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BACKGROUND: Upper extremity strength and function are rarely assessed in routine multiple sclerosis (MS) care. This study aimed to evaluate hand muscle strength and functionality in individuals with MS and investigate correlations with upper extremity function, cognitive status, health-related quality of life (HRQOL), and balance. METHODS: A cross-sectional study was conducted with 45 consecutive individuals with MS between the ages of 18 and 65. Upper limb motor strength was evaluated using a hand grip strength dynamometer. Upper limb functional capacity was assessed using the Nine-Hole Peg Test (9HPT) and the Duruoz Hand Index (DHI). Balance, coordination, and falls were measured with the Berg Balance Scale (BBS), Falls Efficacy Scale (FES), and the 30-Second Chair Stand Test (30CST). Cognitive function was evaluated using the Montreal Cognitive Assessment instrument and the Symbol Digit Modalities Test. Level of HRQOL was assessed using the self-reported 54-item MS Quality of Life-54 questionnaire. RESULTS: Out of the 45 participants (80% women, mean age 36.6 ± 8.6 years), higher hand grip dynamometer measures were strongly correlated with better DHI, 9HPT, BBS, FES, and 30CST scores. In the regression analysis, a 1-unit increase in dynamometer measures led to a 0.383 increase in overall HRQOL score. CONCLUSIONS: This study demonstrates that increased hand grip strength (HGS) is associated with better hand functionality, balance, and HRQOL in individuals with MS. It provides evidence to support more systematic measurement of HGS in the care of people with MS. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Neurology / Turk Noroloji Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Fingolimod is the first oral immunomodulatory treatment used as secondary care therapy in the treatment of multiple sclerosis for the last 10 years. The objective of our study is to reveal the experiences of the first generic fingolimod active ingredient treatment in different centers across Turkey. Method: The first generic fingolimod efficacy and safety data of patients followed-up in 29 different clinical multiple sclerosis units in Turkey were analyzed retrospectively. Data regarding efficacy and safety of the patients were transferred to the data system both before the treatment and on the 6th, 12th and 24th month following the treatment. The data were analyzed using the IBM SPSS 20.00. P value of <0.05 was considered to be statistically significant. Results: A total of 508 multiple sclerosis patients, 331 of whom were women, were included in the study. Upon comparing the Expanded Disability Status values before and after the treatment, a significant decrease was observed, especially at month 6 and thereafter. Since bradycardia occurred in 11 of the patients (2.3%), the first dose had to be longer than 6 hours. During the observation of the first dose, no issues that could prevent the use of the drug occurred. Side effects were seen in 49 (10.3%) patients during the course of fingolimod treatment. Respectively, the most frequent side effects were bradycardia, hypotension, headache, dizziness and tachycardia. Conclusion: The observed results regarding efficacy and safety were similar to clinical trial data in the literature and real life data in terms of the first equivalent with fingolimod active ingredient. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

• Post-FGL RDA ratio in RRMS was 31.9 %. • RDA risk higher with young age, longer FGL use, lower lymphocytes, higher lesion load. • 52.9 % of pregnant patients experienced RDA, need careful monitoring. • RDA patients had increased ARR, longer treatment-free intervals. • Disease progression as a med-stop reason linked to lower RDA risk. This study investigates the gap in understanding the dynamics of recurring disease activity (RDA) in RRMS patients after fingolimod (FGL) treatment discontinuation. The aim is to investigate RDA in RRMS patients after stopping FGL, aiming to improve management and comprehension of disease progression post-treatment. In this multicenter, retrospective study, data from 172 of 944 RRMS patients aged 18–55, across nine centers in Turkey, who discontinued FGL treatment, were analyzed. The collected data included EDSS scores, annualized relapse rates (ARR), lymphocyte counts, and MRI findings, with follow-up assessments conducted at 6 months, 1 year, and up to 2 years. RDA was observed in 31.9 % of patients, with incidences of rebound and reactivation at 20.3 % and 11.6 %, respectively. Factors like younger age, longer treatment duration, lower lymphocyte counts, and higher lesion burden increased RDA risk. Notably, 52.9 % of pregnant patients experienced RDA (16.4 % of the overall RDA group), with rebound occurring in six and reactivation in three. Patients with RDA had longer medication-free intervals and increased ARR. Discontinuation reasons varied, with disease progression linked to a lower RDA risk. Findings highlight the necessity for personalized management and vigilant monitoring after FGL discontinuation in RRMS patients, offering critical insights into RDA risk factors, and the complex interplay between treatment cessation, pregnancy, and disease progression. [ABSTRACT FROM AUTHOR]

