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ABSTRACT Background: Botulinum toxin Type A (BoNTA) is a successful treatment for chronic migraine prophylaxis. Objective: We aimed to evaluate the monthly change of effectiveness of BoNTA treatment. Methods: A total of 80 patients (70 females and 10 males) with chronic migraine were included. In our study protocol, we applied to 155 U across 31 fixed-sites and if the patient had pain, 40 U dose injections were applied across 8 specific head/neck muscle areas. Headache days and analgesic intake were noted before the BoNTA injection and during the interviews at the first, second, and third months after the BoNTA injection. Results: The mean age was 37.59 ± 7.60 and 87.5% of the patients were female. The mean number of headache days/month before BoNTA was 18.95±2.69, decreasing to 10.55±3.15 days/month in the first month (p

Abstract Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

Objective: To determine factors that affect paroxysmal atrial fibrillation (PAF) detection. In this regard, we evaluated the relationship between clinical and demographic data, score for the targeting of atrial fibrillation (STAF) score, CHA2DS2-VASc score, and the detection of PAF in patients with cryptogenic ischemic stroke (CIS). Materials and Methods: This retrospective study included 98 patients who underwent 24-hour Holter electrocardiography (ECG) among 310 patients admitted to the neurology department with a diagnosis of CIS between January 2017 and July 2019. PAF was detected in Holter ECG in 49 patients. STAF score, CHA2DS2-VASc score, and demographic and clinical data were compared between patients with and without PAF. Results: Ninety-eight patients with CIS were included in our study. The mean age of the patients was 64.4±14.1 years. Of the patients included in the study, 50% (n=49) were in the group with PAF and 50% (n=49) were in the group without PAF. The comparison of age between patients with and without PAF was statistically significant (66.98±11.9 and 59.84±15.23, respectively; p=0.01). Sex, additional risk factors, presence of vascular disease, recurrent stroke, CHA2DS2- VASc score, left atrial dilatation, left ventricular hypertrophy, mitral insufficiency, STAF score, National Institutes of Health Stroke Scale Score, and modified Rankin Scale were not significantly associated with PAF (p>0.05) Conclusion: PAF should be investigated in strokes of unknown etiology in the elderly population. However, this study shows that STAF and CHA2DS2-VASc score, transthoracic echocardiography findings, and other risk factors are not associated with PAF detection. Future studies with longer Holter ECG recordings in larger samples will shed light on this issue.

Objective:The purpose of this study was to examine obsessive and compulsive signs among patients with Restless Legs syndrome (RLS), to compare the results with healthy controls and to investigate clinic importance of those signs.Methods:Thirty nine patients with RLS and 40 age-, sex- and education- matched healthy controls were assessed in Bezmialem Foundation University Medical Faculty Hospital Neurology and Psychiatry Clinics Hospital. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV axis-1 disorders severe combined immune deficiency-1, socio-demographic data form and Maudsley obsessive compulsive inventory (MOCI) were applied to both patients and controls. Patient group was also classified according to the International RLS Study Group RLS severity scale.Results:Patient group had higher MOCI total scores and doubting and rumination subscale scores than the control group and the difference was statistically significant (p

Objective: Essential tremor (ET) is the most common cause of tremor. We know that this disease, which was presumed to be monosymptomatic until recently, may be accompanied by motor findings and a series of non-motor findings other than action tremor. Alexithymia can be defined as not being able to name emotions, express emotions, distinguish emotions from each other, or living without being aware of one’s own emotions. The aim of our study was to evaluate alexithymia in patients with ET. Materials and Methods: Forty-four patients with ET (mean age=38.22±18.05 years) and 46 control subjects (mean age=37.17±10.68 years) were included in the study. The Fahn-Tolosa-Marin Tremor Rating Scale was used for the patient group and the Toronto Alexithymia Scale (TAS), Beck Depression Inventory and Beck Anxiety Inventory were applied to both groups. Results: The mean TAS was 49.16±8.94 in the patient group and 42.34±6.27 in the control group (p

