The Impact of the COVID-19 Lockdown on the Quality of Life in Chronic Neurological Diseases: The Results of a COVQoL-CND Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson's disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. METHODS: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. RESULTS: The mean age of a total of 577 patients was 49 ± 17 (19-87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, those with comorbid disease, contacted with CO-VID-19 patients, or diagnosed with COVID-19. In the group with a high IES-R score, the rate of DIT was found to be high. IES-R scores were negatively correlated with QoL. IES-R total scores were found highest in the CVD group and lowest in the PD group. The ratio of DIT was found highest in the PNP group and the lowest in the EP group. Contact with CO-VID-19 patients was high in the EP and HA group. CONCLUSIONS: The results of the COVQoL-CND study showed that lockdown causes posttraumatic stress and deterioration in the QoL in CND.

Relationship between Apnea-Hypopnea Index and Oxygen Desaturation in REM-Sleep Period and Morning Headache in Patients with Obstructive Sleep Apnea Syndrome.

INTRODUCTION: In patients with morning headache, REM sleep period decreases though little is known about its physiopathology. We evaluate the polysomnographic records of obstructive sleep apnea syndrome (OSAS) patients with the hypothesis that oxygen desaturations may be a better determinant in patients with morning headache, especially those in REM sleep periods. METHODS: Patient group (group 1) with a total of 361 patients with OSAS and the controls (group 2) with 107 healthy individuals were evaluated. The presence of morning headache was compared between the groups, and sleep parameters were correlated with morning headache. RESULTS: In group 1, patients with OSAS and morning headache, apnea-hypopnea index in the REM sleep period (26.7/hour, min-max: 0-108.4/hour) was higher than those in patients without morning headache (17.8/hour, min-max: 0-107.8/hour). The minimum oxygen saturation in REM sleep period and total sleep time (TST) was lower in patients with morning headache (REM sleep period: 82%, min-max: 50-94% ; TST: 79%, min-max: 50-97%) in compared to patients without morning headache (REM sleep period: 84%, min-max: 50-93% ; TST: 81%, min-max: 50-90%). CONCLUSION: Here we demonstrated that higher apnea-hypopnea index and lower oxygen saturation in REM sleep period were associated with morning headache in patients with obstructive sleep apnea syndrome.

A database for screening and registering late onset Pompe disease in Turkey.

The aim of this study was to search for the frequency of late onset Pompe disease (LOPD) among patients who had a myopathy with unknown diagnosis registered in the pre-diagnostic part of a novel registry for LOPD within a collaborative study of neurologists working throughout Turkey. Included in the study were 350 patients older than 18 years who have a myopathic syndrome without a proven diagnosis by serum creatine kinase (CK) levels, electrodiagnostic studies, and/or muscle pathology, and/or genetic tests for myopathies other than LOPD. Acid alpha glucosidase (GAA) in dried blood spot was measured in each patient at two different university laboratories. LOPD was confirmed by mutation analysis in patients with decreased GAA levels from either both or one of the laboratories. Pre-diagnostic data, recorded by 45 investigators from 32 centers on 350 patients revealed low GAA levels in a total of 21 patients; from both laboratories in 6 and from either one of the laboratories in 15. Among them, genetic testing proved LOPD in 3 of 6 patients and 1 of 15 patients with decreased GAA levels from both or one of the laboratories respectively. Registry was transferred to Turkish Neurological Association after completion of the study for possible future use and development. Our collaborative study enabled collection of a considerable amount of data on the registry in a short time. GAA levels by dried blood spot even from two different laboratories in the same patient may not prove LOPD. LOPD seemed to be rarer in Turkey than in Europe.

Evaluation of several classification methods in carpal tunnel syndrome.

OBJECTIVE: To investigate the performance and effectiveness of 4 classification methods including support vector machine, naive Bayes, classification tree, and artificial neural network in the detection of carpal tunnel syndrome. METHODS: This retrospective study was conducted at Yuzuncu Yil University, Van, Turkey, and comprised record of patients suspected of having carpal tunnel syndrome between January and December 2013. The evaluations included age, gender, and 6 electromyography variables, including right/left median nerve sensory velocity, right/left fourth finger peak latency difference, and right/left median nerve motor distal latency. We investigated the performance of classification methods such as support vector machine, naive Bayes, classification tree and artificial neural network in the patients using data obtained from electromyography scan. A total of 6 criteria were used for the assessment of performance, including: true positive rate, false positive rate, true negative rate, false negative rate, accuracy, and preciseness. RESULTS: Of the 109 patients, 88(80.7%) were women and 21(19.3%) men. Besides, 67(61.5%) participants had carpal tunnel syndrome and 42(38.5%) did not have it. On classification tree, only 2 variables, i.e. left fourth finger peak latency difference and right/left median nerve sensory velocity, were found to be statistically significant (p<0.001). Naive Bayes had the highest detection score (91.04%), followed by support vector machine (89.55%). CONCLUSIONS: Naive Bayes yielded better performance than all the other methods in the diagnosis of carpal tunnel syndrome, followed by support vector machine.

