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Öğe Acute Lithium Neurotoxicity: Clinical and Electrophysiological Evaluation of Four Cases(Journal Neurological Sciences, 2013) Keles, Esra; Yuceyar, Ayse Nur; Bayam, Ece; Bademkiran, Fikret; Sirin, Hadiye; Sagduyu Kocaman, AyseLithium is one of the first choice agents for long-term prophylaxis and the treatment of acute episodes of bipolar disorders. Because of its narrow therapeutic range and the common undesirable side effects, using lower lithium dosages with lower lithium serum levels are preferred treatment regimen especially for maintenance treatment. Concomitant drug using (especially neuroleptics), underlying infections and metabolic causes; such as dehydration and renal insufficiency take place in factors facilitating the development of toxicity. Lithium intoxication is distinguished in three different patterns as "acute", "chronic" and "toxicity during chronic use". Although patients with lithium poisoning may present with a variety of clinical manifestations, neurological symptoms appeared to dominate with a certain risk of persistency. In this report, four cases of lithium intoxication with neurological complications were presented with clinical and electrophysiological findings and lithium neurotoxicity was reviewed with recent literature.Öğe Acute Lithium Neurotoxicity: Clinical and Electrophysiological Evaluation of Four Cases(Journal Neurological Sciences, 2013) Keles, Esra; Yuceyar, Ayse Nur; Bayam, Ece; Bademkiran, Fikret; Sirin, Hadiye; Sagduyu Kocaman, AyseLithium is one of the first choice agents for long-term prophylaxis and the treatment of acute episodes of bipolar disorders. Because of its narrow therapeutic range and the common undesirable side effects, using lower lithium dosages with lower lithium serum levels are preferred treatment regimen especially for maintenance treatment. Concomitant drug using (especially neuroleptics), underlying infections and metabolic causes; such as dehydration and renal insufficiency take place in factors facilitating the development of toxicity. Lithium intoxication is distinguished in three different patterns as "acute", "chronic" and "toxicity during chronic use". Although patients with lithium poisoning may present with a variety of clinical manifestations, neurological symptoms appeared to dominate with a certain risk of persistency. In this report, four cases of lithium intoxication with neurological complications were presented with clinical and electrophysiological findings and lithium neurotoxicity was reviewed with recent literature.Öğe Adductor T and H reflexes in humans(Wiley, 2006) Ertekin, Cumhur; Bademkiran, Fikret; Tataroglu, Cengiz; Aydogdu, Ibrahim; Karapinars, NevinIn the belief that changes in the adductor reflex (AR) may be helpful in evaluating lumbar root and plexus lesions, expression of the AR was studied in 43 healthy human subjects. ARs elicited with an electronic reflex hammer were recorded from the inner side of the proximal thigh using needle and surface electrodes, and patellar reflexes (PRs) were recorded simultaneously. These reflexes were obtained by tapping the ipsilateral medial aspect of the knee, the contralateral patellar tendon, the ipsilateral and contralateral anterior superior iliac spines, and the Achilles tendon. The H reflex of the obturator nerve was also evaluated in 17 cases. ARs were evoked consistently by tapping the ipsilateral medial aspect of the knee and by contralateral patellar tap, and by tapping ipsilateral and contralateral anterior superior iliac spines when a needle recording electrode was used. Sometimes an Achilles tendon tap also elicited the AR ipsilaterally. By contrast, the PR could only be elicited by a tap to the ipsilateral patellar tendon. ARs have somewhat different features than other well-known tendon reflexes such as the PR and are recorded consistently when a needle electrode is used, being elicited from both distal and proximal areas of the legs by tapping the Achilles tendon or anterior superior iliac spines unilaterally or bilaterally. Their role in evaluating lumbar root disease and monitoring adductor spasticity merits investigation.Öğe Anesthetic management of Guillain-Barre syndrome in pregnancy(Elsevier Science Inc, 2007) Kocabas, Seden; Karaman, Semra; Firat, Vicdan; Bademkiran, FikretWe report the case of a 23-year-old woman who was diagnosed with an axonal type of Guillain-Barre syndrome at 16 weeks' gestation. The patient had severe motor loss but she was treated effectively with intravenous immunoglobulin, and she underwent cesarean delivery with epidural anesthesia at full term. (c) 2007 Elsevier Inc. All rights reserved.Öğe Bilateral Ischemic Lumbosacral Plexopathy Presenting as Acute Paraparesia Due to Vascular Graft Occlusion in a Patient With Leriche Syndrome(Journal Neurological Sciences, 2017) Ciftci, Seyma; Ekinci, Aysen Suzen; Tabakoglu, Aycin Yildiz; Bademkiran, FikretAcute ischemia of peripheral nerves generally results from occlusion of a main proximal limb artery or from occlusion of many distal arteries. The rareness of such neuropathies can be explained by the relative resistance of peripheral nerves to ischemia. Leriche syndrome is an aortoiliac occlusive disease that is known to cause neurologic complications such as ischemic neuropathy and spinal cord ischemia. Here, we present a man aged 55 years with bilateral lumbosacral plexopathy that presented as acute paraparesia due to thrombotic occlusion of an axillobifemoral graft, which was performed for the treatment of Leriche syndrome.