INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and tri... more INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and triglyceride levels, and it has been shown that hypertriglyceridemia significantly increases the risk independently. In this study, we wanted to investigate whether there is a similar relationship for stroke. METHODS: A total of 619 patients hospitalized with a diagnosis of acute ischemic stroke in our stroke center were included in the study. Demographic information, accompanying risk factors, hemoglobin level, thrombocyte count, triglyceride level, and C reactive protein level at the time of admission, and the National Institutes of Health Stroke Scale (NIHSS) scores in the first evaluation were recorded. Also, information about mortality in hospital, recurrent stroke, and the modified Rankin Scale (mRS) scores in the follow-up period was entered in our local database. RESULTS: While 182 patients (32.3%) (78 females (42.9%) and 104 males (57.1%); mean age 64.5±12.01 years) were diagnosed with hypertriglyceridemia, this number was 25 (4.4%) patients (13 females (52%) and 12 males (48%); mean age 70.9±17.4 years) for hypotriglyceridemia. Among the risk factors studied, only diabetes mellitus was found to be associated with hypertriglyceridemia in patients with acute ischemic stroke (P<0.05). DISCUSSION AND CONCLUSION: In this study conducted in our stroke center, hypertriglyceridemia and hypotriglyceridemia prevalences were found as 32.3% and 4.4%, respectively. HyperTG or hypoTG did not significantly affect on stroke severity and prognosis. We found out that DM is the major risk factor for acute ischemic stroke patients with hyperTG.
Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study... more Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 agematched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test-short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture and gait of people when they did not recognize their masked faces and those who stated that this difficulty affected their daily lives were higher in the OHC group (p=0.002 and p=0.009, respectively). The number of participants whose difficulty in recognizing masked faces decreased over time was higher in the YHC group (p=0.003). Conclusions: The PwP group demonstrated similar performance to their peers but differed from the YHC group in recognizing masked faces. Knowing difficulties experienced by elderly people in recognizing people who are masked can increase awareness on this issue and enhance their social interaction in pandemic conditions through measures to be taken.
International Journal of Neuroscience, Jan 5, 2021
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.
Onabotulinum toxin A (ONA, Botox®) and abobotulinum toxin A (ABO, Dysport®) are most frequently u... more Onabotulinum toxin A (ONA, Botox®) and abobotulinum toxin A (ABO, Dysport®) are most frequently used in the treatment of movement disorders. The aim of this study was to identify the dose conversion ratio (ABO dose:ONA dose), comparative efficacy, and adverse events in patients who switched from ONA to ABO. There were 64 patients with cervical dystonia (39), hemifacial spasm (16), oromandibular dystonia (5), blepharospasm (3), and extremity dystonia (1) who switched from ONA to ABO. The efficacy, adverse events, duration of action, and severity of the adverse events after the final dose of ONA, initial dose of ABO, and second dose of ABO were investigated in these patients. The mean dose conversion ratio was 4.70 (2.27-9.62). The mean efficacy of the final ONA injection was 70.62%; initial ABO injection, 72.27%; and second ABO injection, 73.52%, which showed improvement on a visual analog scale (p = 0.71, p = 0.5). Incidence of adverse events after the final ONA injection was 18.8%; this increased to 39.1% after the initial ABO injection (p < 0.001) and decreased to 14.1% after the second ABO injection (p = 0.77). After the initial ABO injection, 20% of the adverse events were trivial, 36% were mild, and 32% were severe. After the second ABO injection, 7.8% of the adverse events were mild and 6.3% were severe. Although the mean dose conversion ratio was 4.70, the range was very wide (approximately 2-9). Therefore, we conclude that after the switch from Botox to Dysport, the doses should be tailored to the patients' clinical situation at treatment initiation, without using a dose conversion ratio.
Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi s... more Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi sırasında, sağlık merkezlerine erişim kısıtlanmışken, nöroloji polikliniğinde hareket bozuklukları nedeniyle takipli olan hastaların tele-tıp yöntemi ile tıbbi kontrollerinin sağlanabilmesi, hastalar ve hekimlerin viral yükünü azaltmak adına önemli bir adımdır. Makalemizde, hareket bozuklukları hastalarımızla olan tele-tıp aracılı danışmanlık deneyimimizi paylaşmayı amaçladık. Gereç ve Yöntem: Çalışmada, 11 Mart-20 Haziran 2020 tarihleri arasında ünitemiz ile iletişim kuran 71 hareket bozukluğu hastasının verileri retrospektif olarak incelenmiştir. Bulgular: Yetmiş bir hasta ile yapılan, çoğunluğu WhatsApp® üzerinden gerçekleştirilen toplam 117 yazılı ve sözlü görüşmede, hastaların hekime danışma nedenleri ayrıntılı incelendiğinde; hastaların en sık kötüleşme-katılık ve reçete-rapor istemi ile iletişim kurdukları görüldü. Bu görüşmelerin 25'i (%21,4) hastalara fiziki muayene için randevu verilmesi ile sonuçlanmıştır. Tele-tıp hizmeti ile 92 (%78,6) görüşmede hasta ile fiziki temas kurmadan sorun çözülebilmiştir. Sonuç: Hareket bozuklukları telekonferans aracılığı ile değerlendirmeye oldukça uygundur. Bunu da göz önünde bulundurarak aktif olarak kullandığımız telenöroloji uygulamamızın, pandemi sürecinde hem hastalar hem de sağlık çalışanlarının bulaş riskinin azaltılması açısından yararlı olduğunu düşünmekteyiz. Teletıp uygulamaların dünyada ve ülkemizde yasal yönleri ve kullanımının yaygınlaştırılması açısından geliştirilmesine ihtiyaç vardır. Anahtar Kelimeler: Tele-tıp uygulamaları, hareket bozuklukları, tele-nöroloji Öz Objective: Access to health centers was restricted during the coronavirus disease-2019 pandemic, which hit our country in March 2020. Ensuring the medical control of patients who were followed up in the neurology outpatient clinic with the tele-medicine method was an important step to decrease the viral load of patients and physicians. This study aimed to share our tele-medicine experience with patients with movement disorders. Materials and Methods: The data of 71 patients with movement disorder who communicated with our unit between March 11, 2020 and June 20, 2020 were retrospectively analyzed. Results: A total of 117 verbal and written interviews with 71 patients were mostly conducted via WhatsApp®. The evaluation of reasons for physician consultation revealed that patients most frequently communicated for worsening rigidity and prescription-drug requests. Of these interviews, 25 (21.4%) resulted in setting patient appointments for a physical examination. The tele-medicine service in 92 (78.6%) interviews solved the problem without physical contact with patients. Conclusion: Movement disorder evaluations are suitable through teleconference. Therefore, our teleneurology application, which we actively use, is effective in reducing the risk of viral transmission to both patients and healthcare workers during the pandemic. Developing telemedical applications is necessary in terms of their legal aspects and implementation in the world, especially in our country.
Objective To assess whether trainees can learn and implement the operational definition of interi... more Objective To assess whether trainees can learn and implement the operational definition of interictal epileptiform discharges (IEDs) of the International Federation of Clinical Neurophysiology (IFCN), based on six morphological criteria, and whether its implementation improves their diagnostic performance and inter‐rater agreement (IRA).Methods Seven trainees evaluated a balanced dataset of 70 EEG samples containing sharp transients (35 from patients with epilepsy and 35 from patients with non‐epileptic paroxysmal events). The gold standard was derived from video‐EEG recordings of the habitual clinical episodes. The trainees individually reviewed the EEGs, blinded to all other data, in two successive training sessions, three months apart. The second session was preceded by a teaching module about the IFCN criteria, and the trainees implemented them during the second reading session.Results By implementing the IFCN criteria, trainees significantly improved their specificity (94.29% vs. 77.14%; p=0.01) and overall accuracy (81.43% vs. 64.29%; p=0.01) for identifying IEDs. Sensitivity also improved but did not reach the level of statistical significance (77.14% vs. 60%; p=0.07). IRA improved significantly from fair (k=0.31; 95% CI: 0.22‐0.40) to high‐moderate (k=0.56; 95% CI:0.46‐0.67) beyond‐chance agreement.Significance Implementing the IFCN criteria significantly improves the diagnostic performance and IRA of trainees in identifying IEDs. Teaching the IFCN criteria for IEDs will increase specificity in clinical EEG and avoid over‐reading, the most common cause of misdiagnosing epilepsy.
Background Face and facial expression recognition abilities have been frequently evaluated in the... more Background Face and facial expression recognition abilities have been frequently evaluated in the assessment of social cognition disorders in patients with MS. Investigation of the effect of new difficulties emerging in the field of face recognition with the widespread use of masks during the ongoing COVID-19 pandemic on patients with MS may make new contributions to the literature. Material and methods The study included 44 patients with relapsing-remitting MS (RRMSp) and 51 controls who were matched to the case group in terms of age and education level. The Benton face recognition test-short form (BFRT-sf), Beck Depression Inventory, a close-ended 13-item survey on face recognition difficulties due to mask use during the pandemic was administered to all groups. Results In the RRMSp, the mean disease duration was 8.2 ± 5.6, the mean EDSS score was 1.2 ± 1.0, and the mean MOCA test score was 27.23 ± 2.08. The mean BFRTsf was 19.9 ± 2.4 in the RRMSp and 21.6 ± 1.8 in the healthy controls.Twenty-five percent of RRMSp and 4% of the healthy controls required people to remove their masks to be able to recognize their faces. Improvement in face recognition difficulty over time was reported as 80% in the healthy controls and 34% in the RRMSp. Conclusion RRMSp had worse performance in masked face recognition and required removal of the facial masks more often than healthy controls to recognize the faces. RRMS patients did not show as much improvement in recognizing masked faces over time according to the onset of the pandemic as healthy controls.
Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, a... more Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, and still constitutes a serious health problem affecting millions of people across the world. The evaluation and follow-up of ongoing and/or newly developing neurological involvement after recovery from COVID-19 are important. This study aims to reveal post-COVID-19 neurological symptoms and risk factors for their development. Methods: Patients over the age of 18 years who applied to centers, at least 4 weeks after COVID-19 infection and agreed to participate in the study were included in this cross-sectional study between January 20 and March 15, 2021. The patients were evaluated face to face, and their sociodemographic data, medical history, post-COVID-19 neurological symptoms, treatments, and Beck Depression Inventory scores were recorded. All statistical analyses were performed using SPSS 23 for Windows software package (SPSS Inc., Chicago, IL). Results: Four hundred patients were inc...
INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and tri... more INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and triglyceride levels, and it has been shown that hypertriglyceridemia significantly increases the risk independently. In this study, we wanted to investigate whether there is a similar relationship for stroke. METHODS: A total of 619 patients hospitalized with a diagnosis of acute ischemic stroke in our stroke center were included in the study. Demographic information, accompanying risk factors, hemoglobin level, thrombocyte count, triglyceride level, and C reactive protein level at the time of admission, and the National Institutes of Health Stroke Scale (NIHSS) scores in the first evaluation were recorded. Also, information about mortality in hospital, recurrent stroke, and the modified Rankin Scale (mRS) scores in the follow-up period was entered in our local database. RESULTS: While 182 patients (32.3%) (78 females (42.9%) and 104 males (57.1%); mean age 64.5±12.01 years) were diagnosed with hypertriglyceridemia, this number was 25 (4.4%) patients (13 females (52%) and 12 males (48%); mean age 70.9±17.4 years) for hypotriglyceridemia. Among the risk factors studied, only diabetes mellitus was found to be associated with hypertriglyceridemia in patients with acute ischemic stroke (P<0.05). DISCUSSION AND CONCLUSION: In this study conducted in our stroke center, hypertriglyceridemia and hypotriglyceridemia prevalences were found as 32.3% and 4.4%, respectively. HyperTG or hypoTG did not significantly affect on stroke severity and prognosis. We found out that DM is the major risk factor for acute ischemic stroke patients with hyperTG.
The expression levels of miR-204 and miR-373 were investigated in neuron-derived serum exosomes o... more The expression levels of miR-204 and miR-373 were investigated in neuron-derived serum exosomes obtained from 15 patients with mild AD, 18 with moderate AD, and 21 cognitively healthy individuals. Results and discussion: The miR-204 and miR-373 expressions were significantly decreased in both patient groups compared to the control group. Therefore, we suggest that miR-204 and miR-373 are potential biomarkers for AD. However, due to the preliminary nature of this study, further large-scale studies are needed to support our findings.
ABSTRACT. Patients with Parkinson’s disease (PwP) have face recognition difficulties. Objective: ... more ABSTRACT. Patients with Parkinson’s disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 age-matched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test - short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture a...
To assess whether trainees can learn and implement the operational definition of interictal epile... more To assess whether trainees can learn and implement the operational definition of interictal epileptiform discharges (IEDs) of the International Federation of Clinical Neurophysiology (IFCN), based on six morphological criteria, and whether its implementation improves their diagnostic performance and inter-rater agreement (IRA). Seven trainees evaluated a balanced dataset of 70 EEG samples containing sharp transients (35 from patients with epilepsy and 35 from patients with non-epileptic paroxysmal events). The gold standard was derived from video-EEG recordings of the habitual clinical episodes. The trainees individually reviewed the EEGs, blinded to all other data, in two successive training sessions, three months apart. The second session was preceded by a teaching module about the IFCN criteria, and the trainees implemented them during the second reading session. By implementing the IFCN criteria, trainees significantly improved their specificity (94.29% vs. 77.14%; p=0.01) and overall accuracy (81.43% vs. 64.29%; p=0.01) for identifying IEDs. Sensitivity also improved but did not reach the level of statistical significance (77.14% vs. 60%; p=0.07). IRA improved significantly from fair (k=0.31; 95% CI: 0.22-0.40) to high-moderate (k=0.56; 95% CI:0.46-0.67) beyond-chance agreement. Implementing the IFCN criteria significantly improves the diagnostic performance and IRA of trainees in identifying IEDs. Teaching the IFCN criteria for IEDs will increase specificity in clinical EEG and avoid over-reading, the most common cause of misdiagnosing epilepsy.
Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi s... more Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi sırasında, sağlık merkezlerine erişim kısıtlanmışken, nöroloji polikliniğinde hareket bozuklukları nedeniyle takipli olan hastaların tele-tıp yöntemi ile tıbbi kontrollerinin sağlanabilmesi, hastalar ve hekimlerin viral yükünü azaltmak adına önemli bir adımdır. Makalemizde, hareket bozuklukları hastalarımızla olan tele-tıp aracılı danışmanlık deneyimimizi paylaşmayı amaçladık. Gereç ve Yöntem: Çalışmada, 11 Mart-20 Haziran 2020 tarihleri arasında ünitemiz ile iletişim kuran 71 hareket bozukluğu hastasının verileri retrospektif olarak incelenmiştir. Bulgular: Yetmiş bir hasta ile yapılan, çoğunluğu WhatsApp® üzerinden gerçekleştirilen toplam 117 yazılı ve sözlü görüşmede, hastaların hekime danışma nedenleri ayrıntılı incelendiğinde; hastaların en sık kötüleşme-katılık ve reçete-rapor istemi ile iletişim kurdukları görüldü. Bu görüşmelerin 25'i (%21,4) hastalara fiziki muayene için randevu verilmesi ile sonuçlanmıştır. Tele-tıp hizmeti ile 92 (%78,6) görüşmede hasta ile fiziki temas kurmadan sorun çözülebilmiştir. Sonuç: Hareket bozuklukları telekonferans aracılığı ile değerlendirmeye oldukça uygundur. Bunu da göz önünde bulundurarak aktif olarak kullandığımız telenöroloji uygulamamızın, pandemi sürecinde hem hastalar hem de sağlık çalışanlarının bulaş riskinin azaltılması açısından yararlı olduğunu düşünmekteyiz. Teletıp uygulamaların dünyada ve ülkemizde yasal yönleri ve kullanımının yaygınlaştırılması açısından geliştirilmesine ihtiyaç vardır. Anahtar Kelimeler: Tele-tıp uygulamaları, hareket bozuklukları, tele-nöroloji Öz Objective: Access to health centers was restricted during the coronavirus disease-2019 pandemic, which hit our country in March 2020. Ensuring the medical control of patients who were followed up in the neurology outpatient clinic with the tele-medicine method was an important step to decrease the viral load of patients and physicians. This study aimed to share our tele-medicine experience with patients with movement disorders. Materials and Methods: The data of 71 patients with movement disorder who communicated with our unit between March 11, 2020 and June 20, 2020 were retrospectively analyzed. Results: A total of 117 verbal and written interviews with 71 patients were mostly conducted via WhatsApp®. The evaluation of reasons for physician consultation revealed that patients most frequently communicated for worsening rigidity and prescription-drug requests. Of these interviews, 25 (21.4%) resulted in setting patient appointments for a physical examination. The tele-medicine service in 92 (78.6%) interviews solved the problem without physical contact with patients. Conclusion: Movement disorder evaluations are suitable through teleconference. Therefore, our teleneurology application, which we actively use, is effective in reducing the risk of viral transmission to both patients and healthcare workers during the pandemic. Developing telemedical applications is necessary in terms of their legal aspects and implementation in the world, especially in our country.
Background Face and facial expression recognition abilities have been frequently evaluated in the... more Background Face and facial expression recognition abilities have been frequently evaluated in the assessment of social cognition disorders in patients with MS. Investigation of the effect of new difficulties emerging in the field of face recognition with the widespread use of masks during the ongoing COVID-19 pandemic on patients with MS may make new contributions to the literature. Material and methods The study included 44 patients with relapsing-remitting MS (RRMSp) and 51 controls who were matched to the case group in terms of age and education level. The Benton face recognition test-short form (BFRT-sf), Beck Depression Inventory, a close-ended 13-item survey on face recognition difficulties due to mask use during the pandemic was administered to all groups. Results In the RRMSp, the mean disease duration was 8.2 ± 5.6, the mean EDSS score was 1.2 ± 1.0, and the mean MOCA test score was 27.23 ± 2.08. The mean BFRTsf was 19.9 ± 2.4 in the RRMSp and 21.6 ± 1.8 in the healthy controls.Twenty-five percent of RRMSp and 4% of the healthy controls required people to remove their masks to be able to recognize their faces. Improvement in face recognition difficulty over time was reported as 80% in the healthy controls and 34% in the RRMSp. Conclusion RRMSp had worse performance in masked face recognition and required removal of the facial masks more often than healthy controls to recognize the faces. RRMS patients did not show as much improvement in recognizing masked faces over time according to the onset of the pandemic as healthy controls.
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.
INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and tri... more INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and triglyceride levels, and it has been shown that hypertriglyceridemia significantly increases the risk independently. In this study, we wanted to investigate whether there is a similar relationship for stroke. METHODS: A total of 619 patients hospitalized with a diagnosis of acute ischemic stroke in our stroke center were included in the study. Demographic information, accompanying risk factors, hemoglobin level, thrombocyte count, triglyceride level, and C reactive protein level at the time of admission, and the National Institutes of Health Stroke Scale (NIHSS) scores in the first evaluation were recorded. Also, information about mortality in hospital, recurrent stroke, and the modified Rankin Scale (mRS) scores in the follow-up period was entered in our local database. RESULTS: While 182 patients (32.3%) (78 females (42.9%) and 104 males (57.1%); mean age 64.5±12.01 years) were diagnosed with hypertriglyceridemia, this number was 25 (4.4%) patients (13 females (52%) and 12 males (48%); mean age 70.9±17.4 years) for hypotriglyceridemia. Among the risk factors studied, only diabetes mellitus was found to be associated with hypertriglyceridemia in patients with acute ischemic stroke (P<0.05). DISCUSSION AND CONCLUSION: In this study conducted in our stroke center, hypertriglyceridemia and hypotriglyceridemia prevalences were found as 32.3% and 4.4%, respectively. HyperTG or hypoTG did not significantly affect on stroke severity and prognosis. We found out that DM is the major risk factor for acute ischemic stroke patients with hyperTG.
Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study... more Patients with Parkinson's disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 agematched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test-short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture and gait of people when they did not recognize their masked faces and those who stated that this difficulty affected their daily lives were higher in the OHC group (p=0.002 and p=0.009, respectively). The number of participants whose difficulty in recognizing masked faces decreased over time was higher in the YHC group (p=0.003). Conclusions: The PwP group demonstrated similar performance to their peers but differed from the YHC group in recognizing masked faces. Knowing difficulties experienced by elderly people in recognizing people who are masked can increase awareness on this issue and enhance their social interaction in pandemic conditions through measures to be taken.
International Journal of Neuroscience, Jan 5, 2021
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.
Onabotulinum toxin A (ONA, Botox®) and abobotulinum toxin A (ABO, Dysport®) are most frequently u... more Onabotulinum toxin A (ONA, Botox®) and abobotulinum toxin A (ABO, Dysport®) are most frequently used in the treatment of movement disorders. The aim of this study was to identify the dose conversion ratio (ABO dose:ONA dose), comparative efficacy, and adverse events in patients who switched from ONA to ABO. There were 64 patients with cervical dystonia (39), hemifacial spasm (16), oromandibular dystonia (5), blepharospasm (3), and extremity dystonia (1) who switched from ONA to ABO. The efficacy, adverse events, duration of action, and severity of the adverse events after the final dose of ONA, initial dose of ABO, and second dose of ABO were investigated in these patients. The mean dose conversion ratio was 4.70 (2.27-9.62). The mean efficacy of the final ONA injection was 70.62%; initial ABO injection, 72.27%; and second ABO injection, 73.52%, which showed improvement on a visual analog scale (p = 0.71, p = 0.5). Incidence of adverse events after the final ONA injection was 18.8%; this increased to 39.1% after the initial ABO injection (p < 0.001) and decreased to 14.1% after the second ABO injection (p = 0.77). After the initial ABO injection, 20% of the adverse events were trivial, 36% were mild, and 32% were severe. After the second ABO injection, 7.8% of the adverse events were mild and 6.3% were severe. Although the mean dose conversion ratio was 4.70, the range was very wide (approximately 2-9). Therefore, we conclude that after the switch from Botox to Dysport, the doses should be tailored to the patients' clinical situation at treatment initiation, without using a dose conversion ratio.
Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi s... more Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi sırasında, sağlık merkezlerine erişim kısıtlanmışken, nöroloji polikliniğinde hareket bozuklukları nedeniyle takipli olan hastaların tele-tıp yöntemi ile tıbbi kontrollerinin sağlanabilmesi, hastalar ve hekimlerin viral yükünü azaltmak adına önemli bir adımdır. Makalemizde, hareket bozuklukları hastalarımızla olan tele-tıp aracılı danışmanlık deneyimimizi paylaşmayı amaçladık. Gereç ve Yöntem: Çalışmada, 11 Mart-20 Haziran 2020 tarihleri arasında ünitemiz ile iletişim kuran 71 hareket bozukluğu hastasının verileri retrospektif olarak incelenmiştir. Bulgular: Yetmiş bir hasta ile yapılan, çoğunluğu WhatsApp® üzerinden gerçekleştirilen toplam 117 yazılı ve sözlü görüşmede, hastaların hekime danışma nedenleri ayrıntılı incelendiğinde; hastaların en sık kötüleşme-katılık ve reçete-rapor istemi ile iletişim kurdukları görüldü. Bu görüşmelerin 25'i (%21,4) hastalara fiziki muayene için randevu verilmesi