Introduction:Early diagnosis and treatment are essential for the effective treatment of ischemic stroke. The objective of this study was to assess the effect of stroke knowledge among patients and caregivers on hospital arrival, clinical outcomes, and healthcare costs. Methods:This is a cross-sectional study of 219 patients with ischemic stroke and their family members. Awareness of stroke was measured using a structured questionnaire, and the participants were divided into two groups: those with a high level of awareness of stroke and those with a low level of awareness of stroke. The primary outcome measures were time to hospital arrival, modified Rankin Scale (mRS) scores at 1 and 3 months, and the total treatment cost within 3 months. Results:Patients in the high-awareness group presented to the hospital much earlier (58±21.8 min vs. 185±40.3 min, p=0.001), displayed better functional outcome at 1 month (mRS: 1.64 vs. 2.19, p=0.01) and at 3 months (mRS: 1.52 vs. 1.95, p=0.01) and lower treatment costs ($998 vs. $1679, p=0.001). Interestingly, calling the emergency service as a first response was associated with significantly lower costs. On the other hand, low awareness was associated with delayed intervention, worse clinical outcomes, and greater economic strain. Conclusion:A better understanding of the signs of a stroke by patients and their caregivers leads to faster treatment, improved recovery, and lower costs. Stroke awareness can be enhanced through public health efforts, potentially leading to a significant reduction in the clinical and economic burden of stroke.

To evaluate the real-world effectiveness and safety of eculizumab in patients with AQP4-IgG–positive neuromyelitis optica spectrum disorder (NMOSD) and to identify predictors of disability outcomes. This multinational, retrospective cohort study analyzed data from 46 patients across 26 centers. The outcomes included the annualized relapse rate (ARR), relapse-free status, change in expanded disability status scale (EDSS) scores, and adverse events. To identify predictors of EDSS improvement or worsening, patients were stratified into subgroups (improved vs. stable/worsened) at each follow-up time point and compared based on demographic, clinical, and radiological variables. This retrospective cohort study included 46 patients with AQP4-IgG-positive NMOSD from 26 centers, followed for a mean of 27.3 months. The mean ARR significantly decreased from 1.1 in the 2 years pre-treatment to 0.1 during eculizumab therapy. The relapse-free rate increased from 6.5

This study aimed to evaluate spontaneous swallowing frequency (SS-FR) and type of swallowing during awake and sleep states in patients with Parkinson’s Disease (PD), using polygraphic recordings to identify possible associations with disease severity. A total of 27 PD patients (19 male, 8 female) and 22 age-matched healthy controls were included. All participants underwent whole-night one-hour polygraphic monitoring, and SS-FR and type of swallowing were analyzed during both wakefulness and sleep stages. Clinical characteristics, disease severity (Hoehn and Yahr staging), and motor symptoms (Unified Parkinson’s Disease Rating Scale) were assessed. SS-FR was significantly lower in PD patients compared to controls, both during wakefulness and especially during sleep. In PD patients, SS-FR during wakefulness was positively correlated with Hoehn and Yahr stage and motor symptom scores. The presence of dysphagia was more common in patients with markedly reduced SS-FR, indicating its potential role as a non-invasive marker for swallowing impairment. Salvo swallowing was observed in 4.5

Aim: Variations in the vertebrobasilar arterial system can influence cerebral hemodynamics and predispose to vascular disease. Because the inner ear is supplied by the vertebrobasilar circulation, patients with isolated vertigo may have increased posterior circulation stroke risk. This study compared basilar artery morphology between patients with isolated vertigo and those with pontine infarction. Materials and Methods: We retrospectively analyzed 80 patients admitted with acute isolated PI and 59 controls presenting with isolated vertigo between September 2019 and August 2023. Demographics, vascular risk factors, neuroimaging features, and etiologies were reviewed. BA configuration, basilar artery length, basilar artery bending distance, vertebral artery dominance, and bulbar contact were assessed. Results: Hypertension, diabetes mellitus, hyperlipidemia, prior posterior circulation stroke, and smoking were significantly more prevalent in the PI group (p

