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Background: COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immunity of COVID-19 vaccinations have included mRNA vaccines, and information on inactivated virus vaccine responses, long-term protectivity, and comparative studies with mRNA vaccines are very limited. Here, we aimed to investigate the association between humoral vaccine responses and COVID-19 infection outcomes following mRNA and inactivated virus vaccines in a large national cohort of pwMS receiving DMTs. Methods: This is a cross-sectional and prospective multicenter study on COVID-19-vaccinated pwMS. Blood samples of pwMS with or without DMTs and healthy controls were collected after two doses of inactivated virus (Sinovac) or mRNA (Pfizer-BioNTech) vaccines. PwMS were sub-grouped according to the mode of action of the DMTs that they were receiving. SARS-CoV-2 IgG titers were evaluated by chemiluminescent microparticle immunoassay. A representative sample of this study cohort was followed up for a year. COVID-19 infection status and clinical outcomes were compared between the mRNA and inactivated virus groups as well as among pwMS subgroups. Results: A total of 1484 pwMS (1387 treated, 97 untreated) and 185 healthy controls were included in the analyses (male/female: 544/1125). Of those, 852 (51.05%) received BioNTech, and 817 (48.95%) received Sinovac. mRNA and inactivated virus vaccines result in similar seropositivity; however, the BioNTech vaccination group had significantly higher antibody titers (7.175±10.074) compared with the Sinovac vaccination group (823±1.774) (p

Objective: Ischemic stroke is one of the common neurological pathology. Identifying the risk factors and treating cardiac pathologies play an important role in preventing ischemic stroke stroke. In this study, we aimed to examine the relationship between transthoracic echocardiography findings, localization of ischemia and the etiology of stroke. Methods: We included 149 patients with ischemic stroke who were followed up at Neurology Department of İzmir Katip Çelebi University Atatürk Training and Research Hospital between January 2018-January 2019. Demographic characteristics of the patients, etiology and localization of stroke, presence of cardiac arrhythmias, and transthoracic electrocardiography findings were recorded and the relationship between these parameters were examined. Results: We enrolled 81 female (54.4%) and 68 male (45.6%) patients in this study. The mean age was 68.0312.35. 84.6% of the patients have atherosclerotic and15.4% have cardioembolic stroke. The most common risk factor was hyperlipidemia. Atrial fibrillation was detected in 21.1% of the patients. While atrial fibrillation was more common in patients with cardioembolic stroke, smoking was more common in patients with atherosclerotic stroke. Although most patients had multiple risk factors prior to stroke, almost half of the patients did not use any antiaggregant or anticoagulant therapy. Cardioembolic strokes were positively correlated with greater left atrium width. There was no correlation between transthoracic electrocardiography findings and stroke location. Conclusion: Determination of risk factors in patients with ischemic stroke, investigation of cardiac pathologies, and applying appropriate treatments are important in terms of preventing both new and recurrent stroke development.

Introduction: Various restrictions due to the coronavirus infection have affected working life globally. People with multiple sclerosis (pwMS) have several difficulties in social life, patient follow-up, and receiving treatments. In this study, we aimed to evaluate the experiences of pwMS during the COVID-19 pandemic. Method: We developed a 50-question survey aiming to determine fears, anxieties, and the problems experienced by patients regarding their diseases and social lives during the COVID-19 pandemic. The questionnaire was released online via the Turkish MS Society website, local MS societies websites, and social media accounts. Only the answers of the patients who filled out the questionnaire completely were evaluated. Results: In total, 6008 patients took the survey, and 3255 of them completed the questionnaire. Among all, 378 patients (11.6\%) were positive for COVID-19. The most common COVID-19-related symptom was fatigue (48.4\%). The routine medical follow-up was interrupted in 61.4\% and the medication was discontinued in 14\% of the patients. Approximately 25\% of the patients reported different symptoms related to relapse activity. The main concern of the patients related to the COVID-19 pandemic was the disruption of the health of the ones they loved. Among all the patients, 4.4\% lost their jobs. Conclusion: Our data showed that the COVID-19 pandemic strongly affected the working lives of pwMS. Also, the pandemic changed the attitudes of patients and neurologists. Therefore, the long-term effects of the COVID-19 pandemic on disease approach, patient follow-up, social conditions, and working life should be monitored.

