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    Could tear endothelin-1 levels be associated with disability in multiple sclerosis?
    (Asean Neurological Assoc, 2023) Cam, Mustafa; Sehitoglu, Hilal
    Background: Endothelin-1 (ET-1) is a potent vasoconstrictor substance mainly secreted by endothelial cells. Increased ET-1 levels in plasma or cerebrospinal fluid (CSF) have been identified in multiple sclerosis (MS). We aimed to analyze tear ET-1 levels; visual evoked potential (VEP) and disability scores in patients with MS and in healthy controls. Methods: Adult patients (18-65 year-old) diagnosed with MS according to the McDonald criteria, and healthy controls were recruited for the study. Demographic features, VEP, and tear ET-1 levels were evaluated. Disability in the MS group was assessed and grouped by EDSS score (<3 vs. >= 3). The EDSS score in healthy controls was zero. Results: Both in the total number of patients overall and in the patients with EDSS score <3, tear ET-1 levels were higher in the MS group than that in the controls (p<0.001). In the MS group, the ET-1 level was higher in the patients with EDSS score >= 3 than in those with EDSS score <3 (p<0.001). The tear ET-1 level was positively correlated with age and EDSS score in the MS group (p<0.001). Conclusion: To the best of our knowledge, there is no study in the literature that measures tear ET-1 levels in MS and examines their relationship with EDSS score and VEP. Higher tear ET-1 levels seem to be associated with disability and abnormal VEP in MS. Tear ET-1 measurement may be a simple new noninvasive marker indicating the disability in the patients with MS in the future.
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    Evaluation of iris epithelial and stromal thickness in patients with migraine by using optical coherence tomography
    (Asean Neurological Assoc, 2022) Cam, Mustafa; Arikan, Sedat
    Objective: The amount of light reaching to the retina is an important factor for photophobia formation. Therefore, investigation of iris thickness in patients with migraine can be valuable for revealing their susceptibility to photophobia. In this study, it was aimed to evaluate the iris epithelial and stromal thickness, retinal ganglion cell layer (RGCL) thickness, and retinal nerve fibre layer (RNFL) thickness of patients with migraine. Methods: Forty-nine migraine patients (Group 1) and 50 control participants (Group 2) were included into this study. For obtaining standard measure in all participants, the epithelial and stromal thickness of dilatory and sphincter iris muscle was measured from the equal distance to the pupillary margin by using anterior segment mode of optical coherence tomography (AS-OCT). Additionally, RNFL and RGCL thicknesses were measured by using posterior segment mode of OCT (PS-OCT). Results: The epithelial thickness of iris sphincter muscle and the epithelial thickness of iris dilatory muscle was found to be significantly higher in patients with migraine compared to control subjects (p<0.001, p=0.001 respectively). Additionally the stromal thickness of both iris sphincter and iris dilatory muscle (p<0.001, p<0.001 respectively) as well as the total thickness of iris sphincter and iris dilatory muscle was significantly higher in patients with migraine than control subjects (p<0.001, p=0.02 respectively). However, no significant difference was found between patients with migraine and control subjects in terms of RNFL and RGCL thicknesses (p=0.1 and p=0.7 respectively). Conclusion: The finding of high epithelial and stromal iris thickness in patients with migraine may support the possible role of increased pupillary dynamic in photophobia formation.
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    Evaluation of Retinal Morphology and Contrast Sensitivity Function in Patients with Restless Legs Syndrome
    (Galenos Publ House, 2022) Cam, Mustafa; Yildiz, Aydin; Arikan, Sedat
    Objective: The decreased number of dopamine receptors in the putamen are considered to play an important role in the pathophysiology of restless legs syndrome (RLS). Retinal dopamine plays an important role in contrast sensitivity (CS) by establishing communication between retinal cells. It is also suggested that retinal dopaminergic neurons protect other retinal neurons. In this study, we aimed to investigate the thickness of retinal layers and CS function (CSF) of patients with RLS. Materials and Methods: A total of 68 participants were included in this prospective case-control study. The participants were divided into two groups as those with RLS (n=35) in group 1 and control subjects (n=33) in group 2. Optical coherence tomography was used to measure central macular thickness, retinal nerve fiber layer thickness (RNFL), and retinal ganglion cell inner plexiform layer thickness (GCIPL). RNFL thickness was measured as average and as sectoral (superior, inferior, nasal and temporal). Additionally, the CS test measured at all spatial frequencies of 1.5, 3, 6, 12 and 18 cycle per degree (cpd) was performed in all participants. Results: The average and superior sectoral RNFL thicknesses in group 1 were statistically significantly thinner than group 2 (p=0.03 and p=0.01 respectively). However, the thicknesses of other RNFL sectors were not different between group 1 and group 2. There were no statistically significant differences between group 1 and group 2 regarding the thicknesses of GCIPL and central macula. The mean values of CSF at all spatial frequencies of 1.5 cpd, 3 cpd, 6 cpd, 12 cpd and 18 cpd were statistically significantly higher in group 2 in comparison to group 1 (p<0.001 for all spatial frequencies). Conclusion: The decreased thickness of retinal layers and reduced CSF in patients with RLS support retinal dopaminergic dysfunction.
