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Significant advancements have been achieved in delineating the progress of the Global PROMS (PROMS) Initiative. The PROMS Initiative, a collaborative endeavor by the European Charcot Foundation and the Multiple Sclerosis International Federation, strives to amplify the influence of patient input on MS care and establish a cohesive perspective on Patient-Reported Outcomes (PROs) for diverse stakeholders. This initiative has established an expansive, participatory governance framework launching four dedicated working groups that have made substantive contributions to research, clinical management, eHealth, and healthcare system reform. The initiative prioritizes the global integration of patient (For the purposes of the Global PROMS Initiative, the term “patient” refers to the people with the disease (aka People with Multiple Sclerosis – pwMS): any individual with lived experience of the disease. People affected by the disease/Multiple Sclerosis: any individual or group that is affected by the disease: E.g., family members, caregivers will be also engaged as the other stakeholders in the initiative). insights into the management of MS care. It merges subjective PROs with objective clinical metrics, thereby addressing the complex variability of disease presentation and progression. Following the completion of its second phase, the initiative aims to help increasing the uptake of eHealth tools and passive PROs within research and clinical settings, affirming its unwavering dedication to the progressive refinement of MS care. Looking forward, the initiative is poised to continue enhancing global surveys, rethinking to the relevant statistical approaches in clinical trials, and cultivating a unified stance among ‘industry’, regulatory bodies and health policy making regarding the application of PROs in MS healthcare strategies.

Objective: Myasthenia gravis (MG) is a chronic autoimmune neuromuscular disorder with a variable course that complicates the prediction of remission. This study aimed to evaluate the utility of repetitive nerve stimulation (RNS) in monitoring clinical status through the assessment of decremental response rates in the nasalis and trapezius muscles during treatment. Subjects and Methods: A prospective study was conducted with 52 patients diagnosed with generalized MG. Patients underwent clinical assessments, including tests for anti-acetylcholine receptor and anti-muscle-specific kinase antibodies, and were classified according to the Myasthenia Gravis Foundation of America classification. Electrophysiological testing through RNS and single-fiber electromyography was performed. Data analysis involved comparing the RNS decrement rates with clinical and demographic variables. Follow-up for assessing remission spans 2 years. Results: Among the 52 patients, 53.8% achieved clinical remission. In the remission group, 14.3% of the patients exhibited a decremental response compared with 70.8% in the nonremission group, particularly in the nasalis and trapezius muscles, in the follow-up RNS conducted 2 years after the initial assessment (P < 0.05). The remission group presented significantly lower rates of antibody positivity and less bulbar involvement. Interestingly, initial clinical severity did not correlate significantly with remission. Conclusion: This study demonstrated the usefulness of RNS in assessing the clinical status of MG patients and evaluating the effectiveness of current therapeutic strategies. These findings suggest that focusing on specific muscle responses in RNS can provide valuable information for patient management.

Context: This study evaluated the diagnostic accuracy of repetitive nerve stimulation (RNS) compared with single-fiber electromyography (SF-EMG) in generalized myasthenia gravis (MG). Aims: The aim of the study was to determine the diagnostic sensitivity of RNS in various muscles and assess the effect of varying decrement cutoff values on diagnostic efficacy. Setting and Design: This was a prospective study of 34 confirmed generalized MG patients. Subjects and Methods: RNS was performed on five muscles. Clinical features, autoantibody presence, and SF-EMG jitter rates recorded from the frontalis muscle were analyzed. Patients were classified according to the MG Foundation of America classification. Statistical Analysis: SPSS version 23 was used for descriptive statistics, comparisons of categorical and quantitative data, and correlation analysis, with the significance level set at P < 0.05. Results: Among the patients (58.8% males and mean age = 59.47 ± 13.37 years), SF-EMG detected increased jitter in 91.2%, whereas RNS identified a significant decrease of 50% across at least one muscle. The decremental response was >10% in the abductor digiti minimi (ADM), trapezius, nasalis, abductor pollicis brevis, and extensor indicis proprius muscles in 5.9%, 26.5%, 29.4%, 11.8%, and 29.4% of patients, respectively. A sensitivity improvement at lower decrement values was observed only in the ADM muscle. A significant correlation was found between decreases in the trapezius muscle and seropositivity. Conclusions: Optimal muscle selection improves RNS diagnostic accuracy in MGs. The study recommends incorporating the spinal accessory and radial nerves in RNS due to their high sensitivity, although modifying the decrement cutoff value has a limited overall effect.

