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BACKGROUND: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. METHODS: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients' database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. RESULTS: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. DISCUSSION: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs.
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Clorhidrato de Fingolimod , Esclerosis Múltiple , Humanos , Clorhidrato de Fingolimod/uso terapéutico , Estudios Retrospectivos , Acetato de Glatiramer/uso terapéutico , Inmunosupresores/uso terapéutico , Turquía , Esclerosis Múltiple/tratamiento farmacológico , Interferón beta/uso terapéutico , RecurrenciaRESUMEN
OBJECTIVE: Restless legs syndrome (RLS) is a well-established disease that has recently been shown to have variants affecting the arms, face, abdomen, and genital area. To our knowledge, there has been no study reporting on the RLS variant affecting the head region. METHODS: The retrospective study reviewed a total of 460 patients who presented to Firat University Medical School and were diagnosed as having RLS based on the International Restless Legs Syndrome Study Group (IRLSSG) criteria between June 2017 and January 2020. Of these, 18 patients that presented with head-related RLS symptoms (in addition to legs or arms) and four cases that presented with isolated head involvement were included in the study. RESULTS: In 15 out of 18 (81.8%) patients, the restless head syndrome was accompanied by restless arm syndrome (RAS). In the remaining four (18.2%) patients, the disease involved the head region alone. The disease initially emerged in a single region in the body and gradually spread to one or multiple other regions in most patients and the symptoms were relieved by head rubbing. Serum iron level was low in 8 (36.4%) patients and normal in 14 (63.6%) patients. All the patients had normal cranial imaging and the symptoms were eliminated after dopaminergic therapy. CONCLUSIONS: Although RLS typically involves the legs alone, it may also affect other body parts such as upper extremities, abdomen, face, and genital area. We propose that the novel RLS variant described in the present study could be termed "restless head syndrome."
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Síndrome de las Piernas Inquietas , Dopamina , Humanos , Pierna , Síndrome de las Piernas Inquietas/complicaciones , Estudios Retrospectivos , Extremidad SuperiorRESUMEN
OBJECTIVES: In recent years, radiological and biochemical data have emerged regarding the development of cellular damage in the brain of patients with migraine, calling into question what has traditionally been accepted as a benign disorder. In order to investigate whether cellular damage develops in the brain of episodic migraine patient, serum levels of neuron-specific enolase (NSE) and S100B have been evaluated in recent studies. However, contradictory results were obtained in these studies. Moreover, there is no study on NSE and S100B in cases of chronic migraine. METHODS: Patients with episodic migraine with or without aura and chronic migraine were included. In addition, 27 healthy volunteers were included as a control group. Control group was selected from healthy volunteers of the same age and sex. We investigated serum NSE and S100B levels during the interictal period in 26 patients with episodic migraine and 27 patients with chronic migraine. RESULTS: The serum NSE and S100B levels were significantly higher in both patients with episodic and chronic migraine than controls. Although there were no significant differences in the serum NSE and S100B levels between the two patients' groups, these markers were found to be higher in cases of chronic migraine. CONCLUSION: These results suggest that there is both neuronal and glial involvement in the two migraine groups. Elevations in these markers in cases of episodic migraine suggest that cellular damage not only results from headache episodes, but that there may be also an ongoing pathological process during the interictal period.
