Ayşe Bora Tokçaer - Academia.edu (original) (raw)

Papers by Ayşe Bora Tokçaer

Research paper thumbnail of 1.105 Susceptibility to Compression Neuropathy in Parkinson's Disease

Parkinsonism & Related Disorders, 2012

Research paper thumbnail of Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial

Turkish Journal of Medical Sciences, Aug 8, 2019

Introduction Parkinson's disease (PD) is a progressive and degenerative disorder characterized by... more Introduction Parkinson's disease (PD) is a progressive and degenerative disorder characterized by an inadequate production of dopamine due to pathology in the substantia nigra. Rigidity, bradykinesia, and postural instability are the cardinal features that lead to gait impairment and functional limitations [1]. Gait and balance impairments are important determinants of disability and quality of life in PD [2]. Overall, fatigue is one of the most common and disabling nonmotor symptoms and can be seen at all stages of the disease [3]. Aerobic training with treadmill training (TT) is effective in improving the gait, balance, and quality of life and relieving fatigue in subjects with PD [4,5]. Body weight-supported treadmill training (BWSTT) allows safe walking practice by supporting a portion of the body weight mechanically and stimulates activity-dependent neural plasticity [6]. Furthermore, physical performance and aerobic activities can be performed at higher intensities when the body weight is partially supported during walking compared to conventional TT [7]. This is especially beneficial in the rehabilitation of neurologically Background/aim: Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD. Materials and methods: Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. Results: The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS-motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002). Conclusion: Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.

Research paper thumbnail of Dopamine transporter SPECT imaging in Parkinson’s disease and parkinsonian disorders

Turkish Journal of Medical Sciences, Apr 30, 2021

The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminer... more The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminergic function of presynaptic terminals which is valuable for the differential diagnosis of parkinsonian disorders related to a striatal dopaminergic deficiency from movement disorders not related a striatal dopaminergic deficiency. DAT imaging with single-photon emission computed tomography (SPECT) can be used to confirm or exclude a diagnosis of dopamine deficient parkinsonism in cases where the diagnosis is unclear. It can also detect the dopaminergic dysfunction in presymptomatic subjects at risk for Parkinson's disease (PD) since the reduced radiotracer binding to DATs in striatum is already present in the prodromal stage of PD. This review covers the rationale of using DAT SPECT imaging in the diagnosis of PD and other parkinsonian disorders, specifically focusing on the practical aspects of imaging and routine clinical indications.

Research paper thumbnail of The Reliability and Validity of the Manual Ability Measure-36 in Patients with Parkinson’s Disease

Turkish Journal Of Neurology, Jun 20, 2022

Re cei ved/Ge lifl Ta ri hi: 09.12.2021 Ac cep ted/Ka bul Ta ri hi: 13.03.2022 Objective: Althoug... more Re cei ved/Ge lifl Ta ri hi: 09.12.2021 Ac cep ted/Ka bul Ta ri hi: 13.03.2022 Objective: Although impaired manual dexterity is one of the most disabling symptoms in patients with Parkinson's disease (PD), there is no reliable and valid patient-reported outcome measure (PROM) for assessing dexterity. Therefore, this study aimed to investigate: (1) The test-retest reliability of the manual ability measure-36 (MAM-36) in patients with PD; (2) the minimum detectable change (MDC) in the MAM-36 scores; (3) the concurrent and known-groups validity of the MAM-36 scores; and (4) the cutoff score that best discriminates patients with PD from healthy individuals. Materials and Methods: This was a cross-sectional study. The MAM-36 was repeated after 4 weeks to determine the test-retest reliability which was calculated with the intraclass correlation coefficient (ICC), Bland-Altman plots, and MDC. The concurrent validity was assessed using correlations between the MAM-36 and nine-hole peg test, Movement Disorders Society Unified Parkinson's Disease Rating scale (MDS-UPDRS), MDS-UPDRS II, MDS-UPDRS III, Hoehn and Yahr stage, and 8-item PD questionnaire. The known-groups validity was determined by comparing the MAM-36 scores between patients with PD and healthy individuals. Receiver operating characteristic analysis was used to determine the cutoff score for the MAM-36 to best discriminate patients with PD from healthy individuals. Results: Thirty six patients with PD and 32 healthy individuals were included. Excellent test-retest reliability was found (ICC: 0.953). The Bland-Altman plot demonstrated a high agreement. The MDC was 2.33. The MAM-36 had fair to high correlations with the other outcome measurements (correlation coefficients ranged from-0.473 to-0.763, p<0.05 for all). Patients with PD had lower scores than healthy individuals in terms of the MAM-36 (p<0.001). The cutoff score of 76.50 best distinguished patients with PD from healthy individuals. Conclusion: The MAM-36 is a reliable and valid measurement for assessing manual dexterity in patients with PD. It is also the only clinically available PROM in assessing manual dexterity for patients with PD in the Turkish population.

