A prospective case control questionnaire study for restless leg syndrome on 600 pregnant women.

AIM: To evaluate the clinical characteristics of pregnant women with restless leg syndrome (RLS). MATERIALS AND METHODS: A total of 600 pregnant women were asked to complete a questionnaire of RLS and medications. RESULTS: The educational and socio-economical status was significantly lower in study group. The number of patients living in joint family in the study group was statistically higher compared to control group. Hypothyroidism was more frequent in the study group. Calcium and magnesium intake were significantly higher in patients with RLS inversely iron intake was higher in patients without RLS. Lower hemoglobin levels were found to increase the risk of restless leg in pregnancy. Living in a joint family and low educational status were also independent risk factors for restless leg in pregnancy. Iron intake was found to decrease the risk of restless leg. Lower hemoglobin levels were found to be discriminative factor for the presence of RLS. Severity of RLS decreased by iron intake and increased by magnesium intake. CONCLUSION: Hemoglobin levels, iron intake, living in joint family, educational status are the independent risk factors for restless leg in pregnancy. Lower hemoglobin levels and supplementation of iron are the independent predictors for severity of RLS in pregnant women.

Forced normalization: An overlooked entity in epileptic patients.

The "forced normalization" phenomenon is characterized by acute/subacute onset of psychotic symptoms in the early post-ictal period with dramatic improvement of electrophysiological epileptiform activity. A 56 years old female with going on personality changes, maladaptive behaviours and a mild cognitive impairment since last seizure which was forty-five days ago has been admitted. An evident increase was observed in her maladaptive behaviours with the use of levetiracetam. She began describing visual hallucinations and déjàvu. Control EEG performed 24h after the seizure was completely normal. Levetiracetam therapy was replaced with phenytoin. Quetiapine therapy was also administered. Psychotic symptoms disappeared.

The association between the parenchymal neurological involvement and posterior uveitis in Behçet's syndrome.

OBJECTIVES: Behçet's syndrome (BS) is a systemic vasculitis, which may involve multiple organ systems simultaneously. Clinical findings in BS often fit into well-recognized patterns, such as the association between papulo-pustular skin lesions and arthritis. We have recently observed a distinct pattern, in which a subtype of neuro-Behçet's syndrome (NBS) is often preceded by specific ophthalmic manifestations of the disease process. The purpose of this study is to evaluate the association between the parenchymal subtype of NBS and posterior uveitis (PU). METHODS: We have retrospectively reviewed the clinical records of 295 patients with BS, who met the international classification criteria for BS, diagnosed at two major rheumatology clinics from 2010 to 2014. Patient demographics, ophthalmic examinations, clinical and radiologic patterns of neurological involvement were recorded. Manifestations of BS were classified as PU, NBS, vascular involvement, and arthritis. The association between clinical findings was analysed for statistical significance. RESULTS: Of the 295 patients, 100 had PU and 44 had NBS. 30 patients had parenchymal NBS and 14 had vascular NBS. Patients with PU were significantly more likely to have neurological involvement compared to those without PU (p<0.001; Odds Ratio: 3.924; 95% CI: 1.786-8.621). Rate of posterior uveitis was higher in patients with parenchymal NBS when compared to patients with vascular NBS, vascular BS or arthritis (63.3%, 21.4%, 22% and 4.2% respectively, p<0.001). CONCLUSIONS: Our findings suggest a clinically and statistically significant association between posterior uveitis and parenchymal type of neurologic involvement in BS. The development of posterior uveitis in a patient with previously diagnosed BS should be recognized as a "warning sign" for predisposition to neurologic involvement. These patients should be informed about the possible signs and symptoms of neurological involvement, which can cause very rapid and irreversible damage unless recognized and treated immediately.

Pathophysiology underlying drooling in Parkinson's disease: oropharyngeal bradykinesia.

We aimed to investigate the association between drooling and possible etiological factors in Parkinson's disease (PD) and to determine its effect on the quality of life. Demographic data of the 63 patients with idiopathic PD were recorded. Radboud Oral Motor Inventory for Parkinson's disease (ROMP) test was administered to all patients to evaluate speech, swallowing functions, and saliva control. The freezing of gait questionnaire (FOGQ) was used to evaluate gait and freezing of gait. Dynamic Parkinson gait scale (DYPAGS) was administered for the objective quantification of PD gait features. Disease severity was assessed by UPDRS and modified Hoehn & Yahr Scale. PD specific health-related quality was evaluated by PDQ-39 questionnaire. Drooling was only significantly correlated to UPDRS score; a stronger association was found between drooling and UPDRS 3 motor score; and a more significant association was determined between drooling and the bradykinesia questions of the motor part of UPDRS 3. Interestingly, no significant association was found between sialorrhea score and PDQ-39 score. Based on the results of this study, we concluded that oropharyngeal bradykinesia may be responsible for drooling in PD. In contrast to a general expectation, we did not find any adverse impact of drooling on the quality of life.

