Applications of Botulinum Toxin at a Neurology Clinic: An Eleven-year Experience

Objective: The aim of this study was to report our experience with Botulinum toxin (BoNT) in the treatment of various neurologic conditions. Materials and Methods: We conducted a retrospective analysis of 128 patients who received BoNT in our Neurology clinic during an 11-year period (January 2003 to December 2014). All patients received BoNT type A injections. Results: A total of 858 injections of BoNT were administered to 128 patients. Seventy (54.7%) patients with hemifacial spasm had 456 injection sessions, 24 (18.8%) patients with blepharospasm had 209 injection sessions, 21 (16.4%) patients with cervical dystonia had 145 injection sessions, 8 (6.3%) patients with spasticity had 29 injection sessions, 3 (2.3%) patients with migraine-type headache had 14 injection sessions, 1 (0.8%) patient with sialorrhea had 3 injection sessions, and 1 (0.8%) patient with upper-extremity dystonia underwent 2 injection sessions. The mean onset of effects after injection was 7.11±2.34 days, the duration of effect was 13.0±5.46 weeks, and the amount of improvement was 61.5±16.7% in all patients. A total of 27 (3.14%) adverse effects were recorded in 858 injection sessions. The adverse effects were mild and tolerable. Conclusion: Our results show that BoNT type A is an effective and safe therapy for various types of neurologic conditions

Üniversite öğrencilerinde huzursuz bacaklar sendromu sıklığı ve yaşam kalitesi ile ilişkisi

Amaç: Bu çalışmanın amacı üniversite öğrencileri arasında huzursuz bacaklar sendromu sıklığını, semptom şiddetini ve huzursuz bacaklar sendromunun yaşam kalitesi ile ilişkisini araştırmaktır. Gereç ve Yöntem: Katılımcı öğrencilere huzursuz bacaklar sendromu tanı kriterlerini içeren dört soru soruldu ve bu dört soruya ‘evet’ cevabı veren öğrenciler Nöroloji uzmanı tarafından Uluslararası Huzursuz Bacaklar Sendromu Çalışma Grubu (UHBÇG) kriterlerine göre değerlendirildi ve huzursuz bacaklar sendromu tanısı konuldu. Huzursuz bacaklar sendromu bulunan öğrencilere hastalık şiddetini ölçmek için UHBÇG Şiddet Skalası uygulandı ve yaşam kalitesini değerlendirmek için tüm katılımcılara Kısa form-36 (KF-36) uygulandı. Bulgular: Çalışmaya 238’i (%53,2) kız, 209’u (%46,8) erkek olmak üzere toplam 447 öğrenci katıldı. Öğrencilerin %7.6’sında huzursuz bacaklar sendromu saptandı. Huzursuz bacaklar sendromu şiddeti ortalama 13,1 ± 5,44 olarak belirlendi. Huzursuz bacaklar sendromu bulunan öğrencilerde KF-36 fizik ve mental bölümü skorları anlamlı düzeyde düşük saptandı. Huzursuz bacaklar sendromu S şiddet düzeyi ile KF-36 fizik bölümü skorları arasında anlamlı negatif ilişki saptandı. Sonuç: Üniversite öğrencilerinin halen toplumda yeterince bilinmeyen ve yaşam kalitesini olumsuz etkileyebilen huzursuz bacaklar sendromu açısından değerlendirilmesinin faydalı olacağını düşünmekteyiz

Evaluation of retinal nerve fiber layer thickness in a patient with bilateral optic disc drusen

