Publications by authors named "Gülden Akdal"

41 Publications

The effect of directional social cues on saccadic eye movements in Parkinson's disease.

Exp Brain Res 2021 Apr 29. Epub 2021 Apr 29.

School of Psychology, University of Lincoln, Lincoln, LN6 7TS, UK.

There is growing interest in how social processes and behaviour might be affected in Parkinson's disease. A task which has been widely used to assess how people orient attention in response to social cues is the spatial cueing task. Socially relevant directional cues, such as a picture of someone gazing or pointing to the left or the right have been shown to cause orienting of visual attention in the cued direction. The basal ganglia may play a role in responding to such directional cues, but no studies to date have examined whether similar social cueing effects are seen in people with Parkinson's disease. In this study, patients and healthy controls completed a prosaccade (Experiment 1) and an antisaccade task (Experiment 2) in which the target was preceded by arrow, eye gaze or pointing finger cues. Patients showed increased errors and response times for antisaccades but not prosaccades. Healthy participants made most anticipatory errors on pointing finger cue trials, but Parkinson's patients were equally affected by arrow, eye gaze and pointing cues. It is concluded that Parkinson's patients have a reduced ability to suppress responding to directional cues, but this effect is not specific to social cues.
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http://dx.doi.org/10.1007/s00221-021-06034-7DOI Listing
April 2021

Selective Bilateral Vestibular Neuropathy in a Turkish CMT1B Family With a Novel Mutation.

Neurol Clin Pract 2021 Apr;11(2):e129-e134

Department of Neurology (GA, RTA, İŞŞ) and Department of Neurosciences (GA, KK), Institute of Health Sciences, Department of Medical Genetics (E. Bora, AK, AÜ), Dokuz Eylül University, İzmir, Turkey; Department of Neurology (MB), Mardin State Hospital, Mardin, Turkey; Department of Molecular Biology and Genetics (E. Battaloğlu), Boğaziçi University, İstanbul, Turkey; Hearing, Speech and Balance Unit (GK), Department of Otorhinolaryngology, Dokuz Eylül University, İzmir, Turkey; and Department of Neurology (GMH), Royal Prince Alfred Hospital, University of Sydney, Australia.

Purpose Of Review: To report the findings in 12 members over 3 generations of a family with dominantly inherited Charcot-Marie-Tooth disease (CMT1B) due to a novel mutation, who all had moderately severe selective impairment of vestibular function with normal hearing. Methods used were video head impulse testing of the function of all 6 semicircular canals, Romberg test on foam, nerve conduction studies, and whole exome and Sanger sequencing.

Recent Findings: All affected patients had a demyelinating neuropathy and a novel mutation: c.362A>G (chr1: 161276584, p.D121G). All also had normal hearing for age but a moderately severe impairment of semicircular canal function and a positive Romberg test on foam.

Summary: Some CMT mutations can impair vestibular function, presumably because of a vestibular nerve involvement but spare hearing. In such patients, impairment of vestibular function and impairment of proprioception contribute to imbalance.
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http://dx.doi.org/10.1212/CPJ.0000000000000930DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032420PMC
April 2021

Deficits in saccadic eye movements differ between subtypes of patients with mild cognitive impairment.

J Clin Exp Neuropsychol 2021 Mar 1;43(2):187-198. Epub 2021 Apr 1.

Department of Neurosciences, Institute of Health Sciences, Dokuz Eylül University, İzmir, Turkey.

: Mild cognitive impairment (MCI) is known to be heterogeneous in its cognitive features and course of progression. Whilst memory impairment is characteristic of amnestic MCI (aMCI), cognitive deficits other than memory can occur in both aMCI and non-amnestic MCI (naMCI) and accurate assessment of the subtypes of MCI is difficult for clinicians without the application of extensive neuropsychological testing. In this study, we examine metrics derived from recording of reflexive and voluntary saccadic eye movements as a potential alternative method for discriminating between subtypes and assessing cognitive functions in MCI.: A total of 29 MCI patients and 29 age- and education-matched healthy controls (HCs) participated in the cross-sectional study. We recorded and pro-saccades and anti-saccade responses. All the participants also completed a comprehensive neuropsychological tests battery.: Significant differences in saccadic eye movement were found between the subtypes of MCI and HCs. Patients with aMCI had a higher percentage of short latency "express" saccades than HCs. We found strong associations between saccadic reaction times and cognitive domains, including executive functions and attention. The mini-mental state examination (MMSE) was also found to correlate with uncorrected errors in the anti-saccade task.: The increased proportion of saccades in the express latency range in aMCI may be indicative of problems with cognitive inhibitory control in these patients. A focus on this and other saccade metrics in the preclinical and prodromal stages of dementia may help to predict the clinical progression of the disease and direct interventions for the management of MCI. The clinical significance of saccadic eye movement impairments in MCI is not yet fully understood and should be investigated in further studies using larger samples.
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http://dx.doi.org/10.1080/13803395.2021.1900077DOI Listing
March 2021

The Complex Genetic Landscape of Hereditary Ataxias in Turkey and Implications in Clinical Practice.

