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Öğe Abnormal Dynamic Pupillometry Relates to Neurologic Disability and Retinal Axonal Loss in Patients With Multiple Sclerosis(Assoc Research Vision Ophthalmology Inc, 2021) Bitirgen, Gulfidan; Akpinar, Zehra; Turk, Huseyin B.; Malik, Rayaz A.Purpose: To assess alterations in quantitative dynamic pupil responses to light in relation to neurologic disability and retinal axonal loss in patients with multiple sclerosis (MS). Methods: Twenty-five patients with relapsing-remitting MS and 25 healthy subjects were included in this cross-sectional study. Pupillary responses were measured with an infrared dynamic pupillometry unit, and peripapillary retinal nerve fiber layer (RNFL) thickness was measured with spectral-domain optical coherence tomography. Neurologic disability was assessed by the Expanded Disability Status Scale (EDSS). Patients with a history of optic neuritis (ON) within 6 months were excluded. Only the right eyes were assessed, except in 11 patients with a history of unilateral ON in whom both eyes were further analyzed to evaluate the effect of previous ON. Results: The initial pupil diameter (P = 0.003) and pupil contraction amplitude (P = 0.027) were lower in patients with MS compared with healthy controls. Initial pupil diameter correlated with EDSS score (? = ?0.458; P = 0.021), and RNFL correlated with contraction latency (? = ?0.524; P = 0.007). There were no significant differences in any of the pupil parameters between eyes with and without a history of ON, and between the ON and fellow eyes of the 11 patients with previous unilateral ON. Conclusions: Dynamic pupillometry reveals significant alterations in pupillary light reflex responses associated with neurologic disability and retinal axonal loss, independent of previous ON. Translational Relevance: Dynamic pupillometry is a simple, noninvasive tool that may be useful in detecting autonomic dysfunction in patients with MS.Öğe Assessment of Early Stage Non-Motor Symptoms in Parkinson's Disease(Turkish Neurological Soc, 2013) Gumus, Haluk; Akpinar, Zehra; Demir, OrhanObjective: In this study, our purpose is to asses the frequency of non-motor symptoms and to discuss its effect on the morbidity of the disease. Material and Met-hod: We included 80 Parkinson's patients diagnosed according to the United Kingdom Brain Bank Criteria with a clinical stage of Hoehn Yahr stages 1 and 2, who were followed in the Department of Neurology. Results: We have seen an increase in the frequency of non-motor symptoms in patients with higher UPDRS scores. Discussion: Non-motor symptoms in Parkinson's disease can often go unnoticed. The success of the treatment also depend on the symptomatic treatment. Therefore, non-motor symptoms should be detected and treated early during the course of the disease.Öğe Atypical Sporadic Creutzfeldt-Jakob Disease Mimicking Nonconvulsive Status Epilepticus(Kare Publ, 2014) Uca, Ali Ulvi; Genc, Bulent Oguz; Guney, Figen; Akpinar, ZehraSporadic Creutzfeldt- Jakob disease (sCJD) is the most common disorder among the very rare prion diseases (human transmissible subacute spongiform encephalopathies). The diagnosis might be easy if a patient with characteristics features of myoclonus, progressive dementia and periodic electroencephalography activity. Diagnosis of some patients with unusual symptoms and signs may be challenging. The reported case is a 65 years old female patient who was finally diagnosed as CJD, after previously being misdiagnosed with depression, dementia and refractory nonconvulsive status epilepticus.