A comparison of the relations between brain atrophy, cognition and optic coherance tomography between multiple sclerosis patients and healthy controls

Çalışmamızda McDonald tanı kriterlerine göre kesin MS tanısı almış olan Uludağ Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı Multipl Skleroz Polikliniğinde izlenen Multipl Skleroz (MS) hastalığı tanılı 43 hasta ve 15 sağlıklı kontrol grubu alındı. MS'li olgular Relapsing Remiting (RRMS), Relapsing Remiting Optik Nörit (RRMS-ON) geçirmiş olgular ve Sekonder Progresif (SPMS) olmak üzre üç gruba ayrıldı ve TFT, Vit B12, folik asit değerleri incelendi. Hamilton depresyon testi ile depresyon varlığı dışlandı. Göz dibi muayeneleri yapıldı ve optik koherans tomografileri (OKT) çekildi. Olgulara uzman psikolog tarafından modifiye edilmiş Wechsler bellek ölçeği, Sözel bellek süreçleri testi, Görsel bellek testi, Mantıksal bellek testi, Dikkat testi, Çizgilerin yönünü belirleme testi, Raven testi (RSPM), Stroop, Benton yüz tanıma testi, Akıcılık testleri ve PASAT testi uygulandı. Tüm olguların otomatik segmentasyon yöntemi ile bilateral kranial subkortikal volümleri ölçüldü. Elde edilen volüm ülçümleri total intrakranial volüme oranlanarak beyin parankimal fraksiyonları hesaplandı. Çalışmaya toplam 58 (%65,5'i kadın, %34,5'i erkek) olgu alındı. Gruplar arasında atrofi açısından sol akkumbens, sol lateral ventrikül, sol talamus, sol kaudat, sol putamen, sol pallidum volümleri ile sağ lateral ventrikül, sağ talamus, sağ putamen, sağ pallidum, sağ hipocampus, sağ akkumbens, 3. ventrikül ve beyaz cevher hipointens volümleri açısından anlamlı fark saptandı. Derin gri cevher, meziyal temporal yapılar ve lateral ventrikül volümleri ile dikkat, akıcılık, sözel bellek süreçleri ve mantıksal bellek süreçleri testleri arasında anlamlı korelasyon mevcuttu. Optik nörit geçirsin yada geçirmesin tüm MS hastalarında SPMS grubunda daha kötü olmak üzre OKT skorları artmış olarak bulundu. Retinal sinir lifi kalınlığı (RSLK) ile beyin parankimal fraksiyonu arasında anlamlı korelasyon tesbit edildi. MS hastalarında yapılan beyin atrofisi ilgili çalışmalar ülkemizde elle çizme şeklinde yapılmakta, otomatik segmentasyon yöntemi henüz yaygın kullanılmamaktadır. Yaptığımız bu çalışma ile güvenilir ve ayrıntılı subkortikal ölçümler OKT sonuçları ve kognitif testlerler ile ilişkilendirilerek literatüre değerli ve güvenilir bilgiler sağlanmıştır.Forty-three MS patients diagnosed according to McDonald's ctiteria and being followed up in the outpatient MS Unit of Neurology Department in Uludag University Medical Faculty and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as RRMS, Relapsing Remitting Optic Neuritis (RRMS-ON) and SPMS. Thyroid function tests, serum vitamine B12 and folic acid levels were measured in all the cases. Fundoscopy and OCT were done for all them. Hamilton depression test scores above 16 were included. An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test and Paced Auditory Serial Addition tests in all cases. Cranial subcortical volumes of the subjects were measured using an automatic segmentation method. Brain parenchymal fractions were calculated using the obtained volume measurements proportioning to the total intracranial volume. Fifty eight subjects (65,5% female, 34,5% male) were enrolled in the study. There were statistically significant differences between the patients and the control group in terms of volumes of the left accumbens, left lateral ventrikule, left thalamus, left caudate nucleus, left putamen, left pallidum, right lateral ventricule, right thalamus, right putamen, right pallidum, right hippocampus, right accumbens, third ventricule and the hypointense white matter. There was significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricule volumes and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, were increased, being worser especially in the SPMS group. Correlations between the retinal nerve fiber layer thickness and the brain parenchymal fractions of the patients were statistically significant. Manual methods instead of automatic segmentation method is being more commonly used in the studies with brain atrophy and MS in our country. Our study contributed to the literature by showing the correlations between the reliable and detailed subcortical measurements, OCT results and cognitive tests in MS patients

