Uric acid: The role in the pathophysiology and the prediction in the diagnosis of Parkinson’s disease : A Turkish-based study = A húgysavnak a Parkinson-kór kórélattanában és a diagnózis előrejelzésében betöltött szerepe – török populáción alapuló vizsgálat

Oxidative stress has been associated as an essential contributor to the development of neurodegenerative diseases. Recent developments in the field of Parkinson’s Disease (PD) pathophysiology have led to a renewed interest in this field. As an antioxidant, uric acid (UA) has arisen as a potential neuroprotectant. Higher concentrations of UA are linked to reducing the risk of the development of the disease and preventing its progression. However, the expositions are unsatisfactory because the outcomes of these reports have not been consistent. This study is set out to assess the association of whether lower UA concentrations increased the PD risk by investigating its relationship with patients’ demographic and clinical data, and to determine whether previous studies are compatible with the Turkish-sampled population. Furthermore, we aimed to determine UA’s probability of being an early-stage diagnostic marker. A total of 305 patients and 100 healthy controls were included. Serum UA levels of patients and controls were compared with clinical features. We classified the patients into three motor subtypes and determined the disease severity by modified Hoehn&Yahr Staging Scale (mH&Y) and Unified Parkinson’s Disease Rating Scale (UPDRS). Standardized Mini-Mental State Examination (MMSE-TR) was assessed for cognition. There were not any significant differences of age and sex between patients and controls (p=0.030, p=0.132). The mean UA was 5.06±1.33 mg/dL in patients and 5.46±1.44 in controls, and a statistical significance was detected (p=0.022). The mean MMSE-TR were 24.83±4.35 in patients and 27.09±2.13 in controls, and statictical significance was revealed (p=0.001). The mean duration of the disease was 6.31±4.16 years, mean UPDRS scores were 59.74±22.33, and mH&Y scores were 2.29±0.91. In binary comparisons, patients with tremor-dominant motor subtype had lower UA concentrations than controls (p=0.014). ROC curve analysis revealed UA’s cut-off as ≤9.15, the specificity was 99.3, the sensitivity was 10.0, and the area under the curve was 0.576 (p<0.005). Regression analysis revealed age as an independent risk factor on UA values. Oxidative stress might be a factor in the development of PD, and UA may be a possible prospective protecting factor in the clinical course of the disease. However, it does not affect the severity. Our results support that lower uric acid concentrations are associated with PD; however, it is not a powerful indicator for predicting PD risk. As we reveal more about UA and its effect in further investigations, its significant role will become well-defined

The effect of disease severity and chronic CPAP-therapy on cognitive functions and event related potentials in OSAS = A betegségsúlyosság és a krónikus CPAP-terápia hatása a kognitív funkciókra és az eseményhez kapcsolódó potenciálokra OSAS-ban

