Publications by authors named "Husnu Efendi"

16 Publications

  • Page 1 of 1

White Matter Evaluation in Multiple Sclerosis Through Magnetic Resonance Kurtosis Imaging.

Cureus 2019 Dec 19;11(12):e6424. Epub 2019 Dec 19.

Biomedical Engineering, Kocaeli University, Kocaeli, TUR.

Objectives: To investigate diffusional changes in multiple sclerosis (MS) plaques and non-Gaussian behavior of water diffusion by using diffusional kurtosis imaging (DKI).

Methods: 31 MS patients and 21 controls underwent MRI on a 3T scanner. Mean kurtosis (MK) parametric maps were computed. Region of interest (ROI) was delineated as white matter (WM) in controls and MS plaques and WM in patients.

Results: There was no significance of WM kurtosis and skewness parameters among MS group and control group patients p=0.213 and p=0.390, respectively. In MS patients, kurtosis, skewness, maximum intensity, minimum intensity, and median intensity values of WM, Plaque 1, Plaque 2, and Plague 3 were significantly higher at p<0.0001 for all.  Conclusions: DKI may provide more extensive characterization of lesions and WM and may be a sensitive indicator of tissue damage and microstructural change in patients with MS in addition to conventional diffusional evaluations.
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http://dx.doi.org/10.7759/cureus.6424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6970098PMC
December 2019

Comparative analysis of fingolimod versus teriflunomide in relapsing-remitting multiple sclerosis.

Mult Scler Relat Disord 2019 Nov 26;36:101376. Epub 2019 Aug 26.

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

Background: Fingolimod and teriflunomide are commonly used in the treatment of relapsing-remitting multiple sclerosis (RRMS). These have not been compared in controlled trials, but only in observational studies, with inconclusive results. Comparison of their effect on relapse and disability in a real-world setting is therefore needed.

Objectives: The objective of this study was to compare the efficacy of fingolimod and teriflunomide in reducing disease activity in RRMS.

Methods: This multicenter, retrospective observational study was carried out with prospectively collected data from 15 centers. All consecutive RRMS patients treated with teriflunomide or fingolimod were included. Data for relapses, Expanded Disability Status Scale (EDSS) scores and brain magnetic resonance imaging (MRI) scans were collected. Patients were matched using propensity scores. Annualized relapse rates (ARR), disability accumulation, percentage of patients with active MRI and treatment discontinuation over a median 2.5-year follow-up period were compared.

Results: Propensity score matching retained 349 out of 1388 patients in the fingolimod group and 349 out 678 in the teriflunomide group for final analyses. Mean ARR decreased markedly from baseline after 1 and 2 years of treatment in both the fingolimod (0.58-0.17 after 1 year and 0.11 after 2 years, p < 0.001) and teriflunomide (0.56-0.29 after 1 year and 0.31 after 2 years, p < 0.001) groups. Mean ARR was lower in fingolimod-treated patients than in those treated with teriflunomide at years 1 (p = 0.02) and 2 (p = 0.004). Compared to teriflunomide, the fingolimod group exhibited a higher percentage of relapse-free patients and a lower percentage of MRI-active patients after 2.5-year follow-up. Disability worsening was similar between the two groups. Patients were less likely to discontinue fingolimod than teriflunomide (p < 0.001).

Conclusion: Fingolimod was associated with a better relapse control and lower discontinuation rate than teriflunomide. The two oral therapies exhibited similar effects on disability outcomes.
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http://dx.doi.org/10.1016/j.msard.2019.101376DOI Listing
November 2019

Erratum: Evaluating Treatment Decision for Multiple Sclerosis: Real Life and Patient Experiences.

Noro Psikiyatr Ars 2019 03;56(1):82

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

[This corrects the article on p. S10 in vol. 55, PMID: 30692848.].
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http://dx.doi.org/10.29399/npa.23599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6427070PMC
March 2019

Evaluating Treatment Decision for Multiple Sclerosis: Real Life and Patient Experiences.

