Bu derlemede ilk çaðlardan bu yana yutma ile ilgili kýsa klinik geliþme incelenmiþtir. Ayný zamanda orofaringiyal organlarýn iþlevsel anlamýnýn keþfine de vurgu yapýlmaya çalýþýlmýþtýr.

This review aims to present a brief historical perspective of the clinical development of swallowing since ancient times. It also highlights the discovery of the functional meaning of the oropharyngeal organs. These historical developments are enriched with some anecdotal details.

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Amaç: Yeni tanýmlanan distal uyarýmlý medial femoral kütanöz (MFK) sinir uyarým çalýþmasýnýn, daha geniþ yaþ ve vücut kitle indeksi (VKÝ) aralýðýna sahip olan saðlýklý popülasyonda normal deðerlerinin tanýmlanmasý amaçlanmýþtýr.
Gereç ve Yöntem: Klinik ve elektrofizyolojik olarak alt ekstremiteleri etkileyecek periferik sinir hastalýðý dýþlanmýþ 144 saðlýklý gönüllüde distal uyarýmlý MFK sinir çalýþmasý iki yanlý olarak yapýlmýþtýr. Denekler yaþlarýna göre 18-39,9 (yaþ 1), 40–59,9 (yaþ 2) ile 60 ve üstü (yaþ 3) olmak üzere 3 grupta sýnýflandýrýldý. VKÝ’lerine göre de 24,9 ve altý (VKÝ 1), 25–29,9 (VKÝ 2) ile 30 ve üstü (VKÝ 3) olarak gruplandýrýldý.
Bulgular: MFK amplitüdü saðda ve solda ortalama 5,7 μV, tepe latansý saðda ve solda ortalama 2,8 ms ve ortalama iletim hýzý saðda 61,5 m/sn, solda 61,9 m/sn olarak bulundu. Sað ve sol tarafta elde edilen MFK amplitüdleri oldukça benzer olup taraflar arasý amplitüd farký ortalamasý %10,1 ± 9,1 idi (0–56,6). MFK amplitüdü ile yaþ ve VKÝ arasýnda negatif baðýntý vardý.
Sonuç: Çalýþmamýz yeni tanýmlanan distal uyarýmlý MFK duyusal sinir iletim çalýþmasýnýn tekrarlanabilir ve kolay uygulanabilir olduðunu göstermiþtir.

Objective: To determine the normal values of the newly described distal stimulated medial femoral cutaneous (MFC) nerve conduction study in a healthy population using a wide range of ages and body mass index (BMI) values.
Materials and Methods: Distal stimulated MFC nerve conduction studies were performed bilaterally in 144 healthy volunteers with no peripheral nerve diseases affecting the lower extremities according to clinical and electrophysiological evaluations. The volunteers were divided into three groups according to their age: 18–39.9 years (age 1), 40–59.9 years (age 2), and 60 years and above (age 3). They were also grouped according to their BMI: 24.9 or less (BMI 1), 25–29.9 (BMI 2), and 30 or more (BMI 3).
Results: The mean MFC amplitude was 5.7 μV on both sides, the mean peak latency was 2.8 ms on both sides, and the mean conduction velocity was 61.5 m/s on the right and 61.9 m/s on the left. The MFC amplitudes obtained on the right and left sides were similar, and the mean amplitude difference between sides was 10.1 ± 9.1% (0–56.6). A negative correlation was identified between MFC amplitude and age and BMI.
Conclusion: This study revealed that the newly described distal stimulated MFC sensory nerve conduction study is repeatable and easily applicable.