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Biomarcadores/sangre , Trastornos Migrañosos/sangre , Trastornos Migrañosos/patología , Fosfopiruvato Hidratasa/sangre , Subunidad beta de la Proteína de Unión al Calcio S100/sangre , Adulto , Encéfalo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroglía/patología , Neuronas/patologíaRESUMEN
BACKGROUND: Headache is a leading disabler in adults worldwide. In children and adolescents, the same may be true but the evidence is much poorer. It is notable that published epidemiological studies of these age groups have largely ignored headaches not fulfilling any specific set of ICHD criteria, although such headaches appear to be common. A new approach to these is needed: here we introduce, and investigate, a diagnostic category termed "undifferentiated headache" (UdH), defined in young people as recurrent mild-intensity headache of < 1 h's duration. METHODS: We conducted a nationwide cross-sectional survey in 31 schools in six regions of Turkey selected by mixed convenience-based and purposive modified cluster-sampling. A validated, standardised self-completed structured questionnaire was administered by a physician-investigator to entire classes of pupils aged 6-17 years. RESULTS: Of the identified sample of 7889 pupils, 7088 (89.8%) participated. The 1-year prevalence of UdH was 29.2%, of migraine (definite and probable) 26.7%, and of tension-type headache (TTH) (definite and probable) 12.9%. UdH differed with respect to almost all headache features and associated symptoms from both migraine and TTH. Burden of headache and use of acute medication were lower in UdH than in migraine and TTH. Headache yesterday was less common in UdH than migraine (OR 0.32; 95% CI 0.28-0.37) and TTH (OR 0.64; 95% CI 0.56-0.77). Quality of life (QoL) was better in UdH (33.6 ± 5.2) than in migraine (30.3 ± 5.6; p < 0.001) and TTH (32.4 ± 5.3; p < 0.001), but worse than in pupils without headache (35.7 ± 4.7; p < 0.001). CONCLUSIONS: This large nationwide study in Turkey of pupils aged 6-17 years has shown that many children and adolescents have a headache type that does not conform to existing accepted diagnostic criteria. This new diagnostic category of presumably still-evolving headache (undifferentiated headache) is common. UdH differs in almost all measurable respects from both migraine and TTH. Although characterised by mild headaches lasting < 1 h, UdH is associated with significant adverse impact on QoL. Longitudinal cohort studies are needed to evaluate the prognosis of UdH but, meanwhile, recognition of UdH and its distinction from migraine and TTH has implications for epidemiological studies, public-health policy and routine clinical practice.
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Cefalea/diagnóstico , Cefalea/epidemiología , Instituciones Académicas/tendencias , Encuestas y Cuestionarios , Adolescente , Niño , Estudios Transversales/métodos , Femenino , Cefalea/terapia , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Calidad de Vida , Turquía/epidemiologíaRESUMEN
Behçet's disease (BD) is a chronic inflammatory disease. Increased productions of cytokines including interleukin (IL)-1ß and IL-18 are documented, and IL-1α and ß gene polymorphisms are associated with susceptibility to the disease. IL-33 is a recently discovered member of IL-1 cytokine family. The aim of the study was to detect serum IL-33 level and IL-33 gene polymorphisms in a cohort of BD. Unrelated 117 patients with BD and 149 healthy controls (HC) were enrolled. Serum IL-33 levels were analyzed by enzyme-linked immunosorbent assay method. DNA samples were harvested using an appropriate commercial DNA isolation kit. Four single nucleotide polymorphisms of IL-33 gene (rs7044343, rs1157505, rs11792633 and rs1929992) were genotyped using the appropriate commercial primer/probe sets on real-time PCR. Serum IL-33 level was not significantly different in the BD and HC groups (p > 0.05). However, its level was lower in the active BD patients compared to the inactive ones and HC group (p = 0.044 and p = 0.037, respectively). There was no significant difference in terms of the genotypic and allelic distributions of rs1157505 and rs1929992 polymorphisms (p > 0.05 for all). However, the TT variants of rs7044343 and rs11792633 polymorphisms were very rare, and the T allele frequencies of these polymorphisms were lower, in the BD group compared to the HC group (p < 0.0001 for all). The rs7044343 and rs11792633 variants of IL-33 gene are associated with the decreased risk of BD in our cohort. Therefore, it may be concluded that IL-33 acts a protective role on the pathogenesis of BD.
