INTRODUCTION:Previous studies have reported conflicting results regarding visual evoked potential (VEP) and OCT abnormalities in patients with Behçet's disease (BD). This study aimed to address these discrepancies by investigating subclinical optic neuropathy and retinal dysfunction in Behçet's disease using VEP and OCT. METHODS:Seventy-five patients with BD and 40 age- and sex-matched healthy controls underwent comprehensive neurological and ophthalmological examinations. VEP was used to assess P100 latency and amplitude, while peripapillary retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses were measured using OCT. Subgroup analyses were performed according to neurological and ocular involvement. RESULTS:Mean disease duration was 9 ± 6 years (0-26 years). No significant differences were observed in P100 latency or amplitude between patients with BD and healthy controls, nor between BD subgroups. Subclinical optic neuropathy, defined as prolonged P100 latency exceeding mean + 2 SD, was identified in only one patient (1.33%) in just BD group. Mean RNFL and GCC thicknesses were comparable between groups and subgroups. CONCLUSIONS:Despite its inflammatory nature, silent optic neuropathy detectable by VEP appears to be uncommon in BD. Retinal involvement may not be expected in Behçet's disease patients with mild ocular involvement, no active ocular involvement, and an average disease duration of less than 10 years. Long term follow-up studies involving larger number of patients, especially with neurologic involvement, are needed.

OBJECTIVE:We aimed to explore the role of hyperventilation (HV) during routine EEG recordings in the diagnosis of adults with epilepsy. METHODS:During the COVID-19 pandemic we removed HV from routine EEG recordings due to the transmission risks. Routine EEGs conducted in the year before and after the COVID-19 pandemic were re-evaluated. RESULTS:A total of 167 HV + and 199 HV - EEGs were analyzed. To ensure comparability between the two groups with respect to age and conditions that could contraindicate HV, patients ≥ 55 years and with any conditions contraindicating HV were excluded from both groups. In patients with a diagnosis of epilepsy the prevalence of epileptiform abnormalities was 26.7 % in the HV + and 24.5 % in the HV - group (p = 0.727). CONCLUSIONS:This study did not reveal any evidence indicating that HV improves the diagnostic sensitivity of routine EEG in adults with epilepsy. In adults, hyperventilation during routine EEG recordings may be most useful in incre in patients with a history of absence seizures or seizures triggered by hyperventilation.

Background/aim:Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease. Several studies have shown that alterations of microbiota increase the risk of neurodegenerative disorders. We aimed to reveal whether there is a difference in the gut microbiota of patients with ALS. Materials and methods:The participants are divided into three groups. Group 1 comprised patients with ALS. Healthy family members living in the same house of the patients formed Group 2. Lastly, sex- and age-matched healthy people were included in Group 3. Fecal samples were collected in 15-mL falcon tubes and stored at -80 °C. Genomic DNA isolation was performed on samples. Bacterial primers selected from the 16S rRNA region for the bacterial genome and ITS1 and ITS4 (internal transcribed spacer) were used for the identification of DNA. Next generation sequence analysis (NGS) and taxonomic analyses were performed at the level of bacterial phylum, class, order, family, genus, and species. Alpha and beta diversity indexes were used. The linear discriminant analysis (LDA) effect size method (LEfSe) was applied to identify a microbial taxon specific to ALS disease. Results:The relative abundances of the Succinivibrionaceae and Lachnospiraceae families were significantly lower in patients. The dominant families among patients were Streptococcaceae and Ruminococcaceae, while the dominant families among healthy controls were Bacteroidaceae and Succinivibrionaceae. The LEfSe analysis revealed that four families (Atopobiaceae, Actinomycetaceae, Erysipelatoclostridiaceae, Peptococcacceae) differed significantly between the patients and healthy controls (LDA values> 2.5, p < 0.05). Conclusion:Comparison with family members living in the same house is the strength of this study. We found that there were changes in the microbiota of the patients, consistent with the literature. Studies that analyze the composition of the gut microbiota in the predisease period may be needed to understand whether dysbiosis is caused by the mechanisms inherent in the disease or whether it is dysbiosis that initiates the disease.