BackgroundNeuropathic extremity pain is a disabling symptom in patients with multiple sclerosis. The aim of this study is to evaluate the prevalence of neuropathic extremity pain among patients with multiple sclerosis and to assess its effect on quality of life.MethodsThe present cross-sectional study included 180 patients with relapsing-remitting multiple sclerosis. Douleur Neuropathique 4 pain scale and Leeds Assessment of Neuropathic Symptoms and Signs pain scale were used to evaluate neuropathic pain. The effect of neuropathic extremity pain on quality of life was assessed by the 36-Item Short Form Survey. ResultsThe mean age and the mean disease duration were 38.78±9.37 and 8.96±6.93 years, respectively. The prevalence of neuropathic extremity pain was 38.9% in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale and 47.8% in the Douleur Neuropathique 4 pain scale. The presence of neuropathic extremity pain was associated with the higher Expanded Disability Status Scale in the Leeds Assessment of Neuropathic Symptoms and Signs pain scale (p=0.015) and the longer disease duration in the Douleur Neuropathique 4 pain scale (p=0.021). All patients with psychiatric disorders reported neuropathic extremity pain. Lower 36-Item Short Form Survey scores were obtained in patients with neuropathic extremity pain than patients without neuropathic extremity pain in all domains of 36-Item Short Form Survey.ConclusionsThis study suggests that neuropathic extremity pain is a common symptom among patients with multiple sclerosis. Higher disability and longer disease duration are associated with neuropathic extremity pain. The presence of pain and psychiatric disorders are related to the impairment of the quality of life.Relevance of the article for predictive, preventive, and personalized medicine Questioning of pain is often neglected in multiple sclerosis practice. However, identification and treatment of pain has the potential to increase the quality of life in patients with multiple sclerosis. This article emphasizes that revealing the presence of pain might improve clinical outcome in multiple sclerosis patients providing personalized approaches to disease course.

BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are a group of antibody-mediated chronic inflammatory diseases of the central nervous system. Rituximab is a monoclonal antibody that leads to a reduction in disease activity. OBJECTIVE To evaluate the efficacy of rituximab as monotherapy in NMOSD and to determine whether the efficacy varies depending on the presence of antibodies in this cohort. METHOD This multicentre national retrospective study included patients with NMOSD treated with rituximab at least for 12 months from Turkey. The primary outcomes were the change in the annualised relapse rate, the Expanded Disability Status Scale (EDSS), the number of relapse and radiological activity-free patients. RESULTS A total of 85 patients with NMOSD were included in the study. Of 85 patients, 58 (68.2%) were seropositive for anti-Aquaporin4-IgG (antI-AQP4-IgG). All patients were Anti-Myelin Oligodendrocyte Glycoprotein IgG (anti-MOG-IgG) negative. The median follow-up for rituximab treatment was 21 months (Q1 16-Q3 34.5). During rituximab treatment, the mean annualised relapse rate (ARR) significantly decreased from 1.45 ± 1.53 to 0.15 ± 0.34 (P