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Síndrome de Behçet/genética , Interleucina-33/genética , Adulto , Síndrome de Behçet/sangre , Estudios de Casos y Controles , Femenino , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Interleucina-33/sangre , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido SimpleRESUMEN
The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis (PwMS). One of the main problems with the EDSS method is that different results can be determined by different physicians for the same patient. In this case, it is necessary to produce autonomous solutions that will increase the reliability of the EDSS, which has a decision-making role. This study proposes a machine learning approach to predict EDSS scores using aerobic capacity data from PwMS. The primary goal is to reduce potential complications resulting from incorrect scoring procedures. Cardiovascular and aerobic capacity parameters of individuals, including aerobic capacity, ventilation, respiratory frequency, heart rate, average oxygen density, load, and energy expenditure, were evaluated. These parameters were given as input to CatBoost, gradient boosting (GBM), extreme gradient boosting (XGBoost), and decision tree (DT) machine learning methods. The most significant EDSS results were determined with the XGBoost algorithm. Mean absolute error, root mean square error, mean square error, mean absolute percent error, and R square values were obtained as 0.26, 0.4, 0.26, 16, and 0.68, respectively. The XGBoost based machine learning technique was shown to be effective in predicting EDSS based on aerobic capacity and cardiovascular data in PwMS.
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BACKGROUND/AIM: Multiple sclerosis (MS) is an inflammatory demyelinating central nervous system (CNS) disease. Among the paraclinical tests, brain and spinal Magnetic Resonance Imaging (MRI) is primarily involved in the diagnosis process, and cerebrospinal fluid (CSF) analysis is fundamental in diagnosing MS and the differential diagnosis. A positive relationship was demonstrated between oligoclonal band (OCB) positivity, CSF band number and immunoglobulin G(IgG) index. The study aimed to evaluate whether the number of OCB can predict disease activity and determine a correlation with the IgG index. METHODS: Our study included 401 MS patients who had relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), clinic isolated syndrome (CIS), radiologic isolated syndrome (RIS), Neuromyelitis optica spectrum disorder (NMOSD) and Acute disseminated encephalomyelitis (ADEM) with OCB number groups of 2-4, 4-8, 8-12, and 12 and above. RESULTS: No significant correlation was observed between IgG index, pre-and post-treatment EDSS (Expanded Disability Status Scale Scores) and disease-modifying therapies (DMT). Drug response was better in the patient group with band number between 2 and 8 and post-treatment EDSS scores were lower (1.62±0.44). CONCLUSION: The study results suggested that band number may be as valuable as the IgG index and a predictive biomarker for disease activity.
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Esclerosis Múltiple Crónica Progresiva , Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/diagnóstico por imagen , Esclerosis Múltiple/tratamiento farmacológico , Bandas Oligoclonales/líquido cefalorraquídeo , Esclerosis Múltiple Crónica Progresiva/líquido cefalorraquídeo , Esclerosis Múltiple Recurrente-Remitente/líquido cefalorraquídeo , Inmunoglobulina G/uso terapéuticoRESUMEN
BACKGROUND: We sought to determine the risk factors and clinical outcomes of pregnant women with cerebral venous thrombosis (CVT). METHODS: Nineteen pregnant patients with a diagnosis of CVT were followed in the neurology unit between 2009 and 2012. Patients with central nervous system infection and with CVT secondary to invasive procedures were excluded. Magnetic resonance imaging and magnetic resonance venography were performed for all patients. RESULTS: There were 19 pregnant women ranging in age from 18 to 38 years (mean 27.5 years). The follow-up period ranged from 11 to 24 months (mean 19 months). Symptoms and signs that suggested a rise in intracranial pressure were present nearly in all cases, including headache, vomiting with or without nausea, disturbances of consciousness, and papilledema. Seizures and status epilepticus (with or without preeclampsia) were present in 8 cases. The rate of CVT was higher in the third trimester. The superior sagittal and transverse sinuses were the most commonly affected cerebral sinuses in our patients, and parenchymal involvement was present in 7 patients. There was no maternal mortality, and 20 infants were still alive and healthy. CONCLUSIONS: If magnetic resonance imaging is available, it should be used for the detection of CVT in all pregnant patients instead of computed tomography. Patients with parenchymal lesions, thrombophilia, and antiphospholipid syndrome had a greater risk of being left with neurologic sequelae. For pregnant patients with CVT, low molecular weight heparin in full anticoagulant doses should be continued throughout the pregnancy. Anticoagulant therapy did not appear to predispose patients to further intracranial hemorrhage.
