The Impact of the COVID-19 Lockdown on the Quality of Life in Chronic Neurological Diseases: The Results of a COVQoL-CND Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson's disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. METHODS: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. RESULTS: The mean age of a total of 577 patients was 49 ± 17 (19-87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, those with comorbid disease, contacted with CO-VID-19 patients, or diagnosed with COVID-19. In the group with a high IES-R score, the rate of DIT was found to be high. IES-R scores were negatively correlated with QoL. IES-R total scores were found highest in the CVD group and lowest in the PD group. The ratio of DIT was found highest in the PNP group and the lowest in the EP group. Contact with CO-VID-19 patients was high in the EP and HA group. CONCLUSIONS: The results of the COVQoL-CND study showed that lockdown causes posttraumatic stress and deterioration in the QoL in CND.

Comparison of conventional and modern methods in determining ischemic stroke etiology by general and stroke neurologists

Background/aim: This study aimed to investigate the consistency between stroke and general neurologists in subtype assignment using the Trial of ORG-10172 in Acute Stroke Treatment (TOAST) and Causative Classification of Stroke (CCS) systems. Materials and methods: Fifty consecutive acute ischemic stroke patients admitted to the stroke unit were recruited. Patients were classified by two stroke and two general neurologists, each from different medical centers, according to TOAST followed by the CCS. Each neurologist was assessed for consistency and compliance in pairs. Concordance among all four neurologists was investigated and evaluated using the kappa (ĸ) value. Results: The kappa (ĸ) value of diagnostic compliance between stroke neurologists was 0.61 (95% CI: 0.45­0.77) for TOAST and 0.78 (95% CI: 0.62­0.94) for CSS-5. The kappa (ĸ) value was 0.64 (95% CI: 0.48­0.80) for TOAST and 0.75 (95% CI: 0.60­0.91) for CCS-5 for general neurologists. Compliance was moderate [ĸ: 0.59 (95% CI: 0.52­0.65)] for TOAST and was strong [ĸ: 0.75 (95% CI: 0.68­0.81)] for CCS-5 for all 4 neurologists. 'Cardioembolism' (91.04%) had the highest compliance in both systems. The frequency of the group with 'undetermined etiologies' was less in the CCS (26%) compared to TOAST. Conclusion: The CCS system improved compliance in both stroke and general neurologists compared with TOAST. This suggests that the automatic, evidence-based, easily reproducible CCS system was superior to the TOAST system.

Desensitization in interferon-beta1a allergy: a case report.

We report a 41-year-old patient with multiple sclerosis (MS) who was successfully desensitized after she developed non-injection-site urticaria and angioedema due to interferon (IFN)-beta1a. Although a few cases of urticaria and anaphylaxis have been reported in the literature, to our knowledge this is the first report of a successful desensitization with IFN-beta1a. Desensitization with IFN-beta1a allowed us to continue with the administration of interferon-beta, which is a mainstay in treatment for MS.

The efficacy and safety of dipyrone (Novalgin) tablets in the treatment of acute migraine attacks: a double-blind, cross-over, randomized, placebo-controlled, multi-center study.

Dipyrone, an effective analgesic drug, is widely used in the management of headache. However, few studies have evaluated its efficacy and safety in migraine. We aimed to assess the efficacy and safety of 1 g dipyrone (Novalgin, two 500 mg tablets) on pain and related symptoms in acute migraine attacks with or without aura in a double-blind, cross-over, randomized, placebo-controlled, multi-center study design. Seventy-three migraine with or without aura patients, diagnosed according to the IHS criteria, were randomized to receive dipyrone (for 2 attacks) and placebo (for 1 attack). Pain intensity was measured on a four-point verbal pain scale before and 1, 2, 4 and 24 hours after drug intake. Significant improvement of pain was achieved with dipyrone compared to placebo at all time points measured. Both patient and physician evaluations were significantly in favor of dipyrone. Side effects were few and trivial in both groups. We conclude that dipyrone is an effective, safe and cost-effective option in acute migraine management.

[Comparison of electrocardiographic abnormalities in patients with ischemic and hemorrhagic stroke]. / Iskemik ve Hemorajik Inmeli Hastalarda Elektrokardiyografik Anormalliklerin Karsilastirilmasi.