Optic disc drusen (ODD) is the accumulations of calcified hyaline-like material within the substance of the optic nerve head. Optic disc drusen, especially if it is bilateral, may mimic the clinical presentation of papilledema. Usually retinal nerve fiber layer (RNFL) thinning can be present in ODD. In this report we present uncommon RNFL changes in a patient with bilateral ODD. A 17-year-old male was referred by another center with a diagnosis of optic disc edema. The patient’s visual acuity, the slit-lamp examination and the intraocular pressures were normal in both eyes. On fundus examination, there were irregularly elevated discs bilaterally and the optic nerves appear with hazy disk margins. He did not have visual field defects in automated perimetry. Bilateral ODD were identified and confirmed by B-scan ultrasonography and optical coherence tomography (OCT) demonstrated 4 clock hours of RNFL thickening. Optic disc drusen may be misdiagnosed as papilledema. Thus, clinical suspicion of ODD is important in order to diagnose papilledema and prevents unnecessary interventions. Although most of eyes with ODD have normal or thinner RNFL thickness, some of these eyes can have thicker RNFL thickness

Headache characteristics and frequency of migraine in patients with cervical artery dissections

Headache is a common symptom of cervical artery dissections (CAD). Sometimes, it can be the only symptom and mimic migraine. We aimed to investigate headache characteristics and previous history of migraine in CAD patients, and to compare headache features between patients with internal carotid artery dissection (ICAD) and vertebral artery dissection (VAD). We investigated 53 CAD patients (n = 28 with ICAD, n = 25 with VAD). Demographic and clinical data were evaluated retrospectively. Headache information was obtained from the patient interviews with a structured questionnaire (based on the International Headache Society criteria). The patients with headache were assessed by headache specialist with a face-to-face interview. Headache was evaluated according to International Classification Committee of the International Headache Society ICHD. Headache (n = 38, 71.7%) was the most common symptom in CAD patients, which was mostly thunderclap, throbbing, intense and ipsilateral to dissection. Headache frequency and neck pain were significantly higher in VAD patients (p = 0.002, p < 0.001, respectively). Photophobia and phonophobia were also more common in patients with VAD (p < 0.001, p < 0.001, respectively). 29 (54.7%) of CAD patients had a prior history of headache, that 20 (37.7%) of them met the migraine criteria. CAD should be considered in patients with severe unilateral throbbing headache with phonophobia and photophobia, even in patients with a history of migraine. Phonophobia and photophobia may be more common symptoms in VAD patients. Because headache commonly precedes the development of cerebral ischemic events, it needs prompt and accurate diagnosis and treatment

One-year incidence of Chronic Migraine in Tertiary Headache Outpatient Clinics: A multi-center study

WOS: 000452730900163

Chronic Migraine: Burden, Comorbidities and Treatment

Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of migraine headache. In the International Classification of Headache Disorders, CM is defined as a separate entity and the presence of drug overuse headache is removed from being an exclusion criterion. CM accounts for more than 10% of all migraine patients and includes the group with the most prominent disease-related disability. Diagnosis is often overlooked and most patients do not receive appropriate treatment. CM is associated with social and economic burdens such as frequent use of health services, drug overuse, and significant disruption to work and school life. Compared with episodic migraine, more frequent comorbid disorders are important in migraine chronicity, treatment, and course. With appropriate treatment in CM, it is possible to increase the quality of life of the patient and to reduce the social economic burden associated with migraine. In this review, the disease burden of CM, accompanying comorbid diseases, and current treatment options are reviewed

Chronic Migraine: Burden, Comorbidities, and Treatment

Chronic migraine (CM) is defined as headache occurring on 15 or more days per month for more than three months, which, on at least 8 days per month, has the features of migraine headache. In the International Classification of Headache Disorders, CM is defined as a separate entity and the presence of drug overuse headache is removed from being an exclusion criterion. CM accounts for more than 10% of all migraine patients and includes the group with the most prominent disease-related disability. Diagnosis is often overlooked and most patients do not receive appropriate treatment. CM is associated with social and economic burdens such as frequent use of health services, drug overuse, and significant disruption to work and school life. Compared with episodic migraine, more frequent comorbid disorders are important in migraine chronicity, treatment, and course. With appropriate treatment in CM, it is possible to increase the quality of life of the patient and to reduce the social economic burden associated with migraine. In this review, the disease burden of CM, accompanying comorbid diseases, and current treatment options are reviewed