Peripheric smell regions in patients with temporal and frontal lobe epilepsies: An MRI evaluation.

OBJECTIVES: We investigated peripheric smell regions of olfactory bulb (OB) volume and olfactory sulcus (OS) depth in temporal and frontal lobe epilepsy patients by cranial magnetic resonance imaging (MRI). METHODS: In this retrospective study, cranial MRI images of 150 adult patients were included. Group 1 was consisted of 50 adult patients with temporal lobe epilepsy (TLE). Group 2 was consisted of 50 adult patients with frontal lobe epilepsy (FLE). The control group (Group 3) was consisted of 50 healthy subjects without epilepsy. OB volume and OS depth were measured in all groups. RESULTS: OB volumes of the temporal and frontal epilepsy groups were significantly lower than those of the control group (padjusted < 0.0175). However, OS depths were not different between groups 1-3 (p > 0.05). In the temporal and frontal epilepsy groups, there were positive correlations between OB volumes; OS depths; left OB volume and bilateral OS depths p < 0.05). There were no significant correlations between OB volume and OS depth; and age and gender of the epilepsy group (p > 0.05). CONCLUSION: We concluded that temporal and frontal epilepsy maybe related to decrease in OB volume and may cause olfactory impairment. Olfactory deficit maybe related to central epileptic focus. Therefore, early diagnosis and appropriate treatment of epilepsy are important to prevent olfactory impairment.

First Admission Neutrophil-Lymphocyte Ratio May Indicate Acute Prognosis of Ischemic Stroke.

OBJECTIVES: Our study aimed to determine the relationship between serum periostin levels, and the neutrophil-lymphocyte ratio (NLR) with ischemic stroke subtypes, clinical stroke scales, and acute prognosis in patients with acute ischemic stroke. MATERIALS AND METHODS: Forty-two ischemic stroke patients and 39 age- and sex-matched healthy volunteers were included in our study. Demographic characteristics including age and gender were recorded. Blood serum periostin and NLR values were evaluated in the first 24 hours after admission. Serum periostin levels were compared with healthy controls of similar age and sex. Lesion localization was determined by cranial CT or diffusion MRI of the patients. Stroke scales were recorded on days 1 and 7 of hospitalization in the study group. RESULTS: The mean serum periostin levels were higher than in the control group, but no statistically significant difference was found. There was no correlation between serum periostin levels and prognosis of stroke. First admission NLRs were statistically higher than in the control group. The first admission NLRs were positively correlated with the first admission National Institute of Health Stroke Scale score and the day 7 modified Rankin score. CONCLUSION: Our study is the first study to evaluate both NLR and serum periostin levels in all types of acute ischemic stroke. While our study did not show that first admission serum periostin levels can be used as a biomarker in ischemic stroke, it did indicate that the first admission NLR can be used for acute prognosis of ischemic stroke.

Detecting pain severity with full cup test in painful diabetic peripheral neuropathy.

OBJECTIVES: The aim of this study was to test the utility and validity of the full cup test (FCT) to assess the severity of pain in subjects with painful diabetic peripheral neuropathy (PDPN). METHODS: Subjects with diabetic PDPN were enrolled for this prospective, cross-sectional study. Other causes of PDPN and subjects with cognitive impairment were excluded. The diagnosis of neuropathic pain was made using the results of a physical examination and the Douleur Neuropathique 4 questionnaire. Pain severity was assessed with a FCT and a visual analog scale (VAS) administered before and after treatment. The correlation of FCT with VAS was evaluated to examine validity. RESULTS: A total of 43 (33 female, 10 male) subjects were included. The mean age was 61.9±8.25 years and the mean disease duration was 13.02±7.6 years. Type I diabetes mellitus (DM) was present in 2 (4.7%) subjects and Type II DM in 41 (95.3%) subjects. The mean glycated hemoglobin level was 8.9±1.9 mmol/mol. When the mean VAS and FCT scores were analyzed, the results were 6.7±2.05 and 66.35±23.2, respectively, pretreatment and 4.6±2.2 and 41.36±23.5 posttreatment, which were both statistically significant (p<0.001, p<0.001). The mean control period was 23.4 days (min-max: 15-30 days). The VAS and FCT scores in pretreatment and posttreatment demonstrated a high positive correlation (rs=0.86, p<0.001; rs=0.843, p<0.001). CONCLUSION: The FCT can be useful to detect pain severity in PDPN.