This study aimed to investigate the relationship between rosacea and headaches, focusing on different subtypes, as well as the associated clinical features and triggering factors. In this prospective study, 300 patients diagnosed with rosacea and 320 control subjects without rosacea or any connected mast cell activation illness were included. Patients with rosacea were assessed by a dermatologist according to the 2019 updated rosacea classification (ROSCO panel). Accordingly, patients were classified based on their predominant rosacea subtype as follows: erythematotelangiectatic (ETR), papulopustular (PPR), or phymatous (RhR). Patients experiencing headaches were assessed using the International Headache Classification. Headaches were categorized as migraine, tension-type headaches (TTHs), secondary types (STHs), and cluster-type headaches (CTHs). The ratio of headache was 30.3% in the rosacea group, which did not show a significant difference compared to the control group (30.3% vs. 25.0%, p = 0.138). In 81.3% of rosacea patients with headaches, headache onset occurred after the diagnosis of rosacea. The rate of patients with headaches was higher in the ETR group compared to the PPR and RhR groups (35.2% vs. 16.2% vs. 23.1%, p = 0.007, respectively). In terms of headache subtypes, the rates of patients with migraine and STHs were higher in the ETR group compared to the PPR and RhR groups, while the rate of patients with TTHs was higher in the RhR group. A positive correlation was found between rosacea severity and migraine severity (r = 0.284, p < 0.05). Among the triggering factors for rosacea, only sunlight was found to be associated with headaches. Lower age, female gender, and moderate to severe rosacea severity were identified as independent factors increasing the likelihood of headaches. A significant portion of rosacea patients experience headaches. Particularly, different subtypes of rosacea may be associated with various types of headaches. This study, highlighting the connection between migraine and ETR, is a pioneering work that demonstrates common pathogenic mechanisms and potential triggers.

The aim was to evaluate if foods, against which patient has IgG antibodies, trigger tension type headache (TTH). 22 patients (8 male, 14 female; 8 chronic TTH, 14 frequent episodic TTH) were recruited. The study had four periods: cooperation, provocation, free diet month and elimination were determined. At the cooperation perido patients’ cooperation abilities were checked. All patients were screened for 271 different antibodies against foods using Imupro300. Thus a list of food sensitivity was described for each patient. In provocation period,those detected foods were added to diet. In elimination period, those foods were eliminated from the diet with false foods added. In free diet month, there were no restrictions. Patients recorded the number of the days with headache as well as headache frequency, severity and duration and analgesic intake. These headache features in cooperation, provocation and elimination periods were compared. In the elimination period there was a significant decrease in the number of days with headache, headache frequency and duration in all patients. A significant increase in these three features were observed in the provocation period. In chronic TTH patients, only the number of the days with headache significantly increased in provocation period. IgG antibodies against foods may have a role in TTH. Number of days with headache, headache frequency and duration can be decreased by eliminating related foods from the diet, and this can be a part of the treatment. IgG antibodies against foods may be one of the pathophysiological mechanisms triggering TTH.

Previous neuropsychological data have equivocal suggestions concerning hemispheric involvement during idiom comprehension. The possible contribution of idioms transparency to the lateralization of figurative language comprehension has not been investigated using an interference technique. To analyse the cortical lateralization of idiom transparency processing, we employed inhibitory repetitive transcranial magnetic stimulation (rTMS) to the left and right dorsolateral prefrontal cortex (DLPFC) during the processing of opaque idioms, transparent idioms, and non-idiomatic literal phrases. Based on the Coarse Semantic Coding theory, we predicted a greater right hemisphere involvement when processing opaque than transparent idioms. Eighteen young healthy participants underwent rTMS pulses at 1 Hz frequency, 110% of motor threshold intensity for 15 min (900 pulses) in two sessions at one-week intervals. In a semantic decision task, participants judged the relatedness of an idiom and a target word. The target word was figuratively or literally related to the idiom, or unrelated. The study also included non-idiomatic sentences. We found that left DLPFC functions are more critical for comprehension of opaque rather than transparent idioms when referring to the figurative associations of the idioms. Opaque idioms, in the context of their figurative meaning, rely more heavily on left hemisphere resources. This finding suggests that opaque idioms are seemingly processed as one unit. Taken together, we believe that the transparency of idiomatic expressions may play an important role in modulating hemispheric functions involved in figurative language processing.

