Search

BackgroundThe most common cause of trigeminal neuralgia (TN) is neurovascular compression. However, a number of patients present with unknown etiology. This study aims to investigate the relationship between TN and cervical pathology in patients previously diagnosed with idiopathic TN. MethodsWe designed an observational case-control study. A study group consisting of patients previously diagnosed with idiopathic TN and a control group was included in the study. Cranial MRI’s of TN patients were re-evaluated by a blinded neuroradiologist. Once it was confirmed that no signs of neurovascular compression or any secondary causes were present, a cervical MRI was performed to evaluate cervical pathologies. Results20 patients and 20 controls were investigated. The mean age of TN patients was 64.9±12.6, and the mean age of the control group was 61.3±9.1 (p=0.305). Whilst indentation on the trigeminal spinal tract above C4 spinal level was observed in 12 out of 20 patients, none of the controls had any involvement in the same region (pConclusionsThe results of this study suggest that extramedullary indentation on the trigeminal spinal tract caused by upper cervical discopathy may be one of the possible etiological factors in TN.

Objective: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system that principally affects young adults. Recent studies from different parts of the world have shown that the incidence and prevalence of MS is increasing each year. No data are available on this subject for Turkey. With this study, we aimed to evaluate the 10-year trend of MS prevalence in two rural cities of Turkey for the first time. Materials and Methods: The study was designed as a cross-sectional, community-based, descriptive epidemiologic study. Geyve and Kandıra districts were screened using a validated questionnaire between 2016-2017. During the field study, all suspected participants were invited to a public health center for re-examination along with their laboratory and imaging findings. Local state hospitals were used to complete this process if required and diagnosis was then confirmed. The revised McDonald 2010 criteria were used in diagnosing MS. Results were compared with a previous study that was conducted 10 years prior by the same team using an identical methodology. Results: Seventeen thousand one hundred people were screened in Geyve and 12,120 people were screened in Kandıra. Ten people were diagnosed as having MS in Geyve and four were diagnosed in Kandıra. The total prevalence was found as 47.9/100,000. The female/male ratio was 2.5. Nine patients had relapsing remitting MS, four had secondary progressive MS, and one patient had primary progressive MS. When compared with the previous study, the age-standardized prevalence was not statistically different (49.6/100,000; 48.5/100,000 p=0.955). Conclusion: The results of this study indicate that the prevalence of MS is not increasing in two rural cities in Turkey.

Background: It has been reported that a new type of headache may develop as a result of face mask use during the COVID-19 pandemic. The aim of this study is to investigate the clinical features of face mask-related headache during the COVID-19 pandemic. Methods: This is a cross-sectional study carried out on healthcare workers at the Afyonkarahisar Health Sciences University. The number of workers at our university was established. Sample size was calculated using the G*Power program. A questionnaire consisting of questions relating to pre-existing headache, an aggravation in headache, and de-novo headache was filled out by 3 neurologists with all participants. Results: Data was collected from a total of 375 participants, after the exclusion of 5 individuals who refused to participate. Out of all participants, 26 (6.9%) used a filtering mask, 274 (73.1%) used a surgical mask, 75 (20.0%) participants used a combination of both masks. The number of participants with preexisting headache was 114 (30.4%) had pre-existing headache. Of those with pre-existing headache, 77 (67.5%) healthcare workers had reported an aggravation in their headache after mask use. De-novo headache was observed in 116 (30.9%) of participants. De-novo headache characteristics included throbbing in 17 (14.7%) participants and pressing in 99 (85.3%) participants. In addition, symptoms such as tachypnea, sleep disturbance, and fatigue were found to be significantly higher. Conclusions: This study indicates that healthcare workers develop headaches due to use of masks during the COVID-19 outbreak.

