Nigar Dursun - Academia.edu (original) (raw)

Papers by Nigar Dursun

Toxicon, Jul 1, 2022

Background: The effects of botulinum toxin are transient, and repeat injections are required in c... more Background: The effects of botulinum toxin are transient, and repeat injections are required in children with lower-limb spasticity. However, the efficacy of botulinum toxin in patients who have received previous injections has remained largely unexplored. Methods: We present subgroup analyses of a Phase III study conducted in ambulatory children (aged 2-17) with spastic equinus foot. Patients were randomized to single doses of abobotulinumtoxinA 10U/kg/leg, 15U/kg/leg or placebo injected into the gastrocnemius-soleus complex (one/both legs). The first analysis was pre-specified to review the effect of abobotulinumtoxinA in children previously treated with botulinum toxin versus those new to the treatment; a second post-hoc analysis evaluated the effect of abobotulinumtoxinA in children who changed botulinum toxin formulation. Results: Of the 241 randomized patients, 113 had previously received botulinum toxin, including 86 who had been treated with another formulation. In both analyses, muscle tone (modified Ashworth Scale) and the Physicians Global Assessment at week-4 improved with abobotulinumtoxinA treatment versus placebo, regardless of baseline botulinum toxin status. Placebo responses in patients new to treatment were consistently higher than in the previously treated group. Conclusions: These results demonstrate similar abobotulinumtoxinA efficacy and safety profiles in children with spasticity who are new to botulinum toxin treatment and those previously treated. The efficacy and safety of abobotulinumtoxinA treatment in these previously-treated patients were comparable with the overall trial population, indicating that doses of 10U/kg/leg and 15 U/kg/leg are suitable starting doses for children with spasticity regardless of the previous botulinum toxin preparation used.

Toxicon, Dec 1, 2018

Results The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). ... more Results The response rate was 36%. Seventy-five questionnaires were returned and analysed (52%). A small proportion of children were specifically treated for drooling (< 25%). Assessments were carried out in 75% of cases and 91% of professionals prescribed treatments. Use of assessment tools varied widely. The most common treatment was oro-facial rehabilitation (95% of professionals), followed by anticholinergic drugs (Scopolamine ®) (94%) botulinum toxin injections (66%) and surgery (34%). Scopolamine was considered to be less effective than botulinum toxin and to have more side effects. Regarding the protocol, Botox ® is the most commonly used, with a median dose of 1 U/Kg/gland, injected both in parotid and sub-mandibulars glands. The period between two injections is from 3 to 6 months. Glands are located by ultrasound examination. The analgesic method differs from injection centers. Conclusion The rate of pathological drooling in children with cerebral palsy is likely underestimated and under treated in France. There is a lack of knowledge regarding assessment tools. Aside from rehabilitation, current practice is to prescribe medication as the first-line treatment, however professionals consider that botulinum toxin is more effective and has less side effects. For now there is no general agreement for the protocol of toxin injection. Further studies should be conducted to define a standardized protocol for injections. Keywords Drooling; Children; Cerebral palsy Disclosure of interest The authors declare that they have no competing interest.

Turkish Journal of Osteoporosis, 2020

Objective: To determine the influence of total duration of breastfeeding on bone mineral density ... more Objective: To determine the influence of total duration of breastfeeding on bone mineral density (BMD) and vitamin D levels. Materials and Methods: A total of 1,218 postmenopausal women of mean age 59.59±9.64 years were included in this retrospective analysis. The demographic data, vitamin D levels and BMD measurements of the lumbar spine and femur neck were recorded. Results: According to the World Health Organization criteria, 41.3% of the women were identified to be osteoporotic, 42% as osteopenic and 16.7% as normal. The mean duration of total breastfeeding was 40.57±40.11 (breastfeeding duration range: 0-216) months. Weight (r=0.307, p<0.001), years since menopause (r=0.389, p<0.001), duration of total breast-feeding (r=0.414, p<0.001) and clothing style (r=0.421, p<0.001) were found to be most the important predictors for lumbar spine BMD; age (r=0.194, p<0.001), weight (r=0.479, p<0.001), clothing style (r=0.486, p<0.001), years since menopause (r=0.491, p<0.001) and physical activity level (r=0.494, p<0.001) for femoral neck BMD. For vitamin D status, duration of total breastfeeding (r=0.224, p<0.001), clothing style (r=0.242, p<0.001) and weight (r=0.257, p<0.001) were important predictors. Frequencies of spinal osteoporotic fractures were higher among patients with longer duration of breastfeeding (p=0.002, p=0.021, respectively). Conclusion: The duration of total breastfeeding can be a risk factor for postmenopausal osteoporosis and vitamin D status.