Research paper thumbnail of Detection of EEG background abnormalities in epilepsy by a new spectral index

Clinical Neurophysiology, Apr 1, 2005

Objective: In epileptic disorders, EEG background activity is disorganized in or near the epilept... more Objective: In epileptic disorders, EEG background activity is disorganized in or near the epileptogenic focus and spectral EEG analysis (SEA) can provide useful information about the focus. We tried to develop a new spectral index from basic spectral parameters to detect the epileptic abnormalities at EEG background activity. Methods: A new spectral EEG index, epileptic abnormality index (EAI), was constructed from frequency band power and power asymmetry parameters. Within the index, parameters were weighted due to both conventional EEG knowledge and their power in discrimination healthy subjects from patients. EEG background activity from 99 epileptic patients and 146 healthy subjects was examined both by EAI and by a conventional SEA method, by using z-scoring statistic. Each test results were compared with visual EEG interpretation of subjects. Results: In patient groups, EAI was most successful in lateralization of epileptic abnormalities. It was also helpful in discrimination of epileptic patients from normals in the case where visual EEG interpretation was 'normal'. Conclusions: EAI depends on basic spectral parameters and it combines statistical methods and clinical knowledge about EEG. It increases the analysis capacity of SEA in evaluation of EEG background activity. Significance: EAI is a new and useful approach in detection of EEG background abnormalities in epilepsy and its logical base can also be used in the detection of brain electrical activity abnormalities other than epileptic disorders.

Research paper thumbnail of Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer’s disease

Irish Journal of Medical Science, Jan 19, 2023

Research paper thumbnail of Turkish Standardization of Movement Disorders Society Unified Parkinson's Disease Rating Scale and Unified Dyskinesia Rating Scale

Movement Disorders Clinical Practice, 2017

Background: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and U... more Background: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) were developed as standard tools to rate Parkinson's disease (PD) and drug-induced dyskinesias of PD. As these scales have become widely used, there is a need for translation to non-English languages. Here we present the standardization for the Turkish translations. Methods: The scales were translated into Turkish and then back-translated to English. These backtranslations were reviewed by the MDS team. After cognitive pretesting, movement disorder specialists from nine centers tested 352 patients for MDS-UPDRS, and 250 patients for UDysRS. Confirmatory factor analyses (CFAs) were used to determine if the factor structures for the reference standards could be confirmed in the Turkish data. The comparative fit indexes (CFIs) for the scales were required to be 0.90 or higher. Exploratory factor analyses (EFAs) were conducted to explore the underlying factor structure without the constraint of a pre-specified factor structure. Results: For both scales, the CFIs were 0.94 or greater as compared to the reference standard factor structures. The factor structures were consistent with that of reference standards, although there were some differences in some areas as compared to the EFA of the reference standard dataset. This may be due to the inclusion of patients with different stages of PD and different cultural properties of raters and patients. Conclusions: These results demonstrate that the Turkish translations of MDS-UPDRS and UDysRS have adequate clinimetric properties. They are established as the official translations and can be reliably used in Turkish speaking populations.

Research paper thumbnail of Treatment of Tremor with Botulinum Toxin

Research paper thumbnail of Brain SPECT evaluation of patients with pure photosensitive epilepsy

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1996

This study was performed to determine the utility of 99mTc-HMPAO brain SPECT in evaluating patien... more This study was performed to determine the utility of 99mTc-HMPAO brain SPECT in evaluating patients with pure photosensitive epilepsy. Seven patients (2 boys, 5 girls), aged 8 to 15 yr (mean 11.1 +/- 2.5 yr), were studied. All patients underwent a detailed neurologic examination, interictal and ictal EEGs, CT and/or MRI and SPECT imaging. The baseline SPECT study was performed during the interictal period and the activation study was performed while the patients were having seizures provoked by watching television. The baseline SPECT study showed that six of seven patients had relatively hypoperfused regions in their frontal lobes that could involve the neighboring parietal and temporal regions. The activation study revealed that all seven patients had relative hyperperfusion in these brain regions that were relatively hypoperfused in the baseline study. The side-to-side asymmetry indexes for these visually-interpreted rCBF abnormalities ranged from 3% to 6%. The relatively consiste...

