A BSTRACT Background: Short-latency afferent inhibition (SAI) is a method used to assess sensorimotor integration. Inhibition typically occurs at an interstimulus interval (ISI) of 20–22 ms or N20 + 2 ms. Paired associative stimulation (PAS) applied at certain ISIs consecutively can induce changes in corticospinal excitability. Usually, ISIs of 10 and 25 ms are applied in PAS. In this study, we aimed to investigate the relationship between ISIs of SAI and PAS, a neuromodulation paradigm. To achieve this, we first identified the optimal ISIs that produced maximum inhibition and facilitation during SAI by evaluating multiple ISIs. Subsequently, we applied the PAS paradigm with these ISIs. Materials and Methods: Twelve healthy participants were recruited for the study conducted over three sessions. During the first session, we examined the ISI of maximum inhibitory and ISI of facilitatory or minimum inhibitory (if facilitation was absent) in each participant at multiple ISIs. In the other two sessions, we applied PAS at the ISI of maximum inhibitory and the ISI of facilitatory or minimum inhibitory. We compared the motor-evoked potential (MEP) amplitudes before PAS, immediately after PAS, and 30 min after PAS. Results: The highest inhibition in SAI was observed at an ISI of 22 ms. In 60% of the participants, inhibition was most prominent at this ISI. Facilitation was not observed in 50% of the participants. During the PAS paradigm, which used the ISI of maximum inhibitory, significant facilitation was observed 30 min after the procedure compared with baseline ( P = 0.011) and immediately post-PAS ( P = 0.026). The mean MEP amplitude decreased significantly 30 min after the procedure compared with the baseline in ISI of only detected facilitation ( P = 0.041). Conclusion: Our findings suggest that the ISI of maximum inhibition can vary among individuals, and that facilitation may not be observed in everyone within the ISI range of 22 ms to 40 ms. The results indicate that paired stimuli at ISI of maximum inhibitory in SAI increase corticospinal excitability. In addition, PAS at ISI of only facilitation decreases excitability. These changes in excitability may be explained by spike-timing-dependent plasticity.
{"title":"Paired Associative Stimulation with Interstimulus Intervals of Short-latency Afferent Inhibition on Motor Plasticity","authors":"H. Evren Boran, Bülent Cengiz","doi":"10.4103/nsn.nsn_23_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_23_23","url":null,"abstract":"A BSTRACT Background: Short-latency afferent inhibition (SAI) is a method used to assess sensorimotor integration. Inhibition typically occurs at an interstimulus interval (ISI) of 20–22 ms or N20 + 2 ms. Paired associative stimulation (PAS) applied at certain ISIs consecutively can induce changes in corticospinal excitability. Usually, ISIs of 10 and 25 ms are applied in PAS. In this study, we aimed to investigate the relationship between ISIs of SAI and PAS, a neuromodulation paradigm. To achieve this, we first identified the optimal ISIs that produced maximum inhibition and facilitation during SAI by evaluating multiple ISIs. Subsequently, we applied the PAS paradigm with these ISIs. Materials and Methods: Twelve healthy participants were recruited for the study conducted over three sessions. During the first session, we examined the ISI of maximum inhibitory and ISI of facilitatory or minimum inhibitory (if facilitation was absent) in each participant at multiple ISIs. In the other two sessions, we applied PAS at the ISI of maximum inhibitory and the ISI of facilitatory or minimum inhibitory. We compared the motor-evoked potential (MEP) amplitudes before PAS, immediately after PAS, and 30 min after PAS. Results: The highest inhibition in SAI was observed at an ISI of 22 ms. In 60% of the participants, inhibition was most prominent at this ISI. Facilitation was not observed in 50% of the participants. During the PAS paradigm, which used the ISI of maximum inhibitory, significant facilitation was observed 30 min after the procedure compared with baseline ( P = 0.011) and immediately post-PAS ( P = 0.026). The mean MEP amplitude decreased significantly 30 min after the procedure compared with the baseline in ISI of only detected facilitation ( P = 0.041). Conclusion: Our findings suggest that the ISI of maximum inhibition can vary among individuals, and that facilitation may not be observed in everyone within the ISI range of 22 ms to 40 ms. The results indicate that paired stimuli at ISI of maximum inhibitory in SAI increase corticospinal excitability. In addition, PAS at ISI of only facilitation decreases excitability. These changes in excitability may be explained by spike-timing-dependent plasticity.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Valproic acid (VPA) is a broad-spectrum anti-seizure medication (ASM) that is being used in epilepsy patients with generalized and less frequently focal seizures. It is also commonly utilized by psychiatrists for mood stabilization. Physicians are aware of its common side effects such as weight gain, tremors, disturbed liver function tests, and thrombocytopenia. Rarely, it has also been reported to cause encephalopathy which is usually characterized by acute onset of impaired consciousness, increased seizures, and focal neurological symptoms.[1] Patients may also present with abnormal behavior, ataxia, sensory disorders, visual impairment, catatonia, and status epilepticus.