The Role of the Lipid Profile and Oxidative Stress in Fatigue, Sleep Disorders and Cognitive Impairment in Patients with Multiple Sclerosis.

The aim of this study is to investigate the relationship of the lipid profile, dysfunctional high-density lipoprotein, ischaemia-modified albumin and thiol-disulfide homeostasis with cognitive impairment, fatigue and sleep disorders in patients with multiple sclerosis. The cognitive functions of patients were evaluated with the Brief International Cognitive Assessment for Multiple Sclerosis battery. Fatigue was evaluated with the Fatigue Severity Scale and the Fatigue Impact Scale. The Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale were used to assess patients' sleep disturbance. Peripheral blood samples were collected, and lipid levels and myeloperoxidase and paraoxonase activity were measured. The myeloperoxidase/paraoxonase ratio, which indicates dysfunctional high-density lipoprotein, was calculated. Thiol-disulfide homeostasis and ischaemia-modified albumin were measured.
We did not identify any relationship between dysfunctional high-density lipoprotein and the physical disability, cognitive decline, fatigue and sleep problems of multiple sclerosis. Thiol-disulfide homeostasis was associated with cognitive scores. The shift of the balance towards disulfide was accompanied by a decrease in cognitive scores. On the other hand, we did not detect any relationship between fatigue and sleep disorders and thiol-disulfide homeostasis. Our findings revealed a possible correlation between cognitive dysfunction and thiol-disulfide homeostasis in multiple sclerosis patients.

The relationship between trunk control, spinal posture, and spinal mobility in patients with multiple sclerosis: a cross-sectional study.

Background/aim: Trunk control, which plays a key role in balance and mobility, decreases in patients with multiple sclerosis (PwMS) and many parameters such as sensory, motor, and musculoskeletal systems affect trunk control. The aim of this study was to compare trunk control, spinal mobility, and spinal posture in PwMS with healthy controls and investigate the relationship between trunk control with spinal posture and spinal mobility in PwMS. Materials and methods: The study was completed with 38 PwMS and 38 healthy controls with matched age and sex. Trunk control was evaluated with the Trunk Impairment Scale (TIS). Spinal posture and mobility were evaluated in sagittal and frontal planes using an IDIAG M360 Spinal Mouse. Spinal posture was evaluated in upright, maximum flexion, extension, left and right lateral flexion positions, and spinal mobility was evaluated from upright to flexion, extension, right and left flexion positions in sagittal and frontal planes. Results: TIS scores, thoracic mobility angles (from upright to flexion and left lateral flexion), lumbar mobility angles (from upright to extension and right lateral flexion) and lumbar posture angle (maximum right lateral flexion) were lower, and thoracic posture angles (upright and maximum extension) were higher in PwMS than healthy controls (p < 0.05). No significant difference was found between other spinal postures and mobility values. In addition, there was only a negative relationship between thoracic spinal mobility from upright to extension and trunk control in PwMS (r = -0.349; p = 0.032). Conclusion: These findings indicate the importance of early detection of trunk disturbances in PwMS. Thus, even in the early stages of multiple sclerosis, detailed trunk assessment will guide the implementation of comprehensive exercise programs.

Clinicoradiological evaluation of oxidative stress activity in acute cerebral infarction in the first 24 h and the qualitative importance of dysfunctional HDL in stroke.

BACKGROUND: Acute cerebral infarction (ACI) occurs as a result of instant disruption of vascular flow that causes disbalance between oxidative/antioxidative activity. We examined the relationship of serum neuro-oxidative stress parameters with stroke severity and infarct volume in ACI and emphasized the qualitative importance of high-density lipoprotein (HDL) on its relationship with myeloperoxidase (MPO) and paraoxonase-1 (PON1) in the acute period of stroke. METHODS: One hundred ACI patients applied within the first 24 h and 50 healthy volunteers were included. The patient group was evaluated with demographic data (including arrival serum biochemical assessment), clinical disability scores, infarct volume, serum oxidative/antioxidative parameters (lipid hydroperoxide (LOOH), MPO, PON1, MPO/PON ratio). The relevant serum parameters were compared with the control group. Dysfunctional HDL measurement was based on detecting dysfunctionality as a result of a high positive correlation between the dysfunctional feature of HDL and the MPO/PON ratio. The correlation of serum parameters, clinical disability score, and infarct volume were evaluated, and independent analyses of variability with comorbidities were performed. RESULTS: A negative correlation between PON1 and arrival NIH score/scale (NIHSS), LOOH and discharge modified rankin scale (mRS), triglyceride level, and infarct volume; a positive correlation between MPO\PON ratio and infarct volume was determined. Logistic regression analyses showed that hypertension, diabetes, and high HbA1C may be predictors of stroke severity, and diabetes mellitus, high HbA1C, infarct volume, and high NIHSS score may be predictors of early disability (p < 0.005). The ROC curve analysis revealed that determining the cut-off value for LOOH is of importance in determining early disability scores (7.2 and 6.2, respectively). DISCUSSION: The balance between oxidative and antioxidative stress parameters and their quantitative/qualitative changes is of importance, especially in the acute period of ACI. Dysfunctional HDL's evolution and its relationship with other oxidants are significant not only in the cardiovascular aspect but also in the clinicoradiological aspect.

