Murat Terzi

Background: Dimethyl fumarate (DMF) is approved as a first-line treatment in relapsing-remitting multiple sclerosis (RRMS). Aim: To evaluate the demographic, clinical, and radiological outcomes of DMF treatment in a real-world setting. Study design: Multicenter retrospective study based on data from 61 clinics across Türkiye. Methods: Side effects, leukocyte and lymphocyte counts, liver enzymes, EDSS (Expanded Disability Status Scale), and upper- and lower-extremity test results were evaluated in patients with RRMS before DMF initiation and at 1, 6, 12, and 24 months. Additionally, NEDA-3 (No Evidence of Disease Activity-3) status was assessed at the 1 and 2-year follow-ups. Results: 1,749 patients participated in this retrospective study. The most common side effects were flushing and gastrointestinal symptoms, which were more frequent in women and in patients with lower weight and lower Body Mass Index (BMI). Leukocyte and lymphocyte counts initially decreased and then stabilized, whereas transient elevations in liver enzymes resolved during follow-up. EDSS scores showed a significant improvement beginning at the 6-month follow-up. Performance on the Nine-Hole Peg Test (9HPT) improved, whereas no significant change was observed in the Timed 25-Foot Walk (T25FW). In addition, approximately 70% of the patients achieved NEDA-3 status at both the 1 and 2-year follow-ups. Conclusion: DMF demonstrated a favorable safety profile and was associated with significant improvements in EDSS while maintaining NEDA-3 status in approximately 70% of patients with RRMS. Adverse events occurred more frequently among women and among patients with lower body weight and lower BMI.

Background: Dysphagia is common in individuals with Idiopathic Parkinson's Disease (IwIPD) and affects both swallowing safety and efficiency. Pharyngeal residue and penetration–aspiration are key impairments associated with dysphagia in this population, yet their relationship across different bolus consistencies and volumes remains incompletely understood. The clinical role of patient‐reported outcome measures, such as the Eating Assessment Tool‐10 (EAT‐10), in relation to instrumental swallowing findings also requires further investigation. This study aimed (1) to examine the relationship between pharyngeal residue and penetration–aspiration across different bolus consistencies and volumes in IwIPD, and (2) to evaluate the discriminative performance of the EAT‐10 against FEES findings related to these swallowing impairments. Methods: Ninety‐seven IwIPD were included. Participants completed the EAT‐10 and underwent Flexible Endoscopic Evaluation of Swallowing (FEES). Ten swallowing trials were conducted using boluses of varying consistencies and volumes prepared according to the International Dysphagia Diet Standardisation Initiative (IDDSI). FEES recordings were independently rated by three clinicians using the Penetration–Aspiration Scale (PAS) and the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS). Results: Larger bolus volumes were associated with higher residue severity and PAS scores across planned within‐consistency comparisons. Significant correlations were observed between PAS scores and both EAT‐10 and YPRSRS scores across consistencies and volumes ( ρ = 0.56–0.91, p < 0.01). The EAT‐10 showed discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration across swallowing trials. Interrater reliability for YPRSRS and PAS ratings ranged from 0.58 to 0.87. Vallecular residue was highest for regular solid, while PAS scores were highest for thin liquid at 20 mL. Conclusion: In IwIPD, swallowing efficiency was strongly associated with swallowing safety across different bolus consistencies and volumes. EAT‐10 scores showed discriminative performance against FEES findings; however, the EAT‐10 should be interpreted as a patient‐reported screening measure rather than a diagnostic test for physiological swallowing impairment. Comprehensive FEES protocols incorporating a range of bolus consistencies and volumes may support more accurate assessment and individualized dysphagia management in this population. WHAT THIS PAPER ADDS: What is already known on this subject Dysphagia is highly prevalent in individuals with Idiopathic Parkinson's Disease (IwIPD) and may involve impairments in both swallowing safety and swallowing efficiency, including pharyngeal residue, penetration, and aspiration. Bolus consistency and volume are known to influence swallowing performance. Patient‐reported outcome measures, such as the Eating Assessment Tool‐10 (EAT‐10), are widely used in dysphagia screening, but they cannot replace instrumental swallowing assessment. What this study adds to existing knowledge This study demonstrates a strong relationship between pharyngeal residue severity and penetration–aspiration across different IDDSI‐defined bolus consistencies and volumes in IwIPD. The findings show that larger bolus volumes were associated with greater pharyngeal residue severity and higher PAS scores, while swallowing outcomes varied across consistencies and anatomical residue sites. The study also shows that EAT‐10 scores demonstrated discriminative performance against FEES findings related to pharyngeal residue, penetration, and aspiration, while highlighting the need for cautious interpretation of EAT‐10 cut‐off values in this population. What are the potential or actual clinical implications of this study? The findings support the importance of evaluating both swallowing safety and swallowing efficiency during instrumental assessment in IwIPD. The EAT‐10 may help guide referral decisions for further instrumental swallowing assessment, but it should not be interpreted as a diagnostic test for physiological swallowing impairment. FEES protocols incorporating a range of bolus consistencies and volumes may support more comprehensive clinical characterization of dysphagia and individualized management in this population.