ile sonuçlanmıştır. Tele-tıp hizmeti ile 92 (%78,6) görüşmede hasta ile fiziki temas kurmadan sorun çözülebilmiştir. Sonuç: Hareket bozuklukları telekonferans aracılığı ile değerlendirmeye oldukça uygundur. Bunu da göz önünde bulundurarak aktif olarak kullandığımız telenöroloji uygulamamızın, pandemi sürecinde hem hastalar hem de sağlık çalışanlarının bulaş riskinin azaltılması açısından yararlı olduğunu düşünmekteyiz. Teletıp uygulamaların dünyada ve ülkemizde yasal yönleri ve kullanımının yaygınlaştırılması açısından geliştirilmesine ihtiyaç vardır. Anahtar Kelimeler: Tele-tıp uygulamaları, hareket bozuklukları, tele-nöroloji Öz Objective: Access to health centers was restricted during the coronavirus disease-2019 pandemic, which hit our country in March 2020. Ensuring the medical control of patients who were followed up in the neurology outpatient clinic with the tele-medicine method was an important step to decrease the viral load of patients and physicians. This study aimed to share our tele-medicine experience with patients with movement disorders. Materials and Methods: The data of 71 patients with movement disorder who communicated with our unit between March 11, 2020 and June 20, 2020 were retrospectively analyzed. Results: A total of 117 verbal and written interviews with 71 patients were mostly conducted via WhatsApp®. The evaluation of reasons for physician consultation revealed that patients most frequently communicated for worsening rigidity and prescription-drug requests. Of these interviews, 25 (21.4%) resulted in setting patient appointments for a physical examination. The tele-medicine service in 92 (78.6%) interviews solved the problem without physical contact with patients. Conclusion: Movement disorder evaluations are suitable through teleconference. Therefore, our teleneurology application, which we actively use, is effective in reducing the risk of viral transmission to both patients and healthcare workers during the pandemic. Developing telemedical applications is necessary in terms of their legal aspects and implementation in the world, especially in our country.
Objective To assess whether trainees can learn and implement the operational definition of interi... more Objective To assess whether trainees can learn and implement the operational definition of interictal epileptiform discharges (IEDs) of the International Federation of Clinical Neurophysiology (IFCN), based on six morphological criteria, and whether its implementation improves their diagnostic performance and inter‐rater agreement (IRA).Methods Seven trainees evaluated a balanced dataset of 70 EEG samples containing sharp transients (35 from patients with epilepsy and 35 from patients with non‐epileptic paroxysmal events). The gold standard was derived from video‐EEG recordings of the habitual clinical episodes. The trainees individually reviewed the EEGs, blinded to all other data, in two successive training sessions, three months apart. The second session was preceded by a teaching module about the IFCN criteria, and the trainees implemented them during the second reading session.Results By implementing the IFCN criteria, trainees significantly improved their specificity (94.29% vs. 77.14%; p=0.01) and overall accuracy (81.43% vs. 64.29%; p=0.01) for identifying IEDs. Sensitivity also improved but did not reach the level of statistical significance (77.14% vs. 60%; p=0.07). IRA improved significantly from fair (k=0.31; 95% CI: 0.22‐0.40) to high‐moderate (k=0.56; 95% CI:0.46‐0.67) beyond‐chance agreement.Significance Implementing the IFCN criteria significantly improves the diagnostic performance and IRA of trainees in identifying IEDs. Teaching the IFCN criteria for IEDs will increase specificity in clinical EEG and avoid over‐reading, the most common cause of misdiagnosing epilepsy.
Background Face and facial expression recognition abilities have been frequently evaluated in the... more Background Face and facial expression recognition abilities have been frequently evaluated in the assessment of social cognition disorders in patients with MS. Investigation of the effect of new difficulties emerging in the field of face recognition with the widespread use of masks during the ongoing COVID-19 pandemic on patients with MS may make new contributions to the literature. Material and methods The study included 44 patients with relapsing-remitting MS (RRMSp) and 51 controls who were matched to the case group in terms of age and education level. The Benton face recognition test-short form (BFRT-sf), Beck Depression Inventory, a close-ended 13-item survey on face recognition difficulties due to mask use during the pandemic was administered to all groups. Results In the RRMSp, the mean disease duration was 8.2 ± 5.6, the mean EDSS score was 1.2 ± 1.0, and the mean MOCA test score was 27.23 ± 2.08. The mean BFRTsf was 19.9 ± 2.4 in the RRMSp and 21.6 ± 1.8 in the healthy controls.Twenty-five percent of RRMSp and 4% of the healthy controls required people to remove their masks to be able to recognize their faces. Improvement in face recognition difficulty over time was reported as 80% in the healthy controls and 34% in the RRMSp. Conclusion RRMSp had worse performance in masked face recognition and required removal of the facial masks more often than healthy controls to recognize the faces. RRMS patients did not show as much improvement in recognizing masked faces over time according to the onset of the pandemic as healthy controls.
Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, a... more Background: COVID-19 was declared as a pandemic by World Health Organization on March 11, 2020, and still constitutes a serious health problem affecting millions of people across the world. The evaluation and follow-up of ongoing and/or newly developing neurological involvement after recovery from COVID-19 are important. This study aims to reveal post-COVID-19 neurological symptoms and risk factors for their development. Methods: Patients over the age of 18 years who applied to centers, at least 4 weeks after COVID-19 infection and agreed to participate in the study were included in this cross-sectional study between January 20 and March 15, 2021. The patients were evaluated face to face, and their sociodemographic data, medical history, post-COVID-19 neurological symptoms, treatments, and Beck Depression Inventory scores were recorded. All statistical analyses were performed using SPSS 23 for Windows software package (SPSS Inc., Chicago, IL). Results: Four hundred patients were inc...
INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and tri... more INTRODUCTION: Many studies are examining the relationship between cardiovascular diseases and triglyceride levels, and it has been shown that hypertriglyceridemia significantly increases the risk independently. In this study, we wanted to investigate whether there is a similar relationship for stroke. METHODS: A total of 619 patients hospitalized with a diagnosis of acute ischemic stroke in our stroke center were included in the study. Demographic information, accompanying risk factors, hemoglobin level, thrombocyte count, triglyceride level, and C reactive protein level at the time of admission, and the National Institutes of Health Stroke Scale (NIHSS) scores in the first evaluation were recorded. Also, information about mortality in hospital, recurrent stroke, and the modified Rankin Scale (mRS) scores in the follow-up period was entered in our local database. RESULTS: While 182 patients (32.3%) (78 females (42.9%) and 104 males (57.1%); mean age 64.5±12.01 years) were diagnosed with hypertriglyceridemia, this number was 25 (4.4%) patients (13 females (52%) and 12 males (48%); mean age 70.9±17.4 years) for hypotriglyceridemia. Among the risk factors studied, only diabetes mellitus was found to be associated with hypertriglyceridemia in patients with acute ischemic stroke (P<0.05). DISCUSSION AND CONCLUSION: In this study conducted in our stroke center, hypertriglyceridemia and hypotriglyceridemia prevalences were found as 32.3% and 4.4%, respectively. HyperTG or hypoTG did not significantly affect on stroke severity and prognosis. We found out that DM is the major risk factor for acute ischemic stroke patients with hyperTG.
The expression levels of miR-204 and miR-373 were investigated in neuron-derived serum exosomes o... more The expression levels of miR-204 and miR-373 were investigated in neuron-derived serum exosomes obtained from 15 patients with mild AD, 18 with moderate AD, and 21 cognitively healthy individuals. Results and discussion: The miR-204 and miR-373 expressions were significantly decreased in both patient groups compared to the control group. Therefore, we suggest that miR-204 and miR-373 are potential biomarkers for AD. However, due to the preliminary nature of this study, further large-scale studies are needed to support our findings.
ABSTRACT. Patients with Parkinson’s disease (PwP) have face recognition difficulties. Objective: ... more ABSTRACT. Patients with Parkinson’s disease (PwP) have face recognition difficulties. Objective: This study aimed to evaluate the difficulties of PwP in recognizing masked faces during the COVID-19 pandemic. Methods: A total of 64 PwP, 58 age-matched older healthy controls (OHCs), and 61 younger healthy controls (YHCs) were included in the study. The Benton Face Recognition Test - short form (BFRT-sf) and the 13-item questionnaire on face recognition difficulties due to masks during the pandemic developed by the authors were applied to all three study groups. Results: Both the PwP and OHC groups scored worse in BFRT-sf when compared with the YHC group (p<0.001 and p<0.001, respectively). The number of those who had difficulty in recognizing people seen every day and the number of those who asked people to remove their masks because they did not recognize them were higher in the PWP group (p=0.026 and p=0.002, respectively). The number of individuals who looked at the posture a...
To assess whether trainees can learn and implement the operational definition of interictal epile... more To assess whether trainees can learn and implement the operational definition of interictal epileptiform discharges (IEDs) of the International Federation of Clinical Neurophysiology (IFCN), based on six morphological criteria, and whether its implementation improves their diagnostic performance and inter-rater agreement (IRA). Seven trainees evaluated a balanced dataset of 70 EEG samples containing sharp transients (35 from patients with epilepsy and 35 from patients with non-epileptic paroxysmal events). The gold standard was derived from video-EEG recordings of the habitual clinical episodes. The trainees individually reviewed the EEGs, blinded to all other data, in two successive training sessions, three months apart. The second session was preceded by a teaching module about the IFCN criteria, and the trainees implemented them during the second reading session. By implementing the IFCN criteria, trainees significantly improved their specificity (94.29% vs. 77.14%; p=0.01) and overall accuracy (81.43% vs. 64.29%; p=0.01) for identifying IEDs. Sensitivity also improved but did not reach the level of statistical significance (77.14% vs. 60%; p=0.07). IRA improved significantly from fair (k=0.31; 95% CI: 0.22-0.40) to high-moderate (k=0.56; 95% CI:0.46-0.67) beyond-chance agreement. Implementing the IFCN criteria significantly improves the diagnostic performance and IRA of trainees in identifying IEDs. Teaching the IFCN criteria for IEDs will increase specificity in clinical EEG and avoid over-reading, the most common cause of misdiagnosing epilepsy.
Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi s... more Mart 2020 itibari ile ülkemizi de etkisi altına almış olan koronavirüs hastalığı-2019 pandemisi sırasında, sağlık merkezlerine erişim kısıtlanmışken, nöroloji polikliniğinde hareket bozuklukları nedeniyle takipli olan hastaların tele-tıp yöntemi ile tıbbi kontrollerinin sağlanabilmesi, hastalar ve hekimlerin viral yükünü azaltmak adına önemli bir adımdır. Makalemizde, hareket bozuklukları hastalarımızla olan tele-tıp aracılı danışmanlık deneyimimizi paylaşmayı amaçladık. Gereç ve Yöntem: Çalışmada, 11 Mart-20 Haziran 2020 tarihleri arasında ünitemiz ile iletişim kuran 71 hareket bozukluğu hastasının verileri retrospektif olarak incelenmiştir. Bulgular: Yetmiş bir hasta ile yapılan, çoğunluğu WhatsApp® üzerinden gerçekleştirilen toplam 117 yazılı ve sözlü görüşmede, hastaların hekime danışma nedenleri ayrıntılı incelendiğinde; hastaların en sık kötüleşme-katılık ve reçete-rapor istemi ile iletişim kurdukları görüldü. Bu görüşmelerin 25'i (%21,4) hastalara fiziki muayene için randevu verilmesi ile sonuçlanmıştır. Tele-tıp hizmeti ile 92 (%78,6) görüşmede hasta ile fiziki temas kurmadan sorun çözülebilmiştir. Sonuç: Hareket bozuklukları telekonferans aracılığı ile değerlendirmeye oldukça uygundur. Bunu da göz önünde bulundurarak aktif olarak kullandığımız telenöroloji uygulamamızın, pandemi sürecinde hem hastalar hem de sağlık çalışanlarının bulaş riskinin azaltılması açısından yararlı olduğunu düşünmekteyiz. Teletıp uygulamaların dünyada ve ülkemizde yasal yönleri ve kullanımının yaygınlaştırılması açısından geliştirilmesine ihtiyaç vardır. Anahtar Kelimeler: Tele-tıp uygulamaları, hareket bozuklukları, tele-nöroloji Öz Objective: Access to health centers was restricted during the coronavirus disease-2019 pandemic, which hit our country in March 2020. Ensuring the medical control of patients who were followed up in the neurology outpatient clinic with the tele-medicine method was an important step to decrease the viral load of patients and physicians. This study aimed to share our tele-medicine experience with patients with movement disorders. Materials and Methods: The data of 71 patients with movement disorder who communicated with our unit between March 11, 2020 and June 20, 2020 were retrospectively analyzed. Results: A total of 117 verbal and written interviews with 71 patients were mostly conducted via WhatsApp®. The evaluation of reasons for physician consultation revealed that patients most frequently communicated for worsening rigidity and prescription-drug requests. Of these interviews, 25 (21.4%) resulted in setting patient appointments for a physical examination. The tele-medicine service in 92 (78.6%) interviews solved the problem without physical contact with patients. Conclusion: Movement disorder evaluations are suitable through teleconference. Therefore, our teleneurology application, which we actively use, is effective in reducing the risk of viral transmission to both patients and healthcare workers during the pandemic. Developing telemedical applications is necessary in terms of their legal aspects and implementation in the world, especially in our country.
Background Face and facial expression recognition abilities have been frequently evaluated in the... more Background Face and facial expression recognition abilities have been frequently evaluated in the assessment of social cognition disorders in patients with MS. Investigation of the effect of new difficulties emerging in the field of face recognition with the widespread use of masks during the ongoing COVID-19 pandemic on patients with MS may make new contributions to the literature. Material and methods The study included 44 patients with relapsing-remitting MS (RRMSp) and 51 controls who were matched to the case group in terms of age and education level. The Benton face recognition test-short form (BFRT-sf), Beck Depression Inventory, a close-ended 13-item survey on face recognition difficulties due to mask use during the pandemic was administered to all groups. Results In the RRMSp, the mean disease duration was 8.2 ± 5.6, the mean EDSS score was 1.2 ± 1.0, and the mean MOCA test score was 27.23 ± 2.08. The mean BFRTsf was 19.9 ± 2.4 in the RRMSp and 21.6 ± 1.8 in the healthy controls.Twenty-five percent of RRMSp and 4% of the healthy controls required people to remove their masks to be able to recognize their faces. Improvement in face recognition difficulty over time was reported as 80% in the healthy controls and 34% in the RRMSp. Conclusion RRMSp had worse performance in masked face recognition and required removal of the facial masks more often than healthy controls to recognize the faces. RRMS patients did not show as much improvement in recognizing masked faces over time according to the onset of the pandemic as healthy controls.
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.
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