Fakülteler / Faculties
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Item Evaluation of Diffusion Tensor Imaging Findings in Clinically Isolated Syndrome and Relapsing-Remitting Multiple Sclerosis Patients(2023) Alatas, Ozkan; Cavusoglu, Berrin; Caylak, Ali; Keskin, Onur; Idiman, Egemen; Idiman, Fethi; Ada, EmelObjective: To compare diffusion tensor imaging (DTI) findings of the normal-appearing white matter (NAWM) and corpus callosum (CC) in patients with clinically isolated syndrome (CIS) and relapsing-remitting multiple sclerosis (RRMS) and a healthy control (HC) group. Materials and Methods: The CIS (n = 10), RRMS (n = 29), and HC (n = 13) groups were evaluated by DTI in this retrospective study. Mean diffusion (MD) and fractional anisotropy (FA) maps as well as MD and FA measurements were made from the corpus callosum genu (CCG), corpus callosum splenium (CCS), and NAWM areas from the frontal, parietal, occipital and temporal lobes. Results: The mean FA values of the NAWM in the temporal lobes were bilaterally lower in both the CIS and RRMS groups than in the HC group. However, no difference was found between the CIS and RRMS groups. In addition, the CIS group had lower FA values in the CCG, whereas the RRMS group had lower FA values in the CCS compared with the HC group. The MD values were significantly different in the CCG between the RRMS and HC groups. Conclusion: DTI contributes to detecting early changes in the NAWM and CC in patients diagnosed with CIS and RRMS. Additionally, DTI can aid in the follow-up care and management of these patients.Item Anti-N-Methyl-D-Aspartate Receptor Encephalitis During Pregnancy: A Case Report(2019) Keskin, Ahmet O.; Tanburoglu, Anil; Idiman, Egemen; Ozturk, Vesile; https://orcid.org/0000-0002-2942-323X; https://orcid.org/0000-0001-9627-3502; 30788880; AAJ-2044-2021; AAK-1876-2021Following a generalized tonic-clonic seizure, a previously healthy 27-year-old pregnant woman (18-week pregnancy) was admitted to our emergency department. She experienced lethargy, forgetfulness and persecutory hallucinations the day before hospitalization. Cerebrospinal fluid examination revealed moderate pleocytosis, and abdominal ultrasonography did not detect neoplasia. Orofacial dyskinesia, catatonia and central hypoventilation gradually developed despite medical intervention to ameliorate the symptoms. At 32 weeks of pregnancy, vaginal bleeding and hypotension occurred. Further, owing to septic shock due to fetal demise, the patient died. N-methyl-d-aspartate antibody test results obtained after the patient's death were positive (2++). Currently, no consensus exists on the appropriate treatment and follow-up for pregnant women with anti-N-methyl-d-aspartate receptor encephalitis; however, immunomodulators and teratoma resection may be helpful. Second line immunotherapy (rituximab, cyclophosphamide) and teratoma resection may be necessary in pregnant patients with high N-methyl-d-aspartate receptor antibody titers and inadequate response to first-line treatment.Item Let's Raise The Awareness Of MS Specialists Concerning The Frequency And Impact Of RLS In MS And Consequently The Life Quality Of Patients With MS: Striking Results Of The 'RELOMS-T' Study(2018) Sevim, Serhan; Demirkiran, Meltem; Terzi, Murat; Yuceyar, Nur; Tasdelen, Bahar; Idiman, Egemen; Kurtuncu, Murat; Boz, Cavit; Tuncel, Deniz; Karabudak, Rana; Siva, Aksel; Ozcan, Cemal; Neyal, Munife; Goksel, Basak Karakurum; Balal, Mehmet; Sen, Sedat; Ekmekci, Ozgul; Kara, Derya; https://orcid.org/0000-0003-2766-2277; AAE-2609-2021Item Optical Coherence Tomography Angiography (OCTA) In Differential Diagnosis Of Aquaporin-4 Antibody Seronegative NMOSD And Multiple Sclerosis(2022) Tiftikcioglu, Bedile Irem; Emre, Sinan; Idiman, Fethi; Idiman, Egemen; 35030370Backround: Optic neuritis(ON) is a common feature of both relapsing-remitting multiple sclerosis(RRMS) and neuromyelitis optica spectrum disorders(NMOSD). It is crucial to early differentiate these two diseases, as they differ in pathophysiology and treatment.