Erken evre Parkinson hastalığında olfaktör disfonksiyon ve epizodik verbal bellek arasındaki İlişki

WOS: 000348845400013PubMed ID: 28360659Introduction: Olfactory dysfunction is an early and common symptom in idiopathic Parkinson's disease (IPD). Recently, the relation between olfactory dysfunction and cognitive loss in IPD has been reported. In our study, we aimed to investigate the relation between olfactory dysfunction and cognitive impairments in early IPD related with this theory. Methods: In this study, we included 28 patients with stage 1 and stage 2 IPD according to the Hoehn-Yahr (H-Y) scale and 19 healthy participants. The University of Pennsylvania Smell Identification Test (UPSIT) was performed for evaluating olfactory function. For cognitive investigation in participants, the clock drawing test, Stroop test, verbal fluency test, Benton face recognition test (BFR), Benton line judgment orientation test (BLO), and Auditory Verbal Learning Test (AVLT) were performed. Results: We found significantly lower UPSIT scores in the patient group compared to controls (p=0.018). In the neuropsychological investigation, only Stroop test and BLOT test scores were significantly lower in the patient group compared to controls (p=0.003, p=0.002, respectively). We found a negative correlation between UPSIT scores and Stroop time (p=0.033) and Stroop error (p=0.037) and a positive correlation between UPSIT scores and SBST long-term memory scores (p=0.016) in patients. Conclusion: In our study, we found mild cognitive impairment related with visuospatial and executive functions in early-stage IPD compared to controls. But, in the patient group, we detected a different impairment pattern of memory and frontal functions that correlated with hyposmia. This different pattern might be indicating a subgroup of IPD characterized by low performance in episodic verbal memory, with accompanying olfactory dysfunction in the early stage.Giriş: Olfaktör disfonksiyon, İdyopatik Parkinson Hastalığının (IPH) erken ve sık görülen bir semptomudur. Son zamanlarda, olfaktör disfonksiyon ile kognitif kayıp arasında ilişki olduğu bildirilmiştir. Çalışmamızda, bu teori ile ilişkili olarak, erken evre IPH’da olfaktör disfonksiyon ve kognitif bozukluklar arasındaki ilişkiyi araştırmayı amaçladık. Yöntem: Bu çalışmaya, Hoehn- Yahr (H-Y) evrelemesine göre evre 1 ve evre 2 IPH tanısı almış 28 hasta ve 19 sağlıklı birey dahil ettik. Olfaktör fonksiyonu değerlendirmek için University of Pennsylvania Smell Identification Test (UPSIT) uygulandı. Hastalarda kognitif fonksiyonu değerlendirmek için, Saat çizme testi, Stroop testi, verbal akıcılık testi, Benton face recognition testi (BFR), Benton line judgement orientation test (BLO), Sözel bellek süreçleri testi (SBST) uygulandı. Bulgular: Kontroller ile mukayese edildiğinde hasta grubunda UPSIT skorlarını anlamlı olarak daha düşük bulduk (p=0.018). Nöropsikolojik değerlendirmede sadece Stroop testi ve BLOT testi kontroller ile mukayese edildiğinde hasta grubunda anlamlı olarak daha düşüktü (sırasıyla p=0,003, p=0,002). UPSIT skorları ile Stroop zamanı ve Stroop hata skorları arasında negatif korelasyon (p=0,037), UPSIT skorları ile SBST uzun süreli bellek skorları arasında pozitif korelasyon bulduk. Sonuç: Çalışmamızda, daha önceki çalışmalardaki gibi, erken evre IPH’da vizyospasyal ve yürütücü fonksiyonlarla ilişkili hafif kognitif bozukluk saptadık. Fakat hasta grubunda hiposmi ile korele şekilde bellek ve frontal fonksiyonlarda farklı bir bozulma paterni saptadık. Bu farklı patern, IPH’ın erken döneminde koku bozukluğu eşliğinde epizodik verbal bellekte performans düşüklüğü görülmesi şeklinde bir alt gruba işaret ediyor olabili

Autosomal Dominant Cortical Tremor, Myoclonus, and Epilepsy Syndrome mimicking Juvenile Myoclonic Epilepsy

Introduction: Autosomal dominant cortical tremor, myoclonus, and epilepsy (ADCME) syndrome is a genetically heterogeneous and under-recognized disease characterized by tremulous movements mimicking essential tremor, myoclonus, and rare generalized tonic-clonic seizures. Here we described the clinical and electrophysiological features of three siblings with ADCME syndrome mimicking juvenile myoclonic epilepsy (JME)

Autosomal Dominant Cortical Tremor, Myoclonus, and Epilepsy Syndrome Mimicking Juvenile Myoclonic Epilepsy