Background: Pregnancy is a distinct neuroendocrine and immunological state in women with multiple sclerosis (MS). Relapse activity typically decreases during gestation and increases after delivery, but the relationship between peri-pregnancy brain volumetric measures and disability remains unclear. Methods: This retrospective longitudinal pilot study included 14 women with relapsing-remitting MS who underwent MRI examinations before pregnancy and after delivery. Thirty-eight MRI scans were analyzed, with a mean of 2.71 ± 0.99 timepoints per patient. Global and regional brain volumes were measured using the longitudinal FreeSurfer pipeline. Choroid plexus (CP) volume was evaluated as an exploratory neuroimmune imaging marker. Associations between volumetric measures and Expanded Disability Status Scale (EDSS) scores were assessed using linear mixed-effects modeling with forward stepwise selection. Results: The final EDSS model retained bilateral ventral diencephalon (ventral DC) volumes, left amygdala volume, right pallidum volume, left nucleus accumbens volume, and cerebral cortex volume. The most prominent association involved the left ventral DC, where lower volume was associated with higher EDSS scores (p = 0.0008). CP volume showed no significant longitudinal change across peri-pregnancy MRI timepoints (p = 0.21) and was not retained in the final EDSS model. Conclusion: Regional brain volumetric measures, particularly ventral DC volumes, were associated with disability across the peri-pregnancy period despite low EDSS levels. To our knowledge, this is the first longitudinal evaluation of CP volume across the peri-pregnancy period in women with MS; no significant change was observed over time. These exploratory findings require confirmation in larger prospective studies using standardized serial MRI protocols.

COVID-19 affects the olfactory system and the hippocampus, leading to severe olfactory and cognitive impairments. This study aimed to quantify volumetric changes in the olfactory bulbs and hippocampus in patients with COVID-19, and to investigate these differences in relation to loss of smell and taste. This stereological MRI study included 60 COVID-19 (+) participants and 54 non-COVID-19 participants. Using OsiriX software, the volumes of the olfactory bulb and hippocampus were manually measured from 3T MRI images. Compared with controls, participants with loss of smell and taste had smaller olfactory bulb volumes. This decrease was especially noticeable in the left olfactory bulb of female patients. Furthermore, the right hippocampal volume in male patients with loss of smell and taste was significantly decreased. These findings suggest that atrophy of the olfactory bulb and hippocampus may be specific to certain regions and sexes following SARS-CoV-2 infection. Stereological MRI assessments can effectively identify these changes. Prospective longitudinal studies are needed to determine the clinical significance of these changes and their impact on patient management.