Difficulties of self-management in people with MS (pwMS) is considered as one of the most important factors contributing to low rehabilitation efficacy, more severe long-term complications and increase in healthcare costs. Despite the emergence of research in the last decade documenting causes, types, and course of cognitive difficulties in MS disease subtypes, limited evidence is available in the literature for direct comparison of self-management and cognitive deficits. In this study we aimed to investigate the relationship between cognitive performance and self-management in pwMS.PwMS who applied to neurology out-patient clinics of seven different centers were included into study. Multiple Sclerosis Self-Management Scale- Revised (MSSM-R) was used for the assessment of self-management behaviors and Multiple Sclerosis inventory cognition scale (MUSIC) was used for the assessment of cognitive performance and fatigue.In this study, 194 (144 female and 50 male) pwMS participated (mean age = 38.9 years). The course of the disease was RRMS in 173 patients and mean EDSS was 2.0. 68.5% of the participants were married, 32.5% were employed, and 57.2% had secondary education. The MSSM-R mean score of the study group was 42.6 ± 10.4 (1-81). There was a positive correlation between MSSM-R and MUSIC-cog scores (r = 0.21, p = 0.003). A hierarchical multiple regression revealed that income level (β = 0.196, t = 2.692, p = 0.008) and cognitive performance (β = 0.167, t = 2.063, p = 0.041) together with control variables (gender, age, educational status, employment status, duration of disease, EDSS and fatigue) explained 5.5% of the variance in self-management.Cognitive performance is a predictor of self-management in pwMS. Better self-management behavior is also related with employment and income level in pwMS. Studies evaluating patients' cognitive abilities and evaluating the effectiveness of adapted self-management training programs are needed.

Introduction: The main purpose of the present study is to confirm Peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness is a biomarker of axonal degeneration in patients with Multiple Sclerosis (MS) and to evaluate its relationship with Neurofilament heavy chain (NfH) and Nitrotyrosine (NT). Method: We quantified serum (s) and/or cerebrospinal fluid (CSF) NfH and NT levels in 30 relapsing-remitting MS patients (RRMS), 16 secondary progressive MS (SPMS) patients and in 29 control subjects matched for age and gender. Optical coherence tomography (OCT) measurements of pRNFL were performed in all subjects. Clinical outcomes were tested by Multiple Sclerosis Functional Composite (MSFC) and Expanded Disability Status Scale (EDSS). Results: RRMS patients exhibited significantly higher NfH/NT levels (99 pg/mL, 107.52 nM respectively) than controls (74 pg/mL, 48.72 nM) in CSF (p, Scientific Research Found of Ege University School of Medicine [12-TIP-003], This study was supported by the Scientific Research Found of Ege University School of Medicine (12-TIP-003).

Background: COVID-19 is a multisystemic infection with variables consequences depending on individual and comorbid conditions. The course and outcomes of COVID-19 during neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) are not clearly known. Objective methods: the aim of this study was to examine the features and outcomes of COVID-19 infection in NMOSD and MOGAD patients. The patients' demographic and clinical factors, disease modifying treatment (DMT) used and disease information of COVID-19 infection were recorded. Conditions leading to hospitalization and severe exposure to COVID-19 infection were also analyzed. Results: the study included 63 patients from 25 centers. Thirty-two patients (50.8%) belong to AQP-4 seropositive group, 13 (20.6%) and 18 (28.6%) were in MOG-positive and double-seronegative groups, respectively. Risk factors for severe COVID-19 infection and hospitalization were advanced age, high disability level and the presence of comorbid disease. Disease severity was found to be high in double-seronegative NMOSD and low in MOGAD patients. No statistically significant effect of DMTs on disease severity and hospitalization was found. Conclusion: in NMOSD and MOGAD patients, advanced age, high disability and presence of comorbid disease pose risks for severe COVID-19 infection. There was no direct significant effect of DMTs for COVID-19 infection., NA

