Investigation of the nonmotor symptoms in patients with STN-DBS therapy in comparison with those without STN-DBS.

The impact of STN-DBS on NMS remains rather as an underestimated topic. Besides, the significance of NMSs in QOL indexes of PD subjects with STN-DBS is unknown. We primarily aimed to evaluate the NMSs and their significance in QOL indexes in PD subjects comparatively with and without STN-DBS therapy. We enrolled all consecutive PD subjects with and without STN-DBS who applied to our movement disorders outpatient clinics between January/2023 and September/2023. We performed comprehensive assessments of the motor and nonmotor features including the clinical scales of Movement Disorder Society-sponsored revision of the MDS-UPDRS, NMSS, HAM-A, HAM-D, and the PDQ-39. Overall, 48 PD subjects with STN-DBS and 161 without STN-DBS treatment were included. The comparative analyses revealed that the sub-scores of the MDS-UPDRS-2, -3 and -4 were higher in the STN-DBS group. However, the MDS-UDPRS-1 and the total scores of the NMSS were similar between groups. Among eight subitems of the NMSS, only, the sub scores of the mood/cognition and the gastrointestinal tract differed. Remarkably, the significant correlations between the scores of the QOL and the NMSS scores in the STN-DBS (-) group, did not persist within the STN-DBS group. Remarkably, the correlations between the NMSS and PQQ-39 disappeared for most of the sub scores within the STN-DBS group. We found indirect evidence regarding the benefit of STN-DBS therapy on NMSs in our cross-sectional study. Besides, we found weaker impact of NMSs in QOL indexes in PD subjects with STN-DBS therapy.

The recovery of sympathetic skin responses with levodopa in a patient with multiple system atrophy-parkinsonian type.

Herein, we report a 62-year-old female patient with Multiple system atrophy (MSA) at whom the sympathetic skin responses (SSRs) were absent at initial investigations. However, the levodopa therapy provided normalization of SSRs and moderately improvement in orthostatic hypotension-related symptoms. Based on this rare illustration, we discuss the possible mechanisms underlying the pathophysiology of autonomic dysfunction in MSA. We remark on the need for future clinical and experimental studies in this field.

A rare patient with Parkinson's disease presenting with isolated progressive micrographia.

Although handwriting impairment is a frequent sign of Parkinson's disease (PD), its significance in the evaluation processes of these patients may be overlooked among physicians. Therefore, we would like to report an illustrative patient who presented with isolated micrographia initially; but received the diagnosis of PD in the follow-up.

Investigation of the factors associated with hemichorea/hemiballismus in post-stroke patients.

Classical knowledge highlights the role of lesions of the subthalamic nuclei (STN) in the pathophysiology of hemichorea/hemiballismus (HH). However, the published reports indicate various other lesion regions in the majority of post-stroke cases with HH. Ergo, we aimed to investigate the significance of the lesion site and clinical features for developing HH in post-stroke patients. Overall, we retrospectively scanned all the patients with stroke who were hospitalized between 01/06/2022 and 31/07/2022 in our neurology clinic. The data regarding the demographic features, comorbidities, stroke etiologies, and laboratory findings, including serum glucose and HBA1C were retrospectively recruited using the electronic-based medical record system. The cranial magnetic resonance imaging (MRI) and computed tomography images have been systematically evaluated for the presence of lesions in localizations that are previously associated with HH. We conducted comparative analyses between patients with and without HH to reveal the discrepancies between groups. The logistic regression analyses were also performed to reveal the predictive values of some features. Overall, the data of 124 post-stroke patients were analyzed. The mean age was 67.9 ± 12.4 years (F/M = 57/67). Six patients were determined to develop HH. The comparative analyses between patients with and without HH revealed that the mean age tended to be higher in the HH group (p = 0.08) and caudate nucleus involvement was more common in the HH group (p = 0.005). Besides cortical involvement was absent in all subjects developing HH. The logistic regression model revealed the presence of a caudate lesion and advanced age as factors associated with HH. We found that the caudate lesion was a crucial determinant of the occurrence of HH in post-stroke patients. With the significance of the other factors of increased age and cortical sparring, we observed differences in the HH group may be investigated also in future-related studies on larger groups.

The investigation of the gait parameter alterations in response to levodopa therapy and tap test in patients with idiopathic normal pressure hydrocephalus.