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Amaç: Çalýþmanýn amacý, Northwick Park aðrý anketi (NPQ) olarak bilinen anketin Ýngilizce’den Hintçe diline çevrilerek psikometrik özelliklerini incelemek, içerik geçerliliðini ve iç tutarlýlýðýný deðerlendirmek ve boyun aðrýsýný deðerlendirmede kullanýlabilirliðini araþtýrmaktýr.
Gereç ve Yöntem: Bu kesitsel çalýþma, en az 4 ay boyunca non-enflamatuvar boyun aðrýsý yaþayan 60 hastayý içermiþtir. Geri çevrilen çevirinin psikometrik özellikleri, iç tutarlýlýk ve test-tekrar test güvenilirliði deðerlendirilerek orijinal Ýngilizce versiyonuyla karþýlaþtýrýlmýþtýr. Ýçerik geçerliliði açýsýndan altý kiþilik uzman panel tarafýndan onaylanmýþtýr.
Bulgular: Faktör analizi, çevrilen Hintçe NPQ varyansýnýn %76,7’sini açýklayan üç faktörlü bir yapýyý ortaya çýkardý. Ýç tutarlýlýk, 0,936 Cronbach alfa deðeri ile gösterildi ve test-tekrar test güvenilirliði, 0,935 (%95 güven aralýðý: 0,906–0,958) aralýðýnda sýnýf içi korelasyon katsayýsý kullanýlarak deðerlendirildi. Hintçe’ye çevrilen NPQ’nun bireysel maddeleri ile orijinal Ýngilizce NPQ arasýnda anlamlý korelasyonlar bulundu.
Sonuç: Hintçeye çevrilen Ýngilizce NPQ, iyi bir faktör yapýsý sergiledi ve orijinal NPQ ile benzer psikometrik özelliklere sahipti. Bu nedenle, Hindistan’daki boyun aðrýsý araþtýrmalarýnda kullanýlmasý önerilebilir.

Objective: To examine the psychometric properties of the Northwick Park neck pain questionnaire (NPQ) by translating it from English to Hindi and evaluating its content validity (CV) and internal consistency to assess its feasibility for assessing neck pain.
Materials and Methods: This cross-sectional study included 60 patients who had been experiencing non-inflammatory neck pain for at least 4 months. The psychometric properties, internal consistency, and test–retest reliability of the back-translated version were assessed and compared with the original English version. A panel of six experts validated the instrument for CV.
Results: The factor analysis revealed a three-factor structure, which accounted for 76.7% of variance in the translated Hindi version of the NPQ. Internal consistency was indicated by a Cronbach’s alpha of 0.936, and test–retest reliability was assessed using an intraclass correlation coefficient of 0.935 (95% confidence interval: 0.906–0.958). Significant correlations were found between the individual items of the translated Hindi and original English NPQs.
Conclusion: The English-to-Hindi-translated NPQ demonstrated a good factor structure and exhibited similar psychometric properties to the original English version. Therefore, it can be recommended for use in neck pain research in India.

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Amaç: Atrial fibrilasyon (AF) iskemik inmenin doðrudan önlenebilir en sýk nedendir. Ülkemizde AF nedenli inme spektrumuna dair nöroloji kaynaklý geniþ ölçekte bir veri bulunmamaktadýr. NöroTek-Türkiye kapsamýnda akut inme algoritmalarýnýn oluþturulmasýna katký yapmasý beklenen AF tespit edilen akut inme hastalarýna dair hastane verisi toplanmýþtýr.
Gereç ve Yöntem: Atrial fibrilasyon (AF) iskemik inmenin doðrudan önlenebilir en sýk nedendir. Ülkemizde AF nedenli inme spektrumuna dair nöroloji kaynaklý geniþ ölçekte bir veri bulunmamaktadýr. NöroTek-Türkiye (TR) kapsamýnda akut inme algoritmalarýnýn oluþturulmasýna katký yapmasý beklenen AF tespit edilen akut inme hastalarýna dair hastane verisi toplanmýþtýr.
Bulgular: Ýskemik inme/GÝA sebebiyle ile interne edilmiþ hastalarda AF oraný %29,8 olup bunlarýn %65’i bilinmekte olan, %5’i paroksismal ve %30’u yeni tanýdýr. AF tanýsý ile gelen hastalarda “etkin” tedavi [internasyonel normalizasyon oraný ≥2,0 varfarin veya rehber dozunda non-vitamin K antagonist oral antikoagülan (NOAK)] alanlarýn oraný %25,3 olup, %42,5 olguda ya hiç ilaç kullanýlmamakta ya da sadece antiplatelet kullanýlmaktaydý. Düþük doz kullaným oraný 42 NOAK alýrken inme geçirmiþ olguda %50 idi. Taburcu edilirken antikoagülan %94,6 (düþük molekül aðýrlýklý veya non-fraksiyone heparin %28,1; varfarin %32,5 ve NOAK %31) hastaya reçete edilmiþti. NOAK ile taburcu edilen olgularýn %22’sinde doz düþük kategoride olup geliþte NOAK almakta olan olgularýn yarýsý ayný ilaçla taburcu edilmiþtir.
Sonuç: NöroTekTR ülkemizde AF’nin akut inmedeki sýklýðý yaný sýra sekonder proflaksi perspektifinde yönetiminin geliþtirilebilecek yönlerini ortaya koydu. Türkiye’de hastanede yatan akut inme olgularýnýn yaklaþýk üçte birinde AF saptanmýþtýr. AF’si bilinen akut inme olgularýnýn dörtte üçünde etkin antikoagülan tedavi kullanýlmamaktaydý. AF’de inme sekonder proflaksisi kapsamýnda heparin, varfarin ve NOAK planlamasý benzer sýklýkta (üçte bir) olup reçete edilen NOAK dozu dörtte bir olguda subterapötiktir. AF’ye baðlý inmenin önlenebilmesi non-medikal ve medikal eðitim gerekli görünmektedir.

