Publications by authors named "Devrimsel Harika Ertem"

21 Publications

  • Page 1 of 1

The role and impact of the headache nurse specialist.

Agri 2022 Jan;34(1):75-76

Department of Pain Management, University of Health Sciences, Şisli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey.

In the current paper, we aim to emphasize the pivotal role of the specialist headache nurse whose scope of work is clearly defined and detailed in western medical practice within tertiary care.
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http://dx.doi.org/10.14744/agri.2020.67365DOI Listing
January 2022

Factors influencing sexual functions in Turkish female patients with migraine.

Agri 2020 Nov;32(4):193-201

Department of Neurology, İstanbul University Cerrahpaşa- Cerrahpaşa Faculty of Medicine, İstanbul, Turkey.

Objectives: Recent studies have shown a more frequent occurrence of sexual dysfunction in patients with headache. The aim of this study was to assess the effects of demographic and clinical characteristics and psychiatric symptoms on sexual dysfunction in Turkish female patients with migraine.

Methods: In all, 18 sexually active patients with episodic migraine (EM), 12 patients with chronic migraine (CM), and 22 healthy controls of similar age were enrolled in the study. A numeric rating scale was administered to assess pain intensity. The psychiatric symptoms and sexual function of all of the participants were evaluated using the Beck depression and anxiety scales and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

Results: The mean GRISS subscale scores did not differ significantly between the migraine groups and the control group (all p values <0.05). A positive correlation was found between the duration of headache and GRISS subscales of noncommunication, dissatisfaction, vaginismus, and anorgasmia in EM patients. In addition, there was a negative correlation with the infrequency and avoidance subscales. No correlation was detected between the GRISS subscale scores and the demographic and clinical characteristics of the patients with CM, with the exception of the level of education. Higher pain intensity scores and the presence of anxiety or depression among the EM and CM patients significantly affected all of the subscale scores of the sexual function inventory.

Conclusion: Although there was no relationship between migraine chronicity and sexual dysfunction, our data indicated that patient demographic characteristics, greater pain severity, and comorbidities of depression or anxiety were associated with greater sexual dysfunction among patients with EM and CM.
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http://dx.doi.org/10.14744/agri.2020.47640DOI Listing
November 2020

Prevalence And Impact Of Myofascial Pain Syndrome In Relapsing-Remitting Multiple Sclerosis And The Effects Of Local Anesthetic Injections For Short-Term Treatment.

Mult Scler Relat Disord 2020 Nov 26;46:102528. Epub 2020 Sep 26.

University Of Health Sciences İstanbul Bakırköy Prof. Dr. Mazhar Osman Psychıatrıc Traınıng And Research Hospıtal, Department of Neurology, Istanbul, Turkey. Electronic address:

Background: Previous studies have suggested that patients with multiple sclerosis (MS) who have comorbid musculoskeletal disorders have a lower quality of life. However, there is limited data on the relationship between myofascial pain syndromes (MFPS) and MS. The aim of the study to investigate the frequency and impact of MFPS in patients with MS, to evaluate the effect of local anesthetic injections for short-term treatment.

Method: Three hundred ninety-eight patients with MS patients were evaluated during the study period. Patients meeting the inclusion criteria investigated for MFPS. Patients with active myofascial trigger points received local anesthetics blocks monthly and attended at least 4 follow-up appointments. Multiple Sclerosis Quality of Life Instrument 54 (MSQO-54), Beck Depression Scale, The Numeric Pain Rating Scale (NPRS), Fatigue Severity Scale, and Fatigue Impact Scale were administered before and after injections. The primary outcome was a 50 % reduction in pain intensity.

Results: One hundred thirty-seven patients with relapsing remitting MS (RRMS) met the inclusion criteria. MFPS was present in 70 of 137 (51.9 %) patients. Thirty-one patients participated; however, 25 patients completed the study. From 3-months post injections, a significant decrease in NPRS was found (p<0.001); in addition, the scores of MSQO-54 have significantly increased and the scores of fatigue impact and severity tests were decreased (p<0.001). No serious complications were noted.

Conclusion: The results of this study support that MFPS can be experienced in patients with RRMS. Local anesthetic injections for trigger points may be an effective, tolerable, and inexpensive treatment for this patient group and contribute to significant reductions in pain severity scores and increase the quality of life.
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http://dx.doi.org/10.1016/j.msard.2020.102528DOI Listing
November 2020

Persistent post-traumatic headache: a migrainous loop or not? The clinical evidence.