Research paper thumbnail of Detection of EEG background abnormalities in epilepsy by a new spectral index

Clinical Neurophysiology, 2005

Objective: In epileptic disorders, EEG background activity is disorganized in or near the epilept... more Objective: In epileptic disorders, EEG background activity is disorganized in or near the epileptogenic focus and spectral EEG analysis (SEA) can provide useful information about the focus. We tried to develop a new spectral index from basic spectral parameters to detect the epileptic abnormalities at EEG background activity. Methods: A new spectral EEG index, epileptic abnormality index (EAI), was constructed from frequency band power and power asymmetry parameters. Within the index, parameters were weighted due to both conventional EEG knowledge and their power in discrimination healthy subjects from patients. EEG background activity from 99 epileptic patients and 146 healthy subjects was examined both by EAI and by a conventional SEA method, by using z-scoring statistic. Each test results were compared with visual EEG interpretation of subjects. Results: In patient groups, EAI was most successful in lateralization of epileptic abnormalities. It was also helpful in discrimination of epileptic patients from normals in the case where visual EEG interpretation was 'normal'. Conclusions: EAI depends on basic spectral parameters and it combines statistical methods and clinical knowledge about EEG. It increases the analysis capacity of SEA in evaluation of EEG background activity. Significance: EAI is a new and useful approach in detection of EEG background abnormalities in epilepsy and its logical base can also be used in the detection of brain electrical activity abnormalities other than epileptic disorders.

Research paper thumbnail of How satisfied are cervical dystonia patients after 3 years of botulinum toxin treatment?

Research paper thumbnail of Functional Surgery in Parkinson’s Disease; Programming and Medication Adjustment in the Stabilization Period of Deep Brain Stimulation

Journal of Parkinson’s Disease and Movement Disorders, 2016

Being used in the treatment of advanced Parkinson's disease, deep brain stimulation treatment is ... more Being used in the treatment of advanced Parkinson's disease, deep brain stimulation treatment is a method that requires close follow-up of the patient in the postoperative period. Surgical targets are predominantly subthalamic nucleus and sometimes globus pallidus internus, and also the thalamus ventral intermediolateral (VIM) nucleus for tremor-dominant Parkinson's disease patients. Programming the stimulator differs for each target and the dopaminergic drugs are slowly reduced during the patient's neuromodulation. Intrinsic and extrinsic side effects should be carefully tracked during the voltage adjustment in follow-ups and the patient should be controlled by optimal treatment.

Research paper thumbnail of Dopamin Agonistleri ve Fibrotik Yan Etkileri

Turkiye Klinikleri Journal of Neurology Special Topics, 2008

Research paper thumbnail of Parkinson Hastalığında Genetik

Turkiye Klinikleri Journal of Neurology Special Topics, 2012

Research paper thumbnail of The coin rotation test: a reliable and valid test in people with Parkinson's disease

Disability and Rehabilitation, 2022

PURPOSE To investigate: (1) the interrater, and test-retest reliability of the coin rotation test... more PURPOSE To investigate: (1) the interrater, and test-retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD. METHOD Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale. RESULTS The CRT had excellent interrater and test-retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD. CONCLUSIONS The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD.Implications for rehabilitationThe coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease.The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention.The coin rotation test correlated with Parkinson's Disease-specific measurement tools.The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.

Research paper thumbnail of The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease

Disability and Rehabilitation, 2022

PURPOSE To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight wa... more PURPOSE To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD. METHODS This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The F8WT showed good interrater and test-retest reliability (ICC = 0.964-0.978 and ICC = 0.905-0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD. CONCLUSIONS The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD.Implications for rehabilitationThe figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD).The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention.The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD.The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.

Research paper thumbnail of Autonomic nervous system dysfunction and serum levels of neurotoxic and neurotrophic cytokines in patients with cobalamin deficiency

Turkish journal of haematology : official journal of Turkish Society of Haematology, 2010

