Beyond conventional therapies: IVIG in treating severe fingolimod-rebound in a postpartum patient with MS.

This case report details a female patient with multiple sclerosis in her 30s, who experienced a significant fingolimod rebound syndrome post partum, characterised by worsening neurological symptoms and severe demyelinating lesions. Traditional treatments, including steroids and plasmapheresis, were ineffective. However, the introduction of intravenous immunoglobulin (IVIG) led to remarkable improvement in her symptoms and disability status. This case highlights the complex immunological changes associated with fingolimod cessation and underscores IVIG's potential as a valuable treatment in managing such rebounds.

The global patient-reported outcomes for multiple sclerosis initiative: bridging the gap between clinical research and care - updates at the 2023 plenary event.

Significant advancements have been achieved in delineating the progress of the Global PROMS (PROMS) Initiative. The PROMS Initiative, a collaborative endeavor by the European Charcot Foundation and the Multiple Sclerosis International Federation, strives to amplify the influence of patient input on MS care and establish a cohesive perspective on Patient-Reported Outcomes (PROs) for diverse stakeholders. This initiative has established an expansive, participatory governance framework launching four dedicated working groups that have made substantive contributions to research, clinical management, eHealth, and healthcare system reform. The initiative prioritizes the global integration of patient (For the purposes of the Global PROMS Initiative, the term "patient" refers to the people with the disease (aka People with Multiple Sclerosis - pwMS): any individual with lived experience of the disease. People affected by the disease/Multiple Sclerosis: any individual or group that is affected by the disease: E.g., family members, caregivers will be also engaged as the other stakeholders in the initiative). insights into the management of MS care. It merges subjective PROs with objective clinical metrics, thereby addressing the complex variability of disease presentation and progression. Following the completion of its second phase, the initiative aims to help increasing the uptake of eHealth tools and passive PROs within research and clinical settings, affirming its unwavering dedication to the progressive refinement of MS care. Looking forward, the initiative is poised to continue enhancing global surveys, rethinking to the relevant statistical approaches in clinical trials, and cultivating a unified stance among 'industry', regulatory bodies and health policy making regarding the application of PROs in MS healthcare strategies.

Oligoclonal band count as a marker of disease activity and progression in multiple sclerosis: A multicenter study.

BACKGROUND: Cerebrospinal fluid (CSF) biomarkers provide critical insights into the pathophysiology and progression of multiple sclerosis (MS), as this study aimed to investigate the relationships between CSF oligoclonal band (OCB) counts and the clinical course and short-term prognosis of MS patients. METHODS: A retrospective cohort analysis covering a five-year period was conducted at two MS centers. Data on demographics, clinical presentation, MRI findings, EDSS scores, annualized relapse rate (ARR) in the first two years, and CSF analyses were analyzed. RESULTS: Among 310 patients, the ages ranged from 19 to 73 years, with a mean age of 38 years. OCBs were detected in 86.5 % (n = 268) of the patients. Those with a greater number of OCB bands had significantly more upper cervical lesions and T2 lesions (p < 0.05). A weak positive correlation was found between OCB and the IgG index score. No significant relationship was observed between band count and the ARR or EDSS score. OCB-positive patients had higher IgG index scores and more upper cervical lesions (p < 0.05). Additionally, patients with elevated IgG index levels (>0.7) exhibited significantly greater EDSS scores and more T2 lesions (p < 0.05). CONCLUSIONS: This study highlights the importance of OCB counts as a significant marker for assessing disease activity and progression in MS patients. These findings emphasize the need for a comprehensive approach that integrates CSF analysis with clinical and radiological data to effectively manage MS and tailor treatment strategies.

Recurring disease activity in relapsing remitting multiple sclerosis: The multicenter RDA-RMS study.