J Headache Pain 2020 May 24;21(1):55. Epub 2020 May 24.

Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.

Background: Headache is a common complication of traumatic brain injury. The International Headache Society defines post-traumatic headache as a secondary headache attributed to trauma or injury to the head that develops within seven days following trauma. Acute post-traumatic headache resolves after 3 months, but persistent post-traumatic headache usually lasts much longer and accounts for 4% of all secondary headache disorders.

Main Body: The clinical features of post-traumatic headache after traumatic brain injury resemble various types of primary headaches and the most frequent are migraine-like or tension-type-like phenotypes. The neuroimaging studies that have compared persistent post-traumatic headache and migraine found different structural and functional brain changes, although migraine and post-traumatic headache may be clinically similar. Therapy of various clinical phenotypes of post-traumatic headache almost entirely mirrors the therapy of the corresponding primary headache and are currently based on expert opinion rather than scientific evidence. Pharmacologic therapies include both abortive and prophylactic agents with prophylaxis targeting comorbidities, especially impaired sleep and post-traumatic disorder. There are also effective options for non-pharmacologic therapy of post-traumatic headache, including cognitive-behavioral approaches, onabotulinum toxin injections, life-style considerations, etc. CONCLUSION: Notwithstanding some phenotypic similarities, persistent post-traumatic headache after traumatic brain injury, is considered a separate phenomenon from migraine but available data is inconclusive. High-quality studies are further required to investigate the pathophysiological mechanisms of this secondary headache, in order to identify new targets for treatment and to prevent disability.
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http://dx.doi.org/10.1186/s10194-020-01122-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245945PMC
May 2020

Evaluation of the Clinical Features, Management, and Prognoses of Patients With Charles Bonnet Syndrome.

J Nerv Ment Dis 2019 Dec;207(12):1045-1047

Department of Neurology, Şişli Hamidiye Etfal Education and Research Hospital, İstanbul, Turkey.

Charles Bonnet syndrome (CBS) is characterized by visual hallucinations with preservation of cognitive abilities. The hallucinations consist mostly of vivid (realistic) objects and tend to reoccur. Here, we evaluate the etiologies, symptoms, treatments, and prognoses of 13 CBS cases. All patients had visual hallucinations but were normal on cognitive and psychiatric assessments. Patient demographic and clinical characteristics, treatment options, and 3-month follow-up data were retrospectively reviewed. The possible causes of CBS and what the patients perceived during their hallucinations were recorded. Antipsychotic agents, such as risperidone and quetiapine, and anticonvulsants, such as levetiracetam, may be effective in some cases.
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http://dx.doi.org/10.1097/NMD.0000000000001101DOI Listing
December 2019

Electrophysiological responsiveness and clinical outcomes of local corticosteroid injection in the treatment of carpal tunnel syndrome.

Arq Neuropsiquiatr 2019 23;77(9):638-645. Epub 2019 Sep 23.

University of Health Sciences, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurosurgery, Istanbul, Turkey.

Carpal tunnel syndrome (CTS) is the most common mononeuropathy caused by entrapment of the median nerve at the wrist. Common treatment options for CTS include oral analgesics, splinting, hand therapy, local injections with steroids or surgery. OBJECTIVE The aim of the present study was to assess the short-term clinical and electrophysiological outcomes of local corticosteroid injection (LCI) in patients with symptomatic CTS. METHODS Electrophysiological parameters were evaluated before and three months after LCI. Moreover, the Numeric Rating Scale (NRS), the Boston Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) were administered before and after the injection. A mixture of 1 mL (40 mg) of methylprednisolone and 1 mL of 0.5% bupivacaine were injected blindly on the volar side of the forearm between the tendons of the radial carpal flexor muscle and long palmar muscle. RESULTS A total of 25 patients (45 hands) were enrolled in the study. Twenty women and five men with a mean age of 49.28 ± 11.37 years were included. A statistically significant difference was noted for improvement of sensory conduction velocities, sensory peak latency, and motor distal latency (p = 0.001) after LCI. A significant difference was recorded between pre- and post-injection for NRS, SSS and FSS scores (p = 0.000). CONCLUSION Local corticosteroid injection for CTS provides a short-term improvement in neurophysiological and clinical outcomes such as pain intensity, symptom severity and functional ability.
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http://dx.doi.org/10.1590/0004-282X20190106DOI Listing
April 2020

Effects of Inappropriate Sexual Behaviors and Neuropsychiatric Symptoms of Patients With Alzheimer Disease and Caregivers' Depression on Caregiver Burden.