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Trombosis Intracraneal/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Trombosis de la Vena/terapia , Adolescente , Adulto , Imagen Eco-Planar , Femenino , Humanos , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/patología , Neuroimagen , Embarazo , Complicaciones Cardiovasculares del Embarazo/patología , Resultado del Embarazo , Factores de Riesgo , Trombosis de la Vena/complicaciones , Trombosis de la Vena/patología , Adulto JovenRESUMEN
The present article describes two unrelated cases of progressive myoclonic epilepsy (PME) of the Lafora's disease and Unverricht-Lundborg types who were treated with topiramate (TPM) as add-on therapy for their myoclonus. After the initiation of topiramate therapy both cases responded with marked decrease in myoclonic seizure frequency and improvement of quality of life. Topiramate appears to be a useful alternative agent in cases of PME and could be consider for adjunctive therapy.
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Anticonvulsivantes/uso terapéutico , Fructosa/análogos & derivados , Epilepsias Mioclónicas Progresivas/tratamiento farmacológico , Quimioterapia Combinada , Femenino , Fructosa/uso terapéutico , Humanos , Topiramato , Adulto JovenRESUMEN
BACKGROUND: One of the biggest problems for persons with Multiple Sclerosis (PwMS) is dizziness, poor posture, and balance problems that cause injury-causing falls. The aim of our study was to reveal the test-retest reliability and validity of the 3-Meter Backward Walk Test (3MBWT) in mildly disabled PwMS. METHODS: This study included a total of 93 mildly disabled PwMS with mean EDSS of 1.89. 3MBWT, Functional Access Test (FRT), Dynamic Gait Index (DGI), Timed 25-Foot Walk (T25FW), and Timed-Up and Go (TUG) were applied to the patients. To measure test-retest reliability, a second evaluation was performed three days after the first evaluation. RESULTS: Cronbach's alpha coefficient was found to be 0.998 (excellent). For intra-rater agreement, the ICC values in the individual test were 0.998. The SEM value was 0.18, the MDC value was found to be 0.50. A very strong correlation was revealed between the 3MBWT and FRT (r: -0.931, p: 0.001), TUG (r: 0.968, p: 0.001), T25FW (r: 0.879, p: 0.001), DGI (r: -0.871, p: 0.001) and falling history (r: 0.932, p: 0.001). CONCLUSION: The 3MBWT was observed to be valid and reliable in mildly disabled PwMS. 3MBWT is an effective and reliable tool for measuring ability to walk backward in mildly disabled PwMS.
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Personas con Discapacidad , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/diagnóstico , Equilibrio Postural , Reproducibilidad de los Resultados , Prueba de Paso , CaminataRESUMEN
BACKGROUND: Although contactin-1 and contactin-2 are known as two proteins involved in axonal regeneration, it is unclear whether these proteins are induced by exercise in persons with multiple sclerosis (PwMS). OBJECTIVE: The aim of this study was to determine the serum levels of contactin-1 and contactin-2 in PwMS and to investigate the change of these markers with exercise. METHODS: A total of 60 participants with relapsing-remitting MS were divided into groups by stratified randomization. The progressive functional exercise was applied to the intervention group. Participants in the control group continued the treatments and lives of the routines. Participants' contactin-1 and contactin-2, cognitive performance and aerobic capacities were evaluated. RESULTS: The comparison of the pre-and post-study values of contactin-1 and contactin-2 showed significant differences only in the intervention group. The contactin-1 and contactin-2 values were similar between the groups before the exercise, whereas a significant difference was found in favor of the intervention group after the exercise. Paced Auditory Serial Addition Test-3 value increased significantly only in the intervention group. CONCLUSION: With this study, it was shown for the first time that contactin-1 and contactin-2, which play an important role in axonal regeneration and axonal organization, can be increased by exercise.
