Can Lamina Cribrosa Indicate Optic Neuritis in Multiple Sclerosis?

Background: In this study, we aimed to evaluate the association of lamina cribrosa thickness (LCT) and lamina cribrosa depth (LCD), as determined by spectral domain optical coherence tomography (SD-OCT), with visual evoked potentials (VEPs) in patients with multiple sclerosis (MS). Materials and Methods: Patients enrolled in this prospective, cross-sectional study were divided into three groups. Group 1 consisted of 25 relapsing-remitting MS patients with VEP pathology in one or both eyes. In patients with VEP pathology in both eyes, one eye was chosen randomly. Group 2 comprised 25 relapsing-remitting MS patients with no VEP pathology or optic neuritis history. A randomly selected single eye of each patient was evaluated. Group 3 consisted of 25 age- and sex-matched healthy volunteers; a randomly selected single eye of these participants was examined. LCT, LCD, and retinal nerve fiber layer (RNFL) thickness measurements were determined in four quadrants (superior, inferior, nasal, and temporal) by SD-OCT. Results: The three groups were similar in terms of age and sex. The mean LCT was lower in Group 1 than in Group 2, but the difference was not statistically significant (268.80 ± 36.69 µm [min-max = 222-394 µm] versus 285.80 ± 12.00 µm [min-max = 249-338 µm]; P = 0.148). The mean LCT was significantly lower in Group 1 than in Group 3 (268.80 ± 36.69 µm [min-max = 222-394 µm] versus 294.80 ± 12.00 µm [min-max = 232-351 µm]; P = 0.012). There was a weak positive correlation between LCT and RNFL-inferior, RNFL-nasal, and RNFL-temporal. Conclusion: We found that the lamina cribrosa was thinner in MS patients with VEP pathology. To the best of our knowledge, this is a novel finding. Our results imply that LCT could be used as an indicator of optic neuritis in MS patients.

Large-Area Resistive Strain Sensing Sheet for Structural Health Monitoring.

Damage significantly influences response of a strain sensor only if it occurs in the proximity of the sensor. Thus, two-dimensional (2D) sensing sheets covering large areas offer reliable early-stage damage detection for structural health monitoring (SHM) applications. This paper presents a scalable sensing sheet design consisting of a dense array of thin-film resistive strain sensors. The sensing sheet is fabricated using flexible printed circuit board (Flex-PCB) manufacturing process which enables low-cost and high-volume sensors that can cover large areas. The lab tests on an aluminum beam showed the sheet has a gauge factor of 2.1 and has a low drift of 1.5 µ ϵ / d a y . The field test on a pedestrian bridge showed the sheet is sensitive enough to track strain induced by the bridge's temperature variations. The strain measured by the sheet had a root-mean-square (RMS) error of 7 µ ϵ r m s compared to a reference strain on the surface, extrapolated from fiber-optic sensors embedded within the bridge structure. The field tests on an existing crack showed that the sensing sheet can track the early-stage damage growth, where it sensed 600 µ ϵ peak strain, whereas the nearby sensors on a damage-free surface did not observe significant strain change.

Hybrid LAE-CMOS Force-Sensing System Employing TFT-Based Compressed Sensing for Scalability of Tactile Sensing Skins.

Tactile sensing requires form-fitting and dense sensor arrays over large-areas. Hybrid systems, combining Large-Area Electronics (LAE) and silicon-CMOS ICs to respectively provide diverse sensing and high-performance computation/control, enable a platform for such sensing. A key challenge is that hybrid systems require a large number of interfaces between the LAE and CMOS domains, particularly as the number of sensors scales. This paper presents an architecture that exploits the attribute of signal sparsity, commonly exhibited in large-scale tactile-sensing applications, to reduce the interfacing complexity to a level set by the sparsity rather than the number of sensors. This enhances scalability compared to sequential-scanning and active-matrix approaches. The architecture implements compressed sensing via thin-film-transistor (TFT) switches, and is demonstrated in a force-sensing system with 20 force sensors, a TFT die (with 161 ZnO TFTs) per sensor, and a custom CMOS IC for system readout and control. Acquisition error of 0.7 k[Formula: see text] is achieved over a 100 k Ω-20 k Ω sensing range, at energy and rate of 2.46  µ J/frame and 31 fps.

