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Abstract Myasthenia Gravis (MG) is a rare neurological disease. Although there are intensive efforts, the underlying mechanism of MG still has not been fully elucidated, and early diagnosis is still a question mark. Diagnostic paraclinical tests are also time-consuming, burden patients financially, and sometimes all test results can be negative. Therefore, rapid, cost-effective novel methods are essential for the early accurate diagnosis of MG. Here, we aimed to determine MG-induced spectral biomarkers from blood serum using infrared spectroscopy. Furthermore, infrared spectroscopy coupled with multivariate analysis methods e.g., principal component analysis (PCA), support vector machine (SVM), discriminant analysis and Neural Network Classifier were used for rapid MG diagnosis. The detailed spectral characterization studies revealed significant increases in lipid peroxidation; saturated lipid, protein, and DNA concentrations; protein phosphorylation; PO2 -asym + sym /protein and PO2 -sym/lipid ratios; as well as structural changes in protein with a significant decrease in lipid dynamics. All these spectral parameters can be used as biomarkers for MG diagnosis and also in MG therapy. Furthermore, MG was diagnosed with 100% accuracy, sensitivity and specificity values by infrared spectroscopy coupled with multivariate analysis methods. In conclusion, FTIR spectroscopy coupled with machine learning technology is advancing towards clinical translation as a rapid, low-cost, sensitive novel approach for MG diagnosis.

Introduction: Previous studies were reported that osteoporosis and bone fracture occurs more frequently among Multiple sclerosis patients than the general population. The aim of this study to investigate the affects of total doses of short-term, high dose corticosteroids on bone mineral density and other affecting factors for bone mineral density in Relapsing-remitting type Multiple Sclerosis patients. Material and methods: Fifty-four patients (37 females, 17 males) with relapsing-remitting type Multiple Sclerosis who filled the diagnostic criteria according to McDonald criteria were included in the study. Femoral and lumbar bone mineral density were measured using dual energy X-ray absorptiometry. Expanded Disability Status Scale, disease duration, number of attacks, cumulative corticosteroid dose were recorded. Serum calcium, potassium, phosphorus, vitamin D, parathormone and osteocalcin levels were measured. Patients were divided into two groups: patients who have received at least 20 g intravenous metilprednisolone (Group I) and patients who have received less than 20 g intravenous metilprednisolone (Group II). We analysed association between cumulative corticosteroid dose and each parameters. Results: Osteopenia was present in 46.2% and osteoporosis in 5.5% of the study population according to femoral neck bone mineral density. Femoral bone mineral density was significantly lower among patients. There was no correlation between cumulative dose of corticosteroid and bone mineral density. Conclusion: Low bone mineral density and osteoporosis are common in Multiple sclerosis patients. High-dose steroid therapy is not be the primary cause of osteoporosis in patients with multiple sclerosis.

Background: It is important to know whether or not the stroke risk factors and etiologies of patients with multiple acute infarcts are different to those of patients with a single acute infarct. Aim: The frequency of multiple acute infarct was investigated in ischemic stroke patients and a comparison was made of the characteristics of stroke patients with and without multiple acute infarct. Patients and Methods: We reviewed the clinical records of 988 ischemic stroke patients who were admitted within 1 week of the onset of stroke and diffusion-weighted imaging (DWI) was performed on first presentation. The clinical characteristics, laboratory, and imaging results were noted from the patient records. According to the DWI findings, the patients were separated into three groups as those with a single acute infarct in a single vascular territory (SI group), those with multiple acute infarcts in a single vascular territory (SMI group) and those with multiple acute infarcts in multiple vascular (MMI group) territories. The frequency of multiple acute infarcts was investigated, and a comparison was made of the characteristics of stroke patients with and without multiple acute infarcts. Results: The SMI group included 119 (12%) patients and the MMI group 126 (12.8%). The most common mechanisms of multiple acute infarcts are large artery atherosclerosis and cardiac origin emboli. Moreover, the risk factors most determined were hypertension, diabetes mellitus, and hyperlipidemia in the MMI group. Conclusion: No difference was determined between the groups in respect of stroke etiology and risk factors.

