Utku Akyildiz - Academia.edu (original) (raw)

Papers by Utku Akyildiz

Journal of Clinical Psychopharmacology

DergiPark (Istanbul University), Aug 3, 2010

Nonkonvulsif status epileptikus (NKSE); genellikle kongnitif fonksiyon bozukluğu yapan, nörolojik... more Nonkonvulsif status epileptikus (NKSE); genellikle kongnitif fonksiyon bozukluğu yapan, nörolojik defisit oluşturan ve sıklıkla tedavi edilebilen, geri dönüşümlü klinik bir tabloyu tanımlar. Otuz yaşında, sağ el dominant, evi ve bir çocuk sahibi bayan hasta; geliş şikayeti 8 yıldır hemen hemen her ay menstruayon döneminde, nadiren de mestrual dönem dışında ortaya çıkan dengesizlik hissi ve sersemlikti. EEG'de tüm tetkik süresince 3-4 Hz'lik bilateral, senkron, simetrik, diken, keskin dalgalar, diken-dalga paroksizmleri izlendi. Atak başlangıcında çekilen EEG elektrofizyolojik status epileptikus olarak rapor edildi. Olgumuz sıklıkla menstruasyon dönemlerinde ve nadiren de mens aralarında uzun süreli dizziness atakları tanımlayan bir NKSE olması nedeniyle ilginç bulunmuş ve dizziness ayırıcı tanısında da hatırlanması için sunulmuştur. Non-konvulsif status epileptikus, dizziness, mensturasyon

Sleep Medicine

INTRODUCTION Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of n... more INTRODUCTION Narcolepsy type 1 (NT1) is caused by hypocretin deficiency, the pathophysiology of narcolepsy type 2 (NT2) has not been delineated. Except for the hypocretin deficiency and cataplexy, all clinical and laboratory features used in the diagnosis of NT2 are identical to those used for NT1. The aim of this study was to assess the rapid eye movement (REM) sleep-related characteristics in the patients with narcolepsy; the characteristics of REM sleep in polysomnography (PSG) and multiple sleep latency test (MSLT) recordings, the quantification of REM sleep without atonia (RSWA) and atonia index, and the analysis of rapid eye movements (REMs) during REM sleep. MATERIALS AND METHODS This study was planned by the Sleep Medicine Study Group of the Turkish Neurology Society, and conducted in 11 centers in eight cities in Turkey. The analysis of RSWA was analyzed by reviewing all REM sleep periods on nocturnal PSG and MSLT recordings per standard criteria. The total duration of the increased muscle tone during REM sleep in the chin and bilateral leg electromyography (EMG) recordings was calculated as RSWA index. The REMs index was also investigated the relation to the RSWA. RESULTS A total of 274 patients were involved; 147 patients (53.6%) were males and 127 patients (46.4%) were females; the mean age was 29.1 ± 12.0 years. The diagnosis of NT1 was made in 166 patients (60.6%), and 108 patients (39.4%) were diagnosed as having NT2. The mean Epworth sleepiness scale score was significantly higher in patients with NT1 than the patients with NT2 (P = 0.001). The diagnosis of REM sleep behavior disorder (RBD) was made in 19.3% of the patients with NT1 versus in 2.8% of the patients with NT2 (P < 0.001). The percentage of SOREMP in PSG recordings was significantly higher in patients with NT1 (37.1%) than those with NT2 (18.9%, P = 0.001). MSLT showed that the mean sleep latency was shorter in patients with NT1 compared to those with NT2 (P < 0.001). The total duration of REMs on electrooculography recordings was also significantly higher in patients with RSWA in comparison with the patients without RSWA (P = 0.002). Total duration of REMs was significantly and positively correlated with the duration of RSWA on chin-EMG and leg-EMG recordings (P = 0.001). ROC analyses showed an RSWA index of ≥2% for the RSWA on chin-EMG with a sensitivity of 86.7% and a specificity of 71.3% (P < 0.001). The REMs index ≥20% was associated with the presence of RSWA with a sensitivity of 70.0% and a specificity of 57.1% (P = 0.008). CONCLUSIONS In this nation-wide study, we identified for the first time that the increase in REMs density during REM sleep may be a major correlate of the RSWA. Significant positive correlations were demonstrated between the total duration of REMs on electrooculography recordings and the mean durations of RSWA in both chin and leg EMG recordings. A REMs index of >20% was demonstrated to have a moderate sensitivity and specificity in the diagnosis of RSWA. As observed in chin RSWA index, REMs index also showed a significantly high association with RBD, in comparison to RSWA per standard criteria.

Türk Nöroloji Derneği, 2020

Guillain-Barre ́ syndrome is an acute inflammatory autoimmune polyradiculoneuritis. Progressive m... more Guillain-Barre ́ syndrome is an acute inflammatory autoimmune polyradiculoneuritis. Progressive motor weakness and areflexia are essential for its diagnosis. Hyperreflexia has rarely been reported in the early healing period of Guillain-Barre ́ syndrome following Campylobacter jejuni infection in patients with acute motor axonal neuropathy with antiganglioside antibody positivity. In this study, we report a 12-year-old girl presenting with complaints of inability to walk, numbness in hands and feet, and hyper-active deep tendon reflexes since the onset of the clinical picture, diagnosed with acute motor-sensory axonal neuropathy type of Guillain-Barre ́ syndrome.