Objective: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in our country. Within the scope of NeuroTek-Turkey, hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute stroke algorithms.
Materials and Methods: Atrial fibrillation (AF) is the most common directly preventable cause of ischemic stroke. There is no dependable neurology-based data on the spectrum of stroke caused by AF in Türkiye. Within the scope of NöroTek-Türkiye (TR), hospital-based data on acute stroke patients with AF were collected to contribute to the creation of acute-stroke algorithms.
Results: The rate of AF in patients hospitalized for ischemic stroke/TIA was 29.8%, of which 65% were known before stroke, 5% were paroxysmal, and 30% were diagnosed after hospital admission. The proportion of patients with AF who received “effective” treatment [international normalization ratio ≥2.0 warfarin or non-vitamin K antagonist oral anticoagulants (NOACs) at a guideline dose] was 25.3%, and, either no medication or only antiplatelet was used in 42.5% of the cases. The low dose rate was 50% in 42 patients who had a stroke while taking NOACs. Anticoagulant was prescribed to the patient at discharge at a rate of 94.6%; low molecular weight or unfractionated heparin was prescribed in 28.1%, warfarin in 32.5%, and NOACs in 31%. The dose was in the low category in 22% of the cases discharged with NOACs, and half of the cases, who received NOACs at admission, were discharged with the same drug.
Conclusion: NöroTekTR revealed the high but expected frequency of AF in acute stroke in Türkiye, as well as the aspects that could be improved in the management of secondary prophylaxis. AF is found in approximately one-third of hospitalized acute stroke cases in Türkiye. Effective anticoagulant therapy was not used in three-quarters of acute stroke cases with known AF. In AF, heparin, warfarin, and NOACs are planned at a similar frequency (one-third) within the scope of stroke secondary prophylaxis, and the prescribed NOAC dose is subtherapeutic in a quarter of the cases. Non-medical and medical education appears necessary to prevent stroke caused by AF.

Abstract | English Full Text

Amaç: Matriks metaloproteinazlar (MMP'ler), kalsiyum baðýmlý çinko içeren proteazlardýr. 28'den fazla enzim içeren MMP'ler, hücre dýþý matriksin bozulmasýna neden olur. MMP'ler birçok biyolojik süreçte önemli rol oynamalarýna raðmen, iskemik inme gibi bazý patolojik süreçlerde de rol oynarlar. MMP'ler arasýnda iskemik inme ile en çok iliþkili olan enzim MMP-9 enzimidir. Bu çalýþmanýn amacý MMP-9 C-1562T (rs3918242) gen polimorfizminin Trakya bölgesinde yaþayan Türk hastalarda iskemik inme geliþimine etkisini deðerlendirmektir.
Gereç ve Yöntem: Matriks metaloproteinazlar (MMP), kalsiyum baðýmlý çinko içeren proteazlardýr. Yirmi sekizden fazla enzim içeren MMP’ler, hücre dýþý matriksin bozulmasýna neden olur. MMP’ler birçok biyolojik süreçte önemli rol oynamalarýna raðmen, iskemik inme (ÝÝ) gibi bazý patolojik süreçlerde de rol oynarlar. MMP’ler arasýnda ÝÝ ile en çok iliþkili olan enzim MMP9 enzimidir. Bu çalýþmanýn amacý MMP9 C-1562T (rs3918242) gen polimorfizminin Trakya Bölgesi’nde yaþayan Türk hastalarda ÝÝ geliþimine etkisini deðerlendirmektir.
Bulgular: Genotipler, C ve T alellerinin varlýðýna göre CC, CT ve TT olarak tanýmlandý. Hastalar ve kontroller arasýnda MMP9 C-1562T gen polimorfizminin genotipik daðýlýmý ve alelik frekansý açýsýndan anlamlý bir fark bulunamadý.
Sonuç: Sonuç olarak bulgularýmýz, MMP9 C-1562T gen polimorfizminin, Trakya Bölgesi’nde yaþayan Türk hastalardaki ÝÝ riski ile iliþkili olmadýðýný göstermektedir.

