Effects of Different Exercise Programs on Symptoms, Sleep, and Quality of Life in Patients with Primary Restless Legs Syndrome.

Background: Restless legs syndrome (RLS) is a sensorimotor disorder that can have a significant detrimental impact on the quality of life and sleep. Objectives: Our aim was to examine the effects of aerobic exercise and stretching exercise programs on symptom severity, sleep, and quality of life in patients with primary RLS. Methods: A total of 18 patients between the ages of 22 and 61 were randomly divided into 3 groups as aerobic exercise, stretching exercises, and control. All exercise programs were applied 3 times a week for 8 weeks. Evaluations were performed before and after treatment. Symptom severity of the patients was evaluated by the International Restless Legs Syndrome Study Group Rating Scale, sleep was evaluated with the Pittsburgh Sleep Quality Index and actigraphy, and quality of life was evaluated with the John Hopkins Restless Legs Syndrome Quality of Life Questionnaire. Recovery status of the patients was determined using the post treatment global change scale. Results: Aerobic exercise and the stretching exercise program were found to be effective in decreasing RLS symptoms (P = 0.025, P = 0.034) and improving subjective sleep quality (P = 0.034, P = 0.025), overall sleep quality (P < 0.001, P = 0.034), and quality of life (P = 0.009, P = 0016). Aerobic exercises were found to be more effective in reducing wake after sleep onset of sleep (P = 0.048), whereas stretching exercises reduced sleep disorders (P = 0.025). Conclusion: Both exercise approaches have been identified as highly effective approaches in patients with RLS. The treatment can be planned according to the choice of the available facilities, patient and clinician preference, and the advantages of the 2 exercise approaches.

Role of the functional head impulse test in evaluating vestibulo-ocular reflex abnormalities in individuals with Parkinson's disease.

PURPOSE: To assess vestibular-ocular reflex (VOR) function in patients with Parkinson's disease (PD) using a new method called functional head impulse test (fHIT). STUDY DESIGN: Case-control study. SETTING: Tertiary medical center. PARTICIPANTS: Twenty individuals with PD were recruited for PD group, and twenty healthy individuals for the control group. Ages of both groups ranged from 47 to 76 years. MAIN OUTCOME MEASURES: According to the modified Hoehn-Yahr score, PD group was classified as an early stage with a range of 1-2.5 and a mid-late stage with a range of 3-5. Percentage of correct answers (%CA) was calculated using fHIT for lateral, anterior and posterior semicircular canal (SCC) planes. RESULTS: PD group had statistically lower fHIT %CA in the right lateral, left lateral, and left posterior SCC planes compared to control group (p < .05). There was no statistical difference between two PD severity groups and functional VOR abnormality. CONCLUSION: It was concluded that the functional VOR in the right lateral and left lateral and left posterior SCC plane was affected in individuals with PD. Our results show that impaired VOR and reduced dynamic visual acuity should be considered in individuals with PD for vestibular rehabilitation exercises.

Altered Trunk Position Sense and Its Relationship With Spinal Posture and Spinal Mobility in Patients With Parkinson's Disease.

INTRODUCTION: Proprioception is significantly affected by dysfunction of the basal ganglia, which play an important role in sensorimotor integration. Parkinson's disease (PD), which is characterized by progressive loss of the dopaminergic neurons of the substantia nigra, leads to a variety of motor and nonmotor symptoms throughout the course of the disease. The aim of this study was to determine trunk position sense and to investigate its relationship with spinal posture and spinal mobility in patients with PD. METHODS: The study included 35 patients with PD and 35 age-matched control subjects. Trunk position sense was determined with "trunk reposition errors." A spinal mouse was used to assess spinal posture and spinal mobility. RESULTS: According to the Hoehn-Yahr rating scale, the majority of the patients were in Stage 1 (68.6%). Trunk position sense was found to be significantly decreased in patients with PD compared with the control group (p < .001) but was not correlated with spinal posture and spinal mobility in patients with PD (p > .05). CONCLUSIONS: This study revealed that trunk position sense was impaired in PD from the early stages of the disease. However, neither spinal posture nor spinal mobility was associated with decreased trunk proprioception. Further research into these relationships in the late stages of PD is needed.