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Personas con Discapacidad , Esclerosis Múltiple , Humanos , Esclerosis Múltiple/terapia , Contactina 2 , Contactina 1 , Ejercicio FísicoRESUMEN
BACKGROUND: Multiple sclerosis is a disease that can reduce the quality of life with a physical disability, neuropsychiatric disorders, and cognitive dysfunctions. Therefore, multiple sclerosis treatment should include treatments for cognitive and neuropsychiatric disorders and pharmacological treatments. This study aimed to examine the effects of exercise on neuropsychiatric disorders, problem-solving skills, and emotional intelligence in multiple sclerosis patients. METHODS: Thirty-six female relapsing-remitting multiple sclerosis patients aged between 18 and 45 years, with an Expanded Disability Status Scale between 1 and 3, who were diagnosed with definitive multiple sclerosis according to the revised McDonald criteria were included in the study. Participants completed outcome measures before and after the 12-week exercise program. Demographic/clinical information of the participants was obtained at baseline, neurological examinations were performed, and graded exercise testing on a bicycle ergometer was performed to determine aerobic capacity. Short Form-12 Version 2, Hospital Anxiety and Depression Scale, Modified Fatigue Impact Scale, Problem-Solving Inventory, Emotional Intelligence Scale were evaluated before and after the exercise program of the participants. RESULTS: While a significant increase was observed in the HRpeak values ââof the participants after the exercise (p < 0.05), the VO2max values also showed a highly significant difference compared to the pre-treatment values. (p < 0.01). While a significant difference was detected in the mental subparameter of Short Form-12 (p < 0.05), a high level of significant difference was found in the physical subparameter (p < 0.01). While no significant difference was observed in the Hospital Anxiety and Depression Scale anxiety subparameter (p > 0.05), a significant difference was found in the depression subparameter (p < 0.01). There was a significant difference in Modified Fatigue Impact Scale physical and cognitive subparameters compared to pre-treatment (p < 0.01). A significant difference was observed in the Emotional Intelligence Scale total score after the treatment (p < 0.01). CONCLUSIONS: The results of our study showed that exercise in relapsing-remitting multiple sclerosis patients provided significant improvements in emotional intelligence, improved neuropsychiatric parameters, and increased problem-solving skills. In addition, to the best of our knowledge, this study is the first study in the literature to investigate the effect of physical activity exercises on problem-solving skills in multiple sclerosis patients.
