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Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients’ database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.

Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS.100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale.The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p0.01) showed a moderately significant, CVLT-II (r= -0.219, p0.05) and BVMT-R (r=-0.218, p0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs.It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs.

Background: Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS.Methods: 100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale.Results: The mean age of the patients was 40.9 +/- 12.3, the duration of the disease was 9.03 +/- 6.89 years, and the mean OAB-V8 score was 17.6 +/- 8.9. SDMT test (r=-0.299, p

Background: Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS. Objective: To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey. Methods: Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D). Results: Out of the 1,068 participants, 173 (16.2%) were found to have RLS [RLS(+)] and 895 (83.8%) did not [RLS(-)]. The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p

Objective: To find out if Charcot–Marie–Tooth (CMT) patients, who have peripheral vestibular as well as peripheral somatosensory impairment, have worse postural balance than those who do not. Methods: We studied 32 patients with various CMT phenotypes and genotypes. Vestibular function was measured with the video head impulse test (vHIT) which tests vestibulo-ocular reflex (VOR) gain from each of the six semicircular canals in response to rapid head rotations. Postural balance was evaluated with a battery of four postural tests with emphasis on the modified clinical test of sensory integration in balance (mCTSIB). Results: Half of the 32 patients had some impairment of vestibular function ranging from mild, affecting only 1–2 semicircular canals, to almost total affecting all 6 semicircular canals. Their mCTSIB scores correlated with VOR gain from the vertical rather than from the lateral semicircular canals. The worse the vertical VOR gain the worse the mCTSIB score. Conclusion: We propose that any CMT patient could have clinically inapparent vestibular impairment that can be easily measured with the vHIT. This vestibular impairment could be contributing to their imbalance and could respond to a focused vestibular rehabilitation program. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature., 216S658 Türkiye Bilimsel ve Teknolojik Araştirma Kurumu, TÜBITAK, Study funded by the Scientific and Technological Research Council of Turkey (TÜBİTAK) under Grant no. (216S658). Acknowledgements

Introduction: The aim of the study was to present the psychometric properties of the Turkish version of the life balance inventory in individuals with multiple sclerosis. Methods: Life balance inventory was translated and adapted considering common suggestions. Participants were cross-sectionally evaluated twice with life balance inventory, with a 1-week interval. Expanded Disability Status Scale, Beck Depression Scale, and Short Form-12 were used to assess the convergent validity. Results: A total of 113 individuals with multiple sclerosis were enrolled in the study. Test-retest reliability of the total score and all subscores of the life balance inventory were excellent (intraclass correlation coefficient > 0.80). The internal consistency of the life distress inventory was excellent (α = 0.73–0.95). The correlation of Expanded Disability Status Scale with life balance inventory and its subscores was low in the scope of divergent validity, as expected ( r Conclusion: The Turkish life balance inventory is a reliable and valid inventory in patients with multiple sclerosis. Life balance inventory comprehensively evaluates the life balance parameters of multiple sclerosis patients.

Purpose Examining sleep-related behavioral disorder strategies in detail for MS patients provides an essential assessment to address specific disease findings. The aim of the study was to demonstrate the reliability and validity of the Turkish Sleep-Related Behaviors Questionnaire in patients with multiple sclerosis (MS). Methods A total of 100 MS patients were filled Sleep-Related Behaviors Questionnaire (SRBQ), Beck Depression Inventory (BDI), Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). One week later, 30 randomly selected patients were refilled the SRBQ. The test-retest reliability, internal consistency, and contruct validity were determined. Results The mean age of the individuals included in the study was 38.9 +/- 11.0 years. The ICC value of the reproducibility of SRBQ was calculated as 0.877 (CI: 0.74-0.94). The test-retest reliability of the SRBQ was excellent (ICC > 0.80). Cronbach's alpha value of the SRBQ was 0.877, which indicates excellent consistency. The SRBQ had correlation coefficients of 0.573, 0.509, and 0.523 with ISI, PSQI, and BDI, respectively. The SRBQ had high validity (r > 0.50, p < 0.01). Conclusion The Turkish SRBQ was found to be valid and reliable in patients with MS. Owing to the long but comprehensive nature of the SRBQ, a low-cost detailed measurement could be obtained in clinical practice.

