Browsing by Author "Derle, Eda"

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Aspirin Resistance in Cerebrovascular Disease and the Role of Glycoprotein IIIa Polymorphism in Turkish Stroke Patients
(2016) Derle, Eda; Ocal, Ruhsen; Kibaroglu, Seda; Celikkol, Ceyda; Bayraktar, Nilufer; Verdi, Hasibe; Atac, Belgin F.; Can, Ufuk; https://orcid.org/0000-0002-3964-268X; https://orcid.org/0000-0002-7886-3688; https://orcid.org/0000-0003-0591-009X; https://orcid.org/0000-0001-6868-2165; https://orcid.org/0000-0001-8689-417X; 26809135; V-3553-2017; AAJ-2956-2021; Y-8758-2018; V-5499-2017; ABG-9966-2020; AAJ-2999-2021
Aspirin resistance occurs in 5-45% of high-risk patients, with various mechanisms proposed for its development. This study aimed to determine the relationships among aspirin resistance, aspirin dosage, type of aspirin and glycoprotein IIIa P1A1/A2 polymorphism in patients with vascular risk factors. Two hundred and eight (75 symptomatic, 133 asymptomatic) patients with vascular risk factors who were using aspirin for primary or secondary prevention were prospectively included. The symptomatic group was further classified into two groups according to aspirin use at the time of stroke. Aspirin resistance was measured by the PFA-100 system (collagen/epinephrine cartridge) and glycoprotein IIIa P1A1/A2 polymorphism was determined by PCR. The overall prevalence of aspirin resistance was 32.2%. The mean age of patients with aspirin resistance was significantly higher than that in those who did not have resistance (P=0.009). The prevalence of aspirin resistance was similar for the symptomatic and asymptomatic under aspirin therapy groups. The resistance rate was found to be highest with 100mg enteric-coated preparation use (39.3%). Increasing the aspirin dosage and/or shifting to uncoated preparations caused a change in aspirin sensitivity of 36-60%. Repeated measurements showed development of aspirin resistance in 14% of patients who were sensitive to aspirin in previous measurements. Glycoprotein IIIaP1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke were not significantly related. The effect of aspirin can change by time, dosage and type of preparation used. There are no relationships among glycoprotein IIIa P1A1/A2 polymorphism, aspirin resistance and development of atherothrombotic stroke. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
Clinical and Radiological Characteristics of Six Patients with Tumefactive Demyelinating Lesions
(2014) Toprak, Munire Kilinc; Kibaroglu, Seda; Derle, Eda; Benli, Ulku Sibel; https://orcid.org/0000-0001-7979-0276; https://orcid.org/0000-0002-3964-268X; https://orcid.org/0000-0003-2122-1016; https://orcid.org/0000-0002-9975-3170; AAJ-8674-2021; AAJ-2956-2021; AAI-8830-2021; AAJ-4403-2021
Clinical results of carotid artery stenting versus carotid endarterectomy
(2016) Derle, Eda; Akinci, Tuba; Kibaroglu, Seda; Harman, Ali; Kural, Feride; Cinar, Pinar; Kilinc, Munire; Akay, Hakki T.; Can, Ufuk; Benli, Ulku S.; 0000-0002-7386-7110; 0000-0002-4226-4034; 0000-0002-9975-3170; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 27744460; AAI-8830-2021; AAJ-2956-2021; K-9824-2013; AAL-9808-2021; AAJ-4403-2021; AAJ-2999-2021
Objective: To review our results of carotid artery stenting (CAS) and carotid endarterectomy (CEA). Methods: We evaluated the medical records of patients undergoing carotid artery revascularization procedure, between 2001 and 2013 in Baskent University Hospital, Ankara, Turkey. Carotid artery stenting or CEA procedures were performed in patients with asymptomatic carotid stenosis (=70%) or symptomatic stenosis (=50%). Demographic data, procedural details, and clinical outcomes were recorded. Primary outcome measures were in 30-day stroke/transient ischemic attacks (TIA)/amaurosis fugax or death. Secondary outcome measures were nerve injury, bleeding complications, length of stay in hospital, stroke, restenosis (ICA patency), and all-cause death during long-term follow-up. Results: One hundred ninety-four CEA and 115 CAS procedures were performed for symptomatic and/or asymptomatic carotid artery stenosis. There is no significant differences 30-day mortality and neurologic morbidity between CAS (13%) and CEA procedures (7.7%). Length of stay in hospital were significantly longer in CEA group (p=0.001). In the post-procedural follow up, only in symptomatic patients, restenosis rate was higher in the CEA group (p=.045). The other endpoints did not differ significantly. Conclusions: Endovascular stent treatment of carotid artery atherosclerotic disease is an alternative for vascular surgery, especially for patients that are high risk for standard CEA. The increasing experience, development of cerebral protection systems and new treatment protocols increases CAS feasibility.