OBJECTIVE: The aim of this study was to compare the electrocardiographic (ECG) abnormalities in patients with acute ischemic and hemorrhagic stroke who had no history of heart disease. METHODS: During 12 months, 222 consecutive stroke patients were enrolled in this study. Of them 162 had ischemic stroke and 60 had hemorrhagic stroke. Frequency of arrhythmias and ECG changes were compared between two stroke groups. Electrocardiographic abnormalities included ischemia-like changes (ST-segment depression or elevation, abnormal T and U waves), QTc prolongation and arrhythmias. RESULTS: Ischemic stroke patients were elder than hemorrhagic ones (64+/-14 years vs. 57+/-13 years, p=0.003). Other clinical characteristics were comparable in both groups. Ischemia-like ECG changes were found in 65% of ischemic stroke patients while they were observed in 57% of hemorrhagic stroke patients (p=0.33). Atrial fibrillation was more frequent in ischemic stroke than in hemorrhagic stroke (34% vs. 13%, p=0.01) patients. Individually, other ECG abnormalities were not different in both groups. With relation of ECG abnormalities to location of the brain lesion, there was a trend in favor of involvement of the temporal, frontal and parietal lobes. CONCLUSION: Regardless stroke-related lesion, ECG abnormalities can be seen frequently in stroke patients without primary heart disease. They can lead to diagnostic and therapeutic difficulties for cardiologists and neurologists.

Ankylosing spondylitis and multiple sclerosis in an HLA-B27 negative patient.

A 41-year-old man presented with vertigo and gait disturbance. He gave a 10-year history of definite ankylosing spondylitis with low back pain, limitation of spinal mobility, decreased chest expansion and radiological evidence of bilateral sacroiliitis. The vertigo attacks started 3 years before and he had insidious evolution of bilateral leg weakness, increased muscle tension and walking disability during the past 2 years. The HLA haplotypes of the patient were A2, A33, B14, B49, Bw4, Bw6, Cw7 and he was HLA-B27 negative. The axial and sagittal cranial magnetic resonance imaging (MRI) showed multiple foci of increased signal intensity in the periventricular white matter and cerebellar hemispheres, suggesting a demyelinating disease process. The MRI of the spine showed centromedullar high intensity lesions at C7, Th7-8, Th9-10 levels. The diagnosis was definite MS (primary progressive MS) as the patient had insidious neurological progression, CSF evidence of inthrathecal production of oligoclonal bands, conduction defects at VEP, multiple brain and additional spinal cord lesions on MRI and continued progression for more than 1 year.

Effect of botulinum-A toxin to cremaster muscle: an experimental study.

OBJECTIVE: A controversy exists on the definition, etiology and treatment of the retractile testes. In the present experimental study, we aimed to show the effect of botulinum-A toxin (Botox) on cremasteric muscle of a rat, and whether it may be an alternative to surgical treatment of retractile testis. METHODS: Ten Wistar rats were used in the study. By stimulating cremasteric reflex, five compound muscle action potentials (CMAP) of the right and left cremasteric muscles of each rat were recorded using surface electrodes. Intramuscular injection of botulinum-A toxin was done to the right side. Saline was injected to the left cremasteric muscles, and the left side also served as control. CMAP of the cremasteric muscles were recorded 45 days after the injection. Statistical analysis was done using Wilcoxon Signed rank test. RESULTS: Mean CMAP of the right side was 3.25+/-1.39 microV before the injection and 0.44+/-0.25 microV after botulinum-A toxin injection. The difference was statistically significant (p<0.05). Mean CMAP on the left side was 3.48+/-0.32 microV and 3.14+/-1.12 microV at baseline and the end of the study, respectively. The difference was not statistically significant (p>0.05). CONCLUSION: The botulinum-A toxin paralyzes the cremasteric muscles of the rats. As cremasteric hypertonicity is accepted as one of the reasons for retractile testes, botulinum-A toxin injection to cremasteric muscles may be helpful in diagnosis and may be an alternative to surgical treatment of this pathology in repeated dosages. Long-term evaluation of this paralysis is necessary.