Erdem Togrol
Gulhane Military Medical Academy, Neurology, Faculty Member
Abstract Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people... more
Abstract
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
Today, Multiple Sclerosis (MS) is one of the leading non-traumatic causes of permanent neurological disability in young and middle-aged populations. A 2020 statistical survey figures show that it affects 2.8 million people worldwide. This figure corresponds to an average of 1/3000 people, which figure is likely to rise further. Globally, the median estimated prevalence of MS is approximately 36 per 100,000 according to the international data, with 2.9 million people living with MS in the World in 2023. Regionally, the estimated median prevalence of MS is highest in Europe and the Americas. Regional differences in incidence generally run parallel to prevalence. A median prevalence and incidence was reported for Eastern Mediterranean area and Middle East but in the last decades this has tended to change. Also the incidence has increased in Mediterranean islands, but not all. Its prevalence increased from 40 per 100,000 to 100 per 100,000 in Turkey while in Greece, Cyprus, Basra Gulf and Middle East in general, a similarly increasing trend was observed in the recent years. The highest prevalence rates were reported in Iran (148.06 per 100,000) and higher incidence rates were estimated at 6.88 per 100,000 population in Kuwait. The same inceasing can be seen in some parts of Russia and Western Asia. In fact, the increasing trend in incidence can be seen even in the Far East, in China and Japan, where the prevalence and incidence were originally low. The gender distribution of MS in the region is also tending to change in the recent years, with more females having MS. Of the various risk factors cited for multiple sclerosis, especially migration seems to an important risk factor for the region, although there are some exceptions.
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A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized... more
A 15-year-old boy sustained a high-voltage electrical injury with full-thickness scalp and calvarial bone necrosis in the parieto-occipital region. While necrotic soft tissues were debrided on the fifth day of injury, the devitalized calvaria was preserved. Bilayered coverage of the necrotic bone was achieved by transposition of 'bipedicled pericranial flap' and 'bipedicled scalp flap'. No complication was observed in the postoperative period. A bone resorption area, smaller than the original necrotic bone area, was observed in the long-term follow-ups.
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Aim: This study has been done to evaluate patients’ knowledge and understanding about their epilepsy, to asses which factors affect to conform to medical care, to put forward proposals which will guide in the planning of health care... more
Aim: This study has been done to evaluate patients’ knowledge and understanding about their epilepsy, to asses which factors affect to conform to medical care, to put forward proposals which will guide in the planning of health care necessities and to emphasize necessity of epilepsy management for our country. Methods: This study was realized with 205 patients with epilepsy who applied to Neurology Outpatient Departments, between the dates of September 2005–March 2006. The Patient Interview Questionnaire has been used as a means of collecting data. Results: 87.3% of patients who participated to this study were male. 76.1% of the participants were single. Mean age at onset of epilepsy in the study population was 15.5±11.9 and the duration of disease was 10.0±7.2 years. 20.5% of patients had graduated from university. 50.25% of patients had no health insurance. It is found that education level is related with knowledge about illness (p
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The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability and prevalence of undiagnosed coeliac disease (CD) in ankylosing spondylitis (AS) were investigated. Blood samples from 30 AS patients and... more
The presence of anti-gliadin antibodies (AGA) and their relationship with intestinal permeability and prevalence of undiagnosed coeliac disease (CD) in ankylosing spondylitis (AS) were investigated. Blood samples from 30 AS patients and 19 age- and sex-matched controls were analysed for human leucocyte antigen (HLA)-B27, AGA and endomysial antibodies (EMA). Immunoglobulin (Ig) A-type AGA and IgG-type EMA were determined by enzyme-linked immunosorbent assay. AGA-positive patients were examined by gastroduodenoscope and proximal small-bowel mucosa biopsies were performed. Eleven (36.7%) AS patients were AGA positive (compared with none of the control subjects) and three (10.0%) of these AS patients were also EMA positive. The presence of AGA was not associated with more severe AS. Mild-to-severe villous atrophy and hyperplasia of crypts with increased chronic inflammatory cells in the lamina propria, which is typical of CD, was only observed in one AGA/EMA-positive AS patient; CD was ...