Strain Transfer for Optimal Performance of Sensing Sheet.

Sensing sheets based on Large Area Electronics (LAE) and Integrated Circuits (ICs) are novel sensors designed to enable reliable early-stage detection of local unusual structural behaviors. Such a device consists of a dense array of strain sensors, patterned onto a flexible polyimide substrate along with associated electronics. Previous tests performed on steel specimens equipped with sensing sheet prototypes and subjected to fatigue cracking pointed to a potential issue: individual sensors that were on or near a crack would immediately be damaged by the crack, thereby rendering them useless in assessing the size of the crack opening or to monitor future crack growth. In these tests, a stiff adhesive was used to bond the sensing sheet prototype to the steel specimen. Such an adhesive provided excellent strain transfer, but it also caused premature failure of individual sensors within the sheet. Therefore, the aim of this paper is to identify an alternative adhesive that survives minor damage, yet provides strain transfer that is sufficient for reliable early-stage crack detection. A sensor sheet prototype is then calibrated for use with the selected adhesive.

The evaluation of alternative method of ferrous ions assessment in pharmaceutical preparations.

ABSTRACT: The atomic absorption spectrometry (AAS) method is one of the most accessible procedures for ferrous ions testing in various compositions including pharmaceutical preparations. The aim of the study was to develop and partially validate analytical method which could be an excellent alternative to the routine procedure performed within dissolution studies. Electric conductivity is simple, fast, and hassle-free method. The samples during dissolution process were measured using conductivity probe in entire dissolution assessment protocol. The conductivity results were compared to data obtained from AAS. The dissolution studies were performed according to modified pharmacopoeial standards, in 900 cm3 of purified water as an acceptor medium, at 37 °C, until the achievement of an equilibrium state for every tested composition. Validity study of the developed method confirmed acceptable linearity of obtained calibration plots (r2 > 0.9553). Linearity at 100% level was found to be 100.59, 97.49, and 94.82, respectively, for drug compositions A, B, and C. Precision results were 100.45, 95.97, and 95.73, respectively, for A, B, and C, with RSD below 2% between all samples in all above mentioned formulations. The drug composition D hindered the proper validation of the method due to the high variability between samples. The method has acceptable performance features for evaluation of three of four solid drug composition containing ferrous ions.

Effectiveness of Greater Occipital Nerve Blocks in Migraine Prophylaxis.

INTRODUCTION: Peripheral nerve blocks have been used in primary headache treatment since a long time. In this study, we aimed to examine the efficiency of greater occipital nerve (GON) block in migraine prophylaxis. METHODS: Data from migraine without aura patients who had GON block were collected and divided into two groups: Group PGON (n=25), which included patients who were under medical prophylaxis and had GON block, and Group GON (n=53), which included patients who had only GON blocks. Migraine was diagnosed using International Headache Society (IHS) classification. Data of 78 patients were analyzed. Headache attack frequency, headache duration, and severity were compared between and within groups in a 3-month follow-up period. RESULTS: The decrease in headache parameters after GON block in both groups was significantly similar. Headache attack frequency decreased from 15.73±7.21 (pretreatment) to 4.52±3.61 (3rd month) in Group GON and from 13.76±8.07 to 3.28±2.15 in Group PGON (p<0.05). Headache duration decreased from 18.51±9.43 to 8.02±5.58 at 3rd month in Group GON and from 15.20±9.16 to 7.20±4.16 in Group PGON (p<0.05). Headache severity decreased from 8.26±1.32 to 5.16±2.64 in Group GON and from 8.08±0.90 to 5.96±1.20 in Group PGON (p<0.05). There was no statistically significant difference between the groups in 3rd month after treatment (p>0.05). CONCLUSION: This study showed significant decreases in headache parameters in both groups. As GON blocks were performed in patients unresponsive to medical prophylaxis, a decrease in the headache parameters in Group PGON similar to that in Group GON can be attributed to GON blocks. Consequently, these results show that repeated GON blocks with local anesthetic can be an effective alternative treatment in migraine patients who are unresponsive to medical prophylaxis or who do not prefer to use medical prophylaxis.

