The Prevalence of Trigeminal Neuralgia in Turkey: A Population-Based Study.

OBJECTIVE: Population-based studies on the prevalence of trigeminal neuralgia (TN) worldwide are rare and the epidemiology of TN in Turkey is unknown. The aim of this study is to determine the prevalence of TN in Turkey. METHODS: We conducted a cross-sectional, population-based, descriptive epidemiological study in Eregli, Turkey. Participants over the age of 18 were screened using a self-assessment form, and potential patients were identified by a 'neuroscreening team'. Suspected patients were invited for a clinical examination and evaluated by a senior neurologist. Any required imaging was carried out at a university hospital. RESULTS: Data were collected from a total of 9605 participants, after the exclusion of 247 individuals who refused to participate. Seven suspected patients were invited to a public health center for clinical evaluation. One patient was diagnosed with SUNCT (Short-lasting, Unilateral, Neuralgiform headache attacks with Conjunctival injection and Tearing) and one patient was diagnosed with post-herpetic neuralgia. A definite diagnosis of TN was confirmed in five participants. The crude prevalence was found to be 52.1/100.000. The mean age of cases was 62.2 ± 8.3 years and the female/male ratio was 4/1. TN was classified as 'symptomatic' in one patient with multiple sclerosis. The other four cases were diagnosed with classical TN. Right side involvement was identified in three cases (60%), whereas left side involvement was seen in two cases (40%). DISCUSSION: This study establishes the prevalence of TN in Turkey for the first time. The prevalence rate is low when compared with other international studies.

Air pollution, a possible risk factor for multiple sclerosis.

OBJECTIVE: Studies focusing attention on the effects of environmental pollution on the etiology of multiple sclerosis (MS) are on the increase. The aim of this study was to determine MS prevalence in a city home to an iron and steel factory which causes air pollution. METHODS: The study was designed as a cross-sectional, population-based, descriptive epidemiologic study. Eregli city, which has an iron and steel factory and proven air pollution, was screened. Additionally, Devrek city, which is a rural and clean city, located 40 km away from Eregli was assigned and results were compared. A validated questionnaire was used for screening. McDonald 2010 criteria were used to diagnose cases. RESULTS: 32 261 people were screened in Eregli, and 21 963 people were screened in Devrek. In total, 41 patients were diagnosed with clinical definite MS. Crude prevalence was found to be 96.1/100 000 in Eregli and 45.5/100 000 in Devrek. The mean age of patients was 39.8, and the female/male ratio was 1.9. CONCLUSION: The results of this study indicate a more than double MS prevalence rate in the area home to an iron and steel factory when compared to the rural city. This supports the hypothesis that air pollution may be a possible etiological factor in MS.

Restless legs syndrome in type 2 diabetes mellitus.

AIMS: This study aimed to investigate the prevalence of restless leg syndrome (RLS) in type-2 diabetes mellitus (DM) patients and to determine the risk factors. METHODS: Patients were recruited from the Dr. Lütfi Kirdar Kartal Training and Research Hospital Diabetes Center. Patients between 18-80 years of age and meeting a minimum 5 years diagnosis of type-2 DM were included. All patients were examined by the same neurologist in terms of having RLS. The diagnosis was made according to the updated International Restless Legs Syndrome Study Group consensus criteria. Mimicking conditions such as myalgia, venous stasis, leg edema, arthritis, leg cramps, positional discomfort and habitual foot tapping were carefully investigated and excluded. Laboratory data, insulin use, family history and other related co-morbidities connected to RLS patients were recorded. RLS severity assessment was scored and recorded. RESULTS: 318 patients were included in the study. The prevalence of RLS in type-2 DM patients was found to be 28.3%. RLS prevalence in females was 33.3% and 20.6% in males. 39 patients (43.3%) had a family history of RLS. 43 patients with RLS had a co-morbidity link with RLS. Any co-morbidity linked to RLS was not seen in 47 patients. The prevalence rate of RLS in patients without co-morbidities was 17.1%. Mean duration of DM in patients with RLS was 15.6±6.7years while in DM patients without RLS was 13.7±6.3years. The relationship between RLS and the duration of diabetes was found to be statically significant. (p=0.025). 68 (75.6%) of patients diagnosed with RLS were treated with insulin. A statistical significance was found in the development of RLS and insulin usage (p=0.035). CONCLUSIONS: This is the first study which shows the RLS prevalence and risk factors in Turkish type-2 diabetes mellitus patients. The results indicated that RLS is much more frequent in DM patients even after excluding polyneuropathy than in general Turkish population. The duration of diabetes and insulin use are related to RLS.