Background : Multiple sclerosis-related optic neuritis is mostly associated with good recovery. The aim of this study was to investigate the causes of progressive visual worsening in multiple sclerosis patients despite treatment. Methods : We retrospectively reviewed the medical records of multiple sclerosis patients with optic neuritis admitted to the ward of our Neurology Department between 2001 and 2020. The patients with unilateral/bilateral progressive visual loss or non-substantial recovery of visual acuity were screened for genetic testing for Leber's hereditary optic neuropathy. Results : Of 1014 multiple sclerosis patients, 411 (39%) reported having optic neuritis. During follow-up, 11 patients manifested atypical characteristics of multiple sclerosis-related optic neuritis (presence of one of the following clinical findings: bilateral simultaneous or sequential eye involvement, progressive visual loss, or no response to corticosteroids during hospitalization), while others presented with typical multiple sclerosis-related optic neuritis. Those multiple sclerosis patients with atypical characteristics of optic neuritis were screened for other possible etiologies of optic neuropathy. We found pathogenic mitochondrial mutations in 5 patients with multiple sclerosis in our study group. Conclusion : In our study group, the prevalence of mitochondrial mutations among all multiple sclerosis patients with optic neuritis was 0.12%. We strongly recommend investigating Leber's hereditary optic neuropathy mutations in MS patients if they suffer from severe or bilateral visual loss without recovery during follow-up. Because Leber's hereditary optic neuropathy mitochondrial mutations indicate relatively poor visual prognosis and have important implications for genetic counseling.

BACKGROUND: Flammer syndrome (FS) occurs from well-described signs and symptoms. The syndrome itself is not a disease, but it may be a directive marker for advancing therapeutic approaches by predictive and preventive measures as well as for personalization of treatments. The syndrome is related to many diseases, but FS has been rarely studied in multiple sclerosis (MS). The study aimed to determine whether FS signs and symptoms occur more often in people with MS than in healthy controls, and in order to personalize the treatment, we investigated the possible effect of current therapies on FS signs and symptoms. METHODS: Two hundred twenty-two MS patients and 203 healthy controls answered the questionnaire consisting of 15 signs and symptoms of FS. RESULTS: MS patients had significantly more complaints in 9 items of FS signs and symptoms (cold hands or/and feet, the reduced feeling of thirst, dizziness, drug side effects, other headaches (tension-type, medication overuse), weight loss, feeling cold, long sleep-onset time, and skin blotches) compared to healthy controls. Six items (low blood pressure, tinnitus, increased odor sensitivity, low pain threshold, and perfectionism) were similar between the two groups. The treatment agents currently used did not have any effect on the signs and symptoms of FS. CONCLUSION: This study showed that FS might be associated with MS. Injectable or oral agents are not related to the signs and symptoms of FS. Further studies are needed to validate this association. RELEVANCE OF THE ARTICLE FOR PREDICTIVE, PREVENTIVE, AND PERSONALIZED MEDICINE: FS is common among MS patients. Being aware of this incidence that might impair the life quality of MS patients is useful to predict the comorbidity and develop preventive strategies and applying personalized treatment options and procedures.

Comprehensive assessment of multiple sclerosis (MS) patients in terms of patient profile, clinical and disease-related factors has great epidemiological value. This study aimed to evaluate patient experience and disease-related awareness in MS patients through a nation-wide survey in Turkey Methods: A total of 1379 MS patients participated in this cross-sectional questionnaire survey conducted between November 2018 and December 2018. The online questionnaire form included items on sociodemographic, disease-related, first-admission, treatment and follow up characteristics as well as the disability status.Patients were diagnosed at median 28.0 years of age, while the average time from admission to diagnosis and time from diagnosis to treatment were 1.2 years and 2.5 months, respectively. Neurology (45.4%) and ophthalmology (23.3%) were the most common clinics for the first admission, while numbness-weakness in lower and upper extremities (37.6%) and double vision-visual problems (30.6%) were the most common symptoms on initial admission. Treatment was initiated after the diagnosis in 1213(88.0%) patients, while 166 (12.0%) patients were treatment-naïve. Treatment discontinuation, treatment switch and use of alternative treatment methods were reported by 31.3%, 49.3% and 22.8% of patients, respectively. The ophthalmology admissions (with double vision or visual problems) were associated with the shortest time from presentation to diagnosis as compared with neurosurgery and internal medicine admissions (median 1.0 vs. 3.0 and 4.0 months, p0.001). The neurology admissions (with numbness-weakness in extremities) were associated with more prompt (median 0.3 vs. 0.5 months, p=0.032) and more frequent onset of treatment after diagnosis (64.5% vs. 2.2% to 15.2%, p0.001). Time from presentation to diagnosis was longer in patients aged50 years (median 6.0 months vs. 2.0 months, p0.001), in patients using alternative medicine (median 3.0 months vs. 1 month, p=0.001) and in patients admitted to a non-MS-center (median 3.0 months vs. 2.0 months, p=0.002). Median (min-max) age at diagnosis was significantly lower in patients with vs. without treatment discontinuation for any reason (26.0(10-56) vs. 29.0(3-60) years, p0.001) and treatment switching (27.0(5-93) vs. 30.0(3-60) years, p0.001).In conclusion, our findings revealed higher likelihood of earlier diagnosis and earlier treatment in patients admitted to an MS-center and in those presenting with ocular problems and sensory-motor deficits, respectively. Our findings also emphasize the association of older patient age with higher likelihood of diagnostic delay, and increased likelihood of treatment discontinuation for any reason and/or treatment switching in case of older patient age, younger age at diagnosis and diagnostic delay. In this regard, our findings highlight the need for improved awareness among patients as well as clinicians on initial manifestations of MS to enable admission or referral to an MS-center and to prevent delay in diagnosis, particularly for onset symptoms other than ocular or sensory-motor characteristics.

