Neurotoxic Agents and Peripheral Neuropathy

Neurotoxicity may develop with exposure to various substances such as antibiotics, chemotherapeutics, heavy metals, and solvents. Some plants and fungi are also known to be neurotoxic. Neurotoxicity can develop acutely within hours, or it can develop as a result of exposure for years. Neurotoxicity can be presented with central or peripheral nervous system findings such as neurobehavioral symptoms, extrapyramidal signs, peripheral neuropathy. Peripheral nerve fibers are affected in different ways by neurotoxicant injury. The pattern of injury depends on the target structure involved. The focus of this chapter includes signs, symptoms, pathophysiology, and treatment options of neurotoxicity

EVALUATION OF A GROUP OF EPILEPSY PATIENTS IN TERMS OF SLEEP QUALITY, FATIGUE AND DEPRESSION

Introduction: The aim of this study is to investigate the relationship between clinical features, sleep quality, fatigue and mental symptoms in epileptic patients. Material and Methods: This cross-sectional study was conducted at epilepsy outpatient clinic of Bozyaka Training and Research Hospital. 81 patients who were followed up for the diagnosis of epilepsy were included in the study. The patients were administered a sociodemographic data form, Pittsburgh Sleep Quality Index, Beck Depression Inventory, Fatigue Severity Scale. Results: The median age of the patients included in the study was 37.42 (51.9%) were women and 39 (48.1%) were men with a education period of 8 years. There was no previous family history of psychiatric illness. Seizure control was achieved in 34 (42%) patients. 53 (65.4%) patients were observed for focal type, 28 (34.6%) patients were for generalized type seizures. The median duration of epilepsy was 13 years. The median Beck Depression Inventory score of the patients was 13, and the number of patients with a Beck Depression Inventory score higher than 19 was 25 (30.9%). There was mild tiredness in 47 (58%) and chronic fatigue in 16 (19.8%) patients. The median of Pittsburgh Sleep Quality Index total score was 4 and 18.5% (15) had poor sleep quality. Chronic fatigue was higher in epilepsy patients without seizure control compared to those with seizure control (p = 0.001). Conclusion: The rate of patients with moderate and severe depression is high in our study. This indicates the significance of evaluating the diagnosis of depression in epilepsy patients. In the follow-up of these patients, it is crucial to investigate the causes of fatigue and depression carefully. Especially psychiatric expert opinion and multidisciplinary follow-up should be carried out without ignoring the presence of depression

Initial cervical spinal cord demyelinating lesions are not associated with restless legs syndrome in patients with multiple sclerosis

Purpose: This study aims to determine the prevalence and severity of restless legs syndrome (RLS) in patients with multiple sclerosis (MS) and its association with spinal cord lesions, fatigue, quality of life, and sleep disturbance. Methods: We recruited 222 consecutive MS patients admitted to MS outpatient clinic. Beck's Depression Inventory (BDI), Fatigue Severity Scale (FSS), Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and MS Quality of Life-54 (MSQoL-54) questionnaire scores of all patients were measured. Initial cervical spinal cord magnetic resonance imaging (MRI) of the patients at first clinical evaluation for diagnosis was reviewed for accompanying demyelinating lesions. Results: RLS was diagnosed in 53 (23.87%) patients. RLS was associated with poor sleep, worse quality of life, increased fatigue, and depressive mood. The sleep quality index, FSS, and MSQoL-54 physical composite scores significantly correlated with RLS severity (P < 0.001, P = 0.001, P < 0.001, respectively). Of the 200 patients, 127 (63.5%) had spinal cord lesions. 22.83% of the patients with cervical spinal cord lesions had RLS comorbidity. We found no significant difference regarding spinal cord demyelinating lesions between RLS positives and negatives. (P = 0.77). In addition, having multiple spinal cord demyelinating lesions did not differ between the two groups (P = 0.84). Besides, the severity of RLS symptoms did not differ in patients who had a single cervical spinal lesion and those who had multiple lesions (P = 0.35). Conclusion: We have demonstrated the negative impact of comorbid RLS on fatigue, sleep quality, mood, and quality of life in MS patients. However, initial spinal cord lesions did not correlate with RLS comorbidity. The severity of RLS symptoms is associated with poor sleep and physical health