Changes in face and face pareidolia processing in patients with migraine: an ERP study.

Migraine is a multifactorial brain disorder characterized by recurrent disabling headache attacks. One of the possible mechanisms in the pathogenesis of migraine may be a decrease in inhibitory cortical stimuli in the primary visual cortex attributable to cortical hyperexcitability. The aim of this study was to investigate the neural correlates underlying face and face pareidolia processing in terms of the event-related potential (ERP) components, N170, vertex positive potential (VPP), and N250, in patients with migraine. In total, 40 patients with migraine without aura, 23 patients with migraine and aura, and 30 healthy controls were enrolled. We recorded ERPs during the presentation of face and face pareidolia images. N170, VPP, and N250 mean amplitudes and latencies were examined. N170 was significantly greater in patients with migraine with aura than in healthy controls. VPP amplitude was significantly greater in patients with migraine without aura than in healthy controls. The face stimuli evoked significantly earlier VPP responses to faces (168.7 ms, SE = 1.46) than pareidolias (173.4 ms, SE = 1.41) in patients with migraine with aura. We did not find a significant difference between N250 amplitude for face and face pareidolia processing. A significant difference was observed between the groups for pareidolia in terms of N170 [F(2,86) = 14,75, P < 0.001] and VPP [F(2,86) = 16.43, P < 0.001] amplitudes. Early ERPs are a valuable tool to study the neural processing of face processing in patients with migraine to demonstrate visual cortical hyperexcitability.NEW & NOTEWORTHY Event-related potentials (ERPs) are important for understanding face and face pareidolia processing in patients with migraine. N170, vertex positive potential (VPP), and N250 ERPs were investigated. N170 was revealed as a potential component of cortical excitability for face and face pareidolia processing in patients with migraine.

Relationship between thiol-disulphide homeostasis and visual evoked potentials in patients with multiple sclerosis.

PURPOSE: To examine the thiol-disulphide homeostasis during an optic neuritis episode in patients with multiple sclerosis and the relationship between this homeostasis and P100 wave latency. MATERIALS AND METHOD: Visual evoked potential reviews of multiple sclerosis patients who presented with an optic neuritis episode were conducted and P100 latencies were measured. Peripheral blood samples were collected from all patients. Native thiol and total thiol concentrations were measured with the automated method that was recently developed. Their amount of disulphide bonds, disulphide/native thiol, disulphide/total thiol and native thiol/total thiol ratios were calculated. The relationship between P100 latency and thiol-disulphide homeostasis was investigated. RESULTS: A significant positive correlation was determined between the disulphide/native thiol ratio and both mean P100 latency and maximum P100 latency (p = 0.021, r = 0.136; p = 0.030, r = 0.177, respectively). DISCUSSION: As the balance of the plasma dominated by antioxidants moves towards the oxidant side, in other words as a higher rate of thiol is oxidised from the thiol pool, P100 latency is extended. N-acetylcysteine and alpha lipoic acid as well as thiol supplements can improve the thiol-disulphide balance, reinforce antioxidant defence and it can help in slowing down the demyelinating damage.

Man-In-The-Barrel Syndrome: Acute bilateral brachial plexopathy after recurrent microtrauma.