Background: The pandemic of the new type of corona virus infection 2019 [Covid-19] also affect people with Multiple Sclerosis (pwMS). Currently, the accumulating information on the effects of the infection regarding the & nbsp;& nbsp;demographic and clinical characteristics of the disease, as well as outcomes within different DMTs & cedil; enable us to have better practices on the management of the Covid-19 infection in pwMS. Objective: To investigate the incidence of coronavirus disease 2019 (Covid-19) and to reveal the relationship between the demographic-clinical and therapeutic features and the outcome of Covid-19 infection in a multi- center national cohort of pwMS.& nbsp; Methods: The Turkish Neurological Society-MS Study Group in association with the Italian MuSC-19 Study Group initiated this study. A web-based electronic Case Report Form (eCRF) of Study-MuSC-19 were used to collect the data. The demographic data and MS histories of the patients were obtained from the file tracking forms of the relevant clinics.& nbsp; Results: 309 MS patients with confirmed Covid-19 infection were included in this study. Two hundred nineteen (219) were females (70.9%). The mean age was 36.9, ranging from 18 to 66, 194 of them (62.8%) were under 40. The clinical phenotype was relapsing-remitting in 277 (89.6%) and progressive in 32 (10.4%). Disease duration ranged from 0.2 years to 31.4 years. The median EDSS was 1.5, ranging from 0 to 8.5. The EDSS score was

Multiple sclerosis is a progressive disease despite so many recent therapy agents. Many symptoms can be seen that can affect the quality of daily life, such as spasticity, urinary incontinence, sensory disturbances, and tremor. These complaints may be refractory to the medical treatments, and the invasive treatment methods may be the only option to improve the quality of life of the patient. Intrathecal baclofen pump therapy can effectively reduce the spasticity in a patient with an inadequate response to oral baclofen. On the other hand, deep brain stimulation significantly reduces tremor and can provide the patient to eat by his/her self. Sacral neuromodulation may be beneficial in a patient with a history of urge incontinence which doesn’t respond to oral agents. Adequate pain control can be achieved with spinal cord stimulators when a patient is unresponsive to the neuropathic pain treatment. Common features of all these invasive therapies are that they are used in patients who do not respond to medical treatments, they have a small number of randomized controlled clinical trial, and almost all of them are incompatible with MRI devices. According to the latest researches, more randomized controlled clinical trials and MRI compatible devices have been produced in recent years. We wanted to discuss these treatment methods even they have not yet been used routinely. We think they would be beneficial in clinical practice after their deficiencies have been overcome.

