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Background & Objective: Ischemic stroke is the leading cause of death and long-term disability worldwide. In patients with ischemic stroke, both cell loss and inflammation are observed. GAS6/sAXL signaling is effective in both inflammation and clearance of dead/dying cells. This study investigated the GAS6/sAXL pathway and its role in patients with acute stroke. Specifically, we evaluated whether GAS6/sAXL was associated with stroke severity and infarct volume. Methods: This study involved 53 patients with acute ischemic stroke (AIS) and 49 healthy controls. GAS6 and sAXL proteins were collected in the first 24 hours in the acute stroke. NIHSS scores, GCS, and demographic data of the patients at the time of admission to the hospital were recorded. The infarct area was calculated using cranial magnetic resonance imaging. Results: Mean age of the patients was 64±12 years, 60% were female. HDL was lower in AIS group (40.5±13.01 mg/dl) than in the control group (55.4±14.9 mg/ dl) (p

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Türkiye. Clinical and paraclinical features were compared between patients with disease onset before 12 years (earlier onset) and ≥12 years (later onset) as well as between our current (2015–2021) and previous (

IL-22 is an alpha-helical cytokine which belongs to the IL-10 family of cytokines. IL-22 is produced by ROR gamma t+ innate and adaptive lymphocytes, including ILC3, gamma delta T, iNKT, Th17 and Th22 cells and some granulocytes. IL-22 receptor is expressed primarily by non-haematopoietic cells. IL-22 is critical for barrier immunity at the mucosal surfaces in the steady state and during infection. Although IL-22 knockout mice were previously shown to develop experimental autoimmune encephalomyelitis (EAE), a murine model of multiple sclerosis (MS), how temporal IL-22 manipulation in adult mice would affect EAE course has not been studied previously. In this study, we overexpressed IL-22 via hydrodynamic gene delivery or blocked it via neutralizing antibodies in C57BL/6 mice to explore the therapeutic impact of IL-22 modulation on the EAE course. IL-22 overexpression significantly decreased EAE scores and demyelination, and reduced infiltration of IFN-gamma+IL-17A+Th17 cells into the central nervous system (CNS). The neutralization of IL-22 did not alter the EAE pathology significantly. We show that IL-22-mediated protection is independent of Reg3 gamma, an epithelial cell-derived antimicrobial peptide induced by IL-22. Thus, overexpression of Reg3 gamma significantly exacerbated EAE scores, demyelination and infiltration of IFN-gamma+IL-17A+ and IL-17A+GM-CSF+Th17 cells to CNS. We also show that Reg3 gamma may inhibit IL-2-mediated STAT5 signalling and impair expansion of Treg cells in vivo and in vitro. Finally, Reg3 gamma overexpression dramatically impacted intestinal microbiota during EAE. Our results provide novel insight into the role of IL-22 and IL-22-induced antimicrobial peptide Reg3 gamma in the pathogenesis of CNS inflammation in a murine model of MS.

In December 2019, coronavirus disease 2019 (COVID-19) emerged in Wuhan and rapidly spread throughout China. Since the outbreak of the pandemic, in addition to the well-known COVID-19 symptoms, various neurological symptoms have been also described in patients with COVID-19. Here, we report an unusual presentation of COVID-19 infection in a teriflunomide-treated individual with multiple sclerosis (MS) who did not interrupt teriflunomide treatment during the infection. The course of the infection was mild in this case as in other reported teriflunomide-treated individuals with COVID-19. COVID-19's presentation may be unusual in people with MS (pwMS). It can also be concluded that teriflunomide may be considered a safe disease-modifying treatment option during the pandemic.

© 2021 Informa UK Limited, trading as Taylor & Francis Group.Objective: To determine the factors affecting mortality and disability in status epilepticus (SE) and to evaluate the prediction ability of the Status Epilepticus Severity Score (STESS) for disability and mortality. Materials and Method: The demographic and clinical characteristics, prognosis and prognosis predictors of 72 patients who were diagnosed with SE between 2013 and 2018 were retrospectively evaluated. The STESS was used to predict prognosis, and the modified Rankin scale (mRS) was used to determine the disability at discharge. Results: The study population had a mean age of 45.4 ± 20.7, and it was found that mortality was 22.2% and acute symptomatic etiology played a 54.1% role in etiology. Advanced age, refractory SE or super-refractory SE, acute symptomatic etiology, and a history of epilepsy were related to mortality, symptomatic etiology (acute, progressive, remote), a history of hospitalization and epilepsy in intensive care or in other departments other than the neurology department were associated with disability. The sensitivity of STESS in predicting mortality was 100%, specificity was 69%, accuracy was 76.4%, positive predictive value (PPV) was 48.5%, and the negative predictive value (NPV) was 100%. The sensitivity of STESS in predicting mobilization during discharge was 55.6% with a 63.9% specificity and 59.7% accuracy, PPV was 60.6%, and NPV was 59%. Conclusion: It was observed that STESS strongly predicts a good prognosis; however, it was not found to be useful in predicting motor disability during discharge. Thus, new studies should be conducted to predict and evaluate mobility in SE patients at discharge.