Mov Disord 2021 Feb 24. Epub 2021 Feb 24.

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

Background: The genetic and epidemiological features of hereditary ataxias have been reported in several populations; however, Turkey is still unexplored. Due to high consanguinity, recessive ataxias are more common in Turkey than in Western European populations.

Objective: To identify the prevalence and genetic structure of hereditary ataxias in the Turkish population.

Methods: Our cohort consisted of 1296 index cases and 324 affected family members. Polymerase chain reaction followed by Sanger sequencing or fragment analysis were performed to screen for the trinucleotide repeat expansions in families with a dominant inheritance pattern, as well as in sporadic cases. The expansion in the frataxin (FXN) gene was tested in all autosomal recessive cases and in sporadic cases with a compatible phenotype. Whole-exome sequencing was applied to 251 probands, selected based on the family history, age of onset, and phenotype.

Results: Mutations in known ataxia genes were identified in 30% of 1296 probands. Friedreich's ataxia was found to be the most common recessive ataxia in Turkey, followed by autosomal recessive spastic ataxia of Charlevoix-Saguenay. Spinocerebellar ataxia types 2 and 1 were the most common dominant ataxias. Whole-exome sequencing was performed in 251 probands with an approximate diagnostic yield of 50%. Forty-eight novel variants were found in a plethora of genes, suggesting a high heterogeneity. Variants of unknown significance were discussed in light of clinical data.

Conclusion: With the large sample size recruited across the country, we consider that our results provide an accurate picture of the frequency of hereditary ataxias in Turkey. © 2021 International Parkinson and Movement Disorder Society.
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http://dx.doi.org/10.1002/mds.28518DOI Listing
February 2021

Optic nerve sheath decompression saves sight in severe papilloedema: results from 81 eyes in 56 patients with pseudotumor cerebri.

Acta Ophthalmol 2020 Dec 30. Epub 2020 Dec 30.

Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

Purpose: To report the outcome of optic nerve sheath decompression (ONSD) for papilloedema in a teaching hospital in western Turkey.

Methods: The charts of 56 patients who had ONSD surgery between April 2007 and September 2019 were collated; and a total of 81 operated and 31 fellow eyes were included. Pre- and postoperative ophthalmologic examination including best-corrected visual acuity (BCVA), colour vision (CV), visual field (VF) analysis, fundoscopic examination and demographic and medical characteristics of the patients were noted and outcomes after surgery were investigated.

Results: Of all study eyes, 49 (43.7%) eyes had BCVA 0.2 or less and 62 (55.3%) eyes had mean deviation (MD) below - 20.0 dB. 62 (55.3%) eyes had Frisen grade 4 or 5 papilloedema. Almost half of the eyes had severe vision loss. After ONSD, BCVA, CV and MD in both operated and fellow non-operated eyes improved significantly (p < 0.001, p = 0.009 and p < 0.001 for operated, p < 0.001, p = 0.007 and p < 0.001 for fellow eyes, respectively). Earlier surgery and higher cerebrospinal fluid opening pressure were related to better outcomes. None of the patients had major operative complications.

Conclusion: Optic nerve sheath decompression can safely improve vision not only of the operated but also of the non-operated eye, even in cases with severe vision loss from severe bilateral papilloedema. Regardless of initial VA and VF, patients may benefit from ONSD; the earlier it is done the more likely the better outcome.
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http://dx.doi.org/10.1111/aos.14732DOI Listing
December 2020

Vestibulo-ocular reflex impairment in SPG7 hereditary spastic paraplegia.

Clin Neurophysiol 2021 Jan 4;132(1):77-79. Epub 2020 Nov 4.

University of Sydney, Royal Prince Alfred Hospital, Neurology Department, Sydney, Australia. Electronic address:

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http://dx.doi.org/10.1016/j.clinph.2020.10.012DOI Listing
January 2021

Vestibular impairment in Charcot-Marie-Tooth disease.

J Neurol 2021 Feb 30;268(2):526-531. Epub 2020 Aug 30.

Department of Neurology, Faculty of Medicine, Ege University, Izmir, Turkey.

Objective: To find out if Charcot-Marie-Tooth (CMT) patients, who have peripheral vestibular as well as peripheral somatosensory impairment, have worse postural balance than those who do not.