Background The 30-second Chair Stand Test (30s-CST) and Modified Four Square Step Test (mFSST) are used to determine the functional status of individuals with multiple sclerosis (MS). No other studies have demonstrated the reliability and validity of the 30s-CST and mFSST. Purpose To identify the test-retest reliability, concurrent validity and the known-group validity of the 30s-CST and mFSST in persons with MS. Methods A total of 64 persons with MS were enrolled. 30s-CST, mFSST, Timed Up and Go Test (TUG) and Five Times Sit to Stand (FTST) tests were performed. 30s-CST and mFSST were conducted again one-hour later. Results The mean age of the persons with MS were 37.9 +/- 11.3 years. The test-retest reliability of the 30s-CST and mFSST were excellent (ICC30s-CST = 0.974, 95%CI: 0.95-0.98; ICCmFSST = 0.992, 95%CI: 0.98-0.99). The 30s-CST was strongly correlated with FTST and TUG (r(1) = -0.871, p(1) = 0.0001; r(2) = -0.741,p(2) = 0.0001). There was a strong relationship between mFSST with TUG and FTST (r(1) = 0.781,p(1) = 0.0001;r(2) = 0.788,p(2) = 0.0001). The SEM95 and MDC95 values of the 30s-CST and mFSST were 0.41/1.13 and 0.34/0.94, respectively. Besides, there were significant differences between the persons with or without fall history in 30s-CST (MD: 1.66, CI: 0.27 to 3.05, p = .019) and mFSST CST (MD:-2.70, CI: -4.73 to -0.67, p = .010) performances. Conclusion The 30s-CST and mFSST are both valid and reliable in mildly-disabled individuals with MS.

Objective: To demonstrate the psychometric properties of the Turkish Fatigue Assessment Scale (FAS). Materials and Methods: A total of 104 patients were recruited. The patients were assessed twice, 1 week apart. Patients completed the FAS, Fatigue Severity Scale (FSS), EuroQol 5 dimensions 3 L (EQ 5D 3 L), and Beck Depression Scale (BDS) in the initial assessment. Thirty four patients completed the FAS again in the second assessment. Results: The mean age of the patients with multiple sclerosis (MS) was 37.6 ± 10.1 years. The intraclass correlation coefficient (ICC) of the FAS was excellent (ICC = 0.812). The Cronbach alpha coefficient of the FAS was 0.914. The alpha of the FAS was excellent (>0.80). Standard error of measurement and minimal detectable change of the FAS were 3.51 and 9.73 respectively. The relationship between the FAS (test, retest) and the FSS was excellent (r1 = 0.767, r2 = 0.782, P < 0.01). The EQ 5D 3 L index score was both strongly related with FAS (test, retest) (r1 = ?0.500, r2 = ?0.745, P < 0.01). The EQ 5D 3 L Visual Analog Scale score was also highly correlated with FAS (test, retest) (r1 = ?0.536, r2 = ?0.764, P < 0.01). Besides, FAS (test, retest) scores were strongly correlated with BDS total scores (r1 = 0.540, r2 = 0.571, P < 0.01). Conclusions: The Turkish FAS is a reliable and valid scale for individuals with MS.

Purpose: To our knowledge, no other studies have demonstrated the reliability and validity of the Figure of Eight Walking Test (F8WT) and L Test in patients with multiple sclerosis (MS). The aim of the study was to prove the test-retest reliability and concurrent validity of the F8WT and L Test in patients with MS.Methods: A cross-sectional study was conducted with 52 patients with MS. A clinical neurologist evaluated patients by Expanded Disability Status Scale (EDSS). Participants completed the F8WT, L Test, Timed Up and Go Test (TUG), and Timed 25-Foot Walk Test (T25FW) in the first assessment session. Then, the F8WT and L Test was retested one hour later. The same evaluator completed all of the assessments.Results: The ICC of both tests were excellent (ICCF8WT: 0.972, ICCL Test: 0.986). F8WT and L test measurement did not show a systematic bias and were within the agreement limits. The Standard Error of Measurement (SEM95) and Minimal Detectable Change (MDC95) values of the F8WT was 0.58 and 1.60, respectively. Besides, L Test's SEM95 and MDC95 were 0.59 and 1.63. The correlation between F8WT with TUG, T25FW and EDSS was 0.849, 0.810 and 0.453. On the other hand, the L test's correlation coefficient with TUG, T25FW and EDSS 0.682, 0.706 and 0.535, respectively (p < 0.01). Individuals with EDSS

Objective: The study aimed to translate and cross-culturally adapt the Fear of Relapse Scale (FoR) into Turkish and determine its psychometric properties. Methods: International guidelines were used for the translation and adaptation process. The patients were asked to fill the FoR, Intolerance of Uncertainty (IUS-12) and Depression Anxiety and Stress Scale (DASS-21). One week later, participants refilled the FoR. The test-retest reliability, internal consistency, and construct validity of the FoR were analyzed. Results: A total of 101 MS patients (37.6 +/- 10.0 years, 81.2% women) were included in the research. The test retest reliability of the FoR was excellent (ICC:0.883; CI:0.64-0.92). The reproducibility of the items of the FoR ranged from 0.2 to 0.8. The Cronbach's alpha coefficient of the FoR was 0.914. The internal consistency of the items was ranged between 0.90 and 0.91 The relationship between FoR with IUS-12, DASS-21 (depression), DASS-21 (anxiety), DASS-21 (stress) was 0.609, 0.641, 0.648 and 0.631, respectively. The correlation coefficients were greater than 0.50 (p < 0.01). Conclusion: The Turkish version of the FoR is a reliable and valid tool to measure relapse fear in patients with MS.