Hypoxic Corpus Callosum Lesion after Cardiac Arrest with Good Prognosis.

Hypoxic ischemic damage of the corpus callosum after cardiac arrest is a rare condition. Lesions of the splenium of the corpus callosum after hypoxia are bilateral and lead to poor prognosis. Herein, we present a case with good prognosis after cardiac arrest with bilateral lesions of the splenium of corpus callosum.

Elevated interictal serum HSP-70 levels as an indicator of neurodegeneration for chronic migraine.

OBJECTIVE: To investigate whether there is a relationship between chronic migraine and heat shock protein-70. METHODS: The case-control progressive study was conducted at Ankara Numune Teaching and Research Hospital, Ankara, Turkey, from January to June 2013, and comprised patients over 18 years of age who were diagnosed with chronic migraine and did not have any other known neurological illness. Age and gender-matched volunteers with no history of headache or neurological illness were included as controls. In order to exclude other central nervous system diseases, computed tomography and/or magnetic resonance imaging was carried out. Blood samples to evaluate serum heat shock protein-70 levels were obtained from the patients during headache-free periods and from the controls following 8 hours of fasting. The samples were interpreted using the enzyme-linked immunosorbent assay reader. RESULTS: There were 40 controls and an equal number of cases in the study. Mean heat shock protein-70 levels were higher in the cases 2.37±1.91ng/dl compared to thecontrols1.81±1.30 ng/dl, but the difference was not statistically significant (p=0.12). Serum heat shock protein-70 levels were also compared in terms of the duration of migraine disease, frequency of migraine attacks, Visual Analogue Scale score, migraine attack duration and the presence of aura, but no statistically significant difference was found (p=0.13, p=0.17, p=0.90, p=0.68, p=0.95 respectively). CONCLUSIONS: Heat shock protein-70 was not a reliable chronic migraine biomarker.

The association of IL-18 gene promoter polymorphisms and the levels of serum IL-18 on the risk of multiple sclerosis.

OBJECTIVES: Multiple sclerosis is an inflammatory condition of the central nervous system whose etiology is influenced by immunologic, genetic, and environmental factors. Aim of the present study was to determine if any relation exists between IL-18 -137C/G and -607C/A gene promoter polymorphisms on the individual susceptibility of multiple sclerosis and also to investigate the possible effect of IL-18 activity regarding this kind of polymorphism and MS. PATIENTS AND METHODS: 113 patients with clinically definite MS and 135 ethnically-matched controls were participated in this study. IL-18 -137C/G and -607C/A gene promoter polymorphisms were analyzed by Sequence Specific Polymerase Chain Reaction (SS-PCR), while levels of serum IL-18 were measured by Enzyme Linked Immunoassay Assay (ELISA) in patients with MS and healthy controls. RESULTS: Our results showed that the IL-18 -607AA genotype indicated 6 times higher risk in the development of MS (OR=6.883; 3.17-14.96; p<0.001). According to our findings, smoking seems to be an important confounding factor in MS patients with carrying IL-18 -607 AA and CA+AA genotypes. However, no meaningful association was found with IL-18 -137C/G gene promoter polymorphism. CONCLUSION: In conclusion, we suggest that IL-18 -607C/A gene promoter polymorphism is a major genetic factor for determining individual susceptibility to MS, where smoking status also increases the risk of MS.

Clinical and polysomnographic features of patients with Restless Legs Syndrome.

OBJECTIVE: To reveal clinical and polysomnographic features in patients treated for restless leg syndrome, and to examine the compatibility of sleep data and clinical features. METHODS: The study was conducted at the Department of Neurology, Ankara Numune Training and Education Hospital, Ankara, Turkey, and comprised patients who presented to the outpatient clinic between January and July 2014 who were diagnosed with restless leg syndrome based on the International RestIess Leg Syndrome Study Group criteria. Patients underwent polysomnography test in spontaneous sleep in a single room. SPSS 18 was used for statistical analyses. RESULTS: Of the 18 patients, 13(72%)were females and 5(28%)were males. Overall mean age was 51.56±11.57years (range: 23-66 years). Fourteen (77.8%) patients reported insomnia; 10(55.5%) patients had excessive daytime sleepiness; 13(72.2%) reported snoring; and 3(17%) had apnoea. Mean International Restless Legs Syndrome Study Group Rating Scale score was 26.11±7.9 (range: 16-40).Mean Epworth Sleepiness Scale score was 9.17±5.1 (range: 0-20). CONCLUSIONS: Restless leg syndrome was more common in women and the most common complaint was insomnia.