Disease activity in Primary Progressive Multiple Sclerosis
(2016) Vural, Atay; Kurne, Asli T.; Sayat, Guliz; Karabudak, Rana N.; Derle, Eda; https://orcid.org/0000-0003-2122-1016; HJH-2490-2023; AAI-8830-2021
Do Mean Platelet Volume and Platelet Distribution Width Have An Association with White Matter Hyperintensities in Migraine Patients?
(2023) Iyigundogdu, Ilkin; Derle, Eda; 37970292
Objective: Increased prevalence of white matter hyperintensities (WMH) is reported in migraine patients; however, the pathophysiology and the progression of these lesions are not definitely clear. Mean platelet volume (MPV) and platelet distribution width (PDW) are easily obtained markers for platelet activity. The aim of this study is to evaluate the relationship between the presence of WMH and MPV and PDW in patients with migraine in order to determine the role of platelet activity in the pathophysiology of WMH.Methods: Patients who were admitted to the neurology outpatient clinics of Baskent University Hospital from January 2011 to December 2015 with migraine and between 18 and 55 years of age were evaluated retrospectively. The blood samples were taken and total blood count parameters including MPV and PDW were analyzed. Brain magnetic resonance images were evaluated.Results: Totally, 218 patients were evaluated in this study. Forty-eight (22.0%) patients had WMH in the brain magnetic resonance imaging. In patients with WMH, the median of age was higher than the patients without WMH and the difference was statistically significant (P < 0.05). There was no statistically significant difference between MPV, PDW values, and the presence of WMH.Conclusions: There are multiple theories suggested for the mechanism of WMH, but the major cause and pathophysiology are still undetermined. Our data suggested that increased platelet activity is insufficient by itself to explain the pathophysiology of WMH in migraine patients and to improve the knowledge on this issue further large longitudinal studies should be performed.
Hyperprolactinemia and galactorrhea with duloxetine in neuropathic pain management
(2021) Derle, Eda; Can, Ufuk; 34671951
Duloxetine is a serotonin-norepinephrine reuptake inhibitor that is widely used in chronic pain treatment in various diseases. Hyperprolactinemia and galactorrhea are rare side effects of this medication. Here, we reported a 34-year-old female with multiple sclerosis who used duloxetine for pain management and mood disorder and experienced galactorrhea.
Ipilimumab Treatment Associated with Myasthenic Crises and Unfavorable Disease Course
(2018) Derle, Eda; Benli, Sibel; 0000-0003-2122-1016; 0000-0002-9975-3170; 29948466; AAI-8830-2021; AAJ-4403-2021
Ipilimumab, a monoclonal antibody targeting the cytotoxic T lymphocyte antigen-4 is a treatment option for metastatic melanoma. This receptor serves as an inhibitor receptor on T lymphocytes and blockage of these results predisposition to autoimmune diseases. The patients with autoimmune disorders were excluded in clinical trials and there is no sufficient data of the treatment on these patients who already have an autoimmune disorder. Here, we report a case of myasthenia gravis who was treated with ipilimumab and we presented the long-term prognosis of the patient after treatment.