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To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and... more
To investigate elastic characteristics of the aorta in patients with epilepsy. Seventy five patients with a diagnosis of epilepsy through clinical and EEG findings and age and sex matched, 50 healthy controls were included. Systolic and diastolic blood pressures plus systolic and diastolic diameter of the aortic root was measured. Aortic strain (AS) and aortic distensibility (AD) and aortic distensibility index (BSI) were calculated. The average age of the epilepsy group was 23.8.8 +/- 8.2 years, and of the control group it was 24.1 +/- 6.2 years (p > 0.05). AS and AD were lower in the epileptic group while the aortic stiffness index was higher (10.4 +/- 4.2 vs 16.9 +/- 0.2, p: 0.001, for AS; 8.7 +/- 4.0 vs 17.2 +/- 0.1, p: 0.001, for AD and 20.1 +/- 0.1 vs 3.5 +/- 1.2, p: 0.001 for BSI). Elastic characteristics of the aorta change in epileptic patients, with a decrease of the distensibility of the aorta and an increase of the stiffness. After this preliminary study, new controll...
Research Interests: Cardiology, Epilepsy, Medicine, Echocardiography, Elasticity, and 8 moreHumans, Internal Medicine, Female, Male, Young Adult, Adult, Aorta, and Diastole
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Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxicity, which may be revealed by various signs and symptoms including seizures in patients breathing O2 at pressures of 2 ATA or higher. The... more
Hyperbaric oxygen treatment (HBOT) involves some risk of central nervous system (CNS) oxygen toxicity, which may be revealed by various signs and symptoms including seizures in patients breathing O2 at pressures of 2 ATA or higher. The aim of this study was to determine the incidence of such seizures in the Underwater and Hyperbaric Medicine Departments of two university hospitals. We retrospectively evaluated 80,679 patient-treatments for 9 clinical indications to determine the incidence of seizures attributable to CNS O2 toxicity. Because different protocols were used for HBOT, the treatments were studied in four groups according to the chamber type used and the medical facility at which it was located. Only 2 seizures were documented, yielding an incidence of 2.4 per 100,000 patient-treatments. Both cases occurred in a multiplace chamber pressurized to 2.4 ATA with O2 delivered by mask for three x 30 min with 5-min air breaks. The seizure incidence reported here is lower than oth...
Research Interests: Incidence Geometry, Turkey, Adolescent, Medicine, Humans, and 15 moreToxicity, Male, Anesthesia, Incidence, Medical Physiology, Adult, Public health systems and services research, Oxygen Toxicity, Hyperbaric Oxygen, Retrospective Studies, Hyperbaric Oxygenation, Aviation and Space History, Seizures, University Hospitals, and Databases as topic
In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ultrasound (TCD) in patients with atrial fibrillation (AF) under anticoagulant therapy, and we compared the treatment groups. Ninety-nine... more
In this study, we evaluated the microembolic signals (MES) frequency with transcranial Doppler ultrasound (TCD) in patients with atrial fibrillation (AF) under anticoagulant therapy, and we compared the treatment groups. Ninety-nine patients with nonvalvular AF with a history of stroke using warfarin (46%), 67 patients using rivaroxaban (31%), and 49 patients using dabigatran (23%), that is, a total of 215 patients, who have been referred to the stroke outpatient section of our department from May 2013 to November 2014, were included in the study. CHA(2)DS(2)VASc scoring was made for all patients, and International Normalized Ratio (INR) value was evaluated in patients using warfarin. All patients were monitored with TCD on the middle cerebral arteries bilaterally for 30 minutes. Embolic signals were evaluated according to their density and the mean number of signals in 2 consecutive recordings. The incidence of emboli in the treatment group was 32 (32%) for warfarin, 24 (36%) for rivaroxaban, and 17 (35%) for dabigatran. The analysis of variance revealed that there was no statistically significant differences between the treatment groups in terms of patients' age (P = .145), CHA(2)DS(2)VASc scores (P = .968), and the number of emboli (P = .783). As CHA(2)DS(2)VASc score increases, number of emboli increase. A statistically significant negative correlation between the number of emboli and INR scores was found in the warfarin group. The number of emboli decreases as INR decreases. As we aim to reduce the risk of emboli to a minimum with anticoagulant therapy, this screening for MES can give us an idea for the risk of stroke.
