Which scale is more useful to detect diabetic neuropathic pain?: A cross-sectional study.

BACKGROUND: Diabetic neuropathy is one of the most common causes of neuropathic pain. LANSS, sLANSS, DN4 and painDETECT are scales which are commonly used worldwide. There are not many studies comparing these screening tools in specific neuropathic pain subgroups. The aim of this study is to compare the utilities of LANSS, sLANSS, DN4 and PainDETECT for the diagnosis of diabetic neuropathic pain. METHODS: One hundred-one individuals without diabetic neuropathic pain were included in control group, 102 patients with diabetic neuropathic pain to DNP group. LANSS, sLANSS, DN4 and painDETECT scores of the groups were compared. RESULTS: The difference between the groups was significant for all questionnaires and for all questions/titles they included. DN4 had the highest sensitivity and painDETECT had the highest specificity. CONCLUSIONS: All questionnaires seemed to be useful for detecting diabetic neuropathic pain. DN4 had a high specificity and sensitivity. PainDETECT, also had a high sensitivity and specificity when cut off value was accepted more than 12.

Lower / upper extremity F-wave ratio for detecting early diabetic neuropathy.

BACKGROUND AND PURPOSE: Results of conventional nerve conduction studies may be within normal limits in early diabetic neuropathy. Previous studies demonstrated that F-wave latency should be used to detect this early neuropathic process. The aim of this study is to evaluate the sensitivity of lower/upper extremity F latency ratios in detecting the early neuropathy in patients with diabetic neuropathic pain. METHODS: 44 patients with diabetic neuropathic pain (DNP) and 44 control subjects whose both conventional nerve conduction studies and F-wave latencies were within normal limits were included to the study. We compared the nerve conduction parameters and lower/upper extremity (tibial/ulnar) F latency ratios of the groups. RESULTS: Tibial F latency was significantly prolonged and tibial/ulnar F latency ratio was significantly higher in DNP group. Our results support that F-waves are useful for detecting early diabetic neuropathy and suggest that comparison with a control group will demonstrate a difference even when the individuals' F-wave latencies are within the normal limits. The difference was significant for tibial but not for ulnar F latency values supporting the length dependent involvement. The tibial/ ulnar F-wave latency ratio was significantly higher in the DNP group, suggesting that it might also be useful to detect early neuropathy and to demonstrate that the underlying process was predominant in lower extremity. CONCLUSION: Further studies may provide additional information about the utility of this ratio for detecting early neuropathy even when F-wave latencies are within normal limits.

Evaluation of cognitive dysfunction by the clock drawing test in multiple sclerosis and clinically isolated syndrome patients: Correlation with other neuropsychological tests.

OBJECTIVES: To evaluate the cognitive status with a simple practical test, clock drawing test (CDT), in a larger multiple sclerosis (MS) patient group and in comparison, with controls. METHODS: We included 171 patients (17-65 years) with MS and clinically isolated syndrome (CIS) and 98 healthy controls who applied between date 2018-2020 years in Neurology Department of Pamukkale University. The CDTs were applied to all subjects. In addition, the cognitive functions of the patient group were evaluated with the neuropsychological test battery. RESULTS: The CDT scores were significantly lower in relapsing-remitting MS (RRMS) group than the control group (p<0.005). Progressive MS patients' CDT scores were significantly lower than RRMS and CIS (p<0.0001). According to our results, the CDT showed progressive deterioration in MS better than another practical and free tests. Additionally, the CDT scores were statistically better in patients whose disease began with sensory symptoms than whose disease started with motor and brainstem symptoms (p<0.0001). CONCLUSION: The CDT cognitive impairment prediction performance is 60%, CDT is a useful, easy-to-administer, practical test that can be used in cognitive assessment in MS and CIS.

NEUROLOGICAL SYMPTOMS COMMON IN COVID-19 PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY.

In December 2019, a novel coronavirus outbreak spread rapidly all over the world. The virus is known to be neuroinvasive, but much is still unknown. In this study, we aimed to present the main neurologic symptoms in patients who were diagnosed with coronavirus disease 2019 (COVID-19). The study was conducted retrospectively by phoning 156 patients in Turkey diagnosed with COVID-19 through real-time polymerase chain reaction; only 100 patients could be reached. Data about their demographics, initial symptoms, neurological symptoms, and sleeping habits were collected. During the disease process, 66% had at least one neurological symptom, 55% had central nervous system symptoms, 42% had peripheral nervous system symptoms, and 64% had sleep disturbances and myalgia. Impaired consciousness, smell and taste impairments, and sleep disturbances were significantly higher in patients with positive chest computed tomography imaging (p < 0.05). Neurological symptoms were observed in COVID-19, as in other coronaviruses. Headache in particular was the most common symptom in our population. In patients with respiratory system findings, the detection of certain neurological symptoms such as smell-taste impairments, impaired consciousness, and sleep disorders were more common. We concluded that COVID-19 patients should be approached in a more holistic way, taking the nervous system into account.

Myasthenia gravis, Guillain-Barré syndrome, or both?

