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Yayın Could apomorphine be an effective treatment option for refractory tremor in Parkinson's disease? A pilot study [Apomorfin parkinson hastaligindaki dirençli tremor için etkili bir tedavi seçenegi olabilir mi? Pilot çalişma](2013) Çinar N.; Şahin S.; Karşidag S.Objective: We aimed to evaluate the extent of the clinical efficacy of intermittent subcutaneous apomorphine in addition to oral treatment in patients with Idiopathic Parkinson's Disease experiencing serious, refractory tremor despite the use of optimal oral dopaminergic medication. Treatment response was assessed with the motor section of the Unified Parkinson's Disease rating scale (UPDRS). Tremor, rigidity and bradykinesia were scored by using specific items of the UPDRS. Material and Method: The study group included 13 consecutive patients with Parkinson's disease who have refractory tremor. Increasing doses of 1 mg, 2 mg, 4 mg subcutaneous apomorphine were used; peak improvement dose and UPDRS scores were determined after 30 minutes. The patients have used oral dopaminergic treatment plus subcutaneous apomorhine and they have been followed on weekly phone calls. The completion of the study was defined as the end of the 1st month. Finally, the UPDRS motor scores of the patients were compared to the basal scores. Results: Three patients dropped out due to side effects. The average reduction rate of total UPDRS, tremor, bradykinesia and rigidity scores were found as 20.6%, 38.5%, 30.1% and 16.6% respectively. At the end of the first month, tremor, bradykinesia and rigidity scores were statistically improved in comparison to those of the baseline. Conclusion: Subcutaneous apomorphine combined to oral dopaminergic medications may provide effective relief in serious and refractory rest tremor as well as bradykinesia and rigidity in selected Parkinson patients.Yayın Evaluation of cognitive impairment after posterior cerebral artery infarction [Posteri·or serebral arter i·nfarkti sonrasi geli·şen bi·li·şsel bozulmanin degerlendi·ri·lmesi·](Turkish Society of Cerebrovascular Diseases, 2013) Çinar N.; Şahin Ş.; Önay T.O.; Batum K.; Karsi¸dag S.OBJECTIVE: The assessment of cognitive impairment after posterior cerebral artery (PCA) ischemic infarction has not been well documanted. MATERIAL and METHODS: Twenty-six oriented, cooperated and non-aphasic consecutive patients with right or left (10/16) PCA infarction who were hospitalized between the years 2010-2012 were enrolled to the study. The branches of PSA were dealt as cortical and subcortical infarct under two groups. Short mental state examination test and cognitive test battery (CTB) created from Wechsler memory scale (WMS), word-catogory association test and similarity test parameters were applied to the patients at the first week and third month follow-up visits and the groups were compared with each other. RESULTS: There was a significant improvement in catogory association test and total score of cognitive test battery (CTB) in right PCA group, also there was a significant improvement in catogory association test in left PCA group at the first and 3th month evaluations. At the first month evaluations, total score of CTB of the subcortical segment PCA infarcts are lower than the cortical segment PCA infarcts. At the 3th month evaluations the scores increased in the both groups; but the scores in the subcortical PCA infarcts were lower than the cortical PCA infarcts. CONCLUSION: Our findings suggest that there was a cognitive impairment in patients with PCA infarction. The impairment in verbal fluency which was showed by catogory association test was found more prominent in the second evaluation. Further studies including functional imaging methods and cortical function tests are needed.Yayın Interictal psychiatric disorders in epilepsy [Epİlepsİde İnterİktal psİkİyatrİk bozukluklar](2012) Çinar N.; Şah S.; Batum K.; Karşidag S.Epilepsy can cause many different problems such as psychosocial problems except seizures. According to the temporal distribution, the psychiatric disorders which epilepsy caused can be addressed into the two main groups such as peri-ictal (preictal, ictal, postictal) and interictal. The interictal findings tend to be permanent. This study aimed to reveal interictal psychiatric disorders in detail. Totally 180 patients who are followed by our clinic for at least two years were evaluated retrospectively. Epileptic seizures are classified according to criterias of International League Against Epilepsy 1981 and Semiological Classification-1998 (Hans Lüders-Soheyl Noachtar), psychiatric disorders are classified according to criterias of DSM-IV. The cases were divided into two groups according to the presence of psychiatric disorders. The mean age was 35 ± 19 (9-87) years, female / male ratio was105/75, mean age at onset of epilepsy was 25 ± 20 years. Psychiatric disorder ratio was found 43.3% of cases. They are (in order of frequency); depression, generalized anxiety disorder, psychotic disorder, attention deficit, obsessive-compulsive disorder, panic disorder and affective disorder. Four percent of the patients had a history of attempting suicide. There was no statistical difference between the groups which psychiatric disorders detected and undetected about age, gender, seizure type, antiepileptic drugs and drugs number. Despite, there was no statistical reflection, the ratio of symptomatic epilepsy, frequent seizure and aura was relatively high in psychiatric disorder group. The most common psychiatric disorders are depression and anxiety disorders in the interictal period. This situations may even cause person commit suicide. It must be considered and measures should be taken that, psychiatric disorders can prepare a ground for several problems such as control of epileptic