A BSTRACT Introduction: Sciatic neuropathy is one of the most important neuropathies of the lower extremity. Although electromyography (EMG) is useful for detecting and localizing neurologic damage, assessing the severity of neuropathy, determining prognoses, and detecting confounding or accompanying neurologic pathologies, electrodiagnostic analyses of sciatic neuropathy are rare in the literature. Methods: The EMG database between 2017 and 2022 was reviewed. Neurophysiologic data of 58 patients who were electrophysiologically diagnosed as having sciatic neuropathy were included in the study. The adult patient group was divided into three groups, injection trauma, noninjection trauma, and other etiologies for subgroup analyze. Pediatric patients were not divided into subgroups because of their limited number. Results: Sciatic neuropathy was found in nine patients in the pediatric group, and 48 patients in the adult group. Sciatic neuropathy was left sided in six (66.7%) pediatric patients and 25 (52%) adult patients. It was bilateral in one adult patient. There was no significant difference between the groups in terms of nerve conduction studies. No statistically significant difference was found in the needle EMG of the gastrocnemius medialis, tibialis anterior (TA), and biceps femoris short-head muscles ( P = 0.78, P = 0.32, and P = 0.14, respectively). In both injection and noninjection trauma patients, the most common needle EMG findings in the gastrocnemius medialis muscle were detected as grade 2. Grades 3 and 4 findings were observed predominantly in peroneal division innervated TA and biceps femoris short-head muscles. Conclusion: The most common etiology of sciatic neuropathy in adults was injection-related trauma. The peroneal division is more prone to injury in sciatic neuropathy in the context of sciatic variations. Consequently, we considered that the degree of damage in noninjection traumas might be higher in both distal and proximal segments compared with injection traumas.
{"title":"Electrodiagnostic Features of Sciatic Neuropathy: Six-year Referral Center Experience","authors":"Fatma Gokcem Yildiz, Handan Uzuncakmak-Uyanik, Khayala Aghamirzayeva, Cagri Mesut Temucin","doi":"10.4103/nsn.nsn_46_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_46_23","url":null,"abstract":"A BSTRACT Introduction: Sciatic neuropathy is one of the most important neuropathies of the lower extremity. Although electromyography (EMG) is useful for detecting and localizing neurologic damage, assessing the severity of neuropathy, determining prognoses, and detecting confounding or accompanying neurologic pathologies, electrodiagnostic analyses of sciatic neuropathy are rare in the literature. Methods: The EMG database between 2017 and 2022 was reviewed. Neurophysiologic data of 58 patients who were electrophysiologically diagnosed as having sciatic neuropathy were included in the study. The adult patient group was divided into three groups, injection trauma, noninjection trauma, and other etiologies for subgroup analyze. Pediatric patients were not divided into subgroups because of their limited number. Results: Sciatic neuropathy was found in nine patients in the pediatric group, and 48 patients in the adult group. Sciatic neuropathy was left sided in six (66.7%) pediatric patients and 25 (52%) adult patients. It was bilateral in one adult patient. There was no significant difference between the groups in terms of nerve conduction studies. No statistically significant difference was found in the needle EMG of the gastrocnemius medialis, tibialis anterior (TA), and biceps femoris short-head muscles ( P = 0.78, P = 0.32, and P = 0.14, respectively). In both injection and noninjection trauma patients, the most common needle EMG findings in the gastrocnemius medialis muscle were detected as grade 2. Grades 3 and 4 findings were observed predominantly in peroneal division innervated TA and biceps femoris short-head muscles. Conclusion: The most common etiology of sciatic neuropathy in adults was injection-related trauma. The peroneal division is more prone to injury in sciatic neuropathy in the context of sciatic variations. Consequently, we considered that the degree of damage in noninjection traumas might be higher in both distal and proximal segments compared with injection traumas.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"62 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":"135844702","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 Background: The dysregulation of various pathways and cellular processes contributes to the carcinogenic transition from low-grade gliomas to high-grade gliomas. The altered tumor microenvironment, altered epigenetic state, and high mutation heterogeneity are critical factors in glial tumors. The morphogen retinoic acid (RA) controls the homeostasis, regeneration, and development of the brain. RA receptor (RAR) gene methylation has been shown in different types of glial tumors. Aims and Objectives: This study assessed the RARß gene as a potential therapeutic target in gliomas. Materials and Methods: Using in silico methods, potential drugs targeting the RARß gene were compared based on temozolomide’s effectiveness in treating gliomas. Results and Conclusion: Computational techniques can be used to identify drug-mediated pathways. This in silico study holds promise for RARB and RARB-targeted treatment strategies in gliomas.