In addition to ocular neurodegeneration in multiple sclerosis (MS), accompanying microvascular changes in the retina are thought to occur. In this study we sought to compare retinal neurodegenerative changes using optical coherence tomography (OCT) and microvascular changes using OCT angiography (OCTA) of MS patients and healthy controls. This cross-sectional study included 164 eyes of 83 MS patients and 114 eyes of 57 healthy control subjects. There were significant differences in retinal nerve fibre layer (RNFL), ganglion cell complex (GCC), and radial peripapillary capillary (RPC) vessel density (VD) between the MS group and the control group, but no significant differences in superficial capillary plexus (SCP) VD and deep capillary plexus (DCP) VD, foveal avascular zone (FAZ), non-flow area (NFA), and choriocapillary flow (CCF) values. Comparing the eyes with and without previous optic neuritis showed no significant differences in the OCT and OCTA measurements. A negative correlation was found between the expanded disability status scale score and disease duration and the RNFL and GCC values. A positive correlation was found between the RNFL and GCC values and the SCP VD and RPC VD. In MS patients, RPC VD values decreased in correlation with decreases in RNFL and GCC. This reduction increased as the disease duration and disability criteria increased. OCT and OCTA may be important biomarkers in MS. [ABSTRACT FROM AUTHOR]

Introduction: Olfactory impairment and cognitive impairment are common non-motor symptoms in Parkinson's disease (PD). Olfactory impairment may be present even many years before the main symptoms of the disease develop. The associations between olfactory loss and cognition in PD are evaluated in this study. Methods: 31 patients with PD and 31 healthy subjects were included in this study. The Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr Scale (H&Y Scale) were administered to all subjects. Butanol threshold test and Sniffin'Sticks test were used to assess olfaction. The Mini Mental State Examination (MMSE) and Clock Drawing Test (CDT) and Stroop Color Word Test (SCWT) were used to assess cognition. Results: The Sniffin'Sticks test scores were significantly lower in the Parkinson group in comparison to the control group (p<0.001). The rate of anosmia was 90% in the PD group while this rate was found to be 54.8% in control group (p=0.005). A significant correlation was found between butanol test scores and stoop 5 and 5 errors. Significant correlations were found between the Sniffin'Sticks scores and MMSE scores (p=0.047) and orientation (p=0.041) and language (p=0.003) functions of the MMSE test. Worse olfaction was associated with worse memory. Conclusions: In PD, olfactory impairment correlates with cognitive impairment and olfactory tests may be used to predict the likelihood of developing dementia in this patient population. [ABSTRACT FROM AUTHOR]

• The rate of progression in patients with late-onset multiple sclerosis (LOMS) is higher than that in the general MS population. • Oligoclonal band (OCB) positivity was found to be higher in the Turkish population when compared to other LOMS studies. • The prevalence of lesions in the spinal cord is higher in LOMS patients. • The onset of motor symptoms and the presence of spinal cord lesions significantly increase the risk of EDSS worsening in LOMS. • Comorbidities that contribute to delayed diagnosis are more common in the LOMS population, emphasizing the importance of recognizing that MS can onset at older ages. Multiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS. In a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated. The mean age of the 136 patients was 60.96±6.42 years (51–79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14. In LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Turkish Sleep Medicine is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Bezmialem Science is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To investigate the factors influencing progression and chronification of episodic migraine, we conducted a 12-month face to face follow-up study of episodic migraine patients. Methods: One hundred eighty patients with episodic migraine were enrolled. 120 parameters were analyzed including demographic factors, social and life-style features, comorbid medical illnesses and headache characteristics. After the first evaluation, all patients was scheduled to a structured face to face interview at 3-months interval for one-year. Results: Thirty-two (17,7%) patients developed chronic daily headache. Four out of 32 (2,2%) had definite chronic migraine. Low education level, obesity, greater tea consumption (≥4 cups/daily), predominantly hot and spicy diet, high headache frequency, long duration of headache and presence of allodynia at baseline, and more days with symptomatic drug intake were significant risk factors for progression and chronification of migraine. Cox regression analysis revealed triptan and NSAID intake, hot and spicy eating habit and allodynia as risk factors for chronification. Conclusion: Higher amount of tea consumption, hot and spicy diet appeared to be new risk factors for chronification of migraine. Weight gain is one of the most important risk factors. Patients should be warned about the risk factors to prevent chronification. [ABSTRACT FROM AUTHOR]

