What is the real effect of pregabalin in patients with diabetic neuropathic pain?(Do patients suffer from less pain or do they less care about it?).

BACKGROUND AND PURPOSE: Depression and anxiety are frequent in patients with chronic diseases such as diabetic neuropathic pain. The pain seems to be more severe in patients in whom depressive findings accompanied pain symptoms. Pregabalin was reported to have positive effects on anxiety and depression. This brings out the question, whether the pain relief effect of pregabalin is due to its analgesic effect or to its effects on mood? The aim of this study is to find out whether the positive effect of pregabalin in patients with diabetic neuropathic pain is limited to its effect on pain. Thus the question - do patients suffer from less pain or do they less care about pain? - should be answered. METHODS: With this aim the NRS scores of 46 patients with diabetic neuropathic pain, whose HADS scores did not change with pregabalin treatment were compared with their baseline levels, retrospectively. RESULTS: The NRS scores of the group were reduced with pregabalin treatment. CONCLUSION: This results suggests that the reduced pain in pregabalin treatment should be independent from its effects on depression and anxiety.

Ocular pulse amplitude and retina nerve fiber layer thickness in migraine patients without aura.

BACKGROUND: To evaluate the ocular pulse amplitude (OPA), the posterior pole asymmetry analysis (PPAA), the peripapillary retinal nerve fiber layer (RNFL) thickness, the ganglion cell layer (GCL) thickness, macular thickness and visual field testing in migraine patients without aura. METHODS: In this prospective, cross-sectional and comparative study 38 migraine patients and 44 age and sex matched controls were included. OPA was measured by dynamic contour tonometry (DCT), PPAA, RNFL, GCL and macular thickness were measured by Heidelberg Spectral Domain Optical Coherence Tomography (SD-OCT) and standard perimetry was performed using the Humphrey automated field analyzer. RESULTS: The difference in OPA was not statistically significant between the two groups (p ≥ 0.05). In the PPAA there was no significant difference between two hemispheres in each eye (p ≥ 0.05). The RNFL thickness was significantly reduced in the temporal and nasal superior sectors in the migraine group (p ≤ 0.05). The GCL and macular thickness measurements were thinner in migraine patients but the difference between groups was not statistically significant (p ≥ 0.05). There was no correlation between RNFL, GCL, macular thickness measurements and OPA values. There was no significant difference in the mean deviation (MD) and pattern standard deviation (PSD) between the two groups (p ≥ 0.05). CONCLUSIONS: Migraine patients without aura have normal OPA values, no significant asymmetry of the posterior pole and decreased peripapillary RNFL thickness in the temporal and nasal superior sectors compared with controls. These findings suggest that there is sectorial RNFL thinning in migraine patients without aura and pulsative choroidal blood flow may not be affected during the chronic course of disease.

Comparison of the Nerve Conduction Parameters in Proximally and Distally Located Muscles Innervated by the Bundles of Median and Ulnar Nerves.

OBJECTIVE: The aim of this study was to investigate and compare the conduction parameters of nerve bundles of median and ulnar nerves that innervate proximal and distal muscles. SUBJECTS AND METHODS: Thirty male and 30 female healthy volunteers between 18 and 70 years of age were enrolled in the study. The conduction parameters were recorded from the proximally located flexor carpi ulnaris, pronator teres and the flexor carpi radialis muscles to the distally located abductor digiti minimi and abductor pollicis brevis muscles for the ulnar and median nerves. Each nerve was stimulated at the region above the elbow and at the axillary region separately. The Student t test was used for statistical analysis, and Levene's test was used to assess whether or not the group variances exhibited a uniform distribution. RESULTS: The conduction velocities were faster (78.27 ± 6.55 vs. 67.83 ± 6.76 m/s, and 74.57 ± 5.66 and 74.23 ± 5.88 vs. 66.38 ± 6.85 m/s) and the durations of compound muscle action potential (CMAP) response were longer (15.65 ± 2.43 vs. 13.55 ± 1.78 ms, and 16.38 ± 2.39 and 16.04 ± 2.34 vs. 13.40 ± 1.79 ms) in proximally located muscles than in distally located muscles that are innervated either by ulnar or median nerves (p < 0.001). However, the CMAP amplitudes were smaller (2.52 ± 1.16 vs. 5.81 ± 3.13 mV, and 2.90 ± 1.20 and 3.59 ± 1.66 vs. 6.88 ± 2.77 mV) in proximal muscles than in distal muscles (p < 0.001). There was no significant difference (p > 0.05) between males and females regarding conduction velocities and CMAP amplitudes recorded from proximal and distal muscles. CONCLUSION: Proximal muscles innervated by median or ulnar nerves had lower CMAP amplitude values, longer CMAP durations and higher conduction velocities than distal muscles. These findings could reveal a temporal dispersion and phase cancellation due to desynchronized conduction during nerve stimulation.

Is gabapentin effective in dry eye disease and neuropathic ocular pain?