[1] Valproate-induced encephalopathy (VIE) is reported to have an incidence of 0.1%–2.5%.[1] It usually has a temporal relationship with VPA initiation or increment of its dose. Diagnosis of VIE in the presence of normal ammonia levels is difficult and challenging leading to misdiagnosis and unnecessary laboratory investigations. To the best of our knowledge, only three cases of VIE with normal ammonia levels have been reported so far.[2–4] Herein, we present a similar case aiming to increase the awareness of physicians about VIE with normal liver function tests, VPA, and ammonia levels. A 63-year-old female patient developed myoclonic jerks in her left arm 2 months ago. She also reported a tonic–clonic seizure of unknown onset. Electroencephalogram (EEG) revealed multifocal epileptiform discharges. She was already on lamotrigine (100 mg/day) and valproic acid (VPA, 1000 mg/day) treatment and, therefore, had not been prescribed additional ASMs. She also received 300 mg quetiapine twice a day for control of her schizoaffective disorder. Other medical comorbidities were hypertension, type 2 diabetes mellitus, and primary hypothyroidism for which she took 150-μg levothyroxine and 10-mg perindopril daily. Family history was unremarkable. During her follow-up, she developed an acute alteration of behavior and agitation that was clinically compatible with delirium. There was no history of fever, headache, nausea-vomiting, or seizure exacerbation. The doses of her current medications were stable, and she had not received any other new drugs. Her vital signs were within normal limits and her physical examination was unremarkable. On neurologic examination, she was drowsy and disoriented providing inappropriate answers to questions. There was no meaningful verbal output. She stared and cried when she was asked questions. There were no focal neurologic deficits or signs of meningeal irritation. She remained confused over the next 2 days. Extensive work-up including complete blood count, liver function tests, kidney function tests, blood sugar, thyroid function tests, routine urine examination, venous blood gas analysis, and blood and urine culture tests were normal, as well as her electrocardiogram and chest X-ray. Cranial magnetic resonance imaging was unremarkable. However
{"title":"Valproate-Induced Nonhyperammonemic Encephalopathy with Electroencephalogram Background Slowing and Triphasic Waves","authors":"Nese Dericioglu, Melike Cakan","doi":"10.4103/nsn.nsn_28_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_28_23","url":null,"abstract":"Dear Editor, Valproic acid (VPA) is a broad-spectrum anti-seizure medication (ASM) that is being used in epilepsy patients with generalized and less frequently focal seizures. It is also commonly utilized by psychiatrists for mood stabilization. Physicians are aware of its common side effects such as weight gain, tremors, disturbed liver function tests, and thrombocytopenia. Rarely, it has also been reported to cause encephalopathy which is usually characterized by acute onset of impaired consciousness, increased seizures, and focal neurological symptoms.[1] Patients may also present with abnormal behavior, ataxia, sensory disorders, visual impairment, catatonia, and status epilepticus.[1] Valproate-induced encephalopathy (VIE) is reported to have an incidence of 0.1%–2.5%.[1] It usually has a temporal relationship with VPA initiation or increment of its dose. Diagnosis of VIE in the presence of normal ammonia levels is difficult and challenging leading to misdiagnosis and unnecessary laboratory investigations. To the best of our knowledge, only three cases of VIE with normal ammonia levels have been reported so far.[2–4] Herein, we present a similar case aiming to increase the awareness of physicians about VIE with normal liver function tests, VPA, and ammonia levels. A 63-year-old female patient developed myoclonic jerks in her left arm 2 months ago. She also reported a tonic–clonic seizure of unknown onset. Electroencephalogram (EEG) revealed multifocal epileptiform discharges. She was already on lamotrigine (100 mg/day) and valproic acid (VPA, 1000 mg/day) treatment and, therefore, had not been prescribed additional ASMs. She also received 300 mg quetiapine twice a day for control of her schizoaffective disorder. Other medical comorbidities were hypertension, type 2 diabetes mellitus, and primary hypothyroidism for which she took 150-μg levothyroxine and 10-mg perindopril daily. Family history was unremarkable. During her follow-up, she developed an acute alteration of behavior and agitation that was clinically compatible with delirium. There was no history of fever, headache, nausea-vomiting, or seizure exacerbation. The doses of her current medications were stable, and she had not received any other new drugs. Her vital signs were within normal limits and her physical examination was unremarkable. On neurologic examination, she was drowsy and disoriented providing inappropriate answers to questions. There was no meaningful verbal output. She stared and cried when she was asked questions. There were no focal neurologic deficits or signs of meningeal irritation. She remained confused over the next 2 days. Extensive work-up including complete blood count, liver function tests, kidney function tests, blood sugar, thyroid function tests, routine urine examination, venous blood gas analysis, and blood and urine culture tests were normal, as well as her electrocardiogram and chest X-ray. Cranial magnetic resonance imaging was unremarkable. However","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Burcin Aktar, S. Ozyurek, E. Goz, B. Çolakoğlu, B. Balci