Methods: We studied 32 patients with various CMT phenotypes and genotypes. Vestibular function was measured with the video head impulse test (vHIT) which tests vestibulo-ocular reflex (VOR) gain from each of the six semicircular canals in response to rapid head rotations. Postural balance was evaluated with a battery of four postural tests with emphasis on the modified clinical test of sensory integration in balance (mCTSIB).

Results: Half of the 32 patients had some impairment of vestibular function ranging from mild, affecting only 1-2 semicircular canals, to almost total affecting all 6 semicircular canals. Their mCTSIB scores correlated with VOR gain from the vertical rather than from the lateral semicircular canals. The worse the vertical VOR gain the worse the mCTSIB score.

Conclusion: We propose that any CMT patient could have clinically inapparent vestibular impairment that can be easily measured with the vHIT. This vestibular impairment could be contributing to their imbalance and could respond to a focused vestibular rehabilitation program.
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http://dx.doi.org/10.1007/s00415-020-10186-xDOI Listing
February 2021

Imbalance, motion sensitivity, anxiety and handicap in vestibular migraine and migraine only patients.

Auris Nasus Larynx 2020 Oct 13;47(5):747-751. Epub 2020 Mar 13.

Department of Neurology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

Objective: The aim of this study is to compare the balance ability, anxiety level and motion sickness susceptibility in Vestibular Migraine (VM) patients, migraineurs without history of vertigo (Migraine-only, MO) and healthy controls (HC). We tested the hypothesis that VM patients have worse balance performance and higher anxiety level and motion sickness than MO and HC group.

Methods: This cross-sectional study included of 123 definite VM patients, 58 MO patients and 49 HCs. All subjects were evaluated with the Dynamic Gait Index (DGI), the modified Clinical Test of Sensory Integration and Balance (mCTSIB), the Motion Sickness Susceptibility Questionnaire Short-Form (MSSQ-Short), the Panic Agoraphobic Spectrum Self-Report version (PAS-SR) and the Dizziness Handicap Inventory (DHI).

Results: The main balance outcomes indicated that DGI and mCTSIB scores were worse in VM than in MO patients and worse in MO patients than in HCs. Almost 50% of the VM patients fell in the most challenging mCTSIB conditions compared with 20% of MO patients and none of the HCs. VM patients had more marked motion sickness susceptibility, higher anxiety and DHI scores than MO patients and HCs. VM patients who fell had higher DHI and anxiety scores than those who did not.

Conclusion: Balance problems, motion sickness, anxiety, and disability are more marked in VM patients than in MO patients and more marked in MO patients than in HCs. Focused treatments of these problems which could help VM patients need further study.
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http://dx.doi.org/10.1016/j.anl.2020.02.015DOI Listing
October 2020

Efficacy of Epley Maneuver on Quality of Life of Elderly Patients with Subjective BPPV.

J Int Adv Otol 2019 Dec;15(3):420-424

Department Otolaryngology-Head and Neck Surgery, Manisa Celal Bayar University School of Medicine, Manisa, Turkey.

Objectives: This study aimed to evaluate the efficacy of the repositioning maneuver on quality of life in elderly patients with dizziness and/or vertigo.

Materials And Methods: This controlled, prospective randomized clinical trial was conducted in elderly patients aged 65 years and above with a positive history of benign paroxysmal positional vertigo (BPPV), presence of vertigo, and no observable nystagmus during the Dix-Hallpike test, so-called Subjective BPPV (S-BPPV). Individuals were evaluated by visual analog scale (VAS) and dizziness handicap inventory (DHI). Groups were defined as treatment (treated with Epley maneuver bilaterally) or no treatment control (no treatment modality or canalith repositioning maneuver). Ten days after the first assessment, all patients were reassessed using VAS and DHI.

Results: A total of 50 patients were randomized into two groups: 25 to the treatment group, and 25 to the control group. No significant differences were observed for baseline VAS and total DHI scores between the groups (p=0.636, p=0.846, respectively). On the other hand, after the reassessment, VAS and total DHI scores were both significantly reduced in the treatment group (p<0.001, p<0.001, respectively), but no reduction in either score was found in the control group (p=0.216, p=0.731, respectively).

Conclusion: This study showed that elderly patients with S-BPPV benefit from the Epley maneuver, in particular global and disease-specific quality of life.
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http://dx.doi.org/10.5152/iao.2019.6483DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937179PMC
December 2019

Vertebral artery dissection from neck self-manipulation presenting with acute severe bilateral hearing loss.

J Neurol 2020 Jan 18;267(1):285-287. Epub 2019 Nov 18.

Neurology Department, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.

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http://dx.doi.org/10.1007/s00415-019-09636-yDOI Listing
January 2020

Plasma levels of inflammatory mediators in vestibular migraine.

Int J Neurosci 2020 Apr 24;130(4):330-335. Epub 2019 Oct 24.