Background and purpose – Obstructive sleep apnea syndrome (OSAS) may cause daytime sleepiness, mood changes and dysfunction in various cognitive areas due to recurrent arousals and / or chronic intermittent hypoxia. Different possibilities have been proposed regarding the most affected cognitive areas and mechanisms of OSAS. However, it is difficult to compare findings of the different studies due to the fact that individuals with different disease severities were included in the study groups. In the current study, we aimed to determine the relationship between severity of OSAS and cognitive functions, to investigate the effect of continuous positive airway pressure (CPAP) titration treatment on cognitive functions and the relationship between these changes and electrophysiological potential. Methods – The study included 4 groups of patients with simple snoring and mild, mode rate and severe OSAS. In the pre treatment evaluations, verbal fluency, visuospatial memory, attention, executive functions, lan guage abilities and electrophysiological tests for event related potential were performed. The same procedure was reapplied after 4 months of CPAP therapy. Results – Long term recall scores and total word fluency scores were found to be low in the groups with moderate and severe disease compared to the patients with simple snoring (p: 0.04, p: 0.03, respectively). The information processing time was higher in patients with severe disease compared to patients with simple snoring (p: 0.02). The P200 and N100 latencies related to event related potentials (ERP) were significantly different between the groups (p: 0.004, p: 0.008, respectively). After CPAP treatment, significant differences were found in N100 amplitude and latencies and all cognitive areas except abstraction. In addition, N100 amplitude and latency change rate as well as change in attention and memory abilities were correlated (r: 0.72, p: 0.02; r: 0.57, p: 0.03, respectively). Conclusion – In the current research, disease severity was found to negatively affect long term logical memory, sustained attention and verbal fluency. Moreover, significant improvement was detected in all cognitive areas with CPAP treatment. The findings of our study support that changes in N100 potential have the potential to be used as a biomarker that can be used to monitor cognitive function recovery after treatment. | Háttér és cél – Az obstruktív alvási apnoe szindróma (OSAS) az ismétlődő ébredések és/vagy a krónikus intermittáló hypoxia miatt nappali álmosságot, hangulatváltozásokat és különböző kognitív területek működési zava rát okozhatja. Az OSAS által leginkább érintett kognitív területekre és annak mecha nizmusára vonatkozóan különböző lehető ségeket javasoltak. A különböző vizsgálatok eredményeit azonban nehéz összehasonlíta ni, mivel a vizsgálati csoportokba különböző súlyosságú betegséggel küzdő egyéneket vontak be. Jelen tanulmányban az volt a cé lunk, hogy meghatározzuk az OSAS súlyos sága és a kognitív funkciók közötti össze függést, megvizsgáljuk a folyamatos pozitív légúti nyomás (CPAP) titráló kezelés hatását a kognitív funkciókra, valamint e változások és az elektrofiziológiai potenciál közötti kapcsolatot. Módszerek – A vizsgálatban négy csoport ban egyszerű horkoló, valamint enyhe, köze pes és súlyos OSAS ban szenvedő betegek vettek részt. A kezelés előtti értékelések során verbális folyékonyságot, vizuospatialis memóriát, figyelmet, végrehajtó funkciókat, nyelvi képességeket teszteltek, és az eseményhez kötött potenciál elektrofiziológiai vizsgálatait végezték el. Ugyanezeket az eljárásokat négy hónapnyi CPAP terápia után újra elvégezték. Eredmények – A hosszú távú emlékezet pontszámai és a teljes szófolyamatossági pontszámok alacsonyak voltak a közepesen súlyos és súlyos betegségben szenvedők cso portjaiban az egyszerű horkolásban szenve dő betegekhez képest (p: 0,04, illetve p: 0,03). Az információfeldolgozási idő hosszabb volt a súlyos betegségben szenvedő betegeknél az egyszerű horkolásban szenvedő betegekhez képest (p: 0,02). Az eseményhez kapcsolódó potenciálokhoz (ERP) kapcsoló dó P200 és N100 latenciák szignifikánsan különböztek a csoportok között (p: 0,004, illetve p: 0,008). A CPAP kezelést követően szignifikáns kü lönbségeket találtunk az N100 amplitúdóban és latenciában, valamint az absztrakció kivé telével minden kognitív területen. Ezenkívül az N100 amplitúdó és latencia változásának aránya, valamint a figyelem és a memória képességek változása korrelált egymással (r: 0,72, p: 0,02; r: 0,57, p: 0,03). Következtetés – A jelen kutatásban a betegség súlyossága negatívan befolyásolta a hosszú távú logikai memóriát, a fenntartott figyelmet és a verbális folyékonyságot. Ezen túlmenően a CPAP kezeléssel szignifikáns javulást észleltek valamennyi kognitív terüle ten. Vizsgálatunk eredményei alátámasztják, hogy az N100 potenciál változásai olyan biomarkerként használhatók, amely a kezelés után a kognitív funkciók helyreállításának nyomon követésére használható