Although multiple sclerosis predominantly affects young adults, recent advances in diagnostic methods and therapeutic strategies have led to an increasing recognition of the disease in older adults. Aging induces distinct pathophysiological, clinical, and radiological changes in patients with multiple sclerosis, and management in this population requires a tailored approach due to comorbidities and age-related differences in treatment response. This narrative review synthesizes evidence published between 2000 and 2025 on the epidemiology, age-related pathophysiological mechanisms, clinical course, and therapeutic considerations of multiple sclerosis in older adults, based on findings retrieved from PubMed, Scopus, and Web of Science, to support age-adapted clinical decision-making. The reviewed literature indicates a growing prevalence of multiple sclerosis in older adults across diverse geographic regions. With advancing age, disability accumulation and disease progression independent of relapse activity become more prominent than inflammatory relapse-related activity, and age-associated impairment of remyelination is thought to contribute significantly to this process. The limited number of clinical studies specifically focusing on this population highlights an important unmet need in the field. Increasing research efforts in older adults with multiple sclerosis may enhance clinicians’ understanding and improve the effectiveness of treatment strategies.

Introduction: Radiologically Isolated Syndrome (RIS) represents a preclinical stage of multiple sclerosis (MS) characterized by incidental MRI findings suggestive of MS in the absence of neurological symptoms. Identifying imaging biomarkers that predict conversion to MS remains a major clinical challenge. Paramagnetic rim (PR) lesions have emerged as markers of chronic active inflammation in MS; however, their prognostic value in RIS remains unclear. This study aimed to evaluate the impact of PR lesion presence and PR burden on the risk of conversion from RIS to MS. Methods: This retrospective, single-center observational cohort study included 46 patients diagnosed with RIS who had susceptibility-weighted imaging (SWI) sequences available at baseline. PR lesions were defined as hypointense rims on SWI. PR presence was analyzed as a binary variable, and PR burden was categorized according to lesion count. The primary outcome was conversion to MS according to the 2017 McDonald criteria. Associations between PR variables and MS conversion were assessed using odds ratios (ORs) with 95% confidence intervals (CIs). Results: During follow-up, 20 patients (43.5%) converted to clinically definite MS. MS conversion occurred in 63.6% of PR-positive patients compared with 25.0% of PR-negative patients (p<0.001). PR positivity was associated with a significantly increased risk of MS conversion (OR: 5.25; 95% CI: 1.48–18.66). Analysis of PR burden demonstrated a stepwise increase in MS conversion rates with higher PR counts, reaching 77.8% in patients with ≥3 PR lesions. Conclusion: The presence of PR lesions and increasing PR burden are strongly associated with a higher risk of conversion to MS in patients with RIS. PR lesions may serve as clinically meaningful imaging biomarkers for risk stratification and early identification of high-risk individuals in the preclinical stage of MS

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.

Multiple sclerosis (MS) is characterized as an immune-mediated central nervous system disease marked by chronic inflammation, demyelination, and progressive neurodegeneration. In this study, we evaluated the contribution of low-frequency and rare genetic variants to MS susceptibility within one of the largest family-based MS cohorts to date, comprising 215 individuals from 59 Turkish multiplex MS families. Whole exome sequencing was conducted on all samples including affected and unaffected members, followed by investigation of the effect of well-established human leukocyte antigen loci for MS on the elevated MS risk observed in our families. Subsequently, a gene-based burden analysis was performed on candidate genes identified through both our segregation analysis and existing literature. To prioritize the genes and pathways that are potentially associated with MS, a segregation-based analysis of the variants was conducted and complemented by gene-based pathway enrichment analysis. Our results highlighted the significance of the extracellular matrix in MS pathogenesis, as we identified laminin-related genes including LAMA5 and LAMB1 from both the segregation analysis and gene-based burden test. Hemidesmosome assembly emerged as a key pathway in our analysis, primarily driven by the identification of DST and PLEC as significant genes in the gene-based segregation analysis. Finally, we identified two rare coding variants passing our allele frequency and deleteriousness score-based filters, rs41266745 (C> T) in the CD109 gene with CADD phred score 24 and rs143093165 (T> G) in the ITPR1 gene with CADD phred score 22 and LOEUF 0.325, segregating within more than one family. Overall, this is one of the first and largest family-based MS studies from Turkey that features a unique cohort from an admixed population that enabled the detection of novel low-frequency and rare variants associated with MS. The findings from this study offer valuable insights that could guide future research aimed at further exploring and understanding the factors contributing to MS risk.

