Retinal Nerve Fibre Layer Thickness in Migraine Patients with or without Aura.

The objective of this study was to evaluate the retinal nerve fibre layer (RNFL) thickness using spectral-domain optical coherence tomography (Optos SD-OCT, UK) in migraine patients with or without aura and to search for possible structural effects of migraine on the retina. Eighty eyes of 40 migraine patients and 80 eyes of 40 healthy subjects were included in this study. All four quadrants (temporal, superior, nasal, and inferior) and average peripapillary RNFL measurements were taken with SD-OCT in both groups. The average age of the patients and the control group were 35.7 ± 9.5 and 40.9 ± 12.7 years, respectively. In the migraine group, 45% of patients were with aura, and 55% were without aura. The average frequency of attacks per month and the migraine diagnosis time was 4.6 ± 4.4 and 6.2 ± 5.6, respectively. Parameters related to RNFL thickness of right and left eyes' average, superior, inferior, nasal, and temporal quadrant values were found to be similar in migraine and control subjects (p > 0.05). Focusing on the RNFL thickness of right and left eyes and the migraine parameters, there were no statistically significant differences between migraineurs with aura and without aura (p > 0.05). The correlations between the RNFL thickness parameters and the migraine patient's MIDAS (Migraine Disability Assessment Score) score, frequency of attacks, and diagnosis time of migraine were studied and no correlation was noted (p > 0.05). These findings demonstrated that migraine disease with or without aura does not have any effect on the thickness of the RNFL.

Silent neurological involvement in biopsy-defined coeliac patients.

Coeliac disease (CD) is an autoimmune disease of small intestine associated with sensitivity to gluten. The clinical manifestations are often of gastrointestinal nature, although the disease may be present asymptomatically as well. It is a chronic disease and in the absence of overt neurological involvement, extended gluten exposure may give rise to silent or subtle morphological and white-matter changes in central nervous system. The present study investigates such changes using brain volumetry and the assessment of white-matter tissue in CD patients without neurological symptoms. Seventeen CD patients without any neurological involvement were included in the study and went under neurological evaluation and anatomical MRI. Individual gray- and white-matter, and subcortical structure volumes were acquired for using automated volumetric analyses. The observed white-matter hyperintensities (WMH) evaluated using Age-Related White-Matter Changes scale. Findings show a bilateral decrease in cortical gray-matter and caudate nuclei volumes in CD compared to controls. Negative correlations were found between the duration of the disease and the volumes of the affected regions. Cerebellum was seemingly unaffected. In addition, significantly higher proportion of WMH was found in CD patients, specifically in bilateral frontal and occipitoparietal cortices. We observed a significant gray-matter and caudate nucleus atrophy in the CD patients in the absence of marked neurological symptoms. Present findings point out to a need for histopathological investigations potentially focusing on anti-TG2 antibodies, and serial volumetric analyses on the CD-related cortical and subcortical changes.

Contribution of brainstem circuits in pathophysiology of NREM-sleep parasomnias.

OBJECTIVE: We aimed to investigate the brainstem circuits to reveal if there was any abnormality in these circuits in clinically diagnosed patients with NREM parasomnias during wakefulness. METHODS: Twelve patients with NREM-sleep parasomnia diagnosed according to ICSD-3 criteria and a control group of 16 healthy subjects were enrolled into our study. We analyzed the auditory startle reflex (ASR), blink reflex (BR), prepulse inhibition (PPI) of BR and recovery excitability of BR. RESULTS: There was a trend for longer responses from orbicularis oculi and sternocleidomastoid muscles after auditory stimulation in the patients compared to those in the healthy subjects. The recovery percentages at 200 ms and 300 ms showed a borderline significance in the patients. No significant difference was found in the R2-PPI between the patients and healthy subjects. CONCLUSIONS: Our results suggest a mildly enhanced ASR and relatively early facilitation of BR excitability in patients with NREM-sleep parasomnia during daytime. Although our findings suggest involvement of brainstem networks in NREM-sleep parasomnia during wakefulness, it would be better to study these networks at night and during daytime to see if there is any contribution.

The role of pedunculopontine nucleus in isolated REM sleep behavior disorder and REM sleep without atonia.

INTRODUCTION: The aim of this study was to analyze the functions of pedunculopontine nucleus (PPN) in isolated REM sleep behavior disorder (iRBD) and REM sleep without atonia (RSWA) to investigate the role of PPN in dream-enacting motor behaviors in RBD. We evaluated the activity of PPN through the prepulse modulation (PPM) together with other brainstem reflexes to investigate the differences in changes at brainstem. METHODS: We included nine patients with isolated RSWA and 10 patients with iRBD. For diagnosis, all patients underwent polysomnography. None of the patients had parkinsonism or dementia. We also included 17 healthy participants with similar age and sex. Blink reflex (BR), PPM of BR, recovery excitability of BR, and auditory startle reflex (ASR) were recorded in all participants. RESULTS: There was a prepulse inhibition deficit in iRBD and RSWA groups compared to healthy subjects. The BR-R2 recovery at 200 ms interval was also higher in patients with iRBD and RSWA. In ASR recordings, the response probabilities were higher in the RBD group compared to RSWA and control groups. CONCLUSION: The PPM was abnormal in both iRBD and RSWA whereas ASR was enhanced in iRBD. We suggest that there are certain similarities and differences in the pathophysiologies of iRBD and RSWA.