EEG changes in intensive care patients diagnosed with COVID-19: a prospective clinical study.

INTRODUCTION: Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was declared a pandemic on March 11th, 2020, by the World Health Organization (WHO). There has been a substantial increase in the epileptic seizures and status epilepticus reported in the pandemic period. In this context, it is aimed with this study to identify the electroencephalography (EEG) features of patients admitted to the intensive care unit with the diagnosis of COVID-19 and to look for any specific patterns in these features. MATERIAL AND METHOD: The material of this study primarily comprised the neurological evaluations and continuous EEG recordings of 87 intensive care patients who were diagnosed with COVID-19. In addition, demographic and clinical features and comorbid conditions of these patients were also analyzed, and any correlation thereof was investigated. RESULTS: The EEG data of 87 patients who were diagnosed with COVID-19 and were followed up in the intensive care unit were recorded and then analyzed. Abnormal EEG findings were detected in 93.1% (n = 81) of the patients, which were found to increase significantly with age (p < 0.001). The mean age of patients with specific epileptiform abnormalities on EEG was found to be significantly higher than those with non-specific abnormalities. Epileptiform discharges were seen in 37.9% (n = 33) of the patients. Nonconvulsive status epilepticus (NCSE) was detected in 5.7% of the patients, and antiepileptic drugs were started in 25 (28.7%) of the patients. DISCUSSION: Statistically significant EEG changes were observed in the continuous EEGs of the patients followed up in the intensive care unit due to COVID-19 infection. However, further studies are needed to associate the EEG changes observed in the COVID-19 patients with the epileptogenesis of COVID-19 infection.

The Investigation of the Effects of Repetitive Transcranialmagnetic Stimulation Treatment on Taste and Smell Sensations in Depressed Patients.

INTRODUCTION: Loss in sense of smell and taste is a condition that can occur without an organic pathology and it is noteworthy in patients diagnosed with Major Depressive Disorder (MDD). Few studies have shown that Repetitive Transcranial Magnetic Stimulation (tTMS) can correct losses in sense of smell and taste. In this study, we aimed to examine the effects of tTMS treatment applied to patients diagnosed with MDD on the sense of smell and taste in this patient group. METHODS: The sense of smell of 56 patients who were diagnosed with MDD and had tTMS indication was examined with the "Sniffin' Sticks" smell test and the sense of taste with the "Taste Strips" taste test. MDD patients who lost at least one sense of smell and taste were included in the study, but a total of 30 patients were able to complete the study. Hamilton Depression Scale (HAM-D) was applied to the patients before tTMS treatment, and this scale was repeated after 15 sessions of tTMS treatment. Taste and smell senses were re-evaluated after the last tTMS session. RESULTS: According to the Sniffin Stick Smell test, 15 of 29 patients with hyposmia had normosmia after tTMS, and 16 of 18 patients who were found to have hypogeusia according to Taste Strips Taste test had Normogeusia after tTMS. There was a positive improvement in both the smell and taste scores of all patients who were treated, compared to before tTMS. The positive improvement in the smell tests of the patients who responded to the treatment according to the HAM-D scores was found to be significantly different than the patients who did not respond. CONCLUSION: The positive effect of tTMS treatment on the sense of smell and taste has been demonstrated even in patients whose HAM-D scores could not be sufficiently decreased. In patients diagnosed with depression, using tTMS alone or adding it to the current treatment suggests that it may have a positive effect on the sense of smell and taste as well as depression treatment.

Latent class cluster analysis identified hidden headache phenotypes in COVID-19: impact of pulmonary infiltration and IL-6.

