Publications by authors named "Pinar Yalinay Dikmen"

23 Publications

  • Page 1 of 1

Intraoperative neuromonitoring practice patterns in spinal deformity surgery: a global survey of the Scoliosis Research Society.

Spine Deform 2021 Mar 23;9(2):315-325. Epub 2020 Nov 23.

Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.

Purpose: Although multimodal IONM has reached a widespread use, several unresolved issues have remained in clinical practice. The aim was to determine differences in approaches to form a basis for taking actions to improve patient safety globally.

Methods: A survey comprising 19 questions in four sections (demographics, setup, routine practices and reaction to alerts) was distributed to the membership of the SRS.

Results: Of the estimated 1300 members, 205 (~ 15%) completed the survey. Respondent demographics reflected SRS member distribution. Most of the respondents had > 10 years of experience. TcMEP and SSEP were available to > 95%. Less than 5% reported that a MD/PhD with neurophysiology background routinely examines patients preoperatively, while 19% would consult if requested. After an uneventful case, 36% reported that they would decrease sedation and check motor function if the patient was to be transferred to ICU intubated. Reactions to dropped signals that recovered or did not fully recover varied between attempting the same correction to aborting the surgery with no rods and returning another day, with or without implant removal. After a decrease of signals, 85.7% use steroids of varied doses. Of the respondents, 53.7% reported using the consensus-created checklist by Vitale et al. Approximately, 14% reported never using the wake-up test while others use it for various conditions.

Conclusion: The responses of 205 experienced SRS members from different regions of the world showed that surgeons had different approaches in their routine IONM practices and in the handling of alerts. This survey indicates the need for additional studies to identify best practices.
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http://dx.doi.org/10.1007/s43390-020-00246-7DOI Listing
March 2021

Thoracoscopic Vertebral Body Tethering for Adolescent Idiopathic Scoliosis: Follow-up Curve Behavior According to Sanders Skeletal Maturity Staging.

Spine (Phila Pa 1976) 2020 Nov;45(22):E1483-E1492

Department of Orthopedics and Traumatology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey.

Study Design: Retrospective analysis of prospectively collected data.

Objective: To report the follow-up curve behaviors in different Sanders staging groups.

Summary Of Background Data: Vertebral body tethering (VBT) is a growth modulation technique that allows gradual spontaneous follow-up curve correction as the patient grows. There is a lack of scientific evidence regarding appropriate patient selection and timing of implantation.

Methods: Patients were grouped into five as: Sanders 1, 2, 3, 4-5, and 6-7. Data were collected preoperatively, at the day before discharge, and at each follow-up. Outcome measures were pulmonary and mechanical complications, readmission, and reoperation rates. Demographic, perioperative, clinical, radiographic, and complication data were compared using Fisher-Freeman-Halton exact tests for categorical variables and Kruskal-Wallis tests for the continuous variables.

Results: Thirty-one (29 F, 2 M) consecutive patients with a minimum of 12 months of follow-up were included. The mean age at surgery was 12.1 (10-14). The mean follow-up was 27.1 (12-62) months. The mean preoperative main thoracic curve magnitude was 47° ± 7.6°. For all curves, preoperative and first erect curve magnitudes, bending flexibility, and operative correction percentages were similar between groups (for all comparisons, P > 0.05). The median height gained during follow-up was different between groups (P < 0.001), which was reflected into median curve correction during follow-up. Total curve correction percentage was different between groups (P = 0.009). Four (12.9%) patients had pulmonary and six (19.4%) had mechanical complications. One (3.2%) patient required readmission and two (6.5%) required reoperation. Occurrence of pulmonary complications was similar in Sanders groups (P = 0.804), while mechanical complications and overcorrection was significantly higher in Sanders 2 patients (P = 0.002 and P = 0.018).

Conclusion: Follow-up curve behavior after VBT is different in patients having different Sanders stages. Sanders 2 patients experienced more overcorrection, thus timing and/or correction should be adjusted, since Sanders 3, 4, and 5 patients displayed a lesser risk of mechanical complications.

Level Of Evidence: 3.
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http://dx.doi.org/10.1097/BRS.0000000000003643DOI Listing
November 2020

Intraoperative motor speech mapping under general anesthesia using long-latency response from laryngeal muscles.

Clin Neurol Neurosurg 2020 03 8;190:105672. Epub 2020 Jan 8.

Acibadem Mehmet Ali Aydinlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.

Objective: The aim of our study was to determine any association between preservation of long latency response evoked by electrophysiological mapping of the caudal part of the pars opercularis (inferior frontal gyrus Broca area) and postoperative speech function after tumour removal in patients under general anesthesia.