The aim of the study is the evaluation cervical and thoracal disc herniations are predisposant factor to the formation and activation of plaques formation of relapsing remitting (R-R ) type multiple sclerosis (MS) patients. We performed a retrospective study on R-R type MS diagnosed patients who also had cervical and thoracal disc herniations. 185 cervical and 136 thoracic in total 321 MR images of 104 (42 men, 62 women) MS patients with R-R type were evaluated retrogradly. When we evaluate the association between cervical or thoracal disc herniation and MS plaques we determined the same localization of cervical herniation and MS plaques was statistically significant. In conclusion, cervical and thoracic disc herniations may contribute to distrupion of blood brain barrier by generating microtraumas and this may lead to MS plaque formation. Therefore, early and effective treatment of MS patients having disc compression is crucial for preventing from sequels and for providing a better life quality. [Med-Science 2017; 6(4.000): 643-645]

Objective: This case is a patient with tongue myokymia following radiation therapy 12 years earlier, documented using video and EMG. Case report: A 68-year-old woman with a history of nasopharyngeal carcinoma presented with subacute onset of difficulty in speaking and involuntary movements of her tongue approximately 12 years after radiation therapy to head and neck. Electromyography displayed myokymic discharges. There was no evidence of recurrent malignancy. Significance: Delayed effects of radiation therapy might be seen decades later. Myokymic discharges may reveal radiation-induced neuropathy. Keywords: Tongue myokymia, Radiation therapy, Long-term effects

Objective: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction is thought to be found in patients with multiple sclerosis (MS). Copeptin is a serum protein that is indicated as an indirect marker of HPA axis. The aim of this study was to evaluate the relationship between HPA axis and clinically silent MS (CSMS) by evaluating copeptin levels. Materials and Methods: Sixty patients with CSMS which was defined as relapsing-remitting MS without attack and progression, and 60 healthy individuals were included in the study from September 2016 to September 2017. All patients were in the remission period. HPA axis dysfunction was examined by measuring serum copeptin levels in all individuals. Copeptin level was compared with clinical parameters in patients with MS. Results: A total of 120 individuals were composed of 60 patients with CSMS and 60 healthy controls. The average ages of the patients and the control group were 37.1+-8 (20-52) and 35.1+-8.9 (18-54), respectively. The copeptin level was significantly lower in patients compared to the control group (p

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Objective: We aimed to determine the association between a polymorphism in the promoter region of the IL-1beta gene resulting in enhanced gene transcription and the clinical phenotype of temporal lobe epilepsy with hippocampal sclerosis (TLE+HS). Materials and Methods: The frequency of a single nucleotide polymorphism (SNP) that results in a C>T transition of 511 base pairs that are five prime to the transcription start site of the IL-1beta gene in a group of 21 patients with TLE+HS, 21 patients with temporal lobe epilepsy without hippocampal sclerosis (TLE-HS), and 23 healthy volunteers. Results: The frequency of the -511T allele was 11/21 in the TLE-HS group, 13/21 in the TLE+HS group, and 12/23 in the control group. Chi-square analysis of genotype and allele distribution showed no significant difference between the patients in TLE+HS, TLE-HS, and control group Conclusion: There was no association between the -511/C>T SNP variation and TLE+HS.

BACKGROUND: Transient ischemic attack (TIA) is a common neurovascular disorder associated with a higher risk of stroke within the first 24 h after the first event. Acute cerebral and arterial neuroimaging combined with long-term electrocardiography (ECG) monitoring have been proven to be useful in determining etiology. Cardio-embolism constitutes 20%–26% etiology of TIAs most of them with atrial fibrillation (AF). Investigation of AF after TIA is very important because oral anticoagulants can reduce the risk of subsequent stroke by two thirds. MATERIALS AND METHODS: The present study included 45 patients suffering from TIA with undetermined source according to the Trial of Org 10172 in Acute Stroke Treatment criteria; the control group (n = 45) was selected from the patients admitted to cardiology outpatient clinic with nonspecific complaints without cerebrovascular and/or cardiovascular disease. All patients underwent echocardiography and 24 h Holter ECG monitoring (HM). RESULTS: There was no significant difference between the patient group and the control group in terms of age and gender. Cholesterol, low-density lipoprotein and urea levels, left atrium diameters and the incidence of hypertension, coronary artery diseases, and AF were significantly higher in TIA group (P < 0.05). In the results of HM, there were six patients with AF in the study group, and in the control group, there was no patients with AF (P = 0.03). DISCUSSION AND CONCLUSION: In acute phase of TIA, 24 h HM is important for determining the etiology and selecting an appropriate treatment that can protect patients from subsequent strokes.

