Publications by authors named "Cagri Mesut Temucin"

32 Publications

Multimodal assessment of intensive care unit-acquired weakness in severe stroke patients.

Acta Neurol Belg 2022 Jul 6. Epub 2022 Jul 6.

Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.

Background: Intensive care unit-acquired weakness (ICUAW) defines generalized muscle weakness seen in critically ill patients in the absence of other causative factors. Herein, we aimed to evaluate ICUAW in stroke patients by electrodiagnostic testing, histopathology, and assessment of respiratory complex activities (RCA), to define the frequency of ICUAW in this patient group, and to reach new parameters for early prediction and diagnosis.

Methods: We prospectively recruited twenty-four severe acute stroke patients during a sixteen-month period. In addition to serial nerve conduction studies (NCS), we performed muscle biopsy and RCA analysis on the non-paretic side when ICUAW developed. Patients undergoing orthopedic surgery without metabolic and neuromuscular diseases constituted the control group for RCA. Survival and longitudinal data were analyzed by joint modeling to determine the relationship between electrophysiological parameters and ICUAW diagnosis.

Results: Eight patients (33%) developed ICUAW, and six of them within the first two weeks. Extensor digitorum brevis, abductor digiti minimi (ADM), rectus femoris and vastus medialis (VM) compound muscle action potential (CMAP) amplitudes showed a significant decrease in the ICUAW group. VM CMAP amplitude (BIC = 358.1574) and ADM CMAP duration (BIC = 361.1028) were the best-correlated parameters with ICUAW diagnosis. The most informative electrophysiological findings during the entire study were obtained within the first 11 days. Muscle biopsies revealed varying degrees of type 2 fiber atrophy. Complex I (p = 0.003) and IV (p = 0.018) activities decreased in patients with ICUAW compared to controls.

Conclusion: VM CMAP amplitude and ADM CMAP duration correlate well with ICUAW diagnosis, and may aid in the early diagnosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13760-022-02009-9DOI Listing
July 2022

Isolated spinal cord granulomatous angiitis: a case report and review of the literature.

J Neurol 2022 Jun 9;269(6):3175-3179. Epub 2022 Jan 9.

Department of Neurology, Hacettepe University Faculty of Medicine, Hacettepe University Hospitals, 06230, Ankara, Turkey.

Introduction: Isolated spinal cord angiitis (ISCA) is very rare disease. But, it is frequently encountered in the differential diagnosis of atypical spinal cord syndromes.

Case Presentation And Review Of The Literature: We present a 31-year-old male who presented with progressive paraparesis, and diagnosed with pathologically confirmed ISCA. Longitudinal cystic transverse myelitis was documented in spinal MRI. He responded well to cyclophosphamide and steroid combination, and no relapse was noted during the 4-year follow-up. A standard systematic analysis of the germane literature disclosed 15 more ISCA cases. In total 16 cases (mean age: 46.5, 10 males), ISCA was diagnosed with pathological evaluation in all (Biopsy in 11, Autopsy in 5). MRI lesion is characterized by usually multisegmental longitudinal and sometimes cystic expansile lesions. In seven cases, it was described as "(pseudo)tumoral" by the authors. Albeit absence of elevation of CSF protein/WBC or "compatible" spinal MRI lesion may aid to exclude ISCA to some extent, pathological confirmation is currently necessary for the diagnosis. In 11 cases, ISCA was treated similar to primary supratentorial vasculitis. Mortality rate is 31%.

Discussion: ISCA diagnosis, a typical example of which we have presented here, can only be established by tissue examination. However, noninvasive diagnostic criteria are critically needed. Our data suggest that this can only be possible with multinational multicenter prospective registry.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00415-021-10912-zDOI Listing
June 2022

Cystinosis beyond kidneys: gastrointestinal system and muscle involvement.

BMC Gastroenterol 2020 Jul 29;20(1):242. Epub 2020 Jul 29.

Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.

Background: Cystinosis is a multisystemic disease resulting from cystine accumulation primarily in kidney and many other tissues. We intended to study the evolution of less commonly seen extrarenal complications of cystinosis in a group of patients who have periods without cysteamine treatment.

Methods: Gastrointestinal and muscular complications of cystinosis were studied in a group of 21 patients.

Results: Twenty one patients were included in the study. Among them, 14 were homozygous and 3 were compound heterozygous for CTNS mutations. The median age of diagnosis was 15 months (range; 5 months-14 years) and the mean age at last visit was 11.3 ± 6.5 years. Nine patients (42%) had end stage renal disease at a mean age of 10.6 years (6.5-17 years). Abdominal ultrasonography and portal vein doppler ultrasonography were performed in19 patients, 14 of them (74%) had hepatomegaly, 10 patients (53%) had granular pattern or heterogeneity of liver. Only one patient had high transaminase levels and liver biopsy showed cystine crystals in the liver. Eleven patients (58%) had borderline or increased portal vein minimum and maximum flow velocities. One patient had CK level of 9024 U/L and electromyographic study showed active myopathic involvement. Two patients were found to have gastroesaphageal reflux only and 4 patients were found to have esophageal remnants in addition to reflux.

