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Öğe A case of brucellosis with multiple neurological complications(2012) Altunrende, Burcu; Altunrende, Sevil; Yıldız, Serpil; Yıldız, NebilBrucellosis may be associated with a wide spectrum of severe neurological complications which can mimic many other neurological diseases. We aim to present a case of brucellosis with multiple neurological complications (ischemic stroke after transient ischemic attacks and venous thrombosis) due to an inadequate treatment of brucellosis as well as the MRI findings of the patient. She had no vascular risk factors and no systemic signs of brucellosis. In conclusion, neurobrucellosis should always be kept in mind in endemic areas when patients present atypically or with neurological diseases with unknown etiologies.Öğe Dirençli jeneralize status epileptikusun propofol ile tedavisi(2008) Karaaslan, Kazım; Gümüş, Esra; Gülcü, Nebahat; Altunrende, BurcuStatus epileptikus, jeneralize, konvülzif nöbetlerin sürekli olarak 5 dakika veya daha uzun sürmesi ya da bilinçte düzelme olmaksızın 2 veya daha fazla sayıda nöbet geçirilmesi şeklinde tanımlanmaktadır. Morbidite ve mortalitesi yüksek acil tıbbi durumlardan biridir. Dirençli status epileptikus ise konvansiyonel antiepileptik ilaç tedavisine rağmen, iki saatten fazla süren nöbetlerin olması veya saatte iki veya daha fazla nöbetin olduğu ve nöbet aralarında bilincin bazal değerlere dönmediği tablo olarak tanımlanmaktadır. Bu makalede propofol infüzyonu ile kontrol altına alınabilen dirençli bir status epileptikus olgusu sunulmuş ve literatür eşliğinde tartışılmıştır.Öğe Dirençli jeneralize status epileptikusun propofol ile tedavisi (olgu sunumu)(2008) Karaaslan, Kazım; Gümüş, Esra; Gülcü, Nebahat; Altunrende, BurcuStatus epileptikus, jeneralize, konvülzif nöbetlerin sürekli olarak 5 dakika veya daha uzun sürmesi ya da bilinçte düzelme olmaksızın 2 veya daha fazla sayıda nöbet geçirilmesi şeklinde tanımlanmaktadır. Morbidite ve mortalitesi yüksek acil tıbbi durumlardan biridir. Dirençli status epileptikus ise konvansiyonel antiepileptik ilaç tedavisine rağmen, iki saatten fazla süren nöbetlerin olması veya saatte iki veya daha fazla nöbetin olduğu ve nöbet aralarında bilincin bazal değerlere dönmediği tablo olarak tanımlanmaktadır. Bu makalede propofol infüzyonu ile kontrol altına alınabilen dirençli bir status epileptikus olgusu sunulmuş ve literatür eşliğinde tartışılmıştır.Öğe The evaluatione of small nerve fiber dysfunction with quantitative sensory testing in patients with type II diabetes mellitus without large fiber neuropathy, and normal values for thermal thresholds(2010) Yıldız, Nebil; Doğan, Nazife; Yıldız, Serpil; Altunrende, Burcu; Dikbaş, OğuzObjective: Quantitative sensory testing (QST) thermal threshold evaluation is used in order to determine small fiber neuropathy, and the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale is used in diagnosing neuropathic pain. The aim of this study is to find out the normal QST thermal threshold values, and to compare the QST values of normal controls and patients with type II diabetes mellitus, who do not have large fiber neuropathy. With this comparison, the study also aims to determine whether QST abnormalities are present in patients without neuropathic pain. Methods: A total of one hundred normal subjects between the ages of 20 and 69, and 50 patients with type II diabetes mellitus aged 40 to 69 years with no sign of large fiber neuropathy were recruited. The normal subjects were divided into 5 subgroups according to their ages. The mean values of the QST thermal detection and thermal pain thresholds were determined. Sixty normal subjects between the ages of 40-69 were defined as a control group for comparison with the diabetic group. The patients were divided into subgroups according to their LANSS points and their data were compared with the data of age-matched controls. Results: The mean ages of total normal subjects and the control group were 