Type 4 (“mirror-pattern”) oligoclonal bands (OCBs) are commonly viewed as systemic immune activation indicators, but their clinical significance in demyelinating disorders remains uncertain. This study assessed features of patients with type 4 OCB positivity and determined variables associated with multiple sclerosis (MS). This multicenter retrospective study included 92 patients with type 4 OCB positivity detected during cerebrospinal fluid evaluation for suspected demyelinating disease. Patients were grouped as: MS, non-MS inflammatory disorders, and diagnostic evaluation ongoing (DEO). Demographic characteristics, relapse features, treatment response, Expanded Disability Status Scale (EDSS) scores, and magnetic resonance imaging (MRI) findings were analyzed. Logistic regression identified factors associated with MS diagnosis. MS patients were younger and had higher relapse frequency than non-MS and DEO groups. Relapses with pyramidal and multisystem involvement were frequent in MS, while opticospinal attacks were more common in non-MS disorders. Periventricular and cortical/juxtacortical MRI lesions were associated with MS, whereas systemic autoimmune diseases occurred only in non-MS and DEO groups. Younger age and polysymptomatic presentation were independently associated with MS, whereas a higher relapse frequency and typical MS-related lesion distribution were associated with MS in the univariable analysis only. Type 4 OCB positivity should not be viewed solely as a systemic immune activation marker. In patients with inflammatory demyelinating disease, the mirror pattern does not exclude MS and should be interpreted with clinical presentation and MRI findings. Its diagnostic relevance depends on patient age, relapse profile, and lesion distribution rather than OCB pattern alone. Type 4 OCB status may inform clinical reasoning but should not independently direct diagnostic decisions.

PURPOSE:This study explores the relationship between social cognition, psychological well-being, and self-compassion in patients with epilepsy, aiming to generate hypotheses for future research on the role of social cognition in epilepsy. METHODS:Including 38 patients with epilepsy and 21 healthy controls, the research assessed psychological well-being using the Flourishing Scale, self-compassion with the Self-Compassion Scale, and social cognition through the Reading the Mind in the Eyes Test (RMET), Facial Emotion Recognition Test (FERT), and Faux-Pas Test. RESULTS:Compared to healthy controls, patients with epilepsy (PWE) performed significantly lower on all social cognition tasks, including FERT (53.09 ± 5.94 vs. 50.07 ± 4.50, p = 0.032), RMET (23.19 ± 3.98 vs. 20.05 ± 4.82, p = 0.014), and the Faux-Pas Test (19.57 ± 4.27 vs. 15.18 ± 6.90, p = 0.11), with effect sizes ranging from d = 0.60 to d = 0.72, indicating small-to-moderate group differences. PWE with generalized seizures performed lower on the Over-Identification and Isolation subdimensions of the Self-Compassion Scale than those with focal seizures, whereas no significant differences in social cognitive performance were observed across seizure types. Patients experiencing fewer than one seizure per month performed higher on the Faux-Pas Test. Correlation analyses revealed that education positively correlated with FERT, and lower perceived Isolation emerged as a strong predictor of better FERT and Faux-Pas performance, independent of demographic or clinical factors. RMET performance was significantly associated with epilepsy diagnosis but was not predicted by psychological variables. CONCLUSION:Lower perceived isolation emerged as a strong and independent predictor of better social cognitive performance, with patients experiencing fewer than one seizure per month also exhibiting higher Faux-Pas Test scores, suggesting that both psychological well-being and seizure frequency are important determinants of social cognition in PWE. Findings may inform the development of psychosocial interventions aimed at reducing isolation and supporting self-compassion in people with epilepsy.