& nbsp;Objective: To compare NMOSD and RRMS patients using optical coherence tomography(OCT) and OCT angiography(OCTA) to assess retinal microvascular network differences.& nbsp;Methods: Fourteen RRMS (28 eyes) and 9 NMOSD patients(18 eyes), and 11 controls were enrolled. Seropositivity for aquaporin-4 antibody (anti-AQP4 Abs) was 44.4%. Peripapillary and macular retinal nerve fiber layer (RNFL) thickness, superficial peripapillary and macular vessel density(VD), area, perimeter and circularity of foveal avascular zone(FAZ) were analyzed.& nbsp;Results: OCTA showed reduction in peripapillary and macular VD and FAZ size in NMOSD+ON compared to RRMS+ON and controls (p = 0.001, p < 0.001 and p = 0.010, p < 0.001 respectively). Peripapillary VD was similar in RRMS +ON and controls. Peripapillary VD in monophasic seronegative NMOSD+ON eyes was significantly lower than monophasic RRMS+ON eyes (p = 0.030), which was no different from controls. FAZ area was smaller in unaffected eyes in NMOSD than RRMS and controls.& nbsp;Conclusions: Both OCT and OCTA revealed considerable differences between RRMS and NMOSD patients, providing promising results in favor of clinical utility of OCTA in differential diagnosis of ON, particularly in antiAQP4 antibody negative patients. OCTA might be a useful biomarker in differentiating NMOSD from MS.Item Coexistence of restless legs syndrome and multiple sclerosis aggravates anxiety and depression(2022) Sevim, Serhan; Demirkiran, Meltem; Terzi, Murat; Yuceyar, Nur; Tasdelen, Bahar; Idiman, Egemen; Kurtuncu, Murat; Boz, Cavit; Tuncel, Deniz; Karabudak, Rana; Siva, Aksel; Ozcan, Abdulcemal; Neyal, Munife; Goksel Karakurum, Basak; Gazaloglu, Gulcan Baran; Balal, Mehmet; Sen, Sedat; Baklan, Meltem Alkaya; Gunduz, Tuncay; Tuncer, Asli; Uygunoglu, Ugur; 35195221Background: Among the comorbidities that accompany multiple sclerosis (MS), restless legs syndrome (RLS) is one of the most common. Anxiety and depression are common psychological comorbidities that impact the quality of life of patients with MS (PwMS), as well as patients with RLS. Objective: To investigate the psychiatric burden of MS and RLS coexistence, we conducted a nationwide, multicenter and cross-sectional survey. Methods: Participants were assessed by using demographic and clinical parameters along with the Hamilton Anxiety and Hamilton Depression Scales (HAM-A and HAM-D). Results: Out of the 1,068 participants, 173 (16.2%) were found to have RLS [RLS(+)] and 895 (83.8%) did not [RLS(-)]. The mean scores for HAM-A and HAM-D were significantly higher among RLS(+) subjects than among RLS(-) subjects (p<0.001 for all variables). Conclusions: According to our data, the presence of RLS in PwMS may increase the occurrence of both anxiety and depression symptoms. Awareness and treatment of RLS in PwMS could possibly reduce the symptoms of psychiatric comorbidities originating from RLS.Item Effects of Body Temperature Lowering on Visual Evoked Potentials in Patients with Multiple Sclerosis(2021) Poyraz, Turan; Idiman, Fethi; Keskin, Ahmet Onur; Karaoglan, Leyla Iyilikci; Idiman, EgemenObjective: Aggravation of neurologic symptoms in patients with multiple sclerosis (MS) due to heating is well known. This phenomenon, known as Uhthoff phenomenon (UP), is explained by transient conduction block in demyelinated nerve fibers and transected axons. The threshold of conduction block dependent on temperature is probably proportional to the degree of demyelination or axonal