Greater occipital and supraorbital nerve blockade for the preventive treatment of migraine: a single-blind, randomized, placebo-controlled study.

OBJECTIVE: Nerve injections have been used for the acute and preventive treatment of migraine in recent decades. Most of these injections focused on greater occipital nerve (GON) blockade. However, few studies were placebo controlled, and only a few of them investigated GON and supraorbital nerve (SON) blockade together. This study aimed to evaluate the efficacy of GON and SON blockade with local anesthetics for the preventive treatment of migraine without aura. METHODS: Eighty-seven patients diagnosed with migraine without aura were included in the study. Patients were divided randomly. One group was injected with 1% lidocaine, the other group was injected with 0.9% saline. GON and SON injections were done bilaterally. The injections were repeated weekly for 3 weeks. Patients were followed up for 2 months to assess clinical response. RESULTS: Seventy-one patients completed the study. After 2 months, the number of headache days decreased significantly from 12.8 ± 10.9 to 5.3 ± 7.4, and VAS decreased from 8.3 ± 1.0 to 5.5 ± 1.9 in the blockade group. The number of headache days decreased from 12.4 ± 10.3 to 7.5 ± 7.2 and VAS decreased from 8.2 ± 1.1 to 7.4 ± 1.3 in the placebo group. Response was seen in 65.1% of the patients in the blockade group (65.4% for episodic migraine, 64.7% for chronic migraine) and 28.6% of the patients in the placebo group. The difference was significant. CONCLUSIONS: The results suggest that GON and SON blockade with lidocaine was more effective than the placebo in the prophylactic treatment of both episodic and chronic migraine.

Multiple sclerosis prevalence study: The comparison of 3 coastal cities, located in the black sea and mediterranean regions of Turkey.

The prevalence of multiple sclerosis (MS) has significantly increased all over the world. Recent studies have shown that Turkey has quite a high prevalence. The aim of this study is to estimate prevalence in the Mediterranean and Black Sea regions of Turkey and to compare the results.This study was designed as a door to door survey in 3 cities. One is located in the Mediterranean region (South), 2 are located in the Black Sea region (North). A previous validated form was used for screening in the field. The patients were examined first in the field, then in the regional health facility. McDonald criteria were used for the diagnosis.In total, 26 patients were diagnosed with MS. The prevalence was found to be 18.6/100,000 in Artvin (Black Sea region), 55.5/100,000 in Ordu, (Black Sea region), 52.00/100,000 in Gazipasa (Mediterranean region). The female/male ratio was 2.25.This study is the first prevalence study which was conducted in the Mediterranean City (South) of Turkey. The prevalence rate was found to be higher than expected in the Mediterranean city of Gazipasa. The results showed that the prevalence varies from region to region. Latitude difference was not observed.

Stroke prevalence among the Turkish population in a rural area of Istanbul: A community-based study.

BACKGROUND: The population-based information on the prevalence of stroke from rural areas of Middle East countries including Turkey is unknown. Our aim is to evaluate the prevalence of stroke in those ⩾18 years in the Turkish population in a rural area of Istanbul. METHODS: A cross-sectional door-to-door study was conducted in a rural area of Istanbul between 1 March and 30 March 2013. A research protocol recommended by World Health Organization for developing countries was used. Each screening teams consisted of one neurologist, one local nurse, and five surveyors. Teams were trained about the survey and questionnaire. The patients, who claimed to have suffered a stroke, were examined, and the diagnosis was confirmed by a neurologist on site. The findings and medical records were documented. RESULTS: In total, 2906 people ⩾18 years were screened. 50 stroke cases were detected. 80% of those were found to have had an ischemic stroke, 14% of those were hemorrhagic cases, and 6% of those had an unclassified stroke type. The overall prevalence rate in those ⩾ 18 years was 1.7%. The male/female ratio was 0.92. Young (<45) stroke prevalence was found to be 0.6%. CONCLUSION: This study was the first of its kind to show the stroke prevalence among Turkish population ⩾ 18 years in a rural area of Istanbul. When compared to other studies which investigate people ⩾45 years from Turkey, the result (in the same age group) was moderate high. The male/female ratio was low compared to many other studies.