Comparison of brain atrophy, cognition and optical coherence tomography results between multiple sclerosis patients and healthy controls

Amaç: Multipl skleroz (MS)’da, motor, duyusal, görsel ve serebellar etkilenmelerin yanı sıra bilişsel bozukluk da özürlülüğün önemli nedenlerinden biridir. Bu çalışmanın amacı, MS’deki kognitif bozukluğun beyin atrofisi ve retinal sinir lifi kalınlığı (RSLK) ile ilişkisini ortaya koymaktır. Materyal Metod: Çalışmamıza MS tanılı 43 hasta ve 15 sağlıklı kontrol alındı. MS’li olgular, relapsing remitting (RRMS), optik nörit geçirmiş relapsing remitting (RRMS+ON) ve sekonder progresif multipl skleroz (SPMS) olmak üzere üç gruba ayrıldı. Olgulara uzman psikolog tarafından Wechsler bellek ölçeği, Sözel, Görsel ve Mantıksal bellek, Dikkat, Çizgilerin yönünü belirleme, Raven (RSPM), Stroop, Benton yüz tanıma, Akıcılık ve PASAT testleri uygulandı. Optik koherans tomografileri (OKT) çekildi. Tüm olguların kranial subkortikal 1,5 tesla MR cihazı ile elde olunan 3 boyutlu T1A görüntülerden volümleri ölçüldü (tam otomatik Freesurfer programı ile). Elde edilen volüm ülçümleri total intrakranial volüme oranlanarak, beyin parankimal fraksiyonları hesaplandı. Bulgular: Çalışmaya toplam 58 (%65,5’i kadın, %34,5’i erkek) olgu alındı. Gruplar arasında, parankimal kalınlık, üçüncü ventrikül ve beyaz cevher volümleri açısından anlamlı farklar saptandı. Derin gri cevher, meziyal temporal yapılar ve lateral ventrikül volümleri ile, dikkat, akıcılık, sözel ve mantıksal bellek süreçleri testleri arasında anlamlı korelasyon mevcuttu. Optik nörit geçirsin ya da geçirmesin tüm MS hastalarında, SPMS grubunda daha belirgin olmak üzere, OKT skorları artmış olarak bulundu. RSLK ile beyin parankimal fraksiyonu arasında anlamlı korelasyon saptandı. Sonuç: MS hastalarında yapılan beyin atrofisi çalışmaları ülkemizde elle çizme şeklinde yapılmakta, otomatik segmentasyon yöntemi henüz yaygın kullanılmamaktadır. Bu çalışmamız ile OKT skorları ile beyin atrofisi arasında anlamlı korelasyon olduğu gösterilmiş ve bunun kognitif testlerdeki azalma şeklinde yansıması izlenerek literatüre değerli ve güvenilir bilgiler sağlanmıştır.Introduction: Cognitive impairment is also an important cause of disability in MS in addition to motor, sensory, visual, and cerebellar affections. The aim of this study is to show the relation between the cognitive disability in MS with brain atrophy and retinal nerve fiber layer (RNFL). Methods: Forty-three multiple sclerosis (MS) patients, and 15 healthy individuals as controls were included in the study. MS patients were divided into three groups as relapsing-remitting MS (RRMS), relapsingremitting with optic neuritis (RRMS+ON), and secondary-progressive MS (SPMS). An experienced psychologist performed modified Wechsler Memory Scale Revised form (WMS-R), Lines Orientation test, Stroop Color Word Interference test (STROOP), Standard Raven Progressive Matrices (SRPM), Benton Facial Recognition Test, verbal fluency test, and Paced Auditory Serial Addition tests in all cases. Optic coherence tomographies (OCT) were done. Cranial subcortical volumes of all subjects were measured using 3-dimensonal T1 A imagines obtained by the cranial subcortical 1.5 tesla MR device (fully automatic Freesurfer program). Brain parenchymal fractions were calculated by proportioning the obtained volume measurements to the total intracranial volume. Results: Fifty-eight subjects (65.5% female, 34.5% male) were enrolled in the study. There were significant differences among the groups in terms of parenchymal thickness, volumes of third ventricle, and white matter. There was a significant correlation between the volumes of the deep gray matter, mesial temporal structures and lateral ventricular volumes, and the test results of the WMS-R. OCT scores of all MS patients, whether or not they experienced optic neuritis, had increased, being worse especially in the SPMS group. Correlation between RNFL and the brain parenchymal fractions of the patients were statistically significant. Conclusion: Manual methods instead of automatic segmentation method are being more commonly used in the studies with brain atrophy and MS in our country. A significant correlation between OCT scores and brain atrophy is shown with our present study, and this is followed as a reflection of decrease in cognitive tests that provides valuable and reliable knowledge for the literature