Objective: Acute ischemic stroke has an effect on electrocardiography (ECG) results and cardiac enzyme levels, but its mechanism has not been clearly established. Our aim was to research ECG and cardiac enzyme changes in acute ischemic stroke and to investigate the association between these changes and stroke localizations and prognosis. Materials and Methods: The study included 241 patients with acute ischemic stroke. Patients without cardiac arrhythmia, history of previous stroke, use of drugs affecting the pattern and duration of ECG rhythm and without acute or chronic myocardial infarction history and electrolyte imbalance were included. The vascular risk factors for stroke, creatine kinase-MB (CK-MB), and troponin I (TnI) levels, and ECG results were examined. Results: One hundred twenty-three patients had right hemisphere infarcts and 118 patients had left hemisphere infarcts with the same mean ages. HT was more prevalent in right hemisphere infarcts (p=0.013). The most common ECG abnormalities were QTc prolongation (31%) and ST depression (24%). CK-MB and TnI levels were significantly higher in patients with right hemispheric and cerebellar infarcts. QRS durations were longer in cerebellar infarcts (p=0.05). Conclusion: The most common ECG abnormality was QTc prolongation in patients with acute ischemic stroke within 24 hours. CK-MB and TnI levels were higher in patients with right hemisphere and cerebellar infarcts.

INTRODUCTION: Patients with pain or numbness without motor deficits are the most common group referred to electrophysiology laboratories as suspected radiculopathy. We wanted to investigate whether electromyography (EMG) was useful for this group in the diagnosis or therapy of radiculopathy. Our aim was to investigate the correlation and classification of EMG and magnetic resonance imaging (MRI) findings in the diagnosis of suspected radiculopathy. METHODS: We included 74 patients with a ≥2-month history of numbness and pain in the neck and back that radiated into the arm or leg. Patients with diabetes mellitus, previous disc or spine operation, polyneuropathy, spinal cord diseases (tumor, infection or syrinxs), motor deficits, and abnormal nerve conduction studies were excluded. RESULTS: The mean age of the patients was 51.58±11.53 years. In total, 41 (55.4%) patients were women and 33 (44.6%) were men; 48.8% (n=36) showed cervical radiculopathy and 51.2% (n=38) exhibited lumbosacral radiculopathy. The most common MRI finding was protrusion (37.8%), and the most common EMG finding was re-innervation (59.5%). The correlation of MRI and EMG findings was significant in lumbar radiculopathy (p=0.007), but not in the cervical radiculopathy results (p=0.976). DISCUSSION AND CONCLUSION: EMG and MRI findings were compatible for lumbar radiculopathy, but not for cervical radiculopathy in mild to moderate grades.

Objectives:The aim of the present study was to investigate the effect and side effects of lamotrigine (LTG) on seizures.Methods:Epilepsy outpatient clinic records for 416 patients who had been monitored for at least 6 months were studied retrospectively. Age, sex, seizure type, number of seizures, additional drugs used in treatment, duration of treatment, and drug side effects were analyzed.Results:Of the 416 patients, 244 (58.7%) were female, and 162 were male (41.3%). Mean age was 33.2±10.7. Monthly seizure rates were reduced 67.3% with LTG treatment, and 328 patients (78.8%) were still receiving treatment, while 88 (21.2%) had stopped usage due to side effects or for other reasons. Of these side effects, dizziness (5.5%) and rash (4.3%) were the most common. Pregnancy occurred in 18 patients on LTG treatment, and no malformation was detected at birth.Conclusion:In refractory epileptic patients, LTG has a high activity level and an acceptable side effect profile.