THE RELATIONSHIP BONE MINERAL DENSITY AND HIGH-DOSE SHORT-TERM CORTICOSTEROID THERAPY IN MULTIPLE SCLEROSIS PATIENTS

Introduction: Previous studies were reported that osteoporosis and bone fracture occurs more frequently among Multiple sclerosis patients than the general population. The aim of this study to investigate the affects of total doses of short-term, high dose corticosteroids on bone mineral density and other affecting factors for bone mineral density in Relapsing-remitting type Multiple Sclerosis patients. Material and methods: Fifty-four patients (37 females, 17 males) with relapsing-remitting type Multiple Sclerosis who filled the diagnostic criteria according to McDonald criteria were included in the study. Femoral and lumbar bone mineral density were measured using dual energy X-ray absorptiometry. Expanded Disability Status Scale, disease duration, number of attacks, cumulative corticosteroid dose were recorded. Serum calcium, potassium, phosphorus, vitamin D, parathormone and osteocalcin levels were measured. Patients were divided into two groups: patients who have received at least 20 g intravenous metilprednisolone (Group I) and patients who have received less than 20 g intravenous metilprednisolone (Group II). We analysed association between cumulative corticosteroid dose and each parameters. Results: Osteopenia was present in 46.2% and osteoporosis in 5.5% of the study population according to femoral neck bone mineral density. Femoral bone mineral density was significantly lower among patients. There was no correlation between cumulative dose of corticosteroid and bone mineral density. Conclusion: Low bone mineral density and osteoporosis are common in Multiple sclerosis patients. High-dose steroid therapy is not be the primary cause of osteoporosis in patients with multiple sclerosis

Acute fluconazole toxicity: a case presenting with protean manifestations including systemic and neurologic symptoms

Neurologic adverse effects of triazole antifungal compounds used for the treatment of systemic and deep mycoses are relatively rare. The most common presentation is the involvement of peripheral nervous system, usually presenting with subjective symptoms such as paresthesia, dysesthesia, or numbness. Among these compounds, fluconazole has relatively more frequent neurological adverse reactions

Comparison of visual and automatic quantitative measurement results on 3D volumetric mri in multiple sclerosis patients

Multiple sclerosis (MS) is a chronic, demyelinating disease in which magnetic resonance imaging (MRI) is frequently used in the diagnosis and treatment process. Atrophy and plaque counting in the brain can be measured quantitatively with 3-dimensional (3D) MRI examinations. This study aims to determine the results of automatic, quantitative measurements of 3D volumetric MRIs in relapsing-remitting MS (RRMS) patients, to compare the consistency with the visual, semi-quantitative evaluation results made by the radiologists. 46 patients who were diagnosed with RRMS between 01/03/2018 and 31/12/2020 in the neurology outpatient clinic of our hospital, were clinically stable in their follow-up, had at least two 3D MRIs without artifacts constituted the study group. A neuroradiologist, a radiologist experienced in neuroradiology, and VolBrain software evaluated the patients' brain volumes, plaque numbers, and differences in follow-up MRIs. The mean age of 21 female and 25 male patients was 40.4 ± 8.8 years; the mean total brain volume was 1127 ± 137.63 mm3. A high level of agreement was found between the radiologists in terms of whole-brain volume differences between the two MRIs, which was not statistically significant (95.7%; K = -0.002; p = 0.88). There was no agreement between VolBrain and radiologists (K = -0.043; p = 0.333). Regarding the plaque number analysis; a high level and statistically significant agreement among radiologists (87%; K = 0.665; p [Med-Science 2021; 10(2.000): 498-501