Cluster Analysis Revealed Two Hidden Phenotypes of Cluster Headache

ObjectiveTo investigate the possible subgroups of patients with Cluster Headache (CH) by using K-means cluster analysis. MethodsA total of 209 individuals (mean (SD) age: 39.8 (11.3) years), diagnosed with CH by headache experts, participated in this cross-sectional multi-center study. All patients completed a semi-structured survey either face to face, preferably, or through phone interviews with a physician. The survey was composed of questions that addressed sociodemographic characteristics as well as detailed clinical features and treatment experiences. ResultsCluster analysis revealed two subgroups. Cluster one patients (n = 81) had younger age at diagnosis (31.04 (9.68) vs. 35.05 (11.02) years; p = 0.009), a higher number of autonomic symptoms (3.28 (1.16) vs. 1.99(0.95); p < 0.001), and showed a better response to triptans (50.00% vs. 28.00; p < 0.001) during attacks, compared with the cluster two subgroup (n = 122). Cluster two patients had higher rates of current smoking (76.0 vs. 33.0%; p=0.002), higher rates of smoking at diagnosis (78.0 vs. 32.0%; p=0.006), higher rates of parental smoking/tobacco exposure during childhood (72.0 vs. 33.0%; p = 0.010), longer duration of attacks with (44.21 (34.44) min. vs. 34.51 (24.97) min; p=0.005) and without (97.50 (63.58) min. vs. (83.95 (49.07) min; p = 0.035) treatment and higher rates of emergency department visits in the last year (81.0 vs. 26.0%; p< 0.001). ConclusionsCluster one and cluster two patients had different phenotypic features, possibly indicating different underlying genetic mechanisms. The cluster 1 phenotype may suggest a genetic or biology-based etiology, whereas the cluster two phenotype may be related to epigenetic mechanisms. Toxic exposure to cigarettes, either personally or secondarily, seems to be an important factor in the cluster two subgroup, inducing drug resistance and longer attacks. We need more studies to elaborate the causal relationship and the missing links of neurobiological pathways of cigarette smoking regarding the identified distinct phenotypic classes of patients with CH

A Multicenter Study of 1144 Patients with Cerebral Venous Thrombosis: the VENOST Study

Senol, M. Guney/0000-0001-6397-9293; Genc, Hamit/0000-0002-6198-2883; UZUNER, NEVZAT/0000-0002-4961-4332; Yesilot, Nilufer/0000-0002-9655-9487; Kozak, Hasan Huseyin/0000-0001-6904-8545; Afsar, Nazire/0000-0001-8123-8560; Uzuner, Nevzat/0000-0002-4961-4332; karahan, ali yavuz/0000-0001-8142-913X; Kusbeci, Ozge Yilmaz/0000-0002-4048-210X; Batur Caglayan, Hale/0000-0002-3279-1842; Tascilar, Nida/0000-0003-0780-0783; Zeydan, Burcu/0000-0002-2270-9868; Nazliel, Bijen/0000-0002-6148-3814; Ekmekci, Hakan/0000-0002-5605-2980WOS: 000407019200036PubMed: 28583818Background: Based on a number of small observational studies, cerebral venous sinus thrombosis has diverse clinical and imaging features, risk factors, and variable outcome. in a large, multicenter cerebral venous thrombosis (VENOST) study, we sought to more precisely characterize the clinical characteristics of Caucasian patients. Methods: All data for the VENOST study were collected between the years 2000 and 2015 from the clinical follow-up files. Clinical and radiological characteristics, risk factors, and outcomes were compared in terms of age and sex distribution. Results: Among 1144 patients 68% were women, and in older age group (>50 years) male patients were more prevalent (16.6% versus 27.8%). the most frequent symptoms were headache (89.4%) and visual field defects (28.9%) in men, and headache (86.1%) and epileptic seizures (26.8%) in women. Gynecological factors comprised the largest group in women, in particular puerperium (18.3%). Prothrombotic conditions (26.4%), mainly methylenetetrahydrofolate reductase mutation (6.3%) and Factor V Leiden mutation (5.1%), were the most common etiologies in both genders. 8.1% of patients had infection-associated and 5.2% had malignancy-related etiology that was significantly higher in men and older age group. Parenchymal involvement constitutively hemorrhagic infarcts, malignancy, and older age was associated with higher Rankin score. Epileptic seizures had no effect on prognosis. Conclusions: Clinical and radiological findings were consistent with previous larger studies but predisposing factors were different with a higher incidence of puerperium. Oral contraceptive use was not a prevalent risk factor in our cohort. Malignancy, older age, and hemorrhagic infarcts had worse outcome. (c) 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved