Objectives: This study aimed to evaluate the efficacy of swallowing disorder rehabilitation in patients with schizophrenia experiencing dysphagia and hypersalivation. Patients and methods: A quasi-experimental pretest-posttest design was used. Forty-seven patients with schizophrenia with dysphagia were screened between April 2018 and January 2020. After exclusions due to noncompliance, seven patients (4 males, 3 females; mean age: 44.28 +/- 21.81 years; range, 19 to 79 years) completed the study. Swallowing was assessed with the Eating Assessment Tool (EAT-10), salivary issues with the Saliva Control Severity and Frequency Scale, and mouth opening with trismus measurement before and after a 12-session rehabilitation program (3 sessions a week). The program included chewing training, oral motor exercises, laryngeal mobilization, thermal tactile stimulation, and neuromuscular electrical stimulation. Results: After treatment, EAT-10, saliva severity, saliva frequency, and trismus scores significantly improved compared to baseline (p < 0.05). Disease history, education, and physical activity did not affect outcomes (p > 0.05). Conclusion: Swallowing disorder rehabilitation effectively improves swallowing and saliva control in dysphagic patients with schizophrenia.
This historical review addresses the development of debates on the cellular unit of the nervous system and functional localization in the brain from the 19th century to the present. The first section summarizes the disagreements between the reticular theory and the neuron doctrine, based on the contributions of Remak, Gerlach, Deiters, Golgi, His, Forel, Nansen, Cajal, Waldeyer, and Sherrington. The second section evaluates discussions on phrenology, holistic cortical approaches, and cortical localization through the work of Gall, Flourens, Broca, Wernicke, Jackson, Hitzig, Fritsch, Ferrier, and Goltz. The final section emphasizes the transition of modern neuroscience from a strictly centralized localization concept to distributed, connectional network models. Historical evidence suggests that brain functions cannot be reduced to single centers nor fully explained within a homogeneous cortical area. The current approach accepts that specific functions emerge through anatomically distinguishable but strongly interconnected networks.
Individuals with aphasia experience limitations in participating in life and daily activities. Contemporary traditional therapy approaches primarily focus on the individual’s neurological, linguistic, and cognitive impairments. The main goals of activity and participation-based approaches are to eliminate the communication barriers caused by aphasia, include individuals with aphasia and their communication partners in the intervention process, and create the necessary environmental conditions. In this review, we provide speech and language therapists with an informative review of the effectiveness of activity and participation-based intervention approaches at national and international levels by conducting a literature review and presenting compensatory strategies that would improve the quality of life of individuals with aphasia and their communication partners. In this context, national and international publications related to activity-participation-based approaches in aphasia were reviewed, information about these approaches was given, and the findings of effectiveness studies were compiled. The results of the review indicate that activity and participation-based approaches are effective in revealing the existing language competencies of individuals with aphasia, enabling them to be more active participants in communication and to develop methods, reducing the stress, depression symptoms, and caregiving burdens of their communication partners, facilitating more effective communication with the individual with aphasia, and enhancing the quality of life for both the individual with aphasia and their communication partner.
Objectives: This study aimed to evaluate the effects of one-year levetiracetam monotherapy on vestibular system function in patients with newly diagnosed generalized epilepsy using objective neurophysiological tests. Patients and methods: In this prospective study, 12 patients (7 males, 5 females; mean age: 26.91 +/- 11.36 years; range, 18 to 65 years) with generalized epilepsy who initiated levetiracetam treatment and 19 healthy controls (1 males, 18 females; mean age: 39.14 +/- 11.88 years; range, 20 to 65 years) were included between March 2021 and March 2022. Cervical and ocular vestibular evoked myogenic potential (VEMP) tests were performed at baseline and after one year of treatment. Latencies, amplitudes, interpeak intervals, and asymmetry ratios were recorded. Intra-and intergroup comparisons were analyzed. Results: After one year of levetiracetam treatment, significant reductions were observed in right cervical VEMP P13 and N23 peak amplitudes (p = 0.01; p = 0.001) and in right cervical VEMP interpeak latency (p = 0.03). In ocular VEMP measurements, right P1 latency and right N1-P1 amplitude showed significant decreases following treatment (p = 0.02). No significant pretreatment amplitude differences were observed between patients and controls. Conclusion: One-year levetiracetam monotherapy was associated with measurable changes in selected VEMP parameters, suggesting mild effects on vestibular reflex pathways. Although these alterations were objectively detectable, their clinical impact appeared limited. Larger prospective studies are needed to clarify the long-term vestibular effects of levetiracetam.