OBJECTIVE: Burnout syndrome is an important problem among healthcare workers. During the Covid-19 pandemic, healthcare professionals have struggled with an unprecedented effort. The aim of this study is to investigate occupational burnout levels among healthcare professionals working at Afyonkarahisar Health Sciences University during the Covid-19 pandemic.MATERIAL AND METHODS: This study was carried out at the Afyonkarahisar Health Sciences University between February 1st and March 1st, 2021. G* power package software was used in the sample calculation. A questionnaire form consisting of 20 parameters on demographic data and work life was used. Maslach Burnout Inventory was used as the burnout scale.RESULTS: A total of 312 healthcare professionals participated in this study. 139 of the participants were men (44.6%) and 173 were women (55.4%). The mean age of the participants was 30.7± 7.28. 138 of the participants were doctors (44.2%) and 174 were nurses (55.8%). 110 of the participants were working in a covid ward or covid intensive care unit (ICU) (35.3%) and 202 were working in other departments (64.7%). The mean subscale scores were 19.21±7.28 for emotional exhaustion, 7.31±7.19 for depersonalization, and 20.05±3.88 for personal accomplishment. These results show that healthcare workers experience high levels of burnout according to the emotional exhaustion and personal accomplishment subscales and moderate burnout according to the depersonalization subscale.CONCLUSIONS: The results of this study are very valuable for establishing future prevention protocols and educating healthcare professionals in the face of a pandemic. Based on our findings, we suggest closely monitoring risk groups that work directly with Covid-19 patients and providing psychological support when necessary. Also, making the necessary arrangements in working conditions is crucial to increase job satisfaction and reduce burnout in healthcare workers., AMAÇ: Tükenmişlik sendromu sağlık çalışanlarında önemli bir sorundur. Covid-19 pandemisinde sağlık çalışanları emsalsiz bir çaba ile mücadele etmişlerdir. Bu çalışmanın amacı, Covid-19 pandemisinde Afyonkarahisar Sağlık Bilimleri Üniversitesinde çalışan sağlık çalışanlarında mesleki tükenmişlik düzeylerini araştırmaktır.GEREÇ VE YÖNTEM: Bu çalışma 01 Şubat - 01 Mart 2021 tarihleri arasında Afyonkarahisar Sağlık Bilimleri Üniversitesi'nde gerçekleştirilmiştir. Örnek hesaplamada G* power paket programı kullanılmıştır. Katılımcıların demografik verileri ve iş hayatına ilişkin 20 parametreden oluşan anket formu kullanılmıştır. Tükenmişlik ölçeği olarak Maslach Tükenmişlik Envanteri kullanılmıştır.BULGULAR: Bu çalışmaya toplam 312 sağlık çalışanı katılmıştır. Katılımcıların 139'u erkek (%44.6), 173'ü kadın (%55.4) idi. Katılımcıların yaş ortalaması 30.7± 7.28 idi. Katılımcıların 138'i doktor (%44.2), 174'ü hemşire (%55.8) idi. Katılımcıların 110'u Covid servis veya Covid yoğun bakım ünitesinde (%35.3), 202'si (%64.7) diğer bölümlerde çalışıyordu. Ortalama duygusal tükenme puanı 19.21 ± 7.28, duyarsızlaşma puanı 7.31 ± 7.19 ve kişisel başarı puanı 20.05 ± 3.88 idi. Bu sonuçlar, sağlık çalışanlarının duygusal tükenme ve kişisel başarı alt boyutlarına göre yüksek düzeyde tükenmişlik, duyarsızlaşma alt boyutuna göre ise orta düzeyde tükenmişlik yaşadıklarını göstermektedir.SONUÇ: Bu çalışmanın sonuçları, gelecekte önleme protokollerinin oluşturulması ve sağlık profesyonellerinin pandemi karşısında eğitilmesi için çok değerlidir. Çalışmamızın sonuçlarına göre doğrudan Covid-19 hastaları ile çalışan risk gruplarının yakından takip edilmesi ve gerektiğinde psikolojik destek verilmesi önemlidir. Ayrıca sağlık çalışanlarında iş doyumunun artırılması ve tükenmişliğin azaltılması için çalışma koşullarında düzenlemelerin yapılması oldukça önemlidir.

Objective: We sought to evaluate neurologic symptoms and findings in patients with COVID- 19 infection hospitalized in a ward and intensive care unit (ICU). Methods: This study was designed as a prospective study. Hospitalized COVID-19 rRt-PCR positive patients in the ward and ICU were included in the study. A 54-item questionnaire was used to evaluate the patients. Patients were examined within 3 hours of hospitalization. Results: A total of 379 patients were included in the study. The mean age of the patients was 56.1 ± 17.8. 89 of the patients were in intensive care. At least one general symptom was recorded in 95.5% of patients. The most common neurologic symptoms were myalgia (48.5%), headache (39.6%), anosmia (34.8%), and dysgeusia (34%). Neurological symptoms in ICU patients were higher than in the ward. 53.6% of patients had comorbidities. Discussion: This study indicated that the prevalence of neurological symptoms was very high in patients with COVID-19. The percentage of neurological symptoms and findings was higher in patients hospitalized in ICU.