© 2021 Informa UK Limited, trading as Taylor & Francis Group.Objective: This study compares the nutritional status and physical activity levels of relapsing-remitting multiple sclerosis (RRMS) patients and healthy people. Method: The study included 120 participants: 60 multiple sclerosis (MS) patients and 60 controls. RRMS diagnoses were made based on the 2017 McDonald criteria. The food intake frequency questionnaire was administered to the participants, their threeday food intake records were collected, their activity levels were determined, and anthropometric measurements were made. The differences between the groups were analyzed using the Mann–Whitney U test and Pearson's exact chi-squared test. Results: The participants with MS (46.7%) had a significantly lower rate of shopping for their own food compared to the control group (68.3%) (p = 0.002). The MS group (3.3%) had a lower rate of intake of green leafy vegetables 5 times weekly or more frequently than the control group (20.0%) (p < 0.05); and the control group (35.0%) had a higher consumption rate of pastry more than 1 to 2 times monthly than the MS group (13.3%) (p < 0.05). The participants with MS had a higher intake of fiber, insoluble fiber, and omega 3 fatty acid than the control group (p < 0.05). Expanded Disability Status Scale (EDSS) scores indicates that a positive correlation was found between daily intake of fiber and insoluble fiber (p < 0.05). The patients with MS in the inactive group had a higher EDSS median [2.00(0.00 –5.00)] than the minimal active group [1.25(0.00 –4.00)] (p = 0.034). Conclusion: With the increase in disability in MS patients, their physical activity levels decrease and it becomes difficult for them to shop on their own. In addition, the consumption frequency of green leafy vegetables, which take time to prepare and a source of fiber, is also decreasing. It has been shown that fiber intake decreases when the disability increase. Therefore, preventing the progression of disability in MS patients is very important in ensuring diversity in food consumption.

HaNDL sendromu, migren benzeri orta siddette veya cok siddetli bas agrisi epizodlari ile beraber gecici norolojik defisitin goruldugu, beyin omurilik sivisinda (BOS) lenfositoz saptanan inme ve aurali migreni taklit edebilen, nadir bir sendromdur. Bu yazida, bas agrisi ile beraber gecici norolojik defisiti ve BOS’ta lenfositozu olan HaNDL sendromu tanisi konulan 26 yasinda erkek hasta sunulmaktadir.

Friedreich's Ataxia (FRDA) is the most common form of autosomal recessive ataxia. The disease primarily results from a GAA trinucleotide repeat expansion within the FXN gene in up to 97% of patients. The clinical presentation begins approximately between the ages of 5 and 15. The major clinical findings of FRDA are progressive extremity and gait ataxia. Although it is known that the disease is caused by low levels of functional protein in the target tissues, there is no effective treatment available for this pathology. However, significant improvements have been achieved in the research into pharmacological treatments for FRDA in recent years. Interferon-gamma (IFN-gamma) has been shown to induce frataxin production in many cell types. In this study, the clinical features, tolerability, and the prognosis of individuals with FRDA to whom IFN-gamma was administered in a university hospital were evaluated retrospectively and the results were discussed. To the best of our knowledge, this is the first study conducted in our country to evaluate the effect of IFN gamma on this patient group.

Multiple Sclerosis (MS) and Wilson’s disease(WD) occur rarely together.To date, only three cases were reported demonstrating the co-occurrence of MS and WD.D-penicillamine may act as an immunomodulatory agent which may slow down the course of MS.MS drugs that influence liver function should be avoided in MS patients with Wilson's disease.