Background and purpose: The clinical spectrum of different neuroradiological features of cerebral sinus–venous thrombosis (CSVT) varies considerably. We sought the relationship between different neuroradiological aspects and clinical presentations in these patients. Methods: The diagnosis of cerebral sinus–venous thrombosis has been confirmed by conventional angiography, MRI combined with MR venography following established diagnostic criteria. We analyzed clinical data, symptoms and signs, imaging findings, location and extent of the thrombus, and parenchymal lesions, retrospectively. Results: There were 220 consecutive patients with cerebral sinus–venous thrombosis; 98 (45%) had non-lesional sinus–venous thrombosis (NL CSVT), 51 (23%) had non-hemorrhagic infarct (NHI), 45 (20%) had hemorrhagic infarct (HI), and 26 (12%) had intracerebral hemorrhage (ICH). In patients with hemorrhagic lesion (HI+ICH), advanced age, headache (99%), behavioral disturbances (55%), consciousness disturbances (35%), seizures (41%), and language deficits (42%) were significantly higher than the other patients (NL+NHI) (P

WOS: 000373736400014, PubMed ID: 25936385, Objective: To determine the frequency and severity as well as the diagnosis and treatment of overactive bladder problems in patients with multiple sclerosis (MS) followed up at five centers in Turkey. Design: Survey study. Setting: Outpatient tertiary clinics of physical medicine and rehabilitation and neurology. Participants: Consecutive MS patients scheduled for outpatient follow-up (n=309). Intervention: MS patients were asked to complete a questionnaire regarding the frequency and severity, as well as the diagnosis and treatment of their overactive bladder problems. Results: The mean age +/- SD was 39.3 +/- 10.6 years. Urinary urgency was the most common urinary symptom (62%), followed by frequency (50.4%), urge incontinence (44.7%) and nocturia (33%). Residual urine volume was measured using a portable ultrasound instrument in 13.3% of the patients and by catheterization in 16.2% of them. Urodynamic investigations and urinary tract ultrasound were performed on 26.5% and 35.3% of the patients, respectively. Anticholinergic medications were prescribed for 27.5% of the patients. Intermittent catheterization and indwelling catheterization were used on 8.1% and 1.9% of the patients, respectively. The overactive bladder symptom score (OABSS) was significantly higher in patients who had had residual urine measurement (P

Background: Previous clinicopathological studies have reported central hypoventilation alongside unilateral infarcts in the caudal brainstem. As already known, the respiratory centers are located in the medullary and pontine centers. Methods: We sought patients with acute respiratory failure with brainstem involvement proved by MRI from 4,500 patients with first ischemic stroke consecutively admitted to our stroke unit over a period of 7 years. Results: We report six patients with a unilateral dorsolateral medulla oblongata lesion, completely sparing the corticospinal tract, who presented impairments in automatic and voluntary respiratory movements. Topographical analysis showed involvement of the nucleus and tractus solitarius,nucleus ambiguus and retroambiguus,nucleus reticularis medulla oblongata, and nucleus tractus solitarius. Conclusions: Our findings provide insight into the central organization of respiratory control in the dorsolateral medulla oblongata in humans, and the importance of critical respiratory management in these patients.

Background and purpose: The mechanism and pathogenesis of ischemic spinal stroke remain largely undetermined because most clinical studies have included mostly patients without a systematic study of associated vascular and concomitant disease of the vertebral body. Therefore, we assessed the pathogenetic mechanisms and short-term outcomes of the patients with spinal stroke based on clinical data and magnetic resonance imaging findings. Methods: We studied clinical, imaging, and outcome data for 36 patients with acute spinal stroke admitted between 1998 and 2008. There were 16 men and 20 women (mean age 73, range 56–85 years). Results: Twelve patients (33%) had anterior spinal artery patterns, 8 (22%) had anterior and 6 (17%) had posterior unilateral infarct, 5 (14%) had posterior spinal artery infarct pattern, 3 (8%) had central involvement, and 2 (5%) had transverse syndrome. Twelve patients (33%) had no cause of stroke. Patients with central infarct and transverse infarct had a high frequency of peripheral vascular disease and prolonged hypotension, and one patient each had a chronic spinal disease. The onset of all other infarcts was associated with mechanical triggering movements in 12 patients (41%, P