Aims This study aimed to investigate the prevalence of restless leg syndrome (RLS) in type-2 diabetes mellitus (DM) patients and to determine the risk factors. Methods Patients were recruited from the Dr. Lutfi Kirdar Kartal Training and Research Hospital Diabetes Center. Patients between 18–80 years of age and meeting a minimum 5 years diagnosis of type-2 DM were included. All patients were examined by the same neurologist in terms of having RLS. The diagnosis was made according to the updated International Restless Legs Syndrome Study Group consensus criteria. Mimicking conditions such as myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort and habitual foot tapping were carefully investigated and excluded. Laboratory data, insulin use, family history and other related co-morbidities connected to RLS patients were recorded. RLS severity assessment was scored and recorded. Results 318 patients were included in the study. The prevalence of RLS in type-2 DM patients was found to be 28.3%. RLS prevalence in females was 33.3% and 20.6% in males. 39 patients (43.3%) had a family history of RLS. 43 patients with RLS had a co-morbidity link with RLS. Any co-morbidity linked to RLS was not seen in 47 patients. The prevalence rate of RLS in patients without co-morbidities was 17.1%. Mean duration of DM in patients with RLS was 15.6 ± 6.7 years while in DM patients without RLS was 13.7 ± 6.3 years. The relationship between RLS and the duration of diabetes was found to be statically significant. (p = 0.025). 68 (75.6%) of patients diagnosed with RLS were treated with insulin. A statistical significance was found in the development of RLS and insulin usage (p = 0.035). Conclusions This is the first study which shows the RLS prevalence and risk factors in Turkish type-2 diabetes mellitus patients. The results indicated that RLS is much more frequent in DM patients even after excluding polyneuropathy than in general Turkish population. The duration of diabetes and insulin use are related to RLS.

BACKGROUND: After the first COVID-19 case, reported neurological complications are increasing day by day. METHOD: In this paper, we present a benign-course Guillain-Barre syndrome (GBS) emerging 2 weeks after COVID-19 infection in a 35-years-old male. RESULTS: Cough and fever were started 18 days ago and his PCR test was resulted positive for COVID-19 infection. After treatment and quarantine were completed, he developed sudden leg weakness following autonomic features. Cerebrospinal fluid was suggestive for GBS despite the electrodiagnostic test was not helpful because it was done in the first days. He recovered without needing any immunotherapy. CONCLUSION: Our case suggested that COVID-19 can cause atypical benign GBS forms in addition to well-known variants. Comprehensive studies are needed to describe the unknowns and determine the exact prevalence of GBS after COVID-19 infection, including mild cases that did not require hospital admission.

Population-based studies on the prevalence of trigeminal neuralgia (TN) worldwide are rare and the epidemiology of TN in Turkey is unknown. The aim of this study is to determine the prevalence of TN in Turkey.We conducted a cross-sectional, population-based, descriptive epidemiological study in Ereğli, Turkey. Participants over the age of 18 were screened using a self-assessment form, and potential patients were identified by a 'neuroscreening team'. Suspected patients were invited for a clinical examination and evaluated by a senior neurologist. Any required imaging was carried out at a university hospital.Data were collected from a total of 9605 participants, after the exclusion of 247 individuals who refused to participate. Seven suspected patients were invited to a public health center for clinical evaluation. One patient was diagnosed with SUNCT (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) and one patient was diagnosed with post-herpetic neuralgia. A definite diagnosis of TN was confirmed in five participants. The crude prevalence was found to be 52.1/100.000. The mean age of cases was 62.2 ± 8.3 years and the female/male ratio was 4/1. TN was classified as 'symptomatic' in one patient with multiple sclerosis. The other four cases were diagnosed with classical TN. Right side involvement was identified in three cases (60%), whereas left side involvement was seen in two cases (40%).This study establishes the prevalence of TN in Turkey for the first time. The prevalence rate is low when compared with other international studies.

Background. This study aims to determine the stroke prevalence in Akçakoca which is a rural area in Turkey. Methods. The study was designed as a cross-sectional, door-to-door survey. The stroke questionnaire was completed by a trained team in the presence of the participants according to their answers. Based on the screenings, patients who had been diagnosed with stroke previously were reexamined by a neurologist and determined the prevalence values, risk factors, and stroke types. Results. A total of 3750 people over 44 years old were reached in the screenings. It was determined that 83 people had previously suffered a stroke. The prevalence rate of stroke in those above 44 years was found to be 2.2 (98% confidence level and ± 2% margin of error). 70 (84.3%) patients had suffered an ischemic stroke while 12 (14.5%) had suffered a hemorrhagic stroke. Male/female ratio was 1.1. Conclusion. The results of this study give the prevalence rate of stroke among the Turkish population living in a rural area. Due to a lack of other similar studies, it is impossible to make any data comparison. However, the results of this study help shed light on the stroke prevalence rate.

