Multiple Sclerosis (MS) is a T-cell-mediated autoimmune disease with distinct clinical and pathologic phenotypes. Thyroid disorders play an essential role in studies evaluating the coexistence of both autoimmune and nonautoimmune diseases in MS patients. This study aimed to elucidate the characteristics of RRMS patients with thyroid pathologies and to determine the impact of the coexistence of both diseases on clinical or radiologic outcomes. Demographic, clinical, laboratory, and radiological data of patients with thyroid pathology (RRMS and thyroid pathology) who were followed up in our center for at least 12 months were retrospectively evaluated from patient files. Thyroid pathology was present in 34 patients with RRMS, 29 females and five males. Hashimoto's disease was the most common pathology. There was no significant difference between the presence or absence of thyroid pathologies in patients with RRMS in terms of clinical, radiologic, and laboratory characteristics. Thyroid pathologies, especially Hashimoto's disease, are among the most common autoimmune disorders in MS. This condition does not adversely affect the course of MS. On the other hand, no significant difference is expected in the hormonal follow-up of patients with Hashimoto's disease accompanying MS. Correction of thyroid pathology and hormone replacement therapy may be necessary for the course of MS. Further studies evaluating prospective standardized replacement therapies are needed.

Background/aim: Multiple sclerosis (MS) is an inflammatory demyelinating central nervous system (CNS) disease. Among the paraclinical tests, brain and spinal Magnetic Resonance Imaging (MRI) is primarily involved in the diagnosis process, and cerebrospinal fluid (CSF) analysis is fundamental in diagnosing MS and the differential diagnosis. A positive relationship was demonstrated between oligoclonal band (OCB) positivity, CSF band number and immunoglobulin G(IgG) index. The study aimed to evaluate whether the number of OCB can predict disease activity and determine a correlation with the IgG index. Methods: Our study included 401 MS patients who had relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), clinic isolated syndrome (CIS), radiologic isolated syndrome (RIS), Neuromyelitis optica spectrum disorder (NMOSD) and Acute disseminated encephalomyelitis (ADEM) with OCB number groups of 2-4, 4-8, 8-12, and 12 and above. Results: No significant correlation was observed between IgG index, pre-and post-treatment EDSS (Expanded Disability Status Scale Scores) and disease-modifying therapies (DMT). Drug response was better in the patient group with band number between 2 and 8 and post-treatment EDSS scores were lower (1.62 +/- 0.44). Conclusion: The study results suggested that band number may be as valuable as the IgG index and a predictive biomarker for disease activity.

Immune checkpoint inhibitors (ICIs) are highly effective in treating cancer and are increasingly used. Thus, awareness of various complications in the form of immunity-related adverse events is increasing. Transverse myelitis following ICIs is a rare but severe neurological adverse event, and information about this entity is minimal. ICI-associated transverse myelitis should be considered a rapid and comprehensive differential diagnosis after evaluating infective, metabolic, or other inflammatory-autoimmune pathologies. After diagnosis, early immunomodulation is required through intravenous high-dose methylprednisolone, IVIg, or plasmapheresis. It should be kept in mind that different etiologies may coexist or a superimposed condition may cause each other, and concurrent treatment should not be delayed. Further studies are needed to investigate the neurological manifestations that may develop in association with these therapies further and help establish guidelines for their management. In this case report, a rare case of ICI-associated transverse myelitis in a 62-year-old male patient was presented.