OBJECTIVE The imbalance between neurotoxic cytokine tumor necrosis factor-α (TNF-α) and neurotrop... more OBJECTIVE The imbalance between neurotoxic cytokine tumor necrosis factor-α (TNF-α) and neurotrophic cytokines epidermal growth factor (EGF) and interleukin-6 (IL-6) plays a role in the pathogenesis of cobalamin (Cbl) deficiency-induced neuropathy. The aim of this study was to evaluate autonomic nervous system dysfunction and to look for any relationship between autonomic nervous system disturbances and serum cytokine levels (TNF-α, EGF, IL-6) in patients with Cbl deficiency. METHODS Serum levels of TNF-α, EGF and IL-6 were studied in patients with Cbl deficiency (n=41) and a healthy control group (n=17) and after 3 months in patients who underwent Cbl replacement therapy (n=22). All patients with Cbl deficiency underwent electrophysiological studies (EPS) for the diagnosis of neuropathy. Statistical analysis was performed using SPSS for Windows 11.5 software. RESULTS With EPS, 29 of 41 Cbl-deficient patients (70.73%) demonstrated neurological dysfunction [3 (7.32%), 19 (46.34%) and...

Research paper thumbnail of The COVID-19 Pandemic and Neurology

Türkan Acar1, Esra Acıman Demirel2, Nazire Afşar3, Aylin Akçalı4, Gülşen Akman Demir5, Aybala Nes... more 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 ...

Research paper thumbnail of Hareket Bozuklukları Fenomenolojisi

Research paper thumbnail of The Role of the Dopamine β-hydroxylase Functional Polymorphism in Patients with Early-Onset Parkinson’s Disease in the Turkish Population

Turkish Journal Of Neurology, 2021

Objective: A functional single nucleotide polymorphism, rs1611115, in the dopamine β-hydroxylase ... more Objective: A functional single nucleotide polymorphism, rs1611115, in the dopamine β-hydroxylase (DBH) gene, is reported to regulate plasma enzyme activity levels. Here, we report the first evaluation of this association in patients with early-onset Parkinson's disease (EOPD) and healthy controls in the Turkish population. Materials and Methods: We evaluated the DBH rs1611115 polymorphism in 114 (64 male and 50 female) Turkish patients with EOPD and 58 sex-and agematched healthy controls from the Turkish population. A total of 27.2% (n=31) of our patients who had any variation including pathogenic or non-pathogenic missense, nonsense and/or intronic variation with unknown significance in EOPD genes were grouped as "variation-positive EOPD". A total of 50.8% (n=58) of our patients were grouped as "variation and family history-negative EOPD" and the possible contribution of the DBH rs1611115 polymorphism to EOPD pathogenesis was evaluated in this group. Results: There was no significant difference in the genotypic and allelic frequencies of DBH rs1611115 between patients with EOPD and controls. To our knowledge, this is the first evaluation of the DBH rs1611115 polymorphism in patients with EOPD and ethnically matched controls in the Turkish population. Conclusion: Some previous studies have reported conflicting association results between DBH rs1611115 polymorphism and PD pathogenesis in different ethnic groups. Therefore, further studies are needed to evaluate dopamine metabolism-related genetic variants and to determine their possible roles in EOPD susceptibility in the Turkish population.

Research paper thumbnail of 1.105 Susceptibility to Compression Neuropathy in Parkinson's Disease

Parkinsonism & Related Disorders, 2012

Research paper thumbnail of Effects of different percentages of body weight-supported treadmill training in Parkinson’s disease: a double-blind randomized controlled trial

