Clinical, Demographic, and Radiological Characteristics of Patients Demonstrating Antibodies Against Myelin Oligodendrocyte Glycoprotein.

Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayis University's Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

Co-assessment of OCT-A and choroidal vascularity index data in multiple sclerosis patients.

OBJECTIVE: To evaluate optical coherence tomography-angiography (OCT-A) findings and choroidal vascular index (CVI) in patients with multiple sclerosis (MS). METHODS: 113 patients, including multiple sclerosis patients with optic neuritis attack (MSON+) and no optic neuritis attack (MSON-) and healthy control group (HCG), participated in this cross-sectional study. OCT-A images of all patients were taken and CVI was calculated. RESULTS: Superior flow (SF), deep flow (DF), foveal, and parafoveal superior vascular density (sVD) were decreased in the MSON+ group compared to HCG (p < 0.05). Optic disk flow (ODF) and optic disk head density (ONHD) values decreased in the MS group (p < 0.05). CVI was decreased in the MSON+ group compared to HCG (p < 0.05). There is a correlation between CVI and foveal and parafoveal sVD. CONCLUSION: Non-invasive diagnostic tools such as OCT-A and CVI can be used for early diagnosis and follow-up of microvascular pathologies in inflammatory diseases such as MS.

The effect of Transcutaneous Electrical Nerve Stimulation (TENS) and Interferential Currents (IFC) on pain, functional capacity, and quality of life in patients with multiple sclerosis: A randomized controlled, single-blinded study.

OBJECTIVE: The aim is to compare the effects of different electrical stimulations on pain, functional capacity and quality of life in patients with Multiple Sclerosis (pwMS). METHOD: 40 pwMS were included in the study, randomized by simple random method and divided into 2 groups. Low-frequency Transkutaneal Electric Stimulation (TENS) was applied to 1st group and Interferential current was applied to 2nd group for 30 min 5 days/a week for 4 weeks. For pain severity Visual Analogue Scale (VAS), for neuropathic pain the LANSS questionnaire was used. Functional capacity was evaluated with the 2-minute walk test (2MWT) and quality of life was evaluated with the 'Multiple Sclerosis International Quality of Life Scale (MusiQol)'. RESULTS: The most severe and mean VAS and LANSS results significiantly decreased, 2MWT results significiantly increased in two groups (p<0.05). A significiant increase was found in all sub-headings of the MusiQol, except for the relationship with the health system in TENS group (p<0.05). An increase was found in the total score, activities of daily living, well-being, relationship with friends, relationship with family, sexual life, rejection sub-headings of the MusiQol in IFC group (p<0.05). There was no significant difference between the groups in terms of VAS, LANSS, 2MWT and MusiQol (p>0.05). CONCLUSION: In this study, it was found that interference current and TENS applications decrease pain and increase functional capacity. However, it was determined that TENS application was a more effective method in increasing the quality of life. CLINICALTRIALS: NCT05110586.

The reliability and validity of the Figure of 8 walk test in mildly disabled persons with multiple sclerosis.

BACKGROUND: Figure of 8 Walk Test (F8WT) assesses the multidirectional and adaptive requirements of both straight and curved path walking. The study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the F8WT in patients with Multiple Sclerosis (pwMS). METHODS: 45 mildly disabled pwMS (10 male, 35 female) were included in the study. Reliability of F8WT test was evaluated with Intraclass Correlation Coefficient (ICC). MDC estimates were calculated using baseline data. The correlation between the F8WT and Berg Balance Scale (BBS), The Timed Up and Go test (TUG), The Timed 25-Foot Walk Test (T25FW), The Four Square Step Test (FSST) was used for the validity. RESULTS: The intra-rater (ICC 0.980-0.983) and inter-rater (ICC 0.976-0.985) reliability of the F8WT was determined to be excellent. MDC values for intra-rater were 1.04-1.08 s, and MDC values for inter-rater were 1.16-0.99 s. The correlation with F8WT and BBS (p = 0.000, r = -0.702), TUG (p = 0.000, r = 0.854), T25FW (p = 0.000, r = 0.784), FSST (p = 0.000, r = 0.748) was found to be statistically significant. CONCLUSION: The F8WT has good reliability and validity in mildly disabled pwMS. According to the MDC results, small differences in pwMS can be adequately detected with F8WT. Therefore, it may be a clinically suitable test for detecting balance and walking.