OBJECTIVES:Kappa free light chains (κ-FLC) have emerged as a reliable biomarker for diagnosing multiple sclerosis (MS). Compared to oligoclonal band (OCB) measurement, κ-FLC presents distinct advantages, including enhanced accessibility in clinical practice. This study evaluates κ-FLC index values in MS patients and explores its potential as a practical alternative to the OCB test. METHODS:Cerebrospinal fluid (CSF) and serum κ-FLC concentrations were quantified using an immunonephelometry analyzer, while OCB analysis was performed via agarose isoelectric focusing combined with immunoblotting. The cut-off values were set at ≥0.7 for the CSF IgG index and ≥6.6 for the κ-FLC index, with values exceeding these thresholds considered positive. κ -FLC index values were compared between OCB-negative and OCB-positive patients, between patients with negative and positive CSF IgG index, and across different OCB types. RESULTS:OCB positivity was detected in 82.7 % of patients, whereas a positive κ-FLC index was observed in 91.7 %. The IgG index was positive in 51.9 % and negative in 48.1 %. Among patients with a negative IgG index, 84.3 % exhibited a positive κ-FLC index. Additionally, CSF κ-FLC values were significantly higher in patients with a positive IgG index compared to those with a negative IgG index. On the other hand, patients with type 2 (+) OCBs had higher κ-FLC index values than those with negative OCBs. CONCLUSIONS:The κ-FLC index may serve as a valuable tool for identifying OCB-negative patients with a high likelihood of MS, offering a practical and accessible alternative for diagnostic evaluation.

OBJECTIVES:This study aimed to: 1) evaluate the macrostructure of sleep and identify the presence of sleep disorders such as hypersomnia, fatigue, apnea risk, and restless legs syndrome (RLS) in neuromyelitis optica spectrum disorder (NMOSD) patients, using both questionnaires and quantitative tests; 2) assess the correlation between the data from these questionnaires and quantitative tests in NMOSD patients, and predict which patients may require further investigation. METHODS:The study population comprised 26 consecutive NMOSD patients, along with a control group of 20 healthy volunteers. Polysomnography (PSG) and the Multiple Sleep Latency Test (MSLT) were conducted, along with the administration of various questionnaires, including the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepinesss Scale (ESS), STOP-Bang scale, RLS diagnostic questionnaire, RLS Severity Scale, and the Beck Depression Inventory (BDI). These assessments were performed prospectively to evaluate sleep quality, daytime sleepiness, the detection of obstructive sleep apnea syndrome (OSAS), the presence of RLS, the severity of RLS, and the presence of depressive symptoms. RESULTS:An increase in the NREM1 ratio was observed in NMOSD patients compared to healthy controls, with higher values for total apnea hypopnea index (AHI), REM AHI, and NREM AHI, while the minimum O2 saturation was lower. However, no significant differences were observed between the groups regarding sleep efficiency, periodic legs movement (PLM) index, arousal index, sleep latency, and REM latency. According to the MSLT data analysis, we found that sleep latency was shorter, and hypersomnia/narcolepsy occurred more frequently. There was no significant difference in the STOP-Bang score between the two groups. The ESS score, PSQI score, presence of RLS, and body mass index (BDI) score were significantly higher in the patient group. CONCLUSION:Our findings suggest that the macrostructure of sleep is significantly impacted in NMOSD patients, with a higher prevalence of OSAS, hypersomnia/narcolepsy, and RLS. To enhance the quality of life in these patients, it is crucial to investigate sleep disorders early using qualitative methods and to implement appropriate treatments at an early stage.

BACKGROUND:Azathioprine (AZA) and rituximab (RTX) are frequently used drugs in the treatment of Myelin Oligodendrocyte Glycoprotein Associated Disease (MOGAD). OBJECTIVES:The aim of this study was to evaluate the efficacy and safety data of AZA and RTX treatments in MOGAD. METHODS:Patients diagnosed according to the 2023 MOGAD diagnostic criteria and receiving AZA or RTX treatment were included in the study. RESULTS:In 142 patients included in the study, the female/male value was 1.2. The rate of OCB positivity in MOGAD patients was 22.6 %. Patients on RTX had higher EDSS values than patients on AZA. However, the RTX group demonstrated a more pronounced improvement in disability, reflected by a greater negative trend in the ΔEDSS values. The attack-free rate was 78 % in the RTX group and 68 % in the AZA group during their treatment period. Both groups had no difference in the time of the first attack. The main factor affecting the time to first attack was having a higher EDSS at the time of treatment initiation. The survival analysis found that EDSS scores improved significantly in patients treated with RTX. CONCLUSION:Although survival analyses for both treatments appear to be similar, using RTX provides better EDSS scores.

