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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 37 | Issue 2
Page Nos. 41-99

Online since Monday, June 29, 2020

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REVIEW ARTICLE  

Vestibular migraine: Considered from both the vestibular and the migraine point of view p. 41
Gulden Akdal, Pınar Özçelik, Aynur Özge
DOI:10.4103/NSN.NSN_72_20  
A temporal overlap between vestibular symptoms, such as vertigo and head movement intolerance, and migraine symptoms, such as headache, photophobia, and phonophobia, is a requisite diagnostic criterion for the diagnosis of vestibular migraine (VM). Diagnostic criteria for VM have been proposed by an International Vestibular Research Group (the Bárány Society) and a headache research group (International Headache Society); however, in practice, it is still acceptable to divide patients suspected of VM into “definite VM” and “probable VM” groups. Here, a neuro-otologist and a headache specialist consider VM from their own points of view using four real cases, two from a dizzy clinic and two from a headache clinic, with expert opinions and arguments according to the current literature. The management is summarized on the basis of mechanism and comorbidity and the importance of prophylactic medication.
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ORIGINAL ARTICLES Top

Electrodiagnostic patterns of demyelination and hughes functional grading in typical chronic inflammatory demyelinating polyneuropathy p. 50
Fatin Hatim Towman, Farqad Bader Hamdan
DOI:10.4103/NSN.NSN_8_20  
Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterized by progressive or relapsing motor or sensory symptoms, with variants differing in the relative distribution of these symptoms and electrophysiologic findings. We aimed to correlate the electrodiagnostic patterns of demyelination using Hughes Functional Grading Scale in patients with CIDP. Methods: A case–control study was conducted at the neurophysiology department of Al-Imamian Al-Kadhymian Medical city and Nursing Home Hospital, Medical City, Baghdad from December 2017 to June 2018. Fifteen patients with CIDP aged 30–60 years with disease duration between 6 months and 2 years and 20 age-matched healthy subjects (control group) were included in the study. The participants were submitted to medical history, clinical neurological examination, and electrophysiologic tests. Results: Patients with CIDP demonstrated prolonged distal sensory and motor latencies, decreased sensory nerve action potential amplitude, slowing of sensory and motor nerve conduction velocity, and prolonged mean F-wave latency. The majority showed absent sural sensory responses. Significant relationships were demonstrated between the Hughes Functional Grading Scale and different neurophysiologic parameters, and no correlation was found with the terminal latency index. Conclusions: Patients with high Hughes functional scoring also have severe abnormalities in motor parameters, usually in the range of demyelination. The involvement of nerve segments was multifocal affecting mostly the proximal and intermediate nerve segments; the terminal segments were involved to a lesser extent.
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Reliability and validity of the Turkish version of king's Parkinson's disease pain scale p. 57
Ferhan Soyuer, Murat Gültekin, Feyzan Cankurtaran, Ferhan Elmalı
DOI:10.4103/NSN.NSN_34_20  
Objective: Pain, a nonmotor symptom in Parkinson's disease (PD), affects approximately 40%–85% of patients and adversely affects their daily activities. Therefore, our aim was to establish the validity and reliability of the Turkish version of King's PD Pain Scale (KPDPS) and to make it available for Turkish patients with PD patients. Methods: The first phase of the study involved the translation and adaptation of the KPDPS to Turkish. For the language validity of the scale, a translation back-translation method was applied, and expert's opinion was considered for content validity. In the second stage, the developed Turkish scale was administered to 152 patients with PD. In the study, test-retest was performed in 50 patients for 1 week. Results: The internal consistency value was found as 0.856 in the KPDPS. When the test-retest was performed, the internal consistency value of the scale showed excellent reliability. The test-retest-Cronbach's alpha value for the whole scale was 0.827. According to the data analysis results, it showed that 14 items on the scale were sufficient for the evaluation of pain in patients with PD. Conclusion: The results from this study show that KPDPS items have adequate internal consistency and test-retest reliability. The Turkish KPDPS can be used as a reliable and valid instrument for assessing the pain symptoms common to patients with PD.
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Analysis of vestibular-evoked myogenic potentials in the vestibular migraine p. 63
Belgin Tutar, Güler Berkiten, Onur Akan, Ziya Saltürk, Berk Gürpinar, Semih Karaketir, Tolgar Lütfi Kumral, Yavuz Uyar, Ömür Biltekin Tuna
DOI:10.4103/NSN.NSN_4_20  
Objectives: The objective of this study is to determine the subclinical vestibular dysfunction of patients with vestibular migraine (VM) in the interattack period who had no vestibular symptoms. We assessed ascending utricular and descending saccular pathways using cervical vestibular-evoked myogenic potentials (cVEMP) and ocular vestibular-evoked myogenic potentials (oVEMP) in patients with VM and a healthy control group and then compared the electrophysiologic findings with each other. Materials and Methods: Between January 2017 and January 2018, 116 patients (aged 18–62 years) were enrolled in the study. The study group consisted of 68 women with VM and the control group comprised 48 healthy women. Results: For cVEMP findings, the mean left ear P1 latency of the VM group was statistically significantly longer than that of the control group (P = 0.024; P < 0.05). No statistical significance was found in left ear N1 latency, P1-N1 interpeak intervals and mean amplitudes between the VM and the control groups (P > 0.05). Amplitude asymmetry ratios (AARs) were not statistically significantly different between the two groups in cVEMP (P > 0.05). In terms of oVEMP findings, no statistically significant difference was found in the right ear parameters of N1, P1, P1-N1 intervals, and amplitudes of the VM and the control groups (P > 0.05). The left ear oVEMPs of the VM group showed absent responses in 12 cases and were statistically significant compared with the control group (P = 0.037; P < 0.05). The AARs were significantly greater for the the VM group than the control group in oVEMP (P = 0.006; P < 0.05). Conclusion: These electrophysiologic findings suggest that peripheral vestibular structures such as the utricle, saccule and also other central vestibular structures might be affected in VM. Patients with VM had subclinical vestibular dysfunction despite being in the interattack period. To support the diagnosis of VM, VEMPs are easy and cost-effective tests.