Physiotherapy research international : the journal for researchers and clinicians in physical therapy, 2018

To investigate combined effects of robot-assisted training (RAT) and physical therapy versus phys... more To investigate combined effects of robot-assisted training (RAT) and physical therapy versus physical therapy only on balance and gait function of chronic stroke patients after botulinum toxin-A (BoNT-A) treatment. Forty-eight chronic stroke patients, received BoNT-A treatment for lower extremity spastic muscles, were randomly assigned to RAT (n = 32) and control (n = 16) groups in a 2:1 ratio. RAT group received 30 min of RAT (RoboGait®) plus 60 min of physical therapy, whereas controls received 90 min of physical therapy for 3 weeks during weekdays. Outcome assessments were measured at baseline and post-treatment Weeks 6 and 12. Spasticity was assessed by Modified Ashworth Scale and Tardieu Scale. Balance and gait functions were assessed by Berg Balance Scale, Timed Up and Go test, and Rivermead Visual Gait Assessment. Demographic and baseline characteristics were similar in both groups (p > .05) for all parameters. Significant improvements were determined in both RAT and contr...

Türkiye Klinikleri Journal of Case Reports, 2021

ABS TRACT Isotretinoin, which is commonly used for the treatment of severe and treatment-resistan... more ABS TRACT Isotretinoin, which is commonly used for the treatment of severe and treatment-resistant acne vulgaris, is associated with many adverse effects including musculoskeletal pain and arthralgia, and rarely sacroiliitis. Isotretinoin-induced sacroiliitis is typically limited with the discontinuation of isotretinoin and usually reduces with non-steroidal anti-inflammatory drugs. In this article, we present a patient using isotretinoin for her facial acne, lived inflammatory pain in her lower back and right hip region after 8 weeks of isotiretionin treatment and diagnosed sacroiliitis. As a result we want to draw attention to the fact that this drug can cause low back pain and sacroiliitis as a side effect.

Disability and Rehabilitation, 2002

Archives of Physical Medicine and Rehabilitation, Jul 1, 2000

Objective: To examine the relation between glenohumeral joint subluxation and reflex sympathetic ... more Objective: To examine the relation between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients. Design: Case-control study. Setting: Inpatient rehabilitation hospital. Patients: Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in the study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Main Outcome Measures: Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points. Results: Glenohumeral subluxation was found in 74.3% of the RSD and 40% of the non-RSD group (p ϭ .004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (p ϭ .019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (p ϭ .152). Conclusion: Findings from this study suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients.

Toxicon, Dec 1, 2016

coefficient. Results: Weak but significant correlations were observed between change in MAS score... more coefficient. Results: Weak but significant correlations were observed between change in MAS scores and investigator-or patient-assessed benefit (rho¼0.28 and 0.20, respectively; P<0.01). Change in MAS score correlated better with investigator-reported benefits than with patient-reported benefits; a correlation was demonstrated between investigator and patient assessment of benefit (rho¼0.66; P<0.01). Significant correlations were observed between change from baseline in GAS T scores and investigator-or patientassessed benefit (rho¼0.39 and 0.47, respectively; P<0.01). A significant correlation was also demonstrated between MAS change score and change from baseline in GAS T-score (rho¼-0.28; P<0.01). Conclusions: In patients receiving BoNT-A treatment in the ULIS-II study, MAS change scores at follow-up correlated with investigator and patient global assessment of benefits, as well as GAS T scores. Correlations between MAS and investigator-assessed benefits were stronger compared with the correlation between MAS and patient-assessed benefits, which suggests that MAS change does not necessarily translate to patient benefits, whereas goal attainment may provide a more patient-centered reflection of outcome.