The presence of brachial diplegia despite the normal muscular strength of the lower extremities is called the man-in-the-barrel syndrome (MIBS). Although this rare syndrome often occurs due to the bilateral supratentorial brain lesions, it may also rarely occur as a result of infratentorial causes. In this report, we describe a case presenting with MIBS of which etiological underlying cause was bilateral brachial plexopathy developed secondarily to recurrent microtrauma. A 51-year-old male patient presented to our clinic with complaints of pain and weakness on both arms. After electrodiagnostic examination, bilateral brachial plexopathy was identified. The findings of the patient improved following methylprednisolone therapy. It is very important to determine the treatable causes of this syndrome at an early stage.

Thiol-Disulfide Homeostasis in Cerebral Venous Sinus Thrombosis.

BACKGROUND: The objective of this study is to examine thiol-disulfide homeostasis in patients with cerebral venous sinus thrombosis. METHODS: Fifty-three patients diagnosed with cerebral venous sinus thrombosis and 80 healthy volunteers were included in the study. The native thiol and total thiol concentrations were measured with the newly developed automated method. In addition, their amount of disulfide bonds was calculated. RESULTS: The total thiol and native thiol levels of the patients with cerebral venous sinus thrombosis were significantly lower than the healthy volunteers (p = 0.001, p = 0.001, respectively). In terms of dynamic disulfide bond formation, there was no statistically significant difference between the groups (p > 0.05). A significant negative correlation was determined between native thiol and total thiol levels and the number of sinuses that had thrombosis (r = -0.136, p = 0.033; r = -0.141, p = 0.015, respectively). There was no correlation between National Institutes of Health Stroke Scale score and thiol-disulfide homeostasis parameters. CONCLUSIONS: This study is the first study to examine thiol-disulfide homeostasis in patients with cerebral venous sinus thrombosis. The thiol-disulfide balance is impaired under oxidative stress. This study revealed that this balance is disrupted in correlation with widespread thrombosis in patients with cerebral venous sinus thrombosis. Therefore, fortification of thiol deficiency with N-acetyl cysteine or alpha-lipoic acid can prevent the progress of thrombosis and can be beneficial in cerebral venous sinus thrombosis treatment.

A novel oxidative stress marker in migraine patients: dynamic thiol-disulphide homeostasis.

The aim of this study was to investigate dynamic thiol-disulphide homeostasis as a novel oxidative stress parameter in migraine patients. A total of 115 participants were included in the study, and 63 of whom were diagnosed with migraine. The total thiol (-SH+-S-S-) and native thiol (-SH) levels in the serum were measured in all patients and healthy individuals. The dynamic disulphide bond (-S-S-) and (-S-S-) × 100/(-SH), (-S-S-) × 100/(-SH+-S-S-), and -SH × 100/(-SH+-S-S-) ratios were calculated from these values. The total and native thiol levels of migraine patients participating in the study were found to be significantly higher than the total and native thiol levels of healthy individuals. No statistically significant difference was determined in terms of the dynamic disulphide bond amounts or (-S-S-) × 100/(-SH), (-S-S-) × 100/(-SH+-S-S-), and -SH × 100/(-SH+-S-S-) ratios. The total thiol, native thiol, and dynamic disulphide bond levels, and (-S-S-) × 100/(-SH), (-S-S-) × 100/(-SH+-S-S-), and -SH × 100/(-SH+-S-S-) ratios were not correlated with attack frequency, pain intensity, or migraine type. Oxidative stress is considered to be one of the molecular changes underlying the pathogenesis of migraine.

A novel oxidative stress marker in patients with Alzheimer's disease: dynamic thiol-disulphide homeostasis.

OBJECTIVE: The aim of this study was to evaluate the dynamic thiol-disulphide homeostasis as an oxidative stress parameter, using a newly proposed method, in patients with Alzheimer's disease. METHODS: In total, 97 participants were included in the study. Among them, 51 had been diagnosed with Alzheimer's disease, and the remaining 46 were healthy individuals. Total thiol (-SH+-S-S-) levels and native thiol (-SH) levels in serum of each participant were measured. The amount of dynamic disulphide bonds (-S-S-) and (-S-S-) ×100/(-SH), (-S-S-) ×100/(-SH+-S-S-), and -SH×100/(-SH+-S-S-) ratios were calculated from these values. The obtained data were used to compare Alzheimer's disease patients with healthy individuals. RESULTS: The average total thiol and native thiol levels of patient with Alzheimer's disease in the study were found to be significantly lower than those levels of healthy individuals. In addition, in the patient group, the -S-S-×100/-S-S+-SH ratio was found to be significantly higher, whereas the -SH×100/-S-S+-SH ratio was found to be significantly lower compared with healthy individuals. Total thiol and native thiol levels, dynamic disulphide bond amount, and -S-S-×100/-SH, -S-S-×100/-S-S+-SH, and -SH×100/-S-S+-SH ratios were not found to be correlated with mini mental state examination score or duration of disease. CONCLUSION: Recent studies have shown that oxidative stress is the one of the molecular changes underlying the pathogenesis of Alzheimer's disease. In this study, we have investigated the dynamic thiol-disulphide homeostasis in patients with Alzheimer's disease, using a novel method.