Why do multiple sclerosis and migraine coexist?

BACKGROUND: Migraine coexistence, which is high in multiple sclerosis (MS), is reported. To better understand the etiology of the coexistence of MS and migraine and the outcomes of this relationship, the vitamin D, vitamin D-binding protein (VITDBP), vitamin D receptor (VITDR), high-sensitivity C-reactive protein (hs-CRP), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), total antioxidant status (TAS), total oxidant status (TOS), and Oxidative Stress Index (OSI) values were examined in patients with the coexistence of relapsing-remitting multiple sclerosis (RRMS) and migraine. METHODS: This study was conducted between January 1, 2019, and July 25, 2019, at the neurology and biochemistry clinics of two different tertiary hospitals simultaneously. Overall, 50 RRMS patients with migraine, 50 RRMS patients without migraine, and 50 healthy volunteers were included in the study. The participants' vitamin D, VITDBP, VITDR, hs-CRP, SOD, CAT, GSH-Px, TAS, TOS, and OSI values were measured. RESULTS: The vitamin D and VITDR values of the RRMS patients with migraine were lower than those of the RRMS patients without migraine (respectively, p = 0.014, p < 0.001). There was no significant difference between the RRMS patients with and without migraine in terms of their VITDBP values (p = 0.570). The SOD, CAT, GSH-Px, and TAS values of the RRMS patients with migraine were lower than those without migraine (all p < 0.001). The hs-CRP and TOS values of the RRMS patients with migraine were higher than those without migraine (all p < 0.001). CONCLUSION: To the best of our knowledge, this is the first study on this topic to date. Based on the results, our study may shed light on the etiopathogenesis of the coexistence of MS and migraine and new treatments. However, more studies are needed to better understand the etiology of this relationship and its negative effects.

Endothelial and Autonomic Functions in Patients with Migraine.

OBJECTIVE: It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. DESIGN: This was a cross-sectional, randomized study. SUBJECTS AND METHODS: A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.8 ± 12.2 years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. RESULTS: Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P < 0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P < 0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P < 0.001). CONCLUSIONS: We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.

Comorbid fibromyalgia in migraine patients: clinical significance and impact on daily life.

Objective: Herein, we aimed to investigate the impact of FM in migraine patients and the specific features and discriminations of this group of migraineurs with FM according to patients without FM. Methods: 102 consecutive migraine patients among 18-50 years old who accepted to involve in the study were included. All patients were asked to complete the following self-report questionnaires for the assessment of pain-related disability, migraine-related disability, anxiety, depression, sleep disturbance and quality of life. All statistical analyses were performed using the SPSS statistics 20 program. Results: 92% of the patients were diagnosed with episodic migraine, whereas 8% of them was diagnosed with chronic migraine (CM). Comorbid FM which was detected to present in 30.3% of the patients. FM was more frequent in CM patients and in migraine patients with aura. The analyses comparing FM (+) and FM (-) migraineurs revealed that headache frequency, migraine disease duration, headache impact test, MIDAS scores were significantly higher in FM (+) migraineurs. Furthermore, the vitality and role-emotional domains of the SF-36 resulted in worse scores in the group of FM (+) migraineurs. Conclusion: The results of our study may suggest the presence of FM as a clinical sign of a more severe migraine. However, the long-term prospective studies including these group of patients are needed to understand the prognostic impact and importance of the comorbid FM in migraine. Abbreviations: FM: Fibromyalgia; MIDAS: Migraine Disability Assessment.

Is there a relationship between basilar artery tortuosity and vertigo?