Background: Studies indicate that depression and cognitive functions are important issues of mental health, a serious health issue worth evaluating with possible alternative non-medical treatment options in MS patients. Aim: The aim of this study was to investigate the effect of practice on fatigue, respiratory closure, depression and cognition in patients diagnosed with MS and whether the benefit of Hatha Yoga training is affected by personality structure. Methods: The study included 25 participants between the ages of 18 and 70 who were diagnosed with MS, with an EDSS of 6 and below and who did not show symptoms of depression and did not use antidepressants. Any previous cerebrovascular disease, hypertension (HTN), diabetes mellitus (DM), thyroid dysfunction, or vitamin B12 deficiency was determined as an exclusion criterion. In the study, patients received Hatha Yoga practice 2 days a week for 8 weeks. The MOCA (Montreal Cognitive Assessment) and Beck Depression Scale, personality analysis test, pulmonary function test, and Fatigue Impact Scale were applied to all patients fulfilling the inclusion criteria at the beginning and after the completion of Yoga practice. Results: According to the results obtained, a statistically significant decrease in Beck Depression Inventory scores (p = 0.020) and a significant increase in MOCA Cognitive Test scores (p < 0.001) were detected following the yoga intervention. Although an increase was observed in respiratory capacity (FVC), this change did not reach statistical significance (p = 0.082). These findings demonstrate that yoga practice significantly improves depression levels and cognitive functions. The relationship between the benefits derived from yoga training and personality traits was evaluated using the participants’ Temperament and Character Inventory (TCI) profiles. Following the yoga intervention, a statistically significant increase was observed in novelty seeking (p < 0.001) and persistence (p < 0.001). Conversely, participants exhibited a significant decrease in harm avoidance post-yoga (p < 0.001). However, no statistically significant changes were found in reward dependence (p = 0.766) or cooperation (p = 0.181) scores after the intervention.

Background/Objectives: Sexual dysfunction is a common but underrecognized complication of multiple sclerosis (MS). This study investigated the prevalence, clinical characteristics, and independent clinical and radiological factors associated with sexual dysfunction in people with MS. Methods: This single-center cross-sectional study included 161 patients with MS. Neurological disability, depressive symptoms, urinary dysfunction, and MS-related sexual symptoms were assessed using the Expanded Disability Status Scale, Beck Depression Inventory (BDI), International Consultation on Incontinence Questionnaire–Short Form (ICIQ-SF), and Multiple Sclerosis Intimacy and Sexuality Questionnaire-19 (MSISQ-19), respectively. Sexual dysfunction was defined according to validated sex-specific cut-off values on the Female Sexual Function Index (FSFI) and the International Index of Erectile Function (IIEF). Independent associations were evaluated using multivariable logistic regression. Results: Sexual dysfunction was identified in 119 of 161 patients (73.9%). Patients with sexual dysfunction had greater neurological disability, more frequent spinal cord lesions, and more severe urinary symptoms than those without sexual dysfunction. In multivariable analysis, depressive symptom severity (adjusted OR 1.06, 95% CI 1.01–1.12; p = 0.027) and EDSS score (adjusted OR 1.60, 95% CI 1.24–2.06; p < 0.001) remained independently associated with sexual dysfunction . Conclusions: Sexual dysfunction is highly prevalent in people with MS. Although neurological disability remains an important independent correlate, depressive symptom severity also contributes independently, underscoring the need for routine assessment of both neurological and psychological factors as part of comprehensive MS care.

Aim To evaluate the performance and reference reliability of three large language models in neurology using a national board examination framework. Methods A total of 803 validated multiple-choice questions from Turkish National Neurology Board Examinations (2015–2024) were administered to ChatGPT Plus, Gemini Advanced, and Microsoft Copilot Pro using a standardized prompt requiring an answer and a supporting reference. Model performance was compared with overall examinee performance and analyzed by neurological subspecialty, question type, and presence of visual content. References provided for incorrectly answered questions were independently evaluated by three board certified neurologists. Results Mean accuracy rates were 87% for Gemini, 86% for Copilot, and 85% for ChatGPT, significantly outperforming the human examinee average of 65% (p < 0.001), with no significant differences among models. Accuracy did not differ by question type or neurological subspecialty. All models outperformed examinees on non-visual questions, whereas no performance advantage was observed for visually based items. Reference evaluation revealed substantial limitations: ChatGPT frequently provided insufficient citations (39.6%), while fabricated references predominated in Gemini (53.0%) and Co-pilot (42.1%). Conclusion Large language models demonstrate high and consistent accuracy on neurology board examination questions, with performance exceeding that of the average examinee. On visually based questions, accuracy was lower than for non-visual items, and the performance advantage over examinees disappeared. High rates of insufficient referencing indicate a clear need for expert oversight, supporting the use of LLMs as complementary tools in neurology education rather than autonomous sources of clinical or academic authority.