BACKGROUND AND OBJECTIVE: Clinical studies on COVID-19 headache are limited. This prospective study aimed to define headache characteristics, associated clinical and laboratory factors, and treatment response in COVID-19. METHODS: Cross-sectional study enrolled 287 patients diagnosed with COVID-19 and hospitalized on a regular ward during the pandemic. All patients were examined face to face and followed by a neurologist during their stay in the hospital. The characteristics, concomitant symptoms, treatment responses, and laboratory findings of COVID-19-associated headaches were recorded. RESULTS: Eighty-three COVID-19 patients reported headache (28.9%), in which 85.5% had no prior headaches. Mean age was 48.40 ± 15.90 and 58% was men. Compared to COVID-19 patients without headache (n = 204), patients with headache showed significantly higher frequency of pulmonary involvement (76%) and increased D-dimer levels. Fifty-nine percent of headaches responded iv paracetamol 1000 mg, and 85% of the paracetamol unresponsive headaches were relieved by greater occipital nerve (GON) blocks. Latent class cluster analysis identified 2 distinct class of bilateral, frontal, throbbing headaches: severe (VAS > 84), longer (> 14 h), frequent (> 7 headache days), paracetamol unresponsive-GON responsive headaches (85%), with pulmonary involvement (100%), and higher IL-6 levels (> 90 pg/mL) were classified in cluster 1. Cluster 2 included moderately affected patients (VAS > 54, > 6 h, > 4 days, 60% pulmonary involvement, > 20 pg/mL IL-6) and paracetamol responsive headaches (96%). VAS scores showed positive linear correlation with IL-6 levels (p < 0.001; r = 0.567). CONCLUSION: The intensity, duration, frequency, bilateral frontal location, and treatment response of COVID-19 headache was related to pulmonary involvement and IL-6 levels, which indicated a role of inflammation in determining the headache manifestations in moderately affected hospitalized patients. ROC curve cutoff values pointed that VAS > 70 severity, > 9 h duration, > 5 headache days, and IL-6 > 43 pg/mL levels can be diagnostic for COVID-19 headache. GON blocks can effectively abort headache when patients are unresponsive to paracetamol, and other NSAIDs are avoided during the SARS-CoV-2 infection.

Greater occipital nerve block efficacy in COVID­19 associated headache: a preliminary study.

COVID­19 is an infection caused by the new coronavirus SARS­CoV­2. Headache is one of the most common neurological findings. In the treatment of various chronic headaches, the greater occipital nerve (GON) block is often used as a safe and effective method. The aim of our study was to investigate the effectiveness of the GON block in the treatment of headaches observed in COVID­19 patients. Between March and May 2020, 27 patients (with laboratory­confirmed 2019­nCoV infection by next­generation sequencing confirmation of real­time PCR) that had moderate or severe headache associated with COVID­19 and treated with a single session of GON block were retrospectively analyzed. The visual analogue scale (VAS) values and the number of analgesic usage of patients were recorded before and after the blockade on the 1st and 10th days. Fifteen (55.6%) patients included in the study were male and twelve (44.4%) were female. In terms of VAS values, the difference between pre­treatment and post­treatment values on the 1st and 10th days was found statistically significant. Likewise, the difference between analgesic use before and after the procedure was statistically significant. GON block appears to be an effective pain management method in COVID­19 related headache, and it revealed promising reductions in pain scores and analgesic usage. As well as we know, this is the first study of "COVID­19 associated headache treated with GON blockade". More long term and well­designed prospective studies with more participants are needed to better define this headache and develop effective treatment strategies.

Cerebral hemodynamic alterations in patients with Covid-19

Background/aim: Coronavirus 2019 disease (Covid-19) was first seen in December 2019 and afterwards it became pandemic. Several systemic involvements have been reported in Covid-19 patients. In this study, it was aimed to investigate the cerebrovascular hemodynamics in patients with Covid-19. Materials and methods: The sample of this study included 20 patients hospitalized in our clinic diagnosed with Covid-19 via PCR modality and 20 healthy volunteers of similar age and sex. Bilateral middle cerebral arteries were investigated with transcranial Doppler ultrasonography. Basal cerebral blood flow velocities and vasomotor reactivity rates were determined and statistically compared. Results: When patient and control groups were compared, the mean blood flow velocity was found to be higher in Covid-19 patients than in the healthy volunteers and it was statistically significant (P = 0.00). The mean vasomotor reactivity rates values were found to be lower in the Covid-19 group than the healthy group and was also statistically significant (P = 0.00). Conclusion: An increase in basal cerebral blood velocity and a decrease in vasomotor reactivity rates in patients with Covid-19 can be considered as an indicator of dysfunction of cerebral hemodynamics in the central nervous system and this can be evaluated as a result of endothelial dysfunction.

A prospective clinical study of detailed neurological manifestations in patients with COVID-19.