Turkish Journal of Medical Sciences, Aug 8, 2019

Introduction Parkinson's disease (PD) is a progressive and degenerative disorder characterized by... more Introduction Parkinson's disease (PD) is a progressive and degenerative disorder characterized by an inadequate production of dopamine due to pathology in the substantia nigra. Rigidity, bradykinesia, and postural instability are the cardinal features that lead to gait impairment and functional limitations [1]. Gait and balance impairments are important determinants of disability and quality of life in PD [2]. Overall, fatigue is one of the most common and disabling nonmotor symptoms and can be seen at all stages of the disease [3]. Aerobic training with treadmill training (TT) is effective in improving the gait, balance, and quality of life and relieving fatigue in subjects with PD [4,5]. Body weight-supported treadmill training (BWSTT) allows safe walking practice by supporting a portion of the body weight mechanically and stimulates activity-dependent neural plasticity [6]. Furthermore, physical performance and aerobic activities can be performed at higher intensities when the body weight is partially supported during walking compared to conventional TT [7]. This is especially beneficial in the rehabilitation of neurologically Background/aim: Body weight-supported treadmill training (BWSTT) might have greater effects than conventional treadmill training (TT) in neurological diseases such as Parkinson's disease (PD). The aim of this study was to evaluate the effects of different percentages of BWSTT on gait, balance, quality of life, and fatigue in PD. Materials and methods: Thirty-five patients with moderate to advanced PD were randomized into three BWSTT groups according to the supported percentage of body weight: 0% BWSTT (control group; unsupported TT), 10% BWSTT, or 20% BWSTT. Five patients were excluded due to early discharge and 30 patients completed BWSTT sessions lasting 30 min, 5 days a week, for 6 weeks during their inpatient rehabilitation stay. The primary outcome was 6-min walk distance (6MWD). Secondary outcomes were Unified Parkinson's Disease Rating Scale (UPDRS), Berg Balance Scale (BBS), Nottingham Health Profile (NHP), Fatigue Impact Scale, and Fatigue Severity Scale scores. Measurements were performed before and after the training. Results: The unsupported TT group demonstrated no significant improvement in the outcome measures after a 6-week training except for BBS and NHP emotional subscores. Moreover, the NHP pain subscore increased in the unsupported TT group after training. The 10% and 20% supported BWSTT groups demonstrated significant improvements in 6MWD (P = 0.004 and P < 0.001, respectively), UPDRS-motor score (P = 0.012 and P = 0.005, respectively), NHP pain subscore (P = 0.003 and P = 0.002, respectively), and fatigue (P = 0.005 for both) after training. The 20% BWSTT provided the highest improvement in balance among the three groups (P < 0.001) and greater relief of fatigue than 10% BWSTT (P = 0.002). Conclusion: Six weeks of BWSTT improved walking distance and balance ability, relieved fatigue, and additionally reduced pain in patients with moderate to advanced PD.

Research paper thumbnail of Dopamine transporter SPECT imaging in Parkinson’s disease and parkinsonian disorders

Turkish Journal of Medical Sciences, Apr 30, 2021

The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminer... more The dopamine transporter (DAT) imaging provides an objective tool for the assessment of dopaminergic function of presynaptic terminals which is valuable for the differential diagnosis of parkinsonian disorders related to a striatal dopaminergic deficiency from movement disorders not related a striatal dopaminergic deficiency. DAT imaging with single-photon emission computed tomography (SPECT) can be used to confirm or exclude a diagnosis of dopamine deficient parkinsonism in cases where the diagnosis is unclear. It can also detect the dopaminergic dysfunction in presymptomatic subjects at risk for Parkinson's disease (PD) since the reduced radiotracer binding to DATs in striatum is already present in the prodromal stage of PD. This review covers the rationale of using DAT SPECT imaging in the diagnosis of PD and other parkinsonian disorders, specifically focusing on the practical aspects of imaging and routine clinical indications.

Research paper thumbnail of The Reliability and Validity of the Manual Ability Measure-36 in Patients with Parkinson’s Disease

Turkish Journal Of Neurology, Jun 20, 2022

Re cei ved/Ge lifl Ta ri hi: 09.12.2021 Ac cep ted/Ka bul Ta ri hi: 13.03.2022 Objective: Althoug... more Re cei ved/Ge lifl Ta ri hi: 09.12.2021 Ac cep ted/Ka bul Ta ri hi: 13.03.2022 Objective: Although impaired manual dexterity is one of the most disabling symptoms in patients with Parkinson's disease (PD), there is no reliable and valid patient-reported outcome measure (PROM) for assessing dexterity. Therefore, this study aimed to investigate: (1) The test-retest reliability of the manual ability measure-36 (MAM-36) in patients with PD; (2) the minimum detectable change (MDC) in the MAM-36 scores; (3) the concurrent and known-groups validity of the MAM-36 scores; and (4) the cutoff score that best discriminates patients with PD from healthy individuals. Materials and Methods: This was a cross-sectional study. The MAM-36 was repeated after 4 weeks to determine the test-retest reliability which was calculated with the intraclass correlation coefficient (ICC), Bland-Altman plots, and MDC. The concurrent validity was assessed using correlations between the MAM-36 and nine-hole peg test, Movement Disorders Society Unified Parkinson's Disease Rating scale (MDS-UPDRS), MDS-UPDRS II, MDS-UPDRS III, Hoehn and Yahr stage, and 8-item PD questionnaire. The known-groups validity was determined by comparing the MAM-36 scores between patients with PD and healthy individuals. Receiver operating characteristic analysis was used to determine the cutoff score for the MAM-36 to best discriminate patients with PD from healthy individuals. Results: Thirty six patients with PD and 32 healthy individuals were included. Excellent test-retest reliability was found (ICC: 0.953). The Bland-Altman plot demonstrated a high agreement. The MDC was 2.33. The MAM-36 had fair to high correlations with the other outcome measurements (correlation coefficients ranged from-0.473 to-0.763, p<0.05 for all). Patients with PD had lower scores than healthy individuals in terms of the MAM-36 (p<0.001). The cutoff score of 76.50 best distinguished patients with PD from healthy individuals. Conclusion: The MAM-36 is a reliable and valid measurement for assessing manual dexterity in patients with PD. It is also the only clinically available PROM in assessing manual dexterity for patients with PD in the Turkish population.