Stroke Prevalence in a Coastal Town on the Black Sea Coast in Turkey: Community Based Study.

BACKGROUND: This study aims to determine the stroke prevalence in Akçakoca which is a rural area in Turkey. METHODS: The study was designed as a cross-sectional, door-to-door survey. The stroke questionnaire was completed by a trained team in the presence of the participants according to their answers. Based on the screenings, patients who had been diagnosed with stroke previously were reexamined by a neurologist and determined the prevalence values, risk factors, and stroke types. RESULTS: A total of 3750 people over 44 years old were reached in the screenings. It was determined that 83 people had previously suffered a stroke. The prevalence rate of stroke in those above 44 years was found to be 2.2 (98% confidence level and ± 2% margin of error). 70 (84.3%) patients had suffered an ischemic stroke while 12 (14.5%) had suffered a hemorrhagic stroke. Male/female ratio was 1.1. CONCLUSION: The results of this study give the prevalence rate of stroke among the Turkish population living in a rural area. Due to a lack of other similar studies, it is impossible to make any data comparison. However, the results of this study help shed light on the stroke prevalence rate.

Stroke epidemiology in Karabük city Turkey: Community based study.

INTRODUCTION: Stroke has been projected to increase in developing countries like Turkey. Information about the prevalence of stroke may uncover the etiology of stroke and overcome its impact burden. However, data is limited due to a lack of studies based in Turkey and neighboring regions. We aimed to investigate the prevalence and risk factors of stroke in the Turkish city of Karabük and to pave the way for future epidemiological studies in Turkey. METHODS: The study was designed as a cross-sectional, door-to-door survey. The questionnaire was completed by a trained team in the presence of the participants according to their answers. Patients who had been diagnosed with stroke prior to the survey were re-examined by a neurologist. RESULTS: 3131 persons who were above 44 years old were screened. 129 of them were found to have had a stroke previously. The prevalence rate of stroke above 44 years was found to be 4.12% (98% confidence level and ± 2% margin of error). 72.1% of stroke patients had hypertension. Male/female ratio was 0.72. CONCLUSION: This study showed a high prevalence rate of stroke in Karabük Turkey with a low male/female ratio when compared to other studies.

Prevalence of Multiple Sclerosis in a Turkish City Bordering an Iron and Steel Factory.

BACKGROUND AND PURPOSE: Multiple sclerosis (MS) is an autoimmune disease characterized by inflammatory demyelination. Recent studies have shown that long-term exposure to air pollutants (including PM10 particulates) is potentially an environmental risk factor for MS. We aimed to determine the prevalence rates of MS in two cities with different levels of air pollution. METHODS: This door-to-door population-based study was conducted between April 2014 and June 2015. Two cities were screened for the prevalence rates of MS: 1) Karabük, which borders an iron-and-steel factory, and 2) Akçakoca, which is a coastal city located in the same region. A validated survey form was used for screening MS. The 2010 McDonald Criteria were used for diagnosing MS. The patients were examined twice, first by a neurology assistant in the field and then by a senior neurologist in public health centers in the cities. RESULTS: The prevalence of MS was 95.9/100,000 in Karabük and 46.1/100,000 in Akçakoca. In total, 33 patients were diagnosed with clinically definite MS. The female/male ratio was 1.5, and 21 patients were diagnosed with relapsing-remitting MS, 9 with secondary progressive MS, and 3 with primary progressive MS. CONCLUSIONS: We found that the prevalence of MS was more than two fold higher in Karabük than in Akçakoca, which supports a link between air pollution and the pathogenesis of MS. However, larger etiological and epidemiological studies are needed to confirm this hypothesis.

Effects of multiple sclerosis and medications on menopausal age.

