Esen Çiçekli

Background: Endothelial dysfunction and chronic low-grade inflammation have been implicated in the pathophysiology of restless legs syndrome (RLS). The Endothelial Activation and Stress Index (EASIX), a composite biomarker calculated from serum lactate dehydrogenase, creatinine, and platelet count, reflects endothelial activation and systemic biological stress. However, its association with RLS has not previously been investigated. Objective: To compare EASIX levels between patients with RLS and healthy controls and to evaluate the relationship between EASIX and disease severity. Methods: This retrospective case–control study included 199 patients diagnosed with RLS according to the International Restless Legs Syndrome Study Group criteria and 190 healthy controls. Demographic, clinical, and laboratory data were collected retrospectively. EASIX was calculated as LDH (U/L) × creatinine (mg/dL) / platelet count (10⁹/L). Correlations between EASIX and disease duration, disease stage, and International Restless Legs Syndrome Rating Scale (IRLS) scores were assessed using Spearman’s correlation analysis. To account for the potential confounding effect of age, analysis of covariance (ANCOVA) was performed with age as a covariate. Results: Patients with RLS had significantly higher unadjusted EASIX levels than healthy controls (0,520 ± 0,228 vs. 0,465 ± 0,159, p = 0.005). Serum lactate dehydrogenase, urea, WBC, Neutrophil and EASİX levels were also significantly higher, whereas serum iron levels were significantly lower in the RLS group. EASIX demonstrated weak but significant positive correlations with IRLS score ( r = 0.167, p = 0.018), disease stage ( r = 0.180, p = 0.011), and disease duration ( r = 0.198, p = 0.005). However, after adjustment for age, the difference in EASIX between the RLS and control groups was no longer statistically significant ( p = 0.490). In multivariable logistic regression analysis, EASIX was not independently associated with RLS (OR = 1.202, 95% CI: 0.621–2.328, p = 0.585). Conclusions: EASIX levels were higher in patients with RLS than in healthy controls in the unadjusted analysis; however, this difference was no longer statistically significant after adjustment for age, and EASIX was not independently associated with RLS in multivariable analysis. Although weak correlations with disease severity and duration were observed in unadjusted analyses, these associations were not significant after age adjustment. These findings should therefore be considered exploratory and hypothesis-generating. The diagnostic, severity-related, and prognostic utility of EASIX as a biomarker in RLS remains to be established in prospective, longitudinal, and externally validated studies. Clinical trial number: Not applicable.

Myasthenia gravis (MG) is an autoimmune disease involving several immune mechanisms. Recently, semaphorins have emerged as potential diagnostic and prognostic biomarkers in autoimmune neurological and non-neurological diseases. This study investigated the role of immune semaphorins, namely semaphorins 3A, 3F, 4A, 4D, and 7A, in the diagnosis and prognosis of MG and their potential as biomarkers. Serum levels of semaphorin 3A, 3F, 4A, 4D, and 7A were compared between 41 patients with MG and 39 healthy controls. Patients were grouped according to the Myasthenia Gravis Activities of Daily Living scale, and differences in semaphorin levels between groups were analyzed. Semaphorin 4A levels were significantly lower, whereas semaphorin 7A levels were higher in patients with MG than in controls. However, no significant correlation was found between the disease stage and semaphorin levels. Our findings suggest that the levels of semaphorin 4A and 7A may not only support the diagnosis of MG and aid in differential diagnosis but also shed light on the development of future therapeutic protocols targeting semaphorin proteins and receptors in other autoimmune and inflammatory diseases.