Objectives: This multicenter study aimed to identify the clinical, laboratory, and demographic determinants associated with stroke recurrence in a large nationwide cohort of patients presenting with acute stroke. Patients and methods: This retrospective multicenter cohort study included 1,132 patients (614 males, 518 females; mean age: 70.0 +/- 12.6 years) who hospitalized with acute stroke across tertiary centers in Turkiye between February 2016 and December 2024. Sociodemographic characteristics, vascular risk factors, clinical presentation, laboratory parameters, neuroimaging findings, and clinical outcomes were obtained from hospital records. Stroke recurrence was defined as the primary endpoint. Bivariate analyses were initially performed to evaluate associations between potential predictors and recurrence, followed by multivariate logistic regression analysis to determine independent determinants. Results: Stroke recurrence occurred in 24.3% of the cohort. In bivariate analyses, recurrence was significantly associated with hypertension (odds ratio [OR] = 1.677, p = 0.002), hyperlipidemia (OR = 1.575, p = 0.01), diabetes mellitus (OR = 1.390, p = 0.025), atrial fibrillation (OR = 2.531, p < 0.001), and carotid artery stenosis (OR = 3.085, p < 0.001). However, in multivariate logistic regression analysis, only advanced age (OR = 1.030, p < 0.001) and carotid artery stenosis (OR = 3.085, p < 0.001) remained independent predictors of stroke recurrence. Conclusion: Advanced age and carotid artery stenosis emerged as the strongest independent determinants of stroke recurrence in this nationwide multicenter cohort. These findings highlight the importance of early vascular evaluation and individualized risk stratification to improve secondary stroke prevention strategies.
Objectives: This study aimed to assess the mental health status of neurology residents in T & uuml;rkiye and identify contributing factors, with the goal of enhancing the quality of neurology training. Patients and methods: A web-based, multiple-choice survey was designed by a study-group of the Turkish Society of Neurology. Neurology residents throughout T & uuml;rkiye were invited to participate via email between October 2023 and May 2024. The questionnaire gathered data on demographics, institutional characteristics, educational activities, and working conditions. Mental health and job satisfaction were evaluated using the Minnesota Job Satisfaction Questionnaire, Maslach Burnout Inventory, Beck Anxiety Inventory, and Beck Depression Inventory. Results: A total of 226 neurology residents (135 females, 91 males; median age: 28 years; range, 25 to 47 years) who completed the online survey were included in the analysis. Participants reported a median of 55 working hours per week, with approximately 10% of this time dedicated to educational activities. Symptoms of depression were present in 64.6% of respondents, while anxiety affected 72.1%. Burnout symptoms were identified in 97.3% of participants, and 46.5% met criteria for burnout. Weekly working hours and time allocated for research and education were positively associated with job satisfaction, yet inversely correlated with burnout, depression, and anxiety. Exploratory factor analysis revealed six principal components influencing burnout and job satisfaction: weekly working hours, time allocated for education, confidence in personal competency, adequacy of clinical equipment, time spent on research, and sociodemographic characteristics (Kaiser-Meyer-Olkin: 0.64; cumulative explained variance: 69.02%). Conclusion: This study demonstrated a high prevalence of burnout, depressive symptoms, and anxiety among neurology residents in T & uuml;rkiye. Targeted interventions such as the reduction of daily clinical workload and the expansion of protected time for academic activities may be warranted to mitigate these adverse psychological outcomes and promote professional well-being.
Objectives: This study aimed to compare social cognition and apathy between patients with amyotrophic lateral sclerosis (ALS) without dementia and healthy controls (HCs). Patients and methods: This cross-sectional study examined 17 patients (9 males, 8 females; median age: 58 years; range, 31 to 70 years) with ALS and 34 HCs (19 males, 15 females; median age: 58.5 years; range, 31 to 69 years) between February 2024 and February 2025. Data from the Beck Depression Inventory, the revised ALS Functional Rating Scale, reading the mind in the eyes test, and theory of mind (ToM) tests were collected. The results were compared with HCs. Results: There were no significant differences between groups in terms of age, education level, or sex ( p > 0.05). Affective ToM scores were comparable between groups ( p > 0.05). Patients with ALS exhibited lower median cognitive ToM scores than HCs (27 [7.5] vs. 30 [5], p = 0.035). The median total Dimensional Apathy Scale scores were higher in the ALS group than in the HC group (18 [11.5] vs. 12 [5.25], p = 0.001). The groups differed in the cognitive and emotional dimensions of apathy but not in the executive dimension. Conclusion: Lower cognitive ToM performance, higher initiation, and emotional apathy scores were observed at increased rates in patients with ALS without dementia.