Introduction: Stroke has been projected to increase in developing countries like Turkey. Information about the prevalence of stroke may uncover the etiology of stroke and overcome its impact burden. However, data is limited due to a lack of studies based in Turkey and neighboring regions. We aimed to investigate the prevalence and risk factors of stroke in the Turkish city of Karabük and to pave the way for future epidemiological studies in Turkey. Methods: The study was designed as a cross-sectional, door-to-door survey. The questionnaire was completed by a trained team in the presence of the participants according to their answers. Patients who had been diagnosed with stroke prior to the survey were re-examined by a neurologist. Results: 3131 persons who were above 44years old were screened. 129 of them were found to have had a stroke previously. The prevalence rate of stroke above 44years was found to be 4.12% (98% confidence level and ±2% margin of error). 72.1% of stroke patients had hypertension. Male/female ratio was 0.72. Conclusion: This study showed a high prevalence rate of stroke in Karabük Turkey with a low male/female ratio when compared to other studies. Keywords: Stroke, Epidemiology, Turkey, Risk factors

Wernicke ensefalopatisi, tiamin eksikligine bagli, mortalitesi ve morbiditesi yuksek, nadir gorulen norolojik bir hastaliktir. Hastaligin klinik triadi konfuzyon, ataksi ve oftalmoparezidir. Klasik olarak alkol bagimlilarinda gorulmekle birlikte son yillarda alkol bagimliligi olmayan kisilerde de malignite, hiperemesis ve gecirilmis cerrahi operasyonlara bagli vakalar bildirilmistir. Biz de, alkol bagimliligi olmamasina karsin, pankreas malignitesi nedeniyle 2 yil once Whipple cerrahisi geciren ve son zamanlarda alkol tuketmeye baslayan, Wernike Ensefalopatisi gelismesine bu iki faktorun bir arada sebep oldugunu dusundugumuz bir olgu sunmayi amacladik.

Objective Studies focusing attention on the effects of environmental pollution on the etiology of multiple sclerosis (MS) are on the increase. The aim of this study was to determine MS prevalence in a city home to an iron and steel factory which causes air pollution. Methods The study was designed as a cross-sectional, population-based, descriptive epidemiologic study. Eregli city, which has an iron and steel factory and proven air pollution, was screened. Additionally, Devrek city, which is a rural and clean city, located 40 km away from Eregli was assigned and results were compared. A validated questionnaire was used for screening. McDonald 2010 criteria were used to diagnose cases. Results 32 261 people were screened in Eregli, and 21 963 people were screened in Devrek. In total, 41 patients were diagnosed with clinical definite MS. Crude prevalence was found to be 96.1/100 000 in Eregli and 45.5/100 000 in Devrek. The mean age of patients was 39.8, and the female/male ratio was 1.9. Conclusion The results of this study indicate a more than double MS prevalence rate in the area home to an iron and steel factory when compared to the rural city. This supports the hypothesis that air pollution may be a possible etiological factor in MS.

PubMed ID: 30334992, The prevalence of multiple sclerosis (MS) has significantly increased all over the world. Recent studies have shown that Turkey has quite a high prevalence. The aim of this study is to estimate prevalence in the Mediterranean and Black Sea regions of Turkey and to compare the results. This study was designed as a door to door survey in 3 cities. One is located in the Mediterranean region (South), 2 are located in the Black Sea region (North). A previous validated form was used for screening in the field. The patients were examined first in the field, then in the regional health facility. McDonald criteria were used for the diagnosis. In total, 26 patients were diagnosed with MS. The prevalence was found to be 18.6/100,000 in Artvin (Black Sea region), 55.5/100,000 in Ordu, (Black Sea region), 52.00/100,000 in Gazipaşa (Mediterranean region). The female/male ratio was 2.25. This study is the first prevalence study which was conducted in the Mediterranean City (South) of Turkey. The prevalence rate was found to be higher than expected in the Mediterranean city of Gazipaşa. The results showed that the prevalence varies from region to region. Latitude difference was not observed. Copyright © 2018 the Author(s).

Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled, and only a few of them investigated GON and supraorbital nerve (SON) blockade together. This study aimed to evaluate the efficacy of GON and SON blockade with local anesthetics for the preventive treatment of migraine without aura.Eighty-seven patients diagnosed with migraine without aura were included in the study. Patients were divided randomly. One group was injected with 1% lidocaine, the other group was injected with 0.9% saline. GON and SON injections were done bilaterally. The injections were repeated weekly for 3 weeks. Patients were followed up for 2 months to assess clinical response.Seventy-one patients completed the study. After 2 months, the number of headache days decreased significantly from 12.8 ± 10.9 to 5.3 ± 7.4, and VAS decreased from 8.3 ± 1.0 to 5.5 ± 1.9 in the blockade group. The number of headache days decreased from 12.4 ± 10.3 to 7.5 ± 7.2 and VAS decreased from 8.2 ± 1.1 to 7.4 ± 1.3 in the placebo group. Response was seen in 65.1% of the patients in the blockade group (65.4% for episodic migraine, 64.7% for chronic migraine) and 28.6% of the patients in the placebo group. The difference was significant.The results suggest that GON and SON blockade with lidocaine was more effective than the placebo in the prophylactic treatment of both episodic and chronic migraine.

Objectives We aimed to determine whether multiple sclerosis (MS) and methylprednisolone and disease-modifying drugs have an effect on menopausal age. Methods A total of 86 patients and 98 healthy subjects were included in this study. The natural menopausal age of the patients and healthy subjects were compared. The cumulative dosages of methylprednisolone, beta interferons (IFNβs), and glatiramer acetate were calculated. The effects of the Expanded Disability Status Scale (EDSS), duration of the disease, and cumulative dosage of medications on menopausal age were evaluated. Results The patients’ mean menopausal age was 45.3 ± 4.8 years and healthy subjects’ menopausal age was 46.8 ± 4.3 years, with no significant difference between the two groups. The cumulative dosage of methylprednisolone showed an effect on menopausal age. There was a significant inverse correlation between menopausal age and dosage of IFNβ-1b, while the disease duration and EDSS score showed no correlation with menopausal age. Conclusions We conclude that menopausal age is not affected by MS. However, long-term methylprednisolone and IFNβ-1b treatments may change menopausal age in a dose-dependent manner.

Although various modalities of treatment of chronic inflammatory demyelinating polyradiculopathy (CIDP) there are not any treatment protocol agreed.We retrospectively evaluated the 20 CIDP patients (14 male, 6 female). Five patients were excluded from the study because they could not continue their treatments due to various problems during the treatment. The remaining 15 patients treated with monthly high dose intravenous methyl prednisolone for five years (IVMP) and followed up for 10 years.The mean age of the patients was 48.1±14.6 years. The mean duration of disease was 6.8±3.1 years. We were found statistically significant difference between the pre-treatment and sixth month modified Rankin scores (p0.001). Similarly, significant improvement was observed at the end of first, fourth and fifth years of treatment. Statistically significant difference was found between baseline and tenth year modified Rankin scores of 12 patients who were treated with only IVMP during 10 years follow-up.Long-term monthly IVMP pulse therapy seems to be very effective in the treatment of CIDP.

OBJECTIVE: Stroke is one of the leading causes of death in world populations and leads to substantial disability and labor loss in the population. Risk factors for stroke are important in terms of preventive medicine. Early diagnosis and treatment of patients having risk factors for stroke can prevent stroke. Metabolic syndrome (MetS), which is characterized by insulin resistance, and prothrombotic and proinflammatory processes, has become one of the important risk factors in the last century owing to its effects on mortality and morbidity. The present study aimed to investigate the effects of MetS on mortality in ischemic stroke. METHODS: One hundred and thirty-seven patients (81 females and 56 males) without a previous stroke, who were diagnosed with ischemic stroke in the Neurology Clinic, within the 24 hours of the disease, evaluated in terms of etiopathogenesis, and fulfilled or not fulfilled the MetS criteria, were randomly included. RESULTS: The mean age was 69.78±10.76 years for the whole study group, 66.32±12.04 years for males and 72.18 ±9.12 years for females. MetS was present in 67 (48.9%) of 137 patients. Forty-six (56.8%) of 81 female patients and 21 (37.5%) of 56 male patients had MetS. With regard to mortality rates of patients with and without MetS; 7 (25.9%) of 16 patients who died within the first 10 days had no MetS, whereas 9 (37.5%) had MetS. Eleven (40.7%) of 19 patients who died between the 10th and 30th days had no MetS, whereas 8 (33.3%) had MetS. Nine (33.3%) of 16 patients who died between 3 months and 1 year had MetS, whereas 7 (29.2%) patients had no MetS. CONCLUSION: One-year evaluation of the patients with ischemic stroke revealed that MetS risk factor had no effect on mortality rates.