Conclusions: In addition to renal functions, extrarenal organs may be affected from cystine accumulation even in childhood, especially in patients who are incompliant to treatment, resulting in complications such as swallowing difficulty, hepatomegaly and portal hypertension.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12876-020-01385-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7392712PMC
July 2020

Tracking Pain in Resting State Networks in Patients with Hereditary and Diabetic Neuropathy.

Noro Psikiyatr Ars 2019 Jun 9;56(2):92-98. Epub 2018 Jul 9.

Department of Radiology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Introduction: Chronic pain is associated with maladaptive plastic changes in the brain. It is usually more prominent in acquired pathologies of nerve fibers as in diabetic neuropathy despite less severe degeneration than hereditary neuropathies. Based on clinical differences concerning pain perception, we hypothesized that functional connectivity analysis would reveal distinct patterns in resting-state networks in these groups.

Methods: Ten diabetic patients with painful neuropathy (5F/5M; mean age=50.10±6.05 years), 10 patients with hereditary neuropathy (5F/5M; mean age=37.80±14.01 years), 18 age-and gender-matched healthy controls (eight for painful diabetic neuropathy and 10 for hereditary neuropathy) and seven diabetic controls without painful neuropathy were enrolled in the study. All subjects (n=45) underwent a 5-min resting-state scan in a 3T magnetic resonance scanner. The images were analyzed with seed-based functional connectivity method. The group-level maps of the default mode network and insula-cingulate network were identified for each group.

Results: Patients with hereditary neuropathy displayed increased connectivity between left insula and left anterior cingulate cortex and inversely correlated activity between left insula and left inferior parietal lobule compared to their controls. In patients with painful diabetic neuropathy, the major findings were the increased connectivity between left anterior cingulate cortex and posterior cingulate cortex/precuneus, and the increased connectivity between medial prefrontal cortex and left medial temporal region compared to their controls.

Conclusion: This study revealed that hereditary and diabetic painful neuropathy patients exhibit different patterns of functional connectivity. The clinical differences in these groups regarding the presence of neuropathic pain may relate to this difference in cortical organization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/npa.2017.22660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563856PMC
June 2019

Electrophysiologic evaluation of facial nerve functions after oxaliplatin treatment.

Cancer Chemother Pharmacol 2019 09 17;84(3):513-520. Epub 2019 Apr 17.

Department of Audiology, Faculty of Health Sciences, Medipol University, Istanbul, Turkey.

Purpose: This study analyzes the effect of oxaliplatin treatment on the facial nerve. The facial nerve is the most commonly paralyzed cranial motor nerve because it advances through a long, curved bone canal. Electroneurography and blink reflex are the electrophysiological measurements used for evaluating facial nerve function. Oxaliplatin is a cytotoxic agent used in adjuvant or palliative systemic therapy for colorectal cancer treatment.

Methods: This study was performed on 20 individuals who were at least 18 years old at Hacettepe University Ear Nose Throat Department, Audiology and Speech Disorders Unit, and Neurology Division EMG Laboratory as they received oxaliplatin treatment from Hacettepe University Oncology Hospital. Electroneurography and blink-reflex values were recorded and examined. The parameters taken during the second and fourth months were compared for this purpose.

Results: This study shows that the prolongation of distal latencies of compound muscle action potential is statistically significant, the amplitudes showed no difference. The ENoG results were analyzed, the prolongation of latency measurements between pre-treatment and the fourth month after treatment were statistically significant. The blink-reflex results showed that comparison with the baseline values, the prolongation of latencies in R1 measurements between pre-treatment, the second month, and the fourth month were significant.

Conclusions: The facial nerve is affected asymptomatically by oxaliplatin treatment. During oxaliplatin treatment, the evaluation of facial nerve function could be beneficial for patients by improving their quality of life. Electroneurography and blink-reflex tests can be used in the early evaluations of different medicines to determine their neurotoxicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00280-019-03841-2DOI Listing
September 2019

Cardiac autonomic function evaluation in pediatric and adult patients with congenital myasthenic syndromes.

Neuromuscul Disord 2019 04 19;29(4):290-295. Epub 2019 Feb 19.

Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Cardiac autonomic dysfunction has been examined in myasthenia gravis but not in congenital myasthenic syndromes (CMS). We aimed to evaluate cardiac autonomic functions in genetically defined CMS. Patients diagnosed with and under treatment for CMS were reviewed for 24-hour cardiac rhythm monitoring. Heart rate variability (HRV) measures were defined as: SDNN, mean of the standard deviations for all R-R intervals; SDNNi, standard deviation of all R-R intervals in successive five-minute epochs; RMSSD, square root of the mean of squared differences between successive R-R intervals. Ten patients with mutations in the epsilon subunit of the acetylcholine receptor (AChRε) and five patients with mutations in the collagen-like tail of asymmetric acetylcholinesterase (ColQ) were included. Median age at evaluation was 17 (2.5-46) years. In the AChRε group, RMSSD values; and in the ColQ group, SDNN, SDNNi and RMSSD values were significantly lower than those of healthy subjects. This first extensive report examining HRV in CMS showed alterations in patients with ColQ mutations and, to a lesser extent, in the group with AChRε mutations. This might indicate an increased risk of cardiac arrhythmias. We suggest cardiological follow-up in CMS, and consideration of any potential cardiovascular effects of therapeutic agents used in management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.nmd.2019.02.004DOI Listing
April 2019

Sudden Sensoryneural Hearing Loss As a Rare Attack Type in Multiple Sclerosis.

Noro Psikiyatr Ars 2018 Dec 4;55(4):380-382. Epub 2018 Jul 4.

Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5152/npa.2017.19270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300834PMC
December 2018

Effects of Low-Frequency Repetitive Transcranial Magnetic Stimulation on Swallowing Function and Quality of Life of Post-stroke Patients.

Dysphagia 2019 06 2;34(3):360-371. Epub 2019 Jan 2.

Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Hacettepe University, 06100, Sıhhıye, Ankara, Turkey.

Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive techniques, which is used to modulate cortical regions in patients with stroke. The aim of this single blind, controlled study was to investigate the effect of rTMS on swallowing function and quality of life of mono-hemispheric post-stroke patients with dysphagia. Twenty-eight patients were randomized and split between study and control group. Each group received conventional dysphagia rehabilitation 3 days a week for 4 weeks, and study group also received 1 Hz rTMS to unaffected hemisphere in the final week. The descriptive information was noted. The clinical and radiological swallowing evaluation and quality of life assessment have been performed at four different times including before and after the treatment, 1 month and 3 months after the treatment. At baseline, no significant differences were observed between groups in terms of demographic and clinical features (p > 0.05). Swallowing function and quality of life of the patients were statistically improved in both groups towards the third month (p < 0.05). Swallowing function was comparable between two groups. However, a significant improvement was observed on appetite, fear of eating, and mental health parameters of quality of life assessment in the study group compared to the control group (p < 0.05). In conclusion, despite positive changes in some aspects of quality of life, rTMS did not enhance the swallowing function when compared conventional dysphagia rehabilitation. Therefore, the application of 1 Hz rTMS should be reconsidered to improve swallowing function in the chronic period.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00455-018-09965-6DOI Listing
June 2019

Alteration of the affective modulation of the startle reflex during antidepressant treatment.

Psychophysiology 2019 02 27;56(2):e13286. Epub 2018 Sep 27.

Department of Psychiatry, Hacettepe University, Ankara, Turkey.

Whereas the amplitude of the startle reflex varies with stimulus valence in the normal population, a lack of this affective modulation has been reported in patients with major depressive disorder. The present study sought to clarify blunted startle modulation as a feature of depression by comparing 16 patients diagnosed with major depression prior to and after 2 weeks of SSRI treatment, and 16 healthy controls. The affect-modulated startle reflex paradigm and the Self-Assessment Manikin were used to probe affective reactivity. In addition, a preliminary analysis of change in affective reactivity pattern was performed with depressed patients who could be assessed in the eighth week of treatment (n = 13). The control group showed a linear trend in response across valence categories, which was stable over sessions. Blunted affective reactivity was observed only in the patients and persisted after 2 weeks of treatment. Nevertheless, a linear trend could be detected in the eighth week of treatment. These findings confirm that the affective reactivity is blunted in depression and provide initial evidence for the lack of change in the early phase of SSRI antidepressant treatment. Nevertheless, in a small group, the emergence of a linear trend in response was evident later with treatment. Large-scale studies are required to assess the relation between the treatment response and the change in affective modulation of the startle reflex, as a potential biomarker.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/psyp.13286DOI Listing
February 2019

Modulation of Cerebellar-Cortical Connections in Multiple System Atrophy Type C by Cerebellar Repetitive Transcranial Magnetic Stimulation.

Neuromodulation 2018 Jun 7;21(4):402-408. Epub 2017 Mar 7.

Department of Neurology, Hacettepe University Medical School, Ankara, Turkey.

Objective: This study aims at modulating the altered cerebellar-cortical interactions in patients with multiple system atrophy-cerebellar subtype (MSA-C) by using cerebellar repetitive transcranial magnetic stimulation (rTMS). We hypothesized that cerebellar modulation by low-frequency rTMS can resolve the abnormal cortical excitability in multiple system atrophy cerebellar subtype.