Myasthenia gravis (MG) and Guillain-Barré syndrome (GBS) are autoimmune disorders that may cause weakness in the extremities. The coexistence of MG and GBS in the same patient has rarely been reported previously. A 52-year-old male presenting with ptosis of the left eye that worsened with fatigue, especially toward evening, was evaluated in our outpatient department. His acetylcholine receptor antibody results were positive, supporting the diagnosis of MG. His medical history revealed a post-infectious acute onset of weakness in four extremities, difficulty in swallowing and respiratory failure, which was compatible with a myasthenic crisis; however, his nerve conduction studies and albuminocytologic dissociation at the time were compatible with GBS. With this case report, we aimed to mention this rare coincidental state, discuss possible diagnoses and review all other similar cases in the literature with their main features.

What is the price of residence in rural areas for patients with epilepsy?

INTRODUCTION: We aimed to investigate the effects of the urban or rural dwelling of patients with epilepsy living in Giresun on their use of health services, quality of life, and self-efficacy. METHODS: In this cross-sectional study, patients with epilepsy who were admitted to the neurology outpatient clinic between January 2022 and August 2022 were evaluated. All the participants were individually interviewed to complete the Epilepsy Self-Efficacy Scale (ESES) and Quality of Life in Epilepsy Inventory (QOLIE-10) questionnaire. The frequency of admission to the emergency department, neurology outpatient clinic, and general practitioner clinic where the primary reason for the visit was epilepsy in the last year was determined using the hospital database. RESULTS: This study was composed of 109 patients. The rural dwelling was found in 45% of the participants. The mean age of seizure onset was significantly lower in patients dwelling in rural areas Mean GP and ED visits didn't differ according to dwelling. On the other hand, mean neurology outpatient clinic visits were significantly lower in patients living in rural areas. The QOLIE-10 didn't differ according to the dwelling. However, lower ESES results were obtained in patients living in rural areas. CONCLUSION: This study shows that there is a disparity in neurologist visits among patients with epilepsy dwelling in rural areas. Furthermore, lower ESES scores were found in these patients. Educational interventions should be addressed particularly to the patients dwelling in rural areas to strengthen self-efficacy, and fill the gaps for the shortage of health personnel and qualified health care.

Myocarditis-myositis-myasthenia gravis overlap syndrome depending on immune checkpoint inhibitor.

Immune checkpoint inhibitors are breakthrough monoclonal antibodies in cancer therapy developed against mechanisms that suppress the immune response. After the devastating effects of chemotherapy, these specific agents have given hope to cancer patients. However, every drug has side effects itself and these useful drugs have theirs too. In addition to systemic side effects, there are also neurological side effects, the frequency of which is increasing day by day, although they are reported very rarely for now. Here, we present a case that has myositis-myocarditis-myasthenia gravis overlap syndrome. These three syndromes are very rare even to be seen alone, which are detected together. This syndrome with a very high mortality was brought under control in this case, and the fact that nivolumab treatment can be continued makes the case even more interesting. In this article, it is aimed to draw attention to this serious triple complication of immune checkpoint inhibitors and to review the relevant literature on a case basis.

Different phenotypes of transthyretin-associated familial amyloid polyneuropathy due to a mutation in p.Glu109Gln in members of the same family.

Transthyretin-associated familial amyloid polyneuropathy (TTR-FAP) is an unusual but life-threatening disease that is autosomal dominant inherited and involves the mutation of the transthyretin (TTR) gene. A total of 26 patients with TTR-FAP and different mutations, including the p.Glu 109Gln mutation (previously annotated p. Glu89Gln), were previously reported in Turkey. Herein, we reported two patients from the same family who had the same p.Glu 109Gln mutation but had different clinical phenotypes. The clinical picture mainly involved polyneuropathy in one patient and cardiac involvement in the other patient. This case report mentions that TTR-FAP can cause different clinical phenotypes, even due to the same mutation and even in the same family.

Neuropathic Pain Frequency in Neurology Outpatients: A Multicenter Study.

INTRODUCTION: Neuropathic pain is common, but the frequency of misdiagnosis and irrational treatment is high. The aim of this study is to evaluate the rate of neuropathic pain in neurology outpatient clinics by using valid and reliable scales and review the treatments of patients. METHODS: The study was conducted for 3 months in eleven tertiary health care facilities. All outpatients were asked about neuropathic pain symptoms. Patients with previous neuropathic pain diagnosis or who have neuropathic pain symptoms were included and asked to fill painDETECT and douleur neuropathic en 4 questions (DN4) questionnaire. Patients whose DN4 score is higher than 3 and/or painDETECT score higher than 13 and/or who are on drugs for neuropathic pain were considered patients with neuropathic pain. The frequency of neuropathic pain was calculated and the treatments of patients with neuropathic pain were recorded. RESULTS: Neuropathic pain frequency was 2.7% (95% CI: 1.5-4.9). The most common cause was diabetic neuropathy. According to painDETECT, the mean overall pain intensity was 5.7±2.4, being lower among patients receiving treatment. Pharmacological neuropathic pain treatment was used by 72.8% of patients and the most common drug was pregabalin. However, 70% of those receiving gabapentinoids were using ineffective doses. Besides, 4.6% of the patients were on medications which are not listed in neuropathic pain treatment guidelines. CONCLUSION: In our cohort, the neuropathic pain severity was moderate and the frequency was lower than the literature. Although there are many guidelines, high proportion of patients were being treated by ineffective dosages or irrational treatments.