Objectives We aimed to determine whether multiple sclerosis (MS) and methylprednisolone and disease-modifying drugs have an effect on menopausal age. Methods A total of 86 patients and 98 healthy subjects were included in this study. The natural menopausal age of the patients and healthy subjects were compared. The cumulative dosages of methylprednisolone, beta interferons (IFNßs), and glatiramer acetate were calculated. The effects of the Expanded Disability Status Scale (EDSS), duration of the disease, and cumulative dosage of medications on menopausal age were evaluated. Results The patients' mean menopausal age was 45.3 ± 4.8 years and healthy subjects' menopausal age was 46.8 ± 4.3 years, with no significant difference between the two groups. The cumulative dosage of methylprednisolone showed an effect on menopausal age. There was a significant inverse correlation between menopausal age and dosage of IFNß-1b, while the disease duration and EDSS score showed no correlation with menopausal age. Conclusions We conclude that menopausal age is not affected by MS. However, long-term methylprednisolone and IFNß-1b treatments may change menopausal age in a dose-dependent manner.

Obesity in adolescents and the risk factors.

OBJECTIVES: This study aims to investigate the frequency of obesity and to identify possible risk factors affecting obesity in adolescents. MATERIALS AND METHODS: This cross-sectional study included a total of 1,357 adolescents between March 2011 and May 2012 in Beyoglu district of Istanbul province of Turkey. The questionnaire including 38 questions which was developed based on the Youth Risk Behavior Survey, which is used by the Center for Disease Control and Prevention (CDC), was used for the data collection. The weight and height of the participants were measured and their body mass index (BMI) values were calculated. RESULTS: Of all participants, 54.8% were females, 5% of them were underweight, 12.6% were overweight, and 2.6% were obese. Among the male participants, the BMI values were higher (21.06±3.32 kg/m2) than females (20.26±2.88 kg/m2) (p<0.0001). The obesity ratio was higher in males (p<0.0001) and in children of highly educated parents (p<0.05). Of the participants, 23.5% were physically active. Physical activity level was higher in males, compared to females (p<0.0001). The rate of breakfast habit was higher in males than females (p=0.002). Healthy diets and losing weight in a healthy way were more commonly accepted by the students in the public schools, compared to those in private schools (p<0.0001). CONCLUSION: Obesity is an important public health problem and proper eating habits and regular physical activity should be encouraged. High-income families should also encourage their children to become more aware of the importance of physical activity. The right time for this is childhood and adolescence, in which permanent habits can be easily acquired.

Botulinum toxin in the treatment of trigeminal neuralgia: 6-Month follow-up.

BACKGROUND: Botulinum toxin type-A (BTX-A) has been successfully utilized to treat trigeminal neuralgia. In this study, through the use of a new technique, the efficacy of the injection of BTX-A to the maxillary and mandibular nerves was evaluated. METHODS: A total of 27 patients were injected with 100 Units of BTX-A to the maxillary and mandibular nerves. Visual analogue scale score and pain frequency were assessed before treatment and at the first week, second month, and sixth month after treatment. Patients with ≥50% reduction in mean pain score at the second and sixth month were defined as responders. RESULTS: A total of 27 patients were included in the study. BTX-A significantly reduced pain intensity and pain attack frequency at the first week, second month, and sixth month after treatment. At the second month, 74.1% of patients, at the sixth month, 88.9% of patients responded to treatment. Forty-four percent of patients did not experience any pain at the sixth month. The mean recurrence period was 87.7 ±â€Š20.4. BTX-A was well tolerated and showed few treatment-related adverse events. CONCLUSION: Injection to the maxillary and mandibular roots seems to be a highly effective method. In the event of recurrence, after each injection, the pain severity and attack frequency decreased.

Treatment of chronic inflammatory demyelinating polyneuropathy with high dose intravenous methylprednisolone monthly for five years: 10-Year follow up.