Materials And Methods: We studied detailed effects of rTMS of the cerebellum on reaction time (RT) and short-latency afferent inhibition (SAI) response in MSA-C group, Alzheimer Disease (AD) group, and a control group of healthy individuals. The RT and SAI responses were measured before and after 1 Hz cerebellar rTMS in all groups. The study was conducted in the neurophysiology laboratory in Hacettepe University Hospital.

Results: Our results indicated that motor cortex disinhibition was predominant in patients with AD and MSA-C. In AD and control groups, there were no changes in SAI after rTMS. However, after application of rTMS over the cerebellum in MSA-C patients, the pathological disinhibition and RT results showed an improvement compared to their previous results.

Conclusion: Our study highlights that cerebellar rTMS impairs abnormal cerebellar-cortical inhibitory connections in case of MSA-C.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ner.12589DOI Listing
June 2018

Brachial Diparesis due to Motor Neuronopathy as One of the Predominant Presenting Signs of Occult Small Cell Lung Carcinoma.

Intern Med 2016 15;55(12):1641-3. Epub 2016 Jun 15.

Department of Neurology, Faculty of Medicine, Hacettepe University, Turkey.

Sensory neuronopathy is a well-established presentation in paraneoplastic neurological syndromes that is mostly associated with small cell lung cancer and anti-Hu antibodies. Motor neuronopathy, on the other hand, is an extremely rare observation in this syndrome. A 56-year-old man presented with asymmetric brachial diparesis and sensory ataxia. Electrophysiological studies revealed sensory ganglionopathy and progressive anterior horn degeneration in cervical segments. Small cell lung carcinoma with associated anti-Hu antibodies was later diagnosed. The patient did not improve despite the administration of steroids and chemotherapy. Paraneoplastic syndromes may exceptionally present with a bilateral arm weakness. Cases accompanied by sensory ganglionopathy should therefore be promptly investigated for any underlying malignancy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2169/internalmedicine.55.4888DOI Listing
March 2017

Vincristine-induced neurotoxicity: electrophysiological features in children.

Neurol Res 2016 Feb;38(2):124-9

b Department of Neurology , Hacettepe University Faculty of Medicine , Ankara , Turkey.

Objective: Neuropathy caused by vincristine toxicity can be diagnosed by electrophysiological examination. The purpose of this study is to demonstrate the electrophysiological features of vincristine toxicity.

Methods: Electrophysiological data from 25 children receiving vincristine treatment and 25 normal controls were evaluated retrospectively. Nerve conduction study (NCS) parameters were compared. Additionally amplitude and negative peak duration (NPD) of distal compound muscle action potentials (CMAP) were analysed by factor analysis.

Results: Distal CMAP amplitudes in the patient group were significantly lower and the distal CMAP NPDs were prolonged. There were no significant differences in other motor and sensory NCS parameters.

Conclusion: Contrary to generally accepted sensorimotor involvement, motor NCS abnormalities are more pronounced in vincristine toxicity. The current study is the first time prolonged distal CMAP NPDs were detected and indicated in vincristine-related weakness, which may be a clue to understanding its mechanism, as well as differentiating from other situations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/01616412.2016.1139321DOI Listing
February 2016

Fulminant Central Plus Peripheral Nervous System Demyelination without Antibodies to Neurofascin.

Can J Neurol Sci 2016 Jan 14;43(1):149-56. Epub 2015 Aug 14.

1Hacettepe University Medical Faculty,Department of Neurology,Ankara,Turkey.

Background: Combined central and peripheral nervous system demyelination is a rare and poorly described phenomenon. Recently, anti-neurofascin antibodies were reported to be positive in 86% of these patients in a Japanese cohort. Yet, there seems to be a clinical, radiological, and serological heterogeneity among these patients. In this report, our aim is to describe characteristics of our patients with this entity and compare with others in the literature.

Methods: We report clinical, electrophysiological, radiological, and laboratory characteristics of five patients with both multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy from our institutional database containing 1890 MS patients.

Results: Three patients presented with extensive, active demyelination of both central nervous system and peripheral nervous system with hypertrophic peripheral nerves. Plexuses, trunks, division and cords were involved in the process. Oligoclonal band was negative. Conduction block was not detected. Corticosteroid treatment was not adequate. Others had a slowly progressive clinical course. Serum anti-neurofascin antibody was negative. Review of the literature revealed similar cases with active disease, early-onset hypertrophic peripheral nerves, and central demyelination, in addition to other cases with an insidious course.

Conclusions: Patients with combined central and peripheral demyelination form a spectrum. Some patients may have an antibody-mediated syndrome with or without anti-neurofascin antibodies and others seem to represent a coincidence.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/cjn.2015.238DOI Listing
January 2016

A rare case of longitudinal Brucella myelitis.