Clinical Overlap of Multiple Sclerosis and Autoimmune Hepatitis: Three Cases.

Multiple sclerosis (MS) is an autoimmune, inflammatory disease characterized by demyelination and axonal degeneration in the central nervous system. MS is the second major cause of disability following trauma, and is mostly seen between the ages of 20 - 40 years and in women. Autoimmune hepatitis (AH) is a chronic disease characterized by hypergammaglobulinemia, high levels of transaminases, presence of antibodies, and histologically by the necroinflammatory process with interface hepatitis. In AH, the etiological agent of the disease and the cause of liver injury remain unknown. MS may be associated with AH, autoimmune thyroiditis, and type 1 diabetes mellitus (DM). In literature, 8 cases with overlap of MS and AH have been reported. In this report, we present 3 cases which were detected with overlap of MS and AH, and are very rare condition in literature.

Coexistence of the POEMS syndrome with hepatitis B: a rare case report.

POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a rare multisystemic disease of unknown pathogenesis. Proinflammatory and proangiogenic cytokines play important roles in its pathogenesis. POEMS syndrome is a rare cause of ascites. Until now, the coexistence of POEMS syndrome and hepatitis B has not been reported. In this case report, we present a 48-year-old male patient who presented with malaise, fatigue, diarrhea, and abdominal swelling. Organomegaly, endocrinopathy, ascites, skin changes, and polyneuropathy were identified, and we arrived at a diagnosis of POEMS syndrome. The patient was administered methylprednisolone 64 mg/day, lamivudine 100 mg/day, calcium 1.5 g/day, and calcitriol 0.5 µg/day. The patient's clinical manifestations had moderately resolved at the follow-up visits. At the end of 6 months of follow-up, his ascites was minimally reduced, and his neurologic manifestations had not lessened. The present case shows that accurate diagnosis is required for the management of patients with coexisting POEMS syndrome and hepatitis B.

The levels of trace elements and heavy metals in patients with acute migraine headache.

OBJECTIVE: To compare the levels of trace elements and heavy metal in patients with acute migraine and healthy controls. METHODS: The prospective study was conducted at Yuzuncu Yil University, Turkey, from May to July 2013, and comprised migraine patients and an equal number of healthy controls. International Headache Society classification was used for diagnosing migraine. Serum copper, zinc, lead, iron, cadmium, cobalt, manganese, and magnesium levels were measured in both groups. Metal concentrations were assessed by atomic absorption spectrophotometry. SPSS 13 was used for statistical analysis. RESULTS: There were 25 migraine patients with an average age of 36.4±8.9 years and 25 healthy controls with a mean age of 42.4±9.5 years. Cadmium, iron, manganese and lead levels were significantly elevated in the patients compared to the controls (p<0.05 each), while copper, magnesium and zinc were decreased and cobalt demonstrated no change. CONCLUSIONS: Trace elements and heavy metals may have a role in the genesis of considerable oxidative stress in patients with acute migraine headache.

Clinical and perinatal outcomes in eclamptic women with posterior reversible encephalopathy syndrome.

PURPOSE: To compare the clinical and perinatal outcomes in eclamptic women with and without posterior reversible encephalopathy syndrome (PRES). METHODS: This single-center, retrospective, cohort study was conducted between 2008 and 2013. The clinical and perinatal outcomes of eclamptic patients were obtained from hospital records. Magnetic resonance imaging was used for the diagnosis of PRES. Eighty-one eclamptic women were divided into two groups: 45 and 36 patients were included in the PRES and non-PRES groups, respectively. RESULTS: In the PRES group, headache and visual impairment together (60.0 %) were the most common presenting symptoms. In the non-PRES group, only headache was the most common (50 %) presenting symptom. Occipital and parietal lobes were the most frequently affected areas in the PRES group. Women in the PRES group had a higher body mass index value (p = 0.005), longer hospitalization time (p = 0.001), and higher level of proteinuria (p = 0.012) than those in the non-PRES group. Women in the non-PRES group had higher Apgar scores (p = 0.002) than those in the PRES group. CONCLUSIONS: This study indicates that PRES manifests predominantly with headache and visual impairment together. Adverse neonatal outcomes are also common in these patients.