Patients And Methods: Twelve native Turkish-speaking patients with tumors in the dominant left frontal lobe, near the Broca area, were included in a single-center prospective cohort study. Hooked-wire electrodes were placed in both cricothyroid muscles (CTHY) before anesthesia and a monopolar electrode was used to stimulate the caudal portion of the pars opercularis of the inferior frontal gyrus before and after tumor removal. A long latency response (LLR) elicited at the contralateral (CTHY) muscle was interpreted as a positive stimulation of the Broca area. Patients received one pre-op and two post-op cognitive assessments. The Montreal Cognitive Assessment (MoCA) was used to assess global cognition and a "Cookie Theft" picture description task from the Boston Diagnostic Aphasia Examination test was used in assessing the language functions.

Results: Electrical stimulation elicited a long latency response (LLR) in 9 (75 %) out of the 12 patients. The mean latency of the LLR was 50 ± 11 ms. Four (33.3 %) of the 12 patients showed temporary impairment in fluent speech postoperatively and all had full recovery during the 3-month follow-up period.

Conclusions: The use of electrophysiological mapping methods by using EMG recording from laryngeal muscles may help to identify the opercular part of the Broca area under general anesthesia in order to preserve fluent speech functions.
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http://dx.doi.org/10.1016/j.clineuro.2020.105672DOI Listing
March 2020

Determination of Anxiety, Health Anxiety and Somatosensory Amplification Levels in Individuals with Benign Paroxysmal Positional Vertigo.

J Int Adv Otol 2019 Dec;15(3):436-441

Clinic of Ear Nose and Throat, Maslak Acibadem Hospital, İstanbul, Turkey.

Objectives: Psychiatric comorbidities may intensify peripheral vertigo and increase the number of repositioning maneuvers required. This study was designed to examine the relationship between benign paroxysmal positional vertigo (BPPV) and anxiety and assess its association with somatic amplification and health anxiety.

Materials And Methods: Sixty patients with BPPV (43 women, 17 men; age range: 24-81 years, mean age 40.4±13.3), and 60 healthy participants (29 women, 31 men; age range: 18-71, mean age 38.2±11.43) were prospectively enrolled. The participants completed the Beck Anxiety Inventory (BAI), Short Health Anxiety Inventory (SHAI), and Somatosensory Amplification Scale (SSAS) questionnaires.

Results: The BAI scores of the patients with BPPV were higher than those of the control group participants and were as follows: (16.4 vs. 12.7; p=0.01). The SHAI (p=0.44) and SSAS (p=0.60) scores were not significantly different between the two groups. The BAI scores were positively correlated with the SHAI (rho: 0.273, p=0.035) and SSAS (rho: 0.357, p=0.005) scores. Neither the number of BPPV attacks nor the number of Epley maneuvers required showed any correlation with the BAI [(rho: 0.208, p=0.11); (rho: -0.007, p=0.96)], SHAI [(rho: 0.068, p=0.06); (rho: 0.021, p=0.87)], and SSAS [(rho: -0.081, p=0.53); (rho: -0.012, p=0.92)] scores.

Conclusion: Our findings indicate that patients with BPPV had higher anxiety scores than healthy participants. Although our findings indicated normal health anxiety and somatic amplification levels in patients with BPPV, regular evaluation of psychological status would be a good strategy to prevent chronic dizziness.
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http://dx.doi.org/10.5152/iao.2019.6874DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937190PMC
December 2019

Intraoperative neuromonitoring of anterior root muscle response during hip surgery under spinal anesthesia.

J Clin Monit Comput 2019 Aug 10;33(4):695-702. Epub 2018 Nov 10.

Orthopedic and Traumatology Department, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Ic Erenkoy Mah. Kerem Aydınlar Kampusu. Kayısdag Cad. Atasehir, 34752, Istanbul, Turkey.

The aim of this study was to evaluate the anterior root muscle (ARM) response monitorability during total hip arthroplasty (THA) under spinal anesthesia. A total of 20 adults (64.6 ± 13.87 years old) were monitored using ARM response and free-run electromyography during THA. To elicit the ARM response from muscles, percutaneous stimulation of the lumbosacral roots was performed by self-adhesive electrodes placed over the skin of the projection of the first and third lumbar interspinous space (anode) and over the abdominal skin of the umbilicus (cathode). Latency and amplitude values of the ARM response were recorded from both sides (non-operated and operated) and from five muscles as follows: rectus femoris (RF), vastus lateralis (VL), biceps femoris long-head (BF), Tibialis Anterior (TA) and gastrocnemius. The most recorded ARM response in a muscle was the TA (n = 38); the least recorded AMR response in a muscle was the BF (n = 33). The mean stimulus intensities for the non-operated and the operated sides were 462.5 ± 112.8 V and 520.0 ± 172.3 V (p = 0.834), respectively. The mean latencies and amplitude values of the ARM response from muscles were as follows: 8.8 ± 1.4 ms; 98.8 ± 114.5 µV for RF; 9.8 ± 2.1 ms; 119.1 ± 122.23 µV for VL; 9.5 ± 1.6 ms; 39.6 ± 30.3 µV for BF; 15.1 ± 1.9 ms; 146.6 ± 150.9 µV for TA; 15.6 ± 2.4 ms; 81.0 ± 99.9 µV for Gastrocnemius. The present study demonstrates that the ARM response could easily and safely be obtained during THA under spinal anesthesia. This non-invasive technique may have a potential to detect early neurological deficit in patients who need complex hip surgery under spinal anesthesia.
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http://dx.doi.org/10.1007/s10877-018-0212-6DOI Listing
August 2019