Objective: Matrix metalloproteinases (MMPs) are calcium-dependent zinc-containing proteases containing more than 28 enzymes that cause the degrading of the extracellular matrix. Although MMPs play key roles in many biological processes, they influence some pathological processes such as ischemic stroke (IS). Among MMPs, the enzyme most associated with IS is the MMP9 enzyme. This study aimed to evaluate the effect of the C-1562T (rs3918242) gene polymorphism of MMP9 on the development of IS in Turkish patients living in the Trakya Region.
Materials and Methods: Our study involved 60 patients with IS and 60 controls. The patients with IS were categorized according to the Trial of ORG 10172 in Acute Stroke Treatment classification of stroke subtypes, and MMP9 C-1652T gene polymorphism was identified using polymerase chain reaction, followed by restriction fragment length polymorphism using the Pael (SphI) restriction enzyme.
Results: Genotypes were defined as CC, CT, and TT according to the presence of C and T alleles. No significant differences were identified in the genotype distribution and allele frequency of MMP9 C-1562T gene polymorphism between the patients with IS and controls.
Conclusion: Our findings suggest that MMP9 C-1562T gene polymorphism is not associated with the risk of IS in Turkish patients living in the Trakya Region.

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Amaç: Östrojen reseptörü 1 (ESR1) polimorfizmleri, Alzheimer hastalýðý (AH) ile iliþkilidir ve genin birinci intron bölgesindeki polimorfizmlerin ESR1 mRNA transkripsiyonunu etkilediði bilinmektedir. ESR1’in ilk intron bölgesi, iyi bilinen iki önemli polimorfizm içerir: PvuII rs2234693 (NM 000125.3: c.453-397T>C) ve Xbal rs9340799 (NM 000125.3: c.453-351A>G). Her iki polimorfizmin AH ile iliþkili olduðu gösterilmiþtir, ancak popülasyonlar arasýnda tutarlý sonuçlar elde edilmemiþtir. Çalýþmamýzda, Türk AH hastalarýndan oluþan kohortumuzda ESR1 PvuII ve XbaI polimorfizmlerinin hastalýk ile iliþkili olup olmadýðýný belirlemeye çalýþtýk. Ayrýca PvuII ve XbaI polimorfizmlerinin ESR1 mRNA ekspresyonunu etkileyerek hastalýða katký saðlayýp saðlamadýðýný da araþtýrdýk.
Gereç ve Yöntem: Genotipleme 424 AH hastasý (ortalama yaþ: 64,5 ± 11,1 yýl) ve 302 kontrolde (ortalama yaþ: 56,4 ± 13,0 yýl) gerçekleþtirildi. ESR1 PvuII ve XbaI polimorfizmlerinin prevalansýný belirlemek için polimeraz zincir reaksiyonu ve restriksiyon enzim kesimi yöntemi kullanýldý. ESR1 mRNA ekspresyonu, 85 hasta ve ayný yaþtaki 53 kontrolün periferik kan hücrelerinde kantitatif gerçek zamanlý polimeraz zincir reaksiyonu ile analiz edildi.
Bulgular: Hastalar ve kontroller arasýnda ESR1 PvuII ve XbaI polimorfizmlerinin genotip ve allel sýklýðý açýsýndan anlamlý bir farklýlýk bulunmadý. Bununla birlikte, PvuII C ve XbaI G allel frekanslarý, APOE ε4 alel taþýyýcýsý hastalarda anlamlý olarak daha yüksek bulundu. ESR1 mRNA düzeyinin hastalarda kontrollere göre anlamlý derecede düþük olduðu belirlendi (P = 0,001). XbaI A allel taþýyýcýlýðý, hastalarda düþük ESR1 mRNA düzeyi ile iliþkili bulundu (P = 0,044) ve bu iliþkinin, yaþ, cinsiyet ve APOE ε4 taþýyýcýlýk durumu gibi deðiþkenler için düzeltme yapýldýktan sonra bile anlamlý olduðu belirlendi (P = 0,035).
Sonuç: Çalýþmamýz, PvuII ve XbaI allel daðýlýmýnýn APOE ε4 alleli ile iliþkili olduðunu gösterdi. XbaI polimorfizmi, ESR1 mRNA düzeyini etkileyerek AH riskini artýrabilir.