Background: Poor quality of life (QOL) has emerged as a key morbidity in patients with idiopathic intracranial hypertension (IIH). This work aimed to develop and validate an IIH-specific quality of life assessment tool. Methods: This cross-sectional study was conducted on 146 Egyptian and 156 Turkish patients with IIH. A 14-item questionnaire was created to assess QOL in those patients; Quality of Life in IIH patients questionnaire (QOLIH). The questionnaire items were hypothesized into two domains: one domain represents activities of daily living (ADL) (Q1-7 and Q12), and the other domain represents psycho-cognitive function (Q8-11, Q13, Q14). To assess the convergent validity of this questionnaire, the following tests were also employed: the Visual Analog Scale (VAS), Headache Impact Test-6 (HIT-6), Short Form-12 Health Survey (SF-12), and Low Vision Quality-of-Life Questionnaire (LVQOL). Results: Confirmatory factor analysis (CFA) revealed that standardized factor loadings were generally acceptable (>0.60) for Q1-12. However, Q13 and Q14 consistently displayed weak loadings (<0.40), suggesting their removal. Cronbach's Alpha for the total score of the QOLIH questionnaire (Q1-12) in the Egyptian patients was 0.940, and in the Turkish patients, it was 0.938, indicating excellent internal consistency. There were statistically significant correlations of a strong degree between QOLIH total score and HIT-6, SF-12, and LVQOL total scores in Egyptian and Turkish patients (r coef. > 0.7). Conclusion: The final Arabic and Turkish versions of QOLIH questionnaire consist of 12 items. Both versions are valid and reliable tools that can be used in the assessment of QOL in IIH patients.

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.

Background Dual seropositivity for AQP4-IgG and MOG-IgG represents a rare and diagnostically challenging immunological phenotype within CNS inflammatory demyelinating disorders, and its clinical implications and prognostic significance remain poorly defined; therefore, this study was undertaken to address these gaps in knowledge. Methods We conducted a retrospective multicenter case series using a targeted case-ascertainment approach across neuroimmunology centers in Türkiye. The inclusion criteria were as follows: (1) confirmed dual seropositivity for AQP4-IgG and MOG-IgG through validated cell-based assays, specifically indirect immunofluorescence assay or flow cytometry-based live cell assay; (2) a clinical phenotype consistent with central nervous system inflammatory demyelination; and (3) a minimum follow-up duration of six months. Clinical, radiological, cerebrospinal fluid, therapeutic, and outcome data were systematically collected and analyzed. Results Eleven patients (7 female; median age: 40 years) were included. Initial presentations included optic neuritis (n=7) and myelitis (n=4). Longitudinally extensive transverse myelitis was observed in 4 patients (36.4%), while 3 had short-segment lesions. Long-segment optic nerve hyperintensity was seen in 5 of 7 optic neuritis cases. Two patients relapsed and two died due to systemic comorbid conditions. At last follow-up, patients with comorbidities had significantly higher EDSS scores than those without comorbidities (median: 4.0 vs. 1.0; p=0.008). Conclusion Although dual AQP4-IgG and MOG-IgG seropositivity is rare, it is clinically significant. Prognosis is more strongly influenced by systemic comorbidities and overall clinical burden than by serostatus alone. Clinical management should therefore be guided by the overall disease phenotype and coexisting systemic conditions rather than antibody status in isolation.

Background: Both the presence of multiple sclerosis (MS) and the use of immunomodulatory therapy for this disease can change the vaccine response in individuals with MS. In this study, due to the lack of guidelines for vaccination of MS patients in our country, the aim was to create a Delphi consensus on vaccination practices and vaccine types in MS patients. Methods: The Real-time Delphi technique, a more structured and predefined version of the traditional Delphi study was used to ensure a comprehensive research process. The stages of the structured online Delphi application process, which includes repeated rounds, (three rounds) are applied. Fifteen participants are sufficient to achieve homogeneous outcomes according to expertise criteria and in this study, the group comprised 31 experts who met these criteria and participated in all stages. Results: The assessment of the level of consensus among panelists revealed that there was "almost perfect consensus" on 16 items and "significant consensus" on 12 items. When examining the items in which the panelists did not reach a consensus, it was found that there was "minor consensus (slight-1)" on 1 item, and there was "no consensus (indicate poor-0)" on 2 items. Conclusion: We wanted to share a "country" practice and our current recommendations on vaccination strategies, by making use of articles containing country-based recommendations and working-group recommendations, as well as our national experiences.