BACKGROUND: This study investigates the gap in understanding the dynamics of recurring disease activity (RDA) in RRMS patients after fingolimod (FGL) treatment discontinuation. The aim is to investigate RDA in RRMS patients after stopping FGL, aiming to improve management and comprehension of disease progression post-treatment. METHODS: In this multicenter, retrospective study, data from 172 of 944 RRMS patients aged 18-55, across nine centers in Turkey, who discontinued FGL treatment, were analyzed. The collected data included EDSS scores, annualized relapse rates (ARR), lymphocyte counts, and MRI findings, with follow-up assessments conducted at 6 months, 1 year, and up to 2 years. RESULTS: RDA was observed in 31.9 % of patients, with incidences of rebound and reactivation at 20.3 % and 11.6 %, respectively. Factors like younger age, longer treatment duration, lower lymphocyte counts, and higher lesion burden increased RDA risk. Notably, 52.9 % of pregnant patients experienced RDA (16.4 % of the overall RDA group), with rebound occurring in six and reactivation in three. Patients with RDA had longer medication-free intervals and increased ARR. Discontinuation reasons varied, with disease progression linked to a lower RDA risk. CONCLUSION: Findings highlight the necessity for personalized management and vigilant monitoring after FGL discontinuation in RRMS patients, offering critical insights into RDA risk factors, and the complex interplay between treatment cessation, pregnancy, and disease progression.

Hand Grip Strength as a Predictive Tool for Upper Extremity Functionality, Balance, and Quality of Life in People With Multiple Sclerosis.

BACKGROUND: Upper extremity strength and function are rarely assessed in routine multiple sclerosis (MS) care. This study aimed to evaluate hand muscle strength and functionality in individuals with MS and investigate correlations with upper extremity function, cognitive status, health-related quality of life (HRQOL), and balance. METHODS: A cross-sectional study was conducted with 45 consecutive individuals with MS between the ages of 18 and 65. Upper limb motor strength was evaluated using a hand grip strength dynamometer. Upper limb functional capacity was assessed using the Nine-Hole Peg Test (9HPT) and the Duruoz Hand Index (DHI). Balance, coordination, and falls were measured with the Berg Balance Scale (BBS), Falls Efficacy Scale (FES), and the 30-Second Chair Stand Test (30CST). Cognitive function was evaluated using the Montreal Cognitive Assessment instrument and the Symbol Digit Modalities Test. Level of HRQOL was assessed using the self-reported 54-item MS Quality of Life-54 questionnaire. RESULTS: Out of the 45 participants (80% women, mean age 36.6 ± 8.6 years), higher hand grip dynamometer measures were strongly correlated with better DHI, 9HPT, BBS, FES, and 30CST scores. In the regression analysis, a 1-unit increase in dynamometer measures led to a 0.383 increase in overall HRQOL score. CONCLUSIONS: This study demonstrates that increased hand grip strength (HGS) is associated with better hand functionality, balance, and HRQOL in individuals with MS. It provides evidence to support more systematic measurement of HGS in the care of people with MS.

Clinical and demographic characteristics of late-onset multiple sclerosis: LOMS-TR study.

OBJECTIVES: Multiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS. METHODS: In a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated. RESULTS: The mean age of the 136 patients was 60.96±6.42 years (51-79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14. CONCLUSIONS: In LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself.

Clinical significance and prognostic value of serum autoantibody tests in multiple sclerosis.

INTRODUCTION: It is known that multiple sclerosis (MS) often coexists with other autoimmune diseases. Hence, autoantibody (auto-Ab) tests may prove useful in the differential diagnosis of MS. The objectives of this study were to: (a) investigate the prevalence of auto-Ab positivity at the beginning of the MS diagnostic process; (b) assess whether Auto-Ab+ and Auto-Ab- patients differ in baseline clinical, laboratory, and radiological parameters; and (c) investigate the prognostic value during a two-year follow-up period. MATERIAL AND METHODS: This retrospective study consisted of 450 patients aged between 18 and 55 years. All patients underwent a wide range of auto-Ab tests, anti-nuclear antibody (ANA) tests in particular. The expanded disability status scale (EDSS) scores of the patients were recorded at the time of diagnosis and at the end of a two-year follow-up period. RESULTS: The mean age of the 212 patients, 148 (69.8%) female and 64 (30.2%) male, included in the study sample was 37 ± 10.83 years. The rate of relapsing cases was 84% (178). Oligoclonal band (OCB) was positive in 142 (86.6%) of the 164 tested cases. At least one of the auto-Ab tests was positive in 51 (24.1%) of the cases. ANA test was positive in 21 (9.9%) cases. There was no significant difference between patients with at least one positive auto-Ab test and without any positive auto-Ab test and between ANA-positive and ANA-negative patients in terms of age, gender, clinical features of MS, presence of brain stem lesion, presence of spinal lesion, OCB positivity, level of clinical improvement after the first pulse steroid treatment, family history, presence of comorbidity, presence of autoimmune disease, or EDSS scores recorded at the end of the two-year follow-up period (p > 0.05). CONCLUSIONS: Our study findings revealed that Auto-Ab positivity was more common in MS patients than in the general population. However, given their limited contribution to the diagnosis and differential diagnosis of MS with no effect on the prognostic process, auto-Ab tests should be requested only in the event of accompanying autoimmune disease symptoms, and in cases where the diagnosis of MS may be suspected.