{"title":"Methylation of RARß is a New Clinical Biomarker for Treatment in Higher-grade Gliomas","authors":"Cigdem Toprak, Emine Ikbal Atli, Rasime Kalkan","doi":"10.4103/nsn.nsn_26_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_26_23","url":null,"abstract":"A BSTRACT Background: The dysregulation of various pathways and cellular processes contributes to the carcinogenic transition from low-grade gliomas to high-grade gliomas. The altered tumor microenvironment, altered epigenetic state, and high mutation heterogeneity are critical factors in glial tumors. The morphogen retinoic acid (RA) controls the homeostasis, regeneration, and development of the brain. RA receptor (RAR) gene methylation has been shown in different types of glial tumors. Aims and Objectives: This study assessed the RARß gene as a potential therapeutic target in gliomas. Materials and Methods: Using in silico methods, potential drugs targeting the RARß gene were compared based on temozolomide’s effectiveness in treating gliomas. Results and Conclusion: Computational techniques can be used to identify drug-mediated pathways. This in silico study holds promise for RARB and RARB-targeted treatment strategies in gliomas.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"67 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":"135844705","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}
Tugba Gurbuz, Çağrı Güleç, Fatih Toprak, S. Toprak, S. Sozer
Objective: High glucose levels cause metabolic and vascular complications by affecting the nervous system with an increased risk of stroke and seizures. There are still no effective treatment modalities for the high morbidity and mortality rates detected in such situations. Neural stem cells (NSCs) provide neurogenesis in the nervous system, but high glucose is detrimental to NSCs. This study investigates the intrinsic and extrinsic effects of the growth factors insulin-like growth factor-I (IGF-I) and mechano-growth factor (MGF) on NSCs when exposed to high glucose levels. Thus, the possibility of new treatment options for diabetes patients is explored. Materials and Methods: Rat NSCs grown in cell culture conditions were exposed to a control glucose concentration of 17.5 mM and high concentrations of 27.75, 41.75, and 83.75 mM for 24 h. The high glucose concentrations were designed to recapitulate the in vivo conditions of diabetes mellitus, diabetic ketoacidosis, and hyperglycemia hyperosmolar status. Then, 0.2 μg/ml IGF-I and MGF growth factors were separately added and their expressions in the NCSs investigated by real-time reverse transcription-polymerase chain reaction. The effects of exogenous IGF-I and MGF administration on NSC proliferation under high glucose conditions were measured by BrdU incorporation assay using flow cytometry analysis. Results: A significant increase was detected in the relative gene expression fold changes of IGF-I and MGF in the NSCs. The MGF relative fold change was greater than the IGF-I for each high glucose condition. NSCs exposed to 27.75 mM glucose revealed a 17-fold and 40-fold increase in the IGF-I and MGF gene expressions, respectively; the 41.75 mM glucose similarly revealed 68-and 161-fold increases and the 83.75 mM glucose 75-and 137-fold increases. Exogenous IGF-I administration increased its expression profile, while the administration of MGF lowered its expression. The NSC was in the growth (G0/G1) phase of the cell cycle during the 24 h culture time. The percentage of proliferated NSC decreased to 89% (17.5 mM), 85% (27.75 mM), 50.30% (41.75 mM), and 28.97% (83.75 mM). Surprisingly, the increase in both IGF-I and MGF saved the NSCs from cell death. Conclusion: Exogenous IGF-I and MGF administrations via high glucose environments increased NSC proliferation at the time of injury and protected the NSCs from cell death. The neuroprotective effect of MGF was greater than that of IGF-I. Thus, due to their neurogenesis potential, exogenous IGF-I and MGF could be applied in the treatment of diabetes patients to relieve neural damage.