J Geriatr Psychiatry Neurol 2020 09 16;33(5):243-249. Epub 2019 Sep 16.

İstanbul Gedik University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, İstanbul, Turkey.

Objective: We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers' depression, on the caregiver burden.

Method: One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI).

Results: Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD ( = .009, χ = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs ( = .000, χ = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores ( < .05).

Conclusions: The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.
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http://dx.doi.org/10.1177/0891988719874123DOI Listing
September 2020

Evaluation of burden and depression among caregivers of stroke patients: The role of percutaneous endoscopic gastrostomy feeding tube.

Clin Nutr ESPEN 2019 10 21;33:154-157. Epub 2019 Jun 21.

KTO Karatay University, Medical Faculty Affiliated Konya Medicana Hospital, Department of Neurology, Konya, Turkey. Electronic address:

Background & Aims: Malnutrition problems are very common after a stroke. Several clinical studies have shown the contribution of percutaneous endoscopic gastrostomy (PEG) feeding after stroke in terms of improving nutritional status and reducing mortality. The aim of this study is to compare the burden and depression among caregivers of ischemic stroke patients fed with PEG and orally.

Methods: A total of 63 caregivers of patients with acute ischemic stroke who were followed up in the neurointensive care unit with modified Rankin Scale 4 or 5 were recruited in this cross-sectional survey. Clinical data of patients and demographical profile as age, gender, kinship to patient, income, and level of education of caregivers were recorded. On their 3rd-month follow-up visit, Beck Depression Inventory and The Zarit Burden Interview (ZBI) were administered to caregivers to evaluate depressive symptoms and caregiver burden. A semi-structured questionnairre was developed and conducted by the researchers with the caregivers to assess their thoughts of nutrition.

Results: Thirty-two caregivers of stroke patients on PEG and 31 caregivers of stroke patients who were fed orally were evaluated. The groups did not differ statistically in terms of demographic variables and depression scores (p > 0.05). However, the mean score of ZBI was significantly higher in the group of caregivers of stroke patients who were fed orally (p = 0.00). Caregivers of stroke patients on PEG had higher scores of caregivers' thoughts of nutrition support therapy questionnairre (p = 0.00).

Conclusions: Our findings demonstrate that caregivers of stroke patients report lower burden and higher level of positive thinking with PEG feeding than oral feeding. This suggests that nutritional care could include convenient and practicable methods for caregivers of patients with stroke in order to meet patients' nutritional requirements.
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http://dx.doi.org/10.1016/j.clnesp.2019.06.002DOI Listing
October 2019

DNA damage effects of inhalation anesthetics in human bronchoalveolar cells.

Medicine (Baltimore) 2019 Aug;98(32):e16518

University of Health Science, Sisli Hamidiye Etfal Research and Training Hospital, Department of Neurology, Istanbul, Turkey.

Background: The main objective was to evaluate and compare the local genotoxicity of sevoflurane and desflurane in bronchoalveolar cells, while the secondary outcome was to detect systemic oxidative DNA damage. To our knowledge, our study is the first one to evaluate the local effects of inhalation anesthetics in human bronchoalveolar cells in patients.

Methods: American Society of Anesthesiologists group I-II patients scheduled for lumbar discectomy surgery were enrolled in this randomized prospective study. Patients were randomized to sevoflurane or desflurane for anesthesia maintenance. Bronchoalveolar lavage samples and peripheral blood samples were taken at 2-time points: the first point (baseline, T1); and the second point (postexposure, T2). Final number of 48 samples were the sevoflurane (n = 22) and desflurane (n = 26) groups. Comet assay was applied to examine genotoxic properties. Oxidative DNA damage in plasma was measured with 8-hydroxy-2'-deoxyguanosine (8-OHdG).