Cervical vestibular evoked myogenic potentials and video head impulse test studies: alternative methods for detecting brainstem involvement in multiple sclerosis.

BACKGROUND: Brainstem involvement (BSI) has been reported as a major predictive factor for future disability in Multiple Sclerosis (MS). AIMS/OBJECTIVES: To evaluate whether Cervical Vestibular Evoked Myogenic Potentials (cVEMPs) and Video Head Impulse Test (vHIT) can be used to detect demyelinating lesions in vestibular pathways in MS. MATERIAL AND METHODS: Fifty three people with MS and 40 controls were evaluated with Dizziness Handicap Inventory (DHI), vHIT and cVEMP. RESULTS: The median value of DHI in MS group was significantly higher than controls (p<.001). According to vHIT results, while the results of horizontal canal vestibulo-ocular reflex gain in group with brain stem involvement (gBSI (+)) were significantly different from both controls and group without brain stem involvement (gBSI (-)) (p= .036 and .024, respectively), results of gBSI (-) were similar with controls (p= .858). When cVEMP results were examined, mean P1 wave latency in gBSI (+) was significantly longer than controls (p= .002), but difference between gBSI (-) and controls and gBSI (+) was not statistically significant (p= .104 and .279, respectively). CONCLUSIONS AND SIGNIFICANCE: vHIT and cVEMP can be used in diagnosis and follow-up of people with MS without demyelinating brainstem lesions on MRI.

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow.

BACKGROUND: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. OBJECTIVE: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. METHODS: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. RESULTS: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. CONCLUSION: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

Determining the utility of minimum F-wave latency alterations in the electrodiagnosis of ulnar neuropathy at the elbow / Determinação da utilidade das alterações mínimas da latência da onda F no eletrodiagnóstico da neuropatia ulnar do cotovelo

ABSTRACT Background: Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy. There is little information about the application of F-wave studies for evaluation of UNE. Objective: The aim of this study was to evaluate the diagnostic value of minimum F-wave (F-min) latency alterations by comparing this with nerve conduction analyses in UNE-suspected patients. Methods: Ninety-four UNE-suspected patients were admitted to this study. Sensory and motor nerve conduction and F-wave analyses on the median and ulnar nerves were performed on both upper extremities. Results: A total of 188 upper extremities of 94 patients were examined. Their mean age was 41.4±12.9 years, and 69 patients were female (73.4%). The mean ulnar-nerve across-elbow motor conduction velocity (MCV) in the affected arms was significantly slower than the velocity in healthy arms. The mean ulnar-nerve F-min latencies were significantly longer in the affected arms. Fifty-one patients were electrophysiologically diagnosed as presenting UNE (54.2%). Significantly slower mean ulnar-nerve across-elbow MCV, longer mean ulnar-nerve F-min latency and longer distal onset latency were detected in UNE-positive arms. Lastly, patients who were symptomatic but had normal nerve conduction were evaluated separately. Only the mean ulnar F-min latency was significantly longer in this group, compared with the healthy arms. Conclusion: Our study confirmed the utility of F-min latency measurements in the electrodiagnosis of UNE. F-wave latency differences can help in making an early diagnosis to provide better treatment options.