COVID-19, caused by severe acute respiratory syndrome coronavirus-2, typically presents with respiratory symptoms and fever, but still a variety of clinical presentations have been reported. In this study, it was aimed to report a case of COVID-19 with an atypical presentation and an atypical course. As well, the recovery phase was complicated with GBS and consequently cytomegalovirus infection. It should be kept in mind that patients with COVID-19 severe disease need to be followed for neurological and other complications which may arise during the course of critical illness.

The classically affected cranial nerve from intracranial hypertension is the sixth nerve. Carcinomatous meningitis can cause persistent or progressive cranial nerve palsies by infiltrating them in the subarachnoid space. Here we present a rare case of episodic, short-lasting, and unilateral oculomotor nerve palsy associated with carcinomatous meningitis and intracranial hypertension in a 44-year-old woman diagnosed with metastatic lung adenocarcinoma. As the survival rates enhance for metastatic cancers, neurologists should expect more perplexing neurologic presentations and consider leptomeningeal metastasis and intracranial hypertension in patients who have cancer and present with short episodes of diplopia and unilateral third nerve palsy.

Türkan Acar1, Esra Acıman Demirel2, Nazire Afşar3, Aylin Akçalı4, Gülşen Akman Demir5, Aybala Neslihan Alagöz6, Tuğçe Angın Mengi7, Ethem Murat Arsava8, Semih Ayta9, Nerses Bebek5, Başar Bilgiç5, Cavit Boz10, Arman Çakar5, Neşe Çelebisoy11, Mehmet Uğur Çevik12, Firuze Delen13, Hacer Durmuş Tekçe5, Hakan Ekmekçi14, Ayşe Deniz Elmalı5, Oğuz Osman Erdinç15, Füsun Ferda Erdoğan16, Fettah Eren17, Ufuk Ergün18, Yeşim Gülşen Parman5, Haluk Gümüş14, Demet İlhan Algın15, Rana Karabudak8, Ömer Karadaş19, Özlem Kayım Yıldız20, Emine Rabia Koç21, Demet Özbabalık Adapınar22, Atilla Özcan Özdemir15, Şerefnur Öztürk14*, Ayşe Sağduyu Kocaman3, Şevki Şahin23, Esen Saka Topçuoğlu8, Özden Şener24, F. İrsel Tezer8, Rıfat Erdem Toğrol25, Ayşe Bora Tokçaer26, Mehmet Akif Topçuoğlu8, Neşe Tuncer27, Ali Ulvi Uca28, Kayıhan Uluç27, Erdem Yaka29, Mehmet İlker Yön30 1Sakarya University Faculty of Medicine, Department of Neurology, Adapazari, Turkey 2Bulent Ecevit University Faculty of Medicine, Department of Neurology, Zonguldak, Turkey 3Acibadem Ecevit University Faculty of Medicine, Department of Neurology, Istanbul, Turkey 4Gaziantep University Faculty of Medicine, Department of Neurology, Gaziantep, Turkey 5Istanbul University Istanbul Faculty of Medicine, Department of Neurology, Istanbul, Turkey 6Kocaeli University Faculty of Medicine, Department of Neurology, Kocaeli, Turkey 7Nigde Training and Research Hospital, Clinic of Neurology, Nigde, Turkey 8Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey 9University of Health Sciences Turkey, Haseki Training and Research Hospital, Pediatric Neurology Unit, Istanbul, Turkey 10Karadeniz Technical University Faculty of Medicine, Department of Neurology, Trabzon, Turkey 11Ege University Faculty of Medicine, Department of Neurology, İzmir, Turkey 12Dicle University Faculty of Medicine, Department of Neurology, Diyarbakir, Turkey 13University of Health Sciences Turkey, Kanuni Sultan Suleyman Training and Research Hospital, Clinic of Neurology, Istanbul, Turkey 14Selcuk University Faculty of Medicine, Department of Neurology, Konya, Turkey 15Osmangazi University Faculty of Medicine, Department of Neurology, Eskisehir, Turkey 16Erciyes University Faculty of Medicine, Department of Neurology, Kayseri, Turkey 17University of Health Sciences Turkey, Konya Training and Research Hospital, Clinic of Neurology, Konya, Turkey 18Kırıkkale University Faculty of Medicine, Department of Neurology, Kirikkale, Turkey 19University of Health Sciences Turkey, Gulhane Training and Research Hospital, Clinic of Neurology, Ankara,Turkey 20Cumhuriyet University Faculty of Medicine, Department of Neurology, Sivas, Turkey 21Uludag University Faculty of Medicine, Department of Neurology, Bursa, Turkey 22Acıbadem Eskişehir Hospital, Department of Neurology, Eskisehir, Turkey