{"title":"In Vitro investigation of insulin-like growth factor-i and mechano-growth factor on proliferation of neural stem cells in high glucose environment","authors":"Tugba Gurbuz, Çağrı Güleç, Fatih Toprak, S. Toprak, S. Sozer","doi":"10.4103/nsn.nsn_137_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_137_22","url":null,"abstract":"Objective: High glucose levels cause metabolic and vascular complications by affecting the nervous system with an increased risk of stroke and seizures. There are still no effective treatment modalities for the high morbidity and mortality rates detected in such situations. Neural stem cells (NSCs) provide neurogenesis in the nervous system, but high glucose is detrimental to NSCs. This study investigates the intrinsic and extrinsic effects of the growth factors insulin-like growth factor-I (IGF-I) and mechano-growth factor (MGF) on NSCs when exposed to high glucose levels. Thus, the possibility of new treatment options for diabetes patients is explored. Materials and Methods: Rat NSCs grown in cell culture conditions were exposed to a control glucose concentration of 17.5 mM and high concentrations of 27.75, 41.75, and 83.75 mM for 24 h. The high glucose concentrations were designed to recapitulate the in vivo conditions of diabetes mellitus, diabetic ketoacidosis, and hyperglycemia hyperosmolar status. Then, 0.2 μg/ml IGF-I and MGF growth factors were separately added and their expressions in the NCSs investigated by real-time reverse transcription-polymerase chain reaction. The effects of exogenous IGF-I and MGF administration on NSC proliferation under high glucose conditions were measured by BrdU incorporation assay using flow cytometry analysis. Results: A significant increase was detected in the relative gene expression fold changes of IGF-I and MGF in the NSCs. The MGF relative fold change was greater than the IGF-I for each high glucose condition. NSCs exposed to 27.75 mM glucose revealed a 17-fold and 40-fold increase in the IGF-I and MGF gene expressions, respectively; the 41.75 mM glucose similarly revealed 68-and 161-fold increases and the 83.75 mM glucose 75-and 137-fold increases. Exogenous IGF-I administration increased its expression profile, while the administration of MGF lowered its expression. The NSC was in the growth (G0/G1) phase of the cell cycle during the 24 h culture time. The percentage of proliferated NSC decreased to 89% (17.5 mM), 85% (27.75 mM), 50.30% (41.75 mM), and 28.97% (83.75 mM). Surprisingly, the increase in both IGF-I and MGF saved the NSCs from cell death. Conclusion: Exogenous IGF-I and MGF administrations via high glucose environments increased NSC proliferation at the time of injury and protected the NSCs from cell death. The neuroprotective effect of MGF was greater than that of IGF-I. Thus, due to their neurogenesis potential, exogenous IGF-I and MGF could be applied in the treatment of diabetes patients to relieve neural damage.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"27 - 36"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48404505","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}
Figen Esmeli, Hasan Kamil Sucu, Aytül Erol Gökmen, Tolga Özdemirkiran
A BSTRACT Background: Nerve conduction studies (NCS) are an important tool for the diagnosis of neuromuscular diseases. In NCS, factors such as temperature, age, sex, body metrics, and recording technique can affect the values. There are currently no universal normative data. The standardization of NCS is essential for the reliable and consistent identification of pathologic conditions for each laboratory. Aim: We wanted to obtain normal values of our electrophysiology laboratory for the Turkish population. Materials and Methods: The volunteer group consisted of 120 people aged 15–74 years. They were distributed into 12 subgroups according to their age. Each subgroup included five male and five female subjects. Age, sex, weight, height, profession, body mass index, and hand preferences were recorded. Median and ulnar NCS were performed by two experienced clinical neurophysiologists. The skin temperature was corrected to 35.5°C, which was the highest measured value. Results: Age 50 years was used for the cutoff point for nerve conduction velocities (NCVs) because there was no significant difference within the groups aged ≥50 years and <50 years. However, the NCVs of groups aged <50 years and >50 years were significantly different. NCVs and action potential amplitudes were higher in females than males in both age groups. Women had higher NCV values and action potential amplitudes of motor and sensory fibers. Conclusion: Age, temperature, and sex are important factors that affect NCS. We believe this study will provide normal values for future studies, especially in the Turkish population.