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The role of leukoaraiosis on outcomes and recombinant tissue-plasminogen activator-related symptomatic intracerebral hemorrhages in acute stroke p. 70
Ezgi Sezer Eryildiz, Atilla Özcan Özdemir, Dilek Yılmaz, Demet Funda Baş
DOI:10.4103/NSN.NSN_11_20  
Background and Purpose: We aimed to assess whether severe leukoaraiosis (LA) is associated with outcomes and symptomatic intracerebral hemorrhages (sICH) in patients who were treated with recombinant tissue-plasminogen activator (rt-PA) for acute stroke. Methods: We analyzed the data of anterior circulation stroke patients who were treated with rt-PA at our stroke center during 2009–2016. LA was scored according to the van Swieten scale (VSS) on computed tomography (CT) and dichotomized into groups as absent or moderate versus severe LA. We used the safe implementation of thrombolysis in stroke definition for sICH and the modified Rankin Scale (mRS) scores at 3 months after rt-PA were recorded. Results: Of 302 patients, 47 (15.6%) showed severe LA (VSS >4) on CT. The overall sICH rate was 3.6%. Moreover, sICH was significantly more frequent in patients with severe LA (n = 5 of 47; 10.6%) than in patients with absent/moderate LA (n = 6 of 255; 2.4%; P = 0.017). In addition, patients with severe LA had higher baseline glucose level (P = 0.006) and systolic blood pressure (P = 0.005) compared to patients with absent/moderate LA. Patients with severe LA were more likely to have a poor outcome (mRS: 3–6) compared to those without severe LA (P = 0.009). Conclusion: The presence of severe LA on CT increases the risk of sICH and poor outcome in patients treated with rt-PA for acute stroke.
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Motor unit potential analysis of the palatal muscles in obstructive sleep apnea syndrome p. 75
Feray Karaali-Savrun, Nurten Uzun Adatepe, Gülçin Benbir Şenel, Rahsan Inan, Hakan Kaynak, Asim Kaytaz, Derya Karadeniz
DOI:10.4103/NSN.NSN_14_20  
Objectives: Among different theories about pathogenesis of obstructive sleep apnea syndrome (OSAS), dysfunction of upper airway muscles still awaits to be delineated. The aim of this study is to examine differences in motor unit potential (MUP) parameters of upper airway muscles between OSAS patients and healthy controls. Methods: Ten male patients diagnosed as OSAS by whole-night polysomnography were analyzed for MUP parameters of genioglossus (GG) muscle, palatoglossus muscle (PG), palatopharyngeus muscle, and uvular (U) muscle. Eight healthy volunteer men matched by age were enrolled as a control group. Results: In PG muscle parameters, the mean MUP area was significantly smaller (P = 0.040) in OSAS patients than those in controls. On the other hand, U muscle parameters showed a significantly larger mean MUP area (P = 0.022) in OUAS patients compared to those in the control group. In OSAS patients, the percentages of polyphasic MUPs of GG and PG muscles were significantly high (P < 0.001 and P = 0.05, respectively). Body mass index was positively correlated with number of phases of GG muscle (rs = 0.63, P < 0.05) and duration of U muscle (rs = 0.71, P < 0.05) in OSAS patients. Other MUP parameters of palatal muscles were similar between the two groups. Conclusion: Our results showed that, although mild in severity, structural neurogenic and myogenic changes characterized as mild and nonuniform MUP changes may co-exist in OSAS patients. These changes in palatal muscles may be attributed to compensatory adaptation of muscle fibers to other precipitating factors in OSAS.