Intraoperative Neuromonitoring of Motor-Evoked Potentials in Infants Undergoing Surgery of the Spine and Spinal Cord.

J Clin Neurophysiol 2019 Jan;36(1):60-66

Department of Neurosurgery, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey.

Purpose: The aim of this single-center prospective cohort study is to record reliable transcranial motor-evoked potentials (TcMEPs) and to determine their thresholds under inhalational anesthesia in infants undergoing spine and spinal cord surgery.

Methods: A total of 15 infants (age <12 months) with mean (SD) months: 5.82 ± 3.45 were included. The entry criteria were that the child should be no older than 1 year of age and undergoing a surgical procedure at the conus-cauda region. The patients were monitored with motor-evoked potentials (TcMEPs) and bulbocavernosus reflex.

Results: Transcranial motor-evoked potentials were recorded in all the patients in both upper and lower extremities in one muscle at least. All patients were monitored with a mean TcMEP threshold of 488.46 ± 99.76 V (range 310-740 V). The lowest threshold of TcMEPs was used to record the musculus abductor pollicis brevis mean of 315.15 ± 126.95 V (range 140-690 V) and the highest for musculus sphincter ani mean of 444.17 ± 138.54 V (range 206-700 V).

Conclusions: Intraoperative neuromonitoring for spine and spinal cord procedures of the infant population requires higher TcMEP thresholds and train count. Most patients aged older than 6 months require significantly lower TcMEPs.
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http://dx.doi.org/10.1097/WNP.0000000000000523DOI Listing
January 2019

Electromyography in Pediatric Population.

Noro Psikiyatr Ars 2018 Mar 19;55(1):36-39. Epub 2018 Mar 19.

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

Introduction: Electrodiagnostic evaluation provides an important extension to the neurological examination for the evaluation of pediatric neuromuscular disease. Many pediatric neuromuscular diseases are analogous to those seen in the adult. However, the relative frequency of these illnesses varies greatly when different age populations are compared. The purpose of the present study is to provide a retrospective analysis of children referred to our electromyography (EMG) laboratory for electrophysiological examinations.

Methods: We retrospectively reviewed electrodiagnostic records of patients aged between 0-15 years, from January 2004 to June 2013. Patients were classified as having plexopathy, nerve root lesions, polyneuropathy, myopathy, mononeuropathy, anterior horn cell disease, neuromuscular transmission disorder, facial nerve palsy, and other rare disorders.

Results: We reviewed totally 5563 pediatric records, which was on the average 578 studies per year. It was about 14% of the all EMG examinations performed in our laboratory. When we looked at all the procedures, 3271 of the records included needle EMGs, 170 of them were single fiber EMGs, 100 of them were repetitive nerve stimulations, and 52 of them were evoked potentials. The results were normal in 55% of the cases. As a result of electrophysiological examinations, the common diagnoses were: plexopathy (28.6%), polyneuropathy (7.4%), and myopathy (6.6%) in patients aged 0-5 years (41.2% of all records); myopathy (9.4%), PNP (8.5%), mononeuropathy (6.4%), and plexopathy (5.9%) in 6-10 years (28.2% of all records); PNP (11.3%), myopathy (6.6%), and mononeuropathy (5.6%) in 11-15 years (30.6% of all records).

Conclusion: Infants and toddlers mostly suffered from brachial plexopathy which can be prevented by proper obstetrical management. Nerve conduction studies and EMG yielded diagnostic importance for demyelinating neuropathy and myopathy in patients older than 6 years of age.
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http://dx.doi.org/10.5152/npa.17023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6045805PMC
March 2018

A single-center retrospective study of onabotulinumtoxinA for treatment of 245 chronic migraine patients: survey results of a real-world experience.

Acta Neurol Belg 2018 Sep 10;118(3):475-484. Epub 2018 Jul 10.