{"title":"Normal Nerve Conduction Values of Median and Ulnar Nerves in the Turkish Population","authors":"Figen Esmeli, Hasan Kamil Sucu, Aytül Erol Gökmen, Tolga Özdemirkiran","doi":"10.4103/nsn.nsn_21_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_21_23","url":null,"abstract":"A BSTRACT Background: Nerve conduction studies (NCS) are an important tool for the diagnosis of neuromuscular diseases. In NCS, factors such as temperature, age, sex, body metrics, and recording technique can affect the values. There are currently no universal normative data. The standardization of NCS is essential for the reliable and consistent identification of pathologic conditions for each laboratory. Aim: We wanted to obtain normal values of our electrophysiology laboratory for the Turkish population. Materials and Methods: The volunteer group consisted of 120 people aged 15–74 years. They were distributed into 12 subgroups according to their age. Each subgroup included five male and five female subjects. Age, sex, weight, height, profession, body mass index, and hand preferences were recorded. Median and ulnar NCS were performed by two experienced clinical neurophysiologists. The skin temperature was corrected to 35.5°C, which was the highest measured value. Results: Age 50 years was used for the cutoff point for nerve conduction velocities (NCVs) because there was no significant difference within the groups aged ≥50 years and <50 years. However, the NCVs of groups aged <50 years and >50 years were significantly different. NCVs and action potential amplitudes were higher in females than males in both age groups. Women had higher NCV values and action potential amplitudes of motor and sensory fibers. Conclusion: Age, temperature, and sex are important factors that affect NCS. We believe this study will provide normal values for future studies, especially in the Turkish population.","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":"135844389","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 The manifestation of immunological findings in diverse disorders presenting with seizures points to autoimmunity and inflammation in the etiology of epilepsy. Typical examples of autoimmunity-associated epilepsy are autoimmune encephalitis, Rasmussen encephalitis, and glutamic acid decarboxylase (GAD) antibody-positive temporal lobe epilepsy (TLE). The last entity is a typical example of antibody-positive focal epilepsy of unknown cause (FEUC). One of the most prominent findings emphasizing the coexistence of epilepsy and autoimmunity is the detection of anti-neuronal antibodies in patients manifesting with seizures. Emergence of antibody-producing plasma cells in the early course of GAD-antibody-positive TLE and induction of seizures in rodents upon intracerebral administration of N-methyl-D-aspartate receptor antibodies indicate that anti-neuronal antibodies may play a causal (rather than bystander) role in the induction of seizures. By contrast, innate immunity of the central nervous system (CNS) and infiltrating cytotoxic T-cells appear to participate in Rasmussen encephalitis and autoimmune encephalitis with antibodies to intracellular antigens. In addition, repetitive seizures may activate glial cells through the release of damage-associate molecular pattern mediators and activation of toll-like receptors, which in turn leads to disrupted blood–brain barrier and increased cerebral infiltration of peripheral blood immune cells. In conclusion, complex interactions of humoral and cellular immunity in the CNS appear to cause or at least contribute to seizure induction in FEUC. The nature of these interactions has recently started to be understood. Investigation of these mechanisms is substantial for the discovery of new treatment strategies and biomarkers in epilepsy.