Noro Psikiyatr Ars 2018 ;55(Suppl 1):S10-S14

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

There are different decision-making models in medicine for treatment decisions. Shared decision-making model is the most appropriate and widely used model for chronic diseases like Multiple Sclerosis (MS). In this model, the decision making process like treatment options is being discussed step by step between patients and physicians. However, increasing treatment options and medication side effects make the decision-making process more difficult for physicians and reveal the need to share wider knowledge with the patient. In this article we evaluate treatment decision making in patients with MS involving real life experiences.
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http://dx.doi.org/10.29399/npa.23164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6278628PMC
January 2018

A 12-month, Open Label, Multicenter Pilot Study Evaluating Fingolimod Treatment in terms of Patient Satisfaction in Relapsing Remitting Multiple Sclerosis Patients - FINE Trial.

Noro Psikiyatr Ars 2019 Dec 22;56(4):253-257. Epub 2017 Jun 22.

Department of Medical, Novartis Pharmaceuticals Turkey, İstanbul, Turkey.

Introduction: To assess satisfaction and quality of life in patients with relapsing-remitting multiple sclerosis (RRMS) who were receiving fingolimod (0.5 mg/day) for 12 months as a second-line treatment after switching from injectable agents.

Methods: Patients aged 18-65 years with RRMS who fulfilled the eligibility criteria were enrolled from 16 centers throughout Turkey. Treatment Satisfaction Questionnaire for Medication and 36-item Short-Form Health Survey were completed at baseline and four visits to assess patient satisfaction and quality of life.

Results: Forty-two patients (62% male; mean age: 35.7±9.4 years) were eligible for inclusion. Patient satisfaction scores at the end of the study (44.7±9.9) were significantly higher than those at baseline [32.0±9.9; (p<0.001)]. The only significant increase in the quality of life survey was in the emotional aspect (p=0.019). There were 124 adverse events and none of the five serious adverse events noted was considered drug-related.

Conclusion: Large-scale comparative studies performed with disease specific quality of life instruments will allow more information on this issue.
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http://dx.doi.org/10.5152/npa.2017.20515DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927087PMC
December 2019

Differences Between General Neurologists and Multiple Sclerosis Specialists in the Management of Multiple Sclerosis Patients: A National Survey.

Noro Psikiyatr Ars 2019 Dec 20;56(4):269-272. Epub 2017 Jun 20.

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

Introduction: The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs).

Methods: We conducted a survey of 36 questions to 318 neurologists, including 33 MSSs. The survey covered topics including laboratory investigations, pregnancy, and treatment.

Results: Our study found many differences between GNs and MSSs in terms of management, the most important being treatment initiation and switching. GNs had a tendency to initiate treatment later than MSSs however, they tended to switch treatment faster. Our study also showed that GNs ordered magnetic resonance imaging (MRI) more frequently than MSSs, even if patients were clinically stable. Moreover, although GNs more frequently relied on MRI, they did not consider brain atrophy as an important measure in the follow-up of their patients. Furthermore, GNs considered replacement therapy less often than MSSs, even in patients with vitamin D deficiency.

Discussion: Our study revealed important discrepancies between the management patterns of GNs and MSSs in MS patients. These findings suggest the need for a national education program for GNs on MSSs.
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http://dx.doi.org/10.5152/npa.2017.19387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6927082PMC
December 2019

Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management.

Authors:
Hüsnü Efendi

Noro Psikiyatr Ars 2015 Dec 1;52(Suppl 1):S1-S11. Epub 2015 Dec 1.

Department of Neurology, Division of Internal Medicine, Kocaeli University Research and Practice Hospital, Kocaeli, Turkey.

Clinically isolated syndrome (CIS) is a term that describes the first clinical onset of potential multiple sclerosis (MS). The term CIS is typically applied to young adults with episodes of acute or subacute onset, which reaches a peak quite rapidly within 2-3 weeks. In 85% of young adults who develop MS, onset occurs with an acute, CIS of the optic nerves, brainstem, or spinal cord. When clinically silent brain lesions are seen on MRI, the likelihood of developing MS is high. Because no single clinical feature or diagnostic test is sufficient for the diagnosis of CIS, diagnostic criteria have included a combination of both clinical and paraclinical studies. Diagnostic criteria from the International Panel of McDonald and colleagues incorporate MRI evidence of dissemination in time and space to allow a diagnosis of definite MS in patients with CIS. As CIS is typically the earliest clinical expression of MS, research on patients with CIS may provide new insights into early pathological changes and pathogenetic mechanisms that might affect the course of the disorder. With recent improvements in diagnosis and the advent of disease-modifying treatments for MS, there has been growing interest and research in patients with CIS.
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http://dx.doi.org/10.5152/npa.2015.12608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353226PMC
December 2015

The effect of pulse methylprednisolone plus theophylline treatment on clinical, pulmonary and inflammatory markers in relapses of multiple sclerosis.