Research paper thumbnail of Detection of EEG background abnormalities in epilepsy by a new spectral index

Clinical Neurophysiology, Apr 1, 2005

Objective: In epileptic disorders, EEG background activity is disorganized in or near the epilept... more Objective: In epileptic disorders, EEG background activity is disorganized in or near the epileptogenic focus and spectral EEG analysis (SEA) can provide useful information about the focus. We tried to develop a new spectral index from basic spectral parameters to detect the epileptic abnormalities at EEG background activity. Methods: A new spectral EEG index, epileptic abnormality index (EAI), was constructed from frequency band power and power asymmetry parameters. Within the index, parameters were weighted due to both conventional EEG knowledge and their power in discrimination healthy subjects from patients. EEG background activity from 99 epileptic patients and 146 healthy subjects was examined both by EAI and by a conventional SEA method, by using z-scoring statistic. Each test results were compared with visual EEG interpretation of subjects. Results: In patient groups, EAI was most successful in lateralization of epileptic abnormalities. It was also helpful in discrimination of epileptic patients from normals in the case where visual EEG interpretation was 'normal'. Conclusions: EAI depends on basic spectral parameters and it combines statistical methods and clinical knowledge about EEG. It increases the analysis capacity of SEA in evaluation of EEG background activity. Significance: EAI is a new and useful approach in detection of EEG background abnormalities in epilepsy and its logical base can also be used in the detection of brain electrical activity abnormalities other than epileptic disorders.

Research paper thumbnail of Investigation of the relationship between trunk control and balance, gait, functional mobility, and fear of falling in people with Alzheimer’s disease

Irish Journal of Medical Science, Jan 19, 2023

Research paper thumbnail of Turkish Standardization of Movement Disorders Society Unified Parkinson's Disease Rating Scale and Unified Dyskinesia Rating Scale

Movement Disorders Clinical Practice, 2017

Background: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and U... more Background: Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and Unified Dyskinesia Rating Scale (UDysRS) were developed as standard tools to rate Parkinson's disease (PD) and drug-induced dyskinesias of PD. As these scales have become widely used, there is a need for translation to non-English languages. Here we present the standardization for the Turkish translations. Methods: The scales were translated into Turkish and then back-translated to English. These backtranslations were reviewed by the MDS team. After cognitive pretesting, movement disorder specialists from nine centers tested 352 patients for MDS-UPDRS, and 250 patients for UDysRS. Confirmatory factor analyses (CFAs) were used to determine if the factor structures for the reference standards could be confirmed in the Turkish data. The comparative fit indexes (CFIs) for the scales were required to be 0.90 or higher. Exploratory factor analyses (EFAs) were conducted to explore the underlying factor structure without the constraint of a pre-specified factor structure. Results: For both scales, the CFIs were 0.94 or greater as compared to the reference standard factor structures. The factor structures were consistent with that of reference standards, although there were some differences in some areas as compared to the EFA of the reference standard dataset. This may be due to the inclusion of patients with different stages of PD and different cultural properties of raters and patients. Conclusions: These results demonstrate that the Turkish translations of MDS-UPDRS and UDysRS have adequate clinimetric properties. They are established as the official translations and can be reliably used in Turkish speaking populations.

Research paper thumbnail of Treatment of Tremor with Botulinum Toxin

Research paper thumbnail of Brain SPECT evaluation of patients with pure photosensitive epilepsy

Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 1996

This study was performed to determine the utility of 99mTc-HMPAO brain SPECT in evaluating patien... more This study was performed to determine the utility of 99mTc-HMPAO brain SPECT in evaluating patients with pure photosensitive epilepsy. Seven patients (2 boys, 5 girls), aged 8 to 15 yr (mean 11.1 +/- 2.5 yr), were studied. All patients underwent a detailed neurologic examination, interictal and ictal EEGs, CT and/or MRI and SPECT imaging. The baseline SPECT study was performed during the interictal period and the activation study was performed while the patients were having seizures provoked by watching television. The baseline SPECT study showed that six of seven patients had relatively hypoperfused regions in their frontal lobes that could involve the neighboring parietal and temporal regions. The activation study revealed that all seven patients had relative hyperperfusion in these brain regions that were relatively hypoperfused in the baseline study. The side-to-side asymmetry indexes for these visually-interpreted rCBF abnormalities ranged from 3% to 6%. The relatively consiste...