This study aims to evaluate the efficacy of gabapentin treatment in dry eye disease (DED) and neuropathic ocular pain. Our study was performed with 72 patients. The painDETECT questionnaire was used for neuropathic pain screening. Patients who were thought to have severe DED according to ocular surface disease index (OSDI) questionnaire, Schirmer's test type 1 and tear break up time test results were treated with artificial tear and cyclosporine drops. Gabapentin treatment was also initiated in addition to artificial tear and cyclosporine drops treatments to the patients with neuropathic component and DED findings. We divided the patients into two groups: group 1 (n: 36), patients treated with artificial tear and cyclosporine drops and group 2 (n: 36), patients treated with artificial tear, cyclosporine drops and gabapentin. In the first evaluation, no significant differences were found between groups in terms of OSDI score, Schirmer's test result and TBUT. After the 6 weeks of treatment, in both groups OSDI score, Schirmer's test result and TBUT statistically significantly improved. OSDI score, Schirmer's test result and TBUT significantly improved after the 6 weeks of gabapentin treatment than artificial tear and cyclosporine treatment group (p < 0.001). Dry eye patients should be screened for neuropathic ocular pain symptoms and individualized treatment has to be applied. Our study showed that the use of gabapentin is effective in severe dry eye patients with neuropathic ocular pain.

Does nutritional status affect Parkinson's Disease features and quality of life?

OBJECTIVES: The aim of this study was to determine the relationship between nutritional status and Parkinson's Disease (PD) features in association with depression, anxiety and quality of life in people with PD. MATERIALS AND METHODS: This study was conducted on 96 patients with idiopathic PD to whom the following scales were applied: Unified Parkinson's Disease Rating Scale (UPDRS), 39-item PD questionnaire (PDQ-39), Hospital Anxiety and Depression Score (HADS), Mini Nutritional Assessment (MNA). The scales and measurements were applied to patients at their first assessment. Patients with malnutrition or at risk of malnutrition were assessed by the dietitian and nutrition nurse. These patients received nutritional support through personalized diet recommendations and appropriate enteral nutritional products, considering factors such as age, comorbidity, socioeconomic and cultural conditions. At the end of 6 weeks, the scales and measurements applied during the first visit were again applied to the patients. RESULTS: A significant and inverse correlation was determined between mental (Spearman r:-0.510, p<0.001), activities of daily living (Spearman r:-0.520, p<0.001), motor (Spearman r:-0.480, p<0.001), complications (Spearman r:-0.346, p<0.001) UPDRS subdivisions and total scores (Spearman r:-0.644, p<0.001) and total MNA score. A significant and inverse correlation was found between all PDQ-39 subdomains and total MNA score (p<0.05). The highest inverse correlations were found in mobility (Spearman r:-0.690, p<0.001) and stigma (Spearman r:-0.570, p<0.001). Both depression (Spearman r:-0.631, p<0.001) and anxiety (Spearman r:-0.333, p<0.001) scores were determined to be inversely correlated with total MNA score. At the 6-week control visit, significantly lower scores were found in all subdivisions and in the total UPDRS score, PDQ-39 score and in the patients' anxiety and depression scores (p<0.05). MNA scores were found to be significantly higher in the assessment performed after 6 weeks of support for patients who had abnormal nutritional status at inception (p<0.001). CONCLUSION: PD motor and nonmotor functions, disease duration and severity are related to nutritional status. Quality of life was also shown to be affected by changes in the nutritional status. These results show that nutritional status assessment should be a standard approach in the PD treatment and follow-up processes.

Fahr's syndrome presenting with epileptic seizure: Two case reports.

Fahr's syndrome is a neuropsychiatric syndrome characterized by symmetrical and bilateral intracerebral calcifications located in the basal ganglia and usually associated with a phosphorus and calcium metabolism disorder. Clinical manifestations of Fahr's syndrome vary; it may start at different ages and have a variety of presentations. This article discusses rare presentation of Fahr's syndrome with epileptic seizure. These cases are important because they appear to be the first cases in the literature of Fahr's syndrome presenting with generalized tonic clonic seizure.

Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo.

BACKGROUND: Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. OBJECTIVE: To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. STUDY DESIGN: Prospective, nonrandomized, controlled study. SETTING: Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. METHODS: Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device measures vertical pressure fluctuations on 4 independent stable platforms, each placed beneath 2 heels and toe parts of the patient; inputs from these platforms are integrated and processed by a computer digitally. Four separate plates are used and perpendicular pressures of the anterior and posterior feet are measured. Pressure of each force plate is measured and data was analyzed by the software program. LIMITATIONS: A very small, non-randomized, and controlled study with the inability to find an answer to the mechanism of involvement of the somatosensorial system and vestibular system in migrainous headaches. RESULTS: The distribution of patients with posturographical abnormalities in the migrainous vertigo group was significantly different than the control group. Distribution of the patients with posturographical abnormalities in the high frequencies of the head-right position was significantly different in the migrainous vertigo group than in the control group and distribution of the patients with posturographical abnormalities in high frequencies of the head-right position was significantly different in the migraine group than in the controls groups. The stability index of the migrainous vertigo group was significantly higher than in the control group when tested on in the neutral-head position with open eyes. CONCLUSION: In this first study of tetra-ataxiometric static posturography evaluating postural abnormalities in a well-defined population of patients with migrainous vertigo, the central part of the vestibular apparatus would be responsible of postural abnormalities in patients with migraine and migrainous vertigo.