Background:Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims:To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design:Multicenter, retrospective, observational study. Methods:Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayıs University’s Faculty of Medicine were included in the study. Results:Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion:For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

BackgroundMany different pathologies may underlie tumefactive demyelinating lesions. Identifying clinical and radiologic distinguishing features before pathologic examination is essential for diagnosis and treatment. In this study, we aimed to determine the clinical and radiologic features affecting the etiology and disease course of patients with tumefactive lesions (TDL).Materials and MethodsWe included 35 clinicoradiologically or histologically diagnosed TDL patients in our center over 11 years. Patient records were retrospectively evaluated and recorded. Clinical features, cerebral neuroimaging, and histologic biopsy preparations, if any, were assessed by three independent neurologists, two neuroradiologists, and two pathologists at admission and follow-up, respectively.ResultsThe mean age of patients with TDL was 40.02±14.40 years. Symptom onset was 15 (1-365) days. The most common complaints at initial presentation were hemiparesis or hemiplegia, sensory complaints, and cognitive impairment (aphasia or apraxia). The lesions were most commonly localized in the frontal lobe (42.9%). Mass effect was 17.1%, edema 60%, diffusion restriction 62.1%, and contrast enhancement 71.9% (mostly ring-shaped (68.8%)) on MR images. Acute onset and OCB type-2 positivity were associated with MS diagnosis. On the other hand, CSF protein levels above 45 mg/dL were found to be related to non-MS etiologies. Only the predominance of aphasia or apraxia at onset was a risk factor for early high disability (EDSS>4; 3rd month). Subacute-chronic onset, being older than 40 years, or having brainstem symptoms at onset were independent risk factors for late high disability (2nd year).ConclusionAcute onset or OCB type 2 positivity is a clue for early diagnosis of MS, while elevated CSF protein is a clue for demyelinating diseases other than MS. Presentation with cognitive dysfunction at onset is an independent risk factor for early disability, while age above 40 years, subacute-chronic presentation and brainstem findings at presentation are independent risk factors for late disability.