Research paper thumbnail of Detection of EEG background abnormalities in epilepsy by a new spectral index

Clinical Neurophysiology, 2005

Objective: In epileptic disorders, EEG background activity is disorganized in or near the epilept... more Objective: In epileptic disorders, EEG background activity is disorganized in or near the epileptogenic focus and spectral EEG analysis (SEA) can provide useful information about the focus. We tried to develop a new spectral index from basic spectral parameters to detect the epileptic abnormalities at EEG background activity. Methods: A new spectral EEG index, epileptic abnormality index (EAI), was constructed from frequency band power and power asymmetry parameters. Within the index, parameters were weighted due to both conventional EEG knowledge and their power in discrimination healthy subjects from patients. EEG background activity from 99 epileptic patients and 146 healthy subjects was examined both by EAI and by a conventional SEA method, by using z-scoring statistic. Each test results were compared with visual EEG interpretation of subjects. Results: In patient groups, EAI was most successful in lateralization of epileptic abnormalities. It was also helpful in discrimination of epileptic patients from normals in the case where visual EEG interpretation was 'normal'. Conclusions: EAI depends on basic spectral parameters and it combines statistical methods and clinical knowledge about EEG. It increases the analysis capacity of SEA in evaluation of EEG background activity. Significance: EAI is a new and useful approach in detection of EEG background abnormalities in epilepsy and its logical base can also be used in the detection of brain electrical activity abnormalities other than epileptic disorders.

Research paper thumbnail of How satisfied are cervical dystonia patients after 3 years of botulinum toxin treatment?

Research paper thumbnail of Functional Surgery in Parkinson’s Disease; Programming and Medication Adjustment in the Stabilization Period of Deep Brain Stimulation

Journal of Parkinson’s Disease and Movement Disorders, 2016

Being used in the treatment of advanced Parkinson's disease, deep brain stimulation treatment is ... more Being used in the treatment of advanced Parkinson's disease, deep brain stimulation treatment is a method that requires close follow-up of the patient in the postoperative period. Surgical targets are predominantly subthalamic nucleus and sometimes globus pallidus internus, and also the thalamus ventral intermediolateral (VIM) nucleus for tremor-dominant Parkinson's disease patients. Programming the stimulator differs for each target and the dopaminergic drugs are slowly reduced during the patient's neuromodulation. Intrinsic and extrinsic side effects should be carefully tracked during the voltage adjustment in follow-ups and the patient should be controlled by optimal treatment.

Research paper thumbnail of Dopamin Agonistleri ve Fibrotik Yan Etkileri

Turkiye Klinikleri Journal of Neurology Special Topics, 2008

Research paper thumbnail of Parkinson Hastalığında Genetik

Turkiye Klinikleri Journal of Neurology Special Topics, 2012

Research paper thumbnail of The coin rotation test: a reliable and valid test in people with Parkinson's disease

Disability and Rehabilitation, 2022

PURPOSE To investigate: (1) the interrater, and test-retest reliability of the coin rotation test... more PURPOSE To investigate: (1) the interrater, and test-retest reliability of the coin rotation test (CRT) in people with Parkinson's Disease (PwPD); (2) the minimum detectable change in the CRT; (3) the concurrent and known-groups validity of the CRT; and (4) the cut-off times that best discriminate PwPD from healthy people and functionally dependent PwPD from functionally independent PwPD. METHOD Forty-eight PwPD and 33 healthy people were included. The CRT was administered with the nine-hole peg test, Movement Disorders Society Sponsored Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Scale, Parkinson's Disease Questionnaire-8, and Schwab and England Scale. RESULTS The CRT had excellent interrater and test-retest reliability. Minimal detectable changes were 5.96 and 8.23 s for the dominant and non-dominant hand, respectively. The CRT correlated with other outcome measures. Significant differences in the CRT times were found between PwPD and healthy people, and between functionally dependent PwPD and functionally independent PwPD. The cut-off times of 12.66 s on the dominant hand and 15.76 s on the non-dominant best discriminated PwPD from healthy people, while 22.99 s on the dominant hand and 23.48 s on the non-dominant best discriminated functionally dependent PwPD from functionally independent PwPD. CONCLUSIONS The CRT is a reliable, and clinically available tool for assessing manual dexterity in PwPD.Implications for rehabilitationThe coin rotation test is a reliable, valid, and clinically available tool for assessing manual dexterity in Parkinson's Disease.The minimal detectable changes of the coin rotation test are 5.96 s for dominant hand and 8.23 s for the non-dominant hand, which may useful for clinicians and researchers to detect in any true change in manual dexterity after any intervention.The coin rotation test correlated with Parkinson's Disease-specific measurement tools.The coin rotation test times may detect impaired manual dexterity between people with Parkinson's Disease and healthy people, and between functionally dependent and functionally independent in Parkinson's Disease population.