Spine J 2015 Jul 12;15(7):1689-90. Epub 2015 Mar 12.

Department of Neurology, Hacettepe University Hospital, 06100 Sıhhıye, Ankara, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.spinee.2015.03.002DOI Listing
July 2015

Cognitive profiling in relation to short latency afferent inhibition of frontal cortex in multiple system atrophy.

Parkinsonism Relat Disord 2014 Jun 19;20(6):632-6. Epub 2014 Mar 19.

Hacettepe University Faculty of Medicine, Department of Neurology, 06100 Ankara, Turkey. Electronic address:

Background: Cognitive dysfunction occurs in multiple system atrophy (MSA) more frequently than previously known. As a type of synucleinopathy, pathology spreads widely in cortical and subcortical areas as the disease advances. The exact anatomical and imaging substrates, and electrophysiological or biochemical indicators of cognitive impairment in MSA are not yet clear. Diminished short-latency afferent inhibition (SAI) of motor cortex was shown to be an electrophysiological correlate of dementia and mild cognitive impairment associated to Parkinson's disease (PD). We hypothesize that it can also be electrophysiological correlate of cognitive impairment in MSA.

Methods: We studied SAI and a neuropsychological test battery in 19 non-demented MSA patients (11 MSA-P and 8 MSA-C), 10 non-demented PD patients and 10 healthy controls. Neuropsychological test scores were grouped in four main cognitive domains (attention, memory, executive and visuo-spatial functions) and were analyzed by factor analysis.

Results: All subject groups were matched for age. Moreover, the MSA-P, MSA-C, and PD groups were matched for disease duration. Scores of cognitive domains were similar in MSA and PD cases, while scores in attention, executive and visuo-spatial domains were worse in MSA than controls (p < 0.05). SAI was normal in PD but decreased in MSA patients by reaching statistical significance in MSA-C subtype. SAI response was correlated with cognitive performances measured by factor scores of neuropsychological test battery in all study subjects.

Conclusions: These results show that cognitive functions are impaired in MSA patients compared to controls as well as a parallel reduction in SAI response.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.parkreldis.2014.03.012DOI Listing
June 2014

Aligned bacterial PHBV nanofibrous conduit for peripheral nerve regeneration.

Artif Cells Nanomed Biotechnol 2015 22;43(4):243-51. Epub 2014 Jan 22.

Bayındır Hospital , Söğütözü, Ankara , Turkey.

The conventional method of peripheral nerve gap treatment is autografting. This method is limited. In this study, an aligned nanofibrous graft was formed using microbial polyester, Poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV). The regenerative effect of the graft was compared with that of autografting in vivo. To determine the regenerative effect, rats were assessed with sciatic nerve functional index, electromyographic evaluation, and histological evaluation. Results found in this study include PHBV grafts stimulated progressive nerve regeneration, although regeneration was not comparable with that of autografting. We conclude that the study results were promising for aligned bacterial polymeric grafts for peripheral nerve regeneration.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/21691401.2013.875033DOI Listing
May 2016

The effect of poly(3-hydroxybutyrate-co-3- hydroxyhexanoate) (PHBHHx) and human mesenchymal stem cell (hMSC) on axonal regeneration in experimental sciatic nerve damage.

Int J Neurosci 2014 Sep 22;124(9):685-96. Epub 2014 Jan 22.

1Department of Neurosurgery.

This study is designed to evaluate the treatment effect of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) and human mesenchymal stem cells (hMSC) on axonal regeneration in experimental rat sciatic nerve damage, and compare the results of this modality with autologous nerve grafting. In Spraque-Dawley albino rats, 10-mm-long experimental nerve gaps were created. Three groups were constituted, the gap was repaired with autologous nerve graft (autograft group), PHBHHx nerve graft alone (PHBHHx alone group), and PHBHHx nerve graft with hMSCs inside (PHBHHx with hMSC group), respectively. The results were evaluated with functional recovery, electrophysiological evaluation, and histological evaluation either with light microscopy and transmission electron microscopy for axonal regeneration and myelin formation. In functional evaluation, autograft and PHBHHx with hMSC groups showed functional improvement with time, whereas PHBHHx alone group did not. Electrophysiological evaluation showed better results in autograft and PHBHHx with hMSC groups when compared to PHBHHx alone group. There was no statistical difference between autograft and PHBHHx with hMSC groups. Histological evaluation showed regenerated axons in each group. Autograft group was better than the others, and PHBHHx with hMSC group was better than PHBHHx alone group both for axonal regeneration and myelin formation. This study showed that the nerve grafts which were prepared from PHBHHx with oriented nanofiber three-dimensional surfaces aided to nerve regeneration, either used alone or with hMSC. PHBHHx provided better nerve regeneration when used with hMSCs inside than alone, and reached the same statistical treatment effect in functional evaluation and electrophysiological evaluation when compared to autografting.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/00207454.2013.876636DOI Listing
September 2014

Effects of exercise and electrical stimulation on lumbar stabilization in asymptomatic subjects: a comparative study.