Evaluation of the effects of botulinum toxin therapy on the clinical characteristics of pain and pain threshold value in patients with primary cervical dystonia

Objective: In 70% of patients with cervical dystonia (CD), the clinical presentation includes the symptom of pain. In this study, we aimed to define the types and clinical characteristics of the pain and to investigate whether this pain is a result of central sensitization by evaluating pre- and post-botulinum toxin (BoNT) treatment pain threshold values using electrical stimulation.Methods: The study enrolled a total of 35 patients with CD who received BoNT therapy. The patients were evaluated using the pain evaluation scale and Unified Dystonia Rating scale (UDRS) before and after BoNT therapy. The pain threshold values obtained from dystonic muscles, the contiguous or contralateral muscle without dystonic activity and a normal reference muscle with distant localization were recorded through electrical stimulation with EMG guidance, and all values obtained before and after BoNT therapy were compared.Results: No difference was found between the pain threshold values obtained from dystonic muscles before and after treatment. While no difference was observed across genders or VAS groups in terms of pain threshold values, the UDRS (duration and motor severity factor) scores showed significant decreases after treatment with BoNT in patients with painful dystonia and in patients with painless dystonia.Conclusions: The absence of a difference in pre- and post-BoNT treatment pain threshold values in dystonic muscles might be explained by the absence of central sensitization. Pain relief in dystonic patients might occur secondary to decreases in dystonic muscle contractions

A Case With Multicentric Glioblastoma Multiforme

Scientific BACKGROUND: Glioblastoma multiforme is the most malign tumor which can be multifocal, including necrosis, vessel proliferation and excessive mitosis, can infiltrate peripherial tissue, and generally located in supratentorial regions. MR imaging shows a mass lesion with irregular borders and a cavity at the center with non-homogenous contrast enhancement. CASE: Fifty-three years old patient admitted to our emergency department complaining about seizures and weakness on her left side. On neurologic examination she had a 4/5 MRC muscle strength on her left side with a positive babinski sign and also hemihipoestesia including her face on her left side. In cranial MRI, it was found that there were lesions with miscellaneous dimensions in right parietal cortex, left thalamus and left cerebellar pedincule without contrast enhancement. Central nervous system (CNS) infection and the primary CNS were the initial diagnoses. All microbiologic indicators were negative both in the serum and liqeur. A stereotactic biopsy was performed and pathology revealed low grade astrocytoma. Her clinical conditioned worsened by time and died due to infections and multiple organ failure. Pathological autopsy revealed that the mass lesion was glioblastoma multiforme. CONCLUSION: In this case report we presented a case with a MRI and biopsy suggesting a diagnosis of low grade astrıcytoma. However, clinical findings worsened in a short time causing death of the patient. It is discussed that multifocal GBM can be in different grades on the different parts of the lesions. Although imaging techniques are of utmost importance, in case of discordancy clinical follow-up and neurological examination are still the most important to rely o

Mitoxantrone in the treatment of multiple sclerosis: a single-center experience

OBJECTIVE: To investigate the secondary progressive multiple sclerosis (SPMS) patients treated with mitoxantrone (MIT) and discuss the effectiveness and side effects of MIT. METHODS: We retrospectively investigated 48 SPMS patients who completed or were still receiving MIT treatment. Expanded Disability Status Scale (EDSS) scores of the patients were determined who had detailed examination before the treatment. Complete blood count, urine examination, chest x-ray, kidney and liver function tests, transthoracic echocardiography were performed at initiation and during follow-up and 10 mg/m2 MIT was administered every three months. The data were assessed in order to determine the effectiveness and side effects. RESULTS: A total of 48 patients, 34 women and 14 men, had an age of 42 (26-55) years at the initiation of MIT treatment. The duration of the treatment was 12 (3-30) months. The median EDSS scores were 6 (4-8) before the treatment and 6 (4-9) after the treatment. EDSS scores improved in 6 patients, deteriorated in 12 patients and 30 patients remained with stable EDSS scores during the treatment. Seventeen patients had no side effects however 31 patients developed side effects. CONCLUSION: On the basis of this study, which is a clinical assessment of the effectiveness and side effects of MIT, we conclude that MIT can limit disability in SPMS patients and it is useful in treating SPMS patients due to favorable risk-benefit rati