Results: T2 values were higher than baseline values in both the desflurane group (tail-length: 66 ± 24, %DNA in tail: 72 ± 60, tail moment: 47.52 ± 14.4; P = .001, P = .005, P = .001, respectively) and the sevoflurane group (tail-length: 58 ± 33, %DNA in tail: 88 ± 80, tail moment: 51.04 ± 26.4; P = .001, P = .012, P = .001, respectively). T2 plasma 8-OHdG levels were also higher than baseline levels in the desflurane group (3.91 ± 0.19 ng/ml vs 1.32 ± 0.20 ng/ml, P = .001) and sevoflurane group (3.98 ± 0.18 ng/ml vs 1.31 ± 0.11 ng/ml, P = .001). There were no differences between the 2 groups in comet parameters and 8-OHdG levels.

Conclusion: Our results indicate that both inhalation agents cause DNA damage in the bronchoalveolar cells. Also, we detected increases in plasma 8-OHdG concentrations. Local genotoxicity and systemic oxidized DNA damage were similar in both groups.
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http://dx.doi.org/10.1097/MD.0000000000016518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708896PMC
August 2019

Are repetitive pericranial nerve blocks effective in the management of chronic paroxysmal hemicrania?: A case report.

Medicine (Baltimore) 2019 Aug;98(31):e16484

Department of Neurology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.

Introduction: Paroxysmal hemicrania (PH) is a chronic headache disorder characterized by unilateral pain attacks accompanied by cranial autonomic symptoms and responds to indomethacin completely. There are few alternative treatment options for the patients who cannot tolerate indomethacin. Studies exploring the effects of repetitive peripheral cranial nerve blocks in the management of chronic PH are limited.

Patient Concerns And Diagnosis: A 34-year-old woman with a 4-year history of PH was evaluated. Her pain was prevented by indomethacin without side effects; however, she wanted to try to conceive.

Interventions: Repetitive pericranial nerve blocks, great occipital nerve, infraorbital nerve, supraorbital nerve, and sphenopalatine ganglion block, using local anesthetics and steroids were performed once a week for a 6 weeks period.

Outcomes: A follow-up of 3 months showed that there was no pain relief following the injections and patient was needed to be maintained on indomethacin.

Conclusion: Although pericranial nerve blocks have been tried in chronic PH cases with positive influences, this case indicated that repetitive nerve blocks were not always a successful therapy option.
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http://dx.doi.org/10.1097/MD.0000000000016484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6708846PMC
August 2019

Who is the bigger stigmatizor?: The loved one or the society.

Epilepsy Behav 2019 07 8;96:13-22. Epub 2019 May 8.

Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey.

Objective: Epilepsy has long been considered by the society as a dangerous and frightening spiritual possession or even a contagious disease. This results in an unavoidable embarrassment for both the patient and the family leading to social isolation, seclusion, and secretiveness about the diagnosis. The aim of this study was to determine the stigmatizing level of the general Turkish population and to compare these results with the stigmatizing level of the patients' relatives group (PRG).

Methods: This is a substudy of our main study which aimed to develop two scales for the quantification of the stigma level in patients with epilepsy (PWE) and their relatives [Stigma Scale for Epilepsy (SSE) -Self Report (SR) and -Informant Report (IR)]. First-degree relatives of the patients had been included in the main study. For the present study, 202 healthy people who were caregivers and relatives of neurologic patients other than epilepsy were recruited for the control group (CG). A sociodemographic and clinical data form and SSE-IR scale were administered to the CG as well. The relationship between sociodemographic characteristics and SSE-IR scores was evaluated, and a regression analysis was performed in order to analyze sociodemographic factors contributing to SSE-IR scores. Stigmatizing levels were compared between PRG and CG. Statistical analysis was performed using Statistical Package for the Social Sciences version 22.0 software.

Results: Comparison of stigma scores among different sociodemographic strata of the CG showed that there was a statistically significant difference in terms of educational status and occupation (p < 0.01). Multivariate linear regression analysis revealed that education accounted for 10.8% and 8.9% of the variance in the SSE-IR scale respectively in the PRG and the CG. Prejudgment scores and total scores of the PRG were significantly higher than those of the CG. There was no statistically significant difference between two groups in terms of discrimination and false beliefs subscales scores. The proportion of highly stigmatizor participants in the PRG was statistically significantly higher than that of the CG.

Discussion/conclusions: This study showed us that the stigmatization levels in a group of subjects drawn from general population without acquaintance of epilepsy were lower than the relatives of the patients. This result may be partially explained by the ambivalent attitudes of the relatives, as those high scores may stem from not only enacted but also the felt stigma that they were experiencing themselves. It must be a warning sign for both of all the clinicians treating epilepsy and national association against epilepsy, as well as public health officials to increase efforts for awareness raising.
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http://dx.doi.org/10.1016/j.yebeh.2019.04.013DOI Listing
July 2019

The Association between Chronicity of Migraine and Complementary and Alternative Medication Use: The Turkish Perspective.

