared with each other to evaluate association between copeptin levels and disease severity. Results Plasma copeptin levels in RLS patients were significantly higher than controls (P

Cerebral venous sinus thrombosis: gender differences in ten years experience Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon subtype of stroke. CVST is much more common in women than men with a ratio of three to one. This women preponderance is attributed to gender-specific risk factors (GSRF). In many patients, symptoms develop over days or weeks. In some patients, clinical presentations are nonspesific. Patients and Methods: We reviewed the records of patients with CVST treated at Neurology department of Haseki Training and Research Hospital between 2001-2011, which diagnoses were confirmed with cranial magnetic resonance imaging (MRI) and magnetic resonance venography (MRV). Thirty- four patients were included the study. Women/men ratio was 3.25/1. We analyzed the demographic features, comorbid conditions, clinical presentation, neuroradiological findings. Results: Thirty- four patients were included the study. Headache was present in all patients and it was present as isolated in 47.1% (n=16) of the patients. In 52.9% (n=18) of the patients onset of the symptoms were subacute, 29.4% (n=10) chronic, 17.6 (n=6) acute. Of all patients, 76.5% (n=26) were women. Transverse sinus was the mostly affected sinus as either isolated or with the other CSVT in both groups (in 20 women and 8 men). The most common presentation symptom (43.78%) in women was headache whereas; it was intracranial hypertension (34.78%) in men. Half of our women patients with GRSF; 7 (26.92%) women were oral contraceptives user and 5 (15.38%) women were in pregnancy or puerperium period. Conclusion: We have found differences between women and men in the presentation and risk factors.

Purpose: Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters. Methods: Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients. Results: According to the OSAS grading, patients were grouped as mild (n=15), moderate (n=27), and severe (n=59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss. Conclusions: We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema. © 2013 Springer-Verlag.

Copeptin, the C-terminal fragment of antidiuretic hormone (ADH), is a new biomarker that has been found to be elevated in several cardiovascular disorders and is related with prognosis. Patients with obstructive sleep apnea demonstrate a tendency to develop coronary and cerebral atherosclerotic disease. Our aim was to investigate copeptin levels in untreated new diagnosed obstructive sleep apnea patients without manifest cardiovascular disorders in order to determine whether copeptin could be used as a biomarker in this group.A total of 60 patients with obstructive sleep apnea, diagnosed with polysomnography, and 23 healthy volunteers were enrolled into this study. Blood samples were collected after overnight fasting, and copeptin level was measured with an enzyme immunoassay method.Patients with obstructive sleep apnea had a higher incidence of hypertension and body mass index but lower serum copeptin level (0.48 ± 0.24. vs. 0.64 ± 0.28 ng/ml, p = 0.007) compared with the healthy controls. There was no significant difference regarding to serum copeptin levels between the moderate (n = 13) and severe (n = 47) obstructive sleep apnea patients (0.42 ± 0.18 vs. 0.49 ± 0.26 ng/ml, p = 0.409).Rather than reflecting a reduced risk for cardiovascular disorders, we consider that reduced copeptin level is related with disturbed ADH secretion in obstructive sleep apnea patients. Therefore, it would not be advisable to measure copeptin levels in obstructive sleep apnea patients to determine cardiovascular risk, while this marker could be valuable to demonstrate impairment in ADH regulation in this patient group.

Epilepsy is a serious chronic brain disorder of childhood. We performed a cross-sectional prevalence study, determined the prevalence of childhood epilepsy, and identified the significance of certain risk factors for epilepsy among 1625 primary-school students aged 6-14 years, living in the center of Kars province. A questionnaire was prepared according to the definitions and principles of the Commission on Epidemiology and Prognosis, International League Against Epilepsy. Twenty-two children were diagnosed as epileptic. The point prevalence of active epilepsy in males was 4.9/1000, and in females 12.4/1000, representing a total of 8.6/1000. The cumulative prevalence in males was 11.0/1000, and 16.1/1000 in females, representing a total of 13.5/1000. Febrile convulsions, family history of epilepsy, serious maternal illness during pregnancy, a history of head trauma, antenatal/postnatal problems, and a history of neonatal jaundice were statistically significantly related to the development of epilepsy.