Balkan Med J 2013 Mar 1;30(1):33-6. Epub 2013 Mar 1.

Department of Chest Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.

Objective: The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses.

Study Design: Double blind randomized controlled trial.

Material And Methods: The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5(th) and 30(th) days of the treatment.

Results: Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5(th) day 2.4±1.6; 30(th) day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level.

Conclusion: There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.
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http://dx.doi.org/10.5152/balkanmedj.2013.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116016PMC
March 2013

Protective effects of pentoxifylline and nimodipine on acoustic trauma in Guinea pig cochlea.

Otol Neurotol 2011 Aug;32(6):919-25

Department of Otolaryngology-Head and Neck Surgery, Baskent University, Ankara, Turkey.

Objective: To examine the protective effects of the vasodilator and hemorheologically active drug pentoxifylline and the calcium channel blocker nimodipine on the cochlea after acoustic overexposure in guinea pigs.

Methods: Eighteen guinea pigs were used. The animals were divided into 5 groups: 1) control, 2) acoustic trauma, 3) nimodipine plus acoustic trauma, 4) pentoxifylline plus acoustic trauma, and 5) pentoxifylline plus nimodipine plus acoustic trauma. Nimodipine was given to the guinea pigs 3 mg/kg intraperitoneally in a single dose; pentoxifylline was given 150 mg/kg in a single dose intraperitoneally. A gunnery range was used to create acoustic trauma. The auditory brainstem response of each guinea pig was determined first; then, the animals were killed, and their cochleas were examined under an electron microscope.

Results: In the acoustic trauma group, negative auditory brainstem response potentials were seen as was well-adjusted cellular damage to the organ of Corti. In the pentoxifylline group, near-normal auditory brainstem response recordings and organ of Corti histologic findings were found. Organ of Corti damage was seen in the pentoxifylline plus nimodipine plus acoustic trauma group.

Conclusion: We determined that pentoxifylline was highly protective against noise, but nimodipine was not. Also, pentoxifylline and nimodipine, when used together, increased damage to the organ of Corti.
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http://dx.doi.org/10.1097/MAO.0b013e3182267e06DOI Listing
August 2011

Medium-latency reflex response of soleus elicited by peroneal nerve stimulation.

Exp Brain Res 2009 Feb 5;193(2):275-86. Epub 2008 Nov 5.

The Department of Clinical Neurophysiology, Ege University Medical School Hospital, Izmir, Turkey.

A medium-latency response (MLR) has been recorded from soleus during stance and walking, and has been attributed to stretch-evoked volleys in group II afferents. The present paper describes a MLR in soleus evoked by stimulating the deep peroneal nerve, documents its characteristics and addresses its likely origin. The MLR of soleus was recorded in healthy subjects and hemiplegic patients, following electrical stimulation of the deep peroneal nerve at the fibula at rest, during voluntary dorsiflexion, during plantar flexion, during external restraint to the ankle dorsiflexion movement, during limb cooling, during limb ischaemia and 1 h after the ingestion of tizanidine. The dorsiflexion movement of the foot was measured using an accelerometer. During cooling, ischaemia and after tizanidine, changes in the MLR were compared with changes in the soleus H reflex, Achilles tendon reflex and, during cooling, F waves of abductor hallucis. The MLR was facilitated by voluntary dorsiflexion, was suppressed during plantar flexion, disappeared when ankle movement was prevented, and was enhanced in patients with spastic hemiplegia. Cooling delayed the MLR significantly more than the Achilles tendon reflex and the abductor hallucis F wave. During ischaemia the response was significantly less affected than the Achilles tendon reflex and the soleus H reflex. Tizanidine suppressed the MLR, but not the soleus H and tendon reflexes. The latencies and the experiments using cooling, ischaemia and tizanidine implicate soleus group II afferents in the genesis of this response.
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http://dx.doi.org/10.1007/s00221-008-1621-4DOI Listing
February 2009

Route learning impairment associated with encephalomalasia secondary to traumatic brain injury: a case report.