PURPOSE:The aim of this study is to compare the quality of life, daily physical activity level and perception of illness in patients with chronic daily headache, medication-overuse headache, episodic migraine, and episodic tension-type headache across disease subgroups with respect to possible risk factors such as alcohol/caffeine/nicotine use, eating attitude, which may trigger chronic headache and medication overuse. MATERIALS AND METHODS:VAS, International Physical Activity Questionnaire (Short) forms, SF-36 Quality of Life Scale, Illness Perception Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Eating Disorder Examination Questionnaire, Eating Attitude Test, SCID-I were applied to the patients. RESULTS:Disease type mean score and psychological causes mean score were found to be the highest in the chronic tension type headache (CTTH) group among tension type headache (TTH) subgroups. Among the subgroups of migraine patients, the mean score of risk-related causes was found to be the highest in chronic migraine with medication overuse (MOH-M). The mean score of psychological causes was found to be significantly higher in patients with CTTH with medication overuse (TTH-MOH) compared to patients with MOH-M. Worsening of body pain was significant in CDH-M and MOH-M, whereas worsening in physical role difficulty, emotional well-being, general health perception was significant in CTTH and TTH-MOH. CONCLUSIONS:In the TTH group, BMI was found to be statistically significantly higher compared to the migraine group. Similarly, in the TTH-MOH group, BMI was higher than in the MOH-M group. This finding suggests that the relationship between TTH and obesity warrants further attention. Our study also showed that patients with TTH-MOH experience greater difficulties in daily life and work compared to those in the MOH-M group. Additionally, TTH-MOH patients are more likely to attribute the cause of their current headaches to psychogenic factors, in comparison to MOH-M patients. Findings suggest that psychosocial factors have a greater influence on the chronicity of the disease and the emergence of medication overuse in the TTH group compared to the migraine group.

BACKGROUND:Extended interval dosing (EID) of natalizumab (NTZ) every 6 weeks may reduce adverse events while maintaining efficacy. This study compared the effectiveness and safety of EID versus standard interval dosing (SID) in relapsing-remitting multiple sclerosis (RRMS) patients, focusing on treatment adherence and its impact on clinical and radiological outcomes. METHODS:This retrospective study involved 80 patients with RRMS from seven clinics: 52 received SID (300 mg every 4 weeks), and 28 received EID (300 mg every 6 weeks). Clinical and radiological disease activity, treatment adherence, and adverse events were assessed. RESULTS:The SID and EID groups differed significantly in sex distribution (78.8% female in SID vs. 46.4% in EID, p = 0.007), but median age was similar (32 vs. 36 years, p = 0.209). Clinical and radiological worsening rates were similar between the groups, with no significant differences (combined worsening: 9.6% in the SID group vs. 17.9% in the EID group, p = 0.308; radiological worsening: 5.8% in the SID group vs. 7.1% in the EID group, p = 1.00; clinical worsening: 9.6% in the SID group vs. 10.7% in the EID group, p = 1.00). Adherence rates were comparable across both dosing regimens, and no significant differences were observed in terms of treatment discontinuation. No progressive multifocal leukoencephalopathy cases were reported. CONCLUSION:Both SID and EID provide comparable efficacy and safety profiles, with similar adherence rates. Despite the observed sex distribution imbalance, additional analyses confirmed no significant sex- or group-related differences in baseline disability or clinical worsening, strengthening the interpretation that EID preserves efficacy. Findings should still be interpreted with caution due to the study's retrospective nature and limited sample size.