Epileptic seizures in Neuro-Behcet disease: why some patients develop seizure and others not?

PURPOSE: Behcet disease (BD) is a chronic relapsing inflammatory disorder. Neuro BD (NBD) is seen in approximately 5% of all patients. The aim of this study is to investigate the frequency, type and prognosis of epileptic seizures in different forms of NBD. METHODS: All files of 42 patients with NBD were evaluated between 2006 and 2012, retrospectively. The demographic data, the presentation of NBD, clinical findings including seizures, EEG and neuroimaging findings were reviewed. RESULTS: The mean age of patients was 35.02±8.43 years. Thirty (71.4%) patients were male; the remaining 12 of them were female. Twenty-four patients had brainstem lesions; 16 patients had cerebral venous thrombosis. Spinal cord involvement was seen in two patients. Seven patients had epileptic seizures (six partial onset seizures with or without secondary generalization). Six of them had cerebral sinus thrombosis (CVT). Four patients had a seizure as the first symptom of the thrombosis. One patient had late onset seizure due to chronic venous infarct. The other patient with seizure had brainstem involvement. The remaining was diagnosed as epilepsy before the determination of NBD. CONCLUSION: CVT seen in BD seems to be the main risk factor for epileptic seizures in patients with NBD. The prognosis is usually good especially in patients with CVT. Epileptic seizures in patients with brainstem involvement may be an indicator for poor prognosis. Superior sagittal thrombosis or cortical infarct would be predictor of seizures occurrence because of the high ratio in patients with seizures.

Gender differences in older adults with chronic migraine in Turkey.

AIM: Chronic migraine is a growing and disabling subtype of migraine with different risk factors and clinical features, even in older adults. We sought to define and differentiate clinical features of chronic migraine in older adults. We also aimed to compare major clinical features of chronic migraine in older adults with those in younger people of both sexes. METHODS: We used electronic dataset (Turkish Headache Database) from 13 tertiary headache centers in Turkey. Electronic dataset included detailed headache-defining features according to ICHD-II criteria based on face-to-face interviews and examination by a headache specialist. Using statistical methods, clinical variables of chronic migraine in older adults were compared with those of younger adults. We included 915 patients with chronic migraine (mean age 43.80 ± 13.95 years); 83.3% were females. In total, 301 patients (32.9%) with chronic migraine aged >50 years were compared with 614 patients aged <50 years. RESULTS: There was no significant change in men with increasing age. However, duration of headache history, severity of attacks, previous histories of motion sickness and positive family history of headaches were significantly different in women with increasing age. Further sex-related differences have been shown in parameters such as attack duration, quality and associated nausea. CONCLUSION: Chronic migraine is an infrequent type of migraine and shows age-related changes in some phenotypic characteristics, such as severity of attacks, especially in women aged older than 50 years. Furthermore, positive family history of headaches and history of motion sickness increase the likelihood of developing chronic migraine in older women, indicating involvement of some gender-related, but as-yet unknown, genetic factors.

Buccopalpebral reflex in Parkinson disease and blink reflex study.

OBJECTIVE: To define a new primitive reflex named the buccopalpebral reflex (BPR), and to investigate this reflex clinically and neurophysiologically in patients with Parkinson disease. METHODS: This prospectively designed study included 17 patients, 9 BPR positive patients, and 8 BPR negative patients in Ankara Research and Training Hospital, Ankara, Turkey, and was carried out between January and December 2008. All patients had Parkinson disease without any medication. Using the blink reflex technique, 3 branches of the trigeminal nerve were stimulated. Additionally, the Mini Mental State Examination (MMSE), the Unified Parkinson`s Disease Rating Scale (UPDRS), the Hoehn and Yahr Score (HYS), the blink frequency, and the duration of Parkinson disease was also matched between the 2 groups. RESULTS: In patients with positive BPR, 5 had tremor and the remaining 4 had bradykinesia as a dominant symptom, while all other patients with negative BPR had only tremor. When blink reflex findings were compared between the 2 groups, R2 and contralateral R2 latencies that were taken by supraorbital stimulus were significantly shorter in the BPR positive patients. There were no statistically significant differences in terms of MMSE, UPDRS, HYS, and frequency of blinking, and duration of illness between the 2 groups. CONCLUSION: This reflex may be an indicator of sensitivity or decrease of threshold level such as Myerson`s sign, in which there is no inhibition in glabella reflex. The blink reflex findings support this hypothesis.