Objective: Myasthenia gravis (MG) is an autoimmune disease involving several immune mechanisms. Recently, semaphorins have emerged as potential diagnostic and prognostic biomarkers in autoimmune neurological and non‐neurological diseases. This study investigated the role of immune semaphorins, namely semaphorins 3A, 3F, 4A, 4D, and 7A, in the diagnosis and prognosis of MG and their potential as biomarkers. Methods: Serum levels of semaphorin 3A, 3F, 4A, 4D, and 7A were compared between 41 patients with MG and 39 healthy controls. Patients were grouped according to the Myasthenia Gravis Activities of Daily Living scale, and differences in semaphorin levels between groups were analyzed. Result: Semaphorin 4A levels were significantly lower, whereas semaphorin 7A levels were higher in patients with MG than in controls. However, no significant correlation was found between the disease stage and semaphorin levels. Conclusion: Our findings suggest that the levels of semaphorin 4A and 7A may not only support the diagnosis of MG and aid in differential diagnosis but also shed light on the development of future therapeutic protocols targeting semaphorin proteins and receptors in other autoimmune and inflammatory diseases.

Background and Objectives: Semaphorins are immunoregulatory proteins involved in inflammation and neurovascular modulation. Their roles in ischemic stroke pathogenesis and prognosis have recently gained attention. This study aimed to evaluate serum levels of semaphorin 3A, 3F, 4A, 4D, and 7A in patients with acute ischemic stroke and investigate their relationship with disease severity and prognosis. Materials and Methods: A total of 45 patients with acute ischemic stroke and 39 control individuals were enrolled. Serum semaphorin levels were measured using ELISA. Clinical data, including TOAST classification, NIHSS scores, and laboratory parameters, were recorded. Correlations between semaphorin levels and clinical or biochemical variables were analyzed statistically. Results: Semaphorin 4A levels were significantly lower and semaphorin 7A levels significantly higher in the patient group compared to controls (p < 0.001). Semaphorin 7A positively correlated with NIHSS scores (r = 0.390. p = 0.008). Semaphorin 3A and 4A levels showed significant correlations with inflammatory markers and lipid profiles. Semaphorin 3A was higher in female patients. No associations were found with TOAST subtypes or treatment modalities. Five (11.1%) patients died due to stroke-related complications, no significant differences in semaphorin levels were observed between survivors and non-survivors. Conclusions: Semaphorin 3A, 4A, and 7A levels may serve as potential biomarkers for inflammation and disease severity in acute ischemic stroke. Semaphorin 7A, in particular, showed strong prognostic value due to its association with stroke severity. These findings suggest that semaphorins could aid in clinical risk stratification and early intervention planning in ischemic stroke.

Aims: Motor symptoms of Parkinson's disease (PD) adversely impact patients' quality of life. Exercise and physical therapy are important in reducing disability and increasing the quality of life in patients. Data on which type of exercise is more effective in the management of the disease is controversial. We aimed to examine the effect of Tai Chi exercises on motor functions in patients with PD and compare them with classical stretching-strengthening exercises. Methods: This study comprised 51 participants with PD. The patients were divided into 3 groups as the Tai Chi group, the strengthening-stretching exercises group, and the control group. The first 2 groups exercised for 50 minutes 3 days a week for 12 weeks. Berg Balance Scale (BBS), The Timed Up and Go test, The freezing of Gait Questionnaire and the 10-meters walk test (10 MWT) were applied to 3 groups at the beginning and end of the study. Results: The mean BBS scores of the Tai Chi group were higher than those of the control group. The mean timed up and go test and 10 MWT scores of the Tai Chi group were lower than those of the control group. Conclusion: Tai Chi exercises can be an adjunctive treatment method for improving motor functions in patients with PD, as they are easy to apply, have high patient compliance and do not show serious side effects.

Aims: Limited research has explored novel inflammatory targets in myasthenia gravis (MG). This study aimed to investigate the role of the C-reactive protein (CRP)/albumin ratio (CAR) in disease activity and prognosis in MG patients. Methods: CRP, albumin, and CAR levels were compared between MG patients and healthy controls. The relationships of these parameters with MG activities of daily living (MG-ADL) scores and mortality were examined. Results: Sixty-six patients and 51 controls participated. CRP and CAR levels were significantly higher in the patient group (p=0.002, 0.003). No significant difference was found in albumin levels (p=0.154). A positive correlation was observed between the MG-ADL stage and both CRP and CAR levels (p=0.000 for both), with these markers increasing as MG-ADL worsened. A negative correlation was found between the MG-ADL stage and albumin (p=0.003). CRP, CAR, and albumin levels were significantly associated with mortality (p=0.000, 0.000, 0.005). Conclusion: Elevated CRP and CAR levels in MG patients suggest acute inflammation contributing to clinical decline. Albumin’s decrease with worsening MG-ADL suggests its value as a prognostic marker rather than a diagnostic. CAR proved to be a stronger marker than albumin for disease diagnosis, severity monitoring, and mortality prediction. Our findings could help illuminate inflammatory mechanisms in MG and other neuromuscular diseases.