Faculty of Medicine, Department of Neurology, Dokuz Eylül University, Izmir, Turkey.

Vestibular migraine (VM) is an under-recognized entity with substantial burden for the individual and society. The underlying mechanism of VM and its distinction from other migraine mechanisms still remain unclear. Inflammatory pathways have been suggested to contribute to vestibular migraine. Our aim was to further investigate the possible role of inflammation in the pathophysiology of VM. We recruited 30 patients with VM diagnosed according to ICHD-3 criteria and 50 gender- and age-matched controls. Blood samples were obtained from 11 VM patients during an attack and from 13 VM patients under prophylactic treatment. Plasma levels of calcitonin gene related peptide (CGRP), neurokinin A (NKA), substance P (SP), NLRP1, NLRP3, caspase-1, IL-1β, IL-6, TNF-α and NFκB were measured by ELISA. IL-6 levels were significantly reduced in VM patients, whereas levels of other inflammation parameters were comparable to those of healthy controls. Levels of inflammatory mediators were not correlated with clinical parameters. Likewise, there were no significant differences among VM patients with and without headache attack and prophylactic treatment. Our results argue against involvement of systemic inflammation in the pathophysiology of VM.
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http://dx.doi.org/10.1080/00207454.2019.1681994DOI Listing
April 2020

Intravenous Immunoglobulin Treatment for Recurrent Optic Neuritis.

Noro Psikiyatr Ars 2019 Mar 28;56(1):3-6. Epub 2018 Nov 28.

Department of Neurology, Bilim University Faculty of Medicine, Istanbul, Turkey.

Introduction: Recurrent optic neuritis neuritis (rON) is an autoimmune inflammatory condition of unknown cause. Intravenous immunoglobulin (IVIg) treatment is used for many autoimmune disorders; however we do not have any information about its effect in rON, other than case reports. We aimed to evaluate our patients with rON who were treated with IVIg.

Methods: Data from all our patients with rON with or without anti aquaporin4 (AQP4) seropositivity, seen between April 2011 and October 2015, who received IVIg treatment were retrospectively evaluated.

Results: Nine patients (all female) with rON had received IVIg. These patients were aged between 34 and 65 years, and had started receiving monthly IVIg from 6 to 58 months after onset of disease. In three out of nine rON patients serum AQP4 antibody were positive. Under current treatments the patients had continued to have attacks, therefore monthly IVIg was given in addition to the existing immunosuppressant drug. The follow up duration was between 6 to 31 months. Three patients, each suffered one relapse under IVIg treatment. Mean number of relapses in the year prior to treatment was 1.4±0.72, whereas it was 0.3±0.5 during the year after IVIg therapy. During follow-up with IVIg administration only one patient had fever and no other adverse events were reported.

Conclusion: Monthly IVIg is well-tolerated and safe and it seems to be effective in rON as an add on treatment. However, since our study is a retrospective case series, future randomized controlled trials with IVIg are needed.
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http://dx.doi.org/10.5152/npa.2017.20577DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427084PMC
March 2019

Characteristics of optic neuropathy in Behçet disease.

Neurol Neuroimmunol Neuroinflamm 2018 Sep 10;5(5):e490. Epub 2018 Aug 10.

Department of Neurology (G.A.), Faculty of Medicine, Dokuz Eylül University; Department of Neuroscience (G.A.), Dokuz Eylül University, Institute of Health Sciences, Izmir; Department of Neurology (H.E.T.), Bakirköy Dr.Sadi Konuk Training and Research Hospital, Istanbul; Department of Ophthalmology (A.O.S., A.Y., M.S.B.), Faculty of Medicine, Dokuz Eylül University, Izmir; Department of Neurology (U.U., S.S., A.S.), Cerrahpaşa Faculty of Medicine, Istanbul University; Faculty of Medicine, Department of Neurology (B.A., G.A.-D.), Bilim University, Istanbul; Faculty of Medicine, Department of Biostatistics (P.K.), Dokuz Eylül University; Ege University (S.G.Y.), Faculty of Medicine, Department of Ophthalmology; and Ege University (N.Ç.), Faculty of Medicine, Department of Neurology, Izmir, Turkey.

Objective: We present the clinical profile, features, and neuroimaging findings of 25 patients with Behçet disease (BD), and optic neuropathy (ON), which has been rarely reported in BD.

Methods: Data from 5 university hospitals were retrospectively reviewed, and patients with BD and ON were evaluated. There were 2 groups: (1) those already diagnosed with BD when ON developed (BDON group) and (2) those diagnosed with BD during the evaluation of ON (ONBD group).