Multiple Sclerosis (MS) is a leading cause of disability among young adults. Most cases begin with relapsing-remitting MS (RRMS) and can transition to secondary progressive MS (SPMS) over time. It is known that the inflammatory status of the central nervous system changes during the progression of MS. Poly (ADP-ribose) polymerase-1 (PARP-1) is an enzyme involved in several cellular processes. Our study aimed to investigate the relationship between MS and the PARP-1 gene. We analyzed the PARP-1 gene's missense polymorphism rs1136410, promoter region polymorphism rs7527192, and 3'UTR polymorphism rs8679 in 123 MS patients and 168 healthy controls using the PCR-RFLP method. We examined genotype and allele frequency distributions among case-control groups and clinical subgroups. We observed that the CC genotype of rs7527192 polymorphism was increased in SPMS patients compared to controls. We also found that the CC genotype and C allele frequency were increased in the EDSS score > 3-6 group compared to healthy controls. The C allele frequency was increased in EDSS score > 3-6 compared to those with ≤ 3 and ≥ 6. When the results observed in our study are evaluated with the known effect of PARP-1 on the inflammasome pathway, we suggest that rs7527192 may be effective in the progression process through the activity of the PARP-1 inflammasome pathway.

Aim: To evaluate the effect of cervical cord lesions on upper extremity functions in persons with very early-stage multiple sclerosis (MS) and describe the factors that affect the upper extremity functions in that population. Materials and Methods: Two hundred forty-five persons with MS (pwMS) were diagnosed 24 months after the first symptoms and three hundred seventy-eight pwMS initiated disease-modified treatment (DMT) within six months after diagnosis were included to study. Nine-Hole Peg Test (N-HPT) were performed to evaluate upper extremity functions. Participants divided two groups according to presence of cervical cord lesion. Results: There were no significant differences between groups in terms of age, gender, disease duration, and the number of relapses. However, the total Expanded Disability Status Score (EDSS) score, pyramidal and sensory functional system scores were higher in pwMS with cervical cord lesions than without cervical cord lesions. Average and dominant hand N-HPT performance times were found significantly longer in pwMS with cervical cord lesion than without cervical cord lesion in participants-initiated DMT within six months after diagnosis. However, there were no significant differences between groups in participants diagnosed 24 months after first symptoms Age, disease duration, and time from diagnosis to treatment were identified as significant factors influencing N-HPT performance. PwMS who were younger, had a shorter disease duration, and received treatment sooner after diagnosis showed better performance than others. Conclusion: Our study highlights the influence of cervical cord lesions on upper extremity function, even in the early stages of MS, and underscores the importance of early diagnosis and prompt initiation of DMTs.

Objectives: This study aims to investigate the relationship between physical disability and trunk control, balance, and gait parameters in persons with Relapsing Remitting Multiple Sclerosis (RRMS) who have a low Expanded Disability Status Scale (EDSS) score. Materials and Methods: Twenty-three RRMS patients with an age range of 18-50 years, EDSS score ≤ 3 were included in this study. The patients' level of disability (EDSS), trunk control) Trunk Impairment Scale - TIS), lower extremity functionality (Timed 25-Foot Walk Test - T25FW), upper extremity functionality (Nine Hole Peg Test- 9HPT), balance (Biodex Balance System) and gait (Zebris® FDM 2) were evaluated. Results: The mean EDSS score of 23 patients who participate in the study was 2,10±0,67. A moderate, negative correlation (r= -0.429) was found between EDSS and TIS-dynamic parameter, while a moderate, positive correlation (r= 0.608) was found with T25FW (p