Ictal movements mimicking Islamic praying rituals: localizing value in a series of 12 patients.

The aim of this study was to determine the lateralizing value of the ictal praying gesture and of ictal religious speech in patients who are candidates for epilepsy surgery. We retrospectively searched video/EEG data of 1430 patients who were evaluated at an epilepsy center from 1999 to 2014. Twelve patients were found to have demonstrated ictal praying during their complex partial seizures. Among all patients, the ictal focus was in the right temporal region. Ictal behavior simulating prayer, which includes both hands as in the Islamic ritual tradition is a rare automatism that lateralizes the ictal focus.

Investigation of small fiber neuropathy in patients with diabetes mellitus by corneal confocal microscopy.

OBJECTIVES: Corneal confocal microscopy (CCM) is a non-invasive technique that examines the corneal cellular structure. Its use in the detection of small fiber neuropathy is being researched. In our study, we examined the role of CCM in the detection of small fiber neuropathy in diabetic patients, as well as the differences between CCM findings in diabetic patients with and without overt polyneuropathy with neuropathic symptoms. METHODS: 56 Diabetes Mellitus (DM) patients and 18 healthy controls were included in the study. The individuals included in the study were divided into three groups. Patients with diabetes who were found to have polyneuropathy according to electrophysiological diagnostic criteria were classified as Group 1, patients with diabetes and neuropathic symptoms without overt polyneuropathy according to electrophysiological diagnostic criteria were classified as Group 2, and healthy individuals were classified as Group 3. Electrophysiological examination and corneal imaging with CCM were performed in all groups. RESULTS: The CNFD and CNFL values of individuals in the diabetic group were discovered to be lower. CNFD values differ statistically between the groups (p = 0.047). Group 1-Group 3 differs from Group 2-Group 3 (respectively; p = 0.018, p = 0.048). CONCLUSION: Our study demonstrates that CCM can be used in patients with neuropathic symptoms and no polyneuropathy detected in EMG and thought to have small fiber neuropathy. CCM provides an opportunity for early diagnosis in small fiber neuropathy.

Reliability and validity of the 4-meter walk test in patients with multiple sclerosis.

BACKGROUND: Walking speed is considered a vital sign of health and better functional outcomes. It is important to assess walking speed both for disease monitoring and before starting rehabilitation. The aim of this study was to examine the reliability, validity, minimal detectable change, and the ideal cutoff time for differentiating patients with multiple sclerosis (PwMS) who fall from PwMS who do not. METHODS: This study included 43 PwMS (26 female and 17 male) and 36 healthy controls (23 female and 13 male). The 4-meter walk test (4-MWT) was conducted with the 10-meter walk test (10-MWT), timed up and go (TUG) test, dynamic gait index (DGI), timed 25-foot walk (T25-FW), multiple sclerosis walking scale-12 (MSWS-12), and the expanded disability status scale (EDSS). RESULTS: Excellent test-retest reliability (ICC = 0.971) was found for the 4-MWT. The SEM value was 0.38 and MDC value was 1.05. The correlations with 4-MWT, 10-MWT, TUG, DGI, T25-FW, MSWS-12, and EDSS were found to be statistically significant (p < 0.001). PwMS had longer 4-MWT times than healthy controls, and PwMS fallers had longer 4-MWT times than non-fallers with PwMS (r between 0.668 and -0.858; p < 0.05 for all). In order to distinguish fallers from non-fallers with PwMS, a 4-MWT cutoff time of 4.14 s was shown to be optimal. CONCLUSION: The 4-MWT was found to be valid and reliable for PwMS. It is concluded that the 4-MWT is a feasible assessment method for clinical and methodological studies of PwMS with mild to moderate disability.