Neurology Department, School of Medicine, Acıbadem Mehmet Ali Aydınlar University, Ic Erenkoy Mah. Kerem Aydınlar Kampusu, Kayısdag Cad., Atasehir, 34752, Istanbul, Turkey.

Preventive treatment in migraine is associated with poor adherence and persistence. In this observational study, our first aim was to evaluate the perceived effectiveness of onabotulinumtoxinA based on our chronic migraine (CM) patients' treatment experience. The second purpose of this study was to determine the compliance with onabotulinumtoxinA treatment in our cohort. Third, we assessed the reasons for withdrawal from treatment in our CM patients. A total of 245 consecutive patients with CM (40.43 ± 10.15 years; 214 females, 31 males) were treated with at least one onabotulinumtoxinA. Data were collected by a standardized interview over the telephone. One-hundred and eighty patients were willing to answer questions about: (1) perceived effectiveness of onabotulinumtoxinA based on their treatment experience; (2) the current continuity of the treatment; (3) their current migraine-related disability; and (4) their current medication usage. The mean number of onabotulinumtoxinA cycles of all patients and the participants were 2.58 and 2.90, respectively. Of the 180 participants, 149 patients (82.8%) thought that onabotulinumtoxinA was effective in controlling their headaches. The mean score for perceived effectiveness of onabotulinumtoxinA treatment given by the participants was as 6.94 ± 2.4 (on a scale from 0 to 10). Of the 245 treated subjects, 31 (12.6%) were treated for 12 months. Compliance rates with onabotulinumtoxinA were very low in our population. However, even CM patients who did not complete five cycles of the treatment showed marked improvement of their current migraine-related disability and reduction of their medication intake as compared to baseline.
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http://dx.doi.org/10.1007/s13760-018-0978-9DOI Listing
September 2018

Cocaine-induced multifocal leukoencephalopathy mimicking Balo's concentric sclerosis: A 2-year follow-up with serial imaging of a single patient.

Mult Scler Relat Disord 2018 Jan 20;19:96-98. Epub 2017 Nov 20.

Acibadem Mehmet Ali Aydinlar University, School of Medicine, Radiology Department, Turkey.

Cocaine abuse may cause stroke, metabolic or multifocal inflammatory leukoencephalopathy. We described a patient with cocaine abuse who presented with Balo's type acute multifocal leukoencephalopathy. Magnetic Resonance Imaging (MRI) of the brain showed onion like patchy concentric ring enhancement on T1-weighted MRI with gadolinium. Balo's Concentric Sclerosis like radiological findings related to cocaine has not been reported. Levamisole is now frequently used as an ingredient in cocaine and may cause leukoencephalopathy. It is recommended to check urine levamisole levels in patients with cocaine-induced leukoencephalopathy with or without mimicking Balo's Concentric Sclerosis. On the other hand, it is also possible that the cocaine use was coincidental and this was a demyelinating case arising de novo in patient who uses cocaine.
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http://dx.doi.org/10.1016/j.msard.2017.11.011DOI Listing
January 2018

Relationship between MIDAS, depression, anxiety and alexithymia in migraine patients.

Acta Neurol Belg 2020 Aug 16;120(4):837-844. Epub 2017 Nov 16.

Neurology Department, School of Medicine, Acıbadem University, Ic Erenkoy Mah. Kerem Aydınlar Kampusu. Kayısdag Cad., 34752, Atasehir/Istanbul, Turkey.

The co-existence of psychiatric comorbidities with migraine is well known; however, the relationship between alexithymia and migraine has not been persuasively shown yet. The aim of the study was to assess the relationships between migraine-related disability, depression, anxiety and alexithymia. One hundred and forty-five migraine patients (33.18 ± 8.6; 111 females, 34 males), and 50 control subjects (29.06 ± 7.6; 34 females, 16 males) were prospectively enrolled for the study. The participants completed a demographic data form and Migraine Disability Assessment Scale, Beck Depression Inventory, Beck Anxiety Inventory and Toronto Alexithymia Score-20 (TAS-20). All migraine patients were more depressive (p = 0.01) and anxious (p = 0.001) than the healthy subjects. TAS-20 scores of the migraine sufferers and the control group did not indicate alexithymia. The migraine-related disability of all migraine patients was severe (27.84 ± 29.22). Depression and anxiety scores in the migraine patients were highly correlated with each other and TAS-20 (r = 0.485, p = 0.001) and all its subscales in turn: difficulty in identifying (r = 0.435, p < 0.001) and describing feelings (r = 0.451, p = 0.001) and externally oriented thinking (r = 0.302, p = 0.001). Moreover, logistic regression analysis revealed that depression and anxiety predicted alexithymia. Our findings showed a complex relationship between migraine, depression, anxiety and alexithymia. On the other hand, alexithymia apparently was not directly connected to migraine, but its presence could be predicted in migraine patients because of co-morbid depression and anxiety.
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http://dx.doi.org/10.1007/s13760-017-0856-xDOI Listing
August 2020

OnabotulinumtoxinA effectiveness on chronic migraine, negative emotional states and sleep quality: a single-center prospective cohort study.