Neurofibromatosis type 1 is a common neurogenetic disorder. Psychiatric disorders are more common in patients with neurofibromatosis type 1 than the general population. Here we report a neurofibromatosis type 1 patient associated with generalised anxiety disorder. Although the patient is under psychiatric follow-up for approximately 15 years her dermatological complaints has been ignored. Because of this, dermatological lesions that are persisting over 40 years, the patient did not diagnosed as Neurofibromatosis type 1, in case social, pyshcologic and biologic complaints associated with Neurofibromatosis type 1 is ignored. It is clear that the history of the patient was not understood as a whole and she was exposed to use of antipsychotics in an inappropriate way. Because of using antipsychotics tardive dyskinesia occurred in this patient and this reminds us to be more careful while prescribing medicines. It should be noted that human is a biopsychosocial entity and biologic, psychologic and social factors play role during the illness process. Physcians should evaluate their patients as a whole, not only their complaints and family history for not missing any medical condition. [ABSTRACT FROM AUTHOR]

Giriş: Şu ana kadar ailevi Akdeniz ateşine (FMF) eşlik edebilen pek çok komorbid hastalık rapor edilmiştir. Bunlar arasında; sistemik amiloidoz, spondiloartropatiler, Henoch Schönlein purpurası, poliarteritis nodoza ve multipl skleroz (MS) gibi hastalıklar bulunmaktadır. Biz burada FMF'ye eşlik eden spondiloartropati, amiloidoz ve MS komorbid hastalıkları olan ve tüm klinik bulgularda anakinra tedavisi ile gerileme eğiliminin görüldüğü bir olguyu sunmak istedik. Olgu: Kırk beş yaşındaki kadın hasta yaklaşık 8 yıldır FMF ve eşlik eden spondiloartrit, amiloidoz ile takip edilmekte ve kolşisin 0,5 mg 2x2, diklofenak sodyum 75 mg 1x1 kullanmaktadır. Hasta ani gelişen alt ekstremite kas güçsüzlüğü (kas gücü 3/5), eşlik eden bel ağrısı, günde 5-6 kere olan sık dışkılama olması nedeniyle yatırıldı. Hastada M694V mutasyonu homozigot pozitifti, sakroiliak MR'de solda hafif sağda minimal kemik iliği ödemi mevcuttu. Yirmi dört saatlik idrarda 2,6 gram/gün proteinüri tespit edildi. Servikal MR görüntülemesinde spinal kordda lineer T2 hiperintens lezyonlar tespit edildi. Hem serum hem beyin omurilik sıvısında (BOS) identik, BOS'de de oligoklonal bantlar saptandı. Anti-aquaporin-4 (AQP4) ve myelin oligodendrosit glikoprotein antikorları negatif bulunan hastaya MS tanısı kondu. On gün 1 gram pulse steroid tedavisi verildi. Fizik muayenede (FM) kas gücünde hafif iyileşme tespit edildi (4/5) ancak yürüme zorluğu, karın ağrısı, ishal ve bel ağrısı şikayetleri devam eden hastaya anakinra tedavisi başlandı. Anakinra tedavisinin 1. ayında bel ağrısı ve inatçı ishalinin tamamen gerilediği, 24 saatlik idrarda proteinürinin 1 gram/güne gerilediği görüldü. FM'de kas gücünün 5/5 olduğu ve hastanın rahatlıkla yürüyebildiği görüldü. Kontrol servikal MR incelemesinde sebat etseler de lezyonların belirgin olarak silikleştiği görüldü (Şekil 1). Sonuç: Otoenflamatuvar hastalıklar doğal immün sistem disregülasyonu sonucunda oluşmaktadır. Son yıllarda bu disregülasyonun diğer bazı otoimmün hastalıkların oluşumunda etiyolojik bir rol üstlenebileceği düşünülüyor olsa da bu düşünceyi destekleyecek yeterli kanıt yoktur. Sunduğumuz olguda FMF patofizyolojik yolağı üzerinde en etkili ilaç olan anakinra ile diğer komorbid hastalıkların kliniğinde düzelmenin görülmesi bu hipotezi destekler niteliktedir. [ABSTRACT FROM AUTHOR]