seizures and some psycho-socio-economic complexities.Yayın Is herpes zoster merely a simple neuralgia syndrome? [Herpes zoster sadece basit bir nevralji sendromu mudur?](2011) Çinar N.; Şahin S.; Okluoglu T.; Batum K.; Karşidag S.Aim: Although, herpes zoster usually presents with postherpetic neuralgia (PHN) localized at single dermatome, it may also manifest with different clinical presentations. To clarify of these rare conditions, we aimed to examine the cases of PHN followed by our clinic in more details. Method: Medical records of 26 patients in total monitored by the neurology outpatient clinic for PHN between 2008 and 2010 were reviewed. Result: The mean age of the patients was 61.9±16.4 years, with a female-male ratio of 15/11. Ten of the patients (38%) had a chronic illness history such as solid cancer, lymphoma, diabetes mellitus, cardiac valve prosthesis and Parkinson's disease. Eight of the patients had trigeminal nerve lesions (ophthalmic in 7 and mandibular in 1), 3 had spinal cervical lesions, 8 had spinal thoracic lesions and 7 had spinal lumbar dermatomic lesions. Three (11.5%) patients had motor involvement (C7 in one and L4-L5 innervated muscles in two). Four patients (15.3%; symmetric sides of the same dermatome in two and at different dermatomes in another two) had multiple dermatomal involvements. Conclusion: Immunosuppression and advanced ages are known to facilitate varicella reactivation. By reviewing patients with zona zoster monitored by our clinic for accompanying conditions, anatomical localizations and presence of multiple dermatomal involvements, the present study emphasizes that zona may also cause 'motor involvement' besides sensory involvement. Our findings demonstrate that zona is a complex syndrome which may manifest as varying clinical presentations.Yayın Neuroprotective effect of ziprasidone: Preliminary results compared to haloperidol(Ondokuz Mayis Universitesi, 2014) Çinar N.; Karao?lan A.; Midi A.; Çal M.A.; Kelten B.; Çakmak M.A.; Şahin S.Typical and atypical antipsychotic drugs are widely used to treat psychosis. The present study investigated whether ziprasidone, an atypical antipsychotic drug, has a neuroprotective effect on hippocampal neurons in rats with experimentallyinduced transient cerebral ischemia comparatively with haloperidol which is a typical antipsychotic. Transient cerebral ischemia was induced by 10-minute occlusion of bilateral carotis communis arteries. The rats were divided into four groups: Shamoperated control group (Group I), ischemia control group (Group II), haloperidol-treated group (Group III) and ziprasidone-treated group (Group IV). Following 10-minute ischemia, Group III received 1mg/kg haloperidol intramuscularly and Group IV received 2.5 mg/kg ziprasidone intraperitoneally. The animals were sacrificed on the seventh day following induced ischemia to determine the number of intact neurons at hippocampus and dentate gyrus to demonstrate the effects of ischemia and efficacy of the treatments administered. Surviving cell numbers were found in the sham operated group; 198, in the ischemia control group; 80, in the haloperidol-treated group; 185, in ziprasidonetreated group; 189. The groups showed significant difference in the comparison of the surviving cell numbers. However, the number of surviving cells did not significantly different between the ziprasidone and haloperidol-treated group. Previous studies with the ischemia model have demonstrated protective effects of haloperidol on hippocampal region. The findings of the present study show that ziprasidone, which is an atypical antipsychotic drug, may produce neuroprotective effects as potent as haloperidol, which is a typical antipsychotic drug. © 2014 OMU.Yayın Temporal change of cognitive decline in Alzheimer's disease: The results of turquoise Alzheimer's working group [Alzheimer hastali{dotless}gi{dotless}ndaki bilişsel kayi{dotless}plari{dotless}n zamansal degişimi: Turkuaz Alzheimer çali{dotless}şma grubu sonuçlari{dotless}](Turkish Neurological Society, 2014) Çinar N.; Şahin S.; Çakmak M.A.; Karşidag S.; Grubu T.Objective: The aim of the present study was to evaluate the temporal characteristics of the cognitive decline in Alzheimer's Disease (AD). For this reason, the factorial analysis of Mini-Mental State Examination (MMSE) was used in first visit and six months after. Material and Method: In this multicenter, longitudinal study, the data of 268 (152 mild, 116 moderate) cases obtained from the 'Turquoise Alzheimer Working Group' in Turkey, was evaluated. The patients who were diagnosed with probable AD according to the DSM-IV criteria were included in the study. Disability was assessed by means of global deterioration scale. The MMSE, which has 7 components (time orientation, spatial orientation, immediate memory, attention/concentration, delayed recall, language, and constructional praxis) was applied to all patients at the initial visit (baseline) and 6 months after. Results: The baseline evaluation revealed a significant correlation between orientation and attention subscales in the mild AD group. At the second evaluation of mild AD group and at both evaluations of moderate AD group, there were stronger correlations among all subscales. Subscales of time orientation, attention/concentration and immediate memory had higher factor loading in the first evaluation in mild AD group. Subscales of delayed recall and language were more significant in second evaluation. Subscale of spatial orientation was added in moderate AD group in both evaluation periods. Conclusion: Factor analysis of MMSE subscales varied according to the stage and duration of the disease. Generally, disturbances in attention and orientation might be the first findings in AD groups. When assessing AD cases, the properties of subscales in MMSE should be considered.