Eur Neurol 2019 23;81(1-2):24-29. Epub 2019 Apr 23.

Department of Neurology, University of Health Sciences, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey,

Background And Purpose: The term of Complementary and Alternative Medication (CAM) is described by patients as all types of practices to prevent or treat illnesses, which are not currently considered as a part of conventional medicine. Although the advance in treatment for migraine, some patients prefer CAM therapies due to their concerns about conventional therapies. The aim of this study was to evaluate the association between CAM use and chronicity of migraine among Turkish migraineurs.

Methods: Consecutive episodic and chronic migraine patients were recruited. A questionnaire of a list of CAM modalities including traditional therapies specific to Turkish culture, which was constructed by researcher through a literature review was given to all participants. Patterns of CAM treatments and patients' reluctance to share CAM use with their doctors were evaluated.

Results: Sixty-nine patients with episodic migraine and 31 with chronic migraine enrolled in the study. Thirty-six patients reported that they had tried CAM at least once within the last year. Massage, exercise, acupuncture, holistic methods, herbalism, vitamins, psychotherapy, hypnose, cupping, and neural therapy were used. Sociodemographic and clinical variables were not differed in CAM users of both groups. Eighty-one per cent of CAM users stated that they preferred not to tell their doctors about their CAM use if not asked.

Conclusions: Patterns of CAM use in Turkey for migraine differ from western practices. Due to fear of disapproval, patients tend to hide CAM use from their doctors. Exploring the CAM use among migraineurs is essential to prevent potential interactions of CAM therapies with conventional treatments.
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http://dx.doi.org/10.1159/000499910DOI Listing
June 2020

An open/pilot trial of cognitive behavioral therapy in Turkish patients with refractory chronic migraine.

Cogn Neurodyn 2019 Apr 12;13(2):183-189. Epub 2019 Jan 12.

5Department of Psychiatry, Gazi University Health Care Center, Ankara, Turkey.

Cognitive behavioral therapy (CBT) for pain management is a therapy that aims to modify thoughts and behavior to be more realistic and balanced. There are limited number of studies to assess the efficacy of CBT for patients with pharmacotherapy-resistant chronic migraine in our population. We aimed to invstigate the effects of CBT for patients with refractory chronic migraine on pain attack frequency, disability, severity, anxiety and depression. Fourteen patients with refractory chronic migraine who were referred from the headache clinic to the psychiatry department and regularly attended CBT sessions at least once every 2 weeks for at least 6 months, were included in the study. After 2 sessions of psychiatric evaluation, the subjects had 12 40-min CBT sessions and were given relaxation exercises. The Hamilton depression and anxiety inventories, visual analogue scale for assessing the severity of pain, and the Migraine disability assessment (MIDAS) test were used before and after CBT. The mean Hamilton depression scores before and after CBT were 29.07 ± 7.74 and 14.21 ± 7.7, respectively ( < 0.0001). The mean Hamilton anxiety scores before and after CBT were 26.8 ± 11.7 and 11.7 ± 2.6, respectively ( < 0.0001). The mean VAS scores before and after CBT were 8.07 ± 0.91 and 3.71 ± 1.32, respectively ( < 0.0001). The mean MIDAS scores before and after CBT were 55.5 ± 20.4 and 20.12 ± 16.6, respectively ( < 0.0001). Our results showed that CBT had made a statistically significant difference on pain severity, number of migraine attacks and disability in patients with refractory chronic migraine. CBT should be considered in this patient group.
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http://dx.doi.org/10.1007/s11571-019-09519-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426916PMC
April 2019

The impact of parental attitudes toward children with primary headaches.

Clin Child Psychol Psychiatry 2019 Oct 21;24(4):767-775. Epub 2019 Mar 21.

Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey.