Objective: Estrogen receptor 1 (ESR1) polymorphisms are associated with Alzheimer’s disease (AD) and polymorphisms in the first intronic region of the gene are known to affect ESR1 mRNA transcription. The first intronic region of the ESR1 contains two polymorphisms that have received the most attention: PvuII rs2234693 (NM 000125.3: c.453-397T>C) and XbaI rs9340799 (NM 000125.3: c.453-351A>G). Both polymorphisms have been shown to be associated with AD, but consistent findings across populations have not been established. This study aimed to determine whether ESR1 PvuII and XbaI polymorphisms are associated with the disease in a cohort of Turkish AD patients. Whether PvuII and XbaI polymorphisms affect disease susceptibility by influencing ESR1 mRNA expression was also examined.
Materials and Methods: Genotyping was performed in 424 patients with AD (mean age: 64.5 ± 11.1 yrs) and 302 controls (mean age: 56.4 ± 13.0 yrs). The polymerase chain reaction (PCR) and restriction enzyme digestion methods were used to determine the prevalence of the ESR1 PvuII and XbaI polymorphisms. The ESR1 mRNA expression was analyzed in the peripheral blood cells of 85 patients and 53 age-matched controls using quantitative real-time PCR.
Results: No significant difference in genotype and allele frequencies of ESR1 PvuII and XbaI polymorphisms between the patients and controls was found. However, the frequencies of the PvuII C and XbaI G alleles were significantly higher in the patients with the apolipoprotein-E (APOE) ε4 allele. The ESR1 mRNA levels were significantly lower in the patients with AD compared with the controls (P = 0.001). The XbaI A allele was significantly associated with lower ESR1 mRNA levels (P = 0.044) and this association remained significant even after adjusting for confounders such as age, gender and APOE ε4 carrier status (P = 0.035).
Conclusion: This study demonstrated that the distribution of PvuII and XbaI alleles is associated with the APOE ε4 allele. The XbaI polymorphism may be associated with a higher risk of AD by altering ESR1 mRNA levels.