BACKGROUND: COVID-19 is a virus pandemic. According to the first obtained data, COVID-19 has defined with findings such as cough, fever, diarrhea, and fatigue although neurological symptoms of patients with COVID-19 have not been investigated in detail. This study aims to investigate the neurological findings via obtained face-to-face anamnesis and detailed neurological examination in patients with COVID-19. METHODS: Two hundred thirty-nine consecutive inpatients with COVID-19, supported with laboratory tests, were evaluated. Detailed neurological examinations and evaluations of all patients were performed. All evaluations and examinations were performed by two neurologists who have at least five-year experience. RESULTS: This study was carried out 239 patients (133 male + 106 female) with diagnosed COVID-19. Neurological findings were present in 83 of 239 patients (34.7%). The most common neurological finding was a headache (27.6%). D-dimer blood levels were detected to be significantly higher in patients with at least one neurological symptom than patients without the neurological symptom (p < 0.05). IL-6 level was found to be significantly higher in patients with headache than without headache (p < 0.05). Creatine kinase (CK) level was detected to be significantly higher in patients with muscle pain (p < 0.05). CONCLUSION: Neurological symptoms are often seen in patients with COVID-19. Headache was the most common seen neurological symptom in this disease. Dizziness, impaired consciousness, smell and gustation impairments, cerebrovascular disorders, epileptic seizures, and myalgia were detected as other findings apart from the headache. It is suggested that determining these neurological symptoms prevents the diagnosis delay and helps to prohibit virus spread.

Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation?

INTRODUCTION: Even though lifelong premature ejaculation (PE) is highly prevalent, few studies have investigated the neural mechanisms underlying PE. AIM: This study aimed to investigate whether patients with lifelong PE exhibit macrostructural or microstructural alterations of the parts of the brain involved in the male sexual response. MATERIALS AND METHODS: We enrolled 42 healthy participants and 54 lifelong PE patients. Lifelong PE was diagnosed according to the Premature Ejaculation Diagnostic Tool (PEDT) and intravaginal ejaculation latency time (IELT). We compared measures of cortical morphology, such as volumes of gray matter, white matter, cerebellum volumes, and subcortical structures (ie, amygdala, caudate, hippocampus, globus pallidus, putamen, and thalamus) between the groups using a voxel-based morphometry method from whole-brain T1-weighted magnetic resonance imaging. Moreover, we evaluated the relationships between the relevant cerebral alterations and the severity of symptoms obtained from participants via self-reported questionnaires. MAIN OUTCOME MEASURES: Cerebral macrostructural and microstructural alterations were assessed in PE patients and controls, along with the correlation of caudate nucleus changes in PE patients with clinical data (including the PEDT and the IELT). RESULTS: The mean volume of the caudate nucleus was significantly larger in the lifelong PE patients compared with healthy controls (P = .048). Moreover, caudate nucleus volume was positively correlated with PEDT score (r = 0.621; P = .0179) and negatively correlated with the IELT (r = -0.592; P = .0101). However, cortex morphology and the other subcortical volumes were not significantly different between the 2 groups (P > .05). CLINICAL IMPLICATIONS: Microstructural alterations in deep gray matter nuclei might be a useful parameter for studying the mechanism of the neurobiology underlying PE. STRENGTHS AND LIMITATIONS: There are few studies examining microstructural changes in PE patients. This study furthers our understanding of the etiology of PE. Limitations include the small sample, which limits our ability to make an absolute determination as to whether such subcortical changes are the cause or the consequence of lifelong PE. CONCLUSIONS: We found a significant difference in caudate nucleus volume between patients with PE and healthy controls. In addition, the caudate nucleus volume was positively associated with the severity of PE symptoms. More extensive and possibly longitudinal studies are needed to improve our understanding of the mechanism of the neurobiology underlying PE. Atalay HA, Sonkaya AR, Ozbir S, et al. Are There Differences in Brain Morphology in Patients with Lifelong Premature Ejaculation? J Sex Med 2019;16:992-998.

Effects of levetiracetam monotherapy on sperm parameters and sex hormones: Data from newly diagnosed patients with epilepsy.

