Restless legs syndrome (RLS) can be described by an urge to move limbs that typically coincides with an uncomfortable sensation. When at rest or inactivity, signs may start or develop worse; they ...usually go away when one moves or gets up for a walk. RLS can be both idiopathic or secondary to many kinds of health conditions, such as deficiency of iron, diabetes, obesity, hypothyroidism, and chronic renal failure. At the admission, secondary causes and iron tests, such as transferrin saturation and ferritin, must be evaluated. Assessments should be repeated when symptoms worsen, or when augmentation develops. Augmentation is a significant adverse effect of therapy by levodopa and dopamine agonists. More severe signs, early appearance of symptoms, and spreading of symptoms from the legs to other body parts are indicative of augmentation. Non-pharmacological treatments help some RLS patients control their symptoms. Iron-replacement therapy is a first-line treatment option for patients with indications of low body iron stores. The use of α2δ ligands as initial treatments instead of dopamine agonists has been recommended recently.
Huzursuz bacaklar sendromu (HBS), uzuvları hareket ettirme dürtüsünün tipik olarak rahatsız edici bir hisle örtüşmesiyle tanımlanabilir. Dinlenme veya hareketsizlik sırasında belirtiler başlayabilir veya daha kötü gelişebilir; genellikle kişi hareket ettiğinde veya yürüyüşe çıktığında kaybolurlar. HBS hem idiyopatik hem de demir eksikliği, diyabet, obezite, hipotiroidizm ve kronik böbrek yetmezliği gibi birçok sağlık durumuna sekonder olabilir. İlk başvuruda ikincil nedenler ve transferrin saturasyonu, ferritin gibi demir testleri değerlendirilmelidir. Semptomlar kötüleştiğinde veya augmentasyon geliştiğinde değerlendirmeler tekrarlanmalıdır. Augmentasyon, levodopa ve dopamin agonistleriyle yapılan tedavinin önemli bir olumsuz etkisidir. Belirtilerin daha şiddetli olması, belirtilerin erken ortaya çıkması ve belirtilerin bacaklardan diğer vücut bölgelerine yayılması augmentasyonun göstergesidir. Farmakolojik olmayan tedaviler bazı HBS hastalarının semptomlarını kontrol altına almasına yardımcı olur. Demir replasman tedavisi, vücut demir depolarının düşük olduğu belirtileri olan hastalar için birinci basamak tedavi seçeneğidir. Son zamanlarda dopamin agonistleri yerine başlangıç tedavileri olarak α2δ ligandlarının kullanılması önerilmiştir.
: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related ...dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency.
: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions.
: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers.
: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
Summary Rivastigmine is a well-known dual acting acetylcholinesterase and butyrylcholinesterase inhibitor, which is effective on behavioral and psychiatric symptoms including hallucinations, as well ...as cognitive symptoms of dementia. The most common adverse effects of rivastigmine related to cholinergic stimulation in brain and peripheral tissues are gastrointestinal, cardiorespiratory, extrapyramidal, genitourinary, musculoskeletal symptoms, sleep disturbances, and skin irritations with the transdermal patch form in particular. Despite to the previous reports revealing the improving effects of the drug on hallucinations, we presented a-80 year old women with Alzheimer's disease suffering from visual hallucinations whose complaints began with rivastigmine treatment. Since the patient had recent memory disturbance without any behavioral and/or psychiatric symptoms before rivastigmine administration, and visual hallucinations disappeared with the discontinuation of the drug, visual hallucinations were attributed to rivastigmine.
Background
Diabetes mellitus (DM) has been shown to increase the risk of Alzheimer’s disease (AD). Downregulation of selective Alzheimer’s disease indicator-1 (seladin-1) occurs in the cerebral ...regions affected by AD. However, inconsistent results have been reported for the relationship between seladin-1 levels and AD. The effect of DM on serum seladin-1 levels in AD is unknown. The present study is aimed to investigate serum seladin-1 levels in diabetic and non-diabetic patients with AD.
Methods
Forty-six patients with AD and 25 healthy volunteers over 65 years of age were included in this study. The patients were divided into three groups—those with AD only, those with DM and AD, and control groups. Demographic characteristics and serum seladin-1 levels were compared among the groups.
Results
There was no statistically significant difference in seladin-1 levels in the AD only group compared to the control group (
p
= 0.376). However, seladin-1 levels were significantly lower in the DM and AD group compared to the AD only and control groups (
p
= 0.002,
p
= 0.001; respectively). Negative correlations were present between seladin-1 and fasting glucose, postprandial glucose, HbA1c, and insulin (
p
< 0.05; all).
Conclusion
Decreased serum seladin-1 values in the presence of DM and inverse correlations with diabetic parameters in patients with AD, together with a non-significant difference from the control group, suggests that seladin-1 may be altered only in the presence of DM in patients with AD. Lower serum seladin-1 levels may also play a role in the pathogenesis of AD in patients with DM.