Iron Chelation in Treatment of Superficial Siderosis
(2018) Derle, Eda; 0000-0003-2122-1016; 31210906; AAI-8830-2021
Lentiform Fork Sign in A Case with End-Stage Renal Disease and Metabolic Acidosis
(2015) Derle, Eda; Kibaroglu, Seda; Cinar, Pinar; Ocal, Ruhsen; Can, Ufuk; 0000-0002-3964-268X; 0000-0001-8689-417X; 0000-0003-2122-1016; 25381213; AAJ-2956-2021; V-3553-2017; AAJ-2999-2021; AAI-8830-2021
Neurologic Complications After Liver Transplant: Experience at a Single Center
(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Can, Ufuk; Benli, Sibel; Haberal, Mehmet; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0001-8689-417X; 0000-0002-3462-7632; 0000-0002-9975-3170; 25894184; V-3553-2017; AAH-9198-2019; AAI-8830-2021; AAJ-2956-2021; AAJ-2999-2021; AAJ-8097-2021; AAJ-4403-2021
Objectives: Neurologic complications occur frequently after liver transplants. Up to 43% of patients experience severe postsurgical neurologic complications. These complications are significantly associated with longer hospital stay, morbidity, and mortality. The aim of this retrospective study was to evaluate the type and incidence of neurologic complications after liver transplants in adult patients. Materials and Methods: We retrospectively evaluated the medical records of 176 adult patients who had undergone liver transplants between 1995 and 2013. We recorded the demographic data, type of neurologic complications, type, and level of immunosuppressive treatment, and cause of liver failure. Results: Our study sample consisted of 48 deceased-donor liver transplants and 128 living-donor transplants (n = 176). Fifty-three of the patients (30.1%) were female. The age range of the total sample was 18 to 66 years (mean age, 43.1 +/- 13.7 y). As immunosuppressive treatment, most patients received tacrolimus alone (52%) or tacrolimus combined with mycophenolate mofetil (33%). Neurologic complications occurred in 74 of the patients (42%). The most common neurologic complications were diffuse encephalopathy (22.2%) and seizure (14.2%). Other neurologic complications were posterior reversible encephalopathy (1.7%), peripheral neuropathy (1.7%), cerebrovascular disease (1.1%), and central nervous system infection (1.1%). Age, cause of liver failure, and type of transplant were not associated with occurrence of neurologic complications. Conclusions: There was a high incidence of neurologic complications after liver transplants. Diffuse encephalopathy and seizure were common complications. Physicians should be aware of the high risk of neurologic complications after liver transplants. Factors such as immunosuppressive toxicity and metabolic imbalance that predispose patients to neurologic complications after liver transplants should be evaluated immediately, and treatment of postoperative neurologic complications should be initiated as early as possible.
Neuromyelitis Optica in Children: A Review of The Literature
(2014) Derle, Eda; Gunes, H. Nalan; Konuskan, Bahadir; Tuncer-Kurne, Asli; https://orcid.org/0000-0003-2122-1016; 26388586; AAI-8830-2021
Neuromyelitis optica (NMO) is a rare and severe inflammatory disease of the central nervous system (CNS), which constitutes up to 5% of pediatric aquired demyelinating diseases. The optic nerves and the spinal cord are the most affected sites. The discovery of an autoantibody called NMO-IgG, which targets aquaporin-4, the main water channel in the CNS, gave a new direction to understanding the underlying immunologic mechanisms. This specific biomarker also helps to distinguish the disease from other demyelinating disorders. Here, we review the clinical and paraclinical features, immunological properties and treatment options of the disease as reported in the literature.
Neutrophil to lymphocyte ratio, stroke severity and short term clinical outcomes in acute ischemic stroke
(2021) Iyigundogdu, Ilkin; Derle, Eda; Kibaroglu, Seda; Can, Ufuk; 0000-0001-7860-040X; 0000-0002-3964-268X; AAJ-2053-2021; AAJ-2956-2021
Background: Neutrophil to lymphocyte ratio is an easily evaluated systemic inflammation indicator. However, there are limited reports on neutrophil to lymphocyte ratio and functional outcome in ischemic stroke. In this study, we aimed to evaluate the association of neutrophil to lymphocyte ratio and stroke severity, short term functional outcomes and mortality in patients with acute ischemic stroke. Methods: The clinical data of patients who were > 18 age-old and hospitalized with acute ischemic stroke in Baskent University Hospital, Ankara, Turkey between January 2018 and May 2019 were studied retrospectively. Neutrophil to lymphocyte ratio were measured. The neutrophil to lymphocyte ratio and National Institute of Health Stroke Scale (NIHSS) score at admission, mortality during hospitalization and Modified Rankin Scale (mRS) score at discharge of the patients with acute ischemic stroke were correlated. Results: Among the acute ischemic stroke patients due to the exclusion criteria, the data of 134 patients were evaluated. Median age of the patients were 76 +/- 12.5 years and 82 patients (61.2%) were male. The median NIHSS scores of the patients at admission was 5 +/- 4.5. Mortality during the hospitalization was seen in 8 patients (6%). The median neutrophil to lymphocyte ratio value of the patients at admission were found to be 2.6 +/- 3.4. Neutrophil to lymphocyte ratio and NIHSS scores of the patients at admission, duration of the hospitalization, mRS scores at discharge and mortality during hospitalization were found to be positively correlated. Conclusion: Neutrophil to lymphocyte ratio is a simple and easily measured marker and can be used as a potential indicator for prognosis in acute ischemic stroke. However further prospective multicenter investigations are required to confirm the role of neutrophil to lymphocyte ratio for predicting the prognosis in acute ischemic stroke patients.