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    Evaluation of upper endoscopic findings in patients with restless legs syndrome and gastric complaints
    (Assoc Arquivos Neuro- Psiquiatria, 2020) Cam, Mustafa; Kutluana, Ufuk
    Background: The effect of gastrointestinal system disorders on Restless Legs Syndrome/Willis-Ekbom disease (RLS/WED) has been previously demonstrated by using serological tests. However, this association has not been supported by histopathological studies so far. Objective: To investigate the relationship between RLS/WED, upper endoscopic imaging and histopathological results in patients diagnosed with RLS who underwent endoscopy because of gastrointestinal system (GIS) complaints. Methods: Case-control study, including 100 patients diagnosed with RLS who presented dyspeptic complaints and underwent upper GIS endoscopy and 106 age- and sex-matched controls. RLS diagnosis was evaluated according to the four main diagnostic criteria determined by the International RLS Study Group. All patients underwent upper GIS endoscopic intervention and at least one gastric and/or antral biopsy. Results: There was no significant difference between patients and controls in relation to endoscopically seen gastric ulcer, duodenal ulcer, gastroesophageal reflux disease (GERD) findings and Helicobacter pylori (HP) positivity (p>0.05). Intestinal metaplasia and mucosal atrophy were more common in RLS/WED patients compared to controls (p=0.026 and p=0.017, respectively). Additionally, ferritin levels were found to be lower than the reference value. Conclusions: The detection of increased severity of intestinal metaplasia, mucosal atrophy, and gastric inflammation in RLS/WED patients with dyspeptic complaints may entail the close gastrointestinal system evaluation of these patients. However, larger randomized and controlled trials are required on this subject where patients are evaluated by upper GIS endoscopic biopsy.
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    The Relationship of Thyroid Hormone Levels and Motor Symptoms in Parkinson's Disease
    (Duzce Univ, Fac Medicine, 2022) Ocak, Ozgul; Şahin, Erkan Melih; Cam, Mustafa
    Aim: This study aimed to investigate the relationship between thyroid hormone levels and the motor symptoms of Parkinson's patients. Material and Methods: Neurology clinic logs of the patients diagnosed with Parkinson's disease and whose thyroid function tests were measured between 01.01.2018 and 01.04.2021 were selected. Those with primary thyroid hormone disorder were excluded. Motor symptom stages were determined according to the modified Hoehn and Yahr scale (mHYS) by records. According to the thyroid function test results, whether there was a difference in motor symptoms, duration of the disease, and effects of the drugs were examined. Results: Of the 93 patients included in the study, 53 (57.0%) were male and 40 (43.0%) were female. The median age of the patients was 71 years. The motor symptoms of the patients were classified as stage 1 in 21 (22.6%), stage 1.5 in 18 (19.4%), stage 2 in 29 (31.2%), stage 2.5 in 13 (14.0%), stage 3 in 4 (4.3%), stage 4 in 6 (6.5%), and stage 5 in 2 (2.2%) patients. The median levels of TSH, fT3, and fT4 were 2.075 uIU/ml, 2.925 ng/dl, and 1.235 ng/dl, respectively. There was no significant correlation between the mHYS stages of the patients and TSH (r=-0.148, p=0.164), fT3 (r=-0.073, p=0.623), and fT4 levels (r=0.075, p=0.491). Conclusion: There was no relationship between the severity of motor symptoms and hormone levels in patients with normal thyroid functions. Thyroid dysfunction may mimic many motor findings, but they do not affect the severity of motor findings in Parkinson's patients.