OBJECTIVE: The aim of this study was to investigate the relationship between basilar artery (BA) tortuosity, hypogenesis/agenesis of the vertebral artery (VA), and vertigo, with the use of magnetic resonance imaging (MRI). PATIENTS AND METHODS: This case-control study included patients admitted to the outpatient clinics, who were aged 18-80 years, without any known systemic diseases. All patients were evaluated with a 1.5-tesla MRI system. BA Tortuosity, VA agenesis, and VA asymmetry were noted. BA diameter (central) and length (longitudinal) were measured. RESULTS: A total of 154 vertigo patients (46 M, 108 F; mean age of 48.95 ± 17.3 years) and 346 control subjects (112 M, 234 F; mean age of 45.12 ± 17.0 years) were included. The mean age of the vertigo patients was significantly higher than that of the control group (48.95 vs 45.12 years) (p = 0.021). The rate of BA tortuosity was higher in patients with vertigo (p = 0.030). When the participants were divided into two groups according to median age (<45 vs. ≥45 years) there was no statistically significant difference between the groups in terms of VA asymmetry (p = 0.070) and hypogenesis/agenesis (p = 0.577). There was a statistically significant difference between the groups in respect of BA tortuosity (p = 0.033), BA diameter (p < 0.001), and BA length (p < 0.001). When the study populations were divided into two groups according to the presence of vascular tortuosity, the mean age, BA diameter, and BA length values were higher in the tortuosity (+) group (all p < 0.001). CONCLUSION: These results demonstrated that vertigo and BA tortuosity rates seem to increase with age. Likewise, BA diameter and length increased with age, although there was no significant relationship with vertigo. Patients with tortuosity were significantly older, and had higher rates of VA asymmetry/agenesis, and increased BA diameter compared to subjects without tortuosity.

Evaluation of the Optic Nerve by Strain and Shear Wave Elastography in Patients With Migraine.

OBJECTIVES: To investigate the optic nerve's elastic properties using shear wave and strain elastography in patients with migraine compared to healthy individuals. METHODS: The migraine group consisted of 30 patients (16 with visual auras and 14 without auras) who had previously had a diagnosis of migraine. These were age and sex matched with healthy participants to form the control group. The findings from shear wave and strain elastography in the groups were compared. The elastographic examination was performed with a 6-15-MHz multifrequency linear array transducer. RESULTS: The evaluation involved 30 patients with migraine (3 male and 27 female), whose mean age ± SD was 34.63 ± 10 years, and 30 healthy participants (3 males, 27 females), whose mean age was 36.4 ± 10.5 years. In strain elasticity patterns, a statistically insignificant hardening of the optic nerve in the patients with migraine was observed (P = .052). Analysis of the shear wave elastic modulus values (9.8 ± 3.34 and 12.3 ± 5.25 kPa; P = .03) revealed that differences between the healthy participants and patients with migraine were statistically significant. The results for elasticity patterns and the shear modulus suggested that the differences between migraines with and without visual auras were insignificant (P > .05). A positive correlation was discovered between the duration of the disease and the shear modulus in the patients with migraine (r = 0.496; P < .01). CONCLUSIONS: Histopathologic changes in the optic nerve may be seen in patients with migraine due to possible fibrotic changes. Elastographic techniques can be useful diagnostic tools for investigating these changes.

Apelin-13: A Promising Biomarker for Multiple Sclerosis?

OBJECTIVES: Recent studies have shown that Apelin 13 may have a neuroprotective property. Therefore it can be used as a biomarker for multiple sclerosis. Our purpose to assess serum apelin-13 levels in adult patients with multiple sclerosis and healthy controls. PATIENTS AND METHODS: Subjects consisted of 42 relapsing remitting multiple sclerosis patients and 41 controls. Demographic characteristics including age, gender, duration of disease and Expanded Disability Symptom Scale (EDSS) were recorded. In serum samples obtained from the patients and controls, serum apelin-13 levels were measured with Enzyme Linked Immunosorbent Assay (ELISA) method. RESULTS: Serum apelin-13 levels were significantly higher in the patients groups than the healthy controls (P = 0.003). Pearson analysis did not show any significant correlation between EDSS, disease duration and apelin-13 levels. CONCLUSION: The results of our study have been showed statistically significant higher levels of serum apelin-13 in multiple sclerosis patients compared to controls. Further studies with larger patients populations and healthy controls should be done to clarify to use serum apelin levels as a biomarker for multiple sclerosis.

Evaluation of the optic nerve using strain and shear wave elastography in patients with multiple sclerosis and healthy subjects.