Dear Editor, Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) was first described in 2010 by Pittock et al., but the incidence and etiology have yet to be discovered. Since then, approximately 140 cases have been identified from 100 studies worldwide. From a clinical point of view, it may present with various symptoms, but the most common are diplopia, dysarthria, ataxia, and motor and sensory findings.[1] Other conditions must be excluded before the diagnosis of CLIPPERS can be made. We present a 56-year-old male patient without any disease other than hypertension. In addition to the symptoms of dizziness, nausea, and vomiting that started 1 month before the admission to our institution, the patient had a bilateral, occipital localized, and throbbing headache for 1 week. Physical examination revealed mild left peripheral facial paralysis, right 4/5 hemiparesis, right hemihypesthesia that did not involve half of the face, increased pathologic tendon reflex response in the right extremities, and a positive ataxic gait with Romberg sign. Brain and spinal cord T2-weighted fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted imaging magnetic resonance imaging (MRI) revealed marked hyperintense edema with nondiffusion-restricting enlargement that thoroughly homogenized the pons and extended toward the pontobulbar region on T2W images and linear punctate and heterogeneous contrast enhancement on contrast images [Figure 1]. No bleeding or increased vascularity was observed in the susceptibility-weighted imaging sequence lesion. No pathology was detected in arterial magnetic resonance (MR) angiography. Hypoperfusion was detected in the cerebral blood volume values of the lesion on perfusion MRI. The choline peak slightly increased in MR spectroscopy.Figure 1: Baseline magnetic resonance imaging scans at admission. Salt-and-pepper appearance pontine and cerebellar enhancing lesionsThe blood test gave expected results: serology tests for HIV, syphilis, Borrelia, Brucella, Cytomegalovirus, rubella, Toxoplasma, chlamydia, varicella zoster, parvovirus, herpesvirus family and hepatitis A, B, and C viruses, as well as antineutrophil antibodies, were negative. Cerebrospinal fluid (CSF) analysis revealed 12/mm3 leukocyte cells and mild pleocytosis with high protein levels (83.4 mg/dL). No tumor cells were detected. CSF and serum results were negative for onconeuronal and viral serologic antibodies. Anti-aquaporin-4 immunoglobulin G (IgG) antibody and myelin oligodendrocyte glycoprotein IgG antibody were found negative in both cell-based assay and immunofluorescence assay methods. Contrast-enhanced computerized tomography scans of the neck, thorax, abdomen, and pelvis revealed no signs of malignancy. Treatment was started with intravenous methylprednisolone of 1 g/day for 10 days. Gait instability, motor deficit, and facial paralysis improved 48 h after the start of treatment. Then, 0.2 mg/kg/day oral methylprednisolone and 0.5 mg/kg/day azathioprine, targeting dose titration up to an additional 1 mg/kg, were continued. The patient was re-evaluated 2 and 6 weeks later. Neurologic examinations were normal at both visits. In the 2nd week brain MRI study, T2-weighted FLAIR sequences revealed that punctate hyperintensities and gadolinium-retaining lesions were highly reduced and disappeared in the 6th week [Figure 2]. CLIPPERS syndrome was diagnosed with characteristic radiologic images of perivascular involvement of the pons, which responded very well to steroids and exclusion of other systemic diseases.Figure 2: Second week (left) and 6th week (right) magnetic resonance imaging T2 and magnetic resonance imaging with gadoliniumCLIPPERS syndrome affects men more often than women, and the median age at onset is 46 years. Clinically, it may present with various symptoms, but the most common are diplopia, dysarthria, ataxia, and motor and sensory findings.[1] Other conditions must be excluded before CLIPPERS can be diagnosed. In the differential diagnosis, primary malignancies (primary central nervous system lymphoma and brain stem glioma), paraneoplastic syndromes (Bickerstaff encephalitis), neurosarcoidosis, infective diseases (listeria or tuberculosis rhombencephalitis), and demyelinating diseases (multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorder), in particular, should be evaluated. Therefore, detailed systemic examination, blood and CSF examination, malignancy screening, and infection exclusion are essential. Typically, on T2-weighted FLAIR sequences on MRI, punctate hyperintensities with small diameters, no mass effect, and gadolinium uptake, designated as the "salt and pepper sign," occur bilaterally in the pons, cerebellum, or less frequently in cerebral white matter.[1,2] Recently, it has been stated that diagnosis can be obtained more specifically with different quantitative MRI techniques.[3] Diagnosis is made with complete radiologic resolution after high-dose corticosteroid therapy and the absence of an alternative diagnosis. Pathogenic mechanisms are unknown. It is hypothesized that this syndrome may be an autoimmune inflammatory response or constitutes a variant of hematologic malignancies (most commonly lymphoma). In a study in which all cases diagnosed with CLIPPERS syndrome were evaluated, hematologic or solid malignancies and paraneoplastic syndrome were detected in 15.7% of the patients during follow-up after diagnosis.[1] A rapid response to corticosteroid treatment is expected. Maintenance with oral therapy after boluses of high-dose methylprednisolone is generally preferred. Chronic immunosuppressives are often added to treatment to prevent relapses that may exacerbate the disease.[1,4] Although it is stated in the literature that relapse may occur in patients after the prednisone dosage is reduced to below 20 mg/day, there is no difference in terms of relapse between dosages below and above 20 mg/day when additional chronic immunosuppressives are used.[4,5] Clinical trials reported good responses to maintenance therapy with methotrexate, azathioprine, mycophenolate, cyclophosphamide, and rituximab without disease progression.[5] Mortality is higher in cases associated with malignancy. On the other hand, increased CSF protein is more common in cases without malignancy. In relapsed cases, acute steroid treatment is shorter (10 days vs. 6 days), and malignancy and mortality are more frequent. In follow-ups, the recurrence rate is reported as approximately 59% and mortality as 10%.[1] Although a limited number of cases have been reported to date, we state that a slightly longer duration of steroid treatment in the acute period, careful evaluations in this regard in the follow-ups, even if there is no sign of malignancy in the early period, and the use of oral steroids and chronic immunosuppressive treatments together would be appropriate. However, more case series and clinical trials are needed to optimize diagnosis, treatment, and follow-up. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Background Assessment of the visual pathway, which is frequently affected by MS, provides the opportunity to measure the remyelination of acute and chronic MS lesions in vivo and non-invasively. VEP can be used in this context. Amplitude is a parameter of axonal loss, whereas latency is an in vivo biomarker of myelin repair. This study aimed to evaluate DMT's neuroprotective and pro-remyelinating potential by evaluating VEP latency and amplitude in MS patients. Materials and Methods A total of 74 patients with relapsing MS who had no evidence of optic neuritis were included in the study. Patient data were retrospectively analyzed and recorded. In the VEP test, latency above 118 ms and amplitude below 5.0 μV were considered abnormal. Classified according to DMTs (injectables, teriflunomide, dimethyl fumarate, fingolimod, cladribine, and alemtuzumab). Visual evoked potential tests, clinical features, and cerebrospinal fluid examinations were evaluated by three independent neurologists and one clinical neurophysiologist. Results The mean age at diagnosis was 29.2 ± 9.01, and the mean age at first VEP was 34.97 ± 10.64. In women, latency was lower, and amplitude was higher. The mean differences in latency and amplitude were, respectively, latency prolonged by 0.7 ms on the right and 0.5 ms on the left, and amplitude increased by 0.6 μV on the right and 0.37 μV on the left. However, these changes were not statistically significant. Latency worsening was more prominent in those with longer disease duration (p=0.011). Those with amplitude or latency worsening had higher EDSS (p=0.016 and 0.013, respectively). DMTs did not affect these changes. Conclusion Prolonged latency is associated with a long disease duration. Deterioration in both amplitude and latency is evident in high EDSS. These results may be an indirect consequence of axonal degeneration dominating remyelination. DMTs do not ameliorate impaired remyelination and neurodegeneration but seem to be sufficient for short-term maintenance of the current state.

