Deniz Tuncel

Amaç: Optik nörit (ON) ayırıcı tanısı için etiyolojik özelliklerin bilinmesi ve bunların ayırt edilmesi klinik pratikte tanı ve tedavi açısından önemlidir. Bu çalışmada 8 yıllık süreçte kliniğimize ON ile başvuran hastaların klinik, demografik ve radyolojik özelliklerinin saptanması, etiyolojik alt gruplarının belirlenmesi, tedavi yanıtlarının incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Ekim 2016 – Mart 2024 tarihleri arasında ilk ON atağı ile kliniğimize başvuran hastaların verileri hastane bilgi sisteminden retrospektif olarak taranmıştır. Bulgular: Çalışmamıza ilk defa ON atağı geçiren 55 hasta alınmıştır. Hastaların dağılımı 26 multipl skleroz (MS), 1 nöromyelitis optika spektrum bozukluğu (NMOSD), 12 miyelin oligodendrosit glikoprotein antikoru ilişkili hastalık (MOGAD), 16 idiyopatik ON şeklindeydi. Gruplar arasındaki dağılımsal farklılık MS tanısı almış olan ve idiyopatik gruptaki hastalar için unilateral göz tutulumu açısından istatistiksel olarak anlamlı bulunmuştur (χ²=16,021 , p= 0,001). Gruplar arasındaki dağılımsal farklılık MOGAD ilişkili hastalık ile idiyopatik hasta gruplarında papilödem varlığı açısından istatistiksel olarak anlamlı bulunmuştur (χ²=7,210, p=0,049). Gruplar arasındaki dağılımsal farklılık MS tanısı alan hastalar için beyin MRG’de anlamlı görüntüleme bulgusunun varlığı açısından istatistiksel olarak anlamlı bulunmuştur (χ²=27,096, p<0,001). Sonuç: Çalışmamızda ON tanısıyla başvuran hastaların demografik verileri inceledikten sonra bu hastalar laboratuvar çalışmaları ve klinik izlem sonucunda tanısal alt gruplara ayrılmış ve tanısal alt grupların klinik özellikleri, muayene bulguları, radyolojik görüntüleme özellikleri, tedavi özellikleri ve görsel sonuç değerlendirmeleri her grup için ayrı ayrı değerlendirilmiştir. Bu yönden çalışmamızın literatüre katkı sağlayacağı düşüncesindeyiz.

Objective: Human telomerase reverse transcriptase (hTERT) is a key determinant of telomere maintenance and cellular aging. Oxidative stress plays a role in neurodegenerative processes by causing cellular damage through increased reactive oxygen species. Our study aimed to reveal the relationship between hTERT and oxidative stress in the pathophysiology of epilepsy. Methods: The study included 45 individuals diagnosed with epilepsy and 55 healthy controls. hTERT concentration, total oxidant status (TOS), total antioxidant status (TAS), superoxide dismutase (SOD), and thiol‐disulfide homeostasis were measured in serum samples. Results: A significant decrease in hTERT levels, an increase in oxidative stress markers (TOS, OSI), and a decrease in antioxidant levels (TAS, SOD), and total and native thiol levels were determined in epilepsy patients. In addition, a significant and negative correlation was found between hTERT and native thiol. Significance: Our study suggested that the interaction between oxidative stress and hTERT levels in the pathophysiology of epilepsy may play an important role in seizure generation and progressive neural damage. This study will form the basis for further research and guide the identification of potential biomarkers for treating epilepsy. Plain Language Summary: We measured the levels of a protective protein that helps preserve chromosomes and several markers of cell stress in people with epilepsy and healthy volunteers. People with epilepsy showed lower levels of this protective protein, weaker antioxidant defenses, and higher oxidative stress. We also found that lower protein levels were linked to fewer molecules that guard cells from damage. These changes may help explain why seizures occur and why the brain can suffer ongoing injury in epilepsy.

