Investigation of serum adropin levels and its relationship with hypothalamic atrophy in patients with multiple sclerosis.

OBJECTIVE: Adropin is expressed in vascular endothelial cells and regulates nitric oxide (NO) bioavailability by upregulating nitric oxide. In recent years, some studies have revealed its relationship with the pathogenesis of multiple sclerosis (MS). Our aim in this study is to determine serum adropin levels in MS patients and to investigate adropin levels's relationship with hypothalamic atrophy. METHODS: A total of 80 people, 40 of whom had MS and 40 of whom were healthy volunteers, were included in the study. Serum samples were taken from all participants. Hypothalamus and pituitary diameters were calculated from magnetic resonance imaging of MS patients. The relationship between serum adropin levels and demographic characteristics, Expanded Disability Status Scale (EDSS), and hypothalamic atrophy were evaluated. RESULTS: The levels of adropin were 848,282±139,229 ng/L in patients with MS and 2957,108±284,034 ng/L in the healthy controls. MS patients had significantly lower levels of adropin than the healthy controls (p = 0.003). Adropin has the highest diagnostic value (AUC=0.874, (95% CI, 0,800-0,947) as cut-off value (838.00), sensitivity (80.43%) and specificity (70.64%) in the MS group. In the study, serum adropin levels were not significantly correlated with 3 ventricle diameter (3VD) and pituitary diameter (PD) size (p = 0,968) and no significant relationships were determined between adropin and other clinical parameters. CONCLUSION: As a potential diagnostic marker, adropin levels were significantly lower in MS patients than in those without. Comprehensive studies are needed to verify this entity.

Investigation of serum adropin levels and its relationship with hypothalamic atrophy in patients with multiple sclerosis.

Objective Adropin is expressed in vascular endothelial cells and regulates nitric oxide (NO) bioavailability by upregulating nitric oxide. In recent years, some studies have revealed its relationship with the pathogenesis of multiple sclerosis (MS). Our aim in this study is to determine serum adropin levels in MS patients and to investigate adropin levels's relationship with hypothalamic atrophy. Methods A total of 80 people, 40 of whom had MS and 40 of whom were healthy volunteers, were included in the study. Serum samples were taken from all participants. Hypothalamus and pituitary diameters were calculated from magnetic resonance imaging of MS patients. The relationship between serum adropin levels and demographic characteristics, Expanded Disability Status Scale (EDSS), and hypothalamic atrophy were evaluated. Results The levels of adropin were 0.85±0.14 ng/mL in patients with MS and 2.96 ng/mL±0.285 ng/mL in the healthy controls. MS patients had significantly lower levels of adropin than the healthy controls (p = 0.003). Adropin has the highest diagnostic value (AUC=0.874, (95% CI, 0,800-0,947) as cut-off value (838.00), sensitivity (80.43%) and specificity (70.64%) in the MS group. In the study, serum adropin levels were not significantly correlated with 3 ventricle diameter (3VD) and pituitary diameter (PD) size (p = 0,968) and no significant relationships were determined between adropin and other clinical parameters. Conclusion As a potential diagnostic marker, adropin levels were significantly lower in MS patients than in those without. Comprehensive studies are needed to verify this entity.

Possible roles of sestrin2 in multiple sclerosis and its relationships with clinical outcomes / Possíveis papéis da sestrina2 na esclerose múltipla e suas relações com resultados clínicos