BackgroundAlemtuzumab (ATZ) is an anti-CD52 humanized monoclonal antibody indicated for treating highly active relapsing-remitting MS (RRMS). It alters the regulation of the immune system by depleting circulating lymphocytes. Changes in blood cell count, infusion-related reactions, and changes in vital parameters can be seen in the early period with ATZ.AimChanges in blood tests, serum tests, vital parameters, and characteristics of infusion-associated reactions (IARs) observed during the first course of ATZ treatment and thereafter were evaluated.Materials and methodsThe systolic blood pressure (SBP), diastolic blood pressure (DBP), fever, heart rate (HR), changes in blood and serum tests, and IARs developed after the first course of 23 patients with RRMS who received ATZ treatment were evaluated by comparing the results of 26 patients with RRMS who received only intravenous methylprednisolone.ResultsMean age was 36.60 ± 8.98, 73.9% female (n = 17), diagnosis time was 8.52 ± 3.64 years, pre-EDSS: 3.93 ± 1.80. No significant difference was found in vital parameters except for sub-febrile fever that developed on the first day. The number of white blood cells increased significantly after the first day. The hemoglobin level did not change. Lymphocyte (very high) and platelet (mild) counts decreased starting from the first days, and eosinophil (very high) and monocyte (moderate) counts decreased from the third day. There were no significant changes in liver enzymes, thyroid function tests, serum urea, creatinine, and lipid profile during 1-year follow-up. The IAR rate was 95.6% and occurred most frequently on the second and third days. The most common are dermatological findings (52%), headache (20%), pain (10%) and fatigue (8%).ConclusionAlemtuzumab has no appreciable effect on vital parameters during infusion. However, these changes are not clinically correlated, even if there is. Headache in the first days, dermatological (most common) findings, pain, and fatigue are seen in the following days. Most IARs can be resolved with symptomatic treatment and close follow-up. Lymphocytes, eosinophils, and monocytes are significantly reduced and return to baseline levels towards the end of the first year. The first year does not cause significant pathologies in other serum parameters. However, after the first year, watch out for associated autoimmune pathologies, especially thyroid involvement.