Objective: Restless legs syndrome (RLS) is a chronic, progressive sensorimotor disorder characterized by an irresistible urge to move the extremities-especially the legs-and abnormal sensations. Although symptoms are observed during the night at the initial stage of the disease, as the disease progresses, they can be observed at rest during the day. It is seen in 5-15% of the population. We aimed to evaluate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio and systemic inflammation in patients with RLS based on the hypothesis that inflammatory mechanisms may play a role in the pathophysiology of RLS. Materials and Methods: A total of 62 patients with RLS and 40 healthy volunteers were included in the study and the sociodemographic characteristics of both groups were examined. Routine biochemistry and hemogram studies were performed on all patients. NLR was obtained by dividing the absolute number of neutrophils by the number of lymphocytes and PLR by dividing the absolute platelet count by the lymphocyte count. Results: When the NLR levels were evaluated, no significant difference was found between the patient group (1.80±1.10) and the control group (2.01±0.67) (p=0.26). PLR was higher in the RLS group (104.86±46.52) than in the control group (97.78±39.09), but it was not statistically significant (p=0.45). When vitamin B12 and folate levels were evaluated, there was no significant difference between the patient and control groups. Ferritin levels were significantly lower in the patient group (p=0.03). Conclusion: When we evaluated NLR and PLR in the patients with RLS, it was determined that there was no significant difference in either parameter. It can be assumed that hematologic parameters such as neutrophils, lymphocytes, and platelets are easily affected by various conditions, or may be due to the small number of patients. Identifying new bio-indicators that will probably show systematic inflammation and neuro inflammation will clarify this issue in the future.

Objective: In multiple sclerosis (MS); memory, attention, information processing speed, and executive function deficits associated with cortical demyelination and atrophy can be seen in the early phases. In essential tremor (ET) cognitive impairment associated with cerebral-thalamocortical pathway dysfunction, which is characterized by visuospatial functions, verbal memory, and executive functions were seen. We aimed to evaluate cognitive impairment in patients with MS and ET, and to compare the features of impairment. Materials and Methods: Thirty patients ET (mean age 27.7±6.8 years), 30 patients with MS (mean age 32.4±6.6 years) and 20 healthy controls (mean age 28.81±7.3 years) were recruited for the study. For assessing cognitive impairment, the Montreal Cognitive Assessment (MoCA) test was applied to all participants. For grading the disease, the Fahn-Tolosa-Marin Tremor Rating Scale was used in the ET group, and the Expanded Disability Status Scale was used in the MS group. Results: The total MoCA mean scores in patients with MS was 22.4±4.34, 25.8±2.7 in patients with ET, and 28.2±1.8 in controls. When we compared the patients with the controls, the patients’ mean score was lower than in the controls. Cognitive impairment in patients with MS was more apparent than in patients with ET. Naming, attention, language, and delayed recall subgroups in patients with MS were more affected than in patients with ET. Conclusion: In this present study, we determined cognitive impairment can be seen in both group of patients, and MS can cause more prominent deficit than ET. In addition, our study confirms that cognitive impairment in MS and ET can be detected using the MoCA test.

ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

Background: The study aimed to investigate the effects and reliability of simultaneous vertebroplasty and radiofrequency ablation or radiofrequency ablation applied alone for pain control in patients with painful spine metastasis, and to investigate the effect of preventing tumor spread in long-term follow-up., Methods: Patients with painful vertebrae metastasis in the Afyonkarahisar Health Sciences University, Medical Faculty, Hospital Neurosurgery Clinic between 01.01.2015 and 01.06.2020 were recruited. They were divided into groups according to the surgical procedures applied. Group 1 included 26 patients who underwent radiofrequency ablation only, and group 2 included 40 patients who underwent vertebroplasty with radiofrequency ablation. Computed tomography and magnetic resonance imaging were performed in all patients pre-operation. The patients were followed for at least 6 months. Magnetic resonance imaging was performed at the end of the 6th month in neurologically stable patients. The metastatic lesion, pain, and quality of life were evaluated with Visual Analog Scale and Oswestry Disability Survey before and after the procedure., Results: The mean VAS score before the procedure was 8.3 ± 1.07 in the RFA group, and a statistically significant difference was observed in VAS scores at all post-procedural measurement time-points (p < 0.001). The pain scores decreased at a rate of 58.8 and 69.6% of patients showed significant improvements in the QoL in the RFA-only group. The mean VAS score was 7.44 ± 1.06 in group RFA + VP before the procedure; the difference in the mean VAS scores was statistically significant at all measurement time-points after the procedure (p < 0.001). The mean pre-treatment Oswestry Index (to assess the QoL) was 78.50% in the RFA + VP group, which improved to 14.2% after treatment., Conclusion: Ablation + vertebroplasty performed to control palliative pain and prevent tumor spread in patients with painful vertebral metastasis is more successful than vertebroplasty performed alone., (© 2021. The Author(s).)