Cerebral venous sinus thrombosis presentation in emergency department in Van, Turkey.

OBJECTIVE: To exmaine the distribution of age, gender, time between onset and presentation, clinical findings, predisposing factors, platelet distribution width, mean platelet volume values and neuroimaging findings, together with the treatment regime and the outcome for patients of cerebral venous sinus thrombosis. METHODS: The retrospective, descriptive cross-sectional study was conducted at Yuzuncu Yil University, Medical Faculty Hospital in Van, Turkey, comprising 51 cases diagnosed with cerebral venous sinus thrombosis between January 2008 and September 2011. The diagnosis was based on the results of clinical evaluation, cranial magnetic resonance imaging and venography. SPSS 16 was used for statistical analysis. RESULTS: Overall, 43 (84.3%) of the cases were female, and 8 (15.7%) were male.The average age was 32 +/- 11.13 years The most frequent symptom was headache in 41 (80.4%) cases. The postpartum period was one of the most observed predisposing factors in 17 (33.3%) patients. The magnetic resonance imaging was normal in 35 (68.6%) cases, but in all of the cases, magnetic resonance venography was abnormal. Topographically, the most frequent involvement was transverse sinus in 40 (78.4%) cases. Besides, 50 (98%) patients were discharged following full recovery or mild sequela and only 1 (2%) case had severe sequela. CONCLUSION: Patients presenting with headache should be examined carefully in the emergency department. Early diagnosis and treatment with clinical and neuroimaging techniques for such patients is recommended.

Serum levels of trace elements and heavy metals in patients with acute hemorrhagic stroke.

Trace elements are essential components of biological structures, but alternatively, they can be toxic at concentrations beyond those necessary for their biological functions. Changes in the concentration of essential trace elements and heavy metals may affect acute hemorrhagic stroke. The aim of this study was to measure serum levels of essential trace elements [iron (Fe), zinc (Zn), manganese (Mn), copper (Cu), and magnesium (Mg)] and heavy metals [cobalt (Co), cadmium (Cd), and lead (Pb)] in patients with acute hemorrhagic stroke. Twenty-six patients with acute hemorrhagic stroke and 29 healthy controls were enrolled. Atomic absorption spectrophotometry (UNICAM-929) was used to measure serum Fe, Cu, Pb, Cd, Zn, Co, Mn and Mg concentrations. Serum Cd, Pb and Fe levels were significantly higher in patients with acute hemorrhagic stroke than controls (p < 0.001), while serum Cu, Zn, Mg and Mn levels were significantly lower (all p < 0.001). However, there was no significant difference between the groups with respect to serum Co levels (p > 0.05). We first demonstrate increased Cd, Pb, and Fe levels; and decreased Cu, Zn, Mg, and Mn levels in patients with acute hemorrhagic stroke. These findings may have diagnostic and prognostic value for acute hemorrhagic stroke. Further studies are required to elucidate the roles of trace elements and heavy metals in patients with acute hemorrhagic stroke.

Serum prolidase enzyme activity and oxidative stress levels in patients with diabetic neuropathy.

Previous studies have suggested that prolidase and nitric oxide (NO) regulate many processes, such as collagen synthesis and matrix remodeling. Oxidative stress plays an important role in the development of microvascular complications in diabetic patients. Data on serum prolidase activity in patients with diabetes mellitus or diabetic neuropathy (DN) are limited and conflicting. The aim of this study was to measure serum prolidase activity, NO, total antioxidant status (TAS), and malondialdehyde (MDA) levels in patients with DN. Forty-five patients with DN and 40 healthy controls were enrolled. Serum prolidase activity, TAS, MDA, and NO levels were determined. Serum MDA and NO levels were significantly higher in DN patients than controls (p = 0.002, p = 0.001, respectively), while prolidase activity and TAS levels were lower (p = 0.003, p = 0.001, respectively). Prolidase activity was negatively correlated with NO and MDA (r = -0.911, p < 0.001; r = -0.905, p < 0.001, respectively), while positively correlated with TAS (r = 0.981, p < 0.001) in DN patients. The current study is the first showing the decreased serum prolidase enzyme activity. Our results suggest that decreased collagen turnover may occur in DN patients, who have increased oxidative stress and increased NO levels. Decreased prolidase activity seems to be associated with increased NO levels and oxidative stress along with decreased antioxidant levels in DN. Therefore, decreased prolidase activity may play a role in pathogenesis of DN. Prospective clinical studies are necessary to confirm these findings.