Turkiye Klinikleri Journal of Dermatology, 2000

European Journal of Rheumatology, Mar 12, 2018

The reliability and validity of the Turkish version of the Fibromyalgia Participation Questionnai... more The reliability and validity of the Turkish version of the Fibromyalgia Participation Questionnaire Introduction Fibromyalgia syndrome (FMS) is a chronic health problem characterized by a wide range of physical and psychological symptoms such as chronic widespread pain, tender points, sleep disturbance, unrelenting fatigue, cognitive dysfunction, and substantial mood alterations that may lead to anxiety and depression (1, 2). Early efforts at developing specific questionnaires for FMS have mostly focused on detecting these diverse and overwhelming symptoms and have emphasized the affected body functions and the activities of the patients at home (3, 4). The Fibromyalgia Impact Questionnaire (FIQ), which is regarded as the sole disease-specific tool for FMS and has been the gold standard in FMS studies for more than 20 years, and Brief Pain Inventory (BPI), Quality of Life Scale (QOLS), and Patient-Reported Outcomes Measurement Information System (PROMIS), which were later developed and used in those studies, have indeed contributed to the understanding and description of FMS (4-7). However, the FIQ has been criticized for failing to address the complex aspects of participation and lack of the evidence of factorial validity (8). More recently, several authors (9, 10) have emphasized that there is a need for a more specific instrument to document the participation in social functions by patients that may become impaired as a result of the above-mentioned symptoms, creating even more debilitating social problems for FMS patients (9, 10). Farin et al. (11) designed the Fibromyalgia Participation Questionnaire (FPQ) as an instrument for measuring the participation and social functioning of FMS patients. They suggested the FPQ as a psychometrically val

Türkiye klinikleri tıp bilimleri dergisi, 2012

Bu randomize kontrollü çalışma ile serebral palsili çocuklarda hippoterapinin kaba motor fonksiyo... more Bu randomize kontrollü çalışma ile serebral palsili çocuklarda hippoterapinin kaba motor fonksiyonlar, denge, koordinasyon ve yürüme üzerine olan etkilerinin ortaya konması amaçlandı. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Araştırmaya 23 spastik serebral palsili çocuk dâhil edildi. Çalışmaya katılanlar randomize olarak hippoterapi veya kontrol grubuna ayrıldı. Her iki gruptaki tüm çocuklara her gün günde bir saatlik seanslardan oluşan toplam 2 haftalık konvansiyonel fizyoterapi programı uygulandı. Hippoterapi grubu aynı zamanda 10 hafta süre ile haftada 1 kez 30-45 dakikalık hippoterapi eğitimi aldı. Her iki gruptaki tüm çocuklar tedavi öncesi ve sonrasında kaba motor fonksiyonlar açısından Kaba Motor Fonksiyon Ölçütü-88 (KMFÖ-88), denge-koordinasyon açısından Pediatrik Denge Skalası (PDS) ve yürüme fonksiyonları açısından bilgisayarlı yürüme analizi ile değerlendirildi. B Bu ul lg gu ul la ar r: : Araştırmayı hippoterapi grubundan 10, kontrol grubundan 10 hasta tamamladı. Her iki grubun tedavi sonrası değerlendirmesinde KMFÖ-88'in yatma-yuvarlanma, oturma, emekleme-diz üstü durma, ayakta durma ve yürüme-koşma-zıplama alt parametrelerinde ve KMFÖ-88 toplam puanlarında istatistiksel olarak anlamlı gelişmeler elde edildi (tüm parametreler için p<0,05). Hippoterapi grubunda yatma-yuvarlanma, emekleme-diz üstü durma, ayakta durma, KMFÖ-88 toplam puanlarındaki gelişme oranlarının, kontrol grubuna oranla istatistiksel olarak anlamlı derecede yüksek olduğu saptandı (tüm parametreler için p<0,05). PDS her iki grupta anlamlı derecede artış gösterdi (p<0,05 tüm parametreler); iki grubun gelişme oranları arasında istatistiksel olarak anlamlı fark saptanmadı (p>0,05). Hippoterapi grubunda yürüme hızı (sağ p=0,043, sol p=0,026) ve kadans (p=0,028) istatistiksel olarak anlamlı derecede artış gösterdi, ancak kontrol grubunun yürüme parametrelerinde istatistiksel bir gelişme saptanmadı. S So on nu uç ç: : Hippoterapi, serebral palsili çocukların rehabilitasyon ve tedavisinde ek motor kazanımlar sağlayabilecek yararlı bir yardımcı yöntem olarak değerlendirilebilir.