There is a lack of data on parental attitudes toward children with primary headaches. The aim of this study is to determine whether there is a relationship between primary headaches and parental attitudes in the pre-adolescent pediatric population. In this cross-sectional study, 195 children with primary headache and 43 healthy children aged 9-16 years were included. A questionnaire for sociodemographic variables, visual analog scale (VAS), Social Anxiety Scale and Depression Inventory for Adolescents and Children, and Parental Attitudes Determining Scale (PATS), which is an attitude measure specifically designed to evaluate psychological adjustment, were administered. Of 195 children (female/male ratio: 89/106, mean age: 12.59 ± 1.09 years), episodic migraine ( = 90), chronic migraine ( = 25), and tension-type headache ( = 80) were evaluated. There was no significant difference among headache groups and healthy subjects in terms of depression, anxiety, and fathers' attitude scale scores. However, there were significant differences in mean mothers' attitude scale scores and VAS scores ( = .002,  = .000). Mean oppressive-authoritarian attitude subscale scores of mothers' was significantly higher in children with chronic migraine ( = .000). A relationship between depression and VAS scores among all patient groups was detected ( = .000). Parental age was negatively related to PATS scores of children with episodic migraine and tension-type headache ( = .037 and  = .036). Parental attitudes may elevate psychiatric symptoms and influence children's perception of pain intensity and result in chronification of headache. Our findings support that mothers' attitude toward children with chronic migraine has strong impacts on the child's pain experience.
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http://dx.doi.org/10.1177/1359104519838571DOI Listing
October 2019

Factors associated with mortality in acute subdural hematoma: Is decompressive craniectomy effective?

Ulus Travma Acil Cerrahi Derg 2019 Mar;25(2):147-153

Department of Neurosurgery, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul-Turkey.

Background: Despite rapid diagnosis and aggressive neurosurgical intervention, acute subdural hematoma (ASDH) is a severe type of head injury that can result in high morbidity and mortality. Although surgical procedures, such as craniotomy and decompressive craniectomy (DC), can be effective, the preferred approach for treating an ASDH remains controversial. The aim of this report was to evaluate factors associated with mortality in patients with ASDH and determinants of outcome in those with ASDH who underwent DC.

Methods: The demographic details and clinical and radiological characteristics of a total of 93 patients with ASDH who underwent DC during a 60-month period from 2012 to 2017 were evaluated to determine the effect on mortality and any association with the Glasgow Coma Scale (GCS) score recorded on arrival.

Results: Sixty-five male and 28 female subjects with a mean age of 59.82+-19.49 years (range: 16-88 years) were included in the study. Sixteen patients (17.2%) died following the surgery. Older age (p=0.007) and lower GCS scores (p=0.022) were statistically significantly associated with the mortality rate. The mean hematoma thickness was 15.46+-5.73 mm, and the mean midline shift was 9.90+-4.84 mm. The mortality rate was positively correlated with an excessive midline shift (p=0.011; r=0.262) and age (p=0.022; r=0.237) in patients with ADSH. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm was significantly associated with mortality (p=0.014; p=0.039). The etiology of the trauma; comorbidities of subarachnoid, epidural, or intracranial hemorrhage; compression fractures; or contusions were not significantly correlated.

Conclusion: The results indicated that there was a higher mortality rate among older patients and those with a GCS score of <6 on arrival. A midline shift of ≥10 mm and a hematoma thickness of ≥15 mm were significantly related to mortality. Our study supports the conclusion that DC may help prevent further midline shift and be associated with a lower mortality rate compared with a craniotomy.
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http://dx.doi.org/10.5505/tjtes.2018.48079DOI Listing
March 2019

Timing of Decompressive Craniectomy for Malignant Middle Cerebral Artery Infarction: A Single-Center Analysis.

Medicina (Kaunas) 2019 Jan 30;55(2). Epub 2019 Jan 30.

University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, Department of Neurosurgery, Istanbul 34371, Turkey.

: Malignant middle cerebral artery infarction (MMCAI) usually leads to brain edema that may result in transtentorial herniation and brainstem compression. The prognosis of MMCAI is generally poor. The aim of this study was to discuss our experience with surgical decompression for MMCAI, and determine the association between timing of craniectomy and neurological outcomes. We identified consecutive patients diagnosed with MMCAI who underwent decompressive craniectomy (DC). Clinical and demographic data were obtained from electronic medical records, including: age, sex, preoperative Glasgow Coma Scale (GCS) score, surgery timing, postoperative GCS scores, and modified Rankin Scale (mRS) scores. This study included 27 stroke patients (aged 38⁻80 years) operated within 72 h of the onset of neurological symptoms. Sixteen, five, and six patients underwent DC within 24 h, between 24 and 48 h, and after 48 h after onset of symptoms, respectively. Five patients died after the surgery. Patients who underwent DC within 24 h and 24⁻48 h had better mean GCS scores than those who underwent DC after 48 h ( = 0.000, = 0.015). In addition, patients who underwent DC within 24 h had better mean postoperative mRS scores ( = 0.000) than other patients. Patients older than 60 years had significantly lower GCS scores ( = 0.027) and higher mRS scores ( = 0.033) than younger patients. Our findings support that DC had satisfying outcomes in patients who underwent DC within 24 h. Older age and lower Glasgow Coma Scale scores among DC patients with MMCAI are associated with high morbidity and mortality.
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http://dx.doi.org/10.3390/medicina55020031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6409760PMC
January 2019