Objective : We aimed to evaluate the effectiveness and reliability of posterior fossa decompression (PFD) and superficial durotomy in patients who underwent surgery for Chiari malformation type 1 (CM1). Materials and Methods : Our study included 54 patients with the diagnosis of CM1 who had surgery between January 2012 and June 2019. The patients were divided into two groups according to the surgical technique applied. Group 1 included 10 patients who underwent classic PFD and duraplasty, and Group 2 included 44 patients who underwent PFD and superficial durotomy surgery. Pre- and postoperative clinical signs and symptoms of each patient were recorded. Simultaneously, morphometric measurements were compared from computed tomography (CT) and magnetic resonance (MRI) images taken pre- and postoperatively. The data of the two groups were compared. Results : Of the 54 patients, 18 were male, and the mean age was 37.51 ± 15.14. A statistically significant difference was found between the pre- and postoperative morphometric measurements of the subarachnoid distance, craniocervical angle, syringomyelia, and hydrocephalus at the cerebellum level in Group 2 patients who underwent PFD and superficial durotomy surgery (p < 0.05). When morphometric measurements and clinical signs and symptoms of both groups were compared, no significant difference was found (p > 0.05). There was a 92% improvement in clinical signs and symptoms postoperatively. The complications seen in Group 1 decreased to a minimum in Group 2. Conclusion : We believe that a minimally invasive surgical method is superior to avoid major complications. We also found PFD and superficial durotomy shorten the duration of the patient's hospital stay Abbreviations : C1: cervical vertebra 1C2: cervical vertebra 2CM: Chiari malformationCM1: Chiari malformation type 1CSF: cerebrospinal fluidCT: computed tomographyMRI: magnetic resonance imagingPFD: posterior fossa decompressionUSG: ultrasonography.

Aim: To investigate the use of Augmented Reality (AR) technology as it contributes to spinal surgery education with the free-hand technique, and might reduce the error ratio., Material and Methods: Ten candidates, with anatomy education but no surgical experience, applied 36 pedicle screws with C2-C3 posterior transpedicular fixation technique to nine vertebrae models produced via a three-dimensional (3D) printer., Results: Using AR to apply pedicle screws to the experimental vertebrae model increased the safety screw ratio significantly. In comparison of Grade 0 screws to other grades: 6/18 screws (33.3%) in the free-hand technique Group (n=18), and 14/18 screws (77.8%) in the AR Group (n=18), were measured for screw insertion safety ratios. The difference was statistically significant (p=0.018). The resemblance between our results and the results of previous studies researching supportive systems indicates our 3D printed vertebra model might be a helpful educational material., Conclusion: AR increases the safety ratio of cervical pedicle screw fixation significantly. The parameters investigated and used for the production of vertebrae models in this study can be used for experimental material production for future studies to investigate pedicle screw positioning.

Competition for mates has resulted in sophisticated mechanisms of male control over female reproduction. Antiaphrodisiacs are pheromones transferred from males to females during mating that reduce attractiveness of females to subsequent courting males. Antiaphrodisiacs generally help unreceptive females reduce male harassment. However, lack of control over pheromone release by females and male control over the amount transferred provides males an opportunity to use antiaphrodisiacs to delay remating by females that have returned to a receptive state. We propose a model for the evolution of antiaphrodisiacs under the influence of intrasexual selection, and determine whether changes in this signal in 11 species of Heliconius butterflies are consistent with two predictions of the model. First, we find that as predicted, male-contributed chemical mixtures are complex and highly variable across species, with limited phylogenetic signal. Second, differences in rates of evolution in pheromone composition between two major clades of Heliconius are as expected: the clade with a greater potential for male-male competition (polyandrous) shows a faster rate of divergence than the one with typically monoandrous mating system. Taken together, our results provide evidence that for females, antiaphrodisiacs can be both honest signals of receptivity (helping reduce harassment) and chastity belts (a male-imposed reduction in remating)., (© 2011 The Author(s). Evolution© 2011 The Society for the Study of Evolution.)

Hexahydrofarnesylacetone (6,10,14-trimethylpentadecan-2-one, 1) is a widespread ketone occurring in plants and insects. Several species use this compound or the respective alcohol as part of their pheromone bouquet. Here, we showed by using deuterium labeled phytol (3) and GC-MS experiments that the Large Cabbage White butterfly Pieris brassicae can take up phytol in the larval stage and transforms it into 1 by oxidative degradation.