ABSTRACT Background: Characterized by demyelination, inflammation and axonal damage, multiple sclerosis (MS) is one of the most common disorders of central nervous system led by the immune system. There is an urgent and obvious need for biomarkers for the diagnosis and follow-up of MS. Objective: To investigate serum levels of sestrin2 (SESN2), a protein that responds to acute stress, in MS patients. Methods: A total of 85 participants, 40 patients diagnosed previously with relapsing-remitting MS and 45 healthy controls, were included. Serum SESN2 parameters were investigated in blood samples drawn from each participant in the patient and control groups. Results: SESN2 levels were significantly lower in MS patients than in controls (z: -3.06; p=0.002). In the ROC analysis of SESN2, the predictive level for MS was 2.36 ng/mL [sensitivity, 72.50%; specificity, 55.56%; p=0.002; area under the curve (AUC)=0.693]. For the cut-off value in both groups, SESN2 was an independent predictor for MS [Exp (B)=3.977, 95% confidence interval (95%CI) 1.507-10.494 and p=0.013]. Conclusions: The decreased expression of SESN2 may play a role in MS pathogenesis, and SESN2 could be used as a biomarker for MS and as immunotherapeutic agent to treat MS.

RESUMO Antecedentes: Caracterizada por desmielinização, inflamação e dano axonal, a esclerose múltipla (EM) é uma das doenças mais comuns do sistema nervoso central liderada pelo sistema imunológico. Há uma necessidade urgente e óbvia de biomarcadores para o diagnóstico e acompanhamento da EM. Objetivo: Investigar os níveis séricos de sestrina2 (SESN2), uma proteína que responde ao estresse agudo, em pacientes com EM. Métodos: Foram incluídos 85 participantes, 40 pacientes com diagnóstico prévio de EM recorrente-remitente e 45 controles saudáveis. Os parâmetros do SESN2 sérico foram investigados em amostras de sangue coletadas de cada participante nos grupos de paciente e controle. Resultados: os níveis de SESN2 foram significativamente mais baixos em pacientes com EM do que em controles (z: -3,06; p=0,002). Na análise ROC do SESN2, o nível preditivo para MS foi 2,36 ng/mL [sensibilidade, 72,50%; especificidade, 55,56%; p=0,002; área sob a curva (AUC)=0,693]. Para o valor de corte em ambos os grupos, SESN2 foi um preditor independente para MS [Exp (B)=3,977, intervalo de confiança de 95% (95%CI) 1,507-10,494; p=0,013]. Conclusões: A expressão diminuída de SESN2 pode desempenhar um papel na patogênese da EM, e SESN2 poderia ser usado como um biomarcador para EM e como agente imunoterapêutico para o tratamento de EM.

Serum levels of irisin and nesfatin-1 in multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) is an inflammatory and neurodegenerative autoimmune chronic neurological disease. Currently, there are no effective serum biomarkers to verify MS diagnosis, to assess disease prognosis, and evaluate response to MS treatment. OBJECTIVE: The present study is a preliminary assessment of irisin and nesfatin-1 serum levels in patients with relapsing- remitting MS (RRMS). METHODS: A total of 86 participants, 42 patients with RRMS diagnosis and 44 healthy controls were included in the study. The serum irisin and nesfatin-1 parameters of the patients and control group members were analyzed. RESULTS: Irisin and nesfatin-1 levels of the RRMS patients were significantly lower than the controls (z: -3.82, p<0.001; z: -4.79, p<0.001, respectively) The cut-off level of irisin is 10.390 (ng/mL) (sensitivity: 84.1%, specificity: 71.4%, AUC: 0.800), and the cut-off level of nestatin-1 is 7.155 (ng/mL) (sensitivity: 68.2%, specificity: 64.3%, AUC: 0.739) in the ROC analysis. For these cut-off levels in the case-control groups, the lower irisin and nesfatin-1 levels are the independent variables for MS patients (OR 9.723, 95%CI 2.884-32.785, p<0.001; OR 3.992, 95%CI 1.336-11.928, p<0.001) respectively. CONCLUSION: The present study revealed lower irisin and nesfatin-1 levels in patients with RRMS. These findings suggest that the decreased levels of irisin and nesfatin-1 peptides may contribute to MS pathogenesis such as inflammation, oxidative stress, and apoptosis in MS, leading to demyelination, axonal damage with neuronal loss, and gliosis.

Possible roles of sestrin2 in multiple sclerosis and its relationships with clinical outcomes.