Cognitive Functioning and Silent Neurological Manifestations in Behçet's Disease with Ocular Involvement.

Noro Psikiyatr Ars 2019 Sep 9;56(3):173-177. Epub 2018 Jul 9.

Bakırköy Research and Training Hospital for Neurologic and Psychiatric Diseases, Neurology Clinic, İstanbul, Turkey.

Introduction: Various reports have revealed a cognitive dysfunction in Behçet's disease (BD). In this study, we aimed to assess the silent neurological manifestations, behavioral and neuropsychiological impairments of Behçet's disease patients with ocular involvement.

Methods: Thirty BD patients with ocular involvement in the nonactive phase of their illness were applied detailed neurological examination and magnetic resonance imagining (MRI). Neuropsychological tests were performed. Patients' neuropsychological performances were compared to those of healthy, demographically matched twenty subjects.

Results: Neurological manifestations of patients were headache (56.6%), pyramidal signs (13.3%), behavioral changes (3.3%) and sensory symptoms (3.3%). Four patients (13.3%) had white matter hyperintensities lesions on T2/FLAIR brain MRI. Fourteen patients (46%) had impaired cognitive performances on the following tasks: verbal memory (immediate memory p=0.000, maximal learning capacity p=0.009, number of repetitions p=0.000, total learning capacity p=0.001, recall p=0.033), nonverbal memory (immediate memory p=0.029, recall p=0.001), logical memory (immediate memory p=0.001, recall p=0.001), executive (frontal) functions (clock-drawing test p=0.000, Stroop test p=0.001, verbal fluency tests p=0.000). Patients' MMSE and clock drawing test scores were significantly lower than controls (p=0.03). Attention deficit was not detected. Behçet's disease patients showed higher scores on depression scales than healthy subjects but there was no statistically significant difference between anxiety scores.

Conclusion: Neuropsychological deficits, involving mainly memory and executive functioning, subcortical MRI lesions, and non-structural headache may be present in Behçet's disease patients with ocular involvement without overt neurological manifestations.
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http://dx.doi.org/10.5152/npa.2017.19406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6732813PMC
September 2019

Stigma accounts for depression in patients with epilepsy.

Epilepsy Behav 2018 01 22;78:1-6. Epub 2017 Dec 22.

Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Department of Neurology, Istanbul, Turkey.

Objective: Epilepsy is a chronic disease with an increased risk of stigmatization due to psychosocial consequences of the seizures. Intuitively, one may well conclude that stigmatization would lead to depression in patients with epilepsy as well as in other patient groups with increased risk of stigmatization. Indeed, there are a few studies in support of this intuition. In this study, we aimed to investigate the relationship between level of stigmatization and the severity of the depressive symptoms in our patients with epilepsy.

Methods: This is a substudy of our main study, which aimed to develop a scale for the quantification of the stigma level in patients with epilepsy. The study included a total of 302 patients with epilepsy, who had at least a literacy level education and one-week-seizure-freedom. Beck Depression Inventory (BDI) was used to quantify depressive symptoms. The correlation between BDI scores and the Stigma Scale for Epilepsy-Self Report (SSE-SR) scores was evaluated. A regression analysis was done in order to parse out significant sociodemographic and clinical factors contributing to depressive symptoms. Statistical analyses were done using the Statistics Package for the Social Sciences software 24.0 package program.

Results: We saw that 46.9% (n=139) of this population rated themselves as having at least mildly depressive symptoms with BDI (BDI>9). There was a moderate positive correlation between stigma scores and BDI scores (p=0.000, r=0.504), and 96.3% of highly stigmatized patients had at least mildly depressive scores, 73.9% of the nonstigmatized group had none or minimal depressive scores. Stigma scores (β=.51), gender, educational level, seizure frequency, and income level were the variables significantly affecting the BDI scores. Stigma score accounted for 26.2% of the variance in the BDI score.