Competition for mates has substantial effects on sensory systems and often leads to the evolution of extraordinary mating behaviours in nature. The ability of males to find sexually immature females and associate with them until mating is a remarkable example. Although several aspects of such pre-copulatory mate guarding have been investigated, little is known about the mechanisms used by males to locate immature females and assess their maturity. These are not only key components of the origin and maintenance of this mating strategy, but are also necessary for inferring the level to which females cooperate and thus the incidence of sexual conflict. We investigated the cues involved in recognition of immature females in Heliconius charithonia, a butterfly that exhibits mate guarding by perching on pupae. We found that males recognized female pupae using sex-specific volatile monoterpenes produced by them towards the end of pupal development. Considering the presumed biosynthetic pathways of such compounds and the reproductive biology of Heliconius, we propose that these monoterpenes are coevolved signals and not just sex-specific cues exploited by males. Their maintenance, despite lack of female mate choice, may be explained by variation in cost that females pay with this male behaviour under heterogeneous ecological conditions.

The small and large cabbage butterflies, Pieris rapae and P. brassicae, are found worldwide and are of considerable economic importance. The composition of the male scent-producing organs present on the wings was investigated. More than 120 components were identified, but only a small portion proved to be male specific. Major components were the known beetle pheromone ferrulactone (1) in P. rapae and its previously unknown larger analogue, brassicalactone (2), in P. brassicae. The latter carries an additional isoprene unit and is closely related to 1. Other components present in larger amounts on male relative to female wings were hexahydrofarnesylacetone (18) and phytol (23). Brassicalactone (2) was fully characterized by synthesis of its various diastereomers by using ring-closing metathesis. A similar approach to ferrulactone (1) failed, presumably because of its smaller ring size. Instead, this compound was synthesized by using a modified literature procedure. The biological activity of the compounds in the extract was tested by coupled gas chromatographic-electroantennographic (GC-EAD) analysis, which showed that both macrolides and the other major components of the wings can be detected by the antennae of the conspecific female butterflies. Other detectable compounds included several alkanes, which are typical constituents of the butterfly cuticula, derivatives of phytol (23) and long-chain secondary alcohols. Finally, bioassays with males showed that the mixture of 1 (P. rapae) or 2 (P. brassicae) together with 18 and 23 applied to freshly eclosed males increased mating success compared to untreated males. Therefore, the two macrolides 1 and 2 are aphrodisiac pheromone components of male small and large cabbage white butterflies, respectively.

Gilbert (1976) suggested that male-contributed odors of mated females of Heliconius erato could enforce monogamy. We investigated the pheromone system of a relative, Heliconius melpomene, using chemical analysis, behavioral experiments, and feeding experiments with labeled biosynthetic pheromone precursors. The abdominal scent glands of males contained a complex odor bouquet, consisting of the volatile compound (E)-beta-ocimene together with some trace components and a less volatile matrix made up predominately of esters of common C16- and C18-fatty acids with the alcohols ethanol, 2-propanol, 1-butanol, isobutanol, 1-hexanol, and (Z)-3-hexenol. This bouquet is formed during the first days after eclosion, and transferred during copulation to the females. Virgin female scent glands do not contain these compounds. The transfer of ocimene and the esters was shown by analysis of butterflies of both sexes before and after copulation. Additional proof was obtained by males fed with labeled D-13C6- glucose. They produced 13C-labeled ocimene and transferred it to females during copulation. Behavioral tests with ocimene applied to unmated females showed its repellency to males. The esters did not show such activity, but they moderated the evaporation rate of ocimene. Our investigation showed that beta-ocimene is an antiaphrodisiac pheromone of H. melpomene.

The four major components present in scent gland extracts of the male Costa Rica longwing butterflies Heliconius cydno and Heliconius pachinus were identified as 12- and 14-membered macrolides containing a C(18)-carbon skeleton. By use of micro-reactions and spectrometric examinations, structural proposals were made and subsequently proven by synthesis, using ring-closing-metathesis as the key steps. These macrolides, (9Z,11E,13S)-octadeca-9,11-dien-13-olide (5, S-coriolide), (9Z,11E,13S,15Z)-octadeca-9,11,15-trien-13-olide (6), (9Z,13S)-octadec-9-en-13-olide (13), and (9Z,11S)-octadec-9-en-11-olide (25), are biosynthetically obviously derived from oleic, linoleic, and linolenic acids. Their absolute configurations were determined by gas chromatographic investigations on chiral phases, showing all to possess (S)-configuration.