Öğe Delirium in patients with acute ischemic stroke admitted to the non-intensive stroke unit: Incidence and association between clinical features and inflammatory markers(Termedia Publishing House Ltd, 2017) Kozak, Hasan Huseyin; Uguz, Faruk; Kilinc, Ibrahim; Uca, Ali Ulvi; Tokgoz, Osman Serhat; Akpinar, Zehra; Ozer, NejlaBackground: Stroke patients with development of delirium have unfavorable outcomes, higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Studies suggest that delirium is associated with abnormal immunological responses and a resultant increase in inflammatory markers. Objective: Our aim was to determine whether there is an entity relationship between delirium, inflammation and acute ischemic stroke (AIS). Methods: Sixty AIS patients admitted to the hospital were consecutively recruited. Delirium was diagnosed with the clinical assessment according to the Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria. Enzyme-linked immunosorbent assay (ELISA) was used to measure serum levels of Interleukin-1 beta (IL-1 beta), Interleukin 18 (IL-18), Tumor Necrosis Factor-alpha (TNF-alpha), Brain-Derived Neurotrophic Factor (BDNF), and Neuron Specific Enolase (NSE) at admission. Results: Eleven (18.3%) of 60 patients were diagnosed with delirium, and the majority (n = 8, 72.7%) was the hypoactive type. Delirious and non-delirious patients had similar demographic and clinical features. Delirious patients had significantly higher lengths of hospital stay, National Institutes of Health Stroke Scale (NIHSS) at admission and discharge compared to non-delirious patients. In addition, there was no significant statistical difference between delirious and non-delirious patients with AIS in respect of levels of TNF-alpha, IL-1 beta, IL-18, BDNF and NSE. This study suggests that delirium is not scarce in patients with AIS admitted to the non-intensive stroke unit, and that delirium developing after AIS seems not to be associated with serum TNF-alpha, IL-1 beta, IL-18, BDNF and NSE but is associated with length of hospital stay and stroke severity. (C) 2016 Published by Elsevier Sp. z o.o. on behalf of Polish Neurological Society.Öğe Effects of Multiple Sclerosis on Female Sexuality: A Controlled Study(Elsevier Sci Ltd, 2014) Gumus, Haluk; Akpinar, Zehra; Yilmaz, HalimAim. The aim of this study was to investigate the effects of multiple sclerosis (MS) on female sexuality. Methods. Present study included 142 females (70 MS patients, 72 healthy controls). MS patients were evaluated by Expanded Disability Status Scale (EDSS) for functional status, by Beck Depression Inventory (BDI) for severity of depression, by Visual Analog Scale (VAS) for severity of pain, and by Female Sexual Function Inventory (FSFI) for sexual function. Main Outcome Measures. FSFI, BDI, EDSS, and VAS were the main outcome measures. Results. The number of weekly sexual intercourse, total FSFI, and FSFI subscale scores were lower in MS women compared with controls. FSFI total and FSFI subscale scores were statistically significantly lower in MS women with BDI score >= 17 compared with those with BDI score <17. A negative correlation was found between total FSFI score and BDI, EDSS, VAS, age, and duration of complaint, but a positive correlation was found with education level in MS women. Conclusions. Sexual functions are negatively affected in MS women. Sexual functions in MS women seem to be associated with enhanced disability, pain, duration of the disease, and degree of concomitant depression. Therefore, women with MS should also be evaluated in terms of sexual function during routine follow-ups.Öğe A Neuro-Behcet's Case Operated with the Intracranial Mass Misdiagnosis(Korean Neurosurgical Soc, 2012) Tokgoz, Osman Serhat; Akpinar, Zehra; Guney, Figen; Seyithanoglu, AbdullahBehcet's disease (BD) is an inflammatory systemic disorder with oral and genital ulcers, as well as ophthalmologic and cutaneous symptoms. Neurological manifestations in BD represent between 2.2% to 50% of the cases. The 25-year-old male patient, diagnosed with BD three years earlier, was admitted to our clinic with complaints of recurrent headaches. Tumor-like-parenchimal involvement was detected on a cranial magnetic resonance imaging. The lesion was removed surgically and then he suffered from right hemiparesis and epilepsy. Pathological examination of the lesion noted a demyelinating non-tumoural etiology. A neuro-Behcet's case with parenchymal involvement has been examined in light of the literature, in terms of a tumor and a demyelinating disease differential diagnosis.