J Headache Pain 2017 Dec 17;18(1):23. Epub 2017 Feb 17.

Department of Neurology, Acibadem University School of Medicine, Içerenkoy, Kayisdagi Cd, 34752, Atasehir/Istanbul, Turkey.

Background: OnabotulinumtoxinA (OnabotA) is considered effective in in patients with chronic migraine (CM) who failed on traditional therapies. This study was designed to evaluate the effect of OnabotA injection series on migraine outcome, negative emotional states and sleep quality in patients with CM.

Methods: A total of 190 patients with CM (mean (SD) age: 39.3 (10.2) years; 87.9% were female) were included. Data on Pittsburgh sleep quality index (PSQI), headache frequency and severity, number of analgesics used, Migraine Disability Assessment Scale. (MIDAS) scores and Depression, Anxiety and Stress Scale (DASS-21) were evaluated at baseline (visit 1) and 4 consecutive follow up visits, each conducted after OnabotA injection series; at week 12 (visit 2), week 24 (visit 3), week 36 (visit 4) and week 48 (visit 5) to evaluate change from baseline to follow up.

Results: From baseline to visit 5, significant decrease was noted in least square (LS) mean headache frequency (from 19.5 to 8.4, p = 0.002), headache severity (from 8.1 to 6.1, p = 0.017), number of analgesics (from 26.9 to 10.4, p = 0.023) and MIDAS scores (from 67.3 to 18.5, p < 0.001). No significant change from baseline was noted in global PSOI and DASS-21 scores throughout the study.

Conclusions: Our findings revealed that OnabotA therapy was associated with significant improvement in migraine outcome leading to decrease in headache frequency and severity, number of analgesics used and MIDAS scores. While no significant change was noted in overall sleep quality and prevalence of negative emotional states, patients without negative emotional states at baseline showed improved sleep quality throughout the study.
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http://dx.doi.org/10.1186/s10194-017-0723-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5315653PMC
December 2017

Analysis of motor unit firing characteristics in patients with motor neuron diseases.

Somatosens Mot Res 2016 03 24;33(1):16-9. Epub 2016 Feb 24.

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

This study was designed to evaluate firing rate variability in patients with upper/lower motor neuron disorders. Twenty healthy subjects and 19 patients with motor neuron disorders participated in the study. Consecutive motor unit action potential pairs from extensor digitorum communis (EDC) muscle were recorded from each subject with trigger-delay line mode. Patients with motor neuron disorders (17.7 ± 10.8 ms) showed significantly higher mean time variability of interpotential interval value than healthy volunteers (10.3 ± 0.1 ms) (p < 0.001).
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http://dx.doi.org/10.3109/08990220.2016.1142437DOI Listing
March 2016

Pain levels of examined muscles and gender differences in pain during electromyography.

Agri 2015 ;27(2):79-82

Department of Neurology, Acıbadem University School of Medicine, İstanbul, Turkey.

Objectives: The aim of this study was to evaluate the pain level of each muscle during an EMG study and also search for any association between the pain levels and gender.

Methods: Two hundred and twenty-seven subjects (166 females and 111 males) participated in the present study. Numeric analogue scale (NAS) was obtained from the patients after needle EMG for each muscle.

Results: In total, 1242 muscles were examined. The highest pain levels among examined muscles were found on Abductor Pollicis Brevis (APB) (5.8 ± 2.6), First Dorsal Interosseous (4.2 ± 2.6) and Vastus Lateralis (4.0 ± 2.6). NAS levels of the female patients (4.3 ± 2.7) were apparently higher than those of the male patients (2.8 ± 2.3) (p<0.01).

Conclusion: First Dorsal Interosseous muscle was found less painful than APB muscle for the patients. Our study displayed greater pain sensitivity among females compared with males during the needle EMG; however, the pain levels of examined muscles were not higher than moderate for both genders.
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http://dx.doi.org/10.5505/agri.2015.32154DOI Listing
November 2016

The relationships between migraine, depression, anxiety, stress, and sleep disturbances.

Acta Neurol Belg 2015 Jun 3;115(2):117-22. Epub 2014 Jun 3.