Background and Aim: The core muscles are essential for spinal stability during functional activities. Trunk muscle function is affected by specific neurodegenerative processes of Parkinson's disease (PD). This study aimed to investigate whether changes in transversus abdominis (TrA) and internal oblique (IO) thickness during the abdominal drawing-in maneuver (ADIM) were associated with clinical manifestations, core endurance, and functional mobility in patients with PD. Materials and Methods: We included patients with a modified Hoehn and Yahr staging of 3 or lower. TrA and IO muscle thickness were measured using ultrasound both at rest and during ADIM, and the percent change (%) was calculated to assess TrA and IO activation. Patients performed core endurance (prone bridge and sit-ups) and functional mobility tests (timed “up and go” [TUG] and five times sit-to-stand [FTSTS]). All assessments were conducted during the “on” phase. Results: Five female and 17 male patients were included in this study. We found a statistically significant correlation between ultrasound parameters of IO and the clinical manifestations of PD (P < 0.05). Correlations were observed between TrA percent change and prone bridge, sit-ups, TUG, and FTSTS (P < 0.05). Conclusion: To the best of our knowledge, this is the first ultrasound imaging-based study to demonstrate the relationship between TrA and IO muscle thickness and clinical outcomes, and functional performance in patients with PD. Percentage changes in IO were associated with the clinical manifestations of PD. Increased activation of TrA during ADIM was associated with improved core endurance and mobility. The results suggest that a trunk-specific exercise program may be the cornerstone in the treatment of PD-related changes.
{"title":"The relationship between transversus abdominis and internal oblique thickness and disease-related characteristics in Parkinson's disease: An ultrasound-based study","authors":"Burcin Aktar, S. Ozyurek, E. Goz, B. Çolakoğlu, B. Balci","doi":"10.4103/nsn.nsn_97_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_97_22","url":null,"abstract":"Background and Aim: The core muscles are essential for spinal stability during functional activities. Trunk muscle function is affected by specific neurodegenerative processes of Parkinson's disease (PD). This study aimed to investigate whether changes in transversus abdominis (TrA) and internal oblique (IO) thickness during the abdominal drawing-in maneuver (ADIM) were associated with clinical manifestations, core endurance, and functional mobility in patients with PD. Materials and Methods: We included patients with a modified Hoehn and Yahr staging of 3 or lower. TrA and IO muscle thickness were measured using ultrasound both at rest and during ADIM, and the percent change (%) was calculated to assess TrA and IO activation. Patients performed core endurance (prone bridge and sit-ups) and functional mobility tests (timed “up and go” [TUG] and five times sit-to-stand [FTSTS]). All assessments were conducted during the “on” phase. Results: Five female and 17 male patients were included in this study. We found a statistically significant correlation between ultrasound parameters of IO and the clinical manifestations of PD (P < 0.05). Correlations were observed between TrA percent change and prone bridge, sit-ups, TUG, and FTSTS (P < 0.05). Conclusion: To the best of our knowledge, this is the first ultrasound imaging-based study to demonstrate the relationship between TrA and IO muscle thickness and clinical outcomes, and functional performance in patients with PD. Percentage changes in IO were associated with the clinical manifestations of PD. Increased activation of TrA during ADIM was associated with improved core endurance and mobility. The results suggest that a trunk-specific exercise program may be the cornerstone in the treatment of PD-related changes.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"9 - 14"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43869857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Vestibular-evoked myogenic potentials (VEMPs) provide an electrophysiological evaluation of vestibular reflexes. The aim of the study was to search for the habituation of ocular and cervical VEMPs (cVEMPs). Materials and Methods: A total of 20 healthy volunteers (10 men and 10 women), with a mean age of 32.4 years (range: 25–45 years) were included in the study. cVEMP and ocular VEMP (oVEMP) tests were performed using “click stimuli.” In cVEMP and oVEMP tests, the latency and amplitude of the responses recorded with 100 and 250 stimulus sequences were compared. Results: When the traces recorded with 100 repetitions for both tests were compared with the traces obtained with 250 repetitions, it was observed that the latencies increased while the amplitudes decreased with increasing number of stimuli, which was statistically significant. Conclusion: Our results showed that an increase in the number of stimuli in oVEMP and cVEMP tests in healthy individuals led to a decrease in amplitude and an increase in latency. As noninvasive, short, and inexpensive evaluation methods, VEMP tests may be used in evaluating the “habituation response” and may find new areas of investigation.
{"title":"Can vestibular-evoked myogenic potentials be used in the assessment of reflex habituation? A preliminary report","authors":"F. Uyaroglu, Roza Sariteke, N. Çelebisoy","doi":"10.4103/nsn.nsn_149_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_149_22","url":null,"abstract":"Background: Vestibular-evoked myogenic potentials (VEMPs) provide an electrophysiological evaluation of vestibular reflexes. The aim of the study was to search for the habituation of ocular and cervical VEMPs (cVEMPs). Materials and Methods: A total of 20 healthy volunteers (10 men and 10 women), with a mean age of 32.4 years (range: 25–45 years) were included in the study. cVEMP and ocular VEMP (oVEMP) tests were performed using “click stimuli.” In cVEMP and oVEMP tests, the latency and amplitude of the responses recorded with 100 and 250 stimulus sequences were compared. Results: When the traces recorded with 100 repetitions for both tests were compared with the traces obtained with 250 repetitions, it was observed that the latencies increased while the amplitudes decreased with increasing number of stimuli, which was statistically significant. Conclusion: Our results showed that an increase in the number of stimuli in oVEMP and cVEMP tests in healthy individuals led to a decrease in amplitude and an increase in latency. As noninvasive, short, and inexpensive evaluation methods, VEMP tests may be used in evaluating the “habituation response” and may find new areas of investigation.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"43 - 47"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44834209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Ozcelik, Ezgi Uludüz, Rahşan Karacı, F. Domaç, Mustafa İskender, A. Özge, D. Uludüz
Background and Aim: Several factors are suggested to be associated with an increased risk of transforming from episodic migraine (EM) to chronic migraine (CM). We aimed to examine whether some specific attack triggers and comorbidities were associated with CM. Methods: Patients followed up with a diagnosis of definite migraine for at least 1 year were divided into two groups, EM (<15 attacks per month) and CM (>15 attacks per month). The demographic and clinical data, attack-triggering factors, and comorbid diseases were compared between the groups. Results: A total of 403 (286 females) patients were analyzed; 227 (56.3%) of the migraineurs had EM and 176 (43.7%) had CM. The mean age was 40.9 ± 11.3 years in EM, and 42.2 ± 11.7 years in CM. Disease duration was longer in CM compared with EM (P = 0.007). Missing meals (P = 0.044), exposure to heavy scents/perfumes (P = 0.012), intense physical activity (P = 0.037), and withdrawal of caffeine (P = 0.012) were reported significantly higher in CM than in EM. Comorbid history of medication overuse (P < 0.001), hypertension (P = 0.048), hyperlipidemia (P = 0.025), depression (P = 0.021), chronic painful health problems (P = 0.003), iron deficiency anemia (P = 0.006), and history of surgery (P = 0.006) were found significantly high in CM. Conclusion: This study demonstrates that attack-triggering factors, vascular comorbidities, depression, medication overuse, and chronic painful health problems pose significant risks for CM. Vascular comorbidities are independent risk factors for chronification in migraine and might increase the patient's lifetime morbidity and mortality. Therefore, prompt diagnosis of migraine before the transformation to chronicity and effective early management have the utmost importance.