以癫痫发作为表现的多种疾病的免疫学表现表明，自身免疫和炎症是癫痫的病因。自身免疫相关癫痫的典型例子是自身免疫性脑炎、拉斯穆森脑炎和谷氨酸脱羧酶(GAD)抗体阳性的颞叶癫痫(TLE)。最后一个实体是一个典型的抗体阳性局灶性不明原因癫痫(FEUC)。其中一个最突出的发现强调癫痫和自身免疫共存是检测抗神经元抗体的患者表现为癫痫发作。在脑内注射n -甲基- d -天冬氨酸受体抗体后，在gad抗体阳性的TLE早期出现产生抗体的浆细胞，并诱导啮齿动物癫痫发作，这表明抗神经元抗体可能在癫痫发作的诱导中起因果作用(而不是旁观者)。相比之下，中枢神经系统(CNS)的先天免疫和浸润性细胞毒性t细胞似乎参与了拉斯穆森脑炎和自身免疫性脑炎的细胞内抗原抗体。此外，反复发作可通过释放损伤相关分子模式介质和激活toll样受体激活神经胶质细胞，进而导致血脑屏障被破坏和外周血免疫细胞脑浸润增加。综上所述，CNS中体液和细胞免疫的复杂相互作用似乎导致或至少有助于诱发FEUC的癫痫发作。这些相互作用的本质最近才开始被理解。研究这些机制对于发现癫痫的新治疗策略和生物标志物具有重要意义。
{"title":"Autoimmune Mechanisms in Focal Epilepsy of Unknown Cause","authors":"Elif Sanli, Vuslat Yilmaz, Erdem Tuzun","doi":"10.4103/nsn.nsn_226_21","DOIUrl":"https://doi.org/10.4103/nsn.nsn_226_21","url":null,"abstract":"A BSTRACT The manifestation of immunological findings in diverse disorders presenting with seizures points to autoimmunity and inflammation in the etiology of epilepsy. Typical examples of autoimmunity-associated epilepsy are autoimmune encephalitis, Rasmussen encephalitis, and glutamic acid decarboxylase (GAD) antibody-positive temporal lobe epilepsy (TLE). The last entity is a typical example of antibody-positive focal epilepsy of unknown cause (FEUC). One of the most prominent findings emphasizing the coexistence of epilepsy and autoimmunity is the detection of anti-neuronal antibodies in patients manifesting with seizures. Emergence of antibody-producing plasma cells in the early course of GAD-antibody-positive TLE and induction of seizures in rodents upon intracerebral administration of N-methyl-D-aspartate receptor antibodies indicate that anti-neuronal antibodies may play a causal (rather than bystander) role in the induction of seizures. By contrast, innate immunity of the central nervous system (CNS) and infiltrating cytotoxic T-cells appear to participate in Rasmussen encephalitis and autoimmune encephalitis with antibodies to intracellular antigens. In addition, repetitive seizures may activate glial cells through the release of damage-associate molecular pattern mediators and activation of toll-like receptors, which in turn leads to disrupted blood–brain barrier and increased cerebral infiltration of peripheral blood immune cells. In conclusion, complex interactions of humoral and cellular immunity in the CNS appear to cause or at least contribute to seizure induction in FEUC. The nature of these interactions has recently started to be understood. Investigation of these mechanisms is substantial for the discovery of new treatment strategies and biomarkers in epilepsy.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"17 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":"135844695","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}
{"title":"Unusual vessel wall magnetic resonance imaging findings in a cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy patient","authors":"H. Ozdemir, H. Karakaya, F. Gökçay","doi":"10.4103/nsn.nsn_174_21","DOIUrl":"https://doi.org/10.4103/nsn.nsn_174_21","url":null,"abstract":"","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"56 - 58"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49096219","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: Obstructive sleep apnea syndrome (OSAS) is a serious public health problem that causes a significant economic burden worldwide. Apart from several treatment approaches, positive airway pressure (PAP) therapy remains the gold standard. Performing an optimal manual titration study to explore the beneficial and comfortable pressure for patients is essential, but the process is troublous sometimes, requiring multiple attempts. The objective of this study was to present our single-center experience regarding PAP titration studies in OSAS and identify the clinical and laboratory parameters that might predict repeat titration. Materials and Methods: Medical charts of 248 patients with OSAS who were eligible for PAP therapy were retrospectively reviewed. Age, sex, body mass index, modified Mallampati scores, presence of positive Muller maneuvers, and polysomnographic parameters yielded from diagnostic studies were recorded and compared between patients with single versus repeat titrations. Results: The mean age, the proportion of males, and the rate of patients with positive Muller maneuvers were significantly increased in the retitration group (P = 0.015, P = 0.022, and P = 0.001, respectively). Multivariate regression analysis revealed that age and positive Muller maneuvers were independent associates of repeat titration (P = 0.036 and P = 0.005, respectively). Conclusion: Our results suggest that both aging and the presence of a positive Muller maneuver may predict a troublous titration study, raising the need for recurrent attempts. The final common pathway could contribute to a vulnerable and more collapsible airway during sleep. Recognizing the potential need for retitration at the beginning is favorable regarding adjustment of the laboratory conditions and increases the patients' adherence during the management course. The results also confirm the capability of manual titration in terms of exploring proper PAP pressures in the majority of patients with OSAS.
