The correlations between cerebrospinal fluid tau protein levels, immunological parameters of cerebrospinal fluid, and the findings on magnetic resonance imaging in patients with multiple sclerosis in a bout

Amaç ve Hipotez A ksonal dejenerasyon multipl sklerozun önemli bir özelliğidir ve hastalık seyri sırasında erken evrede ortaya çıkar. Aksonal dejenerasyon geri dönüşümsüz nörolojik defisitin nedenidir. Günümüzde multipl sklerozda aksonal dejenerasyonun biyolojik belirteci yoktur. Bu çalışmada beyin omurilik sıvısı tau protein düzeyinin aksonal dejenerasyonun biyolojik belirteci olup olamayacağını araştırdık. Ayrıca tau düzeyi ile demografik özellikleri, beyin omurilik sıvısının diğer parametrelerini ve MRG bulguları arasındaki ilişkileri çalıştık. Yöntem Ç alışmaya McDonald kriterlerine göre multipl skleroz tanısı konulmuş 41 olgu ve 12 ilk atak olgusu alındı. Kontrol grupları multipl skleroz dışı diğer nörolojik hastalıklara sahip 8 olgu (kontrol grubu 1) ve nörolojik açıdan sağlıklı 18 olgudan (kontrol grubu 2) oluşmaktaydı. Beyin omurilik sıvısı tau düzeyleri Innogenetics Innotest h tau antijen kiti ve "sandwich" ELISA yöntemi kullanılarak ölçüldü. MRG'ler 1,5 Tesla Philips Interna cihazı ile multipl skleroz hastaları için standart bir protokole göre çekildi. Bulgular Multipl skleroz hastalarının, kontrol grubu 1 ve kontrol grubu 2'nin ortalama tau düzeyleri sırasıyla 189,15 pg/ml, 228,27 pg/ml ve 170,21 pg/ml'ydi. Multipl skleroz hastaları ile kontrol grupları arasında anlamlı bir fark yoktu fakat relapsing remiting multipl skleroz alt grubunun ortalaması (202,45 pg/ml) Kontrol grubu 2'nin ortalamasından istatiksel olarak anlamlı derecede daha yüksekti. SPMS grubunun ise ortalama BOS tau düzeyi (141,87 pg/ml) Kontrol grubu 2'ye göre istatiksel olarak anlamlı derecede daha düşüktü. T1 ağırlıklı görüntülerde 10-14 arası kara delik saptanan olgularda tau düzeyi 5'ten az kara delik saptananlara göre istatiksel açıdan anlamlı derecede daha yüksekti. Tau düzeyi, 14'ten fazla kara deliğe sahip olgularda düşme eğilimindeydi ancak bu istatiksel açıdan anlamlı değildi. BOS tau düzeyi ile inflamasyonun BOS bulguları olan hücre sayısı ve IgG indeksi arasında korelasyon saptanmadı. MRG'de kontrast tutan lezyon sayısı ile BOS tau düzeyi arasında da korelasyon yoktu. Sonuç Çalışmamızda atak dönemindeki multipl skleroz hastaları ile kontrol grupları arasında tau düzeyi açısından anlamlı bir fark saptanmadı. MS hastaları ve sağlıklı kontrollerin tau değerlerinin geniş bir aralıkta değişmektedir ve MS plaklarının ventriküle ya da spinal kanala olan uzaklığı BOS tau düzeyini etkileyebilmektedir. Tüm bu faktörler tau proteininin multipl sklerozda aksonal dejenerasyonun biyolojik belirteci olarak kullanışlı olmadığını düşündürmektedir. Tüm bu faktörlere rağmen bilinen bir MS hastasında tau düzeyinin giderek artması ve daha sonra azalmaya başlaması artan nörodejenerasyonun belli bir eşiği aşması şeklinde yorumlanabilir. Anahtar Kelimeler Multipl skleroz, beyin omurilik sıvısı, tau proteini, aksonal dejenerasyon Objective and Hypothesis Axonal degeneration is an important feature of multiple sclerosis and occurs early in the disease course. Axonal degeneration is the cause of irreversible neurologic deficit. To date, there is no biological marker of axonal damage in multiple sclerosis. In this study, we aimed to elucidate whether the cerebrospinal fluid tau potein could be a marker of axonal degeneration. We also aimed to assess the correlations between cerebrospinal fluid tau protein levels, demographic features, other parameters of the cerebrospinal fluid, and magnetic resonance imaging features. Material and Methods We included 41 patients with multiple sclerosis that were diagnosed according to McDonald criteria. We also included 12 patients with the first attack of a demyelinating disease suggesting multiple sclerosis. The control groups were consist of 8 patients with with neurological diseases other than multiple sclerosis (control group 1) and 18 patients without neurological symptoms or signs (control group 2). Cerebrospinal fluid tau protein was measured using the ELISA method based on the sandwich method with Innogenetics Innotest h tau antigen kit. Magntic resonance imaging scans were performed with Philips Interna (1,5 Tesla) according to a fixed protocol for patients with multiple sclerosis. Results The mean tau levels of the patients with multiple sclerosis, control group 1, and control group 2 were 189.15 pg/ml, 228.27 pg/ml, and 170.21 pg/ml respectively. No signifcant differences between patients with mutiple sclerosis, and control groups were detected, but in the subgroup of RRMS patients it was significantly higher than the mean tau level of control group 2 (202.45 pg/ml, 170.21 pg/ml respectively). In the subgroup of SPMS patients, the mean CSF tau level was significantly lower than the mean CSF tau level of the control group 2. The mean tau level of multiple sclerosis patients with 10-14 black holes on T1 weighted magnetic resonance images were statistically higher than the mean tau level of patients with less than 5 black holes on T1 weighted images. Tau levels tend to decrease in patietns with more than 14 black holes, but this was not significant. There was no correlation between the CSF tau levels and the IgG index and the number of white cells in the CSF which are the markers of inflammation. The CSF tau level and the number of enhancing lesions on MRI were not correlated, too. Conclusion Our study showed similar tau concentrations in multiple sclerosis patients in an attack and in the control groups. The tau levels of the patients with multple sclerosis and the control groups change in a wide range, and the distance of MS plaques to the ventricles or the spinal canal may effect the level of the tau protein in the CSF. All these factors suggest that tau protein is not a useful biological marker of axonal degeneration in multiple sclerosis. In spite of these factors, the decrease of tau levels after an increment may suggest an increase in neurodegeneration. Key Words Multiple sclerosis, cerebrospinal fluid, tau protein, axonal degeneratio