Öğe Neutrophil Lymphocyte Ratio as a Predictor of Stroke(Elsevier Science Bv, 2013) Tokgoz, Serhat; Kayrak, Mehmet; Akpinar, Zehra; Seyithanoglu, Abdullah; Guney, Figen; Yuruten, BetigulBackground: The aim of this study is to investigate the relationship of the neutrophil to lymphocyte ratio (NLR) with short-term mortality in acute stroke. Methods: This retrospective study included 255 patients with acute cerebral infarction who presented within 24 hours of symptom onset. A hemogram from peripheral venous blood samples was taken at the time of admission. The NLR was calculated as the ratio of neutrophils to lymphocytes. Duration of follow-up was defined as 60 days. Results: Seventy-one of 255 patients died during the follow-up period. The median NLR was significantly increased among the mortality group compared with the survival group (median 11.50, interquartile ratio [IQR] 10.40 vs median 3.79, IQR 4.72; P = .001). In our multivariate Cox regression model, NLR >5.0 (hazard ratio [HR] 3.30; 95% confidence interval [CI] 1.35-8.07), National Institutes of Health Stroke Scale score (HR 1.11; 95% CI 1.07-1.16), glucose values at admission (HR 1.007; 95% CI 1.002-1.011), and history of coronary artery disease (HR 2.49; 95% CI 1.26-4.92) were predictors of short-term mortality. The sensitivity for short-term mortality when the NLR was >5 was 83.10%, and the specificity was 62.00%. The positive predictive value of a NLR >5 was 45.7%, and negative predictive value was 90.50%. A strong linear association between NLR and National Institutes of Health Stroke Scale score was also observed (r = 0.64; P = .001). In addition, the NLR was higher in both the atherosclerotic and cardioembolic stroke subgroups than the lacunar infarct subgroup (6.5 [IQR 7.2], 7.5 [IQR 8.9], and 3.20 [IQR 3.50], respectively; P = .001). Conclusions: The NLR at the time of hospital admission may be a predictor of short-term mortality in acute stroke patients. Because of the routine use and inexpensive nature of hemogram analysis, the NLR should be investigated in future prospective, randomized controlled trials investigating acute stroke.Öğe Personality disorders in pateints with multiple sclerosis: Prevalence and association with depressive and anxiety disorders and clinical features(Asean Neurological Assoc, 2016) Uca, Ali Ulvi; Uguz, Faruk; Kozak, Hasan Huseyin; Turgut, Keziban; Tekin, Gonca; Altas, Mustafa; Akpinar, ZehraObjective: This study examines the current prevalence of mood, anxiety and personality disorders in patients with multiple sclerosis (MS), the impact of personality disorders on clinical features of MS and the existence of depressive and anxiety disorders. Methods: The study sample comprised of 55 patients with relapsing-remitting MS and 56 control subjects. Axis I diagnoses including mood and anxiety disorders and personality disorders were ascertained by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition / Clinical Version and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, respectively. The Expanded Disability Status Scale (EDSS) was used to determine degree of disability due to MS. Results: The prevalence of any mood, any anxiety and any personality disorders in patients with MS were 40.0%, 38.2% and 45.5%, respectively, which are significantly higher than the control subjects. Major depression, generalized anxiety disorder, avoidant personality disorder and obsessive-compulsive personality disorder were more frequent in patients with MS compared to the controls. In comparison to MS patients without personality disorders, MS patients with personality disorders had a more frequent occurence of any mood disorder, any anxiety disorder, major depression, posttraumatic stress disorders and MS attacks, and higher scoresof EDSS. Conclusions: Mood, anxiety and personality disorders are frequently seen in patients with MS. The results also suggest that personality disorders may negatively affect the existence of mood and anxiety disorders as well as the clinical course of MS in the patients.