This study aimed to examine the correlation between DTI, clinical assessment, and electromyography results in patients who underwent primary median nerve repair.Ten patients who underwent primary repair of the complete median nerve transection were included. Study assessments were performed on both the traumatized and non-traumatized extremities and patients were followed up for a minimum duration of 11 months. Clinical assessments, (Tinnel test, static 2-point discrimination test, motor and quality of life assessments), electromyography and DTI were performed.None of the clinical or electromyographic parameters correlated significantly with any of the diffusion tensor imaging parameters, i.e. fractional anisotropy (FA) or apparent diffusion coefficient (ADC) (p0.05 for all). In addition, The Disabilities of the Arm, Shoulder and Hand (DASH) scores did not correlate with either FA (r=0.55, p=0.098) or ADC (r=0.40, p=0.260) values. However, Tinnel positive cases (n=3) had lower relative FA when compared to Tinnel negative cases (n=7) (-0.11±0.19 vs. 0.05±0.04, p=0.033).Our findings do not support the presence of relations between DTI parameters and electromyographic or most of the clinical parameters. Further MRI studies with larger numbers of patients with complete transection of the median nerve using the novel imaging parameters are warranted.Diffusion Tensor Imaging (DTI), Electromyography (EMG), Median nerve, Nerve injury, Nerve repair.L’esame clinico e gli studi di conduzione nervosa con EMG sono spesso utilizzati per monitorare la velocità di recupero dopo la riparazione chirurgica di lesione neurale. Le caratteristiche di diffusione differenziale di tessuti nervosi intatti, in guarigione o danneggiati hanno suggerito che la guarigione dei tessuti nervosi può essere monitorata usando anche il DTI (imaging con tensore di diffusione).Lo scopo di questo studio è esaminare la correlazione tra DTI, valutazione clinica e i risultati dell’elettromiografia in pazienti che hanno subito la riparazione primaria del nervo mediano.Studio di accuratezza diagnostica METODI: Sono stati inclusi 10 pazienti sottoposti a riparazione primaria di completa sezione del nervo mediano. Le valutazioni dello studio sono state eseguite sia sulle estremità traumatizzate che sulle non traumatizzate e i pazienti sono stati seguiti con un follow up di almeno 11 mesi. Sono state effettuate valutazioni cliniche (Tinnel test, test di discriminazione di 2 punti statici, valutazione motoria e della qualità di vita), elettromiografia e DTI.Nessuno dei parametri clinici o elettromiografici ha dimostrato una correlazione statisticamente significativa con alcuno dei parametri dell’imaging con tensore di diffusione, i.e. anisotropia frazionale (FA) o coefficiente di diffusione apparente (ADC) (p0.05 per tutti). In aggiunta, lo score DASH (Disabilities of the Arm, Shoulder and Hand) non ha dimostrato correlazioni con i valori di FA (r=0.55, p=0.098) o ADC (r=0.40, p=0.260). Tuttavia, i casi positivi al Tinnel test (n=3) hanno avuto una minor relativa FA rispetto ai casi negativi al Tinnel test (n=7) (-0.11±0.19 vs. 0.05±0.04, p=0.033).I nostri risultati non supportano la presenza di correlazioni tra i parametri di DTI e parametri elettromiografici o la maggior parte dei parametri clinici. Sono necessari ulteriori studi di RMN con un maggior numero di pazienti con completa sezione del nervo mediano utilizzando i nuovi parametri di imaging.

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

Systemic lupus erythematosus (SLE) is an autoimmune disease with extensive organ involvement. Neuropsychiatric-SLE (NP-SLE) includes the involvement of the central nervous system, and has an epileptic seizure rate of 6.7% to 14.4%. The prognosis of epilepsy in NP-SLE patients is fairly good, usually long-term antiepileptic treatment is not needed and only 24% of patients require polytherapy. Less than half of seizures are focal onset seizures and focal onset seizure secondary status epilepticus is rarely seen in NP-SLE. Presently described is the case of a 17-year-old woman with focal onset seizures and impaired awareness with right lower extremity weakness who had been diagnosed with SLE and whose seizures were not controlled despite antiepileptic treatment. This report was presented to draw attention to the management of super refractory status epilepticus and to review neuropsychiatric-SLE.

AIMS: This study aimed to examine the correlation between DTI, clinical assessment, and electromyography results in patients who underwent primary median nerve repair.

Group 3 Innate lymphoid cells (ILC3) resemble to Th17 cells in their production of effector cytokines and tissue localization. Th17 cells have been shown to be pathogenic in mouse MS models. Previous studies from others and our lab have shown that Sphingosine 1 phosphate 1 (S1P1) receptor impacts Th17 cell biology. S1P1 receptor agonist Fingolimod is used in the treatment of Multiple sclerosis (MS). To this day, however, the effects of fingolimod on human ILC populations have not been studied. In this study, using PBMCs from Fingolimod-receiving or control relapsing-remitting MS patients, combined with ex vivo culture system we characterized the impact of S1P1 agonists on ILC populations via Flow cytometry, real-time qPCR and ELISA. We report that human ILCs express S1P1 receptor, respond to it, as evident in reduced peripheral ILC cellularity in MS patients receiving Fingolimod. Also in culture, exposure to S1P1 agonists reduced gene expression and secretion of GMCSF and IFN-g by human ILC3 and ILC1, respectively. To our knowledge, this is the first report to study the impact of fingolimod on ILC populations in MS patients.