Peripheral and Central Smell Regions in Migraine Patients using Maras Powder (Smokeless Tobacco): A Magnetic Resonance Imaging Evaluation.

Objective In the present study, we investigated the efficacy of Maras powder (smokeless tobacco) use on smell regions in migraine patients. Methods The cranial magnetic resonance imaging images of 58 adult patients were included in this retrospective study. Thirty-eight of them were migraine patients (18 of them using Maras powder and 20 of them not using Maras powder) and 20 of them were healthy controls. Bilateral peripheral (olfactory bulb [OB] volume and olfactory sulcus depth) and central smell regions (insular gyrus area and corpus amygdala area) as well as nasal septal deviation were evaluated. Results In migraine patients (using or not using Maras powder), OB volumes, and in Maras powder using migraine patients, corpus amygdala areas were lower than those in the control group ( p < 0.05). In Maras powder-using migraine patients, left insular gyrus areas of the females were significantly lower than the males ( p < 0.05). Conclusion We concluded that the peripheral smell region of the OB volume decreased in migraine patients (using or not using Maras powder). However, the central smell region of corpus amygdala area decreased in Maras powder using migraine patients. Maras powder usage may increase vascular shrinkage, and the decrease in OB volume and corpus amygdala area becomes prominent. It can be said that Maras powder usage may cause a size decrease in the peripheral and central smell regions in migraine patients. Therefore, migraine patients and non-migrainous people should be noticed for the harmful effects of Maras powder on the vascular system and smell system in the aspects of OB volume and corpus amygdala area decrease.

Carotid Near-Occlusion Stent Experiences.

INTRODUCTION: Treatment strategy for near-occlusions (NO) of the internal carotid artery (ICA) is still controversial. In this study, we aimed to present the clinical results of stent placement in 50 patients with carotid artery (NO) stenosis that presented to our center, and upon which revascularization will be performed. METHODS: Between 2014 and 2017, 50 patients with (NO) from 180 patients who had stents in the Interventional Vascular Neurology clinic were retrospectively studied. All the patients whether using or not using the proximal and distal protection device during the procedure were included. Patients had clinical neurologic evaluation, and underwent carotid artery radiologic imaging before the carotid artery stent (CAS) procedure. Balloon dilatation was applied before the stent procedure for patients that had advanced stenosis. Post-dilatation was applied with a balloon of appropriate size in case of residual narrowing. Findings such as bradycardia, hypotension, reperfusion hemorrhage during and after the stent placement procedure, as well as patients that developed restenosis within 12 months were recorded. RESULTS: This study includes 50 (30 males, 20 females) patients that underwent carotid stent placement. The mean age of patients was 65 (28-81). Reperfusion hemorrhage was seen in 1 (2%) patient and the patient died in week 3. Ten (20%) patients complained of chills and tremor lasting less than 3 hours after the procedure. One (2%) patient had encephalopathy and agitation for less than 24 hours. Two (4%) patients had hypotension, and 15 (30%) patients had a headache for less than 24 hours. Three patients developed local hematoma at the site of the sheath, and were treated by applying compression. Restenosis signs in the stent site was observed in 6 patients (12%) in color Doppler ultrasonography of the carotid performed in the 6th and 12th months. CONCLUSION: Although the innate process of ICA NO is not well known, it might be more frequent than currently considered. Especially after the diagnosis of ICA stenosis, it is important to make the right diagnosis in patients that have new ipsilateral symptoms. After the diagnosis is made, CAS, when performed by an experienced neuro-interventional team, seems beneficial with low complication rates.

The effects of neutrophil to lymphocyte and platelet to lymphocyte ratios on prognosis in patients undergoing mechanical thrombectomy for acute ischemic stroke.