PubMed, Jun 1, 2009

Aim: The purpose of this study was to show if constraint induced movement therapy (CIMT) is effec... more Aim: The purpose of this study was to show if constraint induced movement therapy (CIMT) is effective in a Turkish stroke patient population and whether the effectiveness could be measured by a different evaluation tool, i.e. Kocaeli Functional Evaluation Test (KFET). Methods: Twenty-five patients with subacute or chronic stroke were included in the study. At the beginning, all the patients received a conventional rehabilitation programme for 3 weeks. Seventeen patients who had no improvement in upper extremity functioning with this conventional programme received CIMT for 3 weeks. Active range of motion (ROM) and modified Ashworth scale of the plegic upper extremity were noted; Wolf Motor Function Test (WMFT) and KFET were performed to each patient before and after CIMT. Results: Active ROM of shoulder flexion (P<0.001), abduction (P<0.001), and external rotation (P=0.005), wrist flexion (P=0.025), and extension (P<0.01) of the plegic upper extremity improved significantly after CIMT. There were significant improvements in functional ability scale (P<0.05 for all parameters) and performance time results of 13 (P<0.05 for all parameters) out of 15 parameters of WMFT. Significant improvements were observed in quality-ability scores of every subunit of each activity (P<0.05 for all parameters) and performance time scores (P<0.05 for all parameters) of KFET. Conclusions: CIMT is found to be a noteworthy treatment for improving the function of the hemiplegic upper extremity in this Turkish patient population.

Developmental Medicine & Child Neurology, Jan 22, 2021

AimTo assess the efficacy of intermittent serial casting in conjunction with occupational therapy... more AimTo assess the efficacy of intermittent serial casting in conjunction with occupational therapy and botulinum neurotoxin A (BoNT‐A) in children with cerebral palsy (CP) presenting spastic wrist flexion deformity.MethodThis was a controlled, prospective study in which 34 children (19 females, 15 males; mean [SD] 11y [4y 6mo]) were randomly allocated to casting or control groups in a ratio of 2:1. Both groups were subjected to BoNT‐A treatment and occupational therapy. The casting group additionally received a series of progressive casts intermittently for three consecutive weekends. Outcome measures consisted of passive range of motion (PROM) as assessed by goniometer, muscle tone by Modified Ashworth scale (MAS), and spasticity by Tardieu Scale. Assessments were done at baseline, week 4, and week 12.ResultsBaseline characteristics of casting and control groups were comparable. PROM, MAS, and Tardieu angle of catch (XV3) of the casting and control groups significantly improved after treatment (p<0.001 for all). Nevertheless the mean change from baseline MAS at week 12, mean changes from baseline PROM, Tardieu XV3, and the spasticity grade (Y) at week 4 and week 12 of the casting group showed statistical superiority over those of the control group (p<0.05 for all).InterpretationChildren with CP presenting spastic wrist flexion deformity might gain additional benefits from supplementary intermittent serial casting as well as BoNT‐A injections and occupational therapy. Serial casting could be considered as a complementary treatment to BoNT‐A and occupational therapy in children with clinically significant PROM limitations.What this paper adds Intermittent serial casting is a useful treatment option in children with cerebral palsy with spastic wrist flexion deformity. Intermittent serial casting supplementation to botulinum neurotoxin A and occupational therapy provides additional benefits on passive range of motion, muscle tone, and spasticity.