Kitle iletişim araçlarının yaygınlaşmasıyla birlikte kültürel dönüşümün hız kazanması, kitle iletişim araçları ve popüler kültür arasında karşılıklı beslenmeye dayanan bir ilişkiye zemin hazırlamıştır. Kitle iletişim araçları ve popüler kültür arasındaki ilişkinin arkasında popüler kültür ürünlerinden ekonomik kâr elde etmek isteyen büyük sermaye grupları bulunmaktadır. Temelde ekonomik sebeplere dayanan ilişkiler ağı, toplumsal etkileri açısından kültürel bir boyut kazanmaktadır. Kültürel boyutu, büyük ölçüde en popüler bir iletişim aracı olan televizyon içerikleri ile ilintilidir. Popüler kültürün lokomotifi televizyon, ürettiği ve sunduğu içerikleriyle, popüler kültürün oluşumunda ve sürdürülmesinde önemli bir etkendir. Dünyada olduğu gibi Türkiye’de de televizyon, magazin programları, diziler, reklamlar gibi sunduğu içeriklerle popüler kültürü sürdüren, destekleyen, yenileyen özellikleriyle toplumsal yaşamı dönüştürücü bir nitelik taşımaktadır.

Neurologic diseases influence the morbidity and mortality in non-neurosurgical operations and determine the required tests for the preoperative evaluation, the choice of the anesthetic medication and the perioperative care. The present review provides information about the principles of the preoperative management in patients with neurologic diseases undergoing non-neurosurgical operations and addresses some special preoperative management issues in specific neurological diseases.

Neurologic diseases influence the morbidity and mortality in non-neurosurgical operations and determine the required tests for the preoperative evaluation, the choice of the anesthetic medication and the perioperative care. The present review provides information about the principles of the preoperative management in patients with neurologic diseases undergoing non-neurosurgical operations and addresses some special preoperative management issues in specific neurological diseases

Neurological involvement of the central nervous system in brucellosis is uncommon. Sensorineural hearing loss is a rare complication of neurobrucellosis, which has not attracted enough attention among known manifestations. A 50-year-old man presented with headache, deafness and deteriorated in cognitive functions. The presence of diffuse white matter changes on brain magnetic resonance imaging (MRI) and serum and cerebrospinal fluid findings led to the diagnosis of neurobrucellosis. The differential diagnosis of diffuse white matter diseases is constantly expanding. In the background of fever, deafness, demential symptoms, cognitive impairment and extensive white matter disease, neurobrucelosis should be considered.

OBJECTIVE: Leptin is considered to be a signal factor that regulates body weight and energy expenditure, and there is a strong correlation between serum leptin concentrations, body mass index, and body fat mass in humans. Our aim in this study was to evaluate the role of leptin in valproic acid (VPA) and topiramate (TPM) related weight changes in epileptic patients. METHODS: Body mass index is calculated and serum leptin and insulin levels are measured in 56 patients with epilepsy (40 patients taking VPA and 16 patients taking VPA and TPM) and in 40 healty control subjects. RESULTS: Obesity was seen in 21 patients (52.5%) in VPA treated group, in 15 patients (37.5%) in the control group and in only one male (6.3%) in VPA and TPM treated group. Body mass index was lower in the group treated with VPA and TPM (p

OBJECTIVE: In this study, it was aimed to determine the relation between the cerebral infarction volume and common carotid artery (CCA) intima-media thickness (IMT) and internal carotid artery (ICA) intima-media thickness. METHODS: Forty patients diagnosed with acute ischemic stroke and admitted to our clinic within the first 24 hours were accepted into this study. The brain computed tomographies taken at admission and 72 hours after the onset of the first symptoms were analyzed. The volume of the infarct areas was measured. The bilateral carotis (C) IMT was measured by Doppler ultrasonography. RESULTS: CCA IMT was significantly thicker in the group with single plaque compared to the group without plaque. CONCLUSION: No statistically significant relation between the infarct volume and ICA IMT or CCA IMT was observed.

OBJECTIVE: Mannitol is an osmotic diuretic agent and reduces intracranial pressure. The most serious side effect of mannitol is kidney dysfunction. In this study, renal functions in acute stroke patients treated with mannitol were evaluated. METHODS: One hundred and twenty-two patients followed in the neurology intensive care unit with the diagnosis of stroke and treated with fractionated mannitol for 5 days were evaluated retrospectively. Ninety-six patients had ischemic and 26 had hemorrhagic stroke. Mean age was 69.9 ± 11.8 (18-91) years. Serum urea, creatinine and electrolyte levels measured before and on the second, third, fourth, fifth and tenth days of treatment were compared statistically with paired sample t test. RESULTS: The average urea and creatinine levels on the second, third, fourth and fifth days of treatment were significantly higher than the baseline (p< 0.05). On the other hand, mannitol treatment did not change average sodium, potassium and chlorine levels. The creatinine levels had returned to the normal range on the tenth day of treatment, but the urea levels, although decreased, did not fall to the normal range. CONCLUSION: Our results support the view that close monitoring of renal function is necessary in patients treated with mannitol.