RESUMO Introdução: A neuropatia ulnar do cotovelo (NUC) é a segunda neuropatia por encarceramento mais comum. Existem poucas informações sobre a aplicação dos estudos da onda F para avaliação da NUC. Objetivo: O objetivo deste estudo foi avaliar o valor diagnóstico das alterações mínimas de latência da onda F (F-min), comparando-as com análises de condução nervosa em pacientes com suspeita de NUC. Métodos: Noventa e quatro pacientes com suspeita de NUC foram admitidos neste estudo. A condução nervosa sensitiva e motora e as análises da onda F nos nervos mediano e ulnar foram realizadas em ambas as extremidades superiores. Resultados: Um total de 188 membros superiores de 94 pacientes foi examinado. A média de idade foi 41,4±12,9 anos e 69 pacientes eram do sexo feminino (73,4%). A velocidade de condução motora média do nervo ulnar através do cotovelo (VCM) nos braços afetados foi significativamente mais lenta do que a velocidade em braços saudáveis. As latências médias F-min do nervo ulnar foram significativamente mais longas nos braços afetados. Cinquenta e um pacientes foram diagnosticados eletrofisiologicamente como apresentando NUC (54,2%). Pacientes com presença de NUC tiveram, de forma significativa, detecção de VCM mais lenta no nervo ulnar ao nível do cotovelo, presença de latência mais longa da onda F-mínima no nervo ulnar, bem como latência de início distal mais longa. Por fim, os pacientes sintomáticos, e com condução nervosa normal, foram avaliados separadamente. Apenas a latência da onda F mínima média do nervo ulnar foi significativamente maior neste grupo, em comparação com os braços saudáveis. Conclusão: Nosso estudo confirmou a utilidade das medidas de latência da onda F-mínima no eletrodiagnóstico da NUC. As diferenças de latência da onda F podem ajudar a fazer um diagnóstico precoce para fornecer melhores opções de tratamento.

Restless legs syndrome/Willis-Ekbom disease in multiple sclerosis: a contributing factor for anxiety, disability, sleep disorder, and quality of life.

BACKGROUND: Restless legs syndrome (RLS) is one of the most common and burdensome sleep disorders in the course of multiple sclerosis (MS). OBJECTIVE: To evaluate common MS-related symptoms and consequences between groups with and without RLS and further assess the association of quality of life determinants with RLS symptom severity. METHODS: According to their RLS status, 46 relapsing-remitting MS patients were divided into MS-RLS+ (n=19) and MS-RLS- groups (n=27). Specific questionnaires were administered to assess the patients' health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, anxiety, and depression symptoms. Functional capacity was examined using the Expanded Disability Status Scale (EDSS). RESULTS: The prevalence of RLS was 41.3%. Compared to the MS-RLS- group, those with RLS had higher EDSS scores, more cranial and spinal lesions, longer disease duration, and were older. In the MS-RLS+ group, symptom severity scores were positively correlated with higher anxiety and poorer sleep quality. The symptom severity score was negatively correlated with mental HRQoL and pain scores. CONCLUSION: In conclusion, the findings of the current study indicate the negative impact of RLS on functional capacity, anxiety, sleep quality, and mental HRQoL of MS patients. Further studies using more accurate diagnostic strategies for identifying RLS and other sleep disorders are necessary to clarify the association of MS with RLS and explore relevant clinical implications.

Restless legs syndrome/Willis-Ekbom disease in multiple sclerosis: a contributing factor for anxiety, disability, sleep disorder, and quality of life / Síndrome de las piernas inquietas/enfermedad de Willis-Ekbom en la esclerosis múltiple: un factor que contribuye a la ansiedad, la discapacidad, los trastornos del sueño y la calidad de vida