Appl Neuropsychol 2008 ;15(2):150-5

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

Topographical disorientation is marked by difficulty finding one's way in familiar or new environments. The present case study reports findings from a 30-year-old male with encephalomalasia of the left parahippocampal region secondary to brain trauma with subsequent difficulty in learning of new routes. His navigation in premorbidly known (familiar) surroundings was intact. Magnetic resonance images revealed left parahippocampal and bilateral occipital encephalomalasia. Neuropsychological screening showed impairment in structuring a representation of the spatial relationships among landmarks with relatively preserved ability to learn visual and verbal information of these landmarks. Decreased visual perception and inappropriate visual inputs due to cervical dystonia and right homonymous hemianopsia also appear to play a role in his disability. The current knowledge about the neuronal systems involved in visual cognition and topographical orientation also are addressed in this report.
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http://dx.doi.org/10.1080/09084280802073328DOI Listing
July 2008

The investigation of Chlamydophila pneumoniae in patients with multiple sclerosis.

Int J Neurosci 2007 Mar;117(3):409-15

Kocaeli University, Medical School, Department of Medical Microbiology, Kocaeli, Turkey.

Totally 32 cerebrospinal fluid samples from Multiple sclerosis (MS) patients were collected. DNA was extracted by High Pure PCR Template Preparation Kit. Two genomic segments, outer membrane protein genes ompA and omp9, were targeted for the detection of C. pneumoniae DNA in the samples by PCR tests. To detect ompA, a nested-PCR assay was designed, whereas for omp9, a PCR-Enyzme immunoassay (PCR-EIA) depending on streptavidin-biotin capture and dig detection of the PCR products was performed. C. pneumoniae DNA was not detected by each assays in patient samples.
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http://dx.doi.org/10.1080/00207450600773541DOI Listing
March 2007

Fahr's disease presenting with paroxysmal non-kinesigenic dyskinesia: a case report.

Parkinsonism Relat Disord 2008 19;14(1):69-71. Epub 2007 Jan 19.

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

Fahr's disease is characterized by presence of abnormal calcifications in certain areas of the brain. We report on 23-year-old man admitted to us with the episodes of paroxysmal non-kinesigenic dyskinesia. He was detected to have symmetrical intracerebral calcifications in basal ganglia, thalamus and cerebellar hemispheres, and diagnosed as sporadic Fahr's disease. Paroxysmal dyskinesia was well responded to oxcarbazepine (600 mg/day) treatment.
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http://dx.doi.org/10.1016/j.parkreldis.2006.11.008DOI Listing
April 2008

Fibrous dysplasia of the cranial bones: a case report and review of the literature.

Yale J Biol Med 2005 May;78(3):141-5

Department of Neurology, University of Kocaeli, Derince, Izmit, Turkey.

Fibrous dysplasia (FD) is a relatively uncommon disorder that affects primarily the cranial region; its occurrence in the cranial base in combination with hindbrain herniation and aneurysmal bone cyst (ABC) constitutes an extremely rare condition. We report a case of polyostotic fibrous dysplasia with progressive occipital, temporal, and clival involvement. Clinical findings and differential diagnosis with special emphasis on the imaging features were discussed. A small posterior fossa volume has been thought to lead to hind brain herniation. The resultant obstruction to the CSF pathways at the level of the foramen magnum has been implicated in the development and subsequent progression of syringobulbia.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2259144PMC
May 2005

A non-traumatic interhemispheric subdural haematoma: presented with headache as the sole complaint.

J Headache Pain 2005 Feb 25;6(1):48-50. Epub 2005 Jan 25.

Department of Neurology, Faculty of Medicine, University of Kocaeli, Derince 41900, Kocaeli, Turkey.

Due to their localisations and symptoms, interhemispheric subdural haematomas (ISH) compose a distinct category. Altered level of consciousness and hemiparesis are the most frequent symptoms. We report a case of ISH who presented with headache as the sole complaint. Left cerebellar haematoma and ISH were found in cranial MRI and cranial computed tomography Cranial MR angiogram was normal. Haemogram and coagulation parameters were within normal limits. ISH should be considered among the diagnostic possibilities in elderly patients who present with headache as the sole symptom without other clinical features such as meningeal irritation signs, focal neurological symptoms and alteration of consciousness. Cranial imaging studies should be done in such cases.
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http://dx.doi.org/10.1007/s10194-005-0149-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3451952PMC
February 2005