Öğe Progressive Loss of Corneal and Retinal Nerve Fibers in Patients With Multiple Sclerosis: A 2-Year Follow-up Study(Assoc Research Vision Ophthalmology Inc, 2020) Bitirgen, Gulfidan; Akpinar, Zehra; Uca, Ali Ulvi; Ozkagnici, Ahmet; Petropoulos, Ioannis N.; Malik, Rayaz A.Purpose: To determine longitudinal alterations in corneal nerve fiber morphology, dendritic cell (DC) density, and retinal nerve fiber layer (RNFL) thickness over 2 years in patients with multiple sclerosis (MS). Methods: Thirty-one consecutive patients with relapsing-remitting MS (RRMS) underwent assessment of the Kurtzke Expanded Disability Status Scale (EDSS), Multiple Sclerosis Severity Score (MSSS), corneal confocal microscopy to quantify corneal subbasal nerve morphology and DC density, and spectral-domain optical coherence tomography to quantify RNFL thickness at baseline and after 2 years. Results: There was a significant reduction in corneal nerve fiber area (CNFA) (P = 0.003), nerve fiber width (CNFW) (P = 0.005), and RNFL thickness (P = 0.004) with an increase in EDSS (P = 0.01) over 2 years. The change in corneal nerve fiber density (CNFD) correlated with the change in EDSS (rho = -0.468; P = 0.008), MSSS (rho = -0.442; P = 0.01), DC density (rho = -0.550; P = 0.001), and RNFL (rho = 0.472; P = 0.007). The change in corneal nerve fiber length (CNFL) correlated with the change in EDSS (rho = -0.445; P = 0.01) and MSSS (rho = -0.490; P = 0.005). Furthermore, there was a significant decrease in CNFL (P < 0.001), CNFA (P = 0.02), CNFW (P = 0.04), corneal total branch density (P = 0.01), and RNFL thickness (P = 0.02) and a significant increase in DC density (P = 0.04) in patients with worsening EDSS (n = 15). Conclusions: Corneal confocal microscopy can be used to detect progressive corneal nerve fiber loss that relates to a progression of disability in patients with RRMS. Translational Relevance: Corneal confocal microscopy acts as a sensitive imaging biomarker for progressive nerve degeneration in patients with MS.Öğe The Relationship Between Pain and Clinical Features in Multiple Sclerosis(Turkish Neurological Soc, 2014) Akpinar, Zehra; Tokgoz, Osman Serhat; Gumus, HalukObjective: Multiple sclerosis (MS) is an autoimmune-neurodegenerative disease of the central nervous system. The prevalence of pain is between 29% and 86% and besides neuropathic pain, somatic pain types may also emerge together or separately. In this study we aimed to analyze the relationship between pain and other clinical features in MS. Materials and Methods: One-hundred cases who were followed in MS clinic and who have complaints of pain, were included in this study. We evaluated pain type and localization during patients were filling in the forms. We applied Visual Pain Scale (VPS), Ashworth Spasticity Scale (ASS) and Beck Depression Scale (BDS). Results: When female and male patients were compared, there were no statistical differences between age, disease duration and EDDS scores. Seventy seven percent of cases complained of neuropathic pain, 21% of cases had Lhermitte symptoms. Trigeminal neuralgia has been observed in 1% of cases and 55% of neuropathic extremity pain. In 60% of the cases nociceptive pains, in 12% of the cases joint-extremity-muscle pain, in 47% headache and in 1% painful tonic spasms were present. Pain depending on the treatment was observed only in 2% of the cases. The pain score was high in patients with spasticity and depression. Although there was reasonable positive correlation between age, EDDS score and VPS, poor correlation was obtained between disease period and number of attacks. Conclusion: These findings indicate that MS pain is related with spasticity, disability and depression and these clinical findings should be taken into account during pain treatment.Öğe Sjogren Syndrome Simulating Relapsing Remitting Multiple Sclerosis Clinical Features: Case Report(Turkish Neurological Soc, 2013) Gumus, Haluk; Akpinar, ZehraSjogren syndrome (SS) is a chronic, inflammatory, autoimmune disease. It primarily presents with dry mouth and eyes (sicca symptoms) because it frequently affects exocrine, salivary and lacrimal glands. Neurological involvement in Sjogren syndrome is observed in approximately 20-25% of cases. Eighty seven percent of the neurological involvements are located in the peripheral nervous system and around 13% of the neurological involvements affect the central nervous system. Cerebral involvement presents a heterogeneous profile both in terms of localization (focal or diffuse) and progress of the condition (acute, progressive or reversible). The affected central nervous system can show clinical and radiological signs similar to multiple sclerosis (MS). A case with reported imbalance and difficulty in walking, who also showed MS-like lesions in magnetic resonance imaging and was previously diagnosed with Sjogren syndrome, is discussed.