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

Objective The study was aimed to translate and adapt the Telemedicine Satisfaction and Usefulness Questionnaire (TSUQ) and Telemedicine Patient Questionnaire (TPQ) into Turkish, thereafter to analyze the psychometric properties of both questionnaires. Methods A total of 149 multiple sclerosis (MS) patients were recruited in the study. For 4 years, all patients were supervised by a department clinician using telemedicine. Cronbach's alpha coefficient was used to assess internal consistency. By evaluating the scores of 41 retested patients 1 week later, the test-retest reliability was determined using the intraclass correlation coefficient (ICC). Pearson's correlation coefficient was used to assess the construct validity (r). Results A total of 149 patients (103 women, 46 men) with a mean age of 40.9 +/- 10.9 years were included in the study. MS duration of the patients was 9.15 +/- 6.24 years. Internal consistency of all items and the total score of the TSUQ were excellent (>0.80; ranged 0.971-0.974). On the other hand, the internal consistency of all items and total score of the TPQ was excellent, either (>0.80; ranged 0.878-0.890). The ICC of the TSUQ's and TPQ's total score was excellent (>0.80). The correlation between TSUQ and TPQ was strong (r=0.734, p

To find out if Charcot-Marie-Tooth (CMT) patients, who have peripheral vestibular as well as peripheral somatosensory impairment, have worse postural balance than those who do not.We studied 32 patients with various CMT phenotypes and genotypes. Vestibular function was measured with the video head impulse test (vHIT) which tests vestibulo-ocular reflex (VOR) gain from each of the six semicircular canals in response to rapid head rotations. Postural balance was evaluated with a battery of four postural tests with emphasis on the modified clinical test of sensory integration in balance (mCTSIB).Half of the 32 patients had some impairment of vestibular function ranging from mild, affecting only 1-2 semicircular canals, to almost total affecting all 6 semicircular canals. Their mCTSIB scores correlated with VOR gain from the vertical rather than from the lateral semicircular canals. The worse the vertical VOR gain the worse the mCTSIB score.We propose that any CMT patient could have clinically inapparent vestibular impairment that can be easily measured with the vHIT. This vestibular impairment could be contributing to their imbalance and could respond to a focused vestibular rehabilitation program.

Objective This study aimed to establish the equivalence, reliability, and validity of the Multiple Sclerosis Self-Management Scale Turkish Version (MSSM-T). Methods This methodological study consisted of 240 multiple sclerosis (MS) patients who were followed in an outpatient clinic of a university hospital between October 2016 and April 2017. Data were collected using the demographic characteristics form and the 24-item MSSM-T. Language equivalence, content validity, and construct validity methods were used for the validity of the scale; internal consistency, item analysis, and test-retest methods were used for the reliability. Explanatory factor analysis was used for construct validity, and principal component analysis and varimax rotation were used in the analysis of factor structure. Results The item-total correlations for the Turkish version were found to be sufficient (between 0.238 and 0.674). The Cronbach α reliability coefficient was 0.85, indicating high reliability. The test-retest reliability coefficient was 0.84, indicating high consistency. The Turkish version was found to have 5 factors for the 24 items (F1, healthcare provider relationship/communication; F2, knowledge and information about MS; F3, treatment adherence/barriers; F4, maintaining health behavior; and F5, social/family support), which accounted for the 62.584% of the characteristics in question. Conclusion The MSSM-T is valid and reliable in determining the self-management behaviors of patients with MS for Turkish patients.

Background Recently, urinary excretion of the tetrasaccharide 6-α-D-glucopyranosyl-maltotriose (Glc4) has been proposed as a marker for the diagnosis and monitoring of Pompe disease (PD). We aimed to determine the reference intervals and reliable decision-making levels of urine tetrasaccharide concentrations for the diagnosis of infantile- and late-onset Pompe patients in the Turkish population. Methods In this study, nine patients with PD (five of them with late-onset PD [LOPD]) and 226 healthy individuals (aged 0–64 years) were included. Urine Glc4 concentrations were determined using the ultra-high-performance liquid chromatography (UHPLC) tandem mass spectrometry (MS/MS) method. Results Our data showed that the urine tetrasaccharide levels decreased with age in healthy individuals (p Conclusions The results of this study showed that the reference intervals of tetrasaccharide in urine changed over time; therefore, it is critically important to define age-based decision levels for the diagnosis of LOPD.