Aspirin is used in ischemic stroke therapy. However, some patients are not responsive to the antithrombotic action of aspirin. The aim of this study was to assess the prevalence of aspirin resistance in stroke patients and its association with mortality. One-hundred and six patients (mean age 64.9 ± 14.6 years, 53 male) with acute ischemic stroke were consecutively recruited. All subjects were taking aspirin regularly. Aspirin responsiveness was determined by Ultegra Rapid Platelet Function Assay-ASA (VerifyNow Aspirin). Aspirin resistance was defined as aspirin reaction unit (ARU) ≥ 550. Aspirin resistance was detected in 35 patients. There were not any significant differences in age, gender and comorbidities between aspirin-resistant and aspirin-sensitive patients. The mean National Institute of Health Stroke Scale (NIHSS) scores of the aspirin-resistant and aspirin-sensitive patients were 15 ± 3 and 12 ± 5, respectively (p = 0.006). Twenty-seven patients had a history of prior ischemic stroke and eight of them had aspirin resistance. Eleven patients died in-hospital and a total of 43 patients died during 2 years. Both the in-hospital and 2-year mortality rates were significantly higher in patients with aspirin resistance (20 vs. 5.6%, p = 0.038 and 60.0 vs. 31.0%, p = 0.004, respectively). Regression analysis revealed aspirin resistance [odds ratio (OR) 3.097, 95% confidence interval (CI) 1.070-8.959, p = 0.037] as an independent predictor of 2-year mortality, as well as age (OR 1.051, 95% CI 1.003-1.102, p = 0.038) and NIHSS scores (OR 1.208, 95% CI 1.016-1.437, p = 0.033). Aspirin resistance is not uncommon in patients with acute ischemic stroke and is associated with short and long term mortality in these patients.

Cardiac valvulopathy has been reported in patients with Parkinson's disease treated with pergolide. The aim of this study was to clarify the frequency and severity of valvular heart disease (VHD) in patients treated with pergolide, levodopa or both. We evaluated VHD by transthoracic echocardiography in 25 patients who were taking pergolide, 29 patients taking levodopa and 20 patients taking both levodopa and pergolide. All groups were compared with two separate age-matched control groups. There was no increase in the frequency of any type of echocardiographically-significant valvulopathy in the pergolide groups. Echocardiographically significant aortic regurgitation was found in 8% of the patients in the pergolide group and in 37.9% of the patients in the levodopa group. There was no correlation between VHD and pergolide dose, cumulative dose or duration of therapy. The mean pergolide dose was 2.6+/-1.4 mg/day in the pergolide monotherapy group. We did not find any unequivocal evidence that pergolide causes significant valvular regurgitation. However, the mean pergolide dosage in our study was lower than in previous studies.

Repetitive obstruction of larynx during sleep can lead to daytime pulmonary hypertension and alterations in right ventricular morphology and function in a small fraction of obstructive sleep apnea syndrome (OSAS) patients. Environmental effects, particularly high altitude, can modify the effects of OSAS on pulmonary circulation, since altitude-related hypoxia is related with pulmonary vasoconstriction. This potential interaction, however, was not investigated in previous studies. A total of 41 newly diagnosed OSAS patients were included in this study after pre-enrolment screening. Two-dimensional, three-dimensional, and Doppler echocardiographic data were collected after polysomnographic verification of OSAS. Three-dimensional echocardiograms were analyzed to calculate right ventricular volumes, volume indices, and ejection fraction. Systolic pulmonary artery pressure (38.35 ± 8.60 vs. 30.94 ± 6.47 mmHg; p = 0.002), pulmonary acceleration time (118.36 ± 16.36 vs. 103.13 ± 18.42 ms; p = 0.001), right ventricle (RV) end-diastolic volume index (48.15 ± 11.48 vs. 41.48 ± 6.45 ml; p = 0.009), and RV end-systolic volume index (26.50 ± 8.11 vs. 22.15 ± 3.85; p = 0.01) were significantly higher in OSAS patients, with similar RV ejection fraction (EF) between groups. No significant differences were noted in other two-dimensional, Doppler or speckle-tracking strain, measurements. Both RVEF and pulmonary acceleration time were predictors of disease severity. A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.

Studies that explored the anterior visual pathway in the patients with multiple sclerosis (MS) have demonstrated contradictory results about the correlation between structural and functional status of optic nerve and retina. We aimed to investigate the functional and structural findings in our cohort of mildly disabled relapsing-remitting MS patients. A total of 134 eyes (80 eyes of the patients with MS and 54 eyes of the control group) were investigated. Eyes of MS patients were divided into two groups as eyes with history of optic neuritis (ON group) and without history of optic neuritis (NON group). Ophthalmological investigation including visual evoked potentials, standard automated perimetry, and optical coherence tomography were performed for all participants. Retinal and macular thicknesses were significantly decreased in ON and NON groups compared with controls. Also, visual evoked potential latencies and visual field loss were worse in the both MS groups compared with control group. We did not find any correlation between visual evoked potentials and retinal or macular thickness values but visual field parameters were correlated between retinal and macular layer loss in the NON group. According to our results and some previous studies, although both functional and structural changes were detected in patients with MS, functional status markers do not always show parallelism (or synchrony) with structural changes, especially in eyes with history of optic neuritis. © 2014 Informa Healthcare USA, Inc.