Abstract | English Full Text

Amaç: Blefarospazm (BS), orbikülaris oküli, proserus ve korrugator kaslar gibi perioküler kaslarý da etkileyen bir fokal distonidir. Hastalýk, tek baþýna veya nörodejeneratif hastalýklarýn seyrinde ortaya çýkabilmektedir. Hastalýkta, birinci basamak tedavi botulinum toksin uygulamasýdýr. Bu çalýþmada, BS tanýsý ile izlenen hastalarýn klinik özelliklerini incelenmeyi amaçladýk.
Gereç ve Yöntem: Çalýþmamýzda, BS tanýsý ile takip edilen hastalarýn klinik özellikleri ve tedavi yanýtlarý retrospektif olarak analiz edilmiþtir.
Bulgular: Çalýþmaya katýlan 49 hastanýn, 23’ü kadýn, 26’sý erkekti. Hastalarýn ortalama baþvuru yaþý 56,8 ± 10,8 (35 ile 85 arasýnda), yakýnmalarýnýn ortalama baþlangýç yaþý ise, 52,2 ± 11,9 (21 ile 82 arasýnda) idi. Hastalarýn 14’ünde bir nörodejeneratif hastalýk tanýsý mevcuttu. Hastalarýn 14’ü semptomlarý için botulinum toksinine ek olarak oral tedavi almaktaydý. En sýk oral tedaviler antikolinerjik ilaçlar, benzodiazepinler ve antiepileptiklerdi. Hastalarda ortalama 32,4 ± 5,8 (15,0–42,5 arasýnda) ünite botulinum toksin kullanýldý. Tedavi yanýtý 42 hastada deðerlendirildi. Bu hastalarýn 36’sýnýn (%86) botulinum toksin uygulamasýndan iyi veya çok iyi düzeyde fayda gördüðü öðrenildi. Tedaviden görülen yarar süresi, ortalama 105,35 ± 36,35 (30 ile 180 arasýnda) gün idi. Pretarsal uygulamanýn preseptal uygulamaya göre daha iyi ve uzun süreli yanýt ile iliþkili olduðu saptandý. Analiz edilen diðer klinik parametrelerin botulinum toksin uygulamasýndan görülen faydaya etkisinin olmadýðý dikkati çekti. Yedi hastada botulinum toksinin uygulamasýna baðlý yan etki geliþtiði gözlendi. En sýk gözlenen yan etkiler, orbikülaris oküli kas zaafý, ekimoz ve kseroftalmi idi.
Sonuç: Çalýþmamýzda, botulinum toksininin BS tedavisinde etkili ve güvenilir olduðu ortaya konmuþtur. Pretarsal uygulamanýn, preseptal uygulamaya göre benzer yan etki profiline sahip olmasýna raðmen hasta deðerlendirmesine dayanan fayda oranýna göre daha etkili olduðu ve bu etkinin daha uzun süre devam ettiði saptanmýþtýr.

Objective: Blepharospasm (BS) is a focal dystonia that affects periocular muscles such as the orbicularis oculi, procerus, and corrugator. The disease may occur in isolation or in the course of neurodegenerative diseases, and its first-line treatment is the administration of botulinum toxin. In this study, we aim to analyze the clinical features of patients with BS.
Materials and Methods: In this study, the clinical features and treatment responses of patients with BS were retrospectively analyzed.
Results: Of the 49 patients included in the study, 23 were female and 26 were male. The mean age at administration was 56.8 ± 10.8 (between 35 and 85 years), and the mean age of onset was 52.2 ± 11.9 (between 21 and 82 years). Fourteen patients had a diagnosis of a neurodegenerative disease. Fourteen patients had additional oral treatment for their symptoms. The most common oral treatments were anticholinergic drugs, benzodiazepines, and antiepileptics. The mean unit of botulinum toxin was 32.4 ± 5.8 (15.0–42.5). Treatment response was evaluated in 42 patients. Of these, 36 (86%) had either good or excellent benefit. The mean duration of treatment benefit was 105.35 ± 36.35 (between 30 and 180) days. Pretarsal application was associated with better and more prolonged treatment response than preseptal. Other analyzed clinical parameters showed no effect on the benefit of botulinum toxin. Side effects were observed in seven patients, and the most common were orbicularis oculi weakness, ecchymosis, and xerophthalmia.
Conclusion: Our study demonstrated that botulinum toxin is effective and safe in the treatment of BS. Although pretarsal application has a similar side-effect profile to preseptal application, it was associated with better and longer treatment benefit.