Objectives: Fingolimod is approved in Turkey or the treatment of cases of multiple sclerosis (MS) which cannot be controlled with first-line treatments. There is limited information about its efficacy and safety in clinical practice in Turkey. The aim of this study was to evaluate the efficacy and safety of fingolimod treatment in patients with relapsing-remitting multiple sclerosis who were prescribed fingolimod by the Multiple Sclerosis specialists of Bursa Uludağ University Department of Neurology. Methods: This is a single-center observational study evaluating 142 patients using fingolimod who were followed up for at least 12 months in our center between April 2015 and October 2022. Efficacy results were evaluated in terms of mean number of attacks, annualized relapse rate, relapse-free patient rate, disease progression, clinical and radiological disease activity, and no evidence of disease activity (NEDA-3). The safety outcomes are the rates of treatment-related severe adverse events and patients' continuation rates. Results: Over 12 months of treatment with fingolimod, the average number of attacks decreased by 94.6%, the annual relapse rate decreased by 87%, and most patients did not relapse (83.1%). Alongside this, in 76.4% of cases, there was no disability progression and in 83.3% of cases, magnetic resonance imaging (MRI) activation was not observed. Excluding replacement due to ineffectiveness, 89.4% of patients continued fingolimod therapy. Cardiac events, treatment-related infections and a decreased lymphocyte count were observed as side effects. Conclusion: In our center, switching from first-line treatments to fingolimod was effective in reducing disease activity in patients with multiple sclerosis.

Behcet’s syndrome is a rare inflammatory disorder characterized by oral and genital ulcers, skin lesions, and uveitis. It exhibits a higher prevalence along the historic Silk Road. Neuro-Behcet syndrome (NBS) affects the central nervous system and poses significant morbidity and mortality risks. Infliximab, a TNF-alpha antagonist, has shown potential in NBS management, although the current evidence is mainly derived from case series due to the lack of randomized controlled trials. This retrospective study aimed to evaluate the disease outcomes during the first and second years following infliximab treatment in NBS patients experiencing attacks despite prior conventional immunosuppressive therapy. The study also sought to investigate the safety profile and adverse effects associated with infliximab. Fifty-three NBS patients were examined, with 22 receiving infliximab as either monotherapy or in combination with other therapies. Retrospective analysis was conducted on demographic data, clinical characteristics, and treatment responses. Treatment efficacy was measured using the Expanded Disability Status Scale (EDSS) modified for NBS. The study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist guidelines. Among the study cohort, 60.4

Multipl skleroz, dünya çapında yaklaşık 2,3 milyon insanı etkileyen, en sık genç yetişkinlerde görülen, edinilmiş sakatlığa yol açan nörolojik bir hastalıktır. MS kronik bir hastalık olduğundan hastaların uzun süreli tedavi kullanması gerekmektedir. Hastaların tedaviye uyumu hastalığın seyrini ve uzun dönem prognozu etkilediğinden öncelikli olarak dikkate alınması gereken bir konudur. Tedavi uyumunu etkileyen birçok faktör vardır. Olumsuz faktörlerin tespiti ve düzeltilmesi tedavi etkinlik ve güvenirlilik sonuçlarını ve hastalık sonlanımını etkiler. Bu çalışmada MS polikliniğinde takip edilen hastaların hastalık modifiye edici tedavilere uyumuna etki eden faktörlerin değerlendirilmesi planlanmıştır. Çalışmaya 209 MS hastası dahil edildi ve hastaların yaşı, cinsiyeti, hastalık süresi, eğitim düzeyi, geliri, ilaç kullanımı ve ilaç uygulanma şekli kaydedildi. MS hastalarına Morisky İlaç Uyum Ölçeği-8 (MMAS-8) uygulandı. Ortalama MMAS-8 puanı 6,05±1,94 idi. Tedavi uyumu %31 düşük (n=66), %36,4 orta (n=76) ve %32,1 yüksek (n=67) idi. Yaş, cinsiyet, hastalık süresi, gelir düzeyi, hastalığı değiştirici tedaviler, bu tedavilerin türü ve uygulanma şekline göre tedaviye uyum açısından farklılık saptanmadı (p= 0,074, 0,070, 0,600, 0,976, 0,940, 0,356, 0,249, 0,053, 0,701). Çalışmamızda MS hastalarında yaş, eğitim düzeyi, hastalık süresi, tedavi seçeneği veya uygulama şeklinin hastalık değiştirici tedaviye uyumu etkilemediği görüldü. Çalışma sonuçlarımız MS hastalarında ilaç uyumunu etkileyen farklı faktörlerin açıklanması gerektiğini göstermektedir.