OBJECTIVE: Although various modalities of treatment of chronic inflammatory demyelinating polyradiculopathy (CIDP) there are not any treatment protocol agreed. MATERIALS AND METHODS: We retrospectively evaluated the 20 CIDP patients (14 male, 6 female). Five patients were excluded from the study because they could not continue their treatments due to various problems during the treatment. The remaining 15 patients treated with monthly high dose intravenous methyl prednisolone for five years (IVMP) and followed up for 10 years. RESULTS: The mean age of the patients was 48.1±14.6 years. The mean duration of disease was 6.8±3.1 years. We were found statistically significant difference between the pre-treatment and sixth month modified Rankin scores (p<0.001). Similarly, significant improvement was observed at the end of first, fourth and fifth years of treatment. Statistically significant difference was found between baseline and tenth year modified Rankin scores of 12 patients who were treated with only IVMP during 10 years follow-up. CONCLUSION: Long-term monthly IVMP pulse therapy seems to be very effective in the treatment of CIDP.

The MRI findings of iris metastasis in patients with breast cancer.

Breast cancer and lung cancer are the most common tumors that metastasize to iris. The metastasis of iris was generally diagnosed on ophthalmologic examination. In this case, we reported iris metastasis of patients with adenocarcinoma of breast cancer and MRI findings. We report a case of a 51-year-old. She was diagnosed breast cancer two years ago. After adjuvant chemotherapy, radiotherapy and trastuzumab, she was admitted to hospital with the complaints of headache on February 2012. The magnetic resonance imaging (MRI ) revealed multiple brain metastasis. Whole brain radiotherapy and palliative chemotherapy were applied to the patients. In follow-up, on ophthalmological examination, there was a solid lesion on iris. The orbital MRI was performed and it revealed the thickness on iris of left eye. After diagnostic procedure final pathological rewiev reported that invasive ductal carcinom metastasis. Iris metastasis may be considered by MRI findings following: The thickness on iris and contrast enhanced lesion. This reason may be resulted that the fine niddle aspiration biopsy for diagnosis of iris metastasis is not need.

Prevalence of multiple sclerosis: door-to-door survey in three rural areas of coastal Black Sea regions of Turkey.

BACKGROUND: Little information exists on multiple sclerosis (MS) in Turkey. With a door-to-door survey in an urban part of Istanbul, we recently reported a prevalence rate of 101/100,000 population. We therefore investigated three rural areas of Turkey at the same latitude. METHODS: The same survey methods were used for total populations of two rural areas (Kandira and Geyve) near Istanbul, and for half the population of Erbaa, all near 40° north latitude on the Black Sea coast. RESULTS: In Kandira, 5 of 8 suspects were diagnosed as having MS among 8,171 screened, resulting in a prevalence rate of 61/100,000. Geyve with 7 MS cases in 17,016 screened had a prevalence of 41/100,000, and Erbaa with 15 MS cases in 28,177 screened one of 53/100,000. Together they showed a prevalence of 51/100,000. Of the 27 patients, 20 were women; 25 had definite and 2 possible MS, the former all with abnormal laboratory findings. Average ages were 30.5 years at onset and 39.1 years at diagnosis. Clinical features and course were typical of European MS. CONCLUSION: These findings indicate that Turkey is a high-risk MS area, similar to most regions of Mediterranean Europe, where all recent increases are likely due to (undefined) environmental factors.

Epidemiology of restless legs syndrome in Turkish adults on the western Black Sea coast of Turkey: A door-to-door study in a rural area.

OBJECTIVE: To determine the prevalence and clinical presentation of restless legs syndrome (RLS) in Turkish population living in Kandira, a town located on the Black Sea coast of Istanbul. METHODS: This study was designed as a descriptive, cross-sectional, door-to-door field study. A total of 2111 people aged 18 years and over were selected for the study. The criteria suggested by the IRLSSG (International Restless Legs Syndrome Study Group) were used in the assessment of RLS. All the suspected subjects underwent neurological examination. RESULTS: The prevalence of RLS was found to be 3.4% of Turkish population aged over 18. Female:male ratio was 3.5:1. The prevalence reached peak point (8.3%) in the 58- to 67-year-old group. Prevalence of DM, anemia and polyneuropathy in RLS patients was 13.9%, 8.3% and 4.2%, respectively. CONCLUSION: RLS prevalence is relatively low, but increases with age in both genders in this Turkish population. Although it has negative effects on daily life, it is not well recognized by the population.