Efficacy of local lidocaine application on anxiety and depression and its curative effect on patients with chronic tension-type headache.

BACKGROUND: Tension-type headache (TTH) is a primary headache disorder. In this study, the efficacy of local lidocaine application on anxiety and depression and its curative effect in patients with chronic TTH was investigated. METHODS: Forty-eight patients (24 local lidocaine injection, 24 local saline injection group) with chronic TTH were enrolled in our study. Injections were applied to the trigger points of the muscles that are innervated by C1-C3 and the trigeminal nerve, exit points of the fifth cranial nerve, and around the superior cervical ganglion. Each patient underwent one session every 3 days. Patients were evaluated before and 3 months after the treatment. RESULTS: In both groups, the number of painful days in a month, visual analogue scale values, amount of analgesic use in a month, Hamilton depression score, and Hamilton anxiety score decreased after the treatment. As a result, all of the parameters were found to have improved in both groups (p < 0.05), the results were statistically significant, and the lidocaine group's response to the treatment was better than the placebo group (p < 0.001). CONCLUSION: Our findings suggest that local lidocaine administration can be an effective method in the treatment of chronic TTH.

Lidocaine injection of pericranial myofascial trigger points in the treatment of frequent episodic tension-type headache.

BACKGROUND: The present study aimed to evaluate the efficacy of local lidocaine injections into the myofascial trigger points (TPs) located at the pericranial muscles in patients with episodic tension-type headache (ETTH). METHODS: The study included 108 patients with frequent ETTH that were randomized into 4 groups. One injection of saline (NaCl 0.9%) was administered to group 1 (n = 27), 1 injection of lidocaine (0.5%) was administered to group 2 (n = 27), group 3 (n = 27) received 5 injections of saline (NaCl 0.9%), and group 4 (n = 27) received 5 injections of lidocaine (0.5%); on alternate days 2 mL for each muscle was injected into the frontal, temporal, masseter, sternocleidomastoid, semispinalis capitis, trapezius and splenius capitis muscles bilaterally. The frequency of painful days per month (FPD) and the patients' visual analogue scales (VAS) were evaluated before treatment, and 2, 4 and 6 months after treatment. RESULTS: Mean age of the patients was 36.28 ± 9.41 years (range: 18-54 years). FPD scores improved significantly in group 2, 3 and 4 at 2 months posttreatment compared to pre- treatment (all P < 0.05), and also VAS scores improved significantly in group 2 and 4 at 2 months posttreatment (P < 0.05) but this improvement insisted at the 6 month only in group 4. Group 2 had better VAS and FPD than group 1 only at 2. and 4. months after treatment (for VAS P < 0.0121, P = 0.0232; for FPD P = 0.0003, P = 0.0004, respectively). Group 4 had better scores than group 3 at the 2., 4. and 6. months after treatment in both parameters (all P < 0.05). Group 2 had better scores than group 1 in FPD at the 2. and 4. months posttreatment (P = 0.0003, P = 0.0004, respectively), but not at the 6. month. CONCLUSION: Local lidocaine injections into the myofascial TPs located in the pericranial muscles could be considered as an effective alternative treatment for ETTH.

Genome wide analysis in a discordant monozygotic twin with caudal appendage and multiple congenital anomalies.