Predictors of progression in primary progressive multiple sclerosis in a large Turkish cohort
(2020) Vural, Atay; Derle, Eda; Sayat-Gurel, Guliz; Karabudak, Rana; Tuncer, Asli; 0000-0003-2122-1016; 31743849; AAI-8830-2021
Background: Studies on the predictors of progression for primary progressive multiple sclerosis (PPMS) are limited and there is no information in the literature for populations outside Europe and North America. In this study, we aimed to identify predictors of progression in a large Turkish PPMS cohort. Methods: We analyzed a cohort of 157 PPMS patients to investigate the effect of age of onset, gender, onset symptoms, presence or absence of relapses, and baseline gadolinium-enhancing lesions on the rate of progression to EDSS6 by using Kaplan-Meier analysis and multivariate Cox regression. Results: Older age of onset and presence of spinal motor symptoms at onset were associated with a shorter time to EDSS6 and presence of supratentorial signs at onset was associated with a longer time to EDSS6 according to Kaplan-Meier analysis. These factors remained significant after multivariate Cox-regression analysis. Clinical relapses were present in 22.3% and gadolinium-enhancing lesions on baseline MRI were present in 28% of patients, but these factors were not predictive of time to EDSS6. Conclusion: We identified age of onset and symptom at onset as predictors of progression in Turkish PPMS patients. Presence of clinical relapses or baseline gadolinium-enhancing lesions did not affect PPMS progression rate.
The Prevalence and Recognition Rate of Delirium in Hospitalized Elderly Patients in Turkey
(2014) Aki, Ozlem Erden; Derle, Eda; Karagol, Arda; Turkyilmaz, Canan; Taskintuna, Nilgun; https://orcid.org/0000-0003-2122-1016; 24236908; AAI-8830-2021
Objective. Delirium is frequently observed, but generally under recognized in elderly hospitalized patients. The aims of this study were to determine the prevalence of delirium in elderly patients hospitalized at a university hospital, and to determine the recognition rate by hospital staff during hospitalization. Methods. The study included 108 consecutive patients aged >= 65 years that were hospitalized in the medical and surgical inpatient departments at Baskent University Hospital, Ankara, Turkey. All the patients were evaluated using the Mini Mental State Examination (MMSE) upon admission and Confusion Assessment Method (CAM) on a daily basis during hospitalization. Written documents and consultation requests from psychiatry and/or neurology departments were reviewed for recognition of delirium by hospital staff. Results. Among the 108 patients in the study, delirium was noted in 18 (16.7%) during their hospital stay. Consultation from psychiatry or neurology departments was requested for 5 of the 18 patients, only 1 with a delirium diagnosis, indicating that 17 of the cases (94.4%) were not recognized by their primary physicians. Conclusions. The delirium non-recognition rate in elderly hospitalized patients was very high. We think that hospital staff must be trained to recognize the symptoms of delirium and identify high-risk patients.