J Back Musculoskelet Rehabil 2013 ;26(3):261-6

Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.

Background And Objectives: Segmental stabilization training and electrical stimulation are used as a treatment for patients with low back pain. There is limited information on the efficacy of two interventions in the literature. In this study, the efficacy of the two interventions on the multifidus muscle activation and fatigue, segmental stabilization training and electrical stimulation, were examined and compared.

Material And Methods: Our sample consists of 30 asymptomatic individuals, randomly assigned to one of three groups: the group that was given segmental stabilization training, the group that was given electrical stimulation and the control group that received no treatment. The muscle activity and fatigability of the multifidus were recorded by the surface electromyography before and after the intervention.

Results: No difference is detected for any of the multifidus muscle activation and fatigue characteristics either within or between groups.

Conclusion: Both techniques did not improve multifidus activation capacity. An effort at submaximal and maximal level affects and increases the activity of multifidus.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3233/BMR-130374DOI Listing
November 2013

Motor nerve impairment in diabetic patients with symmetrical distal sensory polyneuropathy: a single nerve fiber conduction velocity study.

Muscle Nerve 2014 Jan 8;49(1):84-9. Epub 2013 Oct 8.

Department of Neurology, Marmara University, Mimar Sinan Cad., Fevzi Çakmak Mah., Üst Kaynarca-Pendik, Istanbul, Turkey.

Introduction: In this study we investigated the clinical utility of single fiber conduction velocity (SF-CV) testing in the evaluation of motor nerve function in diabetic patients with signs and symptoms of symmetrical distal sensory polyneuropathy (DSP). SF-CV findings were compared with conventional nerve conduction studies (NCS).

Methods: Twenty-eight consecutive type 2 diabetic patients with clinically diagnosed DSP were studied.

Results: SF-CV testing of the tibial nerve was abnormal in 16 (57.1%) patients. Twelve patients with normal conventional motor NCS had abnormal findings by tibial SF-CV. SF-CV testing of the tibial nerve was significantly superior to all other motor NCS.

Conclusions: SF-CV testing of the tibial nerve often demonstrates motor nerve impairment in diabetic patients with sensory DSP when conventional NCS are normal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/mus.23876DOI Listing
January 2014

Short latency afferent inhibition in Parkinson's disease patients with dementia.

Mov Disord 2012 Jul 17;27(8):1052-5. Epub 2012 May 17.

Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey.

Background: Cortical cholinergic deficiency occurs in Parkinson's disease (PD) and is more severe in PD dementia (PDD). Short-latency afferent inhibition (SAI) can be used as an in vivo test for the evaluation of the cholinergic circuit in the cerebral motor cortex.

Methods: SAI and neuropsychological profile were studied in nondemented PD, PDD, Alzheimer's disease (AD) patients, and age-matched controls.

Results: SAI was significantly impaired in AD cases (94.7 ± 6.2 versus 55.5 ± 4.0; P < 0.0001). In PD patients, it was not different from controls (61.4 ± 5.8 versus 55.5 ± 4.0; P = 0.412). PDD cases demonstrated a significant impairment in SAI (91.4 ± 5.2 versus 55.5 ± 4.0; P < 0.0001). A high correlation was found between SAI and Mini-Mental State Examination (r = -0.68; P < 0.0001).

Conclusions: These findings add further evidence that differential cholinergic deficiency occurs in PD and PDD. SAI can be a neurophysiological correlate of PDD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/mds.25040DOI Listing
July 2012

Improvement of muscle strength and fatigue with high voltage pulsed galvanic stimulation in multiple sclerosis patients--a non-randomized controlled trial.

J Pak Med Assoc 2011 Aug;61(8):736-43

Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey.

Objective: To examine the effects of High Voltage Pulsed Galvanic Stimulation (HVPGS), that was applied to the spasticity associated weakness in knee flexors and ankle dorsiflexors, on strength and fatigue, in Multiple Sclerosis (MS) patients, in a non-randomized controlled trial.

Methods: A total of 33 MS patients were included. Fatigue and strength were analyzed with 3rd and 30th second data by dynamometric measurements synchronously with surface electromyography (EMG) [power spectrum analysis (amplitude, mean frequency, median frequency and root means square]. In the experimental group HVPGS and in the control group repetitive contractions from Proprioceptive Neuromuscular Facilitation (PNF) technique were applied for 18 treatment sessions.