Caudal appendage is a rare dysmorphic feature of which etiologic mechanisms are not well understood. Here we report monozygotic (MZ) twin brothers who are discordant for the caudal appendage and multiple congenital anomalies. Twins were the product of a 33 weeks of gestation, monochorionic-diamniotic pregnancy. On admission the proband had micrognathia, beaked nose, hypospadias, caudal appendage and juxtaductal aorta coarctation. At birth, he was small for gestational age and he had transient hypothyroidism which was detected in the newborn period. Karyotype analysis showed 46,XY. Monozygosity was shown by 15 microsatellite markers plus amelogenin (AmpFlSTR Identifiler PCR Amplification Kit, Applied Biosystems). Genome-wide copy number analysis of the twins by DNA-DNA hybridization of whole genomic DNA (NimbleGen Human CGH 385K WG-T v2.0 array) showed a significant difference at two neighboring probes with Log2 ratio: 0.72088 which are located on chromosome 3p12.3. Further analysis by high resolution of chromosome 3 array (Roche NimbleGen Human HG18 CHR3 FT Median Probe Spacing 475 bp) and quantitative PCR analysis did not confirm the deletion.

Plasmonically enhanced hot electron based photovoltaic device.

Hot electron photovoltaics is emerging as a candidate for low cost and ultra thin solar cells. Plasmonic means can be utilized to significantly boost device efficiency. We separately form the tunneling metal-insulator-metal (MIM) junction for electron collection and the plasmon exciting MIM structure on top of each other, which provides high flexibility in plasmonic design and tunneling MIM design separately. We demonstrate close to one order of magnitude enhancement in the short circuit current at the resonance wavelengths.

Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness.

Syncope and seizure are frequently encountered problems in daily neurology practice, and they also share common findings such as transient loss of consciousness and atonia. Sometimes, it is difficult to make a differentiation between the two entities using only clinical findings. In this study, nineteen patients aged between 5 and 20 years who had recurrent transient loss of consciousness and occasional atonic events were examined with synchronous tilt testing and video-EEG recordings. Eleven patients were initially diagnosed with epilepsy, and they were given antiepileptic drugs. Eight patients displayed neurally mediated syncope during examination. Four of the eight patients had cardioinhibitory syncope type 2B. Three-fourths of the patients with syncope had been initially diagnosed with epilepsy and were prescribed antiepileptic drugs. One patient with cardioinhibitory syncope who had prolonged asystole and frequent attacks needed a cardiac pacemaker. Following implantation, she had no new attacks. Synchronous tilt testing and video-EEG recordings give more information than doing them separately, and they are helpful in the differential diagnosis of syncope and seizure.

Peripheral neuropathy and visual evoked potential changes in workers exposed to n-hexane.

The aim of this study was to evaluate patients who had peripheral neuropathy and changes to their visual evoked responses resulting from exposure to n-hexane. Eighteen patients with acute or subacute neuropathy, who were working in a shoe factory, were investigated clinically and electrophysiologically. These evaluations were then repeated 9 months to 12 months after cessation of exposure to n-hexane. Results of the nerve conduction studies predominantly showed a decrease in motor and sensory conduction velocities. Between 9 and 12 months after cessation of exposure to n-hexane, 83.3% of patients had a complete clinical recovery. The electrophysiological studies also revealed improvement to the majority of motor and sensory nerve conduction velocities. The results of the visual evoked potential (VEP) studies were considered normal at admission, however, the P100 latencies at the 9-month to 12-month retest had improved (p < 0.05). As the abnormalities identified with clinical examination and nerve conduction studies, and the subclinical abnormalities revealed through VEP assessment, could be reversed after exposure to n-hexane had ceased, the clinical prognosis was usually good.

Reversible encephalopathy due to sulfasalazine.

BACKGROUND: Sulfasalazine was devised by Swedish physician in the late 1930s in an attempt to treat "rheumatic polyarthritis." It is still a widely used anti-inflammatory agent especially in the treatment of rheumatologic disorders and inflammatory bowel diseases. Most of its side effects are benign, tolerable, and dose dependent, but less common severe systemic reactions have also been revealed. CASE PRESENTATION: A 42-year-old woman diagnosed with rheumatoid arthritis was admitted to emergency service because of status epilepticus. Hepatitis and myelotoxicity were also present after laboratory investigations. The patient was on sulfasalazine treatment for 3 weeks with a daily dose of 2g. Cranial magnetic resonance imaging (MRI) revealed bilateral periventricular and subcortical lesions in the white matter of especially temporal and occipital regions. Cerebrospinal fluid (CSF) examination showed very high protein level (564 mg/L). After discontinuation of treatment, the clinical, CSF, and MRI findings regressed rapidly. CONCLUSIONS: Side effects of sulfasalazine include neurotoxicity such as status epilepticus, cranial MRI lesions, and CSF abnormalities that were diagnosed in our patient after excluding other etiologic factors causing encephalitis.