Transient Global Amnesia (TGA) is a dynamic condition. An undefined event causes anterograde amne... more Transient Global Amnesia (TGA) is a dynamic condition. An undefined event causes anterograde amnesia (sometimes with retrograde amnesia) that lasts in a day and preserves of self-identity and of consciousness. Epilepsy, migraine and ischemic events are the possible causes for different hypothesis but still unproven. Sixty three years old woman admitted to emergency department because of amnesia. She felt ill herself and was repeatedly asking similar questions and making same sentences in that period. She was not remember doing things nearby, but she was fully conscious to time, places, herself and her relatives. Neurological examination was normal except the anterograde and partly retrograde amnesia. Within amnesic period, Isotropic Diffusion Weighted Imaging (DWI) and ADC (Apparent Diffusion Coefficient) maps revealed hyper and hypo intensities on MRI respectively at both hippocampus (slightly more prominent at left side) while T1, T2 weighted and Fluid Attenuated Inversion recover...

Turkish Journal Of Neurology, 2019

Objective: To evaluate the value of autoantibody and viral serologic examinations in the diagnosi... more Objective: To evaluate the value of autoantibody and viral serologic examinations in the diagnosis of multiple sclerosis (MS) and stroke and their effect on the course of treatment. Materials and Methods: Patients who were admitted to the neurology clinic between 2012 and 2016 were retrospectively evaluated. The patients were screened for autoantibodies including anti-nuclear antibody (ANA) and anti-dsDNA, and viral serology including Epstein-Barr virus, varicella-zoster virus, cytomegalovirus, herpes simplex virus type 1 and 2. The study cohort was grouped as the MS group, stroke group, and "other" diseases group (e.g. polyneuropathy, myasthenia gravis, dementia, headache, epilepsy). The data from all the groups were further analyzed to determine whether these tests provided an increase in diagnostic performance. Results: Among the autoantibody and viral serologic tests, the most commonly used test was ANA (71 cases in the MS group, 160 cases in the stroke group, and 482 cases in the other diseases group). All test reports, based on positivity/negativity, did not lead to any change in the initial diagnosis of the disease and the treatment strategy in all groups. Conclusion: Information obtained from autoantibody and viral serologic tests does not affect the diagnosis of MS and stroke. Performing these tests for routine screening is considered worthless unless there is an important finding regarding clinical disease.

Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, Jan 23, 2018

The risk factors for depressive symptoms in patients with Parkinson's disease (PD) under dopa... more The risk factors for depressive symptoms in patients with Parkinson's disease (PD) under dopaminergic drug treatment are unclear. In this study, we examined whether some temperament traits are related to the presence of comorbid depression in PD patients, independent of the characteristics of illness and drug treatment. The participants in this study were 74 patients with idiopathic PD who were already treated with stable doses of levodopa or dopamine agonists. Depressive (n = 20) and non-depressive (n = 52) PD patients were assessed by means of the Unified Parkinson's Disease Rating Scale, Beck Depression Inventory, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire. The doses of levodopa and dopamine agonists were converted into levodopa equivalent daily dose. The duration of treatment in the depressive group was significantly longer than in the non-depressive group (P = 0.03). The depressive patients had significantly higher scores on the ...

Turkish Journal of Cerebrovascular Diseases, 2017

POEMS sendromu multisistemik tutuluş ve polinöropati ile seyreden, nadir görülen bir plazma hücre... more POEMS sendromu multisistemik tutuluş ve polinöropati ile seyreden, nadir görülen bir plazma hücre diskrazisidir. Plazmositom tarafından salgılanan vasküler endotelial büyüme faktörü semptomlardan sorumludur. Bu makalede ilk klinik prezentasyonu başağrısı ve iskemik serebrovasküler olay olan bir POEMS olgusu sunulmuştur.