{"title":"Do comorbidities and triggers expedite chronicity in migraine?","authors":"E. Ozcelik, Ezgi Uludüz, Rahşan Karacı, F. Domaç, Mustafa İskender, A. Özge, D. Uludüz","doi":"10.4103/nsn.nsn_229_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_229_22","url":null,"abstract":"Background and Aim: Several factors are suggested to be associated with an increased risk of transforming from episodic migraine (EM) to chronic migraine (CM). We aimed to examine whether some specific attack triggers and comorbidities were associated with CM. Methods: Patients followed up with a diagnosis of definite migraine for at least 1 year were divided into two groups, EM (<15 attacks per month) and CM (>15 attacks per month). The demographic and clinical data, attack-triggering factors, and comorbid diseases were compared between the groups. Results: A total of 403 (286 females) patients were analyzed; 227 (56.3%) of the migraineurs had EM and 176 (43.7%) had CM. The mean age was 40.9 ± 11.3 years in EM, and 42.2 ± 11.7 years in CM. Disease duration was longer in CM compared with EM (P = 0.007). Missing meals (P = 0.044), exposure to heavy scents/perfumes (P = 0.012), intense physical activity (P = 0.037), and withdrawal of caffeine (P = 0.012) were reported significantly higher in CM than in EM. Comorbid history of medication overuse (P < 0.001), hypertension (P = 0.048), hyperlipidemia (P = 0.025), depression (P = 0.021), chronic painful health problems (P = 0.003), iron deficiency anemia (P = 0.006), and history of surgery (P = 0.006) were found significantly high in CM. Conclusion: This study demonstrates that attack-triggering factors, vascular comorbidities, depression, medication overuse, and chronic painful health problems pose significant risks for CM. Vascular comorbidities are independent risk factors for chronification in migraine and might increase the patient's lifetime morbidity and mortality. Therefore, prompt diagnosis of migraine before the transformation to chronicity and effective early management have the utmost importance.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"48 - 55"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43078255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Incesu, Aysel Taşkın, Y. Seçil, Ş. Arıcı, N. Gürgör, F. Tokuçoğlu, G. Akhan, C. Erteki̇n
Introduction: The aim of the study is to search proximal nerve involvement by using proximal root stimulation and possible autonomic neuropathy in type 2 diabetic patients with and without distal symmetric sensorimotor polyneuropathy (DSPN). Patients and Methods: Forty patients with type 2 diabetes and ten volunteers who had no history of diabetes and neuropathy were included. Diabetic patients were equally distributed into two groups according to nerve conduction studies (NCSs): First group comprised of with electrophysiologically confirmed DSPN and second group with normal NCSs. Electrophysiological tests included motor and sensory nerve conduction, needle electromyography, F-response, H-reflex, R-R interval, and sympathetic skin responses (SSRs) studies as well as lumbar root stimulation and cauda equina motor conduction time (CEMCT) calculation. Results: The patients with DSPN had significantly longer F-response latencies and had no H-reflex while H-reflex was observed in 35% of the patients in second group. In the first group, SSRs could not be obtained from both upper and lower limbs in 45% of the patients; however, in the second group, they were absent only in 10% of patients in lower limbs. R-R interval variability was significantly lower in both diabetic groups than volunteers. When compared to the volunteers, cauda equine motor conduction time was significantly prolonged in all diabetic patients, but there was no significant difference between the patient groups. Conclusions: CEMCT prolongation, absence of H-reflex, and decreased R-R interval abnormalities indicating dysautonomia were the most important findings of our study. These results show that early electrophysiological examinations using these methods are important in diabetic patients without polyneuropathy.