Journal of Physical Therapy Science, 2017

An easy-to-use, psychometrically validated screening tool for fibromyalgia is needed. This study ... more An easy-to-use, psychometrically validated screening tool for fibromyalgia is needed. This study aims to evaluate the reliability and validity of the Turkish version of the Fibromyalgia Rapid Screening Tool by correlating it with 2013 American College of Rheumatology alternative diagnostic criteria and the Hospital Anxiety and Depression Scale. [Subjects and Methods] Subjects were 269 Physical Medicine and Rehabilitation clinic outpatients. Patients completed a questionnaire including the Fibromyalgia Rapid Screening Tool (twice), 2013 American College of Rheumatology alternative diagnostic criteria, and the Hospital Anxiety and Depression Scale. Scale reliability was examined by test-retest. The 2013 American College of Rheumatology alternative diagnostic criteria was used for comparison to determine criterion validity. The sensitivity, specificity, and positive and negative likelihood ratios were calculated according to 2013 American College of Rheumatology alternative diagnostic criteria. Logistic regression analysis was conducted to find the confounding effect of the Hospital Anxiety and Depression Scale on Fibromyalgia Rapid Screening Tool to distinguish patients with fibromyalgia syndrome. [Results] The Fibromyalgia Rapid Screening Tool was similar to the 2013 American College of Rheumatology alternative diagnostic criteria in defining patients with fibromyalgia syndrome. Fibromyalgia Rapid Screening Tool score was correlated with 2013 American College of Rheumatology alternative diagnostic criteria subscores. Each point increase in Fibromyalgia Rapid Screening Tool global score meant 10 times greater odds of experiencing fibromyalgia syndrome. [Conclusion] The Turkish version of the Fibromyalgia Rapid Screening Tool is reliable for identifying patients with fibromyalgia.

Disability and Rehabilitation, Jan 21, 2004

İstanbul Kuzey Klinikleri, 2018

OBJECTIVE: The aim of this study was to investigate the frequency of renal calculi in patients wi... more OBJECTIVE: The aim of this study was to investigate the frequency of renal calculi in patients with ankylosing spondylitis (AS) and to determine its relationship with disease assessment variables. METHODS: The study was designed retrospectively, and it included a cohort of 320 patients with AS diagnosed using the Modified New York Criteria. A total of 119 patients who underwent renal ultrasonography (USG), in who the erythrocyte sedimentation rate, C-reactive protein, blood calcium, phosphorus, Vitamin D, parathormone, and urinary calcium excretion were measured, and who also had lateral cervical and lumbar radiography in the same time period were extracted from the cohort. All patients' demographic characteristics and the results of blood and urine tests were recorded. The Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Mobility Index (BASMI), and Modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) were evaluated in all patients. RESULTS: Thirteen of the 119 patients had renal calculi confirmed by USG data. The frequency of nephrolithiasis detected by USG was 10.9% in patients with AS. The disease lasted significantly longer in patients with renal calculi ([nephrolithiasis (+): 18.39±8.72 years; nephrolithiasis (−): 12.02±8.43 years, p=0.01]). The BASMI total score was significantly higher in the group of patients with renal calculi. There was not any significant difference in terms of blood samples, HLA-B27, BASDAI, BASFI, and mSASSS between groups. CONCLUSION: The frequency of renal stones is increased in patients with AS compared to healthy population. Especially patients who had AS for a long time and higher BASMI values are more susceptible to renal calculi. It is important to point out that the results of this type of studies would be more reliable if the study is conducted on large patient groups and population-based prevalence.