ABSTRACT Background: Restless legs syndrome (RLS) is one of the most common and burdensome sleep disorders in the course of multiple sclerosis (MS). Objective: To evaluate common MS-related symptoms and consequences between groups with and without RLS and further assess the association of quality of life determinants with RLS symptom severity. Methods: According to their RLS status, 46 relapsing-remitting MS patients were divided into MS-RLS+ (n=19) and MS-RLS- groups (n=27). Specific questionnaires were administered to assess the patients' health-related quality of life (HRQoL), fatigue levels, sleep quality, daily sleepiness, anxiety, and depression symptoms. Functional capacity was examined using the Expanded Disability Status Scale (EDSS). Results: The prevalence of RLS was 41.3%. Compared to the MS-RLS- group, those with RLS had higher EDSS scores, more cranial and spinal lesions, longer disease duration, and were older. In the MS-RLS+ group, symptom severity scores were positively correlated with higher anxiety and poorer sleep quality. The symptom severity score was negatively correlated with mental HRQoL and pain scores. Conclusion: In conclusion, the findings of the current study indicate the negative impact of RLS on functional capacity, anxiety, sleep quality, and mental HRQoL of MS patients. Further studies using more accurate diagnostic strategies for identifying RLS and other sleep disorders are necessary to clarify the association of MS with RLS and explore relevant clinical implications.

RESUMEN Antecedentes: El síndrome de piernas inquietas (SPI) es uno de los trastornos del sueño más comunes y onerosos en el curso de la esclerosis múltiple (EM). Objetivo: El objetivo de este estudio fue evaluar los síntomas y las consecuencias comunes asociados con la EM entre los grupos con y sin SPI y evaluar aún más la asociación de los determinantes de la calidad de vida con la gravedad de los síntomas del SPI. Métodos: De acuerdo con su estado de SPI, 46 pacientes con EM recurrente-remitente se dividieron en los grupos EM-SPI+ (n=19) y EM-SPI- (n=27). Se utilizaron cuestionarios específicos para evaluar la calidad de vida relacionada con la salud (CVRS), los niveles de fatiga, la calidad del sueño, la somnolencia diaria, la ansiedad y los síntomas de depresión de los pacientes. La capacidad funcional se examinó mediante la escala ampliada del estado de discapacidad (Expanded Disability Status Scale — EDSS). Resultados: La prevalencia de SPI fue del 41,3%. Em comparación com el grupo EM-SPI-, aquellos com SPI tenían púntuaciones más altas em la EDSS, más lesiones craneales y espinales, mayor duración de la enfermedad y eran mayores. Los puntajes de gravedad de los síntomas em el grupo EM-SPI+ se correlacionaron positivamente con una mayor ansiedad y una peor calidad del sueño. Se observaron correlaciones negativas entre la puntuación de gravedad de los síntomas y la CVRS mental y los puntajes de dolor. Conclusiones: En conclusión, el estudio actual indica el impacto negativo del SPI en la discapacidad funcional, la ansiedad, la calidad del sueño y la CVRS mental de los pacientes con EM. Se necesitan más estudios que utilicen estrategias de diagnóstico más precisas para identificar el SPI y otros trastornos del sueño para aclarar la asociación de la EM con el SPI y para explorar implicaciones clínicas relevantes.

The prognostic value of demyelinating electrophysiologic findings and cerebrospinal fluid protein levels in acute inflammatory demyelinating polyneuropathy.

BACKGROUND: Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by rapidly evolving symptoms and disability. Cerebrospinal fluid analysis and electrophysiological studies are crucial in the diagnosis of this syndrome. OBJECTIVE: To evaluate the prognostic value of the type and number of demyelinating findings and cerebrospinal fluid protein levels in patients with acute inflammatory demyelinating polyneuropathy. METHODS: We retrospectively analyzed electrophysiological data and cerebrospinal fluid of 67 consecutive patients with acute inflammatory demyelinating polyneuropathy from Istanbul, Turkey (2011-2019) studied ≤ 24 hours post-onset. RESULTS: The patients who met a higher number of demyelinating criteria had increased disability scores in the first day and first month, and higher cerebrospinal fluid protein levels were correlated with worse prognosis both on the first day and the first month. However, the disability scores did not correlate with any single specific criterion, and no significant correlation was found between the number of satisfied criteria and cerebrospinal fluid protein levels. CONCLUSIONS: The number of demyelinating criteria that are met and high cerebrospinal fluid protein levels at the disease onset may be valuable prognostic markers. More systematic studies conducted with serial nerve conduction studies are required to highlight the roles of the suggested criteria in clinical practice.