Objective: To evaluate sociodemographic profile, clinical characteristics, disability and treatment status of multiple sclerosis (MS) patients in Turkey with respect to patient perspectives and expectations. Methods: A total of 2,176 MS patients participated in this cross-sectional questionnaire survey including items on sociodemographic, disease and treatment characteristics, daily life and perspectives and expectations. Results: Mean (SD) patient age was 36.4(9.4) years and 76.3% of patients were females. The numbness/weakness in the extremities (57.3%) was the most common presenting symptom. Overall, 56.8% reported treatment switch (due to attacks in 47.3%), while 22.2% reported physical disability and 39.7% reported work-related problems. Males had higher rate of MS-related physical disability (33.0% vs. 19.0%, p<0.001) than females. Use of an assistive device was a more common in patients with longer disease duration (≥15 years; 39.0%) and in those under IV treatment (64.0%). Nearly half of patients reported significant concerns related to uncertainty of the future and impaired quality of life as well as lack of hope for future improvement. The majority of patients reported that they would prefer less frequent SC injection dosing and 43.3% reported preference for monthly highefficacy SC injection. Conclusion: This nationwide questionnaire-based study in Turkish MS patients revealed the altered disability status with respect to sociodemographic profile, and altered treatment expectations specific to the route of administration, in addition to significant concerns regarding the uncertainty of the future, impaired quality of life and lack of hope for future improvement in nearly half of patients. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to investigate the level of knowledge of Alzheimer Disease (AD) among caregivers in Bursa. Material and Methods: 50 caregivers who were taking care of medium or sever Alzheimer patient at least for six months one to one were included to the study. The demographic characteristics of patients and caregivers were reported. A survey consisted of 10 questions which question basic main data about the illness was applied to caregivers. Results: %56 of participants did not have knowledge about the illness before they met the disease. %50 of caregivers did not try any methods after the patients diagnosed with Alzheimer. %84 of the participants knew that the disease was persistent and %80 of them knew that the treatment was made by medicines. %86 of them realize that the medicines was given only to back space the disease. %54 of them was unposted about the treatment alternatives except oral tablets. %44 of them knew that the disease did not get better with medicine and %50 of them knew that they have to change the medicine time to time. When we asked the most thing that worry the caregivers the answers were sleeplessness, agitation, tenacity, irritability, urine and fecal incontinence. Conclusion: The enough knowledge of caregivers about the illness may provide facility to early diagnosis, understand problems about the illness, manage the treatment process. [ABSTRACT FROM AUTHOR]

Background Less than half of migraineurs receive prescription treatment and this causes a great loss of economical resources. We aimed to evaluate the effect of migraine treatment on migraine-related economic burden among migraineurs employed in schools. Methods Forty-two subjects with migraine with two or more attacks per month included in this study. The first three-month phase was screening phase, followed by "medication adjustment phase" and the "treatment phase". Subjects prescribed symptomatic treatment only or preventive and symptomatic treatment. All subjects kept the records of the frequency, intensity and duration of headaches, number of days missed from work, decreased productivity at work, number of acute medication intake and referral to the emergency department during an attack. Results Frequency, severity and duration of headache, monthly headache days, analgesic intake per month, number of days with producvtivity loss were found to be significantly lower during treatment phase than screening phase (p<0.05). Impact of treatment started on the fourth and fifth months of the study. Direct cost in the treatment phase was significantly higher compared to the screening phase (p<0.05). Conclusion Our study results showed that migraine treatment significantly decreased indirect cost of migraine. Maximum effort should be made by the headache societies in order to increase the treatment rates of migraine sufferers. [ABSTRACT FROM AUTHOR]