Neurology Department, School of Medicine, Acibadem University, Istanbul, Turkey,

To assess the relationships between migraine, depression, anxiety, stress, and sleep problems. Psychiatric conditions and sleep disturbances are common in migraineurs. Depression, anxiety, stress, migraine, and sleep problems frequently coexist as comorbidities. Eighty-seven episodic migraineurs (62 females, 25 males; 32.8 ± 6.9) and 41 control subjects (25 females, 16 males; 31.5 ± 5.6) were prospectively enrolled for the study. The participants completed a sociodemographic data form and a migraine disability assessment scale (MIDAS), depression, anxiety, stress scale (DASS), and Pittsburg Sleep Quality Index (PSQI). In migraineurs, a significant positive correlation was found between PSQI total scores and MIDAS scores (migraine related disability for at least three consecutive months) (r = 0. 234, p = 0.04). Only 24.1 % of migraineus (n = 21) had minimal or no disability, 75.9 % of the patients (n = 66) had more than a little disability according to MIDAS scores. PSQI total scores were also correlated with pain intensity over a three month period (MIDAS B) (r = 0.221, p = 0.04). While PSQI scores were found significantly different between migraineurs and control subjects (5.5 ± 2.9 vs 4.5 ± 2.5; p = 0.04), the correlation of all the DASS subscale scores between the groups was not statistically significant. Our findings showed that episodic migraine was a risk factor on its own for sleep disturbances without comorbid depression, anxiety, and stress. Moreover, migraine-related disability and pain intensity in migraine attacks were related to poor sleep quality.
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http://dx.doi.org/10.1007/s13760-014-0312-0DOI Listing
June 2015

The relation of sexual function to migraine-related disability, depression and anxiety in patients with migraine.

J Headache Pain 2014 May 27;15:32. Epub 2014 May 27.

Department of Neurology, Acıbadem University School of Medicine, Acıbadem Maslak Hospital, Büyükdere Caddesi, No:40, Maslak/Sarıyer, 34457 Istanbul, Turkey.

Background: Depression and anxiety are two phenomena that affect quality of life as well as sexual function. Depression and anxiety levels are reported to be high in migraine sufferers. We aimed to understand whether sexual function in women with migraine was associated to migraine-related disability and frequency of migraine attacks, and whether this relationship was modulated by depressive and anxiety symptoms.

Methods: As migraine is more commonly seen in females, a total of 50 women with migraine were included. The diagnosis of migraine with or without aura was confirmed by two specialists in Neurology, according to the second edition of International Headache Society (IHS) International Classification of Headache Disorders (ICHD-II) in 2004. Migraine disability assessment scale score, female sexual function index scores, Beck depression inventory score and Beck anxiety inventory scores.

Results: Mean MIDAS score was 19.3 ± 12.8, and mean number of migraine attacks per month were 4.3 ± 2.7. Mean Female Sexual Function Index score was 20.9 ± 5.9 and 90% of patients had sexual dysfunction. Sexual dysfunction was not related to MIDAS score or frequency and severity of attacks. No relationship between sexual function and anxiety was found, whereas severity of depressive symptoms was closely related to sexual function. Depressive symptoms affected all dimensions of sexual function, except for pain.

Conclusion: Sexual dysfunction seemed to be very common in our patients with migraine, while not related to migraine related disability, frequency of attacks and migraine severity or anxiety. The most important factor that predicted sexual function was depression, which was also independent of disease severity and migraine related disability. While future larger scale studies are needed to clarify the exact relationship, depressive and sexual problems should be properly addressed in all patients with migraine, regardless of disease severity or disability.
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http://dx.doi.org/10.1186/1129-2377-15-32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4046390PMC
May 2014

Expected and Experienced Pain Levels in Electromyography.

Noro Psikiyatr Ars 2013 Dec 1;50(4):364-367. Epub 2013 Dec 1.

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

Introduction: The aim of the present study was to assess pain using a visual analogue scale (VAS) in patients awaiting an EMG procedure (i.e., expected VAS) and after an EMG procedure (i.e., experienced VAS).

Methods: Expected and experienced pain in response to nerve conduction studies (NCS) and needle EMG were assessed in 108 patients (61 females, 47 males; mean age 43.2±11.6) using a VAS.

Results: No significant correlations were noted between the expected or the experienced VAS in response to EMG and demographic features of the patients. The expected VAS was significantly higher than the experienced VAS in response to needle EMG (p=0.005). The highest VAS level was noted in the expected VAS in response to needle EMG (4.7±2.2). The lowest VAS level was noted in the experienced VAS in response to NCS (3.6±2.5).

Conclusion: The present study demonstrated that neither the expected nor the experienced pain associated with EMG exceeded a moderate level. Interestingly, we found that expected pain levels in response to needle EMG were significantly higher than experienced pain levels. Therefore, it may be possible to increase compliance if patients are provided with this information before undergoing electrophysiological procedures.
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http://dx.doi.org/10.4274/npa.y6699DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5363430PMC
December 2013

Diagnostic use of dermatomal somatosensory-evoked potentials in spinal disorders: Case series.