PubMed: 32473575 Background: Although studies report a high prevalence rate of restless legs syndrome (RLS) among patients with multiple sclerosis (PwMS) ranging from 13.3 to 65.1%, little is known about the causes of this relationship. Methods: To ascertain the prevalence, features and impact of RLS among PwMS a nation-wide, multicenter, prospective and a cross-sectional survey, designed to reflect all of the PwMS throughout Turkey, was conducted in 13 centers. Exploring the relationship of the two conditions could possibly contribute to the understanding of the causes of the high and wide-ranging prevalence rates and the pathophysiology of both diseases. Results: Of the 1068 participants 173 (16,2%) found to have RLS [RLS(+)] and 895 (83,8%) did not [RLS(-)]. Among the RLS(+) 173, all but 8 patients (4,6%) were underdiagnosed in terms of RLS. More than half of the patients with RLS had ‘severe’ or ‘very severe’ RLS. The onset of RLS was before or synchronous with the onset of MS in about a half of our patients. Conclusion: We conclude that RLS should be meticulously investigated in PwMS and MS can be a direct cause of RLS at least in part of PwMS. Our data about the timing of the onset of MS and RLS, along with the high prevalence of RLS in PwMS suggest that the pathologic changes in the initial phases of MS can possibly trigger RLS symptoms. © 2020 Elsevier B.V.

Introduction: Multiple Sclerosis Knowledge Questionnaire (MSKQ) is a self-administered inventory assessing patients' knowledge about Multiple Sclerosis. In this study, we aimed to test the reliability and validity of MSKQ in Turkish patients. Methods: Patients with Multiple Sclerosis who attended an education seminar in our university hospital were enrolled in the study. Results: Fifty-eight patients completed and returned the questionnaire twice, before and after the seminar. Mean number of items that were answered correctly in the first round was 12.8 (5.2), which increased to 18.7 (3.2) in the second round after the seminar. This increase was found to be significant (p

Cervical vestibular-evoked myogenic potentials (cVEMPs) are accepted to demonstrate the vestibulo-collic reflex. However, the brainstem pathway is still not fully understood. The aim of the study was to evaluate the contribution of cVEMPs to detection of brainstem involvement in multiple sclerosis (MS). Thirty patients fulfilling the criteria for definite MS were included in the study. All were newly diagnosed cases, admitted due to an attack with active lesions on MRI. Thirty-one age- and sex-matched healthy controls constituted the control group. The latencies of peaks p13 and n23 and peak-to-peak amplitude of p13–n23 were measured. Brainstem lesions on MRI were present in 13 of the patients (43.4%). Comparison of the overall results recorded from patients with the healthy controls did not reveal a statistically significant difference in any of the parameters studied (p > 0.05). A significant inter-side difference was not also present between groups (p > 0.05). When p13 and n23 latencies exceeding 2.5 standard deviations (SD) were taken into consideration, it was seen that there were seven patients (23.3%) with prolonged latencies mainly involving the p13 peak. Five of them had brainstem signs on examination and had brainstem lesions on MRI. In the other eight patients with abnormal MRI, normal results were recorded indicating that in only 38% of patients with brainstem lesions, cVEMPs were altered. Absence of a correlation between cVEMPs and brainstem clinical or MRI lesions defies their role in identifying lower brainstem involvement.

Purpose The study was purposed to investigate the effect of COVID-19 disease on fatigue, sleep quality, physical activity, quality of life, and psychological status in people with MS. Methods A total of 104 people with MS, including 46 of them with COVID-19 disease history, were enrolled in the study. All patients were evaluated with the Expanded Disability Status Scale (EDSS), Fatigue Severity Scale (FSS), Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire Short Form (IPAQ-SF), the EuroQoL Instrument (EQ-5D-3L), the Fear of COVID-19 Scale (FCV-19S) and the Coronavirus Anxiety Scale (CAS). Results People with MS in the COVID-19 positive group had a significantly lower IPAQ-Total score (p = 0.014). Besides, the FCV-19S scores of COVID-19 positive patients were significantly higher (p = 0.006). EQ-5D-3L Index and EQ-5D-3L VAS scores were higher in the group with COVID-19 (p1 = 0.021, p2 = 0.014, respectively). FCV-19S had a moderate correlation with EDSS (r = -0.362). IPAQ-Total was moderately associated with MS duration, EDSS and FSS (r1 = -0.471, r2 = -0.389, r3 = -0.388, respectively). The EQ-5D-3L Index was moderately correlated with FSS (r1 = -0.404). There was a weakly significant relationship between EQ-5D-3L Index and BMI, MS duration, PSQI and CAS (r1 = -0.471, r2 =-0.389, r3 = -0.388, r4 = -0.326, respectively). On the other hand, EQ-5D-3L was moderately associated with VAS and EDSS and PSQI (r1 = -0.393, r2 = -0.357, respectively). Conclusion COVID-19 negatively affected the people with MS's physical activity and coronavirus related fear parameters. However, the causality of this influence should be investigated in detail.

