Real-life experiences with galcanezumab and predictors for treatment response in Turkey

BackgroundThe complexity of clinical practice extends far beyond the controlled settings of trials, and there is a need for real-world studies aimed at identifying which patients will respond to anti-CGRP monoclonal antibodies in different countries. This study aimed to investigate the efficacy and safety of galcanezumab in treating migraine in a real-life setting in Turkey, as well as identify predictors of treatment response.MethodsA total of 476 patients who diagnosed with migraine according to ICHD-3 criteria and treated with galcanezumab by headache specialists were voluntarily participated in this cross-sectional study. Galcanezumab is indicated for the prevention of migraine in adults who have at least 4 monthly migraine days in Turkey. All patients filled out a survey on Google Form that comprised 54 questions, addressing various aspects such as demographics, migraine characteristics, previous use of acute symptomatic medication, failures with preventive drug classes, comorbidities, most bothersome symptoms, as well as the interictal burden of migraine.ResultsAmong the participants, 89.3% reported that galcanezumab treatment was beneficial for them. A decrease in the frequency (80.0%), severity (85.7%), and acute medication usage for migraine attacks (71.4%) was reported with galcanezumab treatment. An adverse effect related to galcanezumab was reported in 16.3% of cases, but no serious adverse reactions were observed. Remarkably, 14.3% of participants reported no longer experiencing any headaches, and 18.9% did not require any acute treatment while receiving galcanezumab treatment. A logistic regression model showed that male gender, lack of ictal nausea, and previous failure of more than 2 prophylactic agents may predict the non-responders.ConclusionsThe first large series from Turkey showed that galcanezumab treatment is safe and effective in most of the patients diagnosed with migraine by headache experts in the real-life setting. Patients reported a significant decrease in both ictal and interictal burden of migraine and expressed satisfaction with this treatment

Diagnostic value of long-term routine interictal EEG, FLAIR MR and SPECT in the detection of epileptogenic focus in partial epilepsies

Bu çalışmada 37'si TLE'li, 16'sı ekstra temporal epilepsili olmak üzere, PE teşhisi konan 53 hastanın, USRİE'leri ve FLAIR sekanslarla MR'ları çekilmiş ve USRİE'nin fokal epileptojenik odağı göstermedeki yeri, MR ve SPECT'le olan uyumu, FLAIR MR'ın PE'deki fokal lezyonu gösterme ve dolayısıyla USRİE ile FLAIR MR arasındaki uyumun, EC'ne aday hastalarda, cerrahi öncesi değerlendirmedeki rolünün araştırılması planlanmıştır. Elde edilen bulgularla, USRİE'nin TLE'nde İED'ları göstermede rutin interiktal EEG'ye belirgin olarak üstünlük gösterdiği, ancak altta yatan yapısal bir lezyona bağlı olarak ekstra temporal nöbeti olan hastalarda her iki EEG yöntemi arasında belirgin bir farklılık olmadığı izlenmşitir. Her iki yöntem ile de İED saptanan hastaların EEG'leri incelendiğinde, USRİE'nin nöbetin başladığı odağı tespit etmede rutin interiktal EEG'ye oranla daha başarılı olduğu görülmüştür. TLE'li olgularda, FLAIR MR'ın MTS'a ait hipokampal sinyal yoğunluk artışını göstermede konvansiyonel spin echo (T2) sekanslardan üstün olmadığını, fakat varolan sinyal yoğunluk artışını, T2 ağırlıklı sekanslara göre daha net gösterebildiğini ve lezyonun tanımlanmasının FLAIR sekanslarda daha kolay olduğunu saptadık. Klinik-EEG-MR arası uyumun en yüksek oranda USRİE ile FLAIR MR'da olduğunu gördük. İnteriktal SPECT'in ise gerek klinik, gerekse diğer yöntemlerle uyumunun istenilen düzeyde olmadığını izledik. Tedaviye dirençli TLE'li olgularımızdan USRİE'sinde anterior-mid temporal, tek taraflı odak saptanan ve bu bulgusu FLAIR MR'daki hipokampal skleroz ile uyumlu olan 4 hastada, uzun süreli video monitorizasyona gerek kalmaksızın cerrahi planlanabileceğim düşündük.34 Sonuç olarak; USRİE'nin, rutin interiktal EEG'sinde patoloji saptanamayan TLE'li hastalarda uygulamaya girmesi, FLAIR MR'ın, bilhassa kompleks parsiyel nöbetleri olan hastalarda tercih edilen MR yöntemi olması gerektiği, tedaviye dirençli TLE'li hastaların cerrahi öncesi değerlendirilmesinde, USRİE'si, diğer tetkiklerlede uyumlu olmak koşulu ile, tek taraflı anterior mid temporal odak veren hastalarda uzun süreli video monitorizasyona gerek olmayabileceği düşünülmektedir