Research paper thumbnail of The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease

Disability and Rehabilitation, 2022

PURPOSE To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight wa... more PURPOSE To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD. METHODS This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale. RESULTS The F8WT showed good interrater and test-retest reliability (ICC = 0.964-0.978 and ICC = 0.905-0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD. CONCLUSIONS The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD.Implications for rehabilitationThe figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD).The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention.The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD.The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.

Research paper thumbnail of Autonomic nervous system dysfunction and serum levels of neurotoxic and neurotrophic cytokines in patients with cobalamin deficiency

Turkish journal of haematology : official journal of Turkish Society of Haematology, 2010

OBJECTIVE The imbalance between neurotoxic cytokine tumor necrosis factor-α (TNF-α) and neurotrop... more OBJECTIVE The imbalance between neurotoxic cytokine tumor necrosis factor-α (TNF-α) and neurotrophic cytokines epidermal growth factor (EGF) and interleukin-6 (IL-6) plays a role in the pathogenesis of cobalamin (Cbl) deficiency-induced neuropathy. The aim of this study was to evaluate autonomic nervous system dysfunction and to look for any relationship between autonomic nervous system disturbances and serum cytokine levels (TNF-α, EGF, IL-6) in patients with Cbl deficiency. METHODS Serum levels of TNF-α, EGF and IL-6 were studied in patients with Cbl deficiency (n=41) and a healthy control group (n=17) and after 3 months in patients who underwent Cbl replacement therapy (n=22). All patients with Cbl deficiency underwent electrophysiological studies (EPS) for the diagnosis of neuropathy. Statistical analysis was performed using SPSS for Windows 11.5 software. RESULTS With EPS, 29 of 41 Cbl-deficient patients (70.73%) demonstrated neurological dysfunction [3 (7.32%), 19 (46.34%) and...

Research paper thumbnail of The COVID-19 Pandemic and Neurology

Türkan Acar1, Esra Acıman Demirel2, Nazire Afşar3, Aylin Akçalı4, Gülşen Akman Demir5, Aybala Nes... more 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 ...

Research paper thumbnail of Hareket Bozuklukları Fenomenolojisi

Research paper thumbnail of The Role of the Dopamine β-hydroxylase Functional Polymorphism in Patients with Early-Onset Parkinson’s Disease in the Turkish Population

Turkish Journal Of Neurology, 2021

Objective: A functional single nucleotide polymorphism, rs1611115, in the dopamine β-hydroxylase ... more Objective: A functional single nucleotide polymorphism, rs1611115, in the dopamine β-hydroxylase (DBH) gene, is reported to regulate plasma enzyme activity levels. Here, we report the first evaluation of this association in patients with early-onset Parkinson's disease (EOPD) and healthy controls in the Turkish population. Materials and Methods: We evaluated the DBH rs1611115 polymorphism in 114 (64 male and 50 female) Turkish patients with EOPD and 58 sex-and agematched healthy controls from the Turkish population. A total of 27.2% (n=31) of our patients who had any variation including pathogenic or non-pathogenic missense, nonsense and/or intronic variation with unknown significance in EOPD genes were grouped as "variation-positive EOPD". A total of 50.8% (n=58) of our patients were grouped as "variation and family history-negative EOPD" and the possible contribution of the DBH rs1611115 polymorphism to EOPD pathogenesis was evaluated in this group. Results: There was no significant difference in the genotypic and allelic frequencies of DBH rs1611115 between patients with EOPD and controls. To our knowledge, this is the first evaluation of the DBH rs1611115 polymorphism in patients with EOPD and ethnically matched controls in the Turkish population. Conclusion: Some previous studies have reported conflicting association results between DBH rs1611115 polymorphism and PD pathogenesis in different ethnic groups. Therefore, further studies are needed to evaluate dopamine metabolism-related genetic variants and to determine their possible roles in EOPD susceptibility in the Turkish population.