Conclusion: This study shows that stigmatization of the patients with epilepsy leads to depression in those patients. Therefore, protection of the patients with epilepsy against stigmatization may also help to protect them from a concomitant disabling condition. On the other hand, detection for depressive symptoms in already stigmatized patients with epilepsy may unearth a treatable condition.
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http://dx.doi.org/10.1016/j.yebeh.2017.10.030DOI Listing
January 2018

Development and validation of the stigma scale for epilepsy in Turkey.

Epilepsy Behav 2017 02 14;67:84-90. Epub 2017 Jan 14.

Istanbul University, Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey.

Objective: Epilepsy is a chronic disease with an increased risk of stigma. The aim of this study was to investigate the efficacy of a scale developed by the authors to determine the level of stigma in Turkish patients with epilepsy and their relatives.

Methods: In this pilot study, two scales were developed, one consisting of 32 questions for the patients and one of 20 questions for the patients' relatives. Initially, a total of 30 patients with epilepsy and 30 relatives of the patients were included. The Cronbach's alpha coefficient was calculated in a reliability analysis of validity applying the scales to 302 patients and 201 relatives of the patients. The Pearson correlation coefficient was used for the reliability analysis of the test-retest. The t-test was used in paired series, and factor analysis was conducted. The correlation between the clinical and demographical data and the stigma scores was evaluated.

Results: The scales were applied to participants twice under the same conditions in one-week interval. In the test-retest analysis, the internal consistency of the scales was high and reliable. In the analysis of the patients, the Cronbach's alpha value of the scale was found to be 0.915. In the factor analysis, the questions were grouped into five factors including social isolation, discrimination, insufficiency, false beliefs, and stigma resistance. The factors with the highest contribution to the stigma level were social isolation and discrimination. In the stigma scores, a significant correlation was found between the age of the patient, frequency of seizures, education status, level of income, and the amount of antiepileptic drugs used. In the analysis of the patients' relatives, the Cronbach's alpha value of the scale was found to be 0.892. In the factor analysis, the questions were classified as discrimination, prejudgments, and false beliefs. The factor which most contributed to the stigma level was discrimination. A significant correlation was found in the stigma scores between sex, education status, marital status, and income distribution.

Conclusion: According to our study results, it is clearly seen that both patients and their relatives suffer from epilepsy-associated stigma. Patients with epilepsy and their relatives are faced with discrimination in society, resulting in social isolation. We, therefore, believe that both patients and their relatives should be informed in detail about discrimination to overcome this challenge.
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http://dx.doi.org/10.1016/j.yebeh.2016.12.023DOI Listing
February 2017

Effects of onabotulinumtoxinA treatment on efficacy, depression, anxiety, and disability in Turkish patients with chronic migraine.

Neurol Sci 2016 Nov 14;37(11):1779-1784. Epub 2016 Jul 14.

Neurology Department, Sakarya University Education and Research Hospital, Sakarya, Turkey.

Chronic migraine causes a serious labour loss and disability in the society and increases the risk of depression and anxiety by negatively affecting the quality of life. The purpose of this study was to investigate the effects of onabotulinumtoxinA (BoNT-A) treatment on efficacy before and after treatment in our cases with chronic migraine as well as on depression, anxiety and disability caused by migraine. According to the International Headache Classification (ICHD-III beta version), 60 adult patients who were diagnosed with chronic migraine were included in the study. A total of 155 IU BoNT-A treatment from 31 regions was administered in accordance with the protocol of PREEMPT study. Information about the characteristics of patients' headaches, background and family history, drugs they used was recorded. At the baseline and in the first and third month after the BoNT-A injection, VAS scores, the number of both headache days and attacks, the headache duration, the frequency of application to emergency services and the intake of both analgesics and triptans during attacks were evaluated. MIDAS, BDI and BAI were evaluated at the baseline and in the third month after the BoNT-A injection. BoNT-A injection provided a significant decrease in the number of days and severity of headaches, MIDAS disability scores and psychiatric complaints in cases with chronic migraine who did not respond to prophylactic treatments in the third month of the treatment.
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http://dx.doi.org/10.1007/s10072-016-2665-zDOI Listing
November 2016
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