Organic solvents that are widely used in industrial production and abused amongst teenagers for recreational purposes may cause some neurological abnormalities including polyneuropathy. Poorly ventilated working environments and working without protective garments are the most common reasons of intoxication. N-hexane toxicity often causes sensorimotor mixed type demyelinating neuropathy, but axonal degeneration is not rare. We report five cases that had mainly axonal motor polyneuropathy due to n-hexane containing glue usage, with clinical and electrophysiological data. Clinical and electrophysiological examinations revealed predominantly motor findings. One patient had delayed P100 potential, two had abnormal conduction in fasciculus gracilis. “Coasting” phenomenon was observed in one patient. Neuropathy due to toxic agents is an important public health problem. Working place conditions must be strictly controlled if toxic materials are present. Patients who had electromyography compatible with polyneuropathy should be questioned for toxic exposure. Asymptomatic workers should also be examined. Patients should be followed for the possibility of “coasting” effect.

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is the reason for coronavirus disease 2019 (COVID-19), which was first diagnosed in Wuhan, China. COVID-19 has since led to a worldwide pandemic. SARS-CoV-2 infection increases the risk of thrombotic events, including ischemic strokes. There are limited data on ischemic stroke associated with COVID-19. The aim of our study was to determine the effects of SARS-CoV-2 infection on ischemic stroke. A total of 248 ischemic stroke and transient ischemic attack (TIA) patients hospitalized in our neurology intensive care and stroke units between March 2020 and January 2022 were retrospectively analyzed. Two hundred and five stroke patients were diagnosed with COVID-19-negative strokes. COVID-19-positive patients were first isolated from the relevant units, and neurological follow-up was performed. Forty-three patients who were diagnosed with COVID-19-related ischemic stroke and survived at the end of the isolation period were transferred and followed up in the neurology intensive care and stroke unit. Stroke classifications, vascular risk factors, clinical course, disease severity, laboratory parameters, recanalization treatment results, and mortality rates of ischemic strokes in patients with positive or negative COVID-19 infection were evaluated. COVID-19-positive and COVID-19-negative stroke patients had similar characteristics of age, gender, vascular risk factors and stroke subtype. Cryptogenic stroke was the most common type of stroke in both groups. TIA and small vessel diseases were detected only in the COVID-19-negative group. COVID-19-positive stroke patients had lower lymphocyte counts and higher procalcitonin, troponin and fibrinogen levels. Ischemic strokes had similar clinical characteristics and did not show a different course or prognosis in COVID-19-positive and COVID-19-negative stroke patients.

ObjectivesMultiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS.MethodsIn a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated.ResultsThe mean age of the 136 patients was 60.96±6.42 years (51–79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14.ConclusionsIn LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself.

BACKGROUND:Cognitive evaluation was considered to be very important in the relapse period, on the basis of the presence of isolated cognitive attacks and the necessity of monitoring the patient both physically and cognitively.MATERIALS AND METHODS:People with MS (pwMS) who were hospitalized during relapse were included in the study. All MS patients were evaluated by the neurologist with Expanded Disability Status Scale (EDSS), The 9 Hole Peg Test (9HPT) and the Timed 25-Foot Walk Test (T25-FWT). Additionally, all participants were examined cognitively with the Turkish version of the Brief International Cognitive Assessment for MS (BICAMS) battery. Also, schedules were indicated as during relapse before the treatment (pre-treatment) and the first month after relapse (1-month follow-up).RESULTS:A total of 140 MS patients (mean age; 34.98±10.09, mean disease duration; 6.05±5.29 years) and 86 healthy controls (mean age; 36.94±10.83) were included to the present study. The mean EDSS scores in pre-treatment in MS patients was 2.74±1.14 and decreased significantly in the 1-month follow-up (1.74±1.24; p<0.001). The mean SDMT score was lower by 8.76 points in MS patients than in HCs) in pre-treatment and 7.66 points in 1-month follow-up (p<0.001). The mean SDMT scores of all participants increased with measurement time gradually (p<0.001).CONCLUSION:In this study, it was detected which cognitive domains were affected after relapse treatment and cognitive changes in pwMS during relapse and remission periods compared to the healthy controls. All three BICAMS test scores significantly increased in one-month follow-up than the pre-treatment period. The results showed that CVLT-II and BVMT-R scores improved more in pwMS than in HCs, and also SDMT scores of pwMS showed a trend of increase, but was not a significant improvement.