Results: There were 25 BD patients with ON (13 males). Among these, 13 had ONBD, and 12 had BDON. Seventeen patients had unilateral ON, and 7 patients had recurrent ON. BDON patients were older. Disc edema was seen more in ONBD than in BDON patients (10 vs 3). Fourteen patients also had uveitis, 7 with BDON and 7 with ON→BD. There was other neurologic involvement in 8 patients; in the BDON group, 4/4 had MS-like disease, in the ONBD group, 3 had typical parenchymal BD, and 1 had MS-like disease. Twenty of 21 patients received immunosuppressive medications, corticosteroids, or both. Prognosis was favorable in most: vision improved in 20 patients, more often in those receiving combined therapies.

Conclusion: BD may be diagnosed earlier if it is considered and investigated during the assessment of ON, particularly in high-risk regions. Prognosis of ON related to BD seems to be favorable. Immunosuppressants should be given along with corticosteroids. MS-like presentations should also be kept in mind in patients with BD and ON.
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http://dx.doi.org/10.1212/NXI.0000000000000490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6117194PMC
September 2018

Definition of Balance and Cognition Related to Disability Levels in Vestibular Migraine Patients.

Noro Psikiyatr Ars 2018 Mar 19;55(1):9-14. Epub 2018 Mar 19.

Department of Neurology, Dokuz Eylül University Medical Faculty, İzmir, Turkey.

Objective: To compare the balance and cognition of vestibular migraine (VM) patients with migraineurs without vertigo history and healthy subjects, and to examine the effects of disability level on these functions.

Material-method: The study consisted of 32 VM patients, 32 migraineurs and 31 healthy subjects with similar sex and age. Balance functions were assessed with Balance Evaluation Systems Test (BEST), dizziness and headache severity with Visual Analogue Scale (VAS), disability related to dizziness with Dizziness Handicap Inventory (DHI), cognition with Stroop test.

Results: There was no statistical significant difference among the three groups in terms of age, gender, height, weight, marital status and education levels (p>0.05). Headache severity was higher in migraineurs than vestibular migraineurs and healthy subjects, also dizziness severity was higher in vestibular migraineurs than migraineurs and healthy subjects (p<0.0167). The outcomes of BEST 4, 5, 6 and BEST-total were significantly impaired in VM patients than migraineurs and healthy subjects, and worse in migraineurs rather than healthy subjects (p<0.0167). Stroop effect of cognitive examination was worse in VM and migraine patients rather than healthy subjects (p<0.0167). There was no significantly difference between VM and migraineurs (p>0.0167). There was a negative correlation between Stroop effect and BEST-total in VM patients significantly (r=-0.509, p=0.003), and no significant correlation in migraineurs (p>0.05). Disability levels of VM patients were low in 38.7%, mild in 51.6% and severe in 9.7% related to DHI. There was no significant difference between balance and cognition function in terms of disability levels (p>0.05).

Conclusion: The balance and cognition in VM patients and migraineurs were impaired rather than healthy subjects. The patient groups differed from each other in terms of vertiginous complaints rather than cognition. Solving the functional limitations with further longitudinal examinations can facilitate the treatment. The appropriate physiotherapy programs and patient education methods can be planned for these various issues.
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http://dx.doi.org/10.29399/npa.12617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045802PMC
March 2018

Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project.

J Neurol 2018 Oct 16;265(Suppl 1):3-8. Epub 2018 Apr 16.

Department of Neurology, Ege University, Izmir, Turkey.

Purpose: Comprehensive phenotypical data across countries is needed to understand the determinants, prognosis and consequences of vestibular disease. The registry is a data repository for the members of the European DizzyNet. We report results from a pilot study using data from Turkey and Germany.

Methods: The pilot study included a convenience sample of patients aged 18 or above referred to Ege University Medical School Hospital, Dokuz Eylül University Hospital, Izmir, Turkey, and the German Center for German Center for Vertigo and Balance Disorders, University on Munich, Germany, with symptoms of vertigo or dizziness. Health-related quality of life was assessed with the EQ5-D and the Dizziness Handicap Inventory (DHI). To obtain comparable groups we matched data from the two countries for age, sex and diagnosis by propensity score.

Results: We included 80 adult patients, 40 from each country (60% female, mean age 54.1, SD 12.4). Matching was successful. Vestibular migraine (34%) was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (29%) and Menière's disease (12%). Clinical signs and symptoms were comparable in both countries. Patients from Turkey were more likely to report headaches (65 vs. 32%) and to show gait unsteadiness (51 vs. 5%). Patients from Germany reported significantly higher quality of life and lower values of the DHI score.

Conclusions: Sharing data facilitates research, enhances translation from basic science into clinical applications, and increases transparency. The DizzyNet registry is a first step to data sharing in vestibular research across Europe.
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http://dx.doi.org/10.1007/s00415-018-8864-1DOI Listing
October 2018

Comparison of Audiological Findings in Patients with Vestibular Migraine and Migraine.