Abstract | English Full Text

Amaç: Multipl skleroz (MS) etiyoloji çalýþmalarý hastalýðýn multifaktöriyel olduðunu göstermektedir. Hastalýðýn baþlangýcýnda genetik özellikler daha ön plana çýkarken, hastalýðýn progresyonuna neden olabilecek çevresel tetikleyicilerin varlýðý hala araþtýrma konusudur.
Gereç ve Yöntem: Ayný coðrafi bölgeyi paylaþan 101 MS hastasýný deðerlendirdik. Bu hastalarýn kan ve saç dokularýnda aðýr metal incelemesi yaptýk. Bu hastalarýn 67’si tekrarlayan iyileþen MS (RRMS) grubunda, 34’ü progresif MS (PMS) grubundaydý.
Bulgular: Numuneler, X Series 2 model (ICP MS) cihazý kullanýlarak analiz edildi. Saç örneklerinde alüminyum (Al) PMS grubunda 8,98 μg/g, RRMS grubunda 3,01 μg/g bulundu (P < 0,001). RRMS grubunda Al elementinden farklý olarak magnezyum (Mg), kalsiyum (Ca), kobalt (Co), çinko (Zn) ve stronsiyum (St) elementlerinin yüksek olduðu gözlendi. Ca medyan deðeri için RRMS: 931 μg/g, PMS: 400 μg/g (P < 0,001); Mg için RRMS: 118 ug/g, PMS: 50 ug/g (P < 0,001); Co RRMS için: 0,0150 μg/g, PMS: 0,0075 μg/g (P = 0,008); Zn için RRMS: 138 μg/g, PMS: 101 μg/g (P = 0,008); St RRMS için: 4,76 μg/g, PMS: 3,70 μg/g (P = 0,008). Bu sonuçlarla Al fazlalýðý veya Mg, Ca, Co ve Zn eksikliklerinin MS progresyonu ile iliþkili olabileceðini düþündük. PMS’de cýva (Hg) kan seviyesi hafif düþüktü. Bu bulgu saç numuneleri ile korele deðildi (P = 0,047). Kan Hg düzeyi ile RRMS arasýndaki iliþki ayrýca deðerlendirilmelidir.
Sonuç: Daha önce PMS formlarýyla RRMS subtiplerini aðýr metaller açýsýndan kýyaslayan çalýþma bulamadýk. Özellikle Al elementine fokuslanmak gereklidir.

Objective: Multiple sclerosis (MS) etiology studies show that the disease is multifactorial. While genetic features are more prominent at the beginning of the disease, the existence of environmental triggers that may cause the progression of the disease is still a subject of research.
Materials and Methods: We evaluated 101 MS patients sharing the same geographical area. We performed heavy metal analysis in the blood and hair tissues of these patients. Of these patients, 67 were in the relapsing remitting MS (RRMS) group and 34 were in the progressive MS (PMS) group.
Results: Samples were analyzed using the X Series 2 model (ICP MS) instrument. In hair samples, aluminum (Al) was found to be 8.98 μg/g in the PMS group and 3.01 μg/g in the RRMS group (P < 0.001). Unlike Al element, magnesium (Mg), calcium (Ca), cobalt (Co), zinc (Zn) and strontium (St) elements were observed to be higher in the RRMS group. RRMS for median Ca: 931 μg/g, PMS: 400 μg/g (P < 0.001); RRMS for Mg: 118 μg/g, PMS: 50 μg/g (P < 0.001); For Co RRMS: 0.0150 μg/g, PMS: 0.0075 μg/g (P = 0.008); RRMS for Zn: 138 μg/g, PMS: 101 μg/g (P = 0.008); For St RRMS: 4.76 μg/g, PMS: 3.70 μg/g (P = 0.008). With these results, we thought that Al excess or Mg, Ca, Co, and Zn deficiencies might be associated with MS progression. The mercury (Hg) blood level was slightly low in PMS. This finding was not correlated with hair samples (P = 0.047). The relationship between blood Hg level and RRMS should be evaluated separately.
Conclusion: We could not find any study comparing PMS forms and RRMS subtypes in terms of heavy metals. In particular, it is necessary to focus on the Al element.

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Amaç: Migren patofizyolojisinde nitrik oksitin (NO) rolü ile ilgili provokasyon çalýþmalarý uzun zamandýr yapýlmakta ve önemli bilgiler vermektedir. Literatürde çok sayýda provokasyon çalýþmasý olmasýna raðmen spontan migren ataklarýnda NO’nun rolü ile ilgili daha az sayýda yayýn mevcuttur. Bu çalýþmada migren hastalarýnda provoke edilmemiþ ataklar sýrasýndaki serum NO deðerleri ile interiktal dönemdeki deðerler ve kontrol grubunun sonuçlarýnýn karþýlaþtýrýlmasý amaçlanmýþtýr.
Gereç ve Yöntem: Otuz migrenli hastanýn provoke edilmemiþ ataklarýnýn doðal seyrinde ve ataksýz dönemlerinde plazma NO düzeylerini deðerlendirildi. Ayrýca bunlar 25 saðlýklý kontrolün sonuçlarýyla karþýlaþtýrýldý.
Bulgular: Ortalama plazma NO seviyeleri migren ataklarý sýrasýnda 20,99 ± 4,93 μmol/l, ataklar arasýnda 25,97 ± 9,83 μmol/l ve kontrol grubunda 23,22 ± 7,57 μmol/l idi. Bu sonuçlara göre migrenlilerde ataklar sýrasýnda ortalama plazma NO düzeyleri ataksýz döneme göre anlamlý olarak daha düþüktü (P = 0,025), ancak kontrollerle anlamlý bir fark yoktu (sýrasýyla; P = 0,212 ve P = 0,247).
Sonuç: NO’nun migren ataklarýnýn doðal seyrinde bir etkisinin olup olmadýðýný deðerlendirmek için daha fazla sayýda ve serum düzeylerinin ölçülmesinden farklý yöntemlerle yapýlan spontan atak çalýþmalarýna gerek vardýr.