44.8 ±14.4 and 57.4 ± 8.4, respectively. In diabetic group, according to LANSS, 10 patients (mean age, 55.1 ± 8.5 years) scored above 12 (14.6 ± 3.5), and 40 patients (mean age, 55.5 ± 8.4 years) scored under 12 points (6.8 ± 3.4). In the LANSS>12 group, the least abnormality rate was 100 %, and the most frequently detected abnormality was in the foot cold pain threshold (70%). In the LANSS<12 group, the least abnormality rate was 67.5%, and the most frequently detected abnormality was in the hand cold pain threshold (45%). Conclusion: It was demonstrated that QST was successful in determining thermal detection abnormalities in all patients with probable neuropathic pain according to LANSS Pain Scale. QST is a test, which gives reliable and reproducible results in the diagnosis of small fiber sensory neuropathy. Because of its subjectivity and inefficacy in differentiation of peripheral and central causes, QST findings should be evaluated together with findings of neurological examination and nerve conduction studies.Öğe Multiple sclerosis and hashimoto’s thyroiditis: A case report(2011) Altunrende, Burcu; Yıldız, Serpil; Yıldız, Nebil; Gürel, KamilIt has been suggested that multiple sclerosis (MS) is an immune-mediated disease directed against central nervous system (CNS) myelin, although the exact pathogenesis is still unclear. There are a lot of reports regarding the coincidence of MS with other immune-mediated diseases. In recent years, there have been only few case reports of MS associated with Hashimoto’s thyroiditis. This coincidence is especially important from both clinical and therapeutic standpoints. In this case report, we present a patient with MS and Hashimoto’s thyroiditis and summarize the clinical features. (Archives of Neuropsychiatry 2011; 48: 224-6)Öğe A neurosyphilis case presenting with cognitive dysfunction, epileptic seizures, high signal intensity and significant atrophy in left amygdala/hippocampal region(Turkish Neurological Society, 2014) Arısoy, Özden; Altunrende, Burcu; Boztaş, Mehmet Hamid; Gürel, Safiye; Sırmatel, Fatma; Sercan, MustafaSyphilis is a sexually transmitted, chronic, multisystemic disease. Central nervous system involvement occurs in secondary and tertiary stages. Neurosyphilis presents itself as meningitis or meningovasculitis in secondary stage, and general paresis or tabes dorsalis in tertiary stage. In the antibiotic era, however, instead of classical neurosyphilis atypical forms with intertwined clinical symptoms started to occur more frequently, making the diagnosis more difficult. In this article, we present a neurosyphilis case who applied to the clinic with generalized tonic clonic convulsions resulting in multiple traffic accidents. The characteristic of this case is the ongoing memory problems due to attentional dysfunction as shown in neuropsychological tests despite the penicillin treatment and the presence of a high signal intensity and significant atrophy in his left amygdala/hippocampal area seen in cranial magnetic resonance imaging.Öğe Parkinsonism in elderly rheumatoid arthritis patients(2014) Bes, Cemal; Altunrende, Burcu; Yılmaz Türkoğlu, Şule; Yıldız, Nebil; Soy, MehmetObjective. The incidences of extrapyramidal symptoms and Parkinson's disease were reported to be increased in patients with rheumatoid arthritis (RA). In this study we aimed to explore the frequency of the symptoms of Parkinsonism among RA patients older than 60 years. Patients and Methods. 30 (6 males, 24 females) consecutive RA patients, followed at a rheumatology outpatient clinic, who were 60 years of age or older; 23 patients who were diagnosed as PD and 50 sex and age matched healthy controls were included to the study. All participants were examined for the motor and non-motor findings of Parkinsonism including bradykinesia, rigidity, tremor, postural abnormality, upper limb sway abnormality, gait impairment, decrease in facial expression, seborrhea, slowing of speech and impairment in the self care. Results. When the RA, PD cases and healthy control group were compared for bradykinesia, rigidity, tremor, posture, upper limb sway, gait impairment, facial expression, seborrhea, speech and self care; highly significant differences were seen for all parameters. Two out of the 30 RA cases (6,7%) were diagnosed as Parkinson's disease. Conclusion. The signs of Parkinsonism and Parkinson's disease were found more frequent in elderly RA cases as compared to healthy controls.