Material and methods: Fifty-eight patients (33 females and 25 males) with multiple sclerosis were included in the study. All of the patients underwent a detailed neurological examination, according to the clinical course of multiple sclerosis. For the assessment of quality of life, the Expanded Disability Status Scale (EDSS), Barthel Index (BI) for daily-life activities, and the Multiple Sclerosis Quality of Life-54 Instrument (MSQOL-54) were used. To determine sexual dysfunction, the Female Sexual Function Index (FSFI) and International Index of Erectile Function Questionnaire (IIEF) were used for females and males, respectively. The relationship between the scores of FSFI, IIEF and MSQOL-54, EDSS, BI was investigated.

Background: The population-based information on the prevalence of stroke from rural areas of Middle East countries including Turkey is unknown. Our aim is to evaluate the prevalence of stroke in those ⩾18 years in the Turkish population in a rural area of Istanbul. Methods: A cross-sectional door-to-door study was conducted in a rural area of Istanbul between 1 March and 30 March 2013. A research protocol recommended by World Health Organization for developing countries was used. Each screening teams consisted of one neurologist, one local nurse, and five surveyors. Teams were trained about the survey and questionnaire. The patients, who claimed to have suffered a stroke, were examined, and the diagnosis was confirmed by a neurologist on site. The findings and medical records were documented. Results: In total, 2906 people ⩾18 years were screened. 50 stroke cases were detected. 80% of those were found to have had an ischemic stroke, 14% of those were hemorrhagic cases, and 6% of those had an unclassified stroke type. The overall prevalence rate in those ⩾ 18 years was 1.7%. The male/female ratio was 0.92. Young (Conclusion: This study was the first of its kind to show the stroke prevalence among Turkish population ⩾ 18 years in a rural area of Istanbul. When compared to other studies which investigate people ⩾45 years from Turkey, the result (in the same age group) was moderate high. The male/female ratio was low compared to many other studies.

Background and Purpose Multiple sclerosis (MS) is an autoimmune disease characterized by inflammatory demyelination. Recent studies have shown that long-term exposure to air pollutants (including PM10 particulates) is potentially an environmental risk factor for MS. We aimed to determine the prevalence rates of MS in two cities with different levels of air pollution. Methods This door-to-door population-based study was conducted between April 2014 and June 2015. Two cities were screened for the prevalence rates of MS: 1) Karabük, which borders an iron-and-steel factory, and 2) Akçakoca, which is a coastal city located in the same region. A validated survey form was used for screening MS. The 2010 McDonald Criteria were used for diagnosing MS. The patients were examined twice, first by a neurology assistant in the field and then by a senior neurologist in public health centers in the cities. Results The prevalence of MS was 95.9/100,000 in Karabük and 46.1/100,000 in Akçakoca. In total, 33 patients were diagnosed with clinically definite MS. The female/male ratio was 1.5, and 21 patients were diagnosed with relapsing-remitting MS, 9 with secondary progressive MS, and 3 with primary progressive MS. Conclusions We found that the prevalence of MS was more than two fold higher in Karabük than in Akçakoca, which supports a link between air pollution and the pathogenesis of MS. However, larger etiological and epidemiological studies are needed to confirm this hypothesis. © 2018 Korean Neurological Association.

The association of thymoma with myasthenia gravis has been well documented. However, the relationship between these two syndromes and Addison disease are very rarely encountered in clinical practice. We report on a 32-year-old man who underwent a resection for thymoma 48 months ago. The diagnosis of Addison disease was made followed by a diagnosis of myasthenia gravis on the basis of a high titer of acetylcholine receptor levels. The treatment of oral prednisolone 7.5 mg/day and oral prostigmine 180 mg/day was initiated. His symptoms and physical signs were improved after this treatment. To our knowledge, this is the fourth reported case of thymoma synchronously associated with myasthenia gravis and Addison disease.

The aim of this study was to determine the prevalence of essential tremor (ET) in a Turkish population living in Sile, a rural town located on Black Sea coast of Istanbul. This study was designed as a descriptive cross-sectional field study. People aged 18 years and over were selected for the study. Tremor surveillance questionnaire was applied by door-to-door visits. Subsequently, all subjects who answered the questionnaire had a standard tremor examination. Diagnosis was made based on Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis and clinical evaluation scale. A total of 2227 people was screened. The prevalence of ET was found to be 3.09% (95% Cl=2.42-3.91%) in Turkish population aged over 18 years. The prevalence of ET increased by age in both genders.