Background: Alterations in the cerebral venous system have been increasingly recognized as a significant component of the pathophysiology of multiple sclerosis (MS). This study aimed to explore the relationship between venous sinus diameter and MS to understand potential vascular alterations in MS patients compared with controls. We sought to determine whether these alterations were correlated with disease characteristics such as duration, lesion type, and disability score. Methods: This study included 79 MS patients diagnosed according to the 2017 McDonald criteria and 67 healthy individuals. Magnetic resonance imaging (MRI) scans via a 1.5 Tesla system provided measurements of the superior sagittal sinus, right and left transverse sinus, sinus rectus, and venous structures. Statistical analysis was conducted via SPSS, employing independent sample t tests, ANOVA, chi-square tests, and Pearson correlation analysis, with the significance level set at p < 0.05. Results: This study revealed significant differences in venous sinus diameter between MS patients and controls, with MS patients exhibiting larger diameters. Specifically, patients with brainstem and spinal lesions had larger diameters in certain sinus regions. No significant correlations were found between venous sinus diameter and demographic factors, expanded disability status scale scores, or lesion counts. However, a significant increase in perivenular lesions was noted in patients with longer disease durations. Conclusions: The findings indicate notable vascular alterations in MS patients, particularly in venous sinus diameters, suggesting a potential vascular component in MS pathology. The lack of correlation with conventional clinical and MRI metrics highlights the complexity of MS pathology. These insights underscore the need for further research, particularly longitudinal studies, to elucidate the role of venous changes in MS progression and their potential as therapeutic targets.

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions about vaccination should be made considering the disease process and the medications used by the patient. Since vaccination can be performed at any stage of life, immune system activity should be reviewed in patients with MS except where it is characteristic of the vaccine. In this review, the applications of different vaccines in patients with MS are discussed in two separate sections (part 1 was published in the previous issue).

Multiple sclerosis (MS) is an autoimmune and demyelinating disease of the central nervous system. It is a chronic disease, and in the evaluation of all other health and vital processes, decisions should be made by considering the disease process and the drugs used by the patient. Since vaccination can be performed at every stage of life, from childhood to adulthood, immune system activity, except where it is characteristic of the vaccine, should be reviewed in patients with MS. In this review, the applications of different vaccines in individuals with MS are discussed in two separate sections.

Objective: Coronavirus disease 2019 (COVID-19) may cause neurological impairments in addition to disorders of respiratory and gastrointestinal systems. We aimed to investigate the frequencies and clinical correlates of neurological symptoms in COVID-19. Materials and Methods: This cross-sectional study was conducted with 117 consecutive patients diagnosed as having COVID-19 in two designated centers assigned by the government to follow up the COVID-19 patients in Turkey. Results: The mean age was 53.08 ±15.63 years (range 18 to 89 years). Sixty-five (55.5%) mildly (non-complicated), 32 (27.4%) moderately (mild pneumonia), and 20 (17.1%) severely ill (severe pneumonia) patients are included. Seventy nine patients (67.5%) were detected to suffer from neurological complaints. The most common symptom was taste impairment seen in 36 (30.7%) patients. Other common complaints were smell impairment (25.6%), headache (24.7%), and dizziness (16.2%). Patients with neurological symptoms were younger, and more likely to have accompanying comorbidities. The patients with severe infection were also more likely to have coexisting comorbidities. Higher ferritin and LDH levels, and lower lymphocyte counts indicated the worse disease severity. Conclusion: Our results demonstrated that more than half of the non-critically ill COVID-19 patients experiences neurological complaints. Clinicians should be aware of the neuroinvasive spread of the coronaviruses, and neurological symptoms should be questioned in particular the young patients with accompanying comorbidities.