BACKGROUND: Characterized by demyelination, inflammation and axonal damage, multiple sclerosis (MS) is one of the most common disorders of central nervous system led by the immune system. There is an urgent and obvious need for biomarkers for the diagnosis and follow-up of MS. OBJECTIVE: To investigate serum levels of sestrin2 (SESN2), a protein that responds to acute stress, in MS patients. METHODS: A total of 85 participants, 40 patients diagnosed previously with relapsing-remitting MS and 45 healthy controls, were included. Serum SESN2 parameters were investigated in blood samples drawn from each participant in the patient and control groups. RESULTS: SESN2 levels were significantly lower in MS patients than in controls (z: -3.06; p=0.002). In the ROC analysis of SESN2, the predictive level for MS was 2.36 ng/mL [sensitivity, 72.50%; specificity, 55.56%; p=0.002; area under the curve (AUC)=0.693]. For the cut-off value in both groups, SESN2 was an independent predictor for MS [Exp (B)=3.977, 95% confidence interval (95%CI) 1.507-10.494 and p=0.013]. CONCLUSIONS: The decreased expression of SESN2 may play a role in MS pathogenesis, and SESN2 could be used as a biomarker for MS and as immunotherapeutic agent to treat MS.

The prevalence of bruxism and related factors in patients with multiple sclerosis: a comparative study.

OBJECTIVE: To determine the prevalence of bruxism and related factors in patients with multiple sclerosis (MS). METHODS: Diagnosed with relapsing-remitting MS under the 2010-revised McDonald diagnostic criteria, 182 patients without MS exacerbations during the previous three months were included in the patient group, and 145 healthy individuals made up the control group in the study. Demographic data of the participants in both groups were determined. In the patient and control groups, the diagnosis of definite bruxism was made using the International Classification of Sleep Disorders (Diagnosis and Coding Manual, Second Edition). RESULTS: Bruxism was found in 29.7% (n = 54) of the patients and in 12.4% (n = 18) of the controls, and the difference was statistically significant (p < 0.001). Of all patients, the onset of bruxism was found in 70.4% (n = 38) after the diagnosis and in 29.6% (n = 169) prior to the diagnosis of MS. Compared with those without bruxism, the mean age (p = 0.031) and the score of the Expanded Disability Status Scale (p = 0.001) were also significantly higher among MS patients with bruxism. Between MS patients with and without bruxism, no significant differences were found in terms of sex, marital status, educational status, employment, cigarette smoking, total number of exacerbations, number of exacerbations within the previous year, and drugs used. CONCLUSIONS: The frequency of bruxism was found to be higher in the patients with MS than in the controls. Bruxism is associated with age and the Expanded Disability Status Scale score in MS patients.

The prevalence of bruxism and related factors in patients with multiple sclerosis: a comparative study / A prevalência do bruxismo e fatores relacionados em pacientes com esclerose múltipla: um estudo comparativo

ABSTRACT Objective: To determine the prevalence of bruxism and related factors in patients with multiple sclerosis (MS). Methods: Diagnosed with relapsing-remitting MS under the 2010-revised McDonald diagnostic criteria, 182 patients without MS exacerbations during the previous three months were included in the patient group, and 145 healthy individuals made up the control group in the study. Demographic data of the participants in both groups were determined. In the patient and control groups, the diagnosis of definite bruxism was made using the International Classification of Sleep Disorders (Diagnosis and Coding Manual, Second Edition). Results: Bruxism was found in 29.7% (n = 54) of the patients and in 12.4% (n = 18) of the controls, and the difference was statistically significant (p < 0.001). Of all patients, the onset of bruxism was found in 70.4% (n = 38) after the diagnosis and in 29.6% (n = 169) prior to the diagnosis of MS. Compared with those without bruxism, the mean age (p = 0.031) and the score of the Expanded Disability Status Scale (p = 0.001) were also significantly higher among MS patients with bruxism. Between MS patients with and without bruxism, no significant differences were found in terms of sex, marital status, educational status, employment, cigarette smoking, total number of exacerbations, number of exacerbations within the previous year, and drugs used. Conclusions: The frequency of bruxism was found to be higher in the patients with MS than in the controls. Bruxism is associated with age and the Expanded Disability Status Scale score in MS patients.