Prevalence of essential tremor: a door-to-door survey in Sile, Istanbul, Turkey.

The aim of this study was to determine the prevalence of essential tremor (ET) in a Turkish population living in Sile, a rural town located on Black Sea coast of Istanbul. This study was designed as a descriptive cross-sectional field study. People aged 18 years and over were selected for the study. Tremor surveillance questionnaire was applied by door-to-door visits. Subsequently, all subjects who answered the questionnaire had a standard tremor examination. Diagnosis was made based on Washington Heights-Inwood Genetic Study of Essential Tremor (WHIGET) diagnosis and clinical evaluation scale. A total of 2227 people was screened. The prevalence of ET was found to be 3.09% (95% Cl=2.42-3.91%) in Turkish population aged over 18 years. The prevalence of ET increased by age in both genders.

Living alone following first-ever stroke: a prospective study in Turkey identifying the risk factors and evaluating their effects.

INTRODUCTION: The incidence of stroke, death, and dependency rates shows variability between countries and ethnic groups. The cost of management of stroke is extremely high. Thus, determination of controllable risk factors is important. The aim of this study was to evaluate the risk factors and the effects of risk factors on death rates, dependency, and stroke recurrence in hospitalised patients having first-ever stroke. METHOD: A total of 100 patients admitting to our hospital during the period April 2002 to March 2003 inclusive who were diagnosed as stroke according to WHO criteria were included in this study and evaluated prospectively. RESULTS: The mean age of the patients was 66.7 +/- 9.9 years and 60% was male. 76 of the patients had ischaemic stroke; 24 had hemorrhagic stroke. The death rates were 12% in the first 28 days and 26% in 6 months. The best predictors of death rate in 6 months were stroke severity, living alone, and prestroke dementia. Stroke severity was also the best predictor for dependency. Peripheral atherosclerosis, pre-stroke dementia, and stroke severity were the best predictors for recurrent stroke. CONCLUSION: Living alone may be an important predictive factor for survival, although its importance has been underestimated.

Respiratory complaints and spirometric parameters of the villagers living around the Seyitomer coal-fired thermal power plant in Kütahya, Turkey.

The aim of the study was to investigate the respiratory effects of the stack emissions of the Seyitömer coal-fired thermal power plant in the Kütahya Province of Turkey. The three villages that are located within 5 km around the power plant were investigated as our "Villages around Power Plant." Two villages which were similar to the Villages around Power Plant as far as climate, culture, and lifestyle were concerned and which were located more than 30 km away from the thermal power plant were investigated as our "Control Villages." The study design was based on the comparison of the respiratory complaints and the spirometric parameters of the individuals living in the two groups of villages. The study was carried out on individuals of 15 years of age and above living in these villages (277 of 302 individuals living in the Villages around Power Plant and 225 of 264 living in the Control Villages). Among the ones living in the Villages around Power Plant, 46.2% had complaints of chest tightness and 29.2% repeated coughing attacks present for more than one year, whereas these percentages were 28.0 and 20.4% in the Control Villages, the differences being statistically significant (P=0.001 and P=0.024, respectively). The complaint of productive coughing present for more than one year was not found to differ statistically significantly between the two groups of villages (P=0.0885). The means of the spirometric parameters of FEV1 and FEF25-75% were found to be statistically significantly lower in the individuals of the Villages around Power Plant compared to the individuals of the Control Villages (P=0.0001 and P=0.0001, respectively). When the spirometric parameters of nonsmokers were compared between the two groups of villages, FEV1, FVC, and FEF25-75% were found to be statistically significantly lower in the Villages around Power Plant compared to the Control Villages (P=0.0001, P=0.0001, and P=0.0001, respectively). No statistically significant differences of the spirometric measurements of current smokers were observed between the two groups of villages (P>0.05). The spirometric parameters revealed statistically significant adverse health effects of the Power Plant, this was particularly apparent v212nfor the nonsmokers. More specific tests to confirm the diagnosis of acute and chronic lung diseases can be suggested to be carried out in the area in further studies. Also follow-up studies can be recommended in the area to detect any new adverse health effects of the Power Plant.