Aim: Aim of this study is to determine socio-demographic and disease features of patients who underwent Botulinum toxin injections, and to present our clinical experience via documenting intervals of ...Botulinum toxin injections and effect-side effect profiles.Material and Methods: Socio-demographic features of patients and characteristic features of Botulinum toxin treatment were recorded. The diagnosis of the patients who underwent Botulinum toxin injections, disease durations and the onset of Botulinum toxin treatments were investigated. Possible side-effects were recorded.Results: Thirty-two patients (20 men, 12 women) with the diagnosis of various types of movement disorders were enrolled the study. Mean age of patients was 60.65±14.40 years (range= 22-83 years). Diagnosis of the patients who underwent Botulinum toxin injections were cervical dystonia, blepharospasm, clonic hemifacial spasm, focal hand dystonia/writer’s cramp, oromandibular dystonia, and dystonic tremor. All patients had repetitive Botulinum toxin injections. There were no remarkable adverse effects, other than mild temporary bruises in injection site in two patients with blepharospasm.Conclusion: Botulinum toxin is an important treatment option in patients with focal dystonia. Botulinum toxin as a neurotoxin of Clostridium botulinum bacteria, suppresses muscle contractions via inhibiting acetylcholine release to the synaptic gap. This reversible effect lasts three to four months due to the neuronal sprouting. It is important to share clinical experiences, data of Botulinum toxin outpatient clinics or clinics from the movement disorders perspective to increase awareness of Botulinum toxin effectivity in patients with movement disorders, focal dystonia particularly.
Amaç: Bu çalışmanın amacı Botulinum toksin enjeksiyonu uygulanan hastaların sosyodemografik özellikleri ve hastalık özelliklerinin belirlenmesi, ve Botulinum toksin uygulama aralıkları ile etki ve yan etki profillerini dokümante ederek klinik deneyimimizin sunulmasıdır.Gereç ve Yöntemler: Hastaların sosyodemografik özellikleri ve Botulinum toksin tedavisinin karakteristik özellikleri kaydedilmiştir. Botulinum toksin enjeksiyonu yapılan hastaların hastalık tanıları, hastalık süreleri ve Botulinum toksin tedavisine başlama süreleri incelenmiştir. Olası yan etkiler kaydedilmiştir.Bulgular: Çeşitli hareket hastalıkları tanısı almış otuz iki hasta (20 erkek, 12 kadın) çalışmaya dahil edilmiştir. Hastaların yaş ortalaması 60.65±14.40 yaştır (aralık= 22-83 yaş). Botulinum toksin enjeksiyonu uygulanan hastaların tanıları servikal distoni, blefarospazm, klonik hemifasiyal spazm, fokal el distonisi/yazıcı krampı, oromandibular distoni ve distonik tremordur. Tüm hastalara tekrarlayan Botulinum nörotoksin enjeksiyonları yapılmıştır. İki blefarospazm hastasında enjeksiyon bölgesinde izlenen hafif morluklar dışında, hastalarda belirgin yan etki görülmemiştir.Sonuç: Botulinum toksin fokal distonili hastalarda önemli bir tedavi seçeneğidir. Clostridium botulinum bakterisinin nörotoksini olan Botulinum nörotoksin, sinaptik aralığa asetilkolin salınımını engelleyerek kas kasılmasını baskılamak üzere çalışır. Geri dönüşümlü olan bir etki ile nöronal filizlenmenin süresiyle ilişkili olarak yaklaşık üç ila dört ay kadar sürmektedir. Özellikle fokal distoni gibi hareket bozuklukları hastalarında Botulinum toksin etkinliğine ilişkin farkındalığı arttırmak amacıyla ve hareket hastalıkları perspektifinden Botulinum toksin poliklinik veya kliniklerinin klinik deneyimlerini ve verilerini paylaşmak önem arz etmektedir.
To investigate subjective sleep quality among women in the menopausal period and to confirm and diagnose the possible sleep disturbances with polysomnographic (PSG) evaluation objectively.
...Sixty-seven women with menopause were enrolled in the study. Sociodemographic characteristics and the features of menopause were recorded. We assessed subjective sleep quality with Pittsburg Sleep Quality Index (PSQI). To confirm sleep disturbances and further diagnose the underlying cause, PSG evaluation was performed to women with PSQI scores of >5 who gave their approval.
Mean PSQI score of women with normal PSG evaluation was 12.00±3.16, while it was 11.00±2.32 in women with abnormal PSG evaluation (p=0.466); 59.7% (n=40) of women had poor sleep quality. Among these, 11 (64.7%) had abnormal results in the PSG evaluation and were diagnosed with obstructive sleep apnea syndrome (OSAS); 54.5% had mild OSAS, 27.3% had moderate, and 18.2% had severe OSAS.
PSQI and PSG evaluations would give a chance to demonstrate sleep problems and shed a light on treatment options according to the underlying causes of sleep disturbances in menopause.
Current DBS programming Değirmenci, Yıldız
Deep Brain Stimulation,
June 2024, Letnik:
4
Journal Article
Odprti dostop
Deep brain stimulation is an established treatment option for various neurological and psychiatric disorders. Throughout its journey as a confirmed long-term efficacious therapeutic option for ...movement disorders such as Parkinson’ s disease, essential tremor and dystonia over the last three decades, programming strategies continuously improved to due to the development of DBS technologies. The aim of this review is to take a glance into current programming strategies in the era of movement disorders particularly with an updated review of the literature for current and emerging DBS technologies.
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