Objectives: This study aimed to investigate factors associated with six-month survival in patients with a history of cancer diagnosis. Patients and methods: This prospective study included 66 patients (37 males, 29 females; median age: 67 years; range, 60 to 73 years) who were admitted to a tertiary hospital with acute ischemic stroke and a history of cancer between July 2020 and October 2022. Results: At six months, 39 (59.1%) patients had died. Multivariable Cox regression analysis identified three factors significantly associated with six-month mortality. Each 1-point increase in the platelet distribution width (hazard ratio [HR] = 1.280, p = 0.008) and neutrophil-to-lymphocyte ratio (HR = 1.040, p < 0.001) were associated with increased mortality. By contrast, each 1-point increase in body mass index was associated with a 10% lower risk of death (HR = 0.899, p = 0.023). Conclusion: Higher neutrophil-to-lymphocyte ratio and platelet distribution width, and lower body mass index were independently associated with six-month mortality in patients with acute ischemic stroke and a history of cancer. These findings highlight the need for careful prognostic assessment, although they should be interpreted with caution given the study’s limited sample size.
Objectives: This study aims to evaluate the efficacy, safety, and complications of intravenous thrombolytic therapy (IVTT), identify the prognostic factors in treated patients, and assess outcomes in patients aged over 80 years. Patients and methods: Between June 2014 and March 2020, 155 patients with acute ischemic stroke were enrolled in this retrospective observational study and assigned to the IVTT group (44 males, 37 females; median age: 69 years; IQR, 58-79 years) and the non-IVTT group (30 males, 44 females; median age: 74 years; IQR, 65-82 years). The modified Rankin scale score at the third month for all patients and hemorrhagic transformation rates in the IVTT group were recorded. Outcomes were compared between patients aged over and under 80 years within the IVTT group. Results: Good outcomes at the third month were significantly higher in the IVTT group than in the non-IVTT group (37% vs. 17.6%, p = 0.007), with symptomatic intracerebral hemorrhage occurring in 6.2% of patients within the first 36 h after IVTT; baseline National Institutes of Health Stroke Scale (NIHSS) score and age were independent predictors of favorable outcomes. Conclusion: In our study, IVTT reduced the disability at the third month and can be safely performed in carefully selected patients. In older patients or those with high NIHSS scores, alternative therapies may also be considered.
Objectives: This study aimed to assess changes over time in the use of disease-modifying therapies among patients with multiple sclerosis in T & uuml;rkiye. Patients and methods: This retrospective observational study used data obtained from national health information systems between January 2, 2015, and December 31, 2022. Patients diagnosed with multiple sclerosis (ICD-10 [International Classification of Diseases, 10th Revision]: G35) who received disease-modifying therapies on at least three occasions during the study period were included. Therapies were classified as injectable, oral, or monoclonal antibody treatments. Annual utilization frequencies and proportional distributions were analyzed. All data were anonymized, and ethical approval was obtained. Results: Data from 54,795 patients (37,574 females, 17,221 males; mean age: 43.4 +/- 11.8 years; range, 11 to 93 years), comprising 562,899 treatment records, were analyzed. Over the study period, the use of injectable therapies gradually decreased, while the use of oral therapies and monoclonal antibody-based treatments markedly increased. Similar patterns were observed in both sexes. Conclusion: Multiple sclerosis treatment practices in T & uuml;rkiye have changed substantially in recent years. The increasing use of oral agents and monoclonal antibody therapies likely reflects expanding availability, reimbursement policies, and evolving prescribing practices. These findings provide valuable descriptive insights for clinical practice, healthcare planning, and policy development.