OBJECTIVES:Cerebral venous sinus thrombosis (CVST) is a cerebrovascular disease characterized by thrombosis of the cerebral venous or dural sinuses. Autoimmune diseases (AD) are important causes of CVST. This study aims to reveal the differences between CVST associated with autoimmune diseases compared with other causes (OCs) and Behcet's syndrome (BS) compared with other ADs.METHODS:This is a single-center retrospective study in which the medical records of 187 patients we followed with a diagnosis of CVST between 2008 and 2023 were collected retrospectively. Four neurologists collected data on initial symptoms, neurological examinations, and laboratory findings. Findings on magnetic resonance imaging and magnetic resonance venography performed on all patients (thrombosis localizations, hemorrhagic or ischemic complications, and collateralization) were re-evaluated by 2 radiologists. The results were compared with AD, other ADs, and OCs groups.RESULTS:There were 28 cases of CVST associated with AD. Of these, 18 were BS, and 10 were other AD. Subacute-chronic onset, headache, and transverse sinus involvement were more common in AD-related patients than in OCs. However, collateralization, venous infarction, hemorrhagic transformation, and bleeding were less common. BS-related patients had earlier age, more frequent transverse sinus, less frequent cortical vein thrombosis, and better collateralization than other ADs.CONCLUSION:CVST is one of the rare complications in autoimmune diseases. It has a more subacute-chronic onset. Since headaches are more common, it is essential to make a differential diagnosis of CVST in autoimmune diseases with chronic headaches. Transverse sinus thrombosis is more common. Collateralization, venous infarction, and hemorrhagic transformation are less.

OBJECTIVES:There is evidence that the inflammatory demyelinating disorder in Multiple Sclerosis (MS) is associated with acute seizures and epilepsy. Additionally, the likelihood of developing epilepsy increases with neurodegeneration. This study aims to reveal the clinical and radiological features of MS-epilepsy/seizure coexistence. METHODS:Among all patients diagnosed with MS that we followed in our center between April 2002 and July 2023, patients with a single seizure history or diagnosed with epilepsy (MS-seizure/epilepsy) were randomized 1:1 in terms of age and gender with MS patients without a diagnosis of epilepsy or seizures. Clinical (comorbidities, annualized relapse rate, disability, seizures during attacks, initial diagnosis, disease duration, disease-modifying therapies (DMTs), refractory epilepsy, anti-seizure drugs), electroencephalography (EEG) and MRI (lesion localization and new lesion(s)) data were retrospectively evaluated. RESULTS:The mean EDSS was 4.07±2.81. 29.4 % of patients had progressive MS (n = 10). Refractory epilepsy was 52.9 % (n = 18), and SE history was 14.7 % (n = 5). Pathology was detected in 69.7 % (n = 23) of patients in the EEG. The most common slow wave activation was detected in 51.5 % (n = 17). Refractory epilepsy was more common in cases under 45 and patients with lesions in thalamic localization. Lesions in the temporal and thalamic regions and cerebral atrophy were more common in the MS-seizure/epilepsy group. CONCLUSION:Patients with demyelinating lesions in the temporal and thalamic regions should be questioned more carefully for epilepsy, and an EEG should be performed in case of clinical suspicion. Since thalamus lesions are more common in patients with refractory epilepsy, anti-seizure treatment strategies should be applied more carefully. The presence of atrophy on MRI confirms the link between neurodegeneration processes and the development of epilepsy.