INTRODUCTION: The aim of the study was to investigate the effect of neutrophil lymphocyte (NLR) and platelet lymphocyte ratio (PLR) on prognosis in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy. MATERIAL-METHOD: A retrospective study was made of the data of 56 patients aged 20-80 years who were diagnosed with AIS and underwent mechanical thrombectomy. Thrombolysis in Brain Ischemia (TIBI) status was evaluated with transcranial Doppler after treatment. The National Institutes of Health Stroke Scale (NIHHS) and modified Rankin scale (mRS) were used to indicate neurological and functional deficits. RESULTS: No difference was determined in the NLR and PLR between patients with or without middle cerebral artery (MCA) occlusion, T and basilar occlusion. These ratios were also no different between the groups with different degrees of recanalization. Platelet lymphocyte ratio was lower in patients with a dramatic improvement at the 24th hour (p=0.046). Neutrophil lymphocyte ratio was higher in patients with symptomatic hemorrhage (p=0.046). CONCLUSION: Although no relationship with outcome has yet been shown, the association with hemorrhagic change and the recovery parameters at the 24th hour may enable NLR and PLR to be used as significant prognostic factors in patients with acute ischemic stroke undergoing mechanical thrombectomy. Further studies are needed. KEY WORDS: Ischemia, Mechanical thrombectomy, Neutrophil lymphocyte ratio, Platelet lymphocyte ratio, Stroke.

Sexual dysfunction and distress in premenopausal women with migraine: association with depression, anxiety and migraine-related disability.

Migraine is a chronic disorder associated with impaired quality of life as well as sexual function. However, data about the sexual distress in women with migraine were lacked.This study aimed to determine the incidence and associated risk factors of both sexual function and distress in premenopausal women with migraine. Sixty-nine women diagnosed with migraine were included. Sexual function and distress were assessed by Female sexual function index (FSFI) and Female sexual distress scale-revised (FSDS-R), respectively. Depression and anxiety were investigated by Hospital depression and anxiety scale (HADS). Migraine related disability was evaluated by Migraine disability assessment scale (MIDAS) and average severity of pain was determied by Visual analog scale (VAS). Fifty-five women reported to have sexual dysfunction. Any headache-related feature including MIDAS and VAS scores, depression or anxiety was found to be related with sexual dysfunction. Sexual distress was noted in 37 cases, and depression, VAS and MIDAS scores were significantly higher in women with sexual distress. This study showed that women with migraine should be screened both for sexual dysfunction and distress to help clinicians dealing with sexual medicine to improve the standart of patient care in their regular practice. Special attention should be given to the ones whose MIDAS and VAS scores were high and who had depression.

Mean Platelet Volume, C-Reactive Protein, and Prognosis in Patients with Acute Ischemic Stroke Following Intravenous Thrombolytic Treatment.

BACKGROUND The aim of this study was to investigate the association between mean platelet volume (MPV), C-reactive protein (CRP), and prognosis in patients with acute ischemic stroke (AIS) following intravenous (IV) thrombolytic treatment. MATERIAL AND METHODS A retrospective clinical study included 129 patients within 4.5 hours from the onset of AIS, who received IV thrombolytic treatment. Clinical data were retrieved from electronic medical records. MPV, CRP, and National Institutes of Health (NIH) Stroke Scale and the modified Rankin Scale (MRS) scores for physical disability were recorded. RESULTS Of the 129 patients, 65.9% were men, and more than half received IV thrombolytic treatment within between 3-4.5 hours. The NIH Stroke Scale scores at 24 hours and at three months after hospital admission were compared with the NIH Stroke Scale scores on hospital admission. A significant correlation was found between the MPV values at 24 hours (r=0.221; p=0.012) and at three months after hospital admission (r=196; p=0.026). There was a significant correlation between CRP values at 24 hours (r=0.224; p=0.021), the difference in NIH Stroke Scale score between 24 hours and three months (r=0.249; p=0.005), and the MPV score at three months (r=0.186; p=0.035). CONCLUSIONS MPV and CRP values were significantly associated with improvement in the NIH Stroke Scale and MRS scores in AIS when patients were treated with IV thrombolytic therapy within 4.5 hours of the onset of symptoms.

The effects of Maras powder use on patients with migraine.