{"title":"Predictors of retitration in the sleep laboratory: Experience of a single center","authors":"U. Akyıldız, A. Gurses","doi":"10.4103/nsn.nsn_141_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_141_22","url":null,"abstract":"Background: Obstructive sleep apnea syndrome (OSAS) is a serious public health problem that causes a significant economic burden worldwide. Apart from several treatment approaches, positive airway pressure (PAP) therapy remains the gold standard. Performing an optimal manual titration study to explore the beneficial and comfortable pressure for patients is essential, but the process is troublous sometimes, requiring multiple attempts. The objective of this study was to present our single-center experience regarding PAP titration studies in OSAS and identify the clinical and laboratory parameters that might predict repeat titration. Materials and Methods: Medical charts of 248 patients with OSAS who were eligible for PAP therapy were retrospectively reviewed. Age, sex, body mass index, modified Mallampati scores, presence of positive Muller maneuvers, and polysomnographic parameters yielded from diagnostic studies were recorded and compared between patients with single versus repeat titrations. Results: The mean age, the proportion of males, and the rate of patients with positive Muller maneuvers were significantly increased in the retitration group (P = 0.015, P = 0.022, and P = 0.001, respectively). Multivariate regression analysis revealed that age and positive Muller maneuvers were independent associates of repeat titration (P = 0.036 and P = 0.005, respectively). Conclusion: Our results suggest that both aging and the presence of a positive Muller maneuver may predict a troublous titration study, raising the need for recurrent attempts. The final common pathway could contribute to a vulnerable and more collapsible airway during sleep. Recognizing the potential need for retitration at the beginning is favorable regarding adjustment of the laboratory conditions and increases the patients' adherence during the management course. The results also confirm the capability of manual titration in terms of exploring proper PAP pressures in the majority of patients with OSAS.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"37 - 42"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45921360","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}
I. Kaya, Meltem İnci, N. Sirin, M. Baslo, E. Orhan
Objective: The objective of this study was to evaluate how the coronavirus disease 2019 pandemic affected the profile of patients admitted to the electromyography (EMG) laboratory and the types of neurophysiologic evaluations. Methods: We included patients who were admitted to our EMG laboratory in the first 6 months of the pandemic period (Period 1) and the same 6 months of the previous year (Period 2). In view of changes in health-care strategies, lockdown, and disease awareness during the pandemic, each group was divided into 3-month periods (early and late). Demographic and clinical characteristics and electrophysiologic data were evaluated retrospectively and compared between the groups. Results: In Period 1, there were 1872 studies of 1829 patients, and in Period 2, there were 625 studies of 607 patients. Electrodiagnoses for cranial neuropathies were more frequent during the pandemic when compared with before the pandemic (P = 0.018). The subgroup analysis revealed that the ratio of segmental anterior horn involvement decreased in the early pandemic period (P = 0.003), myopathies decreased in the late pandemic period (P = 0.001), and cranial neuropathies increased in the late pandemic period (P = 0.005) compared with the same periods in the previous year. Conclusion: During the pandemic, there have been changes in clinical practice approaches in the electrophysiology laboratory. More cranial neuropathies seemed to be diagnosed in the EMG laboratory during the pandemic, including new-onset facial neuropathies, which was the most significant finding of our study.