INTRODUCTION: Autosomal dominant cortical tremor, myoclonus, and epilepsy (ADCME) syndrome is a genetically heterogeneous and under-recognized disease characterized by tremulous movements mimicking essential tremor, myoclonus, and rare generalized tonic-clonic seizures. Here we described the clinical and electrophysiological features of three siblings with ADCME syndrome mimicking juvenile myoclonic epilepsy (JME). METHODS: Three siblings (two females and one male) diagnosed with ADCME were analyzed by electroencephalogram (EEG), somatosensory evoked potentials, and accelerometric recordings. The results were compared with 14 JME patients without tremor and 14 with essential tremor (ET). RESULTS: The shared features of the siblings were cortical tremor, myoclonia, epilepsy, migraine, and psychiatric symptoms. In all siblings, tremor had started before myoclonic epilepsy associated with 4–6 Hz generalized spike and wave discharges. The N20-P25 and P25-N35 amplitudes were substantially higher in the three siblings with ADCME. Although tremor frequencies were similar to those of the ET group, the siblings had mild interrupting low-amplitude myoclonus, suggestive of cortical tremor, in the accelerometric analysis. CONCLUSION: We presented a detailed clinical evaluation with electrophysiological confirmation of ADCME syndrome in a Turkish family. This rare clinical picture might be misdiagnosed as JME and should be kept in mind to ensure correct diagnosis and to provide a homogenous group for genetic studies

An algorithm for automatic detection of repeater F-waves and MUNE studies

Artuğ, Necdet Tuğrul (Arel Author)The present study aims to develop an algorithm and software that automatically detects repeater F-waves which are very difficult to analyze when elicited as high number of recordings in motor unit number estimation studies. The main strategy of the study was to take the repeater F waves discriminated by the neurologist, from limited number of recordings, as the gold standard and to test the conformity of the results of the new automated method. Ten patients with ALS and ten healthy controls were evaluated. 90 F-waves with supramaximal stimuli and 300 F-waves with submaximal stimuli were recorded. Supramaximal recordings were evaluated both manually by an expert neurologist and automatically by the developed software to test the performance of the algorithm. The results both acquired from the neurologist and from the software were found compatible. Therefore, the main expected impact of the present study is to make the analysis of repeater F waves easier primarily in motor unit number estimation studies, since there is currently a continuing need for such automated programs in clinical neurophysiology. Submaximal recordings were examined only by the developed software. The extracted features were: maximum M response amplitude, mean power of M response, mean of sMUP values, MUNE value, number of baskets, persistence of F-waves, persistence of repeater F-waves, mean of F-waves' powers, median of F-waves' powers. Feature selection methods were also applied to determine the most valuable features. Various classifiers such as multi-layer perceptron (MLP), radial basis function network (RBF), support vector machines (SVM) and k nearest neighbors (k-NN) were tested to differentiate two classes. Initially all features, then decreased numbers of features after feature selection process were applied to the aforementioned classifiers. The classification performance usually increased when decreased features were applied to intelligent systems. Ulnar recordings under submaximal stimulation showed better performance when compared with supramaximal equivalents or median nerve equivalents. The highest performance was obtained as 90% with k-NN algorithm which was a committee decision based classifier. This result was achieved with only two features, namely mean of sMUP amplitude and MUNE value

Automatic Analysis of CMAP Scan Data on Healthy Controls and Motor Neuron Patients

#nofulltext# --- Artuğ, Tuğrul (Arel Author)In this study, motor response recordings were acquired from thenar and hypothenar muscles of poliomyelitis survivors, ALS patients and healthy participants by using CMAP Scan method. CMAP Scan curve was plotted by using 500 stimuli between minimum and maximum stimulus intensity. Automatic analysis software was developed with MATLAB for calculating CMAP Scan parameters. Statistical results revealed that step%, D50 and returner% values can differentiate healthy individuals from the patients. The developed software helps clinicians for following up the progression rate of the diseases which cause anterior horn cell degeneration

The Effect of Clozapine on Tremor in Patients with Parkinson’s Disease who were Initiated Clozapine For Psychotic Symptoms

Aim: Tremor is one of the initial symptoms of Parkinson’s disease and most of the patients suffer from it along the course of the disease. Levodopa and dopamine agonists are used as first-line therapy. Studies showed that clozapine can be effective on patients who are resistant or insufficiently responsive to these therapies. In this retrospective study, we searched the effect of clozapine on tremor. Methods: We retrospectively analyzed the medical records of patients who have been followed in our Movement Disorders Clinic between the years 2005 and 2012. Fourteen patients using clozapine due to psychotic symptoms were included in the study. The patients were assessed using the Unified Parkinson’s disease rating scale (UPDRS) at the beginning and after 2 months of constant dose of clozapine usage. Two patients were excluded from the study because of non-compliance with the treatment due to excessive sedation. Assessments were done on 12 patients. Results: When the UPDRS scores before and after clozapine treatment examined, a statistically significant decrease was found in UPDRS-total, UPDRS-tremor, UPDRS-motor, and UPDRS-activities of daily living tremor scales after treatment. Conclusion: Since clozapine may have a positive effect on tremor in Parkinson’s disease, it can be considered as a treatment option for treatment-resistant psychotic symptoms. (The Medical Bulletin of Haseki 2013;51:173-7