Öğe Presynaptic inhibition and disynaptic reciprocal 1a inhibition in Parkinson's disease, the effect of the dopaminergic treatment(2010) Yıldız, Nebil; Türkoğlu, Şule Aydın; Yıldız, Serpil Kuyucu; Altunrende, BurcuAmaç: Son zamanlarda Parkinson Hastalığında spinal kord patolojisi ile ilgili çalışmalara daha fazla rastlanmaktadır. H refleks incelemesi spinal kordaki nörofizyolojik ve internörinal değişiklikleri inceleyen çalışmalarda önemli bir seçenektir. Dopaminerjik tedavinin spinal internöronal refleks yollarındaki etkisi daha az araştırılmış bir konudur. Bu çalışma Parkinson Hastalığında presinaptik ve disinaptik inhibisyon düzeylerini, dopaminerjik tedavinin etkisini incelemek üzere planlanmıştır. Metod: Presinaptik inhibisyon ve disinaptik resiprokal 1a inhibisyonu Parkinson hastalarında ve normal kontrollerde 1-100 ms intervallerle peroneal sinirin ve tibial sinirin ikili uyarımı ile araştırıldı. Test ve şartlanmış H refleks yanıt amplitüd değişiklikleri hesaplandı. Dopaminerjik tedavi öncesi ve sonrası etkilenen ve daha az etkilenen taraflarda karşılaştırıldı. Bulgular: Disinaptik ve presinaptik inhibisyon tüm deneklerde mevcuttu. Disinaptik resiprokal 1 a inhibisyonu etkilenen tarafta daha kısa süreliydi ve sadece 2 ms'lik intervalde vardı. 20 ms'lik interval için şartlanmış ve test H refleks oranı (presinaptik inhibisyon) etkilenen tarafta kontrollere göre anlamlı düşük bulundu (p: 0.046). 20-10-5-3-2 ms'lik intervallerdeki inhibisyon oranları tedavi sonrası etkilenen tarafta tedavi öncesine göre anlamlı artmıştı (p: 0.031, 0.027,0.014, 0.026, 0.037). Sonuç: Parkinson hastalığında tutulan tarafta presinaptik inhibisyon azalmış, disinaptik inhibisyon süresi kısalmış bulunmuştur. Dopaminerjik tedavi, her iki inhibisyon periyodunda anlamlı artışa neden olmuştur. Bu bulgular Parkinson hastalığında supraspinal etkilerde anormallik varlığını ve ayrıca bazı dopaya cevaplı nöral mekanizmaların rolünü düşündürmüştür.Öğe The relationship of cognitive impairment with neurological and psychiatric variables in multiple sclerosis patients(Taylor & Francis Ltd, 2014) Karadayı, Hüsna; Arısoy, Özden; Altunrende, Burcu; Boztaş, Mehmet Hamid; Sercan, MustafaObjective. Cognitive impairment (CI) in multiple sclerosis (MS) can develop any time. CI is associated with the degree of neuronal loss, but disease duration, fatigue, comorbid affective disorder, and drug dose may also affect cognition. Our aim was to assess which cognitive domain was disturbed primarily in mild MS patients and to see whether CI was related with clinical and psychiatric features. Method. Neurological and psychiatric evaluation of 31 MS patients and 31 age, sex, and education-matched healthy controls were made with Structured Clinical Interview for Axis I Disorders (SCID-I). Depression, anxiety, functionality, fatigue, and disability scoring were determined with Hamilton Depression-Anxiety scales, Global Assessment of Functionality, Fatigue Severity and Expanded Disability Status Scales. Cognitive functions were assessed using Mini Mental, Serial Digit Learning, Verbal and Nonverbal Cancellation, Stroop and Rey Auditory Verbal Learning tests. Results. Retrieval from long-term memory and psychomotor speed were significantly worse in MS group. CI was correlated with disease duration, number of attacks, and physical disability but not with depression and anxiety severity. Disease duration predicted disturbances in recall and psychomotor speed, whereas fatigue and disability predicted depression. Conclusion. Psychomotor speed and memory were primarily impaired in MS patients, and CI was closely associated with clinical aspects of MS rather than with depression and anxiety.