Relationship between pattern reversal visual evoked potential P100 wave latency and dysfunctional HDL in patients with multiple sclerosis subjected to an optic neuritis attack: A case-control study.

Optic neuritis frequently occurs during the clinical course of multiple sclerosis (MS). In this condition, demyelination of the optic nerve occurs, which electrophysiologically causes a delay in P100 wave latency. Sensitive cholesterol homeostasis is critical for the formation of the myelin sheath and for myelin to become functionally mature. High-density lipoprotein (HDL) becomes dysfunctional under oxidative stress and plays an important role in the pathogenesis of MS. In this study, HDL levels of MS patients suffering from optic neuritis were compared with those of healthy individuals, and the relationship between pattern reversal visual evoked potential (PRVEP) P100 wave latency and HDL levels in patients with optic neuritis attacks was analyzed. PRVEP studies were performed in patients with MS who had an episode of optic neuritis, and P100 wave latencies were measured. Peripheral blood samples were collected from healthy participants and patients. Lipid levels and myeloperoxidase (MPO) and paraoxonase (PON) activities were measured, and the MPO/PON ratio was then calculated. The lipid profiles and dysfunctional HDL levels in the healthy and patient groups were compared. Finally, the relationship between these parameters and the PRVEP-P100 wave latency was examined. Total cholesterol and low-density lipoprotein (LDL) levels were significantly higher in the patient group (P = .044; P = .038, respectively). There was no statistically significant difference in HDL levels between groups (P = .659). The distribution of MPO values was similar between groups (P = .452). PON values were significantly lower, whereas the MPO/PON ratios were significantly higher in the patient group than in the control group (P = .025; P = .028, respectively). A statistically significant positive correlation was found between the elevated MPO/PON ratio, representing dysfunctional HDL, and both the mean and maximum PRVEP-P100 wave latencies (P < .001, R = 0.690; P < .001, R = 0.815, respectively). A dysfunctional form of HDL may lead to poor deactivation of remyelination-limiting factors and may ultimately be associated with poor outcomes in optic neuritis.

Investigation of parameters related to lower extremity muscle strength and proprioception in Patients with Multiple Sclerosis: a cross-sectional study.

BACKGROUND: Patients with Multiple Sclerosis (PwMS) may experience a decline in balance, gait, and mobility as well as an increase in fear of falling (FoF) and fatigue due to weaker muscles and proprioceptive loss in their lower limbs. The study aimed to compare lower extremity muscle strength and proprioception, balance, functional mobility, gait, FoF, and fatigue between PwMS and healthy controls and to investigate the relationship between lower extremity muscle strength and proprioception and balance, functional mobility, gait, FoF, and fatigue in PwMS. METHODS: The study was completed with 35 PwMS and 35 healthy controls with matching age and gender. The 5 Repetition Sit-to Stand Test (5-STS-test), knee and ankle reposition tests (using a digital inclinometer), the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, the Dynamic Gait Index (DGI), the Falls Efficacy-International (FES-I), and the Fatigue Severity Scale (FSS) were used for evaluations. RESULTS: The 5-STS test, knee and ankle reposition tests, TUG, FES-I, and FSS Test scores were higher and BBS and DGI scores were lower in PwMS compared to healthy controls (p < 0.05). BBS, DGI, TUG, FES-I, and FSS were associated with 5-STS test and knee and ankle reposition tests except for some nondominant reposition tests in PwMS (r between 0.342 and -0.714; p < 0.05 for all). CONCLUSION: Lower extremity muscle strength and proprioception were associated with balance, functional mobility, gait, FoF, and fatigue in PwMS. These results suggested that detailed assessment of neuromuscular parameters in lower extremity function is important in determining the appropriate rehabilitation programs.

Acute "upside-down" visual inversion in a patient with multiple sclerosis.

Visual and oculomotor signs and symptoms are common and well defined in patients with multiple sclerosis. On the other hand, the phenomenon of "upside-down" reversal of vision is very rare and thus not well known. The physiopathology of this phenomenon also has not been well understood. Herein, we present a female patient with multiple sclerosis, who developed acute "upside-down" visual inversion, and discuss possible mechanisms of this rare phenomenon.

Aquaporin-4 protein antibody-associated optic neuritis related to neuroendocrine tumor after receiving an inactive COVID-19 vaccine.