RESUMO Objetivo: Neste estudo, pretendeu-se determinar a prevalência de bruxismo e fatores relacionados em pacientes com esclerose múltipla (EM). Métodos: Diagnosticados com EM remitente recidivante sob os critérios de McDonald Diagnostic revisados em 2010, 182 pacientes sem ataques de EM durante os últimos três meses foram incluídos no grupo de pacientes, e 145 indivíduos saudáveis constituíram o grupo de controle no estudo. Os dados demográficos dos participantes dos dois grupos foram determinados. Nos grupos de pacientes e controle, o diagnóstico de bruxismo definitivo foi feito usando a Classificação Internacional de Distúrbios do Sono (1) (Manual de Diagnóstico e Codificação Segunda Edição). Resultados: O bruxismo foi detectado em 29,7% (n = 54) dos pacientes e observado dentro de 12,4% (n = 18) dos controles, e a diferença foi estatisticamente significante (p <0,001). De todos os pacientes, o tempo inicial de bruxismo foi encontrado em 70,4% (n = 38) após o diagnóstico e em 29,6% (n = 169) antes do diagnóstico. Em comparação com aqueles sem bruxismo, os níveis de idade média (p = 0,031) e o escore da Escala de Status de Incapacidade Expandida (p = 0,001) também foram significativamente maiores entre os pacientes com esclerose múltipla com bruxismo. Entre os pacientes com esclerose múltipla com e sem bruxismo, não foi encontrada diferença significativa em termos de sexo, estado civil, status educacional, emprego, tabagismo, número total de ataques, número de ataques no último ano e medicamentos utilizados. Conclusões: A freqüência de bruxismo foi maior em pacientes com esclerose múltipla do que nos controles. O bruxismo está associado à idade e ao escore da Escala de Status de Incapacidade Expandida (EDSS) em pacientes com EM.

The Assessment of Sexual Dysfunction in Male Patients with Multiple Sclerosis.

INTRODUCTION: To investigate the effects of multiple sclerosis (MS) on male sexuality. METHODS: While 61 men with MS were included into the study group, 60 healthy men constituted the control group in the study. In MS patients, such parameters as functional status and depression levels were assessed with the Expanded Disability Status Scala (EDSS) and the Beck Depression Scale (BDS), other parameters such as pain levels, sexual function and quality of life (QoL) were evaluated with the Visual Analog Scala (VAS), the International Index of Erectile Function (IIEF) and the short form-36 (SF-36), respectively. RESULTS: Patients with MS were classified as 45 with EDSS <5.5 and 19 with EDSS >5.5. Mean VAS and BDI scores patients with MS were found statistically significantly higher, compared with those of the controls (p<0.05). Mean IIEF and all sub-group scores of SF-36 of patients with MS were found to be statistically significantly lower, compared with those of the control group (p<0.05). Mean EDSS in patients with MS was 2.75±2.42. While there was a positive correlation between IIEF scores of patients with MS, and mean mental and physical components of SF-36, a negative correlation was found between IIEF scores in MS patients, and age, disease duration, number of attacks, number of marital years and scores of EDSS, VAS and BDI (p<0.00). When BDI ≥17 was accepted as the threshold for depression, the depression was detected in 62.5% of patients with MS and 11.7% of the controls (p<0.001). CONCLUSION: Sexual functions are affected negatively in male patients with MS and seem to be associated with increased disability, pain and accompanying depression. Therefore, male patients with MS should also be evaluated with regard to sexual function, as well as disability during their follow-ups.

The relationship of median nerve F-wave parameters with severity and subtypes of carpal tunnel syndrome.