J Spinal Cord Med 2013 Nov 8;36(6):672-8. Epub 2013 May 8.

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

Unlabelled: OBJECTIVE/CONTEXT: Dermatomal somatosensory-evoked potentials (dSEPs) may be valuable for diagnostic purposes in selected cases with spinal disorders.

Design: Reports on cases with successful use of dSEPs.

Findings: Cases 1 and 2 had lesions causing multiple root involvement (upper to middle lumbar region in Case 1 and lower sacral region in Case 2). Cystic lesions in both cases seemed to compress more than one nerve root, and stimulation at the center of the involved dermatomes in dSEPs helped to reveal the functional abnormality. Cases 3 and 4 had lesions involving the spinal cord with or without nerve root impairment. In Case 3, an magnetic resonance imaging (MRI)-verified lesion seemed to occupy a considerable volume of the lower spinal cord, causing only very restricted clinical sensory and motor signs. In Case 4, a cervical MRI showed a small well-circumscribed intramedullary lesion at right C2 level. All neurophysiological investigations were normal in the latter two patients (motor, tibial, and median somatosensory-evoked potentials in Case 3, and electromyography in both) except for the dSEPs.

Conclusions: Objectifying the presence and degree of sensory involvement in spinal disorders may be helpful for establishing diagnoses and in therapeutic decision-making. Valuable information could be provided by dSEPs in selected patients with multiple root or spinal cord involvement.
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http://dx.doi.org/10.1179/2045772313Y.0000000107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3831330PMC
November 2013

Clinical events in psychogenic non-epileptic seizures based on semiological seizure classification.

Neurol Res 2013 Dec 27;35(10):1070-5. Epub 2013 Aug 27.

Acıbadem University School of Medicine, Istanbul, Turkey.

Objectives: None of the classifications of psychogenic non-epileptic seizures (PNES) have been widely accepted and used by physicians so far. In this study we aimed at classifying PNES on the basis of a modified version of semiological seizure classification (SSC). We also sought to assess the interrater reliability (IRR) of the PNES diagnosis based on SSC.

Methods: We classified PNES into four types on the basis of our modification of SSC: pseudoaura, dialeptic, motor, and special (atonic, astatic, hypotonic) spells. Pseudoauras were not included in the statistical analysis. Ninety-one PNES attacks were observed during the 55 video-EEG sessions recorded for all patients. The interrater agreement was assessed by the kappa coefficient.

Results: Twenty-nine women (78·3%) and eight men (21·6%) were surveyed, with a mean age of 28·4 ± 9·6 (range 16-54). The final diagnosis of PNES was established after a mean of 4·5 ± 2·3 years following the onset of PNES attacks in the patients. The mean seizure duration in the PNES was 241 seconds and 40·5% of our patients had PNES longer than 300 seconds. Motor and special PNES were the most common types observed by all the raters. The kappa values for each pair were as follows: Observers I-II 0·51 (p = 0·000), Observers I-III 0·47 (p = 0·000), and Observers II-III 0·73 (p = 0·000).

Conclusions: Interobserver agreement was moderate and substantial for three observers who classified PNES according to our modified SSC. The modified version of SSC could be used without difficulty in classifying PNES. Using SSC for PNES both shortens the period before diagnosis and eliminates the need to learn another new and acceptable classification for PNES.
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http://dx.doi.org/10.1179/1743132813Y.0000000249DOI Listing
December 2013

Botulinum Toxin in Migraine Treatment.

Noro Psikiyatr Ars 2013 Aug 1;50(Suppl 1):S36-S40. Epub 2013 Aug 1.

Acıbadem University, Medical Faculty, Department of Neurology, İstanbul, Turkey.

Since botulinum toxin might have a therapeutic effect on pain, many studies investigating the efficiency of botulinum toxin in headache treatment have been done. The most satisfying results were achieved by botulinum toxin type A (BoNT/A) in the treatment of chronic migraine. In this paper, we reviewed the clinical effectiveness of BoNT/A in migraine and included our clinical experience. In our ongoing pilot study, where we have repeated BoNT/A injections every 12 weeks, The difference in the Migraine Disability Assessment (MIDAS) scores between the first and the second injections was 61.1%; and between the first and the 3rd injections was found to be 65.72%.
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http://dx.doi.org/10.4274/npa.y7198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353076PMC
August 2013

Association between somatic amplification, anxiety, depression, stress and migraine.

J Headache Pain 2013 Jun 25;14:53. Epub 2013 Jun 25.