AIMS: Our aim was to evaluate the elasticity features of the optic nerve using strain (SE) and shear wave elastography (SWE) in multiple sclerosis (MS) patients in comparison with healthy subjects. MATERIAL AND METHODS: One hundred and seven optic nerves from 54 MS patients and 118 optic nerves from 59 healthy subjects were examined prospectively by SE and SWE. Optic nerves were divided into three types in accordance to the elasticity designs, as follows: type 1 predominantly blue (hardest tissue); type 2 predominantly blue/green (hard tissue); and type 3 predominantly green (intermediate tissue). Quantitative measurements of optic nerve hardness with SWE were analyzed in kilopascals. RESULTS: Elastographic images from healthy volunteers showed mostly type 3 optic nerves (61.9%); type 2 was also found (38.1%), but type 1 was not observed. Elastographic examination of MS patients showed mostly type 2 optic nerves (88%), while some type 1 (4.6%) and type 3 optic nerves (6.5%) were rarely observed. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p<0.001). Statistically significant differences were observed between patients and healthy volunteers in the analysis of SWE values (10.381±3.48 kPa and 33.87±11.64 p<0.001). The receiver operating characteristic curve analysis was perfect (0.993; 95% confidence interval [CI]=0.971-0.999), and a cut-off value of 18.3 kPa shear had very high sensitivity and specificity for the patient group. No significant differences were observed between patients with and without previous optic neuritis. CONCLUSION: SE and SWE examination findings concerning the optic nerve in MS patients demonstrated remarkable differences according to the healthy group.

Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients.

PURPOSE: The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. METHODS: Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. RESULTS: The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p < 0.001). A statistically significant improvement was determined by the Western Ontario Rotator Cuff Scale and the Constant and Murley shoulder scores (p Ë‚ 0.001). CONCLUSION: Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. LEVEL OF EVIDENCE: IV.

The evaluation of temperament and quality of life in patients with polycystic ovary syndrome.

AIMS: To evaluate the temperament and quality of life (QoL) of patients with PCOS. MATERIALS AND METHODS: Fifty-three adult patients with PCOS and 38 healthy controls were enrolled in the study. Demographic characteristics including age, education and body mass index (BMI) were recorded. Affective temperaments were assessed by the temperament evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A) scale. The general health-related quality of life (HRQoL) instrument used in this study was short Form 36. Hospital anxiety and depression scale (HADS) were also performed. RESULTS: The patients with PCOS had significantly higher rates of depressive, anxious and hyperthymic scores compared to controls. The PCOS patients had significantly lower mean SF-36 health summary scores. CONCLUSIONS: TEMPS-A seems to be an easy and reliable test to evaluate temperament in PCOS patients.

Autonomic dysfunction in patients with essential tremor.

The aim of this study was to evaluate the autonomic function in patients with essential tremor (ET). Thirty-one adult patients with ET and 26 healthy controls were enrolled in the study. The electrophysiological evaluations of the autonomic nervous system function were performed by sympathetic skin response (SSR) and R-R interval variation (RRIV) tests. The mean latency of SSR in ET patients was significantly delayed compared with the controls (P = 0.01). The mean amplitude of sympathetic skin response was significantly lower in ET patients in comparison to the controls (P = 0.001). No differences were found in mean RRIV values in both group subjects. Sympathetic dysfunction may occur in patients with ET. This may be easily demonstrated by SSR tests.

Autonomic dysfunction in patients with polycystic ovary syndrome.

OBJECTIVE: To assess the autonomic system in patients with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS: Thirty-seven adult patients with PCOS and 33 healthy controls were enrolled in the study. The electrophysiological assessments of the autonomic nervous system function were performed using sympathetic skin response and R-R interval variation tests. RESULTS: The mean latency of sympathetic skin response in PCOS patients was significantly delayed compared with the controls (p = 0.001). The mean amplitude of sympathetic skin response was significantly lower in comparison with the controls (p = 0.01). Mean R-R interval variation during deep breathing was also significantly delayed (p = 0.04). CONCLUSION: There are parasympathetic dysfunction and sympathetic dysfunction in patients with PCOS. This may be easily demonstrated with sympathetic skin response and R-R interval variation tests.

Atypical eclampsia and postpartum status epilepticus.

Preeclampsia is an entity that may present from 20th week of gestation up to 48 hours postpartum and is associated with hypertension and proteinuria. Eclampsia is emergence of convulsions pre-eclampsia in pregnant women with signs and symptoms. Recent studies showed that in some women, preeclampsia and even eclampsia may occur without hypertension or proteinuria. Here, we present a case of 26 years old women who had an uneventful pregnancy until 30 weeks' of gestation. She had only proteinuria in laboratory tests and was diagnosed as status epilepticus in early postpartum period. Preeclampsia and eclampsia is related with serious fetal and maternal morbidity and mortality and may present with atypical course. The awareness of atypical cases of preeclampsia enhances early diagnosis and management which are critical to avoid feto-maternal complications.