Is there an association between the Expanded Disability Status Scale and inflammatory markers in multiple sclerosis?

BACKGROUND: Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease characterized by inflammation of white matter in the central nervous system. It has been indicated that this inflammation causes increased levels of proinflammatory cytokines. Therefore, we aimed to evaluate if there is a possible association between inflammatory markers and the Expanded Disability Status Scale (EDSS) score in patients with MS. METHODS: We reviewed the data of 127 patients (91 women and 36 men) who were retrospectively diagnosed as MS according to the revised Mc Donald's criteria who were seen at our facility between January 2007 and December 2012. Patients were divided into two groups according to EDSS score: Group 1, EDSS < 5; and Group 2, EDSS ≥ 5. The risk factors that were evaluated included age and sex of the patients, duration of MS, drugs, thyroid function tests, vitamin B12 levels, homocysteine levels, immunoglobulins (Ig) A, G, and M, rheumatoid factor, complement 3 and 4, antistreptolysin O, C reactive protein (CRP), white blood cell count, and neutrophile-lymphocyte ratio (NLR). RESULTS: There was a statistically significant difference between the groups in terms of age, duration of the disease, drug received, Ig M, free T3, serum homocysteine levels, CRP, and NLR (p < 0.05). Pearson's correlation analysis showed a significant correlation between age, duration of MS, IgM, serum homocysteine levels, CRP, and NLR. According to the receiver operating characteristic curve analysis, IgM and NLR were discriminative factors in patients in Group 2. CONCLUSION: According to this study, inflammation may have a role in the pathogenesis of MS and in patients with EDSS > 5. Additionally, NLR and CRP levels may be discriminative factors of adverse clinical outcomes.

The impact of detoxifying and repair gene polymorphisms and the levels of serum ROS in the susceptibility to multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is an autoimmune neurodegenerative disease with unknown etiology. Oxidative stress (OS) has been implicated to play a role in its cause; therefore, antioxidants and repair systems may help in restoring oxidant-antioxidant balance. Since polymorphisms in DNA repair genes can result in reduced DNA repair capacity, it is important to investigate its association with OS products to demonstrate the impact of individual susceptibility. Our aim is to examine whether a defect in one of the detoxifying and DNA repair enzyme systems could explain the association between MS and exposure to OS products. METHODS: We investigated the association of polymorphisms in the metabolizing and DNA repair genes with serum Reactive Oxygen Species (ROS) levels. Gene polymorphisms were analyzed by simultaneous multiplex and Restriction Fragment Length Polymorphism Polymerase Chain Reaction and serum ROS levels were detected. RESULTS: OGG1 Ser/Cys and Ser/Cys+Cys/Cys genotypes had higher MS risk. XRCC1 Arg/Gln+Gln/Gln genotype increased the risk of MS. CONCLUSIONS: Our data suggested that OGG1 Ser326Cys gene polymorphism is a major genetic factor involved in the development of MS. Smoking is also a pivotal confounding factor for subjects with mutant genotypes of XRCC1 Arg399Gln. Further studies are needed to reaffirm our results.

Comparison of Cognitive Functions Between Obstructive Sleep Apnea Syndrome and Simple Snoring Patients: OSAS May Be a Modifiable Risk Factor for Cognitive Decline.

By comparing neurocognitive test results from patients with obstructive sleep apnea syndrome (OSAS) and those from patients with simple snoring, we aimed to establish whether OSAS negatively influences cognition. Patients with mild-to-severe OSAS (n = 29) and nonhypoxic simple-snoring patients (n = 30) were admitted to the study. All participants in both groups were evaluated with polysomnography and neurocognitive tests, including the Stroop Test, Rey Auditory Verbal Learning Test, Judgment of Line Orientation, Trail-Making Test, and Symbol Digit Modalities Test (SDMT). Significant differences were identified between the groups for test scores on the Rey 1, SDMT, and Stroop tests. We propose that accurate OSAS diagnosis and treatment might help to prevent cognitive decline.