BACKGROUND: It is accepted that smoking often triggers migraine. However, studies evaluating the relationship between the use of smokeless tobacco and migraine are limited, and there is no clear consensus on the subject. In this study, it was aimed to evaluate the relationship between migraine and Maras powder, which is the most common smokeless tobacco in Turkey. SUBJECTS AND METHODS: The study included a total of 600 subjects, consisting of 300 patients (aged >18 years) diagnosed with a migraine according to the International Headache Society (IHS-ICHD-3 Beta) criteria after presenting at Sütçü Imam University Medical Faculty Neurology Policlinic with the complaint of headache between July 2016 and December 2016 and a control group of 300 individuals with similar features of age, gender, and educational level. A questionnaire was administered to each patient to record the status of smoking or using Maras powder. RESULTS: In the migraine patient group, 16.4% smoked and 9.7% used Maras powder. In the control group, the rate of smoking was 8.5% and the rate of Maras powder use was 11.86%. In males diagnosed with a migraine, the use of Maras powder was found to be at a higher rate than smoking (p<0.001). The Visual Pain Score and the headache frequency values were higher in those who smoked or used Maras powder than in non-users (p<0.001). The Fagerström Test for Nicotine Dependence Smokeless Tobacco results of the patients diagnosed with migraine and who used Maras powder were found to be higher than of those who smoked (Fagerström Test for Nicotine Dependence; p<0.001). When patients were evaluated according to the Migraine Disability Assessment Scale, the majority of migraine patients were seen to be at stages 1 and 2, and one in every three patients who used Maras powder cigarette and one in every two patients who smoked had headaches of a severity which affected their daily activities (p<0.001). CONCLUSION: Smoking or the use of Maras powder increases the frequency and severity of migraines in a similar way. Therefore, Maras powder must be included in the scope of the fight against tobacco and people should be warned about this issue.

The effect of demographic features on aortic arch anatomy and its role in the etiology of cerebrovascular disease.

PURPOSE: The aim of this study was to retrospectively evaluate the distribution of aortic arches, the relationship with demographic characteristics, and the results of carotid and vertebral artery stenting procedures in patients diagnosed with cerebrovascular disease through the intra-arterial digital subtraction angiography (DSA) technique. METHODS: A retrospective examination was performed on 288 patients diagnosed with cerebrovascular disease, who underwent DSA in the Department of Neurology of Gaziantep University Medical Faculty and Kahramanmaras¸ Sütçü Imam University Medical Faculty. The patients were examined in respect of demographic features and aortic arch anatomic structure characteristics. All demographic characteristics, DSA, carotid, and vertebral artery stent results were recorded. RESULTS: The patients comprised 60.1% males and 39.9% females with a mean age of 58.25 years. Type 2 aortic arch was found in 175 (60.7%) patients, Type 2 aortic arch in 99 (34.3%) patients, and Type 3 aortic arch in 14 (4.8%) patients. The right carotid artery stenosis rate was found to be higher in patients with Type 2 aortic arch (P=0.013). When the patients were evaluated according to the presence of a bovine arch, there was no significant difference in terms of age, carotid, and vertebral artery lesions (P>0.05). CONCLUSION: The aortic arch and its branching properties were not found to have a direct effect on increased risk of cerebrovascular disease or stenting rates. This study can be considered to raise awareness for new studies to demonstrate the effect of aortic arch anatomic differences on cerebrovascular diseases.

Carotid artery stenting without using any embolic protective device A single Centre experience.

INTRODUCTION: Despite the use of embolic protective devices in the majority of cases applied with carotid stenting to prevent embolic neurological complications related to the carotid stenting procedure, this procedure is applied to some cases without protection. The aim of this study was to present the clinical outcomes of carotid artery stent application without a cerebral embolism protective device. MATERIAL AND METHOD: A retrospective examination was made of a total of 171 patients applied with a stent between 2014 and 2017. The patients included in the study were applied with a stent because they were symptomatic and determined with >50% narrowing in the carotid artery on angiography or asymptomatic with >60% narrowing. The degree of carotid artery narrowing was determined with Doppler ultrasonography before angiographic examination and with the North American symptomatic carotid endarterectomy trial measurement criteria during angiography. After stenting the carotid artery, patients were observed at the hospital for 24 hours RESULTS: In 10 (5.8%) patients, there was a mid cerebral artery branch infarct ipsilateral to the stent. No reperfusion bleeding was observed in any patient. In 5 (2.9%) patients, encephalopathy and agitation not exceeding 24 hours was observed. Hypotension was determined in 8 (4.6%) patients and headache lasting <24 hours in 53 (31%) patients. 1 (0.5%) patient, rectus abdominis bleeding developed one week after the procedure and within 24 hours, the patient was exitus. CONCLUSION: Revascularisation interventions to be able to prevent the development of stroke are evaluated as important treatment options in patients with symptomatic or severe carotid stenosis. With careful patient selection in experienced centres and a multi-disciplinary approach both before and after the procedure, pleasing results can be obtained without the use of embolic protective devices. KEY WORDS: Carotid artery stenting, Embolic protective device, Stroke.