Turk Arch Otorhinolaryngol 2017 Dec 2;55(4):158-161. Epub 2017 Oct 2.

Department of Neurology, Dokuz Eylül University School of Medicine, İzmir, Turkey.

Objective: The aim of this study was to investigate and compare the auditory findings in vestibular migraine (VM) and migraine patients without a history of vertigo.

Methods: This study was conducted on 44 patients diagnosed with definite VM and 31 patients diagnosed with migraine who were followed and treated between January 2011 and February 2015. Also, 52 healthy subjects were included in this study as a control group. All participants underwent a detailed otorhinolaryngological examination followed by audiological evaluation, including pure tone audiometry, speech reception threshold, speech recognition score, and acoustic immitancemetry.

Results: In the VM group, there were 16 patients (36.4%) with tinnitus, while in the other groups we did not observe any patients with tinnitus. The rate of tinnitus in the VM group was significantly higher in comparison to other groups (p<0.05). None of the groups had any patients with permanent or fluctuating sensorineural hearing loss.

Conclusion: We conclude that patients with VM should be closely and longitudinally followed up for the early detection of other otological symptoms and possible occurrence of sensorineural hearing loss in the long term.
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http://dx.doi.org/10.5152/tao.2017.2609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839523PMC
December 2017

Vestibular impairment in chronic inflammatory demyelinating polyneuropathy.

J Neurol 2018 Feb 19;265(2):381-387. Epub 2017 Dec 19.

Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a common, treatable, autoimmune peripheral neuropathy considered to produce imbalance by weakness and proprioceptive impairment rather than vestibular impairment. We measured semicircular canal vestibular function in 21 CIDP patients (15M/6F) by the video head impulse test and postural stability with a battery comprising the modified Clinical Test of Sensory Integration and Balance, the Berg Balance Scale, the Dynamic Gait Index, the Fall Efficiency Scale, and the International Cooperative Ataxia Rating Scale. Of the 21 patients, 16 had vestibular impairment, ranging from mild-affecting just a single semicircular canal, to severe-affecting all 6 canals. Although the severity of the vestibular impairment did not correlate either with the severity of the postural imbalance or of the peripheral neuropathy, our data show that vestibular impairment is an additional challenge to balance that some CIDP patients will face.
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http://dx.doi.org/10.1007/s00415-017-8712-8DOI Listing
February 2018

Convergence spasm due to aquaporin-positive neuromyelitis optica spectrum disorder.

eNeurologicalSci 2017 Jun 6;7:7-8. Epub 2017 Mar 6.

Dokuz Eylül University Hospital, Neurology Department.

A female 27 presented with nausea and diplopia for 1 week. On examination she had normal vertical gaze but would develop convergence with miosis whenever she made horizontal saccades. Pupils were 6 mm and unreactive to light. MRI showed extensive hyperintensity in the dorsal midbrain and thalamus. Spinal MRI and CSF were both normal. Serum aquaporin-4-antibody was positive. She was treated with steroids and plasmapheresis and after 3 months convergence spasm resolved but pupils remained unreactive. Neuromyelitis optica often presents with brainstem signs, rarely a dorsal midbrain syndrome. Convergence spasm is occasionally of organic neurologic origin.
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http://dx.doi.org/10.1016/j.ensci.2017.03.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5721560PMC
June 2017

Pseudotumor cerebri syndrome without cerebral venous sinus thrombosis in Behçet's disease.

J Neurol Sci 2017 12 5;383:99-100. Epub 2017 Nov 5.

Department of Neurology, Faculty of Medicine, Bilim University, İstanbul, Turkey.

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http://dx.doi.org/10.1016/j.jns.2017.10.038DOI Listing
December 2017

Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms.

J Neurol 2017 Oct 9;264(Suppl 1):37-41. Epub 2017 Mar 9.

Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.

The link between vertigo and anxiety is well known. The aim of this study is to compare anxiety disorders in 3 groups: patients with vestibular migraine (VM), patients with migraine but without vertigo (MO) and healthy controls (HC).We performed cross-sectional analysis of following tests: (a) Hamilton Anxiety Rating Scale (HAMA); (b) State-Trait Anxiety Inventory (STAI-X1 and STAI-X2); (c) Beck Depression Inventory (BDI); (d) Panic-Agoraphobic Scale and (e) Penn State Worry Questionnaire (PSWQ). ANOVA, Kruskal-Wallis and Chi-square tests were used for comparisons and least significant difference was used for further post-hoc analysis. There were 35 definite VM patients, 31 MO patients and 32 volunteer HC. There were no significant differences between three groups in age, total years of education or duration of headaches in VM and MO patients. On the other hand, vertigo severity  was moderately and positively correlated with headache severity and with headache duration. There were significant differences in scores of HARS, BDI, PSWQ, and various PAS-R sub-scales between the three groups. Our study shows that VM patients are significantly more anxious and agoraphobic than MO patients and HC, displaying higher sensitivity to separation and being more prone to seeking medical reassurance.
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http://dx.doi.org/10.1007/s00415-017-8439-6DOI Listing
October 2017

Erratum to: Neuro-otology-some recent clinical advances.