In silico approach to inhibition of tyrosinase by ascorbic acid using molecular docking simulations.

Current evidence suggests that endogenous dopamine may act as a neurotoxin following its oxidation to an oquinone and reaction with cellular thiols, which are neutoxic, which may occur spontaneously or via reaction with tyrosinase or some other enzymes. Tyrosinase (E.C. 1.14.18.1) with two cupper ions coordinated by three histidines is a bifunctional enzyme that catalyses both the hydroxylation of tyrosine to L-DOPA and the consequent oxidation of the resulting catechol-containing species to an o-quinone. Therefore, tyrosinase may play a role in neuromelanin formation in the brain and could be central to dopamine neurotoxicity by contributing to the neurodegeneration associated with Parkinson's disease. In the present study, inhibitory effect of ascorbic acid against tyrosinase has been investigated and it has shown a remarkable inhibitory effect in in vitro assays. Then, the in silico-based experiments established through molecular docking calculations and scoring, docking search algorithm, and data plotting indicated that ascorbic acid is strong inhibitor of tyrosinase by interacting with four amino acid units (histidine 263, serine 282, phenylalanine 264, and valin 283) in the active site of the enzyme. The compound also had two long distant hydrogen bindings with Cu1 and Cu2 with distances of 3.57 and 3.41 A, respectively, through its O5 atom.

The effects of lipoprotein(a) and homocysteine on prognosis and risk factors in acute ischemic stroke.

The role of atherosclerosis in ischemic stroke has been intensively investigated in recent years, and homocysteine (Hcy) and lipoprotein(a) Lp(a) were found to have roles during the process. This study aims to investigate the relationship between acute ischemic stroke and Lp(a) and Hcy levels and to determine the prognosis and functional disability. Forty-one patients with acute ischemic stroke and 33 controls were included in the study. Lp(a) and Hcy levels were examined in both groups. The modified Rankin scale (MRS) scores at discharge and in the first and third months were determined to establish the functional disability and prognosis of stroke patients. In patients with acute ischemic stroke, Hcy levels were significantly higher than the controls (p = 0.003). There was no significant difference between Lp(a) levels in patients with acute ischemic stroke and controls (p = 0.150). Because there was a significant difference in terms of Hcy levels between the groups, it will be suitable to routinely monitor the Hcy levels of individuals who are known to have risk factors for stroke. Neither Lp(a) nor Hcy levels had any correlations with functional disability; therefore, it can be concluded that the Lp(a) and Hcy levels are inexpressive in predicting the functional disability and prognosis for ischemic stroke patients.

Thrombopoietin and mean platelet volume in patients with ischemic stroke.

OBJECTIVE: The aim of this study was to evaluate mean platelet volume (MPV), thrombopoietin (TPO), and platelet levels in patients with ischemic stroke and compare this with healthy controls. METHODS: We prospectively studied 50 patients with ischemic stroke and compared them with 37 control participants who have evaluated in internal medicine polyclinic and had no history of cerebrovascular events. All patients were within 24 hours after stroke; MPV and TPO were measured on admission. RESULTS: Both TPO and MPV values were significantly higher in patients with stroke (P = .00; P = .001). CONCLUSION: Increased TPO levels may increase both platelet count and platelet size, resulting in more hemostatic tendency, which may contribute to the progression of ischemic stroke.

Treatment efficacy with bone marrow derived mesenchymal stem cells and minocycline in rats after cerebral ischemic injury.

OBJECTIVE: We aimed to investigate the effects of bone marrow derived mesenchymal stem cells (MSCs), minocycline, and these two therapies combined on functional and histological improvement in cerebral ischemic injury created rats. MATERIALS AND METHODS: Twenty-eight Sprague Dawley female rats, weighing 250-300 g, were included in the study. Two male rats with similar properties were sacrificed for bone marrow derived MSC production. Group 1 was established as the control group. Group 2 was the group of only minocycline administered rats. Group 3 was the one of only MSCs administered rats. Group 4 was composed of the rats given the combination of MSCs and minocycline. Hematoxylin and eosin staining was done to assess the degeneration of the cells. Immunohistochemical staining was performed to evaluate the regeneration. Motor functions were examined by using Bederson's score. RESULTS: Cell degeneration was the least in group 4. The cells stained with GFAP were observed mostly in group 4. The cells stained with Neu N in group 1 were statistically lower than in other groups. When the groups were ordered in terms of functional improvement at the end of the second week, group 4 had the most and group 1 had the least. CONCLUSIONS: Bone marrow derived MSCs can lead to more histological and functional improvement when administered with minocycline, which is a neuroprotective agent as early as 24 h following the ischemic injury in a rat model. Minocycline therapy alone can be as effective as bone marrow derived MSCs therapy alone in ischemic cerebral rat model.