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Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Adolescente , Adulto , Estudios Transversales , Inteligencia Emocional , Ejercicio Físico , Fatiga/etiología , Fatiga/psicología , Femenino , Humanos , Persona de Mediana Edad , Esclerosis Múltiple/terapia , Esclerosis Múltiple Recurrente-Remitente/psicología , Calidad de Vida , Adulto JovenRESUMEN
BACKGROUND: Multiple sclerosis (MS) is a chronic progressive neurodegenerative disease of the central nervous system. Although there is increasing evidence that aerobic exercise has a positive effect on both cognitive and psychological functioning, there is limited evidence for Relapsing-Remitting MS (RRMS) patients. Moreover, it is unclear at what exercise modality and intensity the irisin, the cleaved and circulating form of the exercise-associated membrane protein Fibronectin Type III Domain Containing 5, is induced in patients with MS. This study aimed to investigate the effect of a regular aerobic exercise program on irisin serum level, depression, fatigue, and cognitive performance in patients with MS. METHODS: Thirty-two individuals with RRMS were randomized into 2 groups as control and study groups (mean EDSS score 1.69 and 1.97, respectively). While the Study Group received a combined exercise training consisting of three sessions of aerobic exercise and Frenkel Coordination Exercises per week for 6 weeks, the Control Group received only Frenkel Coordination Exercise training. Before and after the study, the cognitive performance of the participants were evaluated with the Paced Auditory Serial Addition Test with 3-second stimulus (PASAT-3), their maximum aerobic capacity with the Fitmate Pro® (VO2max), their fatigue status with the Fatigue Impact Scale (FIS), and their depression status with the Beck Depression Inventory (BDI). Irisin serum levels were analyzed with Enzyme-Linked ImmunoSorbent Assay (ELISA) test from the serum samples of individuals. RESULTS: Our results revealed that the irisin serum level significantly increased in the Study Group. Significant improvement in aerobic capacity, PASAT-3, FIS, and BDI values was observed in the Study Group compared to the Control Group. When the ΔIrisin, ΔVO2max, ΔFIS, and ΔBDI values between the groups were compared, a significant difference was found in favor of the study group. CONCLUSION: The aerobic exercise revealed significant changes in depression, fatigue and irisin serum levels in MS patients. We think that this study, in which a significant increase in irisin serum level, significant improvement in depression, cognitive performance and fatigue states were obtained in the Study Group, will be a pioneering study for the future studies aiming to investigate the effects of irisin serum level on these symptoms in detail.
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Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Enfermedades Neurodegenerativas , Depresión/psicología , Depresión/terapia , Ejercicio Físico , Fatiga/etiología , Fatiga/psicología , Fatiga/terapia , Fibronectinas , Humanos , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Esclerosis Múltiple Recurrente-Remitente/psicología , Esclerosis Múltiple Recurrente-Remitente/terapiaRESUMEN
BACKGROUND: During the pandemic, many neurological symptoms have been evaluated as complications of COVID-19 pneumonia. OBJECTIVE: To investigate the frequency and characteristics of neurological findings, and their effects on the prognosis of patients with COVID-19 pneumonia who consulted with the Neurology department. METHODS: Data on 2329 patients who were hospitalized with the diagnosis of COVID-19 pneumonia in our hospital were scanned. The clinical, laboratory and radiological findings relating to treatment of 154 patients who required neurological consultation were retrospectively evaluated by reviewing the clinical notes. RESULTS: The number of COVID-19 pneumonia patients who required neurological consultations while hospitalized in the ICU was 94 (61.0%). The most common symptom among these patients was hyperactive delirium. Mean age, ferritin levels and CRP values ââof those with delirium were higher, while the mean lymphocyte percentage were lower, than those of the patients without delirium. Epileptic seizures were observed in eight patients without an epilepsy diagnosis. Two patients were diagnosed with GBS and one patient with ICU neuropathy. The D-dimer levels of patients with acute hemorrhagic CVD and the thrombocyte levels of patients with acute ischemic CVD were found to be higher than in patients without acute ischemic CVD. CONCLUSION: The proportion of patients who required neurological consultations was higher in the ICUs. We observed neurological symptoms more frequently in the advanced age group. There were no significant increases in the incidence of other neurological conditions except delirium, in COVID-19 patients. We think that further studies are needed to support our data.