PURPOSE: Epilepsy has an impact on the reproductive system. Males with epilepsy have lower fertility rates, hypo-sexuality and reduced potency compared with the general population. Anti-epileptic drugs and epilepsy itself are thought to be responsible for this reduced fertility. LEV is a second-generation anti-epileptic agent with low incidences of both adverse effects and drug-drug interactions. In this study, we have investigated the effects of LEV treatment on sex hormones and sperm parameters in newly diagnosed epilepsy patients. METHODS: We recruited 26 males with newly diagnosed epilepsy and introduced LEV monotherapy. Patients were divided into two groups depending on whether they had partial or generalized seizures. We acquired the results of pre- and post-treatment sperm analyses and serum sex hormone levels. We also recorded the maximum dose, daily dose and treatment duration for each individual. Pre- and post-treatment comparisons and correlations between both sperm and sex hormone parameters and both treatment duration and dose were determined. RESULTS: Pre- and post-treatment sex hormone levels were not significantly different. The total sperm count, percentage of normal morphology and functional sperm count tested after treatment were significantly lower in both groups compared with pre-treatment values (p<0.05). There was a moderate correlation between daily dose and reduction in functional sperm count (r: 0.41, p: 0.034). CONCLUSIONS: Our findings confirm that LEV treatment of newly diagnosed epilepsy patients decreases sperm parameters without altering sex hormone levels. Our results may guide the choice of anti-epileptic drug treatment among men with epilepsy.

Age and gender related prevalence of intracranial calcifications in CT imaging; data from 12,000 healthy subjects.

PURPOSE: Location and extent of intracranial calcifications have been detected accurately with the use of CT technology and since, many clinical or pathological entities have been linked to these calcifications. Our purpose is to provide data regarding the prevalence of calcifications in various locations in brain. MATERIAL AND METHODS: We retrospectively examined 11,941 subjects who underwent non-contrast enhanced brain CT examination. We determined the prevalence of choroid plexus, pineal gland, habenula, dura mater, basal ganglia and vascular calcifications. RESULTS: Of 11,941 subjects, 70.2% had choroid plexus calcifications. Calcifications were most frequently seen in pineal gland and 71.6% of the study population had pineal calcifications. Habeluna and dural calcifications were present in 19.2% and 12.5% of the population respectively. Basal ganglia calcifications and vascular calcifications only constituted 1.3% and 3.5% of the study population respectively. Male dominance was present in all calcification types except basal ganglia calcifications. CONCLUSIONS: Showing associations and dissociations from the literature, our study provides a baseline data regarding the prevalence of various types of intracranial calcifications.

The investigation into the cutaneous silent period in patients with essential tremor pre-treatment and post-treatment.

Although essential tremor (ET) is the most common movement disorder, little is known regarding its pathophysiology. Cutaneous silent period (CSP) is a spinal inhibitory reflex that causes suppression of the voluntary muscle contraction that is induced by strong electrical stimulation of the cutaneous nerves. Clinical interest in the CSP stems from its potential usefulness for evaluating segment and components of sensory nerves that are not well assessed by standard electrodiagnostic methods. The aim of this study was to investigate CSP in patients with ET before and after treatment. A total of 30 patients (12 females + 18 males), having ET diagnosis and propranolol treatment initiated, were studied with technique of CSP. Patient group's pre-treatment latency average is found 84.45 ± 18.63, average CSP duration 42.37 ± 11.82, and CSP final latency average 127.10 ± 19.13. According to post-treatment CSP analysis, it is seen that patients' average latency values are found 83.14 ± 20.92 and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). Post-treatment average CSP duration is found 36.64 ± 13.38, and it is seen that there is a significant statistical shortening compared to pre-treatment durations (p < 0.05). Patients' post-treatment CSP final latency averages are found 123.17 ± 13.67, and it is determined that there is no significant statistical difference compared to pre-treatment latency values (p > 0.05). The main finding of this study is that in ET the CSP is prolonged and that treatment with propranolol shortens the CSP and brings it closer to normal values. A small dose of propranolol has the effect of shortening pathologically prolonged CSP in a subset of ET patients (women and without family history), making further investigations with this method interesting. From this point of view in our study, patients with ET treatment give an idea of the effectiveness of propranolol. In recent years, a technique of CSP is interested in the field of electrophysiology and shows the effect of ET that given other pharmacological treatment and also it can be considered a quantitative measure to compare them. The usefulness of CSP should be supported by further studies with more patients.