PURPOSE: F-wave analysis may help affirm or disprove a compression neuropathy. In this study we have analysed the effects of focal median nerve injury on F wave in Carpal Tunnel Syndrome (CTS). METHOD: We studied 57 patients (100 hands) with clinical and electrophysiological CTS and 31 (62 hands) healthy subjects. Median nerve F-waves were evaluated following 10 supramaximal stimuli and recording from abductor pollicis brevis muscles. Minimum, maximum, and mean F-wave latencies, frequency of the F wave (Fp), chronodispersion (F_{CD}), mean F/M amplitude ratios (mF/M-amp) and F-wave conduction velocity (FwCV) were evaluated. RESULTS: The CTS patients showed prolonged F-wave latencies, decreased Fp, and an increase of the F_{CD} as compared with normative values. Absent F wave was presented in 8 of 34 hands (23.5%) with severe CTS patients. In the severe group, the FwCV was significantly slower (p< 0.001) and the mF/M-amp was significantly higher (p< 0.001) than that of mild and moderate groups, respectively. Also, the mF/M-amp was significantly greater and Fp was lower in the axonal type than in the demyelinating type. The F_{CD} was not different among groups. A strong positive correlations between mMDL with Fmin (r=0.81, p< 0.000), Fmean (r=0.80, p< 0.000) and Fmax (r=0.71, p< 0.000) were revealed. CONCLUSION: Results support the differing effects of demyelinating and axonal injury on F-waves and suggest that the mF/M-amp ratio and FwCV, which is influenced by neuronal damages in the distal segment of the median nerve, is useful in the discrimination of CTS severity.

Cortical and cerebellar atrophy, but no lesion in a patient with neuro-Behçet's disease.

Neuro-Behçet's disease (NBD) is a rare clinical entity. There are no reports about cortical atrophy in NBD. We report a patient with NBD exhibiting only cortical and cerebellar atrophy without any lesions. A 38-year-old male was hospitalized due to gait disorder. He had experienced forgetfulness, irritability, sexual and behavioral dyscontrol, and incontinence for 5 years. Magnetic resonance imaging (MRI) showed cortical and cerebellar atrophy, but there were no lesions. In the differential diagnosis of NBD, physicians should take into account the presence of both brainstem and cerebellar and cortical atrophy even in the absence of typical lesions for NBD, particularly in the presence of cognitive dysfunctions.

The role of atrial fibrillation on mortality and morbidity in patients with ischaemic stroke.

OBJECTIVE: To investigate the impact of atrial fibrillation on mortality and morbidity in ischaemic stroke patients. METHODS: The retrospective study was conducted at the Neurology Clinic, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey, and comprised records of ischaemic stroke patients hospitalised between January 2006 and September 2009. SPSS 13 was used for statistical analysis. RESULTS: Of the 404 patients in the study, 69 (17.1%) had atrial fibrilation. The mean age of such patients was 66.78 +/- 12.23 years compared to 61.01 +/- 15.11 years for the rest. Besides 47 (68.1%) of these patients were females. According to the modified Rankin Scale scores, the degree of disability was significantly higher at the time of arrival and discharge, and mortality rates were significantly higher also (p < 0.01). CONCLUSION: Atrial fibrillation affected the prognosis of ischaemic stroke adversely in terms of mortality and morbidity.

Electrophysciological analysis of entrapment neuropathies developed in acute and subacute period in paretic and non-paretic extremities in patients with stroke.