Introduction: Restless legs syndrome (RLS) is a frequently encountered neurological illness that has no effective treatment and imposes an enormous socioeconomic burden. Autophagy is essential for the maintenance of healthy cellular physiology, cell viability, and defense against pathogenic conditions. However, there is no study investigating the possible role of autophagy‐related proteins (ATGs) in RLS patients. Therefore, we aimed to investigate the expression and diagnostic potential of ATG3 and ATG5, as well as the relationships between these proteins and laboratory markers, depression, disease score, quality of life, and sleep in RLS patients.Methods: A total of 49 patients with RLS and 26 healthy individuals were recruited for the current study. The severity of the disease was assessed using the international RLS rating scale. All participants were administered the Pittsburgh Sleep Quality Index, the Quality‐of‐Life Scale, and the Beck Depression Inventory. The enzyme‐linked immunosorbent assay was employed to quantify the expressions of ATG3 and ATG5.Results: Serum ATG3 and ATG5 expressions were significantly upregulated in RLS patients compared to healthy controls (p = 0.005) and upregulated ATG3 and ATG5 expressions were relationship with the severity of the disease (p < 0.05). ATG3 was substantially correlated with the quality of sleep, whereas ATG5 was correlated with the quality of life and depression status (p < 0.05). The ROC curve analysis demonstrated that ATG3 expressions over 3146.5 ng/mL and ATG5 expressions over 4732.5 ng/mL may predict the presence of RLS (p < 0.01).Conclusion: We report for the first time that autophagy may have a significant impact on the development of RLS.

OBJECTIVE: The aim of this study was to evaluate the Turkish validity and reliability of the Neurorehabilitation Experience Questionnaire, which assesses the experiences of patients receiving neurorehabilitation.

Introduction Osmophobia is hypersensitivity to certain odors. Although osmophobia is a symptom related to migraine, it is also reported in tension-type headache (TTH). Osmophobia is recommended for inclusion in the migraine diagnostic criteria because it increases sensitivity and shows absolute specificity. However, there is no evidence of the association between TTH and osmophobia. This study aimed to evaluate the prevalence and clinical characteristics of osmophobia in a cohort of migraine and TTH patients. Methods For the current analysis, patients who met the inclusion criteria among patients diagnosed with migraine and TTH according to the International Classification of Headache Disorders III criteria in the neurology outpatient clinics of Ankara City Hospital and Akyaz & imath; State Hospital were selected retrospectively. A total of 214 patients (129 with migraine and 85 with TTH) were included in the study. Patients' characteristics, visual analog scale (VAS) pain scores, and Migraine Disability Assessment Scale (MIDAS) scores were recorded. Osmophobia characteristics in migraine and TTH patients were compared along with clinical parameters between the groups and within the groups. Results Osmophobia was found in 68% of migraine patients. The most common type of smell that migraine patients experienced was the scent of perfume. A total of 31.3% of the patients with TTH had osmophobia. While the most irritating odorant in migraine patients was perfume (32%), in TTH patients, it was the smell of food (10.5%). There were no significant differences between osmophobia, and age, education level, disease duration, pain frequency, attack duration, or VAS score in both migraine patients and TTH patients. There was also no significant difference between migraine patients with (2.42) and without (2.33) osmophobia in terms of the MIDAS score. Discussion Our study indicates that osmophobia observed in migraine is valuable in differential diagnosis. However, it can be significantly identified in TTH patients. It should be used together with other supporting criteria in differential diagnosis. It would also be useful to question the characteristics of osmophobia in more detail in the anamnesis.