Relapsing remitting multipl skleroz tedavisinde fingolimod kullanımı

Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system and is characterized by inflammation, demyelination, and axonal loss. Fingolimod is the first oral drug for the treatment of MS approved by the United States Food and Drug Administration, European Union countries, and various other countries. The compound exerts its effect via interaction with lysophospholipid receptors known as sphingosine-1 phosphate receptors. Although fingolimod has a very convenient daily oral dosing, it may cause development of bradycardia at the first dose, macular edema, infection, all of which require attention. Randomized double-blind clinical trials have shown that fingolimod significantly reduces relapse rates and is beneficial in brain magnetic resonance imaging measures when compared with both placebo and intramuscular interferon beta-1a. This review describes the characteristics of fingolimod concerning its efficacy, safety, and tolerability in the clinical context of the management of MS.Multipl skleroz (MS) merkezi sinir sisteminin enflamasyon, demiyelinizasyon ve akson kaybı ile karakterize kronik otoimmün, nörodejeneratif bir hastalığıdır.Fingolimod Amerikan İlaç ve Gıda Dairesi ve Avrupa Birliği üyesi ülkelerin de bulunduğu 80’den fazla ülke tarafından onaylanmış ilk oral MS ilacıdır. Bu bileşik,sfingozin-1 fosfat olarak bilinen lizofosfolipid reseptörleri aracılığı ile etkilerini gösterir. Günlük oral yolla kullanımı kolaylık sağlamakla birlikte bazı hastalardailk doz sırasında bradikardi gelişmesi, maküler ödem, enfeksiyon gibi bazı dikkat edilmesi gereken durumlar ile karşılaşılabilmektedir. Randomize çift-kör klinikçalışmalar, plasebo ve intramüsküler interferon β-1a tedavilerine kıyasla fingolimodun atak sıklığını anlamlı derecede azalttığını ve beyin manyetik rezonansölçütleri üzerine yararlı etkiler gösterdiğini ortaya koymuştur. Bu derlemede, fingolimodun klinikte MS hastalarının yönetimindeki etkinliği, güvenliliği vetolerabilitesi ele alınmıştır

Malign melanomlu olguda beyin metastazı: Melanotik patern

Dear Editor, A man aged 58 years who had been under follow up for malignant melanoma (MM) for six years, was admitted to the neurology outpatient clinic with symptoms of headache and loss of balance. He had had very severe and throbbing headaches for the last 3 days that were not accompanied by nausea and vomiting, and were not completely relieved by analgesics. He also reported loss of balance in the last 2 days, and he had difficulty in holding objects and climbing stairs. From his past medical history, it was learned that he had undergone surgery for MM located on the skin of left shoulder and a lung metastasis that was detected four months ago. On his neurologic examination, he had blurry papillary boundaries prominent on the right side and truncal ataxia. Contrast-enhanced brain magnetic resonance imaging revealed supra- and infratentorial multiple MM metastases that showed lesions in susceptibility weighted imaging (SWI) and VenBOLD sequences that were hyperintense on axial T1-weighted images and hypointense on axial T2-weighted images (Figure 1). Regression of lesions was observed following radiotherapy (Figure 2).Sayın Editör, Altı yıldır malign melanom (MM) nedeni ile takip edilen 58 yaşında erkek hasta baş ağrısı ve dengesizlik şikayetleri ile nöroloji polikliniğimize başvurdu. Son 3 gündür çok şiddetli olan, zonklayıcı, bulantı ve kusmanın eşlik etmediği, analjezikle tamamen geçmeyen baş ağrısı mevcuttu. Son 2 gündür dengesizlik yakınması da olan hasta eşyaları tutarken ve merdiven çıkarken zorlanmaktaydı. Özgeçmişinde 6 yıl önce geçirilmiş sırt bölgesinde MM operasyonu ve 4 ay önce tespit edilen akciğer metastazı olduğu öğrenildi. Nörolojik muayenesinde sağda daha belirgin olmak üzere papil sınırları silikti ve trunkal ataksisi vardı. Kontrastlı kraniyal manyetik rezonans görüntülemede supra-infratentorial alanda multipl, T1A kesitlerde hiperintens, T2A kesitlerde hipointens, venöz bold sekansta [duyarlılık ağırlıklı görüntüleme (SWI)] duyarlılık artefaktları gösteren MM metastazları saptandı (Şekil 1). Uygulanan radyoterapi sonrası lezyonlarda gerileme olduğu görüldü (Şekil 2)