The prognostic value of demyelinating electrophysiologic findings and cerebrospinal fluid protein levels in acute inflammatory demyelinating polyneuropathy / O valor prognóstico dos achados eletrofisiológicos desmielinizantes e os níveis de proteína do líquido cefalorraquidiano na polineuropatia desmielinizante inflamatória aguda

ABSTRACT Background: Guillain-Barre syndrome is an acute immune-mediated polyneuropathy characterized by rapidly evolving symptoms and disability. Cerebrospinal fluid analysis and electrophysiological studies are crucial in the diagnosis of this syndrome. Objective: To evaluate the prognostic value of the type and number of demyelinating findings and cerebrospinal fluid protein levels in patients with acute inflammatory demyelinating polyneuropathy. Methods: We retrospectively analyzed electrophysiological data and cerebrospinal fluid of 67 consecutive patients with acute inflammatory demyelinating polyneuropathy from Istanbul, Turkey (2011-2019) studied ≤ 24 hours post-onset. Results: The patients who met a higher number of demyelinating criteria had increased disability scores in the first day and first month, and higher cerebrospinal fluid protein levels were correlated with worse prognosis both on the first day and the first month. However, the disability scores did not correlate with any single specific criterion, and no significant correlation was found between the number of satisfied criteria and cerebrospinal fluid protein levels. Conclusions: The number of demyelinating criteria that are met and high cerebrospinal fluid protein levels at the disease onset may be valuable prognostic markers. More systematic studies conducted with serial nerve conduction studies are required to highlight the roles of the suggested criteria in clinical practice.

RESUMO Introdução: A síndrome de Guillain-Barré é uma polineuropatia imunomediada aguda caracterizada por sintomas e incapacidade em rápida evolução. A análise do líquido cefalorraquidiano e os estudos eletrofisiológicos são cruciais no diagnóstico dessa síndrome. Objetivo: Avaliar o valor prognóstico do tipo e número de achados desmielinizantes e dos níveis de proteínas do líquido cefalorraquidiano em pacientes com polineuropatia desmielinizante inflamatória aguda. Métodos: Analisamos retrospectivamente dados eletrofisiológicos e líquido cefalorraquidiano de 67 pacientes consecutivos com polineuropatia desmielinizante inflamatória aguda de Istambul, Turquia (2011-2019), estudados ≤24 horas após o início. Resultados: Os pacientes que atenderam a um número maior de critérios desmielinizantes apresentaram escores de incapacidade aumentados no primeiro dia e no primeiro mês, e níveis mais altos de proteína do líquido cefalorraquidiano foram correlacionados com pior prognóstico no primeiro dia e no primeiro mês. No entanto, os escores de incapacidade não se correlacionaram com nenhum critério específico e não foi encontrada correlação significativa entre o número de critérios satisfeitos e os níveis de proteína do líquido cefalorraquidiano. Conclusões: O número de critérios desmielinizantes atendidos e altos níveis de proteína no líquido cefalorraquidiano no início da doença podem ser marcadores prognósticos valiosos. Estudos mais sistemáticos conduzidos com estudos de condução nervosa em série são necessários para destacar os papéis dos critérios sugeridos na prática clínica.

Coexistence of COVID-19 and acute ischemic stroke report of four cases.

Coronaviruses are revealed to target the human respiratory system mainly. However, they also have neuro-invasive abilities and might spread from the respiratory system to the central nervous system. Herein, we report four patients with COVID-19 simultaneously diagnosed with acute ischemic stroke. There were four stroke cases with simultaneously diagnosis of Covid-19 till the April 14, 2020 in the city of Sakarya, Turkey. They were aged between 45 and 77 years. All four cases were likely to have contracted the virus in Sakarya. The patients had all commonly reported symptoms of Covid-19. Three patients have elevated D-dimer levels, and two of them had high C-reactive protein (CRP) levels. They were managed symptomatically for both the infection and the stroke. Our findings suggest that ischemic cerebrovascular diseases may simultaneously develop in the course of Covid-19 independently of the critical disease process. Increased inflammation predicted by CRP and D-dimer levels may play a role in the formation of ischemia. In particular, elder patients with prothrombotic risk factors should also be considered for the signs of cerebrovascular events in addition to infectious symptoms.