Purpose: The study aimed to translate and cross-culturally adapt the SymptoMScreen into Turkish and evaluate its reliability and validity. Methods: One hundred nine MS patients were included in the study. SymptoMScreen was translated into Turkish according to the standardized guidelines and cross-culturally adapted. For construct validity, SymptoMScreen was compared with the Expanded Disability Status Scale (EDSS), Multiple Sclerosis-Related Symptom Checklist (MS-RS), and Beck Depression Scale (BDS) by Spearman's correlation coefficient. Thirty patients refilled SymptoMScreen one week later, and the test-retest reliability was analyzed by the Intraclass Correlation Coefficient (ICC). Internal consistency was evaluated with Cronbach's alpha coefficient. The standard error of measurement (SEM95) and the minimum detectable change (MDC95) were calculated. Results: Test-retest reliability and internal consistency of the SymptoMScreen were excellent (ICC = 0.925, ? = 0.914). SEM95 and MDC95 were 3.28 and 9.29, respectively. There was a strong correlation between the SymptoMScreen with the MS-RS and EDSS (r1= 0.908, p < 0.00; r2= 0.511, p < 0.001). Besides, the SymptoMScreen was moderately correlated with BDS (r = 0.584, p < 0.001). Conclusion: The Turkish version of the SymptoMScreen is a reliable and valid questionnaire for multiple sclerosis patients. © 2021 Elsevier B.V., None.

Adherence to medication treatment in patients with multiple sclerosis (MS) is important to increase its effectiveness, reduce patient disability, prevent attacks, and increase the quality of life.This study investigated factors that influence adherence to disease-modifying therapy in patients with MS.This descriptive study was conducted with 198 patients with MS who met the inclusion criteria and agreed to participate between July 2016 and February 2017. Data were collected using an Individual Identification Form that included sociodemographic characteristics, the Multiple Sclerosis Treatment Adherence Questionnaire, the Fatigue Severity Scale, the Self-Efficacy Scale, and the Brief COPE.We found that 59.6% of the patients were adherent to therapy. Patients were significantly more adherent to Avonex than other treatments, and "memory problems" was the most common reason for missing or forgetting medication in nonadherent patients. There was a significant difference between medication adherence and some sociodemographic characteristics and disease characteristics (P.05). There was no significant difference between coping attitudes, fatigue, and self-efficacy level and medication adherence (P.05).Patients' adherence to medication treatment was low and may be associated with social, physical, and cognitive measures.

Boz, Cavit/0000-0003-0956-3304; Altintas, Ayse/0000-0002-8524-5087; YUCEYAR, NUR/0000-0003-4590-6423; Sevim, Serhan/0000-0002-0518-3374; Efendi, Husnu/0000-0002-9143-3893, WOS: 000502098900008, PubMed: 31473488, Background: Fingolimod and teriflunomide are commonly used in the treatment of relapsing-remitting multiple sclerosis (RRMS). These have not been compared in controlled trials, but only in observational studies, with inconclusive results. Comparison of their effect on relapse and disability in a real-world setting is therefore needed. Objectives: the objective of this study was to compare the efficacy of fingolimod and teriflunomide in reducing disease activity in RRMS. Methods: This multicenter, retrospective observational study was carried out with prospectively collected data from 15 centers. All consecutive RRMS patients treated with teriflunomide or fingolimod were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), disability accumulation, percentage of patients with active MRI and treatment discontinuation over a median 2.5-year follow-up period were compared. Results: Propensity score matching retained 349 out of 1388 patients in the fingolimod group and 349 out 678 in the teriflunomide group for final analyses. Mean ARR decreased markedly from baseline after 1 and 2 years of treatment in both the fingolimod (0.58-0.17 after 1 year and 0.11 after 2 years, p < 0.001) and teriflunomide (0.56-0.29 after 1 year and 0.31 after 2 years, p < 0.001) groups. Mean ARR was lower in fingolimod-treated patients than in those treated with teriflunomide at years 1 (p = 0.02) and 2 (p = 0.004). Compared to teriflunomide, the fingolimod group exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients after 2.5-year follow-up. Disability worsening was similar between the two groups. Patients were less likely to discontinue fingolimod than teriflunomide (p < 0.001). Conclusion: Fingolimod was associated with a better relapse control and lower discontinuation rate than teriflunomide. the two oral therapies exhibited similar effects on disability outcomes.