Guillain-Barre syndrome following spinal anaesthesia.

Guillain-Barre Syndrome (GBS) is the most common disease resulting in acute diffuse flaccid paralysis. It is an autoimmune disease that can occur at any age. The clinical course is characterized by weakness in the arms and legs, areflexia and the progression of muscle weakness from the lower limbs to the upper limbs. The most common causes of GBS include infections, vaccinations, surgery and some medicines. We present the case of a 48 years old male patient, who developed GBS after undergoing surgery for renal calculus, under spinal anaesthesia. In this case report, we presented a rather rare case of GBS occurring following spinal anaesthesia.

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.

Sneddon syndrome associated with Protein S deficiency.

Sneddon syndrome (SS) is rare, arterio-occlusive disorder characterized by generalized livedo racemosa of the skin and various central nervous symptoms due to occlusion of medium-sized arteries of unknown. Seizure, cognitive impairment, hypertension, and history of repetitive miscarriages are the other symptoms seen in this disease. Livedo racemosa involves persisting irreversible skin lesions red or blue in color with irregular margins. Usually, SS occurs in women of childbearing age. Protein S deficiency is an inherited or acquired disorder associated with an increased risk of thrombosis. We present a 33-year-old woman with SS with diffuse livedo racemosa, recurrent cerebrovascular diseases, migraine-type headache, sinus vein thrombosis, and protein S deficiency. Protein S deficiency and with Sneddon syndrome rarely encountered in the literature.

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.

Polyneuropathy due to cyclosporine A in patients with renal transplantation: a case report.

BACKGROUND: Calcineurin inhibitor cyclosporine A (CsA) is a potent immunosuppressive agent. The side effects of CsA include nephrotoxicity, hypertension, hypertrichosis, infection, hyperpotassemia, and, to a lower extent, neuropathy. OBJECTIVES: In this case report, we aimed to present a renal transplant patient with polyneuropathy (PNP) due to the use of CsA and with improvement when switched to rapamycin. METHODS: In electromyography, axonal sensory PNP was detected. CsA was stopped and rapamycin was begun. RESULTS: His complaints rapidly improved after using rapamycin. CONCLUSIONS: Patients using CsA should be closely monitored for peripheral neuropathy and in case of toxicity, alternative immunosuppressive agents should be considered.

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.

Use of pyridoxine and pyridostigmine in children with vincristine-induced neuropathy.

Four children with vincristine (VCR)-induced neuropathy are being reported. All cases were followed with the diagnosis of acute lymphoblastic leukemia. Two were boys aged between 2 and 13 year. Electromyographic examination consisted of sensoriomotor polyneuropathy with axonal involvement in three patients. In another patient, it consisted of motor axonal polyneuropathy. In all patients, pyridoxine and pyridostigmine were successfully used in the treatment of VCR-induced neuropathy. They recovered completely with this drug combination. Recovering period of symptoms was between 1-2 week.

Bilateral brachial plexus palsy and right Horner syndrome due to congenital cervicothoracal syringomyelia.

Syringomyelia (SM) is a disorder in which a cyst forms within the spinal cord. This cyst, called a syrinx, expands and elongates over time, destroying the center of the cord. Horner syndrome is an infrequent illness caused by a lesion of the cervical sympathetic nerve fiber. Its clinical features are facial anhidrosis, ptosis, miosis, and hypochromia iridis of the affected side. A full-term male newborn infant was admitted with weakness in bilateral upper extremities and narrowing of the palpebral fissure on the right side. Ophthalmologic examination revealed a smaller right pupil. Muscle power in bilateral upper limbs was 1/5. Chest X-ray and cranial magnetic resonance imaging were normal. Magnetic resonance imaging of the cervicothoracic spine showed SM at C4-T2 level. Electromyographic examination revealed bilateral brachial plexus palsy. The diagnosis was of brachial plexus palsy and congenital Horner syndrome due to congenital cervicothoracic SM. According to our best knowledge, this association has not been reported in the literature.