Early predictors of functional disability in Guillain-Barré Syndrome.

This study investigated the predictors of prognosis at admission and after the first month in Guillain-Barré syndrome (GBS) patients. This retrospective study used the electronic records of 81 GBS patients. Age, gender, previous GBS history, antecedent febrile illness and presence of cranial nerve dysfunction were recorded. Detailed neurological examinations, routine biochemical and haematological investigations, cerebrospinal fluid (CSF) analysis and electrophysiological studies, GBS subtypes and treatments were assessed. Hughes disability scores (HDSs) were evaluated at the end of the first day and first month. The GBS patient group included 44 male (54.3%) and 37 female (45.7%) patients. The mean age was 52.2 ± 18.5. The mean HDS score was 2.96 at admission and 1.94 at the end of the first month. Plasma sodium, albumin, and CSF protein levels were significantly correlated with low admission HDS scores (p = 0.03, p = 0.011, p = 0.036, and p < 0.001, respectively). Age, plasma sodium, albumin, neutrophil, neutrophil/lymphocyte ratio (NLR) levels, C-reactive protein (CRP) and CSF protein levels were significantly correlated with poor prognosis at the end of the first month (p < 0.05). Concomitant cranial nerve palsies were significantly correlated with low HDS scores (p = 0.011, p = 0.02) but antecedent events were not correlated with functional disability (p = 0.686, p = 0.413). Decreased albumin and sodium levels and increased CSF protein levels indicated poor GBS prognosis. Higher age, elevated NLR, and higher CRP levels indicated worse prognosis at the end of the first month. However, further studies are needed.

Evaluation of body image perception in multiple sclerosis patients without neurological deficit.

Background and purpose: There is a lack of research on the association between body image perception (BIP) and multiple sclerosis (MS). The aim of this study was to evaluate BIP in MS patients and its correlation with depression, anxiety, duration of the disease, and sociodemographic characteristics of the patients. Methods: Fifty patients with MS who applied to our outpatient clinic were examined. Forty-five healthy control were recruited for the study. All patients were diagnosed with MS according to 2010 revisions of McDonald criteria. Expanded Disability Status Scale (EDSS) was performed by the same neurologist for all patients. The participants were asked to complete a sociodemographic form, Body Cathexis Scale (BCS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Results: The mean BCS score was 86.54 ± 32.24 in MS patients and 155.00 ± 20.90 in the healthy subjects (p<0.001). While MS patients had significantly higher anxiety levels, depression scores were similar in both groups. The mean BAI score was 18.50 ± 14.03 for MS patients and 10.06 ± 7.96 in the control group (p=0.001). The BDI score of the patients was 13.77 ± 11.61 and 11.91 ± 8.65 for the controls (p=0.34). Early age of the disease onset, increased number of attacks, increased depressive symptoms, and higher anxiety levels were significantly correlated with higher BCS scores. Age and being single/ divorced/ widowed were also correlated with BCS scores. Conclusion: It is important to preserve the mental well-being of patients. Even in apparently healthy patients, the body perception may be severely impaired.

Inflammatory markers are beneficial in the early stages of cerebral venous thrombosis.