Öğe Repetitive transcranial magnetic stimulation in restless legs syndrome : preliminary results(Springer-Verlag Italia Srl, 2014) Altunrende, Burcu; Yıldız, Serpil; Çevik, Ayşe; Yıldız, NebilOur aim was to compare the effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) over supplementary motor area with that of sham stimulation in restless legs syndrome (RLS). In this prospective study, patients were randomly assigned to either real stimulation group (11 patients), or sham stimulation group (8 patients) in a double-blinded fashion. Five patients, who were initially in the sham stimulation group, received real stimulation 1 month after the sham stimulation. One session of intervention was performed once every 3 days and total of ten sessions were done in each group. The International RLS-Rating Scale (IRLS-RS) was assessed at baseline and after 5th and 10th sessions in both groups and also in five patients in whom both sham and real stimulation were performed. A statistically significant difference was seen in the IRLS scores between real (n = 11) and sham stimulation (n = 8) after 5th and 10th sessions. The real stimulation significantly improved the IRLS-RS scores although they were unaffected by the sham stimulation. In five patients, in whom both sham and real stimulation were performed, a statistically significant improvement was seen in the IRLS-RS scores with the real stimulation and a statistically significant difference was seen in the IRLS scores between real and sham stimulation after 10th session. In conclusion, this method is safe and non-invasive, and the results of this pilot study may support that rTMS has the potential to be used in the treatment of RLS, which should be verified in larger series.Öğe Salivary alpha amylase activity in migraine patients(Elsevier, 2010) Buğdaycı, Güler; Yıldız, Serpil; Altunrende, Burcu; Yıldız, Nebil; Alkoy, SevalObjective: Salivary alpha amylase levels were measured to investigate sympathetic nervous system activity in migraine patients during attack, post-attack and interval periods of headache since salivary alpha amylase levels have been suggested as a potential indirect marker of sympatho-adrenal medullary activity in recent studies. Methods: 50 patients with migraine headache (13 patients in attack, 26 patients in post-attack and 11 patients in interval period) and 60 healthy volunteers were taken into the study. In all participants, the presence of anxiety was measured by using Hamilton Anxiety Rating scale. The visual analog scale scores for pain level estimation were obtained in the attack group. Results: The salivary alpha amylase levels were significantly lower in attack period (p < 0.01) and higher in post-attack period (p < 0.01) when compared with the control group. There was not any significant difference in salivary alpha amylase levels between interval period and control group (p > 0.05). There was a weak negative correlation between the salivary alpha amylase levels and the visual analog scale scores. Conclusions: This is the first study showing the dynamic nature of sympathetic nervous system activity by evaluating the salivary alpha amylase levels a noninvasive, reliable and an easy method in different periods of migraine headache. (C) 2010 Elsevier B.V. All rights reserved.