Rare Presentation of Midbrain Infarction: Isolated Medial Rectus Palsy
(2015) Derle, Eda; Ocal, Ruhsen; Kibaroglu, Seda; Can, Ufuk; 0000-0001-8689-417X; 0000-0002-3964-268X; 0000-0003-2122-1016; 26183888; AAJ-2999-2021; AAJ-2956-2021; AAI-8830-2021; V-3553-2017
A 69-year-old woman presented with sudden onset of diplopia. In neurologic examination left medial rectus palsy without abduction nystagmus was detected. Brain magnetic resonance imaging revealed acute ischemic lesion in mesencephalon on diffusion-weighted images. Sponteneous resolution was observed after 1 month. Medial rectus palsy is a rare presention of acute ischemic stroke and early neuroimaging is important to establish such lesions. (C) 2015 S. Karger AG, Basel
The Relationship Between the Degree of Cognitive Impairment and Retinal Nerve Fiber Layer Thickness
(2015) Oktem, Ece Ozdemir; Derle, Eda; Kibaroglu, Seda; Oktem, Caglar; Akkoyun, Imren; Can, Ufuk; 0000-0002-2860-7424; 0000-0003-2122-1016; 0000-0001-8689-417X; 0000-0002-3964-268X; 25575807; AAK-7713-2021; AAI-8830-2021; AAJ-2999-2021; AAJ-2956-2021
The goal of the present study is to investigate the relationship between the degree of cognitive impairment and retinal nerve fiber layer (RNFL) thickness which is measured by the optical coherence tomography (OCT). Thirty-five patients with Alzheimer's disease (AD), 35 patients with mild cognitive impairment (MCI), and 35 healthy volunteers, between the ages of 60-87, who were examined in the neurology outpatient clinic among 2012-2013 were prospectively involved in our study. Mini mental state examination (MMSE) test, montreal cognitive assessment (MOCA), and also neuropsychological test batteries were used for the neurocognitive evaluation. RNFL thickness was measured by the OCT technique and the differences among groups were studied. The relationship between RNFL thickness and MMSE scores with demographic characteristics was investigated. RNFL thickness was significantly lower in AD and MCI groups compared with the control group (p < 0.01). No significant differences of RNFL were found between the MCI and the AD groups (p > 0.05). Significant correlation was found between MMSE scores and the RNFL values (p < 0.05). Significant thinning in RNFL along with age was detected (p < 0.05). In our study, it is thought that retinal nerve fiber degeneration and central nervous system degeneration may be concurrent according to the thinning of RNFL measured by OCT in AD and MCI groups. RNFL measurement may also be useful for early diagnosis and evaluation of the disease progression. Further studies are needed to optimize the utility of this method as an ocular biomarker in AD.
Relationship Between White Matter Hyperintensities and Retinal Nerve Fiber Layer, Choroid, and Ganglion Cell Layer Thickness in Migraine Patients
(2018) Iyigundogdu, Ilkin; Derle, Eda; Asena, Leyla; Kural, Feride; Kibaroglu, Seda; Ocal, Ruhsen; Akkoyun, Imren; Can, Ufuk; 0000-0001-7860-040X; 0000-0003-2122-1016; 0000-0002-6848-203X; 0000-0002-4226-4034; 0000-0002-3964-268X; 0000-0002-2860-7424; 0000-0001-8689-417X; 28952336; AAJ-2053-2021; AAI-8830-2021; E-5914-2016; AAL-9808-2021; AAJ-2956-2021; V-3553-2017; AAK-7713-2021; AAJ-2999-2021
Aim To compare the relationship between white matter hyperintensities (WMH) on brain magnetic resonance imaging and retinal nerve fiber layer (RNFL), choroid, and ganglion cell layer (GCL) thicknesses in migraine patients and healthy subjects. We also assessed the role of cerebral hypoperfusion in the formation of these WMH lesions. Methods We enrolled 35 migraine patients without WMH, 37 migraine patients with WMH, and 37 healthy control subjects examined in the Neurology outpatient clinic of our tertiary center from May to December 2015. RFNL, choroid, and GCL thicknesses were measured by optic coherence tomography. Results There were no differences in the RFNL, choroid, or GCL thicknesses between migraine patients with and without WMH (p>0.05). Choroid layer thicknesses were significantly lower in migraine patients compared to control subjects (p<0.05), while there were no differences in RFNL and GCL thicknesses (p>0.05). Conclusions The only cerebral hypoperfusion' theory was insufficient to explain the pathophysiology of WMH lesions in migraine patients. In addition, the thinning of the choroid thicknesses in migraine patients suggests a potential causative role for cerebral hypoperfusion and decreased perfusion pressure of the choroid layer.