Öğe Cauda equina sensory conduction time in normal adult humans(Ege Univ, 2019) Ekinci, Aysen Suzen; Tabakoglu, Aycin Yildiz; Oto, Aycan; Bademkiran, Fikret; Ertekin, CumhurObjective: The clinical usefulness of the cauda equina motor conduction time (CE-MCT) is well established either by magnetic or electrical stimulation of the lumbar roots at the lumbar spine levels. However, the cauda equina sensory conduction time (CE-SCT) is not studied systematically in human adults. Methods: Lumbar laminar electrical stimulation from the level of the L1 and L5 vertebrae was applied using needle electrodes. The smallest M-responses obtained from both soleus muscles were considered as the motor threshold for the L1 and L5 motor root levels. Afterwards, with the needles in the same place, the connection cables were removed from the stimulation channel and replaced to the recording channel, then the sensory program of the electromyograph was selected. The posterior tibial nevre was excited with superficia lbipolar electrodes from the popliteal fossa, and after a very slight muscle twitch was observed the intensity was reduced slightly. Therefore, the pure sensory fibers were stimulated. Cauda equina sensory action potentials were recorded and averaged at the laminar levels of L1 and L5 in the spine. Twenty adult normal controls were studied. Results: The monopolar recordings of cauda equina sensory responses at the L1 and L5 laminar levels were measured from their first positive peaks and the CE-SCT was found as 1.9 +/- 0.4 msec (mean +/- SD) and ranged from 1.0 to 2.8 msec. Conclusion: The method of CE-SCT recording and calculation is very easy to use and applicable in all normal adult subjects. The mean CE-SCT value is similar to those found for CE-MTC.Öğe Chronic inflammatory demyelinating polyneuropathy in an HCV related cirrhotic patient with acute hepatitis B superinfection(Elsevier Science Bv, 2007) Ersoz, Galip; Tekin, Fatih; Bademkiran, FikretÖğe Could we Predict Respiratory Failure in Amyotrophic Lateral Sclerosis?(Wolters Kluwer Medknow Publications, 2022) Akkoc, Ceren Cetin; Aykac, Seyma; Bademkiran, Fikret; Aydogdu, Ibrahim; Tasbakan, SezaiIntroduction: Respiratory complications are important in the prognosis of amyotrophic lateral sclerosis (ALS). The aim of this study was to determine the electrophysiological findings that may predict respiratory failure. Methods: According to the Awaji electrodiagnostic criteria, 30 patients with ALS who were diagnosed with definite or probable ALS without respiratory failure were included in the study. Nerve conduction studies, needle electromyography (EMG), and single-breath count tests were performed in all patients. In addition, the pulmonary function tests, swallowing EMG, and arterial blood gas analysis of the patients were recorded and evaluated. The patients were followed until respiratory failure developed. Results: As a result of 18 months of follow-up, 26 of 30 patients developed respiratory failure. When the contribution of the accessory respiratory muscles to the respiratory effort before the development of respiratory failure was evaluated clinically and electrophysiologically, it was observed that the most common muscles involved in the respiratory effort were sternocleidomastoid (SCM), trapezius, and rectus abdominis. Before the development of respiratory failure, the latest neurogenic EMG findings were seen in the SCM (50% cases), trapezius (20% cases), and thoracic paraspinal muscles (17% of cases), respectively. It was thought that this finding could be an important early electrophysiologic marker in predicting the development of respiratory failure in ALS cases. Conclusions: To sum up, the presence of neurogenic changes in certain muscles in needle EMG and demonstration of the contribution of certain accessory respiratory muscles in respiration can be used as an electrophysiological marker to predict the development of respiratory failure.Öğe Effects of a Dynamic Warm-Up, Static Stretching or Static Stretching with Tendon Vibration on Vertical Jump Performance and EMG Responses(Acad Physical Education-Katowice, 2013) Yapicioglu, Bulent; Colakoglu, Muzaffer; Colakoglu, Zafer; Gulluoglu, Halil; Bademkiran, Fikret; Ozkaya, OzgurThe purpose of this study was to investigate the short-term effects of static stretching, with vibration given directly over Achilles tendon, on electro-myographic (EMG) responses and vertical jump (VJ) performances. Fifteen male, college athletes voluntarily participated in this study (n=15; age: 22 +/- 4 years old; body height: 181 +/- 10 cm; body mass: 74 +/- 11 kg). All stages were completed within 90 minutes for each participant. Tendon vibration bouts lasted 30 seconds at 50 Hz for each volunteer. EMG analysis for peripheral silent period, H-reflex, H-reflex threshold, T-reflex and H/M ratio were completed for each experimental phases. EMG data were obtained from the soleus muscle in response to electro stimulation on the popliteal post tibial nerve. As expected, the dynamic warm-up (DW) increased VJ performances (p=0.004). Increased VJ performances after the DW were not statistically substantiated by the EMG findings. In addition, EMG results did not indicate that either static stretching (SS) or tendon vibration combined with static stretching (TVSS) had any detrimental or facilitation effect on vertical jump performances. In conclusion, using TVSS does not seem to facilitate warm-up effects before explosive performance.