BACKGROUND: Cerebral vein thrombosis (CVT) is a rare but serious cause of acute stroke. Inflammation is a hypothetical etiological factor in CVT. OBJECTIVE: The aim of this study was to evaluate inflammatory marker levels in CVT patients and compare these with healthy individuals. METHODS: This prospective case-control study was conducted with 36 newly-diagnosed CVT patients age- and sex-matched with 40 healthy individuals. The laboratory investigations included a serum hemogram, full biochemistry profiles, high sensitivity C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL cholesterol ratio (MHR) values were calculated and compared between the patients and healthy participants. RESULTS: The mean age was 41.4 ± 11.8 years for patients, and 39.3 ± 12.5 for controls. Lymphocyte, total bilirubin, indirect bilirubin, and HDL levels were significantly lower in CVT patients (p < 0.05), while CRP, and ESR values were significantly higher. In the CVT patients the mean NLR and PLR values were significantly higher than in the control individuals. Smoking rates, alcohol consumption, white blood cell, neutrophil, platelet, and MHR values were similar in both groups (p 0.05). CONCLUSIONS: We suggest that NLR, PLR, CRP, ESR, and bilirubin can be used in clinical practice for prediction of CVT in suspected patients as they are inexpensive parameters and widely available. However, further large-scale studies are required to confirm this relationship.

Inflammatory markers are beneficial in the early stages of cerebral venous thrombosis / Los marcadores inflamatorios son beneficiosos en las primeras etapas de la trombosis venosa cerebral

ABSTRACT Cerebral vein thrombosis (CVT) is a rare but serious cause of acute stroke. Inflammation is a hypothetical etiological factor in CVT. Objective: The aim of this study was to evaluate inflammatory marker levels in CVT patients and compare these with healthy individuals. Methods: This prospective case-control study was conducted with 36 newly-diagnosed CVT patients age- and sex-matched with 40 healthy individuals. The laboratory investigations included a serum hemogram, full biochemistry profiles, high sensitivity C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-HDL cholesterol ratio (MHR) values were calculated and compared between the patients and healthy participants. Results: The mean age was 41.4 ± 11.8 years for patients, and 39.3 ± 12.5 for controls. Lymphocyte, total bilirubin, indirect bilirubin, and HDL levels were significantly lower in CVT patients (p < 0.05), while CRP, and ESR values were significantly higher. In the CVT patients the mean NLR and PLR values were significantly higher than in the control individuals. Smoking rates, alcohol consumption, white blood cell, neutrophil, platelet, and MHR values were similar in both groups (p > 0.05). Conclusions: We suggest that NLR, PLR, CRP, ESR, and bilirubin can be used in clinical practice for prediction of CVT in suspected patients as they are inexpensive parameters and widely available. However, further large-scale studies are required to confirm this relationship.

RESUMEN la trombosis de la vena cerebral (CVT) es una causa rara pero grave de accidente cerebrovascular agudo. La inflamación es un factor etiológico hipotético en CVT. Objetivo: El objetivo de este estudio fue evaluar los niveles de marcadores inflamatorios en pacientes con CVT y compararlos con los sujetos sanos. Métodos: Este estudio prospectivo de casos y controles se realizó con 36 pacientes con TVC recién diagnosticados y 40 sujetos sanos con edad y sexo similares. Las investigaciones de laboratorio incluyeron hemograma sérico, perfiles bioquímicos completos, proteína C-reactiva (CRP) de alta sensibilidad y velocidad de sedimentación eritrocitaria (ESR). Se calculó la relación de neutrófilos a linfocitos (NLR), relación de plaquetas a linfocitos (PLR) y monocitos a HDL-colesterol (MHR) y se compararon entre pacientes y sujetos sanos. Resultados: La edad media fue de 41,4 ± 11,8 años para los pacientes y de 39,3 ± 12,5 para los controles. Los niveles de linfocitos, bilirrubina total, bilirrubina indirecta y HDL fueron significativamente más bajos en pacientes con CVT (p ≤ 0.05), mientras que los valores de CRP y ESR fueron significativamente más altos. En los pacientes con CVT, los valores medios de NLR y PLR fueron significativamente más altos que en los sujetos control. Las tasas de tabaquismo, consumo de alcohol, glóbulos blancos, neutrófilos, plaquetas y MHR fueron similares en ambos grupos (p > 0.05). Conclusiones: Sugerimos que la NLR, la PLR, la CRP, la ESR y la bilirrubina se pueden usar en la práctica clínica para la predicción de la CVT en pacientes sospechosos, ya que son parámetros económicos y están ampliamente disponibles. Sin embargo, se requieren más estudios a gran escala para confirmar esta relación.