A Population-Based Survey to Determine the Prevalence of Movement Disorders in Orhangazi District of Bursa, Turkey

OBJECTIVE: : In this study we aimed to determine the prevalence of movement disorders among 40 years and older population in Orhangazi district of Bursa, Turkey. METHODS: This population-based study was planned in three phases. In phase I, door-to-door home interviews were performed on 1256 subjects by residents of departments of neurology and family medicine by using a short questionnaire and 404 subjects with suspected symptoms of movement disorders and Parkinsonism were detected. These subjects were examined and videotaped in phase II. Of the suspected subjects in phase I, 131 did not attend to phase II for various reasons. In phase II, subjects were evaluated by movement disorders specialists by using scales specific to tremor, restless leg syndrome, Parkinson disease, and hemi-facial spasm. In phase III, video recording of all identified patients were reviewed and final diagnoses were made with a consensus of all three specialists. RESULTS: In this phase, subjects were diagnosed to have restless leg syndrome n= 60, 9.71%, essential tremor n= 21, 3.34%, enhanced physhological tremor n= 26, 4.14%, Parkinson’s disease n= 14, 2.23%, hemifacial spasm n= 4, 0.82%, and dystonia n= 2, 0.41%. CONCLUSION: Although essential tremor has been reported as the most common movement disorder, in our study restless leg syndrome had higher prevalence than essential tremo

CIDP and MMN frequency in tertiary care centers in Turkey

Bu çalışma, 16-21 Eylül 2017 tarihlerinde Kyoto[Japonya]’da düzenlenen 23. World Congress of Neurology (WCN) Kongresi‘nde bildiri olarak sunulmuştur.World Federat Neuro

A Case With Multicentric Glioblastoma Multiforme

Scientific BACKGROUND: Glioblastoma multiforme is the most malign tumor which can be multifocal, including necrosis, vessel proliferation and excessive mitosis, can infiltrate peripherial tissue, and generally located in supratentorial regions. MR imaging shows a mass lesion with irregular borders and a cavity at the center with non-homogenous contrast enhancement. CASE: Fifty-three years old patient admitted to our emergency department complaining about seizures and weakness on her left side. On neurologic examination she had a 4/5 MRC muscle strength on her left side with a positive babinski sign and also hemihipoestesia including her face on her left side. In cranial MRI, it was found that there were lesions with miscellaneous dimensions in right parietal cortex, left thalamus and left cerebellar pedincule without contrast enhancement. Central nervous system (CNS) infection and the primary CNS were the initial diagnoses. All microbiologic indicators were negative both in the serum and liqeur. A stereotactic biopsy was performed and pathology revealed low grade astrocytoma. Her clinical conditioned worsened by time and died due to infections and multiple organ failure. Pathological autopsy revealed that the mass lesion was glioblastoma multiforme. CONCLUSION: In this case report we presented a case with a MRI and biopsy suggesting a diagnosis of low grade astrıcytoma. However, clinical findings worsened in a short time causing death of the patient. It is discussed that multifocal GBM can be in different grades on the different parts of the lesions. Although imaging techniques are of utmost importance, in case of discordancy clinical follow-up and neurological examination are still the most important to rely o

Impact of sex hormonal changes on tension-type headache and migraine: a cross-sectional population-based survey in 2,600 women

Sex hormones have some implications on headaches. The objective of the study was to investigate the effects of hormonal changes comparatively on tension-type headache (TTH) and migraine, in a population-based sample. A nationwide face-to-face prevalence study was conducted using a structured electronic questionnaire. 54.3 % of the migraineurs reported that the probability of experiencing headache during menstruation was high, whereas 3.9 % had headache only during menstruation. Forward logistic regression analysis revealed that menstruation was a significant trigger for migraine in comparison to TTH. On the other hand, nearly double the number of TTH sufferers reported "pure menstrual headache" compared to migraineurs (p = 0.02). Menstrual headaches caused significantly higher MIDAS grades. One-third of the definite migraineurs reported improvement during pregnancy and oral contraceptives significantly worsened migraine. Menopause had a slight improving effect on migraine compared to TTH. Sex hormonal changes have major impacts particularly on migraine; however, the effects of hormonal fluctuations on TTH should not be underestimated

Migraine incidence in 5 years: A population-based prospective longitudinal study in Turkey