Department of Psychiatry, Acibadem University School of Medicine, Istanbul, Turkey.

Background: The aim of this study is to investigate the associations between migraine related disability and somatosensory amplification, depression, anxiety, and stress.

Method: Fifty-five migraine patients who applied to the outpatient unit of the Neurology Department of Acibadem University School of Medicine, Maslak Hospital in Istanbul, Turkey, and twenty-eight subjects without migraine were recruited for the study. The participants were asked to complete a sociodemographic form, Migraine Disability Assessment Scale (MIDAS), Depression Anxiety Stress Scale, Somatosensory Amplification Scale (SSAS).

Results: Somatosensory amplification scores were significantly higher in the migraineurs than in the control group (29.85+/-6.63 vs 26.07+/-7.1; p=0.027). Somatosensory amplification scores and depression scores were significantly higher in migraineurs with moderate and severe disability than in patients with minimal and mild disability (31.7+/-6.4 vs 27.71+/-5.49; p=0.01, 11.27+/-8.7 vs 7.38+/-8.11; p=0.04, respectively). A significant positive correlation was found between the frequency of migraine attacks for at least three consecutive months (MIDAS A scores) and the SSAS scores (r=0.363, p=0.007) in migraineurs. The MIDAS total scores were also significantly correlated with the DASS depression subcale scores (r=0.267, p=0.04), and the DASS stress subscale scores (r=0.268, p=0.05).

Conclusion: Psychological factors, and vulnerability to bodily sensations may incease the burden of migraine. We point out that the timely assessing of somatic amplification and the evaluation of mental status would help improve the quality of life of in migraineurs.
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http://dx.doi.org/10.1186/1129-2377-14-53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3695888PMC
June 2013

IgG-based elimination diet in migraine plus irritable bowel syndrome.

Headache 2013 Mar 6;53(3):514-25. Epub 2012 Dec 6.

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

Objectives: To evaluate therapeutic potential of the immunoglobulin G (IgG)-based elimination diet among migraine patients with irritable bowel syndrome (IBS).

Background: Food elimination has been suggested as an effective and inexpensive therapeutic strategy in patients with migraine and concomitant IBS in the past studies.

Methods: A total of 21 patients (mean [standard deviation] age: 38.0 [11.2] years; 85.7% females) diagnosed with migraine and IBS were included in this double-blind, randomized, controlled, cross-over clinical trial composed of baseline (usual diet), first diet (elimination or provocation diets), and second diet (interchange of elimination or provocations diets) phases and 4 visits.

Results: IgG antibody tests against 270 food allergens revealed mean (standard deviation) reaction count to be 23.1 (14.1). Compared with baseline levels, elimination diet per se was associated with significant reductions in attack count (4.8 [2.1] vs 2.7 [2.0]; P < .001), maximum attack duration (2.6 [0.6] vs. 1.4 [1.1] days; P < .001), mean attack duration (1.8 [0.5] vs. 1.1 [0.8] days; P < .01), maximum attack severity (visual analog scale 8.5 [1.4] vs. visual analog scale 6.6 [3.3]; P < .001), and number of attacks with acute medication (4.0 [1.5] vs. 1.9 [1.8]; P < .001). There was a significant reduction in pain-bloating severity (1.8 [1.3] vs. 3.2 [0.8]; P < .05), pain-bloating within the last 10 days (3.2 [2.8] vs. 5.5 [3.1]; P < .05), and improvement obtained in quality of life (3.6 [1.4] vs. 2.9 [1.0]; P < .05) by the elimination diet as compared with provocation diet.

Conclusions: Our findings indicate that food elimination based on IgG antibodies in migraine patients who suffer from concomitant IBS may effectively reduce symptoms from both disorders with possible positive impact on the quality of life of the patients as well as potential savings to the health-care system.
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http://dx.doi.org/10.1111/j.1526-4610.2012.02296.xDOI Listing
March 2013

Short segment incremental study in ulnar neuropathy at the wrist: report of three cases and review of the literature.

Acta Neurol Belg 2010 Mar;110(1):78-83

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

Ulnar nerve lesions may occur at different sublocations at wrist and may involve various branches of the nerve. Standard neurophysiological studies are generally insufficient in revealing these lesions. Demonstration of conduction block and/or focal slowing of nerve conduction is the most definitive electrodiagnostic evidence for the localization of segmental demyelination. Short-segment incremental study (SSIS) is a sensitive technique for detecting the ulnar neuropathy at the wrist (UNW). We report 3 cases of UNW caused by ganglion cysts in Guyon's canal which were studied by using SSIS across the wrist. Even though SSIS is a time-consuming and technically demanding method, it increases the electrodiagnostic potential of detecting segmental demyelination in this location.
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March 2010