Aim: Compression of the median nerve at the wrist is the most frequently observed entrapment neuropathy. The aim of our study was to investigate the accuracy of clinically diagnosed CTS by using electroneuromyography (ENMG). Material and Method: 500 patients who applied to our ENMG laboratory were investigated. 276 CTS(Carpal Tunnel Syndrome) prediagnosed patients were included in the study. Results: There was a concordance between the referral diagnosis and the results of ENMG, in 62.8% of the patients. The ENMG results were normal in 37.2% of the patients. Discussion: There was a low verification rate for the prediagnosis of CTS by ENMG indicating that clinical evaluation alone is inaccurate in the diagnosis of CTS.

BACKGROUND AND PURPOSE: The patients with lupus anticoagulants may have an increased risk for the development of ischemic brain lesions and subdural hematoma in the presence of other known risk factors. There are lots of reports related to antiphospholipid syndrome with subdural hematoma, but intra-axial bleeding is a rare complication. CASE DESCRIPTION: We report a 37-year-old man with ptosis, central typed facial palsy, hemiparesis on the right side and motor aphasia. A CT scan and MRI showed a large cerebral hematoma located in the left fronto-parietal region and other foci of hemorrhage on the right hemisphere. Only persistently abnormal finding in laboratory studies was positive for antiphospholipid antibodies. Based on above findings we concluded that anti-phospholipid antibodies have resulted in intracerebral hemorrhage. CONCLUSION: In the present case, we report and point that hemorrhagic complication in young patients with antiphospholipid antibody syndrome associated with fragility of the vessels and/or platelet dysfunction is another and rare cause of intracerebral bleeding.

PubMed ID: 28953646, Background: Botulinum toxin type-A (BTX-A) has been successfully utilized to treat trigeminal neuralgia. In this study, through the use of a new technique, the efficacy of the injection of BTX-A to the maxillary and mandibular nerves was evaluated. Methods: A total of 27 patients were injected with 100 Units of BTX-A to the maxillary and mandibular nerves. Visual analogue scale score and pain frequency were assessed before treatment and at the first week, second month, and sixth month after treatment. Patients with ?50% reduction in mean pain score at the second and sixth month were defined as responders. Results: A total of 27 patients were included in the study. BTX-A significantly reduced pain intensity and pain attack frequency at the first week, second month, and sixth month after treatment. At the second month, 74.1% of patients, at the sixth month, 88.9% of patients responded to treatment. Forty-four percent of patients did not experience any pain at the sixth month. The mean recurrence period was 87.7±20.4. BTX-A was well tolerated and showed few treatment-related adverse events. Conclusion: Injection to the maxillary and mandibular roots seems to be a highly effective method. In the event of recurrence, after each injection, the pain severity and attack frequency decreased. Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc.

OBJECTIVES Peripheral and central nociceptive mechanisms are responsible for the development of Tension Type Headache (TTH). Analgesics are frequently used in the treatment of acute TTH. Antidepressants are used in prevention. In this study, the therapeutic efficacy of local application of lidocaine was investigated in Episodic Tension Type Headache (ETTH) patients. METHODS ETTH patients with pericranial tenderness (n=20, Group 1) and without pericranial tenderness (n=20, Group 2) were included in our study. Three sessions of local injection of 1% lidocaine were performed in both groups. Two-sided intramuscular injections of 1 mL were applied for each patient. The muscles treated were the frontal, temporal, masseter, sternokloidomastoid, semispinalis capitis, splenius capitis and trapezius muscles. Patients were evaluated in 1st, 2nd, and 3rd months. The number of painful days per month and pain intensities were recorded according to Visual Analog Scale (VAS) before and after the treatment. RESULTS 11 male and 29 female patients were included in the study. The mean ages of Group 1 and Group 2 were 35.95 ± 9.85 (18-53) and 34.85 ± 10.04 (20-54) years, respectively. There was no difference between the groups in terms of age, gender, pain frequency and pain intensity (p>0.05). The frequency and severity of pain was significantly lower in pericranial-sensitive ETTH patients at the 1st, 2nd, and 3rd months after local lidocaine injections compared to ETTH patients having pericranial tenderness (p

Background: Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude. Methods: The same survey methods were used for total populations of two rural areas (Kandıra and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast. Results: In Kandıra, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS. Conclusion: These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

We aimed to determine the prevalence of primary headache among schoolchildren in the city of Agri, located in eastern Turkey, where geographical, climatic and socio-economic conditions differ greatly from those of other regions of Turkey. A cross-sectional school-based (ages ranging from 11 to 18) study was conducted from January to April 2006. Diagnosis was based on the second edition of the International Classification of Headache Disorders. This population was evaluated by a two-stage clustered sampling procedure. In the first phase, 1385 children were asked whether they had had a headache within the past year. For the second-step interview, 540 children (38.9%) with a complaint of headache were selected. Five children who had complained of headaches in the first interview did not agree to participate in the second stage. Of the remaining 535, 473 were identified as having primary headache and 62 as having secondary headache. Overall, one-year prevalence of headache subtypes was 14.3% for migraine, 3.5% for probable migraine, 8.6% for pure tension-type headache, 4.6% for migraine plus tension-type headache, and 3.0% for probable migraine plus tension-type headache. The prevalence of migraine was higher in our study than in previous studies.