Öğe Sympathetic skin responses from frontal region in migraine headache: a pilot study(Sage Publications Ltd, 2008) Yıldız, Serpil; Yıldız, Nebil; Korkmaz, B.; Altunrende, Burcu; Gezici, Ali Rıza; Alkoy, SevalFrontal sympathetic skin responses (F-SSRs) were recorded to investigate sympathetic nervous system activity in migraine headache (MH). Thirty-five patients with unilateral MH and 10 healthy volunteers were studied by evoking bilateral F-SSRs with electrical stimulation of the median nerve in attack, post-attack and interictal periods. The mean latencies were longer and the maximum amplitudes were smaller on the symptomatic side compared with the asymptomatic side (P < 0.05 for both amplitude and latency) in attack and in interictal periods. In five patients, F-SSRs were absent bilaterally, in four patients the responses were absent only on the symptomatic side during the attack period. In the post-attack period, F-SSRs on the symptomatic side had higher amplitudes and shorter latencies compared with the asymptomatic side (P < 0.01 for both amplitude and latency). There is an asymmetric sympathetic hypofunction on the symptomatic side in attack and interictal periods, whereas there is a hyperfunction in the post-attack period.Öğe Sympathetic skin responses from the scalp evoked by electrical stimulation in seborrheic dermatitis(Wiley, 2013) Altunrende, Burcu; Yıldız, Serpil; Kandi, Başak; Yıldız, NebilAlthough the role of autonomic nervous system in seborrheic dermatitis (SD) is still unclear, seborrhea is sometimes accepted as a sign of autonomic dysfunction in several nervous system diseases. Therefore, we aimed to investigate the sympathetic nervous system (SNS) activity in SD by recording sympathetic skin responses (SSR) from the scalp (S-SSR). Thirty-one control subjects and 22 SD patients were studied by evoking right and left S-SSR with electrical stimulation of the right median nerve at the wrist. Mean latencies and maximum amplitudes were calculated for both sides in each group. In seven out of 31 control subjects and in 13 out of 22 patients, the S-SSR could not be elicited on either side. There were four subjects with unilateral response in the patient group. There were significantly more non-responders among the patients with SD (P<0.000). This study suggests that in SD, the autonomic nervous system may be involved. The S-SSR is a new site for recording SSR. The responses are relatively symmetrical and can be evoked easily by electrical stimulation, and may be used to evaluate the SNS function in SD patients and also in healthy subjects.Öğe Transcutaneous electrical posterior tibial nerve stimulation for chronic anal fissure: a preliminary study(Springer, 2013) Altunrende, Burcu; Şengül, Neriman; Arısoy, Özden; Yılmaz, Edip ErdalPurpose Recent studies showed that sacral nerve stimulation might be an effective treatment option for chronic anal fissure. We aimed to evaluate the efficacy of transcutaneous electrical nerve stimulation as a noninvasive alternative treatment for chronic anal fissure by stimulating the sacral nerve in the ankle via the posterior tibial nerve. In this prospective study, transcutaneous electrical nerve stimulation was applied for 10 days in addition to conventional medical treatment in ten patients. Wexner's constipation score, visual analog scale for pain, quality of life (Short Form-36), Hamilton anxiety and depression scores, symptom relief, compliance, fissure healing, and side effects were evaluated before and after treatment (days 0, 5, and 10). Ten patients (eight females/two males) with a mean age of 50.7 +/- 18.5 years were enrolled in the study. Pain and bleeding resolved in all patients 2 days after the treatment, and mucosal healing was observed in six patients 10 days after the treatment. Wexner's constipation and visual analog scale scores for pain decreased significantly (p = 0.001 and p = 0.002, respectively). Hamilton anxiety and depression scores decreased as well (p = 0.001 and p = 0.01, respectively). Among Short Form-36 subscales, only mental health score increased significantly (p = 0.003). One patient underwent surgery at follow-up due to recurrence of symptoms, and rubber band ligation was applied to another patient who had internal hemorrhoidal rectal bleeding at the end of 10 days. Transcutaneous electrical nerve stimulation application to the posterior tibial nerve has the potential to be an alternative treatment option for chronic anal fissure patients who seek noninvasive treatment modality.