American Journal of Physical Medicine & Rehabilitation, Apr 1, 2017

Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment o... more Physical therapy (PT) and botulinum toxin-A (BTX-A) injections are widely used in the treatment of spastic equinus foot due to cerebral palsy. The aim of this study was to show effects of intermittent serial casting (SC) in addition to standard treatment on spasticity, passive range of motion (PROM), and gait. Fifty-one ambulatory patients, treated by BTX-A to plantar flexor muscles, were randomly assigned to casting or control groups in a 2:1 ratio. Both groups received PT for 3 weeks. Casting group additionally received intermittent SC during 3 consecutive weekends. Assessments included Modified Ashworth Scale (MAS), Tardieu Scale, Observational Gait Scale (OGS), and Physician Global Assessment at baseline and posttreatment weeks 4 and 12. Significant improvements in PROM, MAS, Tardieu Scale, and OGS were recorded in both groups (P &amp;amp;amp;amp;lt; 0.001 for all). Average changes in MAS, PROM, angle of catch, spasticity angle, and OGS of the casting group were significantly higher than those ...

Journal of pediatric neurology, Jun 27, 2022

The aim of this study is to evaluate the changes in activity and participation domains of Interna... more The aim of this study is to evaluate the changes in activity and participation domains of International Classification of Functioning (ICF), Disability and Health, in children with cerebral palsy (CP) who received integrated botulinum toxin A (BoNT-A) treatment with intensive rehabilitation with a treatment goal of improved sitting balance. In this prospective observational study, 29 patients with CP (mean age: 6.7 ± 3.8 years) and the Gross Motor Function Classification System (GMFCS) levels of IV and V were included. The primary outcome measures were the mean changes from baseline to posttreatment weeks 10 to 12 of the Child and Adolescent Scale of Participation (CASP) and Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD). The modified Ashworth scale (MAS) and Tardieu scale (TS) results at 6 to 8 weeks of posttreatment were the secondary outcome measures. Statistically significant improvements in home and community participation of CASP (p < 0.001 and 0.001), CPCHILD (p < 0.01), MAS (p < 0.001), and all parameters of TS (p < 0.05) were recorded after treatment. The result of this prospective, observational study showed that the functional improvements in sitting balance by the integrated BoNT-A treatment provides positive effects on activity and participation levels of the patient and quality of life of patients and their families.

Kocaeli Üniversitesi sağlık bilimleri dergisi, May 31, 2022

Objective: To research the effect of kinesiologic taping (KT), applied to the wrist dorsiflexor m... more Objective: To research the effect of kinesiologic taping (KT), applied to the wrist dorsiflexor muscle group using a facilitating (muscle strengthening) technique, on the hand function of children with unilateral cerebral palsy (CP) at its early stages and independent of exercise. Methods: The study tests 20 patients who have been diagnosed with unilateral CP. KT, was applied to the plegic aspect of the dorsiflexor muscle group on the wrists and fingers of all subjects. Patients were evaluated in terms of age, gender, dominant hand. Hand function was evaluated by the Jebsen Hand Function Test (JHFT). The hand function of the patients was evaluated at three time points: before the KT; immediately after the application with KT in situ; and immediately after the KT was removed. Results: The assessment of the patients' ability to perform activities such as turning pages, carrying small objects, eating simultaneously, stacking backgammon pieces on top of each other, moving light-large objects and heavy-large objects, before the KT and after the KT was applied showed a significant stastistical difference (p<0.05 for all parameters). The results of the patients before the KT was applied and after it was removed did not show a statistical significant difference (p>0.05 for all parameters). Conclusion: It is thought that the application of KT to the wrist dorsiflexor and finger extensor muscle groups of children with unilateral CP contributes to the improvement of hand functions. There is a need for long term follow-up studies to see the long-term effect the KT.