Do magnetic resonance imaging features differ between persons with multiple sclerosis of various races and ethnicities?

Those of African American or Latin American descent have been demonstrated to have more severe clinical presentations of multiple sclerosis (MS) than non-Latin American White people with MS. Concurrently, radiological burden of disease on magnetic resonance imaging (MRI) in African Americans with MS has also been described as being more aggressive. Here, we review MRI studies in diverse racial and ethnic groups (adult and pediatric) investigating lesion burden, inflammation, neurodegeneration, and imaging response to disease modifying therapy. We also discuss why such disparities may exist beyond biology, and how future studies may provide greater insights into underlying differences

Relationship Between Sleep-related Violence and NREM Parasomnia: A Case Report

Parasomnia constitutes an important group among the situations that can lead to sleep-related violence scene. Parasomnia attacks are characterized by complex motor behaviors of various degrees, violent behaviors may result in life-threatening and rarely lethal conditions for patients and their relatives. Here is presented a patient with right temporoparietal bone fracture, pneumocephalus and hemotympanum in right ear due to head trauma during a parasomnia attack. The diagnosis could be made by a detailed history taking and polysomnography only after many other investigations. In this context, we aimed to emphasize that not only nocturnal epilepsies, especially frontal lobe epilepsies, but also parasomnia attacks should be kept in mind in differential diagnosis of sleep-related violence

A New Hybrid Decision Making Approach for Housing Suitability Mapping of an Urban Area

In urban planning, housing evaluation of residential areas plays a critical role in promoting economic efficiency. This study produced an evolutionary-based map through the combination of hybrid Multicriteria Decision Making (MCDM) and Geographical Information System (GIS) by assessing suitability of housing location. Suitable locations were modelled and determined with the present study from very low suitability to very high suitability. In the first stage, Fuzzy DEMATEL (the Decision Making Trial and Evaluation Laboratory) and Covariance Matrix Adaptation Evolutionary Strategy (CMA-ES) under fuzzy conditions as a subjective and an objective (model-based) technique, respectively, were employed to find the weights of criteria which are critical part of decision making. In the second stage, housing evaluation map for these two approaches was drawn and their performances were classified and measured with WLC (Weighted Linear Combination) method. 29 criteria determined were prioritized as per judgment of urban planning and real estate experts for Fuzzy DEMATEL and CMA-ES. After having been coded to MATLAB for obtaining optimum weights in CMA-ES, all collected data for 160 houses were mapped as vectorial (positional) and transformed to raster (pixel) data by getting entered in ArcGIS 10.4 software. We achieved CMA-ES-WLC maximization values for 104 alternatives with (positive value) 65% performance, but we obtained FDEMATEL-WLC maximization values for 56 alternatives with (negative value) 35% performance. WLC values calculated with CMA-ES and FDEMATEL weights allowed us to conclude that the houses with the highest suitability in terms of investment are in Alpaslan, Kock, and Melikgazi streets. The result shows that the methodology used in the application of this study performed in Turkey is an important and powerful technology in providing decision support for spatial planning

Management of Multiple Sclerosis patient in special conditions

Multiplesclerosis (MS) is an immunemediatedchronicinflammatorydiseasecharacterizedbyneuroinflammationandneurodegeneration of thecentralnervoussystem (CNS). Thecourseandtreatment of thediseasearethemostcommonquestionsaskedbypatientswith MS. Questionsconcerningtherelationship of MS withpregnancyandthepostpartumperiod, assistedreproductiontechnology, preand post-operativeproblemsandvaccinesarealsofrequentlyasked, andsome of theanswersarestillcontroversial. It is knownthat MS has noharmfuleffect on pregnancyorthefetus. The presence of MS is not an indicationtoterminatepregnancy, anddiseaseprogression is not foundto be relatedwithpregnancy. Therelapsesduringpregnancyareknowntohave a mildcourse but on thecontrary, therelapsesduringthepostpartumperiodtendto be particularly severe. It is suggestedto stop takingdiseasemodifyingtherapies (DMT) at leastonemonthpriortothepregnancyplanningperiod. There is nocontraindicationfortheuseof conventionalcontraceptives; however it is knownthat oral contraceptivesincreasethe risk of venousthromboembolism in MS patientswithimpairedmobility. Patientswithdecreasedfertilityandwhoarecandidatesforassistedreproductiontechnologies (ART) should be informedabouttheincreased risk of relapse. It is alsoshownthatproceduresunderspinalanesthesiaincreasethe risk of relapse, so general anesthesiamay be an alternative in MS patients. Cautioustitration of anestheticdrugs, continuousmonitoringandusingthelowestpossibleeffectivedosearethetreatmentprinciples. Exceptforhepatitis B therearenoadequatepublished data aboutvaccinesthatcause CNS demyelination. Inthispaper, wediscuss how toapproachtheabovementionedparticularissues in MS patient

Visually evoked startle response in a patient with epilepsy: a case report and review of the literature

Both symptomatic and genetic, cases with hyperekplexia or startle seizures induced by acoustic stimuli, are previously reported. By contrast, startle response induced by visual stimuli is rare. While visual stimuli are more commonly associated with startle seizures, here we present an 11-year-old girl with epilepsy, motor-mental retardation, and spastic tetraparesis, who had repetitive startle responses by photic stimulation during the electroencephalogram recording, without any spike-and-wave discharges associated with the startles. We report this unique case with startle responses induced both by acoustic and photic stimuli and review the literature related to this exceptionally rare combination of symptoms

TREATMENT OF OBSTRUCTIVE SLEEP APNEA SYNDROME BY DIAPHRAGM PACING STIMULATION IN A PATIENT WITH AMYOTROPHIC LATERAL SCLEROSIS

Obstructive sleep apnea syndrome (OSAS) is commonly seen in patients with neurological disorders, such as amyotrophic lateral sclerosis (ALS), especially later in disease course when diaphragmatic dysfunction and respiratory compromise becomes evident. The gold standard therapy of OSAS is the noninvasive mechanical ventilation (NIMV). The mainstay treatment for patients with ALS and respiratory disturbances is also accepted as NIMV to prolong life expectancy. Diaphragm pacing stimulation (DPS) has recently been introduced and suggested to be beneficial in patients with ALS. Here we report a patient with ALS, in whom OSAS was completely resolved upon DPS intervention. With more common application of diaphragmatic pacing in ALS patients with respiratory involvement will offer a supportive treatment rather than traditional palliative care