Background: The incidence of migraine has been investigated only in a few studies worldwide and it is not known in our country. We, therefore, aimed to estimate the migraine incidence in a previously accomplished population-based prevalence study sample of 5323 individuals in the year 2008. Methods: The former Turkish headache prevalence study has been completed as a nationwide, randomized, home-based study of face-to-face examination by physicians trained for headache diagnosis by using ICHD criteria. Five years after this study an optimized survey including 50 questions was performed to estimate the migraine incidence in migraine-free individuals in the previous study, with a 56.4 % responder rate. Two validation studies for this survey were performed prior and after the study each in 100 subjects by comparing the gold standard of expert diagnosis of headache, showing high rate of reliability (Crohnbach alpha: 0.911 and 0.706, respectively). Results: Migraine incidence was estimated as 2.38 % (2.98 % in women and 1.93 % in men) per year in 2563 migraine-free individuals; if the population at risk is defined as the group without any headaches, the migraine incidence decreased to 1.99 %. The chronic migraine (CM) incidence [without medication overuse (MOH)] was 0.066 % and that of MOH was 0.259 %. We found a significant burden of the disease on the occupational functionality as well as on social and family life, even in the early years of the migraine. The family history of headaches especially in the fathers could be useful to predict new cases of migraine, besides the well-known risk factor, diagnosis of depression, whereas income and education did not seem to relate to migraine onset. Conclusions: Our study with a large population-based nation-wide sample, using ICHD-II criteria, with structured headache interviews as well as blinded re-validation of the questionnaire diagnoses showed a 2.38 % incidence rate of migraine in Turkey, higher than most of the other previous reports; a finding which could be related to genetic factors and also to the methodological differences in the study designs. Moreover the incidence of CM was found to be 0.066 %.Ibrahim Ethem Ulagay-Menarini Grou

Real-life experiences with galcanezumab and predictors for treatment response in Turkey

Abstract Background The complexity of clinical practice extends far beyond the controlled settings of trials, and there is a need for real-world studies aimed at identifying which patients will respond to anti-CGRP monoclonal antibodies in different countries. This study aimed to investigate the efficacy and safety of galcanezumab in treating migraine in a real-life setting in Turkey, as well as identify predictors of treatment response. Methods A total of 476 patients who diagnosed with migraine according to ICHD-3 criteria and treated with galcanezumab by headache specialists were voluntarily participated in this cross-sectional study. Galcanezumab is indicated for the prevention of migraine in adults who have at least 4 monthly migraine days in Turkey. All patients filled out a survey on Google Form that comprised 54 questions, addressing various aspects such as demographics, migraine characteristics, previous use of acute symptomatic medication, failures with preventive drug classes, comorbidities, most bothersome symptoms, as well as the interictal burden of migraine. Results Among the participants, 89.3% reported that galcanezumab treatment was beneficial for them. A decrease in the frequency (80.0%), severity (85.7%), and acute medication usage for migraine attacks (71.4%) was reported with galcanezumab treatment. An adverse effect related to galcanezumab was reported in 16.3% of cases, but no serious adverse reactions were observed. Remarkably, 14.3% of participants reported no longer experiencing any headaches, and 18.9% did not require any acute treatment while receiving galcanezumab treatment. A logistic regression model showed that male gender, lack of ictal nausea, and previous failure of more than 2 prophylactic agents may predict the non-responders. Conclusions The first large series from Turkey showed that galcanezumab treatment is safe and effective in most of the patients diagnosed with migraine by headache experts in the real-life setting. Patients reported a significant decrease in both ictal and interictal burden of migraine and expressed satisfaction with this treatment

IVIg-induced headache: prospective study of a large cohort with neurological disorders

Background: Intravenous immune globulin (IVIg) is frequently used in some neurological diseases and is also the first-line therapy in Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. We aimed to evaluate the frequency and characteristics of headaches, which is one of the most common side effects of IVIg treatment. Methods: Patients who received IVIg treatment for neurological diseases were prospectively enrolled in 23 centers. Firstly, the characteristics of patients with and without IVIg-induced headaches were analyzed statistically. Then, patients with IVIg-induced headaches were classified into three subgroups determined by their history: no primary headache, tension-type headache (TTH), and migraine. Results: A total of 464 patients (214 women) and 1548 IVIg infusions were enrolled between January and August 2022. The frequency of IVIg-related headaches was 27.37% (127/464). A binary logistic regression analysis performed with significant clinical features disclosed that female sex and fatigue as a side effect were statistically more common in the IVIg-induced headache group. IVIg-related headache duration was long and affected daily living activities more in patients with migraine compared to no primary headache and TTH groups (p = 0.01, respectively). Conclusion: Headache is more likely to occur in female patients receiving IVIg and those who develop fatigue as a side effect during the infusion. Clinicians’ awareness of IVIg-related headache characteristics, especially in patients with migraine, may increase treatment compliance