WOS: 000473218600009, Objective: We aimed to investigate the correlations of urinary symptoms with urodynamic findings in patients with multiple sclerosis (MS) and their effects on quality of life. Methods: Nineteen MS patients with urinary symptoms were included. The data were obtained from files or with face-to-face interviews. Symptom types of patients were categorized as irritative, obstructive, and mixed. The Incontinence Quality of Life Scale, the King's Quality of Life Questionnaire (KQL) and the International Consultation on Incontinence Modular Questionnaire-Short Form were used to determine the effect of urinary symptoms on quality of life. The Extended Disability Status Scale (EDSS) was used to assess disability. All patients underwent urodynamic examination. Results: Of the 478 patients, 34.5% had visited a psychiatrist once in their lifetime, 13.6% were diagnosed with depression, and 13.8% did not know the diagnosis of mental disease; 32.2% were suggested medication by their doctor, 16.7% did not know the name of this medication, and 13.2% stated that the suggested drug was antidepressant. Moreover, 24.9% of the patients were known to use antidepressant at least once in their lifetime, and 16.3% were still using antidepressants. Among patients using antidepressants, 32% continued using this drug upon doctor's recommendation and 13.6% continued with the diagnosis of depression. Conclusion: The urinary symptoms significantly affect the quality of life in MS patients. Since symptoms do not always correlate with the underlying pathology, it is more appropriate to give the treatment based on the bladder type in urodynamic testing.

WOS: 000423337400011, PubMed ID: 29367459, We identify 2 homozygous mutations in the epsilon-subunit of the muscle acetylcholine receptor ( AChR) in 3 patients with severe congenital myasthenia: epsilon R218W in the pre-M1 region in 2 patients and epsilon E184K in the beta 8-beta 9 linker in 1 patient. Arg218 is conserved in all eukaryotic members of the Cysloop receptor superfamily, while Glu184 is conserved in the alpha-, delta-, and epsilon-subunits of AChRs from all species. epsilon R218W reduces channel gating efficiency 338-fold and AChR expression on the cell surface 5-fold, whereas epsilon E184K reduces channel gating efficiency 11-fold but does not alter AChR cell surface expression. Determinations of the effective channel gating rate constants, combined with mutant cycle analyses, demonstrate strong energetic coupling between epsilon R218 and epsilon E184, and between eR218 and epsilon E45 from the beta 1-beta 2 linker, as also observed for equivalent residues in the principal coupling pathway of the alpha-subunit. Thus, efficient and rapid gating of the AChR channel is achieved not only by coupling between conserved residues within the principal coupling pathway of the alpha-subunit, but also between corresponding residues in the epsilon-subunit., NIH grantUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA [NS 6277, NS031744], This work was supported in part by NIH grants NS 6277 to AGE and NS031744 to SMS.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a common, treatable, autoimmune peripheral neuropathy considered to produce imbalance by weakness and proprioceptive impairment rather than vestibular impairment. We measured semicircular canal vestibular function in 21 CIDP patients (15M/6F) by the video head impulse test and postural stability with a battery comprising the modified Clinical Test of Sensory Integration and Balance, the Berg Balance Scale, the Dynamic Gait Index, the Fall Efficiency Scale, and the International Cooperative Ataxia Rating Scale. Of the 21 patients, 16 had vestibular impairment, ranging from mild-affecting just a single semicircular canal, to severe-affecting all 6 canals. Although the severity of the vestibular impairment did not correlate either with the severity of the postural imbalance or of the peripheral neuropathy, our data show that vestibular impairment is an additional challenge to balance that some CIDP patients will face.

Myosin storage myopathy (MSM) is a protein aggregate myopathy caused by the accumulation of myosin in muscle fibres and results from MYH7 mutation. Although MYH7 mutation is also an established cause of variable cardiomyopathy with or without skeletal myopathy, cardiomyopathy with MSM is a rare combination. Here, we update the clinical findings in the two brothers that we previously reported as having recessively inherited MSM characterized by scapuloperoneal distribution of weakness and typical hyaline-like bodies in type 1 muscle fibres. One of the patients, weak from childhood but not severely symptomatic until 28 years of age, had an unusual combination of MSM, severe dilated cardiomyopathy, and respiratory impairment at the age of 44 years. We identified homozygous missense mutation c.5458C>T (p.R1820W) in exon 37 in these patients as the second recessive MYH7 mutation reported to date.

Objective Neurogenic dysphagia (ND) is a prevalent condition that accounts for significant mortality and morbidity worldwide. Screening and follow-up are critical for early diagnosis and management which can mitigate its complications and be cost-saving. The aims of this study are to provide a comprehensive investigation of the dysphagia limit (DL) in a large diverse cohort and to provide a longitudinal assessment of dysphagia in a subset of subjects. Methods We developed a quantitative and noninvasive method for objective assessment of dysphagia by using laryngeal sensor and submental electromyography. DL is the volume at which second or more swallows become necessary to swallow the whole amount of bolus. This study represents 17 years experience with the DL approach in assessing ND in a cohort of 1278 adult subjects consisting of 292 healthy controls, 784 patients with dysphagia, and 202 patients without dysphagia. A total of 192 of all patients were also reevaluated longitudinally over a period of 1–19 months. Results DL has 92% sensitivity, 91% specificity, 94% positive predictive value, and 88% negative predictive value with an accuracy of 0.92. Patients with ALS, stroke, and movement disorders have the highest sensitivity (85–97%) and positive predictive value (90–99%). The clinical severity of dysphagia has significant negative correlation with DL ( r = −0.67, p Conclusions We propose the DL as a reliable, quick, noninvasive, quantitative test to detect and follow both clinical and subclinical dysphagia and it can be performed in an EMG laboratory. Significance Our study provides specific quantitative features of DL test that can be readily utilized by the neurologic community and nominates DL as an objective and robust method to evaluate dysphagia in a wide range of neurologic conditions.