J Neurol 2017 Jan;264(1):204

Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.

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http://dx.doi.org/10.1007/s00415-016-8320-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828376PMC
January 2017

Search for SCA2 blood RNA biomarkers highlights Ataxin-2 as strong modifier of the mitochondrial factor PINK1 levels.

Neurobiol Dis 2016 Dec 3;96:115-126. Epub 2016 Sep 3.

Experimental Neurology, Goethe University Medical School, 60590 Frankfurt/Main, Germany. Electronic address:

Ataxin-2 (ATXN2) polyglutamine domain expansions of large size result in an autosomal dominantly inherited multi-system-atrophy of the nervous system named spinocerebellar ataxia type 2 (SCA2), while expansions of intermediate size act as polygenic risk factors for motor neuron disease (ALS and FTLD) and perhaps also for Levodopa-responsive Parkinson's disease (PD). In view of the established role of ATXN2 for RNA processing in periods of cell stress and the expression of ATXN2 in blood cells such as platelets, we investigated whether global deep RNA sequencing of whole blood from SCA2 patients identifies a molecular profile which might serve as diagnostic biomarker. The bioinformatic analysis of SCA2 blood global transcriptomics revealed various significant effects on RNA processing pathways, as well as the pathways of Huntington's disease and PD where mitochondrial dysfunction is crucial. Notably, an induction of PINK1 and PARK7 expression was observed. Conversely, expression of Pink1 was severely decreased upon global transcriptome profiling of Atxn2-knockout mouse cerebellum and liver, in parallel to strong effects on Opa1 and Ghitm, which encode known mitochondrial dynamics regulators. These results were validated by quantitative PCR and immunoblots. Starvation stress of human SH-SY5Y neuroblastoma cells led to a transcriptional phasic induction of ATXN2 in parallel to PINK1, and the knockdown of one enhanced the expression of the other during stress response. These findings suggest that ATXN2 may modify the known PINK1 roles for mitochondrial quality control and autophagy during cell stress. Given that PINK1 is responsible for autosomal recessive juvenile PD, this genetic interaction provides a concept how the degeneration of nigrostriatal dopaminergic neurons and the Parkinson phenotype may be triggered by ATXN2 mutations.
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http://dx.doi.org/10.1016/j.nbd.2016.09.002DOI Listing
December 2016

Neuro-otology- some recent clinical advances.

J Neurol 2017 Jan 15;264(1):188-203. Epub 2016 Sep 15.

Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.

Vestibular disorders manifesting as vertigo, chronic dizziness and imbalance are common problems in neurological practice. Here, we review some recent interesting and important advances in diagnosis of vestibular disorders using the video head impulse test and in the management of benign positional vertigo and migrainous vertigo.
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http://dx.doi.org/10.1007/s00415-016-8266-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225204PMC
January 2017

Room tilt illusion: a symptom of both peripheral and central vestibular disorders.

Acta Neurol Belg 2017 03 25;117(1):363-365. Epub 2016 Mar 25.

Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.

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http://dx.doi.org/10.1007/s13760-016-0628-zDOI Listing
March 2017

Vestibular symptoms are more frequent in migraine than in tension type headache patients.

J Neurol Sci 2015 Oct 27;357(1-2):295-6. Epub 2015 Jun 27.

Department of Public Health, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.

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http://dx.doi.org/10.1016/j.jns.2015.06.059DOI Listing
October 2015

Population-based study of vestibular symptoms in migraineurs.

Acta Otolaryngol 2015 May 9;135(5):435-9. Epub 2015 Feb 9.

Department of Neurology, Faculty of Medicine, Dokuz Eylül University , İzmir.

Conclusion: The differences between migraineurs with vertigo or motion sickness or both, and migraineurs with neither might reflect differences in migraine pathophysiology.

Objective: To assess vestibular symptoms in 871 definite migraineurs.

Methods: Data were gathered using a structured questionnaire. We considered responses to only 2/150 questions: (1) 'have you had vertigo with or apart from your headaches?' and (2) 'have you experienced motion sickness most of your life?'. The target groups were: (a) migraineurs with either vertigo or motion sickness, 'migraine with vestibular symptoms' (MwVS), their control group being migraineurs with neither vertigo nor motion sickness, 'migraine without vestibular symptoms' (MwoVS); (b) migraineurs who reported vertigo, 'migraine with vertigo' (MwV); their control group being migraineurs without vertigo (MwoV).