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Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 was investigated and the frequency of seizures was analyzed regarding different age, gender, type of seizure and etiological groups.... more
Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 was investigated and the frequency of seizures was analyzed regarding different age, gender, type of seizure and etiological groups. Background: For this purpose, 387 patients were included in the study who were admitted to neurology outpatient clinic with the diagnosis of epilepsy. Methods: The patients are divided into groups based on those characteristics: male / female, generalized seizure / partial seizure, age between 50 and 65 / age over 65. Results: The most common precipitating factor in all groups were found as stress (37[percnt]), sleeplessness (27[percnt]) and forgetting to take the medication (20[percnt]). 31[percnt] of the patients were on Carbamazepine, 21[percnt] were on Levetiracetam and 19[percnt] were on Valproic Asid. The most common etiological causes were identified as idiopathic (39[percnt]), poststroke(24[percnt]) and dementia (15[percnt]). Regarding the tr...
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Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases... more
Background: Coronavirus disease 2019 (COVID-19) pandemic and lockdown period may induce an impairment in quality of life (QoL), disruption in treatment (DIT), and posttraumatic stress disorder (PTSD) in chronic neurological diseases (CNDs). To reach this information, a multicenter, cross-sectional study (COVQoL-CND) was planned. Parkinson’s disease (PD), headache (HA), multiple sclerosis (MS), epilepsy (EP), polyneuropathy (PNP), and cerebrovascular disease (CVD) were selected as the CND. Methods: The COVQoL-CND study includes demographic data, the World Health Organization Quality of Life short form (WHOQOL-BREF), and Impact of Event Scale-Revised (IES-R) forms. Results: The mean age of a total of 577 patients was 49 ± 17 (19–87 years), and the ratio of female/male was 352/225. The mean age of patients with PD, HA, MS, EP, PNP, and CVD were 65 ± 11, 39 ± 12, 38 ± 10, 47 ± 17, 61 ± 12, and 60 ± 15 years, respectively. The IES-R scores were found to be higher in the younger group, th...
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Arrhythmia is not uncommon in the etiology of syncope which mimics epilepsy. Data about the epilepsy induced vagal tonus abnormalities have being increasingly reported. So we aimed to evaluate what a neurologist may gain by a simultaneous... more
Arrhythmia is not uncommon in the etiology of syncope which mimics epilepsy. Data about the epilepsy induced vagal tonus abnormalities have being increasingly reported. So we aimed to evaluate what a neurologist may gain by a simultaneous electrocardiogram (ECG) and electroencephalogram (EEG) recording in the patients who underwent EEG testing due to prediagnosis of epilepsy. We retrospectively evaluated and detected ECG abnormalities in 68 (18%) of 376 patients who underwent EEG testing. A minimum of 20 of minutes artifact-free recording were required for each patient. Standard 1-channel ECG was simultaneously recorded in conjunction with the EEG. In all, 28% of females and 14% of males had ECG abnormalities. Females (mean age 49 years, range 18-88 years) were older compared with the male group (mean age 28 years, range 16-83 years). Atrial fibrillation was more frequent in female group whereas bradycardia and respiratory sinus arrhythmia was higher in male group. One case had been...
Research Interests: Cognitive Science, Electroencephalography, Adolescent, Comorbidity, Electrocardiography, and 15 moreHumans, Simultaneity, Female, Diagnosis, Male, Incidence, Clinical Sciences, Aged, Middle Aged, Cardiac Arrhythmias, Adult, Retrospective Studies, Reproducibility of Results, Sensitivity and Specificity, and Neurosciences
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This study assessed the sensitivity of various methods for the clinical diagnosis of diabetic peripheral neuropathy. A total of 147 randomly selected patients with diabetes mellitus and 65 age- and sex-matched healthy controls were... more
This study assessed the sensitivity of various methods for the clinical diagnosis of diabetic peripheral neuropathy. A total of 147 randomly selected patients with diabetes mellitus and 65 age- and sex-matched healthy controls were evaluated by various clinical (the neuropathy symptom score [NSS], the neuropathy disability score [NDS], vibration perception thresholds [VPTs], Tinel's sign and Phalen's sign), laboratory (fasting plasma glucose and glycosylated haemoglobin levels) and electrophysiological (nerve conduction studies, H-reflex and F-wave measurements) methods. In the patient group, 8.2% had an abnormal NSS, 28.5% had a positive Phalen's sign, 32.6% had a positive Tinel's sign, 42.8% had an abnormal VPT and 57.1% had an abnormal NDS. Significant correlations were found between electrophysiologically confirmed neuropathy and the two provocation tests and abnormal VPTs. In conclusion, assessment with a complete neurological examination and standard electrophy...