{"title":"Electrophysiological investigations in diabetıc patients: Root stimulation and autonomic investigations","authors":"T. Incesu, Aysel Taşkın, Y. Seçil, Ş. Arıcı, N. Gürgör, F. Tokuçoğlu, G. Akhan, C. Erteki̇n","doi":"10.4103/nsn.nsn_41_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_41_22","url":null,"abstract":"Introduction: The aim of the study is to search proximal nerve involvement by using proximal root stimulation and possible autonomic neuropathy in type 2 diabetic patients with and without distal symmetric sensorimotor polyneuropathy (DSPN). Patients and Methods: Forty patients with type 2 diabetes and ten volunteers who had no history of diabetes and neuropathy were included. Diabetic patients were equally distributed into two groups according to nerve conduction studies (NCSs): First group comprised of with electrophysiologically confirmed DSPN and second group with normal NCSs. Electrophysiological tests included motor and sensory nerve conduction, needle electromyography, F-response, H-reflex, R-R interval, and sympathetic skin responses (SSRs) studies as well as lumbar root stimulation and cauda equina motor conduction time (CEMCT) calculation. Results: The patients with DSPN had significantly longer F-response latencies and had no H-reflex while H-reflex was observed in 35% of the patients in second group. In the first group, SSRs could not be obtained from both upper and lower limbs in 45% of the patients; however, in the second group, they were absent only in 10% of patients in lower limbs. R-R interval variability was significantly lower in both diabetic groups than volunteers. When compared to the volunteers, cauda equine motor conduction time was significantly prolonged in all diabetic patients, but there was no significant difference between the patient groups. Conclusions: CEMCT prolongation, absence of H-reflex, and decreased R-R interval abnormalities indicating dysautonomia were the most important findings of our study. These results show that early electrophysiological examinations using these methods are important in diabetic patients without polyneuropathy.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"1 - 8"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43552665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A BSTRACT Aim: The Willis polygon variant, specifically the presence of a fetal posterior cerebral artery (fPCA), can have implications for the treatment and prognosis of patients with acute stroke. This study aimed to investigate the effect of fPCA variations on treatment, follow-up, and prognosis in patients with acute stroke who underwent reperfusion therapies. Materials and Methods: The study analyzed a total of 62 patients, including 33 without any posterior system variant (normal group) and 29 with only the fPCA variant (variant group). Demographic characteristics, clinical features, and computed tomography (CT) findings were compared between the two groups. Treatment methods, acute stroke therapies, and clinical outcomes were evaluated. Results: No significant differences were observed in age, sex, smoking status, or comorbidities between the normal and fPCA groups. Cardiac parameters were similar between the groups. Treatment approaches, artery territories, acute stroke therapies, and time intervals did not differ significantly between the two groups. The National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and CT findings were also similar between the groups. A significant difference was observed in the presence of hemorrhage at 24 h, with higher rates in the normal group. Conclusion: The presence of fPCA does not significantly influence age-related risk factors or comorbidities in patients with acute stroke. Treatment approaches and clinical outcomes were similar regardless of the presence of fPCA, except for a higher risk of hemorrhage in the normal group. The lateral status of the variants did not significantly impact the distribution of risk scores and CT findings.
{"title":"Reperfusion Therapy in Patients with Acute Stroke with the Willis Polygon Variant – A Fetal Posterior Cerebral Artery","authors":"İbrahim Acır, Hacı Ali Erdoğan, Vildan Ayşe Yayla","doi":"10.4103/nsn.nsn_101_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_101_23","url":null,"abstract":"A BSTRACT Aim: The Willis polygon variant, specifically the presence of a fetal posterior cerebral artery (fPCA), can have implications for the treatment and prognosis of patients with acute stroke. This study aimed to investigate the effect of fPCA variations on treatment, follow-up, and prognosis in patients with acute stroke who underwent reperfusion therapies. Materials and Methods: The study analyzed a total of 62 patients, including 33 without any posterior system variant (normal group) and 29 with only the fPCA variant (variant group). Demographic characteristics, clinical features, and computed tomography (CT) findings were compared between the two groups. Treatment methods, acute stroke therapies, and clinical outcomes were evaluated. Results: No significant differences were observed in age, sex, smoking status, or comorbidities between the normal and fPCA groups. Cardiac parameters were similar between the groups. Treatment approaches, artery territories, acute stroke therapies, and time intervals did not differ significantly between the two groups. The National Institutes of Health Stroke Scale scores, modified Rankin Scale scores, and CT findings were also similar between the groups. A significant difference was observed in the presence of hemorrhage at 24 h, with higher rates in the normal group. Conclusion: The presence of fPCA does not significantly influence age-related risk factors or comorbidities in patients with acute stroke. Treatment approaches and clinical outcomes were similar regardless of the presence of fPCA, except for a higher risk of hemorrhage in the normal group. The lateral status of the variants did not significantly impact the distribution of risk scores and CT findings.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Limited data are available about the importance of migrainous features of the trigeminal autonomic cephalalgias (TACs). Methods: We enrolled 99 patients with TACs including 71 cluster headaches, 11 with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, 10 with paroxysmal hemicrania, and seven with hemicrania continua. The presence of diagnostic migraine criteria such as throbbing headache, nausea and/or vomiting, photophobia, phonophobia, and aggravation by physical activity was questioned in these patients as well as autonomic features. Furthermore, supportive features of migraine including motion sickness, atopy and allergy, exacerbation during menstrual periods, irregular sleep, dizziness, and family history of any primary headache were noted. Results: The most common cranial autonomic symptom was lacrimation (87.9%) and the most common migrainous features were throbbing headache (51.5%), phonophobia (41.4%), nausea (39.4%), and photophobia (34.3%). Family history of any primary headache (25.3%) and atopy and allergy (13.1%) was the most common supportive features. Conclusion: We found higher percentages of migrainous features in patients with TACs; phonophobia, throbbing headache, and nausea frequently accompanied TACs. Aggravation by physical activity, which is one of the diagnostic migraine criteria, and motion sickness, which is one of the supportive features of migraine, were much lower in patients with TAC compared with migraineurs.