Varicella zoster infection is an important cause of cranial neuropathy. In Ramsay Hunt syndrome caused by herpes zoster oticus, the involvement of the vestibulocochlear nerve can be seen with peripheral facial palsy, but the involvement of the other cranial nerves is not frequent. A 59-years-old male patient referred to our clinic with diplopia, deafness, dysphagia, and hoarseness after herpes zoster oticus infection. In neurologic examination there was revealed 6th, 7th, 8th, 9th, and 10th cranial nerve involvement on the left. On imaging and laboratory studies, there was no other pathology other than herpes zoster oticus infection to explain the multiple cranial nerve involvement. Our case is one of the very rare cases of multiple cranial nerve involvement due to herpes zoster oticus infection

OBJECTIVE: The clinical progress of multiple sclerosis (MS), initial symptoms and problems during the course of a disease that can be seen, may vary among the patients. Therefore, different applications occurs in the disease diagnosis and treatment plan. The difficulties of diagnosis, treatment and progress of MS disease, experienced by the neurology residents and experts from different regions of the Turkey is intended to introduce. METHODS: Interactive meetings was arrenged in total 11 cities from different regions of Turkey, between March 2008 and June 2008. The data obtained as a result of the responses of participants were evaluated. RESULTS: Neurology specialist and research assistant, total of 242 persons participated. It was observed that 14 percent of visual evoked potential, 40 percent of cerebrospinal fluid (CSF) oligoclonal band review and one percent of magnetic resonance imaging examinations used in diagnosis of MS can’t be done. There was significant differences between regions about feasibility of CSF OCB. Sixty one percent of participants thought to start immunomodulatory treatment to typical relapsing-remitting multiple sclerosis patients, filled in the Mc Donald diagnostic criteria and had two attack story. CONCLUSION: As all the world, in Turkey being very much difference about clinical, radiological and laboratory features of MS lead to the neurology experts work hard and the emergence of different applications about the disease diagnosis and treatment plan

Scientific BACKGROUND: Van der Knaap leukoencephalopathy, also known as megalencephalic leukoencephalopathy with subcortical cysts, is a rare form of leukoencephalopathy, which was first described in 1995. It is characterized by early-onset macrocephaly, with mild motor developmental delay and seizures; gradual onset of ataxia, spasticity, and sometimes extrapyramidal findings; and usually late onset of mild mental deterioration. MRI characteristics included diffuse abnormality in signal intensity and swelling of cerebral hemispheral white matter with cyst-like spaces in the frontoparetal and anterior-temporal subcortical areas. CASE: The patient who had no compliants until 20 years old was admitted to our clinic with refractory seizures that continued for six years. Van Der Knaap leucoencephalopathy was considered after the examination. CONCLUSION: This paper, accompanied by cases in literature, is about a patient with Van Der Knaap leucoencephalopathy who had typical clinical and MRI findings

OBJECTIVE: Bell’s palsy (BP) is the most common disease of the facial nerve. It is acute paralysis of the mimic muscles. The etiology and treatment of BP is not clear. As it is an aesthetic and functional problem, early prognostic diagnosis is more important. Electrophysiologic tests can be used for this purpose METHODS: 46 patients were included to the study. All patients were classified according to House-Brackman system. Facial nerve conduction and blink reflex were studied on 10-12th day of the onset of the BP. RESULTS: The patients who had increase of muscle response (M-response) latency on 10-12th day, had less recovery after one month. There was also no statistical difference between R1 latency on 10-12th day and clinical grade in first month. But there was significant difference between R2 latency on 10-12th day and clinical grade in first month. CONCLUSION: Prolonge of M-response latency and the absence of blink reflex showed poor prognosis