Research Interests: Medicine, Assessment of Neuropathic Pain, Humans, Diabetes mellitus, Female, and 15 moreMale, Hypoglycemia, Diabetic Neuropathy, Middle Aged, Neuropathy, PARESTHESIA, Electrodiagnosis, Perception of Vibration, Predictive value of tests, Medical, Neuropathy Symptom Scores NSS, Disability Evaluation, Diabetic Neuropathies, Neuropathy Disability Score NDS, and Medical and Health Sciences
Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 were investigated and the frequencies of seizures were analysed regarding to different age, gender, type of seizure and etiological... more
Objective: In this study the factors that trigger the seizures in epileptic patients over the age of 50 were investigated and the frequencies of seizures were analysed regarding to different age, gender, type of seizure and etiological groups. Material and Methods: For this purpose, 387 patients were included in the studies who were admitted to neurology outpatient clinic with the diagnosis of epilepsy. The patients are divided into groups based on those characteristics: male / female, generalized seizure / partial seizure, age between 50 and 65 / age over 65, they were evaluated in terms of seizure triggers. Results: The most common precipitating factor in all groups were found as stress (37%), sleeplessness (27%) and forgetting to take the medication (20%). 31% of the patients were on Carbamazepine, 21% were on Levetiracetam and 19% were on Valproic Asid. The most common etiological causes were identified as idiopathic (39%), post stroke (24%) and dementia (15%). Regarding the triggering factor, some statistically significant differences were found between the following groups and control groups; the group with patients between the age 50 and 65: stress, fatigue, waking and sleeping; the group with female patients: sleeplessness; the group with the generalized seizures: alcohol and sleep. Conclusion: In conclusion 68% of our patients complained about at least one seizure precipitant and the most common precipitants were stress, sleeplessness and missing dose of medication. In this study, age between 50 and 65 group is more affected by triggers. Keywords: Epilepsy, Seizure precipitants, Stress, Sleeplessness, Missing
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BACKGROUND: The neurological manifestations of Crohn's disease are rare, dominated by multiple mononeuropathies, peripheral neuropathies (PN) of axonal and demyelinating types, myopathies and the abnormalities of the white matter. In our... more
BACKGROUND: The neurological manifestations of Crohn's disease are rare, dominated by multiple mononeuropathies, peripheral neuropathies (PN) of axonal and demyelinating types, myopathies and the abnormalities of the white matter. In our study, we aimed to report electrophysiological follow-up of a patient with chronic polyradiculoneuritis associated with newly diagnosed active Crohn's disease.CASE: A 32-year-old male patient was admitted with the complaints of abdominal pain and diarrhea for three years and an ascending weakness of all four extremities since two years. On his medical history he did not have any other disease and none of the members of his family had similar complaints. The neurological examination revealed a weakness of the especially distal muscles (2-3/5) with areflexia, hypotonia and distal atrophia in all extremities. He also had a glove and stocking hypoestesia. Routine biochemical and hematological examination were in normal ranges except C-reactive protein. The analysis of the cerebrospinal fluid showed an albumino-cytological dissociation.CONCLUSION: Our results suggest that peripheral neurological findings could be regarded as a possible extraintestinal manifestation of Crohn's disease. It is important to remember that inflammatory bowel diseases may be a reason for a newly diagnosed polyneuropathy (acute or chronic demyelinated polyneuropathy) and therefore detailed examinations are needed if the patients do not have the commonly observed reasons for the development of polyneuropathy and be careful in inflammatory disease patient to develop polyneuropathy.