ABSTRACT Background: Restless legs syndrome (RLS) is one of the most common and burdensome sleep disorders in the course of multiple sclerosis (MS). Objective: To evaluate common MS-related symptoms and consequences between groups with and without RLS and further assess the association of quality of life determinants with RLS symptom severity. Methods: According to their RLS status, 46 relapsing-remitting MS patients were divided into MS-RLS+ (n=19) and MS-RLS- groups (n=27). Specific questionnaires were administered to assess the patients’ health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, anxiety, and depression symptoms. Functional capacity was examined using the Expanded Disability Status Scale (EDSS). Results: The prevalence of RLS was 41.3%. Compared to the MS-RLS- group, those with RLS had higher EDSS scores, more cranial and spinal lesions, longer disease duration, and were older. In the MS-RLS+ group, symptom severity scores were positively correlated with higher anxiety and poorer sleep quality. The symptom severity score was negatively correlated with mental HRQoL and pain scores. Conclusion: In conclusion, the findings of the current study indicate the negative impact of RLS on functional capacity, anxiety, sleep quality, and mental HRQoL of MS patients. Further studies using more accurate diagnostic strategies for identifying RLS and other sleep disorders are necessary to clarify the association of MS with RLS and explore relevant clinical implications.

Fahr sendromu, simetrik ve bilateral intrakraniyal kalsifikasyon ile seyreden nadir bir hastalık tablosu olup psikiyatrik semptomlar, epileptik nöbetler, serebellar bulgular, ekstrapiramidal disfonksiyon ve demans gibi klinik belirtiler ile kendini gösterebilir. Hastalığın birçok farklı klinik tablosu olmasına rağmen etiyolojisi henüz net olarak bilinmemektedir. Bu yazıda epileptik nöbet ile başvuran ve psikiyatrik belirtileri olan Fahr sendromu olgusu sunmaktayız.Fahr syndrome is a rare disease with symmetrical and bilateral intracranial calcium accumulation and may present with clinical symptoms such as psychiatric symptoms, epileptic seizures, cerebellar findings, extrapyramidal dysfunction and dementia. Although the disease has many different clinical manifestations, its etiology is not yet clear. In this article, we present a case of Fahr syndrome with psychiatric symptoms presenting with epileptic seizures.

ABSTRACT Background: Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by rapidly evolving symptoms and disability. Cerebrospinal fluid analysis and electrophysiological studies are crucial in the diagnosis of this syndrome. Objective: To evaluate the prognostic value of the type and number of demyelinating findings and cerebrospinal fluid protein levels in patients with acute inflammatory demyelinating polyneuropathy. Methods: We retrospectively analyzed electrophysiological data and cerebrospinal fluid of 67 consecutive patients with acute inflammatory demyelinating polyneuropathy from Istanbul, Turkey (2011-2019) studied ≤ 24 hours post-onset. Results: The patients who met a higher number of demyelinating criteria had increased disability scores in the first day and first month, and higher cerebrospinal fluid protein levels were correlated with worse prognosis both on the first day and the first month. However, the disability scores did not correlate with any single specific criterion, and no significant correlation was found between the number of satisfied criteria and cerebrospinal fluid protein levels. Conclusions: The number of demyelinating criteria that are met and high cerebrospinal fluid protein levels at the disease onset may be valuable prognostic markers. More systematic studies conducted with serial nerve conduction studies are required to highlight the roles of the suggested criteria in clinical practice.