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COVID-19 , Enfermedades Cardiovasculares , Delirio , COVID-19/complicaciones , Delirio/diagnóstico , Delirio/epidemiología , Delirio/etiología , Humanos , Estudios Retrospectivos , Convulsiones/etiologíaRESUMEN
Background Multiple sclerosis (MS) is an autoimmune and neurodegenerative disease of the central nervous system in which disease activity can be monitored with some biomarkers. The aim of our study was to investigate serum Glial Fibrillary Acidic Protein (GFAP) and Neurofilament Light Chain (NFL) in relapsing-remitting MS (RRMS) patients after the aerobic exercise. Methods A total of 38 participants with RRMS (Expanded Disability Status Scale: 1.0 - 4.5) were randomized to a study group (3 × /week for 8 weeks at 60 - 70 % of maximal aerobic capacity (VO2max) + home exercises) and a control group (were given home exercises programme 3 times a week for 8 week). Serum NFL and GFAP levels were analyzed using enzyme-linked immunosorbent analysis method before and at the end of 8 weeks. Results: NFL and GFAP levels were statistically lower in the study group at the end of the study than before the study. In the control group, no significant changes were observed in serum NFL and GFAP levels. ΔNFL levels were significantly higher in the study group than control group. Conclusion It was shown, for the first time that serum GFAP and NFL levels (%10 and % 32, respectively) in RRMS patients decreased after aerobic exercise. Our study is important in terms of investigating the effects of aerobic exercise in individuals with RRMS and elucidating the underlying measurable biomarkers. The significant reduction of NFL and GFAP, which have an important role in the pathology associated with nervous system damage in MS, with aerobic exercise may be promising in understanding the regulation of disease activity in MS patients.
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Esclerosis Múltiple , Enfermedades Neurodegenerativas , Biomarcadores , Ejercicio Físico , Proteína Ácida Fibrilar de la Glía , Humanos , Filamentos IntermediosRESUMEN
BACKGROUND: Elevated levels of chemerin can predict future ischemic cerebrovascular disease. Although chemerin is thought to play a role in atherosclerotic inflammation, whether circulating chemerin levels are associated with the severity of atherosclerosis remains to be determined. OBJECTIVES: Through the use of carotid Doppler ultrasonography, our aim in this study was to investigate the relationships of serum chemerin levels with carotid intima-media thickness (CIMT) as an indicator of generalized atherosclerosis. METHODS: This study compared 40 patients with ischemic stroke and 40 healthy subjects. Measurements were made at end-diastole using color Doppler ultrasonography (CDUS) after a 5-min rest interval in a quiet and dark room. CIMT was defined as the distance between the innermost edge of the luminal echo to the innermost edge of the media/adventitia echo. CIMT was measured in the posterior wall of both common carotid arteries within 1 cm proximally to the bulbus. Three measurements were made on both sides and the average measurement was taken as the CIMT. Serum chemerin levels were determined in all patients and healthy subjects. RESULTS: Serum chemerin levels were significantly higher in the patient group than in the control group (p=0.004). Serum chemerin levels were positively correlated with CIMT (p<0.05). There was a significant difference between the groups with regard to CIMT (p<0.001). CONCLUSION: Elevated serum chemerin levels appear to be associated with CIMT, thus suggesting that a link exists between chemerin and atherosclerotic ischemic cerebrovascular disease.
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Aterosclerosis , Enfermedades de las Arterias Carótidas , Grosor Intima-Media Carotídeo , Quimiocinas/sangre , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Arteria Carótida Común/diagnóstico por imagen , Humanos , Factores de Riesgo , UltrasonografíaRESUMEN
BACKGROUND: This study aimed to detect ataxia in patients with multiple sclerosis (PwMS) with a deep learning-based approach based on images showing plantar pressure distribution of the patients. The secondary aim of the study was to investigate an alternative and objective method in the early diagnosis of ataxia in these patients. METHODS: A total of 105 images showing plantar pressure distribution of 43 ataxic PwMS and 62 healthy individuals were analyzed. The images were resized for the models including VGG16, VGG19, ResNet, DenseNet, MobileNet, NasNetMobile, and NasNetLarge. Feature vectors were extracted from the resized images and then classified using Support Vector Machines (SVM), K-Nearest Neighbors (K-NN), and Artificial Neural Network (ANN). A 10-fold cross-validation was applied to increase the validity of the classifiers. RESULTS: The VGG19-SVM hybrid model showed the highest accuracy, sensitivity, and specificity values (89.23%, 89.65%, and 88.88%, respectively). CONCLUSION: The proposed method provided an automatic decision support system for detecting ataxia based on images showing plantar pressure distribution in patients with PwMS. The performance of the proposed method indicated that this method can be applied in clinical practice to establish a rapid diagnosis of ataxia that is asymptomatic or difficult to detect clinically and that it can be recommended as a useful aid for the physician in clinical practice.