{"title":"Gray zones in the trigeminal autonomic cephalalgias","authors":"Nevra Oksuz, A. Özge","doi":"10.4103/nsn.nsn_108_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_108_22","url":null,"abstract":"Background: Limited data are available about the importance of migrainous features of the trigeminal autonomic cephalalgias (TACs). Methods: We enrolled 99 patients with TACs including 71 cluster headaches, 11 with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, 10 with paroxysmal hemicrania, and seven with hemicrania continua. The presence of diagnostic migraine criteria such as throbbing headache, nausea and/or vomiting, photophobia, phonophobia, and aggravation by physical activity was questioned in these patients as well as autonomic features. Furthermore, supportive features of migraine including motion sickness, atopy and allergy, exacerbation during menstrual periods, irregular sleep, dizziness, and family history of any primary headache were noted. Results: The most common cranial autonomic symptom was lacrimation (87.9%) and the most common migrainous features were throbbing headache (51.5%), phonophobia (41.4%), nausea (39.4%), and photophobia (34.3%). Family history of any primary headache (25.3%) and atopy and allergy (13.1%) was the most common supportive features. Conclusion: We found higher percentages of migrainous features in patients with TACs; phonophobia, throbbing headache, and nausea frequently accompanied TACs. Aggravation by physical activity, which is one of the diagnostic migraine criteria, and motion sickness, which is one of the supportive features of migraine, were much lower in patients with TAC compared with migraineurs.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"15 - 19"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42613620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hasan Kamil Sucu, Aytül Gökmen, Figen Eşmeli, Tolga Özdemirkiran
A BSTRACT Background: Although carpal tunnel syndrome (CTS) is common and frequently seen in daily practice, diagnostic criteria remain the subject of debate. Some authors consider electrodiagnostic tests as essential, whereas others view them as an unnecessary luxury. Objective: The objective is to investigate whether electrodiagnostic tests are necessary for surgical decision-making for typical CTS. Materials and Methods: The study was planned as a randomized controlled trial. After determining normative values for the population of the geographic region, 101 consecutive cases of typical CTS of the hand (suffering palmar dysesthesia that waking from sleep at night) were enrolled in the study. Hands were randomized into two groups using simple randomization. The first group comprised patients whose surgical candidacy was evaluated without electrodiagnostic tests, and the second group comprised patients whose surgery decisions were based on the results of electrodiagnostic testing. The patients were evaluated at 1, 3, and 12 months postoperatively. Results: Sixty-one hands were randomized to the first group and 40 hands were randomized to the second group. Four cases in the second group received medical treatment because their electrodiagnostic test results were within the normal limits, despite the presence of typical CTS symptoms. There were no differences in favor of the second group regarding any evaluation criteria during the entire follow-up period; however, the first group reported significantly more positive outcomes regarding awakening at the 3-month follow-up and regarding satisfaction at the 1-month follow-up. Conclusion: Additional electrodiagnostic tests may not be mandatory to clinically identify classical CTS or make surgical decisions in these cases. However, many cases may be caused by entrapment of the median nerve in the carpal tunnel, but they may lack typical CTS symptoms, such as waking from night-time sleep. In such cases, properly applied electrodiagnostic tests may be of immense help.