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Comparison of medium supplements in terms of the effects on the differentiation of SH-SY5Y human neuroblastoma cell line p. 82
Belgin Sert Serdar, Tuğba Erkmen, Bekir Uğur Ergür, Pınar Akan, Semra Koçtürk
DOI:10.4103/NSN.NSN_15_20  
Objective: Human SH-SY5Y cell line has been frequently used for in vitro experiments in neuroscience-related research. To reflect a better neuronal characteristic the cell line needs to a differentiation. To compare the results obtained from in vitro models, the similarity of the phenotype and characteristic of the cells has great importance. However, many studies have been performed using the different medium ingredients which affect the differentiation progress of the cells. Therefore, we aimed to compare generally used differentiation mediums, contain only retinoic acid (RA) and supplemented with different ingredients, in the aspect of neuron-like phenotype characteristics and stability. Materials and Methods: The effects of medium ingredients on differentiation levels were evaluated using morphological changing, neurite length, and immunofluorescence detection of neuronal markers such as NFH, β-III Tubulin, and microtubule-associated protein 2 (MAP2). The stability of differentiated cells was followed microscopically at the 7th, 10th, and 14th days by morphological changings and neurite length using Neuron J software. Results: The results revealed that the cells pretreated with RA for 5-day treatment and followed by 5-day treatment with the mix medium and brain-derived neurotrophic factor (BDNF), provided significantly higher neurite length than the other groups (P < 0.001). In this group, the expressions of β-tubulin III, MAP2, and NF-H were also significantly higher than the control group (P < 0.05, P < 0.001, and P < 0.05, respectively) and differentiated cells were stable until the 7th day. Conclusion: The results demonstrated that enriched mediums are necessary for a better differentiation of SH-SY5Y cells. We recommend 10-day treatment period and using of RA, BDNF, dc-AMP, KCI together in SH-SY5Y cell differentiation.
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Validity of international classification of functioning, disability, and health core set in patients with Parkinson's disease and the correlation with other Parkinson scales p. 89
İbrahim Acir, Hacı Ali Erdoğan, Vildan Yayla
DOI:10.4103/NSN.NSN_16_20  
Objectives: Idiopathic Parkinson's Disease (IPD) is a movement disorder that cause tremor, rigidity, bradykinesia, postural instability and deterioration quality of life. To assess the disease different scales can be used: The Unified Parkinson's Disease Rating Scale (UPDRS) for clinical severity, Parkinson's Disease Questionnaire (PDQ39) to assess quality of life, Beck Depression Scale (BD) for mood assessment and Hoehn Yahr Scale (HY) for clinical staging. The International Classification of Functioning, Disability and Health (ICF) is a classification to develop an international common language for the evaluation of the functionality and disability of patients. We aimed to compare validity and efficacy of ICF classification with other scales. Materials and Methods: Thirty-one patients with idiopathic Parkinson's disease were evaluated. PDQ39, UPDRS, Hoehn Yahr, Beck Depression Scale and 'Brief ICF core set for hand condition' which was recommended for Parkinson's disease were applied to patients. The brief ICF core set and other scales were compared and assessed if there was any correlation. For analyzes, the MedCalc Statistical Software version 12.7.7 programme was used. Results: The mean age of the IPD patients was 68.3 ± 6.9 years and 71% of them were female (22) and 29% were male (9). According to ICF codes, patients who have eight or more corrupted codes were recorded as 'major code impairment patients', and those with less than eight codes recorded as 'minor code impairment patients'. The total UPDRS score of major code impairment patients was 58.4 ± 29.8, while the mean score of minor code impairment patients was 21.2 ± 14.05. The PDQ39 score of major code impairment patients was 66.4 ± 24.1, while the mean score of minor code impairment patients was 19.3 ± 13.5. According to Hoehn Yahr stage, the ratio of stage 1 were higher in minor ICF patients. Conclusion: While assessing the functioning of the Parkinson's disease patients, we need comprehensive scales that include many parameters. The ICF coding system is an international system, which is very important to develop a common language. The significant correlation between ICF coding system and other scales in our Parkinson's patients, shows the validity of the coding system.
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Bilateral nerve conduction studies must be considered in the diagnosis of sciatic nerve injury due to intramuscular injection p. 94
Halit Fidanci, İlker Öztürk, Ahmet Candan Köylüoğlu, Mehmet Yıldız, Zülfikar Arlıer
DOI:10.4103/NSN.NSN_22_20  
Objectives: Although compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the nerves are reduced in sciatic nerve injury due to intramuscular injection (SNIII), they may still be higher than the reference values if there is a mild axonal degeneration. In this case, comparing the outcomes of nerve conduction studies of intact and affected lower extremities becomes important. We aimed to determine the role of this comparison in the diagnosis of SNIII. Methods: Patients with SNIII were included. Reference values for lower extremity nerve conduction studies were obtained from healthy participants. Peroneal, posterior tibial, superficial peroneal, and sural nerve conduction studies were performed in both lower extremities. In the first analysis, the CMAP or SNAP amplitude of the nerve was considered abnormal if it was less than the reference value. In the second analysis, the CMAP or SNAP amplitude of the nerve was considered abnormal if it was less than the reference value or <50% of the CMAP or SNAP amplitude obtained from the intact limb nerve. Results: Thirty patients and 31 controls were included in the study. Compared with those found in the first analysis, the number of posterior tibial nerve CMAPs with reduced amplitudes, and the sural and superficial peroneal nerve SNAPs with reduced amplitudes were higher in the second analysis (P = 0.008, P < 0.001, and P = 0.031; respectively). Conclusion: This study showed that nerve conduction studies should be performed in both the intact and affected extremities in SNIII.
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