Nephrology Dialysis Transplantation, 2015

Journal of Mood Disorders, 2016

Parkinson hastalığı olan manik hastada, sildenafil ve panax ginseng tedavisi sonrası gelişen psik... more Parkinson hastalığı olan manik hastada, sildenafil ve panax ginseng tedavisi sonrası gelişen psikotik semptomlar: Bir olgu sunumu Amaç: Parkinson hastalığı (PH) hareket bozukluklarıyla karakterize kronik nörodejeneratif bir hastalıktır. PH'nın tedavisinde kullanılan Dopamin agonistlerinin çeşitli ruhsal belirtilerle ilişkili olduğu bilinmektedir. Özellikle mezolimbik bölgelerdeki D3 reseptörlerine yüksek afinitesi olan Pramipeksol, diğer dopaminerjik agonistlere benzer bir şekilde, mezolimbik dopaminerjik nöronları uyararak, manik ya da psikotik semptomların gelişimine yol açabilir. Panax ginseng, merkezi kolinerjik ve dopaminerjik mekanizmalarla etki gösteren ve sildenafil içeren bitkisel bir ilaçtır. Erektil disfonksiyon tedavisinde yaygın olarak kullanılan bir ilaç olan Sildenafil, ağırlıklı olarak PDE5'İ inhibe eder ve böylece cGMP miktarı artar. PH tedavisinde farklı ilaç grupları kullanıldığında eşlik eden ruhsal belirtiler göz önünde bulundurulmalıdır. Yöntem: Burada Pramipeksol alırken ilk kez mani gelişen ve Pramipeksol tedavisine devam ederken erektil disfonksiyon nedeniyle eklenen panax ginseng ve sildenafil sonrası ayrıca bazı psikotik belirtiler ortaya çıkan bir erkek hasta sunduk. Bulgular: PH olan ve pramipeksol ile birlikte, erektil disfonksiyon nedeniyle sildenafil ve panax ginseng aldıktan sonra bazı psikotik belirtileri olan hasta psikiyatri ünitesine kabul edildi. Sonuç: Bu olgu, PH tedavisinde birincil olarak kullanılmayan bazı ilaçların, PH'nın altta yatan psikopatolojisine, ilaç etkileşimlerine, ve dopaminerjik ilaçların etki mekanizmalarına bağlı olarak bazı ciddi psikotik semptomlara neden olabileceğini göstermektedir.

Turkiye Klinikleri Journal of Neurology Special Topics, 2013

European Respiratory Journal, 2015

Muscle atrophy, fiber-type shifting, reduced contractility, metabolic alterations, capillarizatio... more Muscle atrophy, fiber-type shifting, reduced contractility, metabolic alterations, capillarization defect, and mitochondrial modifications are important adaptations in COPD. Skelatal muscle dysfunction is one of the most devastating systemic manifestations of COPD which eventually leads to increase in morbidity and mortality. In this study we aimed to demonstrate the effects of COPD on both muscles and nerves in neurologically normal patients with different degrees of airflow limitations, using current electrophysiological methods.Electrophysiological examinations were performed using a Keypoint EMG machine with subjects lying supine on a bed at a room temperature. Tests were nerve conduction studies, motor unit potential (MUP) analysis, interference pattern (IP) analysis and macro EMG (mEMG) analysis on the right side in the upper and lower extremities. Multi-motor unit potential (m-MUP) analysis and interference pattern (IP) analysis revealed some changes in biceps brachii (BB) and tibialis anterior (TA) muscles, but macro EMG (mEMG) analysis was similar except for increased fiber density at TA muscles in COPD patients. Increased ulnar and sural sensory latency, decreased ulnar sensory velocity, and increased ulnar motor latency values were found in COPD. There was increased motor unit potential (MUP) turn and phase values in BB muscles and increased MUP turn and decreased MUP duration, area, area/amplitude ratio and size index values in TA muscles in COPD patients. As a conclusion, in COPD more nerve conduction abnormalities and more MUP abnormalities which reflected muscle fiber diameter changes were observed by the use of electrophysiological methods including multi MUP - IP analysis and mEMG analysis.

Clinical neurology and neurosurgery, Jan 17, 2015

Evoked potentials and disability in multiple sclerosis: a different perspective to a neglected me... more Evoked potentials and disability in multiple sclerosis: a different perspective to a neglected method. Because evoked potentials (EP) are reflections of the functional integrity of sensory-motor systems, they are expected to reflect the abnormality in patients with disabilities and handicaps and also be in correlation with scales. This assumption was tested. Patients with multiple sclerosis (MS) and myelopathy (M) and normal controls were investigated by EP, Multiple Sclerosis Walking Scale-12, timed 25-foot walk test and extended disability status scale (EDSS). EP results were converted to ordinal values, and correlations of these values with scales were calculated. Sensitivity and specificity analysis of EP parameters was also performed. Total EP scores revealed high rates of abnormality in both groups, but MS revealed a different correlation pattern from M. The SEP+MEP summed score showed high sensitivity and specificity for MS and this was also correlated with the MS-related dis...

Neuro endocrinology letters, 2007

Central pontin myelinolysis and extra-pontin myelinolysis (CPM/EPM) implies the clinical picture ... more Central pontin myelinolysis and extra-pontin myelinolysis (CPM/EPM) implies the clinical picture after rapid recovery of hyponatremia or hyponatremia alone. SPM/EPM picture can occur without hyponatremia. Findings such as dysarthria, dysphagia, tetraparesia/plegy accompanies the clinical table. Our case was also diabetic, but there were no electrolyte imbalance in admission. The presence of diarrhea in medical history of the patient might indicate a short-term undetected electrolyte imbalance. In our diabetic case that has borderline metabolic status and lack of any detected electrolyte imbalance, we decided to present SPM/EPM table together with literature information.