OBJECTIVE: Autoantibodies against the muscle acetylcholine receptor (AChR) play an essential role in the pathophysiology of autoimmune myasthenia gravis (MG). It is believed that the human leukocyte antigen (HLA) class II molecules are involved in the antibody production in MG because these molecules regulate immune responses to protein antigens by presenting antigenic peptides to CD4 helper T cells, which control the production of antibodies. OBJECTIVE: The aim of the present study was to examine the relationship between HLA haplotypes and AChR antibody in patients with myasthenia gravis. METHODS: A total of 40 (22 female, 18 male) patients with MG were enrolled onto the study and underwent HLA typing and AChR antibody levels. The mean age was 45.4±16 years. The statistical analysis was performed by χ2 test with Yates’ correction to test the presence of an association. RESULTS: The presence of AChR antibodies was significantly associated with HLA CW6 (p0.05). CONCLUSION: Our study demonstrates that the HLA CW6 and HLA B8 haplotypes have significant effects on AChR antibody production on myasthenia gravis patients and that further investigations with large population are required

OBJECTIVE: More than %80 of Multiple Sclerosis (MS) patients are observed to have urinary system dysfunctions during the course of their ilnesses. Neuronal control of the bladder is highly complicated. Autonomic and somatic nerve systems have to function in coordination. It is known that bladder functions are controlled by medial frontal lobe in the cerebral hemispheres and by pontine reticular formation in the brainstem. A i m: In MS, the relationship between the localization of the plaque and bladder dysfunction is not clear. The aim of this study was to identify the effects of the plaque in pons on the clinical and urodynamic findings by comparing the patients having periventricular and pontine plaques and the ones having only periventricular plaque METHODS: Between May 2001 to June 2003,25 MS patients of whom 15 were females and 10 males studied. The mean age of the patients was 44, while the mean disease duration was 57.2 month. Mean EDSS was 1.82(0-3). The patients were divied into two groupes. Group I (12 cases) consisted of those having periventricular and pons plaque, whereas Group II (13 cases) consisted of those having only periventricular plaque. All patients who had spinal cord plaque excluded. Urodynamic evaluation were done. RESULTS: Comparing the plaque localization and the urodynamic results did not reveal any statistical difference between the groups (p=0.841). The symptoms observed in the groups were studied with respect to their relation with the urdynamic findings. All the symptomatic cases in Group I and half of the symptomatic cases in Group II had abnormal urodynamic findings. Among the asymptomatic cases, %71.4 of Group I and %40 of Group II had normal urodynamic findings. CONCLUSION: As a result, existance of pontine plaque in those having periventricular plaque does not affect the urologic symptoms and urodynamic functions

OBJECTIVE: Fatigue and depression are frequently observed symptoms in Multiple Sclerosis (MS). Fatigue has been reported as the major symptom in 53-90% of MS patients. Lifetime incidence of depression has been found as 50% in MS cases. METHODS: There are several studies reporting a positive correlation between depression and fatigue in MS. It has been reported that depression increases the severity of fatigue in these patients. The objective of this study is to evaluate the effects of antidepressant treatment in MS patients having depression and fatigue. RESULTS: 36 cases with definite relapsing-remitting MS (RRMS) who had been free of attacks and steroids for six months were included in this study. Patients, whose examination revealed depression and fatigue, were diagnosed with depression by a psychiatrist. Cases were administered antidepressants and followed by 6 months. The efficacy of the treatment was calculated by Hamilton Depression Rating The decrease in depression and fatigue scores at the end of 3rd and 6th months were found to be statistically significant. (p0.05). CONCLUSION: A partial improvement can be obtained in fatigue by antidepressant treatment

Multiple sclerosis (MS) is a chronic disease characterized by multiple areas of central nervous system inflammation, demyelination and axonal loss. Hereditary spastic paraparesis (HSP) is characterized clinically by progressive spasticity and weakness of the lower limbs and pathologically by retrograd axonal degeneration of the corticospinal tracts and posterior columns. We identified a patient with clinical history and investigation findings consistent with the concurrence of both MS and HSP. Laboratory and radiological investigations, cognitive tests were performed. Genetic confirmation for spastin gene mutation has been completed. If this coexistence is not coincidence the mutation in the spastin gene may be a strong susceptibility locus for MS.