Re-emergent tremor (RET) and the classical parkinsonian rest tremor were considered as two differ... more Re-emergent tremor (RET) and the classical parkinsonian rest tremor were considered as two different phenomena of the same central tremor circuit. However, clinical and accelerometric characteristics of these tremors were not previously compared in a single study. We evaluated disease characteristics and accelerometric measurements of two tremor types in 42 patients with Parkinson's disease. Disease specific features and accelerometric measurements of peak frequency, amplitude at peak frequency and the root mean square (RMS) amplitude of two tremor types were compared. Eighteen patients had RET and the mean latency of the RET was 9.48 (±9.2) s. Groups of only rest tremor and RET did not differ significantly in age of disease onset, disease duration and severity and mean levodopa equivalent dose. Comparison of peak frequency and amplitude at peak frequency were not different between the groups, but RMS amplitude was significantly higher in the RET group (p = 0.03). RMS amplitude of RET was also correlated with disease severity (r = .48, p = 0.04). These results support the previous notion that rest tremor and RET are analogue, both are triggered by the same central ossilator with RET being only the suppression of the rest tremor due to arm repositioning.
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/journals/sfn/sfn_bk.htm
2019 3rd International Symposium on Multidisciplinary Studies and Innovative Technologies (ISMSIT), 2019
In this study, a method for the detection of rigidity movement disorder, which is one of the comm... more In this study, a method for the detection of rigidity movement disorder, which is one of the common symptoms of Parkinson's Disease, was developed. The developed method is based on an electromechanical measuring device. With this method, parameters related to stiffness of the patient's wrist were obtained by the computerized analysis of the recorded measurement data and comparison was made with the stiffness score of the physician. The data were compared with the motor scores of the Unified Parkinson's Disease Assessment Scale (UPDRS) and the Hoehn-Yahr Staging Scale. The results showed that the motor UPDRS scores and the Hoehn-Yahr Staging scale were consistent. Furthermore, it was seen that the rigidity enhancing effect of the Froment maneuver can be distinguished by the established system. It was noted that the stiffness scores with Froment maneuver measurements made for the same patient were 1 point higher than the stiffness scores without Froment maneuver measurements. Also; As a result of the comparison made with the stiffness scoring performed by the physician, it was found that the stiffness data obtained were generally consistent with the physician scoring. However, according to the data obtained, some physician scoring deviations from normal were determined. As a result of these studies, a lower-upper limit was established for stiffness values evaluated between 0-4 points. Thus, an objective method that can be used to evaluate the sign of stiffness was proposed.
Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS), continuous subcutaneous apomo... more Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS), continuous subcutaneous apomorphine infusion (APO), and levodopa-carbidopa intestinal gel infusion (LCIG) are treatments used to treat severe motor fluctuations and dyskinesia in patients with advanced levodopa responsive Parkinson's disease (PD), who can no longer be managed with available combinations of oral medications. This study aims to evaluate patient choice of one of three device-based treatment methods. Methods: A total of 58 patients clinically diagnosed with PD were included in the study. Eligibility for device-based treatment of PD patients with motor symptoms despite optimal medical treatment was assessed based on Hoehn & Yahr Stages, and Unified Parkinson's Disease Rating Scale-Part III. All three device-based treatment methods were thoroughly explained with on-hand demonstrations. Preferences and reasons for choice were recorded. Results: Nineteen patients were ineligible for STN-DBS due to neurological causes. A total of 23 patients preferred STN-DBS, 23 preferred APO, and only one patient preferred LCIG. Thirteen patients preferred to continue oral medical treatment, while two patients positively approached both STN-DBS and APO. Conclusion: The most common reason patients declined STN-DBS and LCIG was concerns about the surgical operation, while the most common reason APO was declined was its frequent administration of injection. While STN-DBS was preferred by younger, less severe patients, APO was preferred by older patients who had longer duration of disease.