Objective To determine the prevalence and clinical presentation of restless legs syndrome (RLS) in Turkish population living in Kandira, a town located on the Black Sea coast of Istanbul. Methods This study was designed as a descriptive, cross-sectional, door-to-door field study. A total of 2111 people aged 18 years and over were selected for the study. The criteria suggested by the IRLSSG (International Restless Legs Syndrome Study Group) were used in the assessment of RLS. All the suspected subjects underwent neurological examination. Results The prevalence of RLS was found to be 3.4% of Turkish population aged over 18. Female:male ratio was 3.5:1. The prevalence reached peak point (8.3%) in the 58- to 67-year-old group. Prevalence of DM, anemia and polyneuropathy in RLS patients was 13.9%, 8.3% and 4.2%, respectively. Conclusion RLS prevalence is relatively low, but increases with age in both genders in this Turkish population. Although it has negative effects on daily life, it is not well recognized by the population.

Background: The prevalence of multiple sclerosis (MS) in Istanbul, Turkey, is unknown. We investigated the prevalence of MS in the district of Maltepe, Istanbul, Turkey. Methods: This was a cross-sectional field research study using door-to-door sampling. Maltepe is a district of Istanbul beside the sea of Marmara (population 359,298 from 2000 census). The two-phase study screened 32,531 subjects using the Poser criteria for clinical diagnosis. The χ2 test was used for analyses of frequency distributions. Results: 33 of 32,531 people were diagnosed with MS. Their average age was 41 ± 12.0 years (43 ± 12.7 years for females and 37 ± 9.6 years for males). The prevalence of MS in Maltepe was 101.4/100,000 within the total population (118.7/100,000 in the female and 76.0/100,000 in the male populations). Conclusions: The prevalence rates of MS in the Turkish population living in a district of Istanbul are considerably higher than we thought. And the prevalence rate is much higher than neighboring countries. They are similar to those recently recorded in Sicily and Germany. These figures suggest that the prevalence rate of MS is not totally dependent upon geographical variation. However, the research of our results needs to be confirmed with further investigations in order to determine the prevalence of MS in Turkey with confidence.

Migraine is more common in female and onset of migraine is most commonly seen in the second and third decades of life. In this study, we aimed to estimate the prevalence and characteristics of migraine among women of ages between 15 to 45 years in Turkey. This is the first study to target this age group. The women were interviewed on a door-to-door basis, from early morning to late evening. Once responded positively to headache, an in-depth interview was performed questioning for migraine features. Diagnosis was made from a questionnaire by eight neurologists. One thousand eight hundred thirty five (1,835) out of 96,000 women living in Maltepe which is a town of Istanbul participated in this study. The prevalence of migraine in females aged 15-45 (reproductive ages) was 15.8% (95% CI, 0.142-0.176). This study showed that migraine onset occurred at a mean age of 22.7, 33% having family history, and with migraine with and without aura having near equal frequencies. The prevalence of migraine in women of reproductive ages in Istanbul as found in our study is lower than that reported in United States and Europe countries, but higher than that in Middle and Far Eastern countries.

The aim of this study was to determine the prevalence and risk factors for neuropathy in type 2 diabetic patients attending a major Turkish diabetes center. Eight hundred and sixty-six consecutive type 2 diabetic patients were included in the study. A single observer performed biothesiometry studies on these patients. The presence of diabetic neuropathy was investigated using neurological symptom scale (NSS) and neurological disability score (NDS) performed. Neuropathy was determined with standardized neurological examinations and defined as the presence of abnormal NSS and NDS together with abnormal sensory or motor signs and symptoms as well as decreased great toe vibration perception. Overall, 60% (n = 520) of the patients were diagnosed as having neuropathy. The prevalence of neuropathy increased with age (p < 0.001) and duration of diabetes (p < 0.001). Multiple logistic regression analysis revealed the duration of diabetes (p < 0.001) and HbA1c levels (p < 0.001) as the risk factors for neuropathy. The overall prevalence of neuropathy in Turkish type 2 diabetic population was 60%. Age, duration of diabetes, and poor glycemic control were considered to be the risk factors for neuropathy.