Objectives: This study aimed to characterize global and regional information-seeking patterns for common Parkinson's disease (PD)-related sleep disorders (SDs) and to assess whether the COVID-19 (coronavirus disease 2019) pandemic caused a permanent structural change in these patterns using interrupted time series analysis. Materials and methods: In this retrospective, multi-country infodemiological study, Google Trends monthly relative search volume data for 10 PD-related SDs was analyzed across nine countries and globally between 2015 and 2025. Relative search volumes were deseasonalized, and prepandemic (March 1, 2015-February 29, 2020) and postpandemic (March 1, 2020-February 28, 2025) periods were compared using a t-test or Mann-Whitney U test, as appropriate, and 95% confidence intervals were estimated by bootstrap. Data extraction used Python pytrends. Interrupted time series regression modeled level (beta 2) and slope (beta 3) changes, with Newey-West corrections for autocorrelation when required. Results: Globally, insomnia relative search volume increased from 42.5 +/- 5.2 to 68.2 +/- 8.4 (p < 0.001). Rapid eye movement sleep behavior disorder (RBD) searches rose by 52.1% (mean difference: +6.3; 95% confidence interval, 4.8-7.9). Interrupted time series showed immediate level increases for insomnia (beta 2 = +12.4, p < 0.001) and excessive daytime sleepiness (beta 2 = +4.2, p = 0.021), and a significant positive slope acceleration in RBD (beta 3 = +0.08, p = 0.045). T & uuml;rkiye demonstrated an accelerated restless leg syndrome slope (beta 3 = +0.45, p < 0.01). Conclusion: The COVID-19 pandemic produced a lasting digital phenotypic shift in PD-related SDs, with notable global increases in insomnia and RBD interest, and region-specific rises, such as restless leg syndrome in T & uuml;rkiye. Infodemiology offers valuable epidemiological surveillance insights to guide clinical and public health responses.
Objectives: This study aimed to evaluate the effects of sedative drugs and natural sleep on sleep success, duration of falling asleep, and the baseline for electroencephalogram (EEG) recording in children, as well as adverse effects. Patients and methods: This single-blind, randomized controlled clinical study was conducted with 180 children (113 males, 67 females; mean age: 41.66 +/- 25.34 months; range, 1 to 7 years) between January and December 2021. The study comprised two stages: Stage I, preliminary preparation, and Stage II, procedure preparation and EEG recording. Results: The sedative drug groups had a significant difference in the duration of falling asleep (p < 0.001). The duration was the shortest in the chloral hydrate group, and it was the longest in the natural sleep group. Excessive fast act patterns were highest in the chloral hydrate group and significantly lower in the natural sleep group (p = 0.042). While frequency values differed significantly among the groups, the frequency value in the hydroxyzine group was significantly higher than that in the melatonin group (p = 0.001). Conclusion: In conclusion, while our study provided clear evidence that melatonin offered a safer sedation alternative with minimal EEG interference, the challenge of developing universally applicable sedation protocols remains. Future research should focus on multicenter trials, innovative sedative combinations, and integrating technological advances to improve both the safety and diagnostic accuracy of pediatric EEG.
Objectives: The main objective of our study was to investigate the role of the interhemispheric callosal network, specifically focusing on the interhemispheric transfer times of different frequency bands during word reading. Patients and methods: This experimental study involved healthy volunteers. Interhemispheric transfer time was calculated as the latency difference of event-related potentials between the contralateral and ipsilateral hemispheres. Interhemispheric transfer times for alpha, theta, and beta frequency bands were separately calculated in electroencephalogram recordings during word reading. We then analyzed differences in interhemispheric transfer times between fast and slow adult readers, with a particular focus on the directionality of interhemispheric transmission. Results: Our findings revealed a specific slowness in right to left transmission within the alpha band for slow readers. Conclusion: Slower interhemispheric transfer time during word decoding and lexicon access in slow readers may be attributed to a neuronal synchronization problem caused by alpha oscillations in smaller-diameter axonal callosal channels. Considering the existing research on alpha oscillation and attention networks, we propose that this result may indicate a difference in attention processes between the two groups. The study sheds light on the importance of callosal network dynamics, specifically alpha oscillations in reading, offering insights into the underlying neural mechanisms and potential attention-related differences between fast and slow readers.
Objectives: This study aimed to develop a clinical prediction model of early neurologic deterioration in patients with acute mild nondisabling ischemic stroke within 4.5 h of onset. Patients and methods: In this prospective cohort study, patients with mild nondisabling ischemic stroke who were admitted within 4.5 h of onset between January 1, 2023, and December 31, 2024, were divided into the early neurologic deterioration group and the nonearly neurologic deterioration group based on the NIHSS (National Institutes of Health Stroke Scale) score within 72 h. The clinical data and imaging data of the patients during their emergency visits were collected. A clinical prediction model of early neurologic deterioration was established. Discrimination, calibration, and the net benefit of the model were assessed. Results: A total of 489 patients were included, of which 422 were in the nonearly neurologic deterioration group and 67 were in the early neurologic deterioration group. Binary Logistic regression analysis showed that systolic blood pressure (odds ratio [OR] = 1.017, p = 0.012), onset-to-treatment time (OR = 1.473), the neutrophil/lymphocyte ratio (OR = 1.017), random blood glucose level (OR = 1.103), number of lesions (OR = 1.480), and vascular stenosis (OR = 1.879) were independent risk factors for early neurologic deterioration (p < 0.05). The area under the receiver operating characteristic curve of the model was 0.754 (95% confidence interval 0.692-0.816, p < 0.001). The prediction accuracy of the model was 87.3%. Hosmer-Lemeshow test yielded a chi-squared value of 4.313 (p = 0.828). The clinical decision cure of the model was higher than the two extreme lines. Conclusion: Onset-to-treatment time, vascular stenosis, number of new lesions, random blood glucose level, systolic blood pressure, and the neutrophil-to-lymphocyte ratio were independent risk factors for early neurologic deterioration. We developed a simple model for predicting early neurologic deterioration of acute mild nondisabling ischemic stroke within 72 h.