Dystonia refers to an involuntary, repetitive, sustained, painful and twisting movements of the a... more Dystonia refers to an involuntary, repetitive, sustained, painful and twisting movements of the affected body part. This movement disorder was first described in 1911 by Hermain Oppenheim, and many studies have been conducted to understand the mechanism, the diagnosis and the treatment of dystonia ever since. However, there are still many unexplained aspects of this phenomenon. Dystonia is diagnosed by clinical manifestations, and various classifications are recommended for the diagnosis and the treatment. Anatomic classification, which is based on the muscle groups involved, is the most helpful classification model to plan the course of the treatment. Dystonias can also be classified based on the age of onset and the cause. These dystonic syndromes can be present without an identified etiology or they can be clinical manifestations of a neurodegenerative or neurometabolic disease. In this review we summarized the differential diagnosis, definition, classifications, possible mechani...
Background: Subthalamic nucleus deep brain stimulation is an effective treatment for the symptoma... more Background: Subthalamic nucleus deep brain stimulation is an effective treatment for the symptomatic treatment of Parkinson's disease. Apart from the obvious motor benefits, some cognitive side effects have been reported, particularly in verbal fluency. Objectives: Our aim was to evaluate the effects of the stimulation on verbal fluency and visuospatial orientation with changing stimulation conditions in 35 patients with Parkinson's disease. Methods: Patients were randomized for their stimulation conditions as ‘both on', ‘both off', ‘right on', and ‘left on' and underwent verbal fluency and visuospatial orientation tasks during their drug-on periods. Letter and categorical fluency tasks and Benton's Judgment of Line Orientation Test were used for assessment. Results: Overall, 6 patients were excluded due to dementia or depression. For verbal fluency, the number of words they produced in 1 min was similar in four stimulation conditions (p > 0.05). No si...
Background: We present the case of a 65-year-old female with sudden-onset involuntary mouth openi... more Background: We present the case of a 65-year-old female with sudden-onset involuntary mouth opening, deviation of the jaw, facial grimacing, and tongue movements that started 6 months prior to her admission. Case Report: She was diagnosed with oromandibular dystonia. Differential diagnosis of oromandibular dystonia and various etiologies were investigated. Neuroimaging studies revealed a left cerebellar infarction. Discussion: To our knowledge, this case is the first oromandibular dystonia presenting with cerebellar ischemic stroke. Possible roles of the cerebellum for the pathophysiology of oromandibular dystonia are discussed.
Oromandibüler distoni, (OMD) s›kl›kla orbikülaris oküli, perioral mimik kaslar›, vokal kordlar ve... more Oromandibüler distoni, (OMD) s›kl›kla orbikülaris oküli, perioral mimik kaslar›, vokal kordlar ve servikal kaslar›n efllik etti¤i bir segmental kraniyal distonidir. Blefarospazmdan sonra ikinci s›kl›kta saptanan kraniyal distonidir. ‹zole olarak veya di¤er kraniyoservikal distoni formlar› ile birlikte bulunabilir. Çi¤neme, yutma ve konuflmay› etkiledi¤i için özürleyici bir hastal›kt›r. Oromandibüler distonili hastalar›n büyük ço¤unlu¤u idyopatiktir ancak Tardif Diskinezi baflta olmak üzere baflka hastal›klara sekonder ç›kabilir. Oromandibüler distoninin botulinum toksiniyle tedavisi, di¤er fokal hiperkinezilerle karfl›laflt›r›ld›¤›nda daha az etkili olsa da, bilinen en etkili tedavidir. Dil ve çi¤neme kaslar› genellikle zor ulafl›lan ve birden fazla ifllevi olan kaslar oldu¤u için anatomileri haklar›nda yeterli bilgi sahibi olmak gerekir. Kaslar›n bir bölümü yüzeyel ve palpabl olmad›klar›ndan, hastalar›n hepsinde injeksiyon s›ras›nda EMG yard›m› gerekmektedir. Ayn› kasa ayn› dozdaki injeksiyona farkl› kiflisel yan›tlar al›nd›¤›ndan, tedavinin bireysellefltirilmesi önemlidir. Yan tesirleri s›kl›k s›ras›yla disfaji, dizartri, yüzde fliflme ve çi¤neme zorlu¤udur.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The aim of the study was to test the validity of the controversial subdivision of essential tremo... more The aim of the study was to test the validity of the controversial subdivision of essential tremor (ET) patients into electrophysiological subgroups. We evaluated a hundred patients with ET using surface electromyographic (EMG) recordings of antagonists forearm muscles and distinguished three groups: the first group showed synchronous activity of antagonistic muscles, the second showed alternating activity of antagonist muscles; and the third group consisted of patients whose EMG recordings were not compatible with the other two groups. We compared patients with synchronous and alternating activity in terms of sex, age at onset, duration of illness, family history of tremor, symmetry and frequency of tremor, and the scores of a disability scale. The only significant difference between the patients with synchronous and alternating activity was that the patients with synchronous activity were more disabled. This result adds to the evidence for distinct electrophysiological subgroups o...