Dorfman-Chanarin Sendromu, otozomal resesif geçişli nadir bir nötral lipid depo bozukluğudur. Bu multisistemik hastalıkta nonbüllöz iktiyozis, vakuollü lökositler, miyopati, nöropati, sağırlık, gelişme geriliği, göz ve karaciğer patolojileri izlenebilir. Bu yazı; nöropati, miyopati, iktiozis, kardiyomiyopati, karaciğerde steatoz, sensörinöral tip işitme kaybı , bilateral optik atrofi, periferik yaymada lipit yüklü vakuoller saptanan, aile öyküsü olmayan Chanarin Dorfman Sendromu tanısı konulan olguyu içermektedir. Nötral lipid depo hastalığının geç dönemde de ayırıcı tanıda düşünülmesi gereken nadir görülen bir hastalık olduğunu vurgulaması açısından bu vaka sunulmuştur.

Aim: This study aims to describe the lesion characteristics of conventional magnetic resonance imaging (MRI) of patients who are directed to a university hospital with a pre-diagnosis of demyelinating disease who are finally diagnosed as MrWMLs.Material and Methods: Individuals who were referred to an MS outpatient clinic of a university hospital with a pre-diagnosis of demyelinating disease and finally diagnosed with migraine according to the International Classification of Headache Disorders (ICHD) -3 (β) criteria who also have MrWMLs and 45 age and gender-matched individuals who are diagnosed with MS according to the 2017 McDonald diagnostic criteria, without migraine-type headache were retrospectively analyzed. Results: Forty-five individuals with migraine and 45 age and gender-matched individuals who are diagnosed with MS were included. The median time since diagnosis was 10 (0.5-32) years for the migraine group and 5 (0.3-20) years in the group with MS (p=0.031). The median age of the group with migraine was 35 (23-54) years, while the median age of the group with MS was 34 (20-55) years. There was no significant difference between the groups in terms of average age and gender distribution (p=0.342 and p=0.389). The total number of T1 and T2 lesions were significantly higher in the MS group. Similarly, the number of infratentorial and periventricular lesions was higher in the MS group (p0.001). The number of deep white matter lesions was higher in the migraine group (p0.05).Conclusion: In this study, conventional MRI tips were defined for differentiating MS lesions from MrWMLs which has an important place in the differential diagnosis of MS. MrWMLs were deep white matter lesions that are predominantly located at the frontal and parietal lobes. Studies involving more individuals and using automated segmentation software may provide more information to differentiate MrWMLs from MS lesions.

This review aims to provide a comprehensive overview of the literature on the use of exercise for migraine treatment with regard to its efficacy, mechanism of action and role in practice.

The aim of this study is to compare the white matter of multiple sclerosis (MS) patients with healthy controls and to monitor the response to the treatment with magnetic resonance spectroscopy (MRS). Fifteen healthy controls and 36 recently diagnosed MS patients never treated with interferon β were included in this study. In the patient group, MRS was performed before treatment, at 6th and 12th month after the initiation of treatment and once in control group. Patient group was divided into 3 interferon groups randomly. Physical examination findings were recorded as Expanded Disability Status Scale scores before treatment, at 6th and 12th month of interferon treatment. At the end of 1 year follow up, 26 of 36 patients completed the study. In patients’ white matter lesions, N-acetylaspartate/creatine (NAA/Cr) ratios were lower than control group's white matters. NAA/Cr ratios were higher in control group's white matter than patient's normal appearing white matter but this difference was not statistically significant. There was no difference in choline/creatine (Cho/Cr) ratios between 2 groups. In follow-up period, NAA/Cr and Cho/Cr ratios obtained from patients’ white matter lesions and normal appearing white matter did not change statistically. This study showed that in MS patients’ white matters, especially in white matter lesions, neuron viability is reduced compared with healthy controls’ normal white matter; and in the patients treated with interferon β NAA/Cr ratios remained stable. These stable levels of metabolite ratios in the patients who received interferon β therapy can be explained with either the shortness of the follow-up period post-treatment or may reflect a positive effect of the beta interferon therapy on the progress of MS.

Posterior reversible encephalopathy syndrome is a clinico-neuroradiologic entity with typical symptoms and symmetric high-signal intensity lesions in the bilateral parietooccipital lobes on T2-weighted or fluid-attenuated inversion recovery magnetic resonance imaging. In this presentation, we report a case of posterior reversible encephalopathy syndrome who was admitted to our emergency department because of seizure and deterioration of consciousness. The aim of this presentation is to alert the emergency physicians about one of the hypertensive emergencies with neurologic symptoms associated with hypertension.