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ABSTRACT Objectives: Susac’s syndrome is a disease of the microvasculature in the brain, inner ear (cochlea and vestibular apparatus) and retina that consists of a clinical trial of encephalopathy, hearing loss and visual disturbance. It... more
ABSTRACT Objectives: Susac’s syndrome is a disease of the microvasculature in the brain, inner ear (cochlea and vestibular apparatus) and retina that consists of a clinical trial of encephalopathy, hearing loss and visual disturbance. It is usually seen in young women. It is first defined by Susac et al. in 1979. Diagnosis is often difficult because the classic triad may take up to 2 years to develop and radiological findings are easily confused with multiple sclerosis. Also, encephalopathy may mask some other findings. Case: We present two cases that we think are particularly instructive because they were male patients, had somewhat unusual presenting symptoms, had no accompanying hearing loss, required relatively less aggressive and less sustained immunosuppression than usual, and followed a relatively short and benign course, without relapse and with excellent outcome.. Conclusion: This two case serve as good examples of the apparent efficacy and sufficiency (in their cases) of Intravenous immunoglobulin for Susac’s syndrome
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External or internal pressures on peripheral nerves may result in compression neuropathies. Although compressive common peroneal nerve palsy is well known, to date very few cases with bilateral palsies have been reported. The clinical and... more
External or internal pressures on peripheral nerves may result in compression neuropathies. Although compressive common peroneal nerve palsy is well known, to date very few cases with bilateral palsies have been reported. The clinical and electrophysiological manifestations of three patients with bilateral peroneal nerve palsies are reported, and their clinical outcomes are discussed. The first patient's transient bilateral palsy was corrected by conservative means. The second patient, with a more severe axonal lesion, did not improve within 3 months, and nearly complete recovery occurred after operative decompression. For the third patient, who had been suffering for a long time, no improvement could be hoped for. Prolonged squatting was the etiological factor in all three cases. Bilateral compression neuropathies of the peroneal nerve, like unilateral lesions, may recover spontaneously. Surgical intervention is recommended for patients with predominantly axonal lesions and for those who do not improve within 3 months.
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The primary source of ammonia is the gut. Ammonia can also be generated by the urease activity of Helicobacter pylori in the gastric mucosa. The aim of this study was to investigate the effect of H. pylori eradication on blood and gastric... more
The primary source of ammonia is the gut. Ammonia can also be generated by the urease activity of Helicobacter pylori in the gastric mucosa. The aim of this study was to investigate the effect of H. pylori eradication on blood and gastric juice ammonia levels and on visual evoked potential (VEP) recordings in cirrhotic patients. Male patients with cirrhosis and H. pylori infection were prospectively evaluated. All patients were given triple regimen for eradication for 10 days. Gastroscopy together with gastric juice sampling for ammonia and mucosal sampling for H. pylori status was performed before and after therapy. Gastric juice and blood ammonia levels were measured and VEP recordings were obtained before and after treatment. Twenty-seven patients were included in the study. Patients with overt clinical hepatic encephalopathy were excluded from the study. Twenty-four out of twenty-seven patients became H. pylori-negative after the treatment. Ammonia measurements and VEP recordings were evaluated in the 24 patients in whom eradication was successful. A slight but statistically significant decrease in blood and a considerable decrease in gastric juice ammonia levels were observed after treatment [from 44.23 micromol/l to 41.6 micromol/l compared with 3234 micromol/l to 2709 micromol/l, respectively (p <.05)] in patients in whom H. pylori was eradicated. VEP recordings were abnormal in 14 out of 24 patients before the treatment. Only four of these 14 patients with abnormal recordings showed improvement. (p > .05). Helicobacter pylori eradication in cirrhotics decreases blood and gastric juice ammonia concentrations whereas it does not provide an improvement in VEP recordings.
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Willis polygon supplies blood to the brain by combining the circulation of the two hemispheres through the anterior communicating artery (ACoA) and by combining the anterior and posterior circulations through posterior communicating... more
Willis polygon supplies blood to the brain by combining the circulation of the two hemispheres through the anterior communicating artery (ACoA) and by combining the anterior and posterior circulations through posterior communicating artery (PCoA). This system is of "normal" ...