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Redes Neurales de la Computación , Máquina de Vectores de Soporte , Ataxia/diagnóstico por imagen , HumanosRESUMEN
Syncopal convulsions and epileptic seizures are clinically hard to distinguish and differ in terms of treatment approaches. It is important to consider the cardiac arrhythmias that impair cerebral perfusion in the differential diagnosis of antiepileptic treatment-resistant convulsions. Here we offer a 72 year old male patient glossopharengial neuralgia after swallowing associated with recurrent episodes of syncopal convulsions. The patient was successfully treated with temporary pacemaker and carbamazepine. This phenomenon is noteworthy in terms of both asystole triggered by glossopharengial neuralgia and syncopal convulsions which are rare in the differential diagnosis of epileptic seizures.
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Enfermedades del Nervio Glosofaríngeo , Paro Cardíaco , Marcapaso Artificial , Anciano , Enfermedades del Nervio Glosofaríngeo/complicaciones , Humanos , Masculino , Convulsiones , Síncope/etiología , Síncope/terapiaRESUMEN
OBJECTIVES: This study aims to evaluate the effects of ocrelizumab (OCZ) on familial Mediterranean fever (FMF) attacks in multiple sclerosis (MS) patients with FMF (MS+FMF patients). PATIENTS AND METHODS: This retrospective observational study included 11 patients (2 males, 9 females; mean age 46.6±9.2; range, 22 to 55 years) with MS+FMF hospitalized between January 2016 and July 2019. Demographic, clinical, and laboratory parameters and patient reported outcomes were analyzed in patients treated with OCZ for 18 months. RESULTS: Combining OCZ with colchicine in MS+FMF patients significantly reduced the frequency of FMF attacks (p=0.003) and the frequency of joint attacks (p=0.002). Consistent with the clinical improvement, the maximum serum C-reactive protein levels were significantly decreased after combination therapy compared to before combination therapy (p=0.003). MS+FMF patients reported that FMF disease activity improved after OCZ therapy (Visual Analog Scale [VAS] 74±9.6 vs. VAS 46.5±8.1 mm, p=0.003). CONCLUSION: Ocrelizumab therapy led to a prominent decrease in the frequency of FMF attacks, alleviated functional impairment, and improved quality of life in MS+FMF patients.
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BACKGROUND: This study reported on a variety of psychological reactions related to anxiety, sleep quality, depression, fatigue, and quality of life in individuals with multiple sclerosis (MS), related to the Covid-19 quarantine experience. OBJECTIVE: The aim of this study was to investigate the neuropsychiatric effects of the COVID-19 pandemic in MS patients and to analyze the risk factors contributing to psychological stress. METHODS: The study was designed as a prospective, cross-sectional survey study. Multiple assessment tools that are used in neurological practice, including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fatigue Impact Scale (FIS), Pittsburgh Sleep Quality Index (PSQI), and Multiple Sclerosis Quality of Life-54 (MSQOL-54) were administered prospectively both during the early and the peak stages of COVID-19 outbreak (ESO and PSO, respectively). The survey forms were designed using SurveyMonkey and the participants were participating in the survey via a web link and QR code. RESULTS: Fifty patients were included in the study. BDI scores, PSQI and FSI measurements, cognitive and social subscale scores and total FIS score, MSQOL-54 measurements, physical and mental subscale scores, and total MSQOL-54 score at PSO were significantly different than those at ESO. The body mass index values of the patients increased significantly at PSO compared to those measured at ESO. CONCLUSIONS: The results provide a basis for the development of psychological interventions that could minimize the prevalence of sleep disorders and depression and could improve patients' quality of life during the outbreak.