WOS: 000422853200007, Combined central and peripheral nervous system demyelination (CCPD) is a fairly new concept and our knowledge is restricted to several case series and case reports. We aimed to contribute to the literature with our experiences in the management of a patient representing both chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multiple sclerosis (MS) features. A 32-year-male patient presented with neuropathic compaints for one year and recent onset of optic neuritis with central demyelinating lesions. Clinical, electrophysiological and radiological response was achieved with corticosteroid treatment and relapsed after cessation. His second simultaneous CCPD exacerbation did not respond on intravenous immunoglobulins (IVIG) but responded well on intravenous high dose corticosteroid. Previous studies reported inadequate responses to high-dose corticosteroids and IVIG in the majority of patients with CCPD. It's estimated to be a unique disease beyond MS and CIDP with heterogenous features. We suggest that awareness of this steroid-dependent condition may improve our knowledge in the pathophysiology and management strategies.

23rd IFCC-EFLM European Congress of Clinical Chemistry and Laboratory Medicine (EuroMedLab) -- MAY 19-23, 2019 -- Barcelona, SPAIN, Sezer, Ebru/0000-0002-6900-3539, WOS: 000529532101238, [No abstract available], Int Federat Clin Chem & Lab Med, European Federat Clin Chem & Lab Med

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

Giriş: Multipl Skleroz (MS)'da aksonal kayıp ve nörodejenerasyon, hastalığın erken dönemlerinden itibaren oluşur ve kalıcı özürlülüğe yol açabilir. Bu çalışmada MS hastalarında beyin volüm kaybı ve klinik parametrelerle ilişkisi araştırılmıştır. Metod: 20 erken evre MS hastasında fiziksel ve kognitif değerlendirme Expanded Disability Status Scale(EDSS) ve Multiple Sclerosis Functional Composite (MSFC), Rey Auditory and Verbal Learning Test (RAVLT) ile yapılmıştır. Manyetik rezonans görüntüleme (MRG) sonrasında elde edilen veriler RIO (region of interest) tekniği ve JIM 4.0 software kullanarak işlenmiştir. BOS, gri, ve beyaz madde volümleri ve beyin parankimal fraksiyonu (BPF) hesaplanmıştır. Bulgular: MS hastalarında ortalama BPF değerleri normal kontrollerden anlamlı olarak düşük bulunmuştur. BPF değerleri hastalık süresi ile negatif orantılıdır. MS hastalarının %27.3 ünde sözel ve işitsel bellek süreçleri testinde anormallik saptanmıştır. BPF değerleri ile kognitif performans, MSFC/EDSS skorlarında anlamlı ilişki saptanmamıştır. Sonuç: BPF ölçümü beyin atrofisini değerlendirmede pratikte ve klinik çalışmalarda kullanılabilecek güvenilir bir metottur. Erken evrede saptanabilen beyin atrofisi klinik özürlülüğe yol açmayabilir. Kortikal reorganizasyon veya akson kaybının klinik özürlülük için bir eşik değerinin varlığı söz konusu olabilir. Beyin atrofisinin klinik öneminin anlaşılması için beyin volümü ölçümlerinin serial izlenmesi ve ayrıntılı nöropsikolojik testlere ihtiyaç vardır., Objective Background: In multiple sclerosis (MS), axonal loss and neurodegeneration occurs early in disease course and may lead to irreversible neurological impairment. We aimed to investigate brain volume loss as an accurate measure of axonal loss and its clinical relevance in early MS. Methods: Twenty MS patients whose first symptoms beginning within the last 2 years were underwent a neurological examination included Expanded Disability Status Scale (EDSS) and Multiple Sclerosis Functional Composite (MSFC). Cognitive status of patients was assessed with Paced Auditory Serial Addition Test (PASAT) and Rey Auditory Verbal Learning Test (RAVLT). For processing magnetic resonance imaging (MRI) data, region of interest technique (ROI) and JIM 4.0 software were established. Brain parenchymal fraction (BPF), cerebrospinal fluid (CSF) volume, gray and white matter volumes of brain was determined in MS patients and in control subjects. The relationship between MRI data and demographic, clinical variables was also evaluated. Results: In MS patients, the mean BPF value was significantly lower than controls. BPF also negatively correlated with the duration of disease. 27.3% of the patients have impairment by verbal memory processes tests. We didn't find significant correlation between BPF scores and cognitive performance, and also MSFC/EDSS scores. There was only significant correlation between PASAT scores and white matter volume. Conclusion: Measurement of BPF is a reliable method for brain atrophy that can be used in clinical practice and clinical trials. The atrophy beginning at the early phase of the disease might not cause clinical disability because of cortical reorganization and there might be individual threshold value of axon loss for clinical disability. In order to determine the clinical relevance of brain atrophy, longitudinal MRI studies with cognitive evaluation by comprehensive neurophysiological tests are needed.