injury. On the other hand, about half of all patients reported improvement in a cold bath (anti-UP effect). This study aimed to assess the effects of body cooling on clinical parameters lneuro-opthalmologic examination and contrast sensitivity in visual acuity/Sloan letter rest, and the Expanded Disability Status Scale (EDSS)] and electrophysiologic measurements [visual evoked potentials (VEP)] in patients with MS previously clinically affected by optic neuritis. Materials and Methods: Twenty patients who described a UP or anti-UP effect with definite MS according to the McDonald and Poser criteria were enrolled in the study. Before the cooling process, all patients with a history of optic neuritis (at least once) were examined clinically, neurologically and neuro-ophthalmologically, and electrophysiologically. Body cooling was achieved using a "Medivance Arctic Sun Temperature Management System" and the body temperature was decreased by about 1 degrees C. After that, all patients were re-evaluated clinically and electrophysiologically. Results: After the cooling process, P100 latency significantly shortened at the 1st, 6th and 24th hours (p<0.001, p<0.001, p<0.001) and EDSS scores improved significantly (p<0.001). Visual acuity, including contrast sensitivity and color vision, significantly improved in both affected and unaffected eyes (p<0.001). Conclusion: These results suggest that heat caused a conduction block in demyelinated or transected axons in the visual pathways. Our results also demonstrate that the cool: o process had beneficial effects on clinical disability scores (EDSS) and the visual system based on clinical and electrophysiologic (VEP) evaluations. These find suggest that the cooling process may be used for symptomatic therapy and increasing life quality of patients with MS.Item 'Is RLS a harbinger and consequence of MS?: Striking results of the 'RELOMS-T' study'(2020) Sevim, Serhan; Demirkiran, Meltem; Terzi, Murat; Yuceyar, Nur; Tasdelen, Bahar; Idiman, Egemen; Kurtuncu, Murat; Boz, Cavit; Tuncel, Deniz; Karabudak, Rana; Siva, Aksel; Ozcan, Abdulcemal; Neyal, Munife; Goksel, Basak Karakurum; Balal, Mehmet; Sen, Sedat; Ekmekci, Ozgul; Oksuz, Nevra; Kaya, Derya; 0000-0003-2766-2277; 32473575; AAE-2609-2021Background: Although studies report a high prevalence rate of restless legs syndrome (RLS) among patients with multiple sclerosis (PwMS) ranging from 13.3 to 65.1%, little is known about the causes of this relationship. Methods: To ascertain the prevalence, features and impact of RLS among PwMS a nation-wide, multicenter, prospective and a cross-sectional survey, designed to reflect all of the PwMS throughout Turkey, was conducted in 13 centers. Exploring the relationship of the two conditions could possibly contribute to the understanding of the causes of the high and wide-ranging prevalence rates and the pathophysiology of both diseases. Results: Of the 1068 participants 173 (16,2%) found to have RLS [RLS(+)] and 895 (83,8%) did not [RLS(-)]. Among the RLS(+) 173, all but 8 patients (4,6%) were underdiagnosed in terms of RLS. More than half of the patients with RLS had 'severe' or 'very severe' RLS. The onset of RLS was before or synchronous with the onset of MS in about a half of our patients. Conclusion: We conclude that RLS should be meticulously investigated in PwMS and MS can be a direct cause of RLS at least in part of PwMS. Our data about the timing of the onset of MS and RLS, along with the high prevalence of RLS in PwMS suggest that the pathologic changes in the initial phases of MS can possibly trigger RLS symptoms.Item Importance of Optical Coherence Tomography Angiography in Differential Diagnosis of NMOSD and RRMS(2019) Tiftikcioglu, B. Irem; Emre, Sinan; Idiman, Fethi; Idiman, Egemen