Levetiracetam monotherapy for late poststroke seizures in the elderly.

Stroke is the most common cause of seizures in the elderly. Antiepileptic drugs are used to treat most patients with late poststroke seizures. The aim of this study was to evaluate the efficacy and tolerability of levetiracetam (LEV) in patients aged 60 or older with late-onset poststroke seizures. This prospective study evaluated patients 60 years of age or older, who had at least two late-onset poststroke seizures and were given LEV monotherapy. Demographic data and seizure and stroke characteristics were recorded. Outpatient visits were made after 2, 4, 6, 9, and 12 months and every 3 months thereafter, and the effectiveness and tolerability of LEV were investigated. Thirty-four patients with a mean age of 69.76+/-6.41 were included in this study. Average seizure frequency before treatment was 3.61+/-3.02/month. Mean follow-up time was 17.68+/-3.24 months. At daily doses of 1000-2000 mg, 82.4% of the patients were seizure free, and 7 patients (20.6%) had side effects. LEV was discontinued in one patient because of severe somnolence. Two patients were switched to another antiepileptic drug because of uncontrolled seizures despite an increase in dose up to 3000 mg/day. LEV monotherapy can be effective and well tolerated in elderly patients with late-onset poststroke seizures.

Does the seizure frequency increase in Ramadan?

During Ramadan, the ninth month of the Islamic lunar calendar, adult Muslims are required to refrain from taking any food, beverages, or oral drugs, as well as from sexual intercourse between dawn and sunset. In this study, we aimed at discovering alterations in drug regimens and the seizure frequency of epileptic patients during Ramadan (15 October 2004-13 November 2004). In the 3 months following Ramadan in the year 2004, 114 patients with epilepsy who were fasting during Ramadan were examined at our Epilepsy Department. Of the 114 patients who were included in the study, 38 patients had seizures and one of these patients developed status epilepticus during Ramadan. When the seizure frequency of these patients during Ramadan was compared to that in the last 1 year and last 3 months period just prior to Ramadan, a statistically significant increase was observed (p<0.001). Moreover, there was an important increase in the risk of having seizures in the patients who changed their drug regimens compared with those who did not (p<0.05). In the patients who received monotherapy or polytherapy, no difference in the frequency of seizures during Ramadan was seen (p>0.05). During Ramadan, an increase in the seizure frequency of patients with epilepsy was observed. The most important reason for this situation was the alteration in the pharmacokinetics and pharmacodynamics of drugs, and consequently, in their efficacy. We believe that in the patients who received monotherapy and who did not change their drug regimes, the increase in seizure frequency may have been related to the changes in their daily rhythms, emotional stress, tiredness and their day-long fasting.

Parapharyngeal tumor mimicking cervicogenic headache.

Nasopharyngeal cancer can occur in any age group and is often misdiagnosed. Cervicogenic headache (CEH) is a clinical condition, putatively originating from nociceptive structures in the neck. A patient with CEH-like symptoms occurring as a result of nasopharyngeal cancer invasion is reported. A 77-year-old man was admitted to the anesthesiology department (pain unit) with a 3-month history of severe unilateral headache. The headache began in the right part of the neck and spread to the right frontoorbital region and was always unilateral. There was no history of neck trauma, and the headache did not increase with neck movement. Analgesics were ineffective. The visual analog scale score for pain was 6. Neurological examination demonstrated tenderness over the right greater occipital nerve and reduced range of motion in the cervical spine. Cervical computerized tomography revealed a solid tumor in the right parapharyngeal region, adjacent to the C2-C3 vertebrae. To the authors' knowledge, this is the first case in the literature of tumoral invasion of nasopharyngeal cancer presenting as CEH. Cervical neuroimaging is obligatory in patients with late-onset, severe CEH.