Objective: Provocation studies on the role of nitric oxide (NO) in the pathophysiology of migraine have long been conducted and provide important information. Although there are many provocation studies in the literature, there are fewer publications on the role of NO in spontaneous migraine attacks. In this study, we aimed to compare the serum NO levels during unprovoked attacks in patients with migraine using the values in the interictal period and the results of the control group.
Materials and Methods: Thirty migraine patients were evaluated for plasma NO levels during the natural course of unprovoked attacks and in the interictal period. They were also compared with the results of 25 healthy controls.
Results: The mean plasma NO levels were 20.99 ± 4.93 μmol/l during migraine attacks, 25.97 ± 9.83 μmol/l between attacks and 23.22 ± 7.57 μmol/l in the control group. According to these results, the mean plasma NO levels were significantly lower in migraineurs during attacks compared to the non-attack period (P = 0.025), but there was no significant difference with controls (P = 0.212 and P = 0.247, respectively).
Conclusion: To evaluate whether NO has an effect on the natural history of migraine attacks, more spontaneous attack studies involving methods other than measuring serum levels are needed.

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Tipik Alzheimer hastalýðý (AH), merkezini progresif amnestik bozukluðun oluþturduðu, kronik nörodejeneratif bir hastalýktýr. Bununla birlikte etkilenen beyin alanlarýna baðlý olarak diðer fokal kortikal demans sendromlarýnýn çeþitli amnestik olmayan klinik profilleri ile atipik olarak ortaya çýkabilir. Bu atipik formlardan birisi, Ulusal Yaþlýlýk Enstitüsü–Alzheimer Derneði’nin 2011 yýlýnda ve Uluslararasý Çalýþma Grubu 2’nin 2014 yýlýnda yayýnladýðý Alzheimer Hastalýðý Taný Kriterleri’nde yer almayan ancak davranýþ nörolojisi uzmanlarýnca iyi bilinen kortikobazal sendromdur (KBS). Bu çalýþmada asimetrik parkinsonizm, miyokloniler, piramidal bulgular, ilkel refleksler ve kraniyal görüntüleme bulgularý ile KBS olarak deðerlendirilen ve beyin omurilik sývýsý biyobelirteçleri AH patolojisi ile uyumlu olan altmýþ bir yaþýndaki bir erkek hasta anlatýlacaktýr. Mevcut taný kriterleri içinde yer almayan, ancak azýmsanamayacak sayýda olgu AH patolojisi ile iliþkili olduðu bilinen KBS’nin gelecekte belirlenecek yeni AH taný kriterlerinde göz ardý edilmemesi gerekmektedir.

Typical Alzheimer’s disease (AD) is a chronic neurodegenerative disease centered on progressive amnestic disorder. However, it may present atypically with various non-amnestic clinical profiles of other focal cortical dementia syndromes depending on the brain areas affected. One of these atypical forms is corticobasal syndrome (CBS), which is not included in the AD diagnostic criteria published by the National Institute of Aging and Alzheimer’s Association in 2011 and the International Working Group 2 in 2014, but is well known by behavioral neurologists. This paper presents the case report of a 61-year-old male patient with asymmetric parkinsonism, myoclonus, pyramidal findings, primitive reflexes, and cranial imaging findings evaluated as CBS and cerebrospinal fluid biomarkers compatible with AD pathology. CBS, which is not included in the current diagnostic criteria, but is known to be associated with AD pathology in a considerable number of cases, should not be ignored in the new AD diagnostic criteria to be determined in the future.

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text

Abstract | English Full Text