This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the ef... more This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the effects of age, sex, psychiatric diagnosis and duration of illness on the severity and topographic distribution of dyskinesia, and to describe the topographic distribution of drug-induced dyskinesia (DID) and drug-induced parkinsonism (DIP) in detail by examining 170 consecutive inpatients on antipsychotic treatment. Age, sex, psychiatric diagnosis or total duration of exposure to antipsychotics had no significant effect on either the severity or the distribution of DID. Drug-induced dyskinesia and DIP did not show a conspicuous pattern of lateralisation. Progression of mild DID to TD may not be a rule and factors other than age, sex, psychiatric diagnosis or duration of antipsychotic exposure might be operating in the development of clinically significant TD. Gait abnormalities and falls might be frequent manifestations of DIP as well as other side effects in these patients.
Bu yaz ıda eksitatör aminoasitler olan glutamik ve aspartik asidin nöronal hasarlanma ve çe şitli... more Bu yaz ıda eksitatör aminoasitler olan glutamik ve aspartik asidin nöronal hasarlanma ve çe şitli nörolojik hastalıkların (stroke, epilepsi, Parkinson hastalığı , Huntington hastalığı , Alzheimer hastal ığı , A1DS'e ba ğlı nörolojik bozukluklar) olu şmasındaki rolü gözden geçirilmi ştir.
Re-emergent tremor (RET) and the classical parkinsonian rest tremor were considered as two differ... more Re-emergent tremor (RET) and the classical parkinsonian rest tremor were considered as two different phenomena of the same central tremor circuit. However, clinical and accelerometric characteristics of these tremors were not previously compared in a single study. We evaluated disease characteristics and accelerometric measurements of two tremor types in 42 patients with Parkinson's disease. Disease specific features and accelerometric measurements of peak frequency, amplitude at peak frequency and the root mean square (RMS) amplitude of two tremor types were compared. Eighteen patients had RET and the mean latency of the RET was 9.48 (±9.2) s. Groups of only rest tremor and RET did not differ significantly in age of disease onset, disease duration and severity and mean levodopa equivalent dose. Comparison of peak frequency and amplitude at peak frequency were not different between the groups, but RMS amplitude was significantly higher in the RET group (p = 0.03). RMS amplitude of RET was also correlated with disease severity (r = .48, p = 0.04). These results support the previous notion that rest tremor and RET are analogue, both are triggered by the same central ossilator with RET being only the suppression of the rest tremor due to arm repositioning.
Access to full text and tables of contents, including tentative ones for forthcoming issues: www.... more Access to full text and tables of contents, including tentative ones for forthcoming issues: www.karger.com/journals/sfn/sfn_bk.htm
2019 3rd International Symposium on Multidisciplinary Studies and Innovative Technologies (ISMSIT), 2019
In this study, a method for the detection of rigidity movement disorder, which is one of the comm... more In this study, a method for the detection of rigidity movement disorder, which is one of the common symptoms of Parkinson's Disease, was developed. The developed method is based on an electromechanical measuring device. With this method, parameters related to stiffness of the patient's wrist were obtained by the computerized analysis of the recorded measurement data and comparison was made with the stiffness score of the physician. The data were compared with the motor scores of the Unified Parkinson's Disease Assessment Scale (UPDRS) and the Hoehn-Yahr Staging Scale. The results showed that the motor UPDRS scores and the Hoehn-Yahr Staging scale were consistent. Furthermore, it was seen that the rigidity enhancing effect of the Froment maneuver can be distinguished by the established system. It was noted that the stiffness scores with Froment maneuver measurements made for the same patient were 1 point higher than the stiffness scores without Froment maneuver measurements. Also; As a result of the comparison made with the stiffness scoring performed by the physician, it was found that the stiffness data obtained were generally consistent with the physician scoring. However, according to the data obtained, some physician scoring deviations from normal were determined. As a result of these studies, a lower-upper limit was established for stiffness values evaluated between 0-4 points. Thus, an objective method that can be used to evaluate the sign of stiffness was proposed.
Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS), continuous subcutaneous apomo... more Introduction: Subthalamic nucleus deep brain stimulation (STN-DBS), continuous subcutaneous apomorphine infusion (APO), and levodopa-carbidopa intestinal gel infusion (LCIG) are treatments used to treat severe motor fluctuations and dyskinesia in patients with advanced levodopa responsive Parkinson's disease (PD), who can no longer be managed with available combinations of oral medications. This study aims to evaluate patient choice of one of three device-based treatment methods. Methods: A total of 58 patients clinically diagnosed with PD were included in the study. Eligibility for device-based treatment of PD patients with motor symptoms despite optimal medical treatment was assessed based on Hoehn & Yahr Stages, and Unified Parkinson's Disease Rating Scale-Part III. All three device-based treatment methods were thoroughly explained with on-hand demonstrations. Preferences and reasons for choice were recorded. Results: Nineteen patients were ineligible for STN-DBS due to neurological causes. A total of 23 patients preferred STN-DBS, 23 preferred APO, and only one patient preferred LCIG. Thirteen patients preferred to continue oral medical treatment, while two patients positively approached both STN-DBS and APO. Conclusion: The most common reason patients declined STN-DBS and LCIG was concerns about the surgical operation, while the most common reason APO was declined was its frequent administration of injection. While STN-DBS was preferred by younger, less severe patients, APO was preferred by older patients who had longer duration of disease.
Dystonia refers to an involuntary, repetitive, sustained, painful and twisting movements of the a... more Dystonia refers to an involuntary, repetitive, sustained, painful and twisting movements of the affected body part. This movement disorder was first described in 1911 by Hermain Oppenheim, and many studies have been conducted to understand the mechanism, the diagnosis and the treatment of dystonia ever since. However, there are still many unexplained aspects of this phenomenon. Dystonia is diagnosed by clinical manifestations, and various classifications are recommended for the diagnosis and the treatment. Anatomic classification, which is based on the muscle groups involved, is the most helpful classification model to plan the course of the treatment. Dystonias can also be classified based on the age of onset and the cause. These dystonic syndromes can be present without an identified etiology or they can be clinical manifestations of a neurodegenerative or neurometabolic disease. In this review we summarized the differential diagnosis, definition, classifications, possible mechani...
Background: Subthalamic nucleus deep brain stimulation is an effective treatment for the symptoma... more Background: Subthalamic nucleus deep brain stimulation is an effective treatment for the symptomatic treatment of Parkinson's disease. Apart from the obvious motor benefits, some cognitive side effects have been reported, particularly in verbal fluency. Objectives: Our aim was to evaluate the effects of the stimulation on verbal fluency and visuospatial orientation with changing stimulation conditions in 35 patients with Parkinson's disease. Methods: Patients were randomized for their stimulation conditions as ‘both on', ‘both off', ‘right on', and ‘left on' and underwent verbal fluency and visuospatial orientation tasks during their drug-on periods. Letter and categorical fluency tasks and Benton's Judgment of Line Orientation Test were used for assessment. Results: Overall, 6 patients were excluded due to dementia or depression. For verbal fluency, the number of words they produced in 1 min was similar in four stimulation conditions (p > 0.05). No si...
Background: We present the case of a 65-year-old female with sudden-onset involuntary mouth openi... more Background: We present the case of a 65-year-old female with sudden-onset involuntary mouth opening, deviation of the jaw, facial grimacing, and tongue movements that started 6 months prior to her admission. Case Report: She was diagnosed with oromandibular dystonia. Differential diagnosis of oromandibular dystonia and various etiologies were investigated. Neuroimaging studies revealed a left cerebellar infarction. Discussion: To our knowledge, this case is the first oromandibular dystonia presenting with cerebellar ischemic stroke. Possible roles of the cerebellum for the pathophysiology of oromandibular dystonia are discussed.
Oromandibüler distoni, (OMD) s›kl›kla orbikülaris oküli, perioral mimik kaslar›, vokal kordlar ve... more Oromandibüler distoni, (OMD) s›kl›kla orbikülaris oküli, perioral mimik kaslar›, vokal kordlar ve servikal kaslar›n efllik etti¤i bir segmental kraniyal distonidir. Blefarospazmdan sonra ikinci s›kl›kta saptanan kraniyal distonidir. ‹zole olarak veya di¤er kraniyoservikal distoni formlar› ile birlikte bulunabilir. Çi¤neme, yutma ve konuflmay› etkiledi¤i için özürleyici bir hastal›kt›r. Oromandibüler distonili hastalar›n büyük ço¤unlu¤u idyopatiktir ancak Tardif Diskinezi baflta olmak üzere baflka hastal›klara sekonder ç›kabilir. Oromandibüler distoninin botulinum toksiniyle tedavisi, di¤er fokal hiperkinezilerle karfl›laflt›r›ld›¤›nda daha az etkili olsa da, bilinen en etkili tedavidir. Dil ve çi¤neme kaslar› genellikle zor ulafl›lan ve birden fazla ifllevi olan kaslar oldu¤u için anatomileri haklar›nda yeterli bilgi sahibi olmak gerekir. Kaslar›n bir bölümü yüzeyel ve palpabl olmad›klar›ndan, hastalar›n hepsinde injeksiyon s›ras›nda EMG yard›m› gerekmektedir. Ayn› kasa ayn› dozdaki injeksiyona farkl› kiflisel yan›tlar al›nd›¤›ndan, tedavinin bireysellefltirilmesi önemlidir. Yan tesirleri s›kl›k s›ras›yla disfaji, dizartri, yüzde fliflme ve çi¤neme zorlu¤udur.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The aim of the study was to test the validity of the controversial subdivision of essential tremo... more The aim of the study was to test the validity of the controversial subdivision of essential tremor (ET) patients into electrophysiological subgroups. We evaluated a hundred patients with ET using surface electromyographic (EMG) recordings of antagonists forearm muscles and distinguished three groups: the first group showed synchronous activity of antagonistic muscles, the second showed alternating activity of antagonist muscles; and the third group consisted of patients whose EMG recordings were not compatible with the other two groups. We compared patients with synchronous and alternating activity in terms of sex, age at onset, duration of illness, family history of tremor, symmetry and frequency of tremor, and the scores of a disability scale. The only significant difference between the patients with synchronous and alternating activity was that the patients with synchronous activity were more disabled. This result adds to the evidence for distinct electrophysiological subgroups o...
This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the ef... more This study attempted to contribute to the subtyping of tardive dyskinesia (TD) by studying the effects of age, sex, psychiatric diagnosis and duration of illness on the severity and topographic distribution of dyskinesia, and to describe the topographic distribution of drug-induced dyskinesia (DID) and drug-induced parkinsonism (DIP) in detail by examining 170 consecutive inpatients on antipsychotic treatment. Age, sex, psychiatric diagnosis or total duration of exposure to antipsychotics had no significant effect on either the severity or the distribution of DID. Drug-induced dyskinesia and DIP did not show a conspicuous pattern of lateralisation. Progression of mild DID to TD may not be a rule and factors other than age, sex, psychiatric diagnosis or duration of antipsychotic exposure might be operating in the development of clinically significant TD. Gait abnormalities and falls might be frequent manifestations of DIP as well as other side effects in these patients.
Bu yaz ıda eksitatör aminoasitler olan glutamik ve aspartik asidin nöronal hasarlanma ve çe şitli... more Bu yaz ıda eksitatör aminoasitler olan glutamik ve aspartik asidin nöronal hasarlanma ve çe şitli nörolojik hastalıkların (stroke, epilepsi, Parkinson hastalığı , Huntington hastalığı , Alzheimer hastal ığı , A1DS'e ba ğlı nörolojik bozukluklar) olu şmasındaki rolü gözden geçirilmi ştir.
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