Results: In both groups and all muscle groups, dynamometric measurement and EMG results in the 30th second were significantly lower according to in the 3rd second before and after the treatments. Both strength and fatigue improved after the treatment both in the HVPGS and PNF group.

Conclusion: It was concluded that, MS patients have both central and peripheral fatigue. FO2 localized and intensive effects in strength and fatigue, HVPGS was more impressive than the PNF. PNF was more effective to obtain general effects. Moreover, the application of HVPGS with other rehabilitation techniques may be more appropriate and effective.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2011

Identification of a novel Twinkle mutation in a family with infantile onset spinocerebellar ataxia by whole exome sequencing.

Pediatr Neurol 2012 Mar;46(3):172-7

Metabolism Unit, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Sıhhiye, Ankara, Turkey.

Whole exome sequencing combined with homozygosity mapping comprises a genetic diagnostic tool to identify genetic defects in families with multiple affected members, compatible with presumed autosomal recessively inherited neurometabolic/neurogenetic disease. These tools were applied to a family with two individuals manifesting ataxia, associated with peripheral sensory neuropathy, athetosis, seizures, deafness, and ophthalmoplegia. A novel homozygous missense mutation c.1366C>G (L456V) in C10orf2 (the Twinkle gene) was identified, confirming infantile onset spinocerebellar ataxia in the probands. Signs in infantile onset spinocerebellar ataxia follow a fairly distinct pattern, affecting early development, followed by ataxia and loss of skills. However, this very rare disease was previously reported only in Finland. We suggest that infantile onset spinocerebellar ataxia should be more frequently considered in the differential diagnosis of neurometabolic diseases in childhood. Next-generation sequencing and its use along with homozygosity mapping offer highly promising techniques for molecular diagnosis, especially in small families affected with very rare neurometabolic disorders such as infantile onset spinocerebellar ataxia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pediatrneurol.2011.12.006DOI Listing
March 2012

Sclerotherapy with bleomycin does not adversely affect facial nerve function in children with cervicofacial cystic lymphatic malformation.

J Pediatr Surg 2010 Aug;45(8):1627-32

Department of Pediatric Surgery, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey.

Background And Purpose: Sclerotherapy with bleomycin sulfate (BS) is currently used in the management of cervicofacial cystic lymphatic malformations in children. Neurotoxic adverse effects of BS after intraventricular or intracavitary administration have been reported; however, the effects of intralesionally administered BS on the adjacent peripheral neural structures have not been previously investigated. The authors conducted a clinical experimental study to evaluate facial nerve function in children who have undergone BS sclerotherapy for cervicofacial cystic lymphatic malformation.

Materials And Methods: Twelve patients who underwent BS sclerotherapy for cervicofacial lymphatic malformation were included in the study. The hospital records were reviewed, and the following data were recorded: age at admission and at the time of motor nerve conduction study (MNCS) and electromyography (EMG) study, sex, time elapsed between sclerotherapy and the EMG study, and the outcome. The MNCS/EMG study was performed by neurologists blinded to the side of sclerotherapy. Bilateral facial MNCS and needle-EMG study of the orbicularis oris muscle on the treated side were performed. The previously treated and untreated sides constituted the study and control groups, respectively. In the MNCS, compound muscle action potential (CMAP) amplitude and distal latencies were recorded from the orbicularis oculi and orbicularis oris muscles on both sides, and needle-EMG of the orbicularis oris muscle was performed on the treated side.

Results: The male-to-female ratio was 2, and age at the time of sclerotherapy ranged from 1 month to 16 years (median, 19.5 months). The lymphatic malformations were located in the right submandibular (n = 5), left submandibular (n = 6), and in the right buccal (n = 1) areas. Bleomycin sulfate was injected 1 to 4 times, and the time elapsed between injections varied from 1 to 6 months. The results of sclerotherapy were excellent, with residual disease observed in only 1 patient. The MNCS/EMG study was performed 6 months to 10 years after completion of sclerotherapy, and ages of the patients at the time of the study ranged from 4 to 17 years. Side-to-side CMAP amplitude difference did not exceed 50% for orbicularis oculi and orbicularis oris muscles. The mean CMAP amplitude of orbicularis oculi and orbicularis oris muscles on the treated and untreated sides (1219.0 +/- 842.0 vs 1202.4 +/- 923.8 microV and 1866.3 +/- 911.5 vs 1921.0 +/- 910.0 microV, respectively) did not differ between groups (P = .76 and P = .80). Distal latencies recorded from orbicularis oculi and orbicularis oris muscles on treated and untreated sides (2.64 +/- 0.46 vs 2.68 +/- 0.47 milliseconds and 3.10 +/- 0.35 vs 3.10 +/- 0.25 milliseconds, respectively) also did not differ between groups (P = .71 and P = .80). Needle-EMG orbicularis oris muscle (n = 11) on the treated side showed normal findings at rest, and there was no spontaneous activity. During mild voluntary contraction, the amplitude and duration of motor unit action potentials were within normal limits except in one case. Interference patterns were also normal in all cases.