We aimed to investigate the relationship between olfactory function and olfactory bulbus (OB) volume, disease duration and Unified Parkinson-s disease rating scale (UPDRS) scores in early stage idiopathic Parkinson-s disease patients. The University of Pennsylvania Smell Identification Test (UPSIT) was used for the evaluation of olfactory function. UPSIT scores for patients with Parkinson-s disease were significantly lower than controls. There was no significant difference between stage 1 and stage 2 patients. OS volumes were higher in stage 1 and 2 patients than controls, but there was no statistical difference between the three groups. No significant correlation was found between UPSIT and UPDRS total scores, nor between UPSIT scores and disease duration in stage 1 and 2 patients. According to our results, we propose UPSIT be used as a screening test to diagnose presymptomatic patients, but not OB volumes. (C) 2013 Elsevier Ltd. All rights reserved.

Determinants of sexual dysfunction in male and female patients with parkinson’s disease Objective: Due to the complex nature of Parkinson’s disease (PD) and distinct sexual physiologies, male and female patients might have different patterns of sexual dysfunction (SD) in PD. The aim of this study was to assess determinants of SD in female and male patients with PD. Methods: Seventy nine outpatients with idiopathic PD (46 male, 33 female; mean age: 67.51±8.27) were recruited between December 2007 and February 2011. Unified Parkinson’s Disease Rating Scale and Hoehn– Yahr stages, Hamilton depression and anxiety scales, Mini-Mental State Examination and Arizona Sexual Experiences scale were the measures. Results: Determinants of SD in the whole group were age and anxiety. Age at disease onset and anxiety designated SD in female group, while age and severity of motor symptoms designated SD in male group. Conclusion: Both in males and females, gonadal steroids decline with advancing age. Dopamine has role in desire, erection, reward-seeking behavior phases of sexuality. Dopamine depletion may cause SD with its dual effects, including erectile dysfunction as well as motor disturbances in PD in male patients. Anxiety effect females more than males due to affected body image and perception of the self.

Optical coherence tomography is supported and used as a technique for visualisation of neuro-axonal loss in multiple sclerosis, but there are also a few studies expressing the opposite view. The aim of our study was to investigate retinal nerve fibre layer and optic nerve head parameters in patients with multiple sclerosis without a history of prior optic neuritis and symptoms of a new clinical attack during the follow-up for a total of 20-month period. Full ophthalmic evaluation was performed for all of the participants. The baseline retinal nerve fibre layer and macular thicknesses and focal and global loss of macular volume values were significantly lower in the eyes of the patients with multiple sclerosis compared with the healthy controls. No significant change between baseline and follow-up scans were found in all optical coherence tomography parameters in the multiple sclerosis group. Statistical analyses revealed significant retinal nerve fibre layer and macular thickness differences between baseline and second measurements in the controls. No significant difference in percent change between baseline and second measurements was observed between the patient and control groups. We conclude that whereas healthy subjects have an age-related tendency toward a decrease in retinal nerve fibre layer thickness, patients with multiple sclerosis patients are likely to pass through different stages of retinal thinning and thickening due to subclinical optic neuritis and, as a result, we could not detect any statistically significant change between baseline and second measurements in our multiple sclerosis patients. © Informa Healthcare USA, Inc.

Acute movement disorder associated with bilateral basal ganglia lesions is an increasingly recognized syndrome in patients with end-stage renal disease, especially in the setting of diabetes mellitus. The exact mechanism of the basal ganglia lesions is unclear. We report a patient with end-stage diabetic nephropathy admitted to our clinic with acute onset bilateral ballistic movements.

Objectives REM sleep behavior disorder (RBD) has been documented to precede or to co-occur with Parkinson's disease (PD). Parkinson's disease is one of the most common neurological conditions associated with visual hallucinations. Cognitive dysfunction is present in PD, even at the early stages of these diseases. In this study we aimed to investigate the relationship between visual hallucinations and RBD in patients with idiopathic Parkinson's disease (IPD). Additionally, we evaluated the association of the cognition and the pattern of cognitive impairment with VHs and RBD, effects of factors like duration and severity of the disease and duration of levodopa usage. Patients and methods Seventy-nine patients, diagnosed as PD, were included the study and then, patients were divided into four groups; with RBD and VHs (group 1), with RBD but no VHs (group 2), with VHs but no RBD (group 3), without RBD and VHs (group 4). We compared each group with the others according to demographic characteristics and neuropsychological test scores. Results Of all patients, in 46% ( n =36) RBD and in 48% ( n =38) VHs were observed. Our study established VHs in 58% of patients with RBD, and RBD in 55% of patients with VHs. However, due to a 40% incidence of VHs in patients without RBD, RBD and VHs were not found to be correlated. All of the neuropsychometric test scores did not reveal significant difference between groups. Conclusion Although it seems like there is a small association between RBD and VHs in our patients, it was not significant. Group 1 presented with significantly worse scores in UPDRS total scores and I, II subscores.

Syphilis is still a significant public health problem in developing countries. Although chorea is a very rare manifestation of neurosyphilis, it might be on occasions the initial symptom. This report presents a patients with neurosyphilis who had chorea as the initial presenting symptom.