Optic neuritis (ON) is highly associated with multiple sclerosis (MS) and conversion rate has been reported to be around 50% over a period of 15 years. We revised the risk factors for developing MS after an attack of ON, in western Turkey. One hundred and twenty-four patients with acute unilateral ON, who were on follow-up for at least 5 years (range 62 to180 months, mean 85 months) were enrolled in the study. Gender, age at onset, seasonal occurrence, severity of visual loss, presence of pain, optic disc appearance, treatment, degree of recovery, presence or absence of lesions on magnetic resonance imaging (MRI) during the initial ON attack and recurrence were considered. Of the 124 patients, 89 (71.8%) were women, 35 (28.2%) were men, with a mean age of 28.7 ± 8.6 years at the time of the initial ON attack. During follow-up, 70 patients (56.5%) developed MS within 17.14 months, ranging from 1 to 125 months. Female gender (p = 0.021), experiencing the attack before 40 years of age (p = 0.02), normal-appe...

MS patients frequently present with urinary system symptoms, which have a negative effect on the quality life. The aim of our study was to demonstrate the validity and reliability of the Turkish King’s Health Questionnaire (KHQ) in MS patients. The study included 37 patients. For analysis of test–retest reliability, the Turkish version of the KHQ developed and the “translation-back translation” method was performed. To assess the validity of these results, Multiple Sclerosis Quality of Life Scale (MQoL-54) and Expanded Disability Status Scale (EDSS) were used. The internal consistency (intra-class correlation coefficient: 0.59–0.94) and test–retest reliability (Cronbach’s α-score 0.59–0.94) of KHQ were found to be high (p < 0.05). A significant correlation was detected between most of the KHQ subscores and the physical and mental MQoL-54 and EDSS (total and bowel/bladder, p < 0.05) subscores. The KHQ may be used to determine the effect of incontinence on the quality of life for MS patients.

Hashimoto's encephalopathy (HE) is a rare immune-mediated encephalopathy developing in patients with high serum concentrations of anti-thyroid antibodies usually in an euthyroid or hypothyroid state. We report a 31-year-old female patient with thyrotoxic HE whose daughter has been followed up with the same diagnosis. Suboptimal response was observed with intravenous methylprednisolone (IVMP), intravenous immunoglobulin (IVIG) and plasmapheresis. Reduction of the anti-thyroid auto-antibody concentrations marked the patient's improvement in each episode. She relapsed under oral immunosuppressive therapy. After removing the thyroid tissue, full recovery has been achieved for the last 18 months. These data may contribute to clarification of the pathogenetic role of anti-thyroid antibodies in HE. Thyroidectomy can be considered as one of the treatment options especially in thyrotoxic HE patients with uncontrolled relapses. Our patient is the first reported HE case with a family history. Genetic background can underlie the etiopathogenesis of HE as is the case in other autoimmune disorders.

The nature of the oropharyngeal dysphagia in polymyositis/dermatomyositis (PM/DM) has been investigated by EMG methods. Nineteen patients with PM/DM were studied. The oropharyngeal phase of swallowing was evaluated by the electrophysiological methods measuring the laryngeal relocation time, pharyngeal transit time and the triggering of the pharyngeal phase of swallowing reflex. The EMG of cricopharyngeal muscle of the upper esophageal sphincter was also recorded in 10 patients. The patients have been compared with a group of 22 healthy controls matched with age and gender. Dysphagia limit was also measured for all patients and control subjects. Fourteen out of 19 patients could not swallow 20 ml or less amount of water at one go and divided the bolus into two or more pieces (piecemeal deglutition) in comparison to normal subjects. In PM/DM patients, the triggering of the swallowing reflex for the voluntarily initiated swallow was normal while the pharyngeal phase of swallowing was significantly prolonged. The cricopharyngeal sphincter muscle EMG demonstrated severe abnormalities in halves of the patients investigated. These findings demonstrated the weakness of the striated oropharyngeal muscles. Cricopharyngeal sphincter muscle was affected less frequently and showed either hyperreflexic or hyporeflexic states during swallowing. It is concluded that the pharyngeal stage of oropharyngeal swallowing is mainly involved in patients with PM/DM.