OBJECTIVE:To evaluated demographic and clinical characteristics of POMS in Turkey and examined the impact of age at onset on prognosis. BACKGROUND:Multiple sclerosis (MS) is a chronic immune-mediated disease of the central nervous system that mainly affects adults. However, 3-5 % of cases begin before age 18, defined as pediatric-onset MS (POMS). POMS often presents with higher relapse rates and distinct clinical patterns compared with adult-onset disease. METHODS:Data from seven MS centers in Turkey were retrospectively reviewed. Patients meeting the 2017 McDonald criteria with onset before age 18 were included. Clinical and demographic features were recorded, and patients were stratified into onset before 14 years and onset at or after 14 years. RESULTS:Among 5827 screened patients, POMS prevalence was 5.83 %. Visual symptoms predominated in patients aged ≥14 years, while brainstem and cerebellar symptoms were more common in younger-onset cases. Female predominance was significant only in the older-onset group. Younger-onset patients had longer delays from symptom onset to diagnosis and treatment, and higher Expanded Disability Status Scale (EDSS) scores at last follow-up. Secondary progressive MS (SPMS) was associated with spinal cord lesions, polysymptomatic onset, higher early relapse rates, and delayed treatment initiation. CONCLUSION:Age at onset influences presentation, diagnostic delay, and disability in POMS. Early recognition and timely therapy may improve outcomes. Larger prospective studies are needed to refine prognostic markers and optimize management in this population. pediatric-onset multiple sclerosis, prognosis, disability, secondary progressive MS, Turkey.

This study aimed to evaluate adherence to disease-modifying therapies (DMTs) among patients with multiple sclerosis (MS) and to identify factors influencing compliance, based on perceptions and preferences of both patients and neurologists. Questionnaires were designed by a team of experts, including MS specialists, psychologists, and statisticians, to capture data on treatment adherence and related factors. A total of 1021 MS patients and their neurologists participated. Patients' adherence to oral, injectable, and infusion DMTs was assessed alongside demographic and disease-related characteristics. The study included 1021 MS patients with a mean age of 35.69 ± 9.07 years. Infusion therapies demonstrated the highest adherence rates (96.6

PurposeMigraine is a prevalent and debilitating neurological condition that can significantly impact an individual’s quality of life. While various genetic and environmental factors contribute to the development and chronification of migraine, the role of specific environmental factors in the chronification of this condition remains inadequately explored. This article aims to address this research gap by focusing on the impact of manageable and unmanageable factors on the chronicity of migraine.Patients and methodsThis cross-sectional observational study included 498 patients diagnosed with episodic or chronic migraine. Demographic characteristics of the patients were recorded on the demographic data form. Then, the patient’s headache characteristics (duration, type, presence of aura, accompanying features, etc.) and the answers to the questions about possible triggers of migraine and environmental factors were recorded in the data form.ResultsIn the chronic migraine group, oversleeping and stress were reported as triggers at a higher rate than in the episodic migraine group. In the episodic migraine group, it was found that participants who had TV transmitters were significantly less likely to benefit from treatment, while in the chronic migraine group, it was found that participants who had pets were significantly less likely to benefit from treatment.ConclusionThis study sheds light on the intricate relationship between environmental factors, migraine phenotype, and treatment response. By using comprehensive statistical methods and analyzing a rich dataset, we have gained valuable insights into the complexities of migraine management.

Introduction:This study was designed to explore the relationship between retinal nerve fiber layer (RNFL) thickness and cognition in Idiopathic Parkinson's disease (IPD) patients without visual symptoms or diagnosis of dementia. Methods:Groups of patients with idiopathic Parkinson's disease and healthy controls were compared ophthalmologically using optical coherence tomography (OCT) and cognitively through neuropsychological tests. Results:The findings highlighted a pronounced RNFL thinning, especially in the right nasal inferior quadrant of IPD patients compared to the control group. Almost half (47%) of the subjects in the IPD group exhibited issues in one or multiple subcomponents of Addenbrooke's Cognitive Examination-Revised (ACE-R). At the same time, the study suggested that effects in the visuospatial domain may be associated with disease severity in IPD patients. However, the investigation could not establish a direct association between the severity or duration of the disease and OCT measurements. A correlation was observed between certain ACE-R scores and some RNFL quadrants. Conclusion:In conclusion, the inception phases of IPD are characterized by discernable visual pathologies and cognitive anomalies. The thinning of the RNFL, which can be identified through OCT, might serve as a pivotal tool for tracking the early progression of IPD and formulating intervention strategies. That being said, more comprehensive studies are essential to wholly understand OCT's role in the early diagnosis and monitoring of IPD.