Seizure as a Neurologic Complication After Liver Transplant
(2015) Derle, Eda; Kibaroglu, Seda; Ocal, Ruhsen; Kirnap, Mahir; Kilinc, Munire; Benli, Sibel; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0001-7979-0276; 0000-0003-2122-1016; 0000-0002-3964-268X; 0000-0002-9975-3170; 25894183; AAJ-8097-2021; AAJ-8674-2021; AAI-8830-2021; AAJ-2956-2021; AAH-9198-2019; AAJ-4403-2021; V-3553-2017
Objectives: Seizure is a common complication after liver transplant and has been reported to occur in up to 42% of patients in different case series. Multiple factors can trigger seizures, including immunosuppressive toxicity, sepsis, metabolic imbalance, and structural brain lesions. The aim of this retrospective study was to evaluate seizure types and associated factors in adult liver transplant patients. Materials and Methods: We retrospectively evaluated the medical records of 142 adult patients who received a liver transplant between 2005 and 2013. We recorded demographic data, immunosuppressive treatment, seizure type, cause, recurrence, and treatment. Results: Of the 146 patients, 23 (15.7%) had a seizure after the liver transplant. This group included 10 females and 13 males, with ages ranging between 18 and 63 (39.9 +/- 14.8 y). Generalized tonic-clonic seizures were the most common, occurring in 20 patients (87%). We observed complex partial seizure and status epilepticus in 1 and 2 patients. Immunosuppressive drug-related seizure occurred in 8 patients (34.8%) with normal drug blood levels, and all but 1 of these patients experienced seizure within the first week after transplant. Multiple factors (26.1%), metabolic imbalance (17.4%), structural lesion (13%), and sepsis (8.7%) were the other factors identified as underlying conditions. Conclusions; In conclusion, seizure occurred in a significant proportion of patients who underwent liver transplant. Immunosuppressive drugs were the most common factor associated with seizure occurrence and drug cessation prevented seizure recurrence.
Spontaneous Spinal Subarachnoid Hemorrhage with Residual Arachnoid Cyst: A Case Report
(2017) Derle, Eda; Iyigundogdu, Ilkin; Yilmaz, Cem; 0000-0003-2122-1016; 0000-0001-7860-040X; 0000-0002-2353-8044; 27593750; AAI-8830-2021; AAJ-2053-2021; AAK-2948-2021
Spinal subarachnoid hemorrhage is a rare condition that usually occurs because of secondary causes and idiopathic spontaneous ones are extremely rare. We report a 56-year-old woman who presented with severe headache, neck pain and urinary retention. Magnetic resonance imaging revealed subarachnoid hemorrhage that extended from T1 to lumbar vertebrae. She was treated conservatively and symptoms were resolved within 1 month. An asymptomatic arachnoid cyst was observed on the follow-up magnetic resonance imaging after 3 months with no neurologic deterioration. She was still stable clinically and radiologically at the end of 19 months. Spinal subarachnoid hemorrhage is a surgical emergency, although in some cases a conservative approach may be useful.
Unfavorable Outcome of Pediatric Onset Multiple Sclerosis: Follow-Up in the Pediatric and Adult Neurology Departments of One Referral Center, in Turkey
(2016) Derle, Eda; Kurne, Asli Tuncer; Konuskan, Bahadir; Karabudak, Rana; Anlar, Banu; 0000-0001-6727-6229; 0000-0003-2122-1016; 27645334; HJH-2490-2023; I-9090-2013; AAI-8830-2021
Background:: The prevalence of MS starting under 18 years of age ranges between 2-10% of the total MS population. Objective:: We aimed to examine the clinical and long term follow-up data of pediatric-onset cases in our institutional MS database. Method:: We evaluated the clinical data from the MS database of the Departments of Neurology and Pediatric Neurology of Hacettepe University Hospital. Results:: The clinical features of 74 patients who had experienced the first attack before age 18 years comprised 3.9% of our MS population. Median age at onset was 15 (3, 5-17, IQR=3.63) years, and female: male ratio was 2.4. The most frequent symptom at onset was brainstemicerebellar dysfunction (32.4%). Seventy two patients (97.3%) initially had relapsing remitting course and in the follow-up, 17 (23%) of them developed secondary progressive (SP) course. The median interval to develop SPMS course was 10 (5-21, IQR=8) years. At the last visit, median disease duration was 6.67 (0.83-25, IQR=9.06) years, 41 (55.4%) of them had EDSS of >= 4. Conclusion:: These findings illustrate the profile of our pediatric MS patients: almost all are relapsing remitting initially; about one fourth become secondarily progressive in 10 years, and about half acquire disability EDSS >= 4 in mean 8 years. (C) 2016 Elsevier B.V. All rights reserved.