OBJECTIVE: To investigate entrapment neuropathies in stroke patients in a hospital in Turkey with Medical Research Council (MRC) score < or = 2/5 and in those with MRC score > or = 3/5. METHODS: The study comprising 40 patients from January 2008 to June 2009 in the Stroke Unit of the Department of Neurology, Yuzuncu Yil University in Van, Turkey, entailed electrophysiological analysis of median, ulnar, radial nerves, peroneal, tibial and sural nerves in paretic and nonparetic upper and lower extremities. National Institute of Health Stroke scale was used for the evaluation of neurological deficient, while nerve conduction studies were performed for the diagnosis of entrapment neuropathies (EN). The patients were divided into two groups based on their initial Medical Research Council (MRC) score: < 2/5 and > 3/5. Both groups had 20 patients each. The readings were compared in the control phase 45 to 50 days after the stroke. Paired samples test and t-test using SPSS version 15 were used for statistical analysis. RESULTS: Carpal tunnel syndrome (CTS) at wrist was found in 7 (35%) patients, cubital tunnel syndrome at elbow in 3 (15%) patients, and evident reduction in motor action potential values of peroneal, median and ulnar nerve in 10 (50%) patients in the control studies for conduction on our patients with Medical Research Council (MRC) score of < or = 2/5, unlike the initial findings, in the paretic side. Among the patients, in the other group, 2 (10%) developed bilateral Carpel tunnel syndrome, and it was also detected in the healthy upper extremities in 2 (10%) more patients. In the control studies for conduction in patients with Medical Research Council score of 3/5, Carpel tunnel syndrome was detected in the healthy side in 4 (20%) patients and in the affected side in 3 (15%) patients. CONCLUSION: In patients with severe paresis, if the affected extremity is not functional, symptoms of entrapment neuropathy are easy to occur.

The effect of local corticosteroid injection on F-wave conduction velocity and sympathetic skin response in carpal tunnel syndrome.

The aim of this study was to evaluate the efficacy of steroid injection for the treatment of the carpal tunnel syndrome (CTS), with F-wave parameters and sympathetic skin response (SSR). Seventeen hands of 10 women patients were treated with local steroid injection with 2-month follow-up. All patients underwent single injection into the carpal tunnel. Response to injection was measured nerve conduction studies (NCSs), median nerve F waves, and SSR before and after treatment. To determine the normal values, 42 hands of 21 healthy women were also studied. There was a significant improvement of sensory and motor nerve conduction values when compared to baseline values (P < 0.01). At the end of follow-up period, the median sensory distal latency and the sensory latency differences between the median and the ulnar nerve were improved 35 and 65%, respectively. The maximum, mean F-wave amplitudes and chronodispersion showed a slight improvement with respect to baseline values and controls, but statistical significance was not achieved after treatment. Although no statistically significant improvements were observed in SSR parameters, slightly decreased amplitudes and increased habituation of SSR were noted at the end of the treatment. The present study shows that the local steroid injection results in improvement in NCSs values, but the F-wave parameters were not effectual in short-term outcome of CTS treatment. These findings suggest that the sensory latency differences between the median and the ulnar wrist-to-digit 4 are better parameters in the median nerve recovery after treatment than the median sensory distal latency. Furthermore, the SSR does not seem to be a sensitive method in follow-up of CTS treatment.

Randomised, controlled blink reflex in patients with migraine and tension type headache.

OBJECTIVES: To investigate the latencies, amplitudes of R1, R2i and R2k responses and R2 habituation; to compare the groups with each other and with the placebo group and to demonstrate new evidences on migraine and tension-type headache TTH mechanisms. METHODS: This analytical study was carried out among 40 migraine patients who were admitted to Yuzuncu Yil University, Medical Faculty, Neurology Clinics between May 2009 and December 2009, with or without aura according to the diagnostic criteria of International Headache Society 2004 classification. Forty TTH patients, who were diagnosed with TTH were included, and 40 control group subjects were formed according to the same demographic data. SPSSv13 was used for Chi-square test, one-way ANOVA and Pearson correlation coefficients was used for the determination of the relation between the groups and categorical. RESULTS: Mean age was 33.04 +/- 9.07 years. An average of RR2k latency was significantly high in migraine group comparing with TTH and the control groups, and in TTH group comparing with the control group. Similarly, the average of LR2k latency was found to be significantly higher in migraine group than TTH and the control groups, and significantly higher in TTH group than the control group. CONCLUSION: Our findings demonstrated that brainstem and trigeminovascular connections play an important role in migraine pathogenesis and that central mechanisms play a role in TTH and concerning these two diseases.