Neuromyelitis optica (NMO), also known as Devic's disease, is a rare, autoimmune, and recurrent demyelinating disorder that primarily affects the spinal cord and optic nerve. We report a case with recurrent optic neuritis caused by the paraneoplastic NMO spectrum disorder in the setting of a gastric neuroendocrine tumor 2 weeks after receiving an inactive COVID-19 vaccine.

Event-Related Potentials Elicited by Face and Face Pareidolia in Parkinson's Disease.

BACKGROUND: Parkinson's disease is associated with impaired ability to recognize emotional facial expressions. In addition to a visual processing disorder, a visual recognition disorder may be involved in these patients. Pareidolia is a type of complex visual illusion that permits the interpretation of a vague stimulus as something known to the observer. Parkinson's patients experience pareidolic illusions. N170 and N250 waveforms are two event-related potentials (ERPs) involved in emotional facial expression recognition. OBJECTIVE: In this study, we investigated how Parkinson's patients process face and face-pareidolia stimuli at the neural level using N170, vertex positive potential (VPP), and N250 components of event-related potentials. METHODS: To examine the response of face and face-pareidolia processing in Parkinson's patients, we measured the N170, VPP, and N250 components of the event-related brain potentials in a group of 21 participants with Parkinson's disease and 26 control participants. RESULTS: We found that the latencies of N170 and VPP responses to both face and face-pareidolia stimuli were increased along with their amplitudes, and the amplitude of N250 responses decreased in Parkinson's patients compared to the control group. In both control and Parkinson's patients, face stimuli generated greater ERP amplitude and shorter latency in responses than did face-pareidolia stimuli. CONCLUSION: The results of our study showed that ERPs associated with face and also face-pareidolia stimuli processing are changed in early-stage neurophysiological activity in the temporoparietal cortex of Parkinson's patients.

Dynamic thiol-disulphide homeostasis in patients with Guillain-Barre Syndrome.

OBJECTIVE: The aim of this study was to evaluate dynamic thiol-disulphide homeostasis as a novel oxidative stress parameter in patients with Guillain-Barre syndrome (GBS). METHODS: A total of 130 participants were included in this study, 70 of whom were diagnosed with GBS. Total thiol (-SH+-S-S-) and native thiol (-SH) levels in serum were measured in all patients and healthy individuals. Amount of dynamic disulphide bond were calculated from these values. In the GBS patients, disability status was determined by the Hughes and Medical Research Center (MRC) sum scores at the time of admission and 3 months thereafter. RESULTS: Total and native thiol levels were significantly lower in patients with GBS compared with healthy individuals. There was no statistically significant difference in the number of dynamic disulphide bonds between groups. There was a negative correlation between total thiol levels in patients with GBS and Hughes scores at month 3. DISCUSSION: Oxidative stress is among the molecular changes underlying the pathogenesis of GBS. In this study, we have investigated the dynamic thiol-disulfide homeostasis in patients with epilepsy using a new method in the literature. Also, functional recovery in Guillain-Barré syndrome patients could be promoted by increasing antioxidant activity.

Monocyte-to-high density lipoprotein ratio is associated with a decreased compound muscle action potential amplitude in patients with diabetic axonal polyneuropathy.

The monocyte-to-high density lipoprotein ratio (MHR) has recently been implemented as an indicator of inflammation and oxidative stress. The present study characterized MHR in patients with diabetic polyneuropathy (DPN), in which oxidative stress and microvascular damage play a role in pathogenesis, relative to patients with non-DPN, diabetic patients without polyneuropathy, and healthy individuals. We further aimed to evaluate the association between MHR and the decreased compound muscle action potential (CMAP) amplitude of patients with diabetic axonal polyneuropathy.We enrolled 90 patients with DPN, 75 patients with nonDPN, 92 diabetic patients without polyneuropathy, and 67 healthy individuals; The monocyte, high-density lipoprotein cholesterol (HDL-C) values were obtained for all participants and MHR was calculated for each individual. Intergroup comparison was performed. The relationship between MHR and the posterior tibial nerve CMAP amplitudes was examined.Statistically significant negative correlation was observed between MHR and the posterior tibial nerve CMAP amplitudes of patients with DPN. The MHR values of the patients with DPN were significantly higher than those of the patients with non-DPN, diabetic patients without polyneuropathy and the control group.This study demonstrated that diabetic patients with higher MHR values may be more likely to develop polyneuropathy.