The First Report of a Patient with Probable Variant Creutzfeldt-Jakob Disease in Turkey

Variant Creutzfeldt-Jakob disease (vCJD) was first reported in the UK in 1996. Here, we report the first Turkish case of vCJD. A 47-year-old man, who has never lived outside of Turkey and had had no transfusion, was admitted to the University Hospital with speech disorder, cognitive decline and ataxia following depression, irritability, and personality change. The immunoassay of the 14-3-3 protein in the cerebrospinal fluid was negative. Brain magnetic resonance imaging revealed high-signal lesions involving the bilateral caudate and lentiform nucleus on T2- and diffusion-weighted imaging. The patient developed akinetic mutism 10 months after disease onset. The clinical presentation and neuroimaging findings were compatible with the vCJD cases reported since 1996 and met the World Health Organization's case definition for probable vCJD

Serological and Molecular Investigation of the Presence and Association of Toxoplasma gondii in Bipolar Affective Disorder and Schizophrenic Patients

Introduction: Toxoplasma gondii is an intracellular parasite that affects about one third of the population in developed countries. It is known that in the brain and muscle tissues of infected people, this parasite maintains its stagnant phase lifelong. T. gondii relation, in terms of neurotropism is shown up to 60% in anxiety, depression, even schizophrenic psychoses. Schizophrenia and bipolar affective disorder (BAD) are neuropsychiatric disorders seen worldwide and their etiologies are not fully understood. Recently, it is suggested that although it is clinically indefinite, it may be a neurotropic agent, such as the trophozoites of the parasite, that have a special affinity to the glia cells of the brain. Materials and Methods: This study consisted of 87 bipolar affective disorder and 63 schizophrenia patients who applied to Eskisehir Osmangazi University Medical Faculty Psychiatry Clinic in a one-year period, and 50 healthy volunteers that had no psychiatric disorders or antipsychotic and antidepressant drug usage history. Blood samples were evaluated for T. gondii presence by real time polymerase chain reaction (PCR) and ELISA. In addition, the relationship between parasitic-mental disorder and social variables was assessed by questionnaires consisting of 29 questions in the patient group and 21 questions in the control group, which included social variables and T. gondii transmission routes and contacts. Results: All serum samples of 150 patients and 50 controls were tested by ELISA and PCR methods, and those identified with T. gondii presence by any of the tests were evaluated as positive. Seropositivity of T. gondii was detected in 61 (30.5%) of 200 serum samples. In 53 (26.5%) of the samples, only anti-toxo IgG antibodies were detected by ELISA and in 8 (4%), positivity was defined by PCR. Anti Toxo IgM antibodies were negative in both groups. PCR positivity was determined only in the patient group. T. gondii presence was defined in 29 (33.3%) of the BAD patients, 18 (28.5%) of the schizophrenic patients and 14 (28%) of the controls. There was no significant difference between patient and control groups. In the evaluation of the study data, Pearson chi-square and Fisher exact chi-square were used and p< 0.05 value was accepted as statistically significant. Conclusion: In this study, though it was not statistically significant, there was a higher frequency of Toxoplasma particularly in the patients with BAD and schizophrenia patients than in the healthy persons. Large cohort studies are required to determine the relationship between this parasite and the neuropsychiatric disorders

Re-examining the characteristics of pediatric multiple sclerosis in the era of antibody-associated demyelinating syndromes.

Background: The discovery of anti-myelin oligodendrocyte glycoprotein (MOG)-IgG and anti-aquaporin 4 (AQP4)-IgG and the observation on certain patients previously diagnosed with multiple sclerosis (MS) actually have an antibody-mediated disease mandated re-evaluation of pediatric MS series. Aim: To describe the characteristics of recent pediatric MS cases by age groups and compare with the cohort established before 2015. Method: Data of pediatric MS patients diagnosed between 2015 and 2021 were collected from 44 pediatric neurology centers across Turkiye. Clinical and paraclinical features were compared between patients with dis-ease onset before 12 years (earlier onset) and >= 12 years (later onset) as well as between our current (2015-2021) and previous (< 2015) cohorts. Results: A total of 634 children (456 girls) were enrolled, 89 (14%) were of earlier onset. The earlier-onset group had lower female/male ratio, more frequent initial diagnosis of acute disseminated encephalomyelitis (ADEM), more frequent brainstem symptoms, longer interval between the first two attacks, less frequent spinal cord involvement on magnetic resonance imaging (MRI), and lower prevalence of cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCBs). The earlier-onset group was less likely to respond to initial disease-modifying treatments. Compared to our previous cohort, the current series had fewer patients with onset < 12 years, initial presentation with ADEM-like features, brainstem or cerebellar symptoms, seizures, and spinal lesions on MRI. The female/male ratio, the frequency of sensorial symptoms, and CSF-restricted OCBs were higher than reported in our previous cohort. Conclusion: Pediatric MS starting before 12 years was less common than reported previously, likely due to exclusion of patients with antibody-mediated diseases. The results underline the importance of antibody testing and indicate pediatric MS may be a more homogeneous disorder and more similar to adult-onset MS than previously thought