OBJECTIVE: To investigate the impact of dopamine oral therapy, the effect of cerebrospinal fluid (CSF) tap test on gait parameters in our idiopathic normal pressure hydrocephalus (iNPH) subjects. METHODS: Patients with a possible diagnosis of iNPH who had been admitted to our outpatient polyclinic between March 2022 and May 2022 were enrolled. In addition to the clinical evaluations, basal gait analysis was performed using a "Gait Analyzer" program which was uploaded to a mobile phone. Thereafter, the gait analyses were re-evaluated after levodopa therapy, 4 h and 2 weeks after the CSF tap test at distinct times, separately. RESULTS: Ultimately, the data of 8 patients with iNPH were enrolled in this study (mean age = 67.37 ± 7.74, F/M = 3/5). Friedman's analysis of variance analyses did not show a difference in any parameters of gait between the distinct evaluation times. On the other hand, the pairwise analysis results showed that the step time and cadence had improved after levodopa therapy, whereas no significant improvement was detected in any of the parameters after the CSF tap test. CONCLUSION: In our pilot study, we found that the gait parameters improved after levodopa therapy. However, the gait parameters did not change after the CSF tap test which may suggest that our measurement method might overlook detecting the gait disturbance specific to the iNPH. Future research to develop new evaluation methods and questionnaires detecting the gait disturbance specific to the iNPH pathophysiology may provide substantial clinical applications.

Can the hummingbird sign contribute to the diagnosis of idiopathic normal pressure hydrocephalus?

BACKGROUND: We read with great interest the article by Atalay et al. in which they illustrate the frequent presence of hummingbird signs in their patient group with idiopathic normal pressure hydrocephalus (iNPH) [1]. The results are substantially interesting; however, we believe that some points may be further deliberated for a better understanding of this crucial study. DISCUSSION: The authors declare that there are no commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest.

Structural neuroimaging findings in migraine patients with restless legs syndrome.

PURPOSE: One out of three migraine patients might have accompanying restless legs syndrome (RLS). In our study, we aimed to compare the volumes of the brain structures of migraineurs with and without RLS. METHODS: We had 37 female patients with migraine and 17 females as the control group. Nineteen migraineurs had no RLS (RLS0) and 18 migraineurs had comorbidity of RLS (RLS1). The volumes of the brain structures were obtained by manual measurements, volBrain, and voxel-based morphometry (VBM). Manually, we measured caudate and putamen volumes. We used age, years of education, depression, anxiety scores, and total intracranial volume as covariates. RESULTS: According to VBM analyses, the volumes of the left superior occipital gyrus and precuneus were increased, and the substantia nigra and cuneus were decreased in the RLS1 group compared with the RLS0 group. RLS1 patients had larger superior temporal gyrus, Brodmann area 38, and left insula, and RLS0 patients had larger Brodmann area 22, right superior temporal gyrus, and Heschl gyrus compared with controls. Migraine and RLS0 patients had a smaller corpus callosum anteriorly, whereas RLS1 patients had a smaller splenium. Caudate volumes were larger in migraine patients via the three techniques. There was a positive relation between the caudate and putamen volumes and attack frequency. CONCLUSIONS: Comorbidity of RLS might be a confounding factor in structural neuroimaging studies in migraine. Deficits in the visual network seem to be related to accompanying RLS; deficits in the auditory network are particularly related to migraine.

Diabetic polyneuropathy, deep white matter lesions, and carotid atherosclerosis: is there any association?

The morphologic and functional damages of diabetes mellitus (DM) on microcirculation can play a role in the pathogenesis of both polyneuropathy and cerebral white matter lesions. The aim of this study is to investigate the relation between polyneuropathy and cerebral deep white matter lesions (DWMLs) and carotid atherosclerosis in patients with type 2 DM. Sixty-six patients with type 2 DM without any disorder that may cause polyneuropathy, and vascular risk factors except for DM and hyperlipidemia were included in the study. DWMLs and carotid atherosclerosis were investigated in patients with and without polyneuropathy. Forty patients (60.6%) had diabetic sensorimotor polyneuropathy. DWMLs were more frequent in patients with polyneuropathy compared to patients without polyneuropathy (p = 0.003). Logistic regression analysis confirmed association between polyneuropathy and DWMLs after adjusted for age (p = 0.013), duration of DM (p = 0.007), and both age and duration of DM (p = 0.016). No statistically significant difference was found between patients with and without polyneuropathy for carotid atherosclerosis. Among patients with polyneuropathy, those having DWMLs had higher mean age (p = 0.003) and longer symptom duration (p = 0.020) compared to patients without DWMLs. No association was found between DWMLs and carotid atherosclerosis. Polyneuropathy and cerebral DWMLs in type 2 DM patients may share common pathogenesis; presence and duration of polyneuropathy symptoms may predict ischemic white matter damage independent of carotid atherosclerosis.