Objectives: This study aimed to investigate the etiology in patients with Horner syndrome (HS) using neuroimaging studies based on demographic and clinical characteristics and to contribute to clinical practice by developing a practical algorithm based on our Patients and methods: This retrospective, two-center study evaluated 54 patients (28 males, 26 females; mean age: 49.3 +/- 14.1 years; range, 21 to 76 years) with HS between January 2013 and February 2022. Demographic and clinical features of the patients, Results: Of the cases included in the study, 18 (33.3%) were idiopathic, three (5.5%) were congenital, 13 (24.1%) were central (first-order neuron), 11 (20.4%) were preganglionic (second-order neuron), and nine (16.7%) were postganglionic (third-order Conclusion: This study showed that neuroimaging methods easily identified etiology in patients with additional neurological findings in HS. The underlying causes could not be defined in a significant part of patients with isolated HS. However, it is essential to carry out detailed neuroimaging studies according to clinical findings to exclude life-threatening causes in patients with HS.
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening cerebrovascular emergency in which thromboembolic complications during endovascular treatment are rare but potentially devastating. This case report describes a 52-year-old male patient with aSAH caused by rupture of an anterior communicating artery aneurysm who developed an intra-procedural middle cerebral artery occlusion during coil embolization. Rescue mechanical thrombectomy achieved complete recanalization (thrombolysis in cerebral infarction Grade 3) followed by successful aneurysm coiling; however, the patient subsequently developed a large infarction, cerebral edema, and fatal brainstem compression. This case highlights that although rescue thrombectomy can provide technical success when thrombolysis is contraindicated, angiographic recanalization does not necessarily translate into favorable clinical outcomes and emphasizes the need for careful peri-procedural management in patients with combined ischemic and hemorrhagic pathology.
Objectives: This study aimed to investigate the association between two single-nucleotide polymorphisms, rs230416 and rs230429, in the GABBR2 (gamma-aminobutyric acid type B receptor subunit 2) gene and susceptibility to migraine with aura in a Turkish cohort. Patients and methods: In this case-control study, a total of 100 patients (15 males, 85 females; mean age: 33.68 +/- 12.16 years; range, 18 to 55 years) with migraine diagnosed according to the International Classification of Headache Disorders criteria and 100 age-and sex-matched healthy controls (25 males, 75 females; mean age: 33.68 +/- 12.16 years; range, 18 to 55 years) were genotyped using the polymerase chain reaction-restriction fragment length polymorphism method between January 2018 and June 2013. Genotype and allele frequencies were compared between groups. The Hardy-Weinberg equilibrium, the chi-square test, and Fisher's exact test were used for statistical analysis (p < 0.05). Power analysis and genetic equilibrium testing were also performed. Results: For rs230416, genotype distributions were 10% GG, 30% AG, and 60% AA in migraineurs, and 5% GG, 25% AG, and 70% AA in controls (p = 0.15). Minor allele (G) frequencies were 25% in cases and 17.5% in controls (p = 0.07). For rs230429, distributions were 10% TT, 38% CT, and 52% CC in patients, and 8% TT, 34% CT, and 58% CC in controls (p = 0.42), with T allele frequencies of 29% and 25%, respectively (p = 0.45). All genotype distributions conformed to the Hardy-Weinberg equilibrium. Conclusion: Although this study did not find a significant association between rs230416 or rs230429 and migraine susceptibility, the findings contribute to the growing literature supporting a minor but biologically relevant role of gamma-aminobutyric acid-mediated pathways in migraine. Future studies with larger, ethnically diverse cohorts and integrative omics approaches are warranted to clarify the functional impact of GABBR2 variants.