{"title":"Can Electrodiagnostic Tests be Omitted from Surgical Decision-making for Typical Carpal Tunnel Syndrome? – A Randomized Controlled Trial","authors":"Hasan Kamil Sucu, Aytül Gökmen, Figen Eşmeli, Tolga Özdemirkiran","doi":"10.4103/nsn.nsn_5_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_5_23","url":null,"abstract":"A BSTRACT Background: Although carpal tunnel syndrome (CTS) is common and frequently seen in daily practice, diagnostic criteria remain the subject of debate. Some authors consider electrodiagnostic tests as essential, whereas others view them as an unnecessary luxury. Objective: The objective is to investigate whether electrodiagnostic tests are necessary for surgical decision-making for typical CTS. Materials and Methods: The study was planned as a randomized controlled trial. After determining normative values for the population of the geographic region, 101 consecutive cases of typical CTS of the hand (suffering palmar dysesthesia that waking from sleep at night) were enrolled in the study. Hands were randomized into two groups using simple randomization. The first group comprised patients whose surgical candidacy was evaluated without electrodiagnostic tests, and the second group comprised patients whose surgery decisions were based on the results of electrodiagnostic testing. The patients were evaluated at 1, 3, and 12 months postoperatively. Results: Sixty-one hands were randomized to the first group and 40 hands were randomized to the second group. Four cases in the second group received medical treatment because their electrodiagnostic test results were within the normal limits, despite the presence of typical CTS symptoms. There were no differences in favor of the second group regarding any evaluation criteria during the entire follow-up period; however, the first group reported significantly more positive outcomes regarding awakening at the 3-month follow-up and regarding satisfaction at the 1-month follow-up. Conclusion: Additional electrodiagnostic tests may not be mandatory to clinically identify classical CTS or make surgical decisions in these cases. However, many cases may be caused by entrapment of the median nerve in the carpal tunnel, but they may lack typical CTS symptoms, such as waking from night-time sleep. In such cases, properly applied electrodiagnostic tests may be of immense help.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hacı Ali Erdoğan, İbrahim Acır, Özlem Yalınkaya Albuz, Hülya Olgun, Vildan Ayşe Yayla
A BSTRACT Background: Atrial fibrillation (AF) is the most common cause of cardioembolic ischemic strokes. It causes large-vessel occlusions and a poor prognosis. Regardless of ischemic stroke etiology, hyperacute therapy strategies are effective treatment modalities. Methods: Patients who were diagnosed as having AF were classified as AF (+) and others without AF were classified as AF (-). It is not clear which treatment should be preferred in patients with stroke who are AF (+). We studied demographic characteristics, recanalization rates, and clinical outcomes in acute patients with ischemic stroke with or without nonvalvular AF who underwent hyperacute treatments. Results: We detected that clinical findings were more severe and the NIHSS scores were significantly higher at admission inpatients who were AF (+). In our study, mechanical thrombectomy rates were high in patients who were AF (+), whereas intravenous tissue plasminogen activator treatment rates were higher in patients who were AF (-). Thrombolysis in cerebral infarction scores were similar in our patient groups. We found high rates of both symptomatic (PH 2) and asymptomatic hemorrhagic transformation in patients who were AF (+) in 24 th -h cranial computed tomography. A positive correlation was found between symptom-admission, symptom-needle, and symptom-groin times and discharge-modified Rankin Scale scores regardless of the hyperacute treatments in all patient groups. Conclusion: As a result, physicians should focus on the diagnosis of AF, and appropriate anticoagulant treatment is important for primary prevention.
{"title":"The Effect of Atrial Fibrillation on Recanalization and Prognosis in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy and/or Intravenous Thrombolysis","authors":"Hacı Ali Erdoğan, İbrahim Acır, Özlem Yalınkaya Albuz, Hülya Olgun, Vildan Ayşe Yayla","doi":"10.4103/nsn.nsn_102_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_102_23","url":null,"abstract":"A BSTRACT Background: Atrial fibrillation (AF) is the most common cause of cardioembolic ischemic strokes. It causes large-vessel occlusions and a poor prognosis. Regardless of ischemic stroke etiology, hyperacute therapy strategies are effective treatment modalities. Methods: Patients who were diagnosed as having AF were classified as AF (+) and others without AF were classified as AF (-). It is not clear which treatment should be preferred in patients with stroke who are AF (+). We studied demographic characteristics, recanalization rates, and clinical outcomes in acute patients with ischemic stroke with or without nonvalvular AF who underwent hyperacute treatments. Results: We detected that clinical findings were more severe and the NIHSS scores were significantly higher at admission inpatients who were AF (+). In our study, mechanical thrombectomy rates were high in patients who were AF (+), whereas intravenous tissue plasminogen activator treatment rates were higher in patients who were AF (-). Thrombolysis in cerebral infarction scores were similar in our patient groups. We found high rates of both symptomatic (PH 2) and asymptomatic hemorrhagic transformation in patients who were AF (+) in 24 th -h cranial computed tomography. A positive correlation was found between symptom-admission, symptom-needle, and symptom-groin times and discharge-modified Rankin Scale scores regardless of the hyperacute treatments in all patient groups. Conclusion: As a result, physicians should focus on the diagnosis of AF, and appropriate anticoagulant treatment is important for primary prevention.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135844700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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