Öğe Use of Corneal Confocal Microscopy to Detect Corneal Nerve Loss and Increased Dendritic Cells in Patients With Multiple Sclerosis(Amer Medical Assoc, 2017) Bitirgen, Gulfidan; Akpinar, Zehra; Malik, Rayaz A.; Ozkagnici, AhmetIMPORTANCE Multiple sclerosis (MS) is characterized by demyelination, axonal degeneration, and inflammation. Corneal confocal microscopy has been used to identify axonal degeneration in several peripheral neuropathies. OBJECTIVE To assess corneal subbasal nerve plexus morphologic features, corneal dendritic cell (DC) density, and peripapillary retinal nerve fiber layer (RNFL) thickness in patients with MS. DESIGN, SETTING, AND PARTICIPANTS This single-center, cross-sectional comparative study was conducted at a tertiary referral university hospital between May 27, 2016, and January 30, 2017. Fifty-seven consecutive patients with relapsing-remittingMS and 30 healthy, age-matched control participants were enrolled in the study. Corneal subbasal nerve plexus measures and DC density were quantified in images acquired with the laser scanning in vivo corneal confocal microscope, and peripapillary RNFL thickness was measured with spectral-domain optical coherence tomography. MAIN OUTCOMES AND MEASURES Corneal nerve fiber density, nerve branch density, nerve fiber length, DC density, peripapillary RNFL thickness, and association with the severity of neurologic disability as assessed by the Kurtzke Expanded Disability Status Scale (score range, 0-10; higher scores indicate greater disability) and Multiple Sclerosis Severity Score (score range, 0.01-9.99; higher scores indicate greater severity). RESULTS Of the 57 participants with MS, 42 (74%) were female and the mean (SD) age was 35.4 (8.9) years; of the 30 healthy controls, 19 (63%) were female and the mean (SD) age was 34.8 (10.2) years. Corneal nerve fiber density (mean [SE] difference, -6.78 [2.14] fibers/mm(2); 95% CI, -11.04 to -2.52; P =.002), nerve branch density (mean [SE] difference, -17.94 [5.45] branches/mm(2); 95% CI, -28.77 to -7.10; P =.001), nerve fiber length (mean [SE] difference, -3.03 [0.89] mm/mm(2); 95% CI, -4.81 to -1.25; P =.001), and the mean peripapillary RNFL thickness (mean [SE] difference, -17.06 [3.14] mu m; 95% CI, -23.29 to -10.82; P <.001) were reduced in patients with MS compared with healthy controls. The DC density was increased (median [interquartile range], 27.7 [12.4-66.8] vs 17.3 [0-28.2] cells/mm(2); P =.03), independent of a patient's history of optic neuritis. Nerve fiber density and RNFL thickness showed inverse associations with the Expanded Disability Status Scale (rho = -0.295; P =.03 for nerve fiber density and rho = -0.374; P =.004 for RNFL thickness) and the Multiple Sclerosis Severity Score (R = -0.354; P =.007 for nerve fiber density and R = -0.283; P =.03 for RNFL thickness), whereas other study measures did not. CONCLUSIONS AND RELEVANCE These data suggest that corneal confocal microscopy demonstrates axonal loss and increased DC density in patients with MS. Additional longitudinal studies are needed to confirm the use of corneal confocal microscopy as an imaging biomarker in patients with MS.Öğe A very rare paroxysmal symptom in multiple sclerosis: convergence spasm(W B Saunders Co-Elsevier Inc, 2016) Anliacik, Suleyman; Uca, Ali Ulvi; Kozak, Hasan Huseyin; Akpinar, ZehraMultiple sclerosis affects many regions of the central nervous system and leads to visual, oculomotor, motor, sensorial, cerebellar, and cognitive disorders. In addition to classic clinical findings, sudden paroxysmal symptoms triggered by motion, hyperventilation, or sensory stimulus may occur. In this article, we present a case of convergence spasm attended by paroxysmal symptoms, a rarely observed situation but one which can have complete recovery through administration of 5-day intravenous (IV) methylprednisolone therapy, together with its imaging findings and video records.