Batı Nil virüsü, asemptomatik bir klinik tablodan ağır ensefalit ve menenjite varan geniş bir klinik varyasyonla prezente olabilir. Akut demiyelinizan polinöropati birlikteliği çok nadir bildirilmiştir. 60 yaş erkek hasta bilinç bozukluğu, kol ve bacaklarda güçsüzlük şikayetleri ile başvurdu. Kliniği, laboratuvar, beyin omurilik sıvısı ve elektrofizyoloji bulguları ön planda Guillain Barre sendromu ile uyumlu idi. Ateş, bilinç bozukluğu ve spastisite gibi atipik bulguların eşlik etmesi nedeniyle detaylı araştırılan olguda serum BN virüsü IgM testi pozitif bulundu. Türkiye’den bildirilen ilk olgu olması nedeniyle sunulmaya değer görüldü.

Gerstmannn sendromu agrafi, parmak agnozisi, sağ-sol dezoryantasyonu ve akalkuli ile karakterize bir klinik tablodur. Saf vakaların hiçbirinde aleksi görülmemektedir. 62 yaşında erkek hasta sol pariyetotemporal alanda akut iskemik enfarkt ile başvurdu. Kliniğinde Gerstmann tetradının yanısıra aleksi tablosu mevcuttu. Nadir görülen bu tablonun klinik-nöroanatomik korelasyonu tartışmalıdır.

Abstract Background The aim of this study was to investigate the predictors of intensive care unit (ICU) admission and mortality among stroke patients and the effects of a pulmonary rehabilitation program on stroke patients. Methods This prospective study enrolled 181 acute ischemic stroke patients aged between 40 and 90 years. Demographical characteristics, laboratory tests, diffusion-weighed magnetic resonance imaging (DWI-MRI) time, nutritional status, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin scale (MRS) scores were recorded for all patients. One-hundred patients participated in the pulmonary rehabilitation program, 81 of whom served as a control group. Results Statistically, one- and three-month mortality was associated with NIHSS and MRS scores at admission and three months (p

Objective: This study aimed to evaluate the R-R interval recording sensitivity in the early diagnosis of diabetic autonomic neuropathy (DAN).Methods: Sixty patients who applied to neurology outpatient clinics and were thought to have diabetic polyneuropathy were accepted to the study. The control group was formed by 31 healthy volunteers. The standard nerve conduction study and R-R interval measurements during resting and deep breathing were evaluated in the patient and control groups.Results: When R-R interval measurements of the patient and control groups during resting and deep breathing were compared, no statistically significant difference between the groups was determined.Conclusion: In the diagnosis of DAN, data about the recording of R-R interval measurements that show heart rate variability in resting and deep breathing as significant was not obtained. In larger patient groups, there is a need for broader studies in which Valsalva maneuver and tilt table test methods are also performed.

ABSTRACT Cerebral vein thrombosis (CVT) is a rare but serious cause of acute stroke. Inflammation is a hypothetical etiological factor in CVT. Objective: The aim of this study was to evaluate inflammatory marker levels in CVT patients and compare these with healthy individuals. Methods: This prospective case-control study was conducted with 36 newly-diagnosed CVT patients age- and sex-matched with 40 healthy individuals. The laboratory investigations included a serum hemogram, full biochemistry profiles, high sensitivity C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL cholesterol ratio (MHR) values were calculated and compared between the patients and healthy participants. Results: The mean age was 41.4 ± 11.8 years for patients, and 39.3 ± 12.5 for controls. Lymphocyte, total bilirubin, indirect bilirubin, and HDL levels were significantly lower in CVT patients (p < 0.05), while CRP, and ESR values were significantly higher. In the CVT patients the mean NLR and PLR values were significantly higher than in the control individuals. Smoking rates, alcohol consumption, white blood cell, neutrophil, platelet, and MHR values were similar in both groups (p > 0.05). Conclusions: We suggest that NLR, PLR, CRP, ESR, and bilirubin can be used in clinical practice for prediction of CVT in suspected patients as they are inexpensive parameters and widely available. However, further large-scale studies are required to confirm this relationship.

ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.