Two Patients with Tuberculous Meningitis

According to the World Health Organization, one-third of the world population is latently infected with M. tuberculosis and 5%-10% of the infected individuals will develop active tuberculosis. It seems that, in the future, tuberculosis infection will be more important regarding the public health as the prevalence of the HIV infection and the multi-drug resistant M. tuberculosis increases. Approximately 1% of the patients with tuberculosis develops central nervous system tuberculosis. Although it’s rare, the mortality and the morbidity of the central nervous system tuberculosis are higher than the other forms of tuberculosis infection. In this paper, we aimed to draw attention to the importance of tuberculous meningitis in the differential diagnosis of the patients with headache or altered consciousness and its early treatment, in every day neurology practice by presenting two cases with tuberculous meningitis having interesting clinical features

Investigation of the efficacy of kinesiological banding in pregnancy-related carpal tunnel syndrome

Karakoyun, Ahmet ( Aksaray, Yazar )Aim: The aim of this study was to investigate the effects of kinesiological banding on symptoms in carpal tunnel syndrome associated with pregnancy.Patients and Methods: Patients who were admitted to the Physical Therapy and Rehabilitation Clinic due to carpal tunnel syndrome and who were diagnosed with carpal tunnel syndrome by electromyography and who were able to reach the visuel analog score, Short Form-36, Boston Carpal Tunnel Questionnaire and Pittsburgh Sleep Quality Index values were included in the study.Results: In both groups, there was a significantly difference between the first visuel analog score day-night and the last visuel analog score day-night and first and last Pittsburgh Sleep Quality Index (p<0,05). While there was a significantly improvement in the Boston Symptom Severity Scale, there was no significantly difference in Boston Functional Capacity Scale. In the comparison between the groups, visuel analog score day, Short Form-36 pain parameter and decrease in Boston Symptom Severity Scale were found statistically significant.Conclusions: In our study, although the superiority of kinesiological banding on hand-wrist rest splint could not be clearly shown, decreased pain and symptoms and an increase in sleep quality were observed.The kinesiological banding should be in mind in patients who have no response to resting splint because of low treatment options during pregnanc.Amaç: Bu çalışmada gebelikle ilişkili karpal tünel sendromunda kinezyolojik bantlamanın semptomlar üzerine etkisinin araştırılması planlandı. Hastalar ve Yöntem: Çalışmaya karpal tünel sendromu nedeniyle Fizik Tedavi ve Rehabilitasyon Kliniğine başvuran ve elektromiyografi ile karpal tünel sendromu tanısı alan , kayıtlarında visuel ağrı skoru, Kısa Form-36, Boston Karpal Tünel Anketi ve Pittsburgh Uyku Kalite İndeksi değerlerine başvuru ve takip esnasında eksiksiz ulaşılabilen hastalar dahil edildi. Bulgular: Her iki grupta da ilk visuel ağrı skoru gündüz-gece ve son visuel ağrı skoru gündüz-gece ve ilk ve son Pittsburgh Uyku Kalite İndeksi arasında anlamlı fark saptandı (p<0,05). Her iki grupta da Boston Semptom Şiddeti Skalasında anlamlı düzelme saptanırken, Boston Fonksiyonel Kapasite Skalasında anlamlı fark saptanmadı. Gruplar arası karşılaştırmada ise kinezyolojik bantlama uygulanan hastalarda visuel ağrı skoru gündüz, Kısa Form-36 ağrı parametresi ve Boston Semptom Şiddeti Skalasındaki azalma istatistiksel olarak anlamlı saptandı. Sonuç: Çalışmamızda kinezyolojik bantlamanın el-el bilek istirahat splintine üstünlüğü net olarak gösterilememesine rağmen ağrı ve semptomlarda azalma ve uyku kalitesinde artış gözlenmiştir. Gebelikte tedavi seçeneklerinin az olması nedeniyle istirahat splintine yanıt alınamayan hastalarda kinezyolojik bantlama aklımızda bulunmalıdır

The Turkish validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery

Abstract Background Cognitive impairment may be seen in as many as 43–70% of patients with multiple sclerosis (MS) and may be observed in all MS subtypes. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) battery may be used to evaluate cognition status. The purpose of the current study is to validate the BICAMS battery in Turkish. Methods Patients with MS attending our clinic between September 2014 and April 2015 were invited to participate. Healthy control participants were matched in terms of age, gender and years of education. Results One hundred seventy-three MS patients and 153 healthy control participants were enrolled in the study. MS patients performed significantly worse in all trials than the members of the healthy control group. In addition, cognitive dysfunction was identified in 78 of the 173 (45.1%) patients. In the MS with cognitive impairment group, 64 out of 151 (42.4%) subjects were RRMS patients, 12 out of 18 (66.7%) were secondary progressive MS patients, and 2 out of 4 (50%) were primer progressive MS patients. Conclusions The BICAMS has been proposed for assessing cognitive impairment in MS patients. This study shows that the battery is suitable for use in Turkey