Amyotrophic lateral sclerosis (ALS) is a motor neuron disease eventually leading to death from respiratory failure. Recessive inheritance is very rare. Here, we describe the clinical findings in a consanguineous family with five men afflicted with recessive ALS and the identification of the homozygous mutation responsible for the disorder. The onset of the disease ranged from 12 to 35 years of age, with variable disease progressions. We performed clinical investigations including metabolic and paraneoplastic screening, cranial and cervical imaging, and electrophysiology. We mapped the disease gene to 9p21.1-p12 with a LOD score of 5.2 via linkage mapping using genotype data for single-nucleotide polymorphism markers and performed exome sequence analysis to identify the disease-causing gene variant. We also Sanger sequenced all coding sequences of SIGMAR1, a gene reported as responsible for juvenile ALS in a family. We did not find any mutation in SIGMAR1. Instead, we identified a novel homozygous missense mutation p.(His705Arg) in GNE which was predicted as damaging by online tools. GNE has been associated with inclusion body myopathy and is expressed in many tissues. We propose that the GNE mutation underlies the pathology in the family.

CONTEXT:There are controversial results and insufficient knowledge in the literature about the genetics of diabetes mellitus complications in the Turkish population and endothelial nitric oxide synthase (eNOS) gene polymorphisms may act as a potential modifier of diabetic vascular complications.OBJECTIVE:The objective of this study was to determine the association between eNOS G894T polymorphisms and diabetes-related diseases.DESIGN:A Turkish case-control study was designed.SETTING:The study was carried out in the Ankara University Hospital.PATIENTS OR OTHER PARTICIPANTS:Totally, 97 Turkish patients with diabetic foot ulcers and 102 controls were enrolled. Patients who had not received antimicrobial treatment in the preceding 6 months were included. Diabetic patients with hand and/or foot ulcers resulting from major trauma, such as road traffic accidents, were excluded.MAIN OUTCOME MEASURE:The effect of eNOS gene polymorphisms on diabetic complications and comorbid diseases was measured.RESULTS:Regarding eNOS G894T gene polymorphisms, 47.4% of the patients had GG (n = 46), 47.4% (n = 46) had GT, and 5.2% (n = 5) had TT alleles in the diabetes mellitus group, and 47.0% (n = 48), 41.2% (n = 42), and 11.8% (n = 12) had GG, GT, and TT alleles in the control group, respectively. There was no significant difference between the groups regarding the eNOS G894T gene allele ratios. Between groups with and without diabetic complications, a significant difference has only been found in the distribution of alleles in patients with comorbid atherosclerotic heart disease, whose GT-TT alleles were significantly higher than the GG alleles (p = 0.004).CONCLUSION:G894T polymorphism of eNOS gene was not associated with foot ulcer and diabetic complications, except in the presence of atherosclerotic heart disease.

Stem cell application is one of the potential treatment methods for seizing the progression of amyotrophic lateral sclerosis (ALS) and for returning motor function if ever possible. Several different methods of stem cell application have been performed in experimental motor neuron disease models; the beneficial effects of these studies are controversial. There are few stem cell studies on ALS patients reported in the literature. The results of these studies either negative or have serious methodological problems. There is no sufficient laboratory or clinical data for designing a stem cell application trial in ALS patients for today.