Rapid eye movement (REM) sleep behavior disorder (RBD) is characterized by recurrent dream enactment behaviors like sleep-related vocalization and/or complex motor behaviors.To investigate the discriminative role of the validated Turkish version of the 9-Item Innsbruck REM Sleep Behavior Disorder Inventory (IRBD-9-Turkish) for idiopathic RBD (iRBD) in patients with obstructive sleep apnea (OSA).The current multicenter study was prospectively conducted in 13 accredited sleep centers in 10 different cities in Türkiye. Clinical data was obtained through a preformed questionnaire, and all participants were submitted to a full-night video-polysomnography (video-PSG) session in a sleep laboratory.A total of 105 patients (mean age: 58.3 ± 11.6 years; 68.6% of male subjects) were prospectively and consecutively enrolled in the study; 51 patients (48.6%) presented iRBD, and 54 (51.4%), OSA, 19 (35.2%) of whom presented abnormal nocturnal behaviors (NBs) demonstrated by clinical and video-PSG findings associated with arousal reactions secondary to apneas and hypopneas. The cut-off value of the IRBD-9 was higher in patients with OSA-NBs than in those with OSA without NBs (p < 0.001), with a sensitivity of 0.765 and a specificity of 0.667, resulting in a correct diagnosis of NBs in 75% of patients with OSA. The receiver operating characteristic (ROC) curves for Factor I (items 1, 2, 3, 6, and 8) and Factor II (items 4, 5, 7, and 9) of the IRBD-9-Turkish showed that both factors were able to distinguish patients with iRBD from those with OSA, but only Factor I distinguishes patients with iRBD from those with OSA-NBs.The present study demonstrated a very high sensitivity and specificity of the IRBD-9-Turkish not only in patients with iRBD, but also in patients with OSA.

Background Isolated rapid eye movement (REM) sleep behavior disorder (iRBD) is characterized by loss of the normal atonia of REM sleep accompanied by repetitive motor and behavior phenomena of dream content. Objective To evaluate the reliability and validity of the Turkish version of the original form of the Innsbruck Rapid Eye Movement Sleep Behavior Disorder Diagnostic Inventory (IRBD-9) scale (IRBD-9-TR) and ensure that this screening test can be easily used in the Turkish language. Methods The present is a multicenter and prospective study involving 184 patients: 51 with iRBD and 133 healthy controls. The iRBD patients were not diagnosed before submitted to video polysomnography (vPSG) and filling out the IRBD-9-TR. Results The optimal cut-off value for the IRBD-9-TR symptom score was of 0.28, with a sensitivity of 0.941 and a specificity of 0.947, and 94.4% of the patients were correctly diagnosed. The rotated factor loadings for the diagnostic accuracy of each individual question showed that the short version of the IRBD-9-TR (questions 1, 2, 3, 6, and 8) presented higher specificity and excellent discrimination of iRBD patients from healthy controls. The Cronbach's α coefficient for the symptom section of the IRBD-9-TR was of 0.857, and the Kappa coefficient, of 0.885. Conclusion The short version of the IRBD-9-TR presents good validity and reliability to be used as a screening test to assess iRBD patients. It is convenient and potentially useful in both outpatient clinical and epidemiologic research settings.

The Leg Activity Measure is the only self-report measure that has been published to date that takes into account both the influence on quality of life and passive and active function in the literature. The purpose is to examine the translation, cross-cultural adaptation validity and reliability of the Turkish version of the Leg Activity Measure (Tr-LegA). Neurological patients (n = 52) with lower limb spasticity (aged 47.09 ± 14.74 years) were enrolled. The study consisted of two stages. At the first stage, the scale was translated into Turkish and culturally adapted. Validity and reliability analyses were conducted at the second stage. Construct validity was evaluated by exploratory factor analysis (EFA). The Rivermead Mobility Index (RMI), Nottingham Health Profile (NHP), and Functional Independence Measure (FIM) were used for convergent validity. The reproducibility (test-retest reliability) was assessed by the intraclass correlation coefficient (ICC). Furthermore, the standard error of measurement (SEM) was calculated. EFA suggested one factor for the Passive Function and two factors for the Active Function and Impact on Quality of Life Scales (QoL). Tr-LegA Passive and Active Function Scales were correlated with the total RMI, NHP, and FIM (p < 0.05). Tr-LegA Impact on Quality of Life Scale was correlated with the RMI and NHP (p < 0.05). Tr-LegA Passive Function Scale (ICC = 0.997), Tr-LegA Active Function Scale (ICC = 0.996), and Tr-LegA Impact on Quality of Life Scale (ICC = 0.976) had good reliability. Only Passive Function Scale had a significant floor effect (25%). Tr-LegA is a valid and reliable multidimensional scale for passive and active function and quality of life in patients with lower limb spasticity. NCT05182411.

Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi Dergisi