Conclusion: Bleomycin sulfate did not adversely affect facial nerve function in children who underwent sclerotherapy for cervicofacial cystic lymphatic malformation when it was applied according to our protocol.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpedsurg.2009.12.014DOI Listing
August 2010

Propriospinal myoclonus in a child.

J Child Neurol 2010 Jul 1;25(7):912-5. Epub 2010 Mar 1.

Department of Pediatric Neurology, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey.

A 6-year-old girl was experiencing repetitive involuntary and massive jerks immediately involving limbs and trunk. The first motor events appeared approximately at 1 year old and only 5 months after a back trauma. Myoclonus became progressively more frequent and more violent, causing episodes of falls. Neurological examination showed jerks characterized by upper limb abduction, lower limb abduction, and head-body hyperextension. Apart from these motor events, the neurological examination was normal. The results of vitamin B(12) and folate, antinuclear antibody, anti-DNA, anti-Tiroglobulin, anti-thyroid peroxidase antibody, lupus anticoagulant, anti-cardiolipin antibody, rheumatoid factor, and C3 and C4 were unexceptional. Electroencephalography and brain and spinal magnetic resonance imaging were unremarkable. Electromyographic records with surface electrodes showed that duration of myoclonic jerks was ranging from 100 to 300 ms. We thought she had propriospinal myoclonus because of presence of the spreading through the shoulder, upper limbs, and lower limbs in addition to thoracolumbar paraspinal muscles.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0883073809343610DOI Listing
July 2010

Diagnostic value of double-step nerve stimulation test in patients with myasthenia gravis.

Clin Neurophysiol 2010 Apr 22;121(4):556-60. Epub 2010 Jan 22.

Department of Neurology, Hacettepe University Medical School, Ankara, Turkey.

Objective: Double-step nerve stimulation test (DSST) is a repetitive nerve stimulation (RNS) technique that is performed under exercise and ischemic conditions. We tested the diagnostic significance of DSST at a distal muscle in 17 control subjects and 10 myasthenic patients who had normal conventional RNS test.

Methods: Myasthenia gravis was diagnosed by SFEMG test and acetylcholine receptor antibody titers. During DSST decremental responses were noted. Sensitivity/specificity of DSST were evaluated by receiver operating characteristics (ROC) analysis and best variable in discrimination of myasthenic patients from control subjects with its optimal cutoff-point was selected.

Results: At a selected cutoff-point, sensitivity and specificity of DSST reached up to 100%. Also DSST response patterns, especially during the resolution of ischemia, showed significant differences in MG patients. There was a delayed recovery in the ischemia-exercise aggravated decremental response after the resolution of ischemia in the patients when compared with rapid recovery in controls.

Conclusions: By using ROC derived cutoff-points, DSST could accurately discriminate MG patients from control subjects. Quantitative results of our study are limited by small series of patients and can vary with larger series. However we think that the difference between the decremental response patterns of patients and controls is a valuable finding.

Significance: DSST can be a sensitive, specific and non-invasive choice in the patients who have high suspicion for MG but normal conventional RNS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clinph.2009.12.017DOI Listing
April 2010

[Evoked potentials and regional cerebral blood flow changes in conversion disorder: a case report and review].

Turk Psikiyatri Derg 2008 ;19(1):101-7

Hacettepe U Psikiyatri AD, Ankara.

Conversion disorder is defined as the presence of functional impairment in motor, sensory or neurovegetative systems which cannot be explained by a general medical condition. Although the diagnostic systems emphasize the absence of an organic basis for the dysfunction in conversion disorder, there has been a growing interest in the specific functional brain correlates of conversion symptoms in recent years, particularly by examining neuroimaging and neurophysiological measures. In this case report, regional cerebral blood flow changes and evoked potentials of a patient with conversion symptoms are presented. Somatosensory evoked potentials (SEP) of this patient with conversion disorder who had signs of movement disorder revealed that the latency to N20, P 25 waves were in normal limits while the amplitudes of the P25 and N33 components were extremely high (giant SEP). Regional cerebral blood flow assessment revealed hypoperfusion in the left parietal and temporal lobes of the brain. Three months after the first assessment, the control scans showed that the left parietal hypoperfusion disappeared while the left temporal hypoperfusion was still present. The following SEP evaluations which were repeated twice in three months intervals after the initial recordings, showed the persistence of the abnormalities in somatosensorial measures. The neurophysiological and neuroimaging findings in conversion disorder were reviewed and the results of the evaluations of this case were discussed in this article.
View Article and Find Full Text PDF

Download full-text PDF

Source
June 2008
-->