{"title":"Impact of the coronavirus disease 2019 pandemic on the patient profile evaluated in the electromyography laboratory","authors":"I. Kaya, Meltem İnci, N. Sirin, M. Baslo, E. Orhan","doi":"10.4103/nsn.nsn_135_22","DOIUrl":"https://doi.org/10.4103/nsn.nsn_135_22","url":null,"abstract":"Objective: The objective of this study was to evaluate how the coronavirus disease 2019 pandemic affected the profile of patients admitted to the electromyography (EMG) laboratory and the types of neurophysiologic evaluations. Methods: We included patients who were admitted to our EMG laboratory in the first 6 months of the pandemic period (Period 1) and the same 6 months of the previous year (Period 2). In view of changes in health-care strategies, lockdown, and disease awareness during the pandemic, each group was divided into 3-month periods (early and late). Demographic and clinical characteristics and electrophysiologic data were evaluated retrospectively and compared between the groups. Results: In Period 1, there were 1872 studies of 1829 patients, and in Period 2, there were 625 studies of 607 patients. Electrodiagnoses for cranial neuropathies were more frequent during the pandemic when compared with before the pandemic (P = 0.018). The subgroup analysis revealed that the ratio of segmental anterior horn involvement decreased in the early pandemic period (P = 0.003), myopathies decreased in the late pandemic period (P = 0.001), and cranial neuropathies increased in the late pandemic period (P = 0.005) compared with the same periods in the previous year. Conclusion: During the pandemic, there have been changes in clinical practice approaches in the electrophysiology laboratory. More cranial neuropathies seemed to be diagnosed in the EMG laboratory during the pandemic, including new-onset facial neuropathies, which was the most significant finding of our study.","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"40 1","pages":"20 - 26"},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45425347","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, We present a patient with lower motor neuron syndrome who exhibited the characteristic “snake-eyes” appearance on magnetic resonance imaging (MRI). The patient was a 27-year-old male who presented with a chief complaint of slowly progressive weakness, clumsiness, and wasting of the muscles in both hands that started 8 years ago. He reported difficulty gripping objects. The patient denied any history of preceding trauma or injury to the affected hand or neck region or a history of poliomyelitis. The parents of the patient had second-degree consanguinity. There was no neurological disease in the family. Neurological examination revealed bilateral wasting of the thenar and hypothenar muscles, as well as wasting of the forearm muscles, and fasciculations in the left arm, with tremulous movements in both hands [Figure 1]. He had slightly asymmetric weakness in the upper extremities, which was distal and left dominant, without any sensory signs. Deep tendon reflexes were hyperactive in all four extremities. Plantar reflexes showed an indifferent response, and the ankle clonus test showed a bilateral positive response. The patient did not have any other neurological deficits or symptoms, and there was no gynecomastia.Figure 1: Thenar, hypothenar, and forearm atrophies of the upper extremitiesAn MRI of the spinal cord was performed, which revealed bilateral intramedullary T2 hyperintensity giving a “snake-eyes” appearance in the bilateral cervical anterior horns in the transverse section [Figure 2]. Flexion imaging showed no displacement of the dorsal dura.Figure 2: The cervical T2-weighted MRI showed a “snake-eye” appearance in the anterior horns in the axial section on the left (thin arrows). A linear hyperintense lesion was detected in the sagittal section in the middle (thick arrow). MRI at maximum flexion of the cervical spine did not show any abnormalities. The peri- and epidural spaces were of normal width on the right. MRI: Magnetic resonance imagingNerve conduction studies were also performed and showed normal amplitudes and velocities of the median, ulnar, tibial, peroneal, and sural nerves with no evidence of conduction block or temporal dispersion. Needle electromyography (EMG) was performed on the proximal and distal muscles of each limb as well as the tongue, which revealed chronic neurogenic changes in the C7–C8 and T1 myotomes. Abnormal spontaneous activity was detected in the bilateral dorsal interossei muscles. The cranial MRI was normal. Blood tests, including metabolic parameters, CK level, HIV, hepatitis, syphilis serology, and vasculitic and tumor markers, were negative. In addition, DNA analysis for Kennedy’s disease, polymerase chain reaction analysis in the C9ORF72 and SOD1 genes, and whole-exome sequencing (performed at the Koc University Neurodegeneration Research Laboratory) were also negative. The patient declined cerebrospinal fluid examination. Based on the patient’s clinical presentation and imaging findings,