Results: Among the 871 definite migraineurs, 534 had MwV, 337 had MwoV, 663 had MwVS, and 208 had MwoVS. The MwVS group had more headache, aura, nausea, vomiting, osmophobia, allergy, allodynia, headache increasing with head motion, noise as trigger for headache, days needing analgesics, and higher migraine disability scores than the MwoVS group. The pattern was the same in the MwV vertigo group as in the MwVS group, apart from migraine disability scores, which were no different.
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http://dx.doi.org/10.3109/00016489.2014.969382DOI Listing
May 2015

Vestibular rehabilitation in acute central vestibulopathy: a randomized controlled trial.

J Vestib Res 2013 ;23(4-5):259-67

School of Physiotherapy and Rehabilitation, Dokuz Eylul University, Izmir, Turkey.

Objective: To investigate the effects of two different rehabilitation programs in acute central vestibulopathy secondary to posterior circulation stroke.

Method: A prospective randomized controlled study was conducted on 25 patients with posterior circulation stroke. Patients were instructed in routine balance and mobility exercises during the acute hospitalization period. At discharge, patients were assigned to either a rehabilitation or home exercise group. The home exercise group was instructed to perform the same exercise program provided in the course of hospitalization period. The rehabilitation group was randomized into the visual feedback posturography training or vestibular rehabilitation group. The balance and gait performance were assessed with clinical and objective measurements before and after 6 weeks of training.

Results: The balance and gait scores were significantly improved in both rehabilitation groups and in the home exercise group (p< 0.05), but no significant difference was found between the groups in terms of post-treatment values (p> 0.05).

Conclusion: The improvements of balance and gait function in rehabilitation groups did not differ from the home exercise group. Rehabilitation programs were equally effective to improve the recovery in acute central vestibulopathy.
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http://dx.doi.org/10.3233/VES-130491DOI Listing
July 2014

Vestibular Migraine.

Authors:
Gülden Akdal

Noro Psikiyatr Ars 2013 Aug 1;50(Suppl 1):S56-S59. Epub 2013 Aug 1.

Dokuz Eylül University, Medical Faculty, Department of Neurology, Izmir, Turkey.

The co-occurrence between migraine and vertigo has been noticed for a long time ago. In recent years, however, growing numbers of epidemiological and clinical studies have definitely shown the significant relation between these two diseases. Recently, the term "vestibular migraine" is used commonly in studies. Vestibular migraine has taken place in appendix in the latest International Headache Society Classification. In this review, epidemiology, clinical features, diagnostic criteria and treatment of vesti-bular migraine will be discussed.
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http://dx.doi.org/10.4274/Npa.y7300DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353080PMC
August 2013

The prevalence of vestibular symptoms in migraine or tension-type headache.

J Vestib Res 2013 Jan;23(2):101-6

Department of Neurology, Dokuz Eylül University Faculty of Medicine, İnciraltı, İzmir, Turkey.

Background: We assessed frequency of vestibular symptoms in Headache Clinic patients over 10 years.

Methods: A descriptive study of 5111 consecutive patients with tension-type headache or migraine, analyzed for dizziness/ vertigo accompanying headache and for a lifetime history of motion-sickness, cyclic vomiting, recurrent abdominal pain or atopy. Migraine patients were re-grouped as those with vestibular symptoms (dizziness/vertigo or motion sickness) and those without and their data then re-analyzed.

Results: There were 1880 migraine patients and 3231 tension-type headache patients. Significantly more migraine patients than tension-type headache patients experienced vestibular symptoms (p< 0.0001). The migraine with vestibular symptoms group was significantly younger (p< 0.05) had more aura, more phonophobia with migraine attacks (p< 0.0001). Menstruation and reported sleep problems impacted on headaches. While past history of cyclical vomiting, recurrent abdominal pain or atopy was about twice as common in migraine with aura and it was also more common in migraine with vestibular symptoms than migraine without vestibular symptoms.

Conclusions: Vestibular symptoms are common in migraine patients. Migraine with vestibular symptoms might constitute a special group, one more likely to have had cyclic vomiting, recurrent abdominal pain or atopy.
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http://dx.doi.org/10.3233/VES-130477DOI Listing
January 2013

Sudden vertigo in a 49-year-old man.

J Clin Neurosci 2012 Dec;19(12):1699, 1751

Department of Neurology and Department of Neurosciences, Dokuz Eylul University Hospital, Inciralti-Izmir 35340, Turkey.

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http://dx.doi.org/10.1016/j.jocn.2011.11.045DOI Listing
December 2012