Ratlarda yayılan kortikal depresyonun subkortikal etkilerinin incelenmesi

Migren toplumun yaklaşık %20 sinde görülür ve başağrısı ve eşlik eden diğer bulgular nedeniyle erişkinlerde iş gücü kaybı ve ekonomik kayıplara neden olan önemli hastalıklardan biridir. Yayılan kortikal depresyon (CSD) migrenin patogenezinde rol alan önemli bir beyin fenomenidir ve migren ağrısını başlattığı düşünülmektedir. Yayılan kortikal depresyonun subkortikal yapılara olan etkisi ve özellikle davranışlara olan etkisi bilinmemektedir. Hayvanlarda yayılan kortikal depresyon modelinin subkortikal direkt yayılımı veya indirekt etkileri ile ilgili az sayıda çalışma vardır ve bunlar anestezi altında yapılmış olan çalışmalardır. Bu çalışmada hayvanlarda yayılan kortikal depresyonun kaudaputamen, amigdala ve talamus gibi yapılardaki etkileri elektrokortikogram kaydı ile incelenmiş, otomatik davranış kaydedici bir cihaz vasıtasıyla mobilizasyon, immobilite, yeme içme davranışı, grooming, dönme, v.b. davranışları kaydedilerek analiz edilmiştir. Eş-zamanlı olarak ratların duymadığımız spektrumda çıkardıkları ağrı ve sevinç sesleri ultrasonik bir ses kaydetme programı ile incelenmiştir. Bu çalışmada, uyanık sıçanlarda CSD nin ağrı ile ilişkili donma (freezing), immobilite gibi spontan davranış değişikliklerine yol açtığı gösterilmiştir. CSD nin ortaya çıkardığı donma, immobilite gibi davranış değişikliklerinin valproik asitle önlenebildiği gösterilmiştir. Beyinde c-fos aktivasyon paterni beyin ve subkortikal diğer yapılar incelendiğinde, davranış ile uyumlu olarak beyin sapı ve nosiseptif ağrı ile ilişkili trigeminal nukleus caudalis (TNC) ve talamus retiküler nükleusda (TRN) istatistiksel anlamlılık gösteren c-fos aktivasyon örüntüsünün valproik asit ile bloke olduğu ortaya çıkmıştır. Valproik asitin migrende akut etkinliğinin saptanması ve bu etkide TRN gibi yapıların rol oynadığının ilk kez gösterilmesi açısından bu çalışma önem taşımaktadır.Migraine is seen approximately in 20% of the population and is one of the debilitating disorders in adults leading to economic loss due to headache and other associated symptoms. Cortical spreading depression (CSD) is an intrinsic brain phenomenon that plays an important role in migraine pathogenesis and considered to initiate migraine attacks. The effect of CSD on subcortical structures and on behaviour remain unclear. There are very few studies investigating direct subcortical spread or indirect effects of CSD in animals and those studies were performed under general anesthesia. In this study, effects of CSD is investigated by recording electrocorticogram (ECoG) in subcortical structures such as cauda-putamen, amigdala and thalamus. In addition, mobilization, immobility, eating, drinking, turning, grooming behaviour is analyzed through automated behaviour recording device (Laboras). Simultaneously, ultrasonic pain calls and chirp sounds by rats are investigated via laboratory animal sound recording device. In this study, CSD caused behavior alterations such as pain related freezing and immobility. CSD induced freezing and immobility were blocked with valproic acid. Brain c-fos activation pattern was investigated in brain and subcortical structures and it was shown that valproic acid significantly blocked c-fos activation in brain stem and nociceptive pain related trigeminal nucleus caudalis (TNC), amygdala and thalamic reticular nucleus (TRN). This is an important study for the discovery of acute efficacy of valproic acid in migraine and role of TRN for this effect

Migraine, Tension-Type and Cluster-Type of Headaches Classification by Using Immunos Algorithms

Objective: To evaluate diagnosis accuracy of immunos algorithms for classification of migraine, tension-type and cluster-type of headaches by using our website based diagnosis survey expert system. Methods: The headache diagnoses of eight-hundred and fifty patients from three different cities in Turkey were evaluated by using immunos algorithms. Data were collected through our website based diagnosis survey expert system under the guidance of neurologists. Results: Immunos algorithms for diagnosis have the maximum accuracy of 95.65% which can be used for classification. Conclusion: It is possible to classify primary headaches with immunos algorithm and using our website based diagnosis expert system will be helpful for neurologist in order to obtain precise results as well as easy information sharing

Diagnostic Accuracy Comparison of Artificial Immune Algorithms for Primary Headaches

The present study evaluated the diagnostic accuracy of immune system algorithms with the aim of classifying the primary types of headache that are not related to any organic etiology. They are divided into four types: migraine, tension, cluster, and other primary headaches. After we took this main objective into consideration, three different neurologists were required to fill in the medical records of 850 patients into ourweb-based expert system hosted on our projectweb site. In the evaluation process, Artificial Immune Systems (AIS) were used as the classification algorithms. The AIS are classification algorithms that are inspired by the biological immune system mechanism that involves significant and distinct capabilities. These algorithms simulate the specialties of the immune system such as discrimination, learning, and the memorizing process in order to be used for classification, optimization, or pattern recognition. According to the results, the accuracy level of the classifier used in this study reached a success continuum ranging from 95% to 99%, except for the inconvenient one that yielded 71% accuracy

Diagnostic Accuracy Comparison of Artificial Immune Algorithms for Primary Headaches

The present study evaluated the diagnostic accuracy of immune system algorithms with the aim of classifying the primary types of headache that are not related to any organic etiology. They are divided into four types: migraine, tension, cluster, and other primary headaches. After we took this main objective into consideration, three different neurologists were required to fill in the medical records of 850 patients into ourweb-based expert system hosted on our projectweb site. In the evaluation process, Artificial Immune Systems (AIS) were used as the classification algorithms. The AIS are classification algorithms that are inspired by the biological immune system mechanism that involves significant and distinct capabilities. These algorithms simulate the specialties of the immune system such as discrimination, learning, and the memorizing process in order to be used for classification, optimization, or pattern recognition. According to the results, the accuracy level of the classifier used in this study reached a success continuum ranging from 95% to 99%, except for the inconvenient one that yielded 71% accuracy

NOTCH3 Variants in Patients with Suspected CADASIL

Background: Cerebral autosomal dominant arteriopathy with subcortical infarctions and leukoencephalopathy (CADASIL) is the most common hereditary form of cerebral small vessel disease. It is clinically, radiologically, and genetically heterogeneous and is caused by NOTCH3 mutations. Methods: In this study, we analyzed NOTCH3 in 368 patients with suspected CADASIL using next-generation sequencing. The significant variants detected were reported along with the clinical and radiological features of the patients. Results: Heterozygous NOTCH3 changes, mostly missense mutations, were detected in 44 of the 368 patients (12%). Conclusions: In this single-center study conducted on a large patient group, 30 different variants were detected, 17 of which were novel. CADASIL, which can result in mortality, has a heterogeneous phenotype among individuals in terms of clinical, demographic, and radiological findings regardless of the NOTCH3 variant

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