Serum iron, vitamin B12 and folic acid levels in Parkinson's disease.

We aimed to investigate possible associations between systemic iron metabolism deficiency and Parkinson's disease, and also to research any possible correlations between stage of the disease and vitamin B12 and folic acid levels. 33 male and 27 female patients diagnosed with idiopathic Parkinson's disease and 22 male and 20 female age- and sex-matched controls were enrolled in the study. Having the diagnosis of secondary Parkinsonism or Parkinson plus syndromes, and for the females, not being in the menopausal stage were considered as exclusion criteria. Recordings of blood samples of both groups collected after 8 h fasts were assessed in terms of serum iron, ferritin levels and iron-binding capacity, vitamin B12 and folic acid levels. The Hoehn and Yahr scale was used to determine the stage of the disease. No statistically significant difference was found with respect to mean serum iron, median serum ferritin levels and median serum iron-binding capacity between the groups. A statistically significant but inverse correlation was found between symptoms' duration and serum iron and ferritin levels. There was no statistically significant difference between the groups with respect to vitamin B12 and folic acid levels. However, a statistically significant but inverse correlation was determined between the patients' vitamin B12 levels and the Hoehn and Yahr scores. As Parkinson's disease progresses, serum iron, ferritin and vitamin B12 levels may decrease. The lower levels of these parameters may be the cause of the progression or may be the result of it.

Nutritional status and anthropometric measurements of patients with multiple sclerosis.

OBJECTIVE: To determine the nutritional status and anthropometric measurements of patients with multiple sclerosis (MS). METHODS: This research was conducted on 37 (15 men, 22 women) new diagnosed MS patients who applied to Ankara Numune Education and Research Hospital, Ankara Turkey, from June to August 2011. The nutritional status of patients was determined by a 3-day and 24-hour dietary record and a food frequency questionnaire. Body composition was analyzed by bioelectrical impedance analyzer, and body mass index was calculated. The Nutrient Data Base (BEBIS) program was used to evaluate the energy and nutrient intakes of patients and compared with Dietary Reference Intakes recommendations. Blood samples were collected and serum glucose, lipid profiles, total protein, albumin, total calcium, magnesium, vitamin B12, and vitamin D levels were analyzed. RESULTS: Approximately 5.4% of patients were underweight, 54.1% were normal weight, 24.3% were overweight and 16.2% were obese. Daily mean energy intakes were 2730+/-840.97 kcal in men and 1967+/-647.24 kcal in women. The percentage of the carbohydrates was 46.9%, proteins was 14.6%, and fats of the total energy was 38.4%. Approximately 16.7% of the patients' serum vitamin D, and 6.7% of the patients' serum vitamin B12 levels were below than the reference ranges. CONCLUSION: Multiple sclerosis patients have high body mass index values and poor nutritional status. It was verified that life style modification with adequate and balanced nutritional habits is very important in MS patients.

Contemporary anticholinesterase pharmaceuticals of natural origin and their synthetic analogues for the treatment of Alzheimer's disease.

Alzheimer's disease (AD), the most common form of dementia, is a degenerative and progressive neurological disorder characterized by deficit in the cholinergic transmission and formation of senile plaques containing beta-amyloid protein in the brain. Although complete pathology of the disease has not been fully elucidated yet, there are several treatment strategies for AD treatment. The complexity of AD is also due to involvement of several enzymes through its progression. Therefore, the most important therapeutic approach has emerged as inhibition of acetylcholinesterase (AChE), which is the key enzyme in the breakdown of acetylcholine. Another very attractive approach to lower beta-amyloid protein in fibrillar form has been the alpha- and beta-secretase inhibitors. On the other hand, recently, N-methyl-D-aspartate (NMDA) receptor antagonists have become a strong alternative, which has been approved to be effective in treatment of moderate to severe type of AD. Within the past few years, some pharmaceuticals have become available for clinical use; however, none of them have been shown to possess ability to discontinue the disease up to date. Hence, there is obviously a great need for discovery of new drug candidates of natural or synthetic origins for AD treatment. This review will cover AChE-inhibiting pharmaceuticals from plants and their synthetic derivatives including relevant patent literatures which may promise a future hope for AD treatment.