Olfactory dysfunction and cognition in radiologically isolated syndrome and relapsing-remitting multiple sclerosis

BACKGROUND: Multiple Sclerosis (MS) is a neuroinflammatory, neurodegenerative, demyelinating disease that causes cognitive, olfactory, and other neurological dysfunctions. Radiologically Isolated Syndrome (RIS), in which only radiological findings are monitored, is accepted as the preclinical stage of demyelinating disease and is considered an important period for disease pathology. Therefore, in this study, we aimed to evaluate the olfactory and cognitive functions and their clinical correlation in RIS and Relapsing-Remitting MS (RRMS) patients and a healthy control group. METHODS: Our study included 10 RRMS patients, 10 RIS patients, and 10 healthy controls. We conducted an olfactor evaluation via the "Sniffin' Sticks" test. The subjects underwent a neuropsychometric test battery to evaluate cognitive functions, including memory, visuospatial, and executive functions. Depression was evaluated using the Beck depression scale. Fatigue and daily life activity were evaluated using the Fatigue Severity Scale (FSS) and the 36-Item Short Form Survey (SF-36), respectively. Disability assessment was done with the Expanded Disability Status Scale (EDSS). RESULTS: RRMS and RIS patients' olfactory test scores were significantly different from those in the control group (p < 0.05). There was a significant difference between the odor threshold scores of patients in the RRMS and RIS groups. There was a significant correlation between memory-oriented cognitive tests and olfactory tests in the RRMS and RIS groups. CONCLUSION: Olfactory dysfunction can be seen in RIS patients, like in RRMS patients. Cognitive and olfactory dysfunction may be together a sign of degeneration in demyelinating diseases

Brain Metastasis in a Patient with Malignant Melanoma: Melanotic Pattern

WOS: 000406221900011

Retrospective analysis of effectiveness of fingolimod in real life setting in Turkey (REFINE)

Background/aim: During multiple sclerosis (MS) treatment different modes of action such as lateral (interferon beta to glatiramer acetate or glatiramer acetate to interferon beta) or vertical (interferon beta/glatiramer acetate to fingolimod) drug switch can be performed. This study aims to investigate the clinical effectiveness of switching from the first-line injectable disease modifying treatments (iDMTs) to fingolimod (FNG) compared to switching between first-line iDMTs. Materials and methods: This is a multicenter, observational and retrospective study of patients with relapsing-remitting MS who had lateral and vertical switch. The observation period included three key assessment time points (before the switch, at switch, and after the switch). Data were collected from the MS patients’ database by neurologists between January 2018 and June 2019. The longest follow-up period of the patients was determined as 24 months after the switch. Results: In 462 MS patients that were included in the study, both treatments significantly decreased the number of relapses during the postswitch 12 months versus preswitch one year while patients in the FNG group experienced significantly fewer relapses compared to iDMT cohort in the postswitch 12 months period. FNG cohort experienced fewer relapses than in the iDMT cohort within the postswitch 2 year. The mean time to first relapse after the switch was significantly longer in the FNG group. Conclusion: The present study revealed superior effectiveness of vertical switch over lateral switch regarding the improvement in relapse outcomes. Patients in the FNG cohort experienced sustainably fewer relapses during the follow-up period after the switch compared the iDMT cohort. Importantly, switching to FNG was more effective in delaying time to first relapse when compared with iDMTs