Background: COVID-19 vaccines are recommended for people with multiple sclerosis (pwMS). Adequate humoral responses are obtained in pwMS receiving disease-modifying therapies (DMTs) after vaccination, with the exception of those receiving B-cell-depleting therapies and non-selective S1P modulators. However, most of the reported studies on the immunity of COVID-19 vaccinations have included mRNA vaccines, and information on inactivated virus vaccine responses, long-term protectivity, and comparative studies with mRNA vaccines are very limited. Here, we aimed to investigate the association between humoral vaccine responses and COVID-19 infection outcomes following mRNA and inactivated virus vaccines in a large national cohort of pwMS receiving DMTs.Methods: This is a cross-sectional and prospective multicenter study on COVID-19-vaccinated pwMS. Blood samples of pwMS with or without DMTs and healthy controls were collected after two doses of inactivated virus (Sinovac) or mRNA (Pfizer-BioNTech) vaccines. PwMS were sub-grouped according to the mode of action of the DMTs that they were receiving. SARS-CoV-2 IgG titers were evaluated by chemiluminescent microparticle immunoassay. A representative sample of this study cohort was followed up for a year. COVID-19 infection status and clinical outcomes were compared between the mRNA and inactivated virus groups as well as among pwMS subgroups.Results: A total of 1484 pwMS (1387 treated, 97 untreated) and 185 healthy controls were included in the an-alyses (male/female: 544/1125). Of those, 852 (51.05%) received BioNTech, and 817 (48.95%) received Sino-vac. mRNA and inactivated virus vaccines result in similar seropositivity; however, the BioNTech vaccination group had significantly higher antibody titers (7.175 +/- 10.074) compared with the Sinovac vaccination group (823 +/- 1.774) (p<0.001). PwMS under ocrelizumab, fingolimod, and cladribine treatments had lower humoral responses compared with the healthy controls in both vaccine types. After a mean of 327 +/- 16 days, 246/704 (34.9%) of pwMS who were contacted had COVID-19 infection, among whom 83% had asymptomatic or mild disease. There was no significant difference in infection rates of COVID-19 between participants vaccinated with BioNTech or Sinovac vaccines. Furthermore, regression analyses show that no association was found regarding age, sex, Expanded Disability Status Scale score (EDSS), the number of vaccination, DMT type, or humoral antibody responses with COVID-19 infection rate and disease severity, except BMI Body mass index (BMI).Conclusion: mRNA and inactivated virus vaccines had similar seropositivity; however, mRNA vaccines appeared to be more effective in producing SARS-CoV-2 IgG antibodies. B-cell-depleting therapies fingolimod and cla-dribine were associated with attenuated antibody titer. mRNA and inactive virus vaccines had equal long-term protectivity against COVID-19 infection regardless of the antibody status.

Background: Follow-on disease modifying therapies (FO-DMTs) do not always require Phase III studies. There are concerns that cheaper FO-DMTs are only used to reduce healthcare costs. However, the well-being of people with MS (pwMS) should be a priority. We aimed to evaluate the efficacy, safety and treatment satisfaction of one of the FO-Fingolimod (FTY) used in Turkey with the approval of Turkish Ministry of Health.Methods: PwMS under FTY were recruited from 13 centers and real-world data and answers of satisfaction and adherence statements of pwMS on FTY treatment were analyzed.Results: Data of 239 pwMS were obtained. The duration of FTY treatment was 2.5 & PLUSMN; 0.8 (1-4) years in pwMS who were included in the study and whose treatment continued for at least one year. Significant decreases in annual relapse rate (p < 0.001), Expanded Disability Status Scale (p < 0.001) and neuroimaging findings (p < 0.001) were observed. While 64% of the patients were satisfied and 71.5% were found to adherent with this FO-FTY.Conclusion: This multicenter retrospective study found that the efficacy, safety and treatment adherence of a prescribed FO-FTY were consistent with the results of real-world studies. Studies including real-world data may provide guidance to address issues related to FO-FTY use.