Retrospective Evaluation of the Results of Low-Dose Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Objectives: This study aimed to investigate the clinical data of patients with acute ischemic stroke who received low-dose intra-venous (IV) thrombolytic therapy (0.9 mg/kg; maximum 50 mg) for various reasons, compare the obtained results with those of patients who received standard-dose thrombolytic therapy, and discuss them in light of the literature. Methods: Patients who received IV thrombolytic therapy within 4.5 h of symptom onset between January 2015 and June 2018 were retrospectively reviewed. Patients were divided into the low-dose group (0.9 mg/kg; max. 50 mg) and the standard-dose group (0.9 mg/kg; max 90 mg) according to the thrombolytic therapy dose, after which demographic data and clinical results were analyzed. Results: A total of 109 patients receiving thrombolytic therapy (19 patients in the low-dose group and 90 patients in the stan-dard-dose group) were included in the study. There was no significant difference between the two groups in terms of good out-come rates (47.4% vs. 52.2%). There was no statistically significant difference in terms of symptomatic and asymptomatic intrace-rebral hemorrhage rates. Conclusion: Our study showed similar efficacy and safety for low-dose IV thrombolytic therapy compared with standard-dose IV thrombolytic therapy administered within 4.5 h of symptom onset in patients with acute ischemic stroke

Blood levels of TNF-, IL-10, and IL-12 in idiopathic sudden sensorineural hearing loss

WOS: 000320784300036PubMed: 23382065Objectives/Hypothesis To investigate the blood levels of TNF-, IL-10, and IL-12 in the idiopathic sudden sensorineural hearing loss patients, and the change of these cytokine levels after treatment. Study Design Prospective clinical trial. Methods Twenty-three patients with idiopathic sudden sensorineural hearing loss and 20 healthy people were selected as study and control groups. Blood samples for TNF-, IL-10, and IL-12 were taken before treatment and 6 weeks after treatment. The study group was given combined treatment including dexamethasone, heparin, pentoxifyline, vitamin B1, and B6 for 10 days, and was divided into two groups: treatment responders and treatment nonresponders. The treatment responders group was also divided into three groups according to most accepted criteria for improvement in the literature. Audiograms were taken before treatment and 6 weeks after treatment to determine the response to the treatment. Results There was no significant difference between pre- and posttreatment values of IL-10 and IL-12 in all study groups (P > 0.05). There was also no significant difference between pre- and posttreatment values of TNF- in treatment responders (P > 0.05). Treatment nonresponders had more elevated posttreatment values of TNF- than pretreatment values (P < 0.05). Conclusion IL-10 and IL-12 may not play a critical role in idiopathic sudden sensorineural hearing loss. But our data supports the role of TNF- in the pathophysiology of idiopathic sudden sensorineural hearing loss, and TNF- receptor blockers may have benefits in these patients. Level of Evidence 3B. Laryngoscope, 201

Are antiepileptic drugs causes of premature atherosclerosis by disturbing lipid metabolism?

21st Meeting of the European-Neurological-Society -- MAY 28-31, 2011 -- Lisbon, PORTUGALWOS: 000289992800551…European Neurolog So

Blood levels of TNF-, IL-10, and IL-12 in idiopathic sudden sensorineural hearing loss

Objectives/Hypothesis To investigate the blood levels of TNF-, IL-10, and IL-12 in the idiopathic sudden sensorineural hearing loss patients, and the change of these cytokine levels after treatment. Study Design Prospective clinical trial. Methods Twenty-three patients with idiopathic sudden sensorineural hearing loss and 20 healthy people were selected as study and control groups. Blood samples for TNF-, IL-10, and IL-12 were taken before treatment and 6 weeks after treatment. The study group was given combined treatment including dexamethasone, heparin, pentoxifyline, vitamin B1, and B6 for 10 days, and was divided into two groups: treatment responders and treatment nonresponders. The treatment responders group was also divided into three groups according to most accepted criteria for improvement in the literature. Audiograms were taken before treatment and 6 weeks after treatment to determine the response to the treatment. Results There was no significant difference between pre- and posttreatment values of IL-10 and IL-12 in all study groups (P > 0.05). There was also no significant difference between pre- and posttreatment values of TNF- in treatment responders (P > 0.05). Treatment nonresponders had more elevated posttreatment values of TNF- than pretreatment values (P < 0.05). Conclusion IL-10 and IL-12 may not play a critical role in idiopathic sudden sensorineural hearing loss. But our data supports the role of TNF- in the pathophysiology of idiopathic sudden sensorineural hearing loss, and TNF- receptor blockers may have benefits in these patients. Level of Evidence 3B. Laryngoscope, 201