{"title":"Lower Motor Syndrome Limited to the Upper Extremities with a Snake-eyes Appearance on the Cervical Cord","authors":"Merve Melodi Cakar, Oguzhan Durgan, Leyla Baysal","doi":"10.4103/nsn.nsn_36_23","DOIUrl":"https://doi.org/10.4103/nsn.nsn_36_23","url":null,"abstract":"Dear Editor, We present a patient with lower motor neuron syndrome who exhibited the characteristic “snake-eyes” appearance on magnetic resonance imaging (MRI). The patient was a 27-year-old male who presented with a chief complaint of slowly progressive weakness, clumsiness, and wasting of the muscles in both hands that started 8 years ago. He reported difficulty gripping objects. The patient denied any history of preceding trauma or injury to the affected hand or neck region or a history of poliomyelitis. The parents of the patient had second-degree consanguinity. There was no neurological disease in the family. Neurological examination revealed bilateral wasting of the thenar and hypothenar muscles, as well as wasting of the forearm muscles, and fasciculations in the left arm, with tremulous movements in both hands [Figure 1]. He had slightly asymmetric weakness in the upper extremities, which was distal and left dominant, without any sensory signs. Deep tendon reflexes were hyperactive in all four extremities. Plantar reflexes showed an indifferent response, and the ankle clonus test showed a bilateral positive response. The patient did not have any other neurological deficits or symptoms, and there was no gynecomastia.Figure 1: Thenar, hypothenar, and forearm atrophies of the upper extremitiesAn MRI of the spinal cord was performed, which revealed bilateral intramedullary T2 hyperintensity giving a “snake-eyes” appearance in the bilateral cervical anterior horns in the transverse section [Figure 2]. Flexion imaging showed no displacement of the dorsal dura.Figure 2: The cervical T2-weighted MRI showed a “snake-eye” appearance in the anterior horns in the axial section on the left (thin arrows). A linear hyperintense lesion was detected in the sagittal section in the middle (thick arrow). MRI at maximum flexion of the cervical spine did not show any abnormalities. The peri- and epidural spaces were of normal width on the right. MRI: Magnetic resonance imagingNerve conduction studies were also performed and showed normal amplitudes and velocities of the median, ulnar, tibial, peroneal, and sural nerves with no evidence of conduction block or temporal dispersion. Needle electromyography (EMG) was performed on the proximal and distal muscles of each limb as well as the tongue, which revealed chronic neurogenic changes in the C7–C8 and T1 myotomes. Abnormal spontaneous activity was detected in the bilateral dorsal interossei muscles. The cranial MRI was normal. Blood tests, including metabolic parameters, CK level, HIV, hepatitis, syphilis serology, and vasculitic and tumor markers, were negative. In addition, DNA analysis for Kennedy’s disease, polymerase chain reaction analysis in the C9ORF72 and SOD1 genes, and whole-exome sequencing (performed at the Koc University Neurodegeneration Research Laboratory) were also negative. The patient declined cerebrospinal fluid examination. Based on the patient’s clinical presentation and imaging findings, ","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"2 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":"135844699","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}
I. Solmaz, F. Azman, G. Utine, D. Yalnızoǧlu, S. Saygi
{"title":"Reflex seizures with hot water and recurrent nonconvulsive status epilepticus in a patient with triple mosaicism and ring formation of chromosome 20","authors":"I. Solmaz, F. Azman, G. Utine, D. Yalnızoǧlu, S. Saygi","doi":"10.4103/nsn.nsn_187_21","DOIUrl":"https://doi.org/10.4103/nsn.nsn_187_21","url":null,"abstract":"","PeriodicalId":48555,"journal":{"name":"Neurological Sciences and Neurophysiology","volume":"39 1","pages":"216 - 218"},"PeriodicalIF":0.4,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46597633","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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