Öğe The effects of the cerebral, cerebellar and vestibular systems on the head stabilization reflex(Springer-Verlag Italia Srl, 2016) Bademkiran, Fikret; Uludag, Burhanettin; Guler, Ayse; Celebisoy, NeseThe head stabilization reflex (HSR) is a brain stem reflex which appears in the neck muscles in response to sudden head position changes and brings the head to its previous position. The reflex mechanism has not been understood. The afferent fibers come from cervical muscle spindles, vestibular structures, and the accessory nerve, the efferents from the accessory nerve. In this study, we aim to investigate the roles of supraspinal neural structures and the vestibular system on the HSR. The patient group consisted of 86 patients (33 cerebral cortical lesion, 14 cerebellar syndrome and 39 vestibular inexcitability or hypoexcitability); the control group was composed of 32 healthy volunteers. Concentric needle electrodes were inserted into the sternocleidomastoid muscle (SCM) and the accessory nerves were stimulated with the electrical stimulator. A reflex response of about 45-55 ms was obtained from the contralateral SCM muscle. 50 % of cases had bilateral loss whereas 37 % of cases with unilateral cerebellar lesions had an ipsilateral reflex loss. Bilateral HSR loss was detected in 84 % of cases with bilateral cerebellar lesions. Bilateral reflex loss was observed in 70 % of patients with unilateral cortical lesions and 94 % of those with bilateral vestibular dysfunction. Ipsilateral HSR loss was observed in 55 % of cases with unilateral vestibular dysfunction. It was discovered that supraspinal structures and the vestibular system may have an excitatory effect on HSR. This effect may be lost in supra-segmental and vestibular dysfunctions. The localization value of HSR was found to be rather poor in our study.Öğe Epileptic nystagmus with different localization of lesions in magnetic resonance imaging in a patient with MELAS(Ege Univ, 2018) Tabakoglu, Aycin Yildiz; Ciftci, Seyma; Ekinci, Aysen Suzen; Guler, Ayse; Bademkiran, Fikret; Karasoy, Hatice; Aydogdu, IbrahimMitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is a syndrome which is characterized as mitochondrial myopathy, encephalopathy, lactic acidosis and recurrent stroke-like episodes. Recurrent attacks of prolonged migrainous headache, different types of epileptic seizures and repeated cerebral lesions are the main clinical features of the disease. Cerebral lesions can cause different seizure types in this syndrome according to affected brain areas. Herein, we are reporting a case of MELAS who experienced recurrent neurologic deficits, confusional states and epileptic seizures with ictal epileptic nystagmus. Ictal electroencephalogram (EEG) recordings and magnetic resonance imaging (MRI) lesions also supported to the ictal focus of epileptic nystagmus. With this case, we would like to take attention to this rare ictal event.Öğe Molecular analysis in X-linked adrenoleukodystrophy patients: identification of a novel mutation(Springer/Plenum Publishers, 2014) Durmaz, Asude; Atik, Tahir; Onay, Huseyin; Canda, Ebru Erbas; Ucar, Sema Kalkan; Bademkiran, Fikret; Coker, Mahmut; Cogulu, Ozgur; Özkınay, FerdaX linked adrenoleukodystrophy (X-ALD) is a neurodegenerative disease characterized by progressive demyelination of the central nervous system, adrenocortical insufficiency and elevated levels of very long chain fatty acids (VLCFAs). It is caused by mutations in ABCD1 gene located at Xq28. More than 1,300 mutations have been identified to date which is unique to each patient. In this study we report the mutational analysis of 2 X-ALD patients (1 male and 1 female) showing variable clinical spectrum. The mutation analysis of the female patient revealed IVS5-6delC (c.1489-6delC) and p. P543L variations in compound heterozygous state. The male patient was found to be hemizygous for a novel mutation, p. R104P. In conclusion, while defining a novel mutation, the cases presented herein may contribute to the mutation and clinical spectrum of X-ALD.Öğe Monomelic Amyotrophy (Hirayama Disease): Clinical Findings, EMG Characteristics and Differential Diagnosis(Journal Neurological Sciences, 2015) Bademkiran, Fikret; Oto, Aycan; Tabakoglu, Aycin; Aydogdu, Ibrahim; Uludag, BurhanettinIntroduction and Objective: Monomelic amyotrophy (MA) is a benign motor neuron disease with a stationary stage after a progressive course, involving one or more myotomes in the upper limb. In the early stages, it may be difficult to discriminate the diseases presenting with similar clinical course. We reviewed clinical and EMG characteristics and differential diagnosis of MA for this purpose. Methods: Fourteen cases admitted to the Neurophysiology EMG laboratory of Medical School of Ege University, and diagnosed as having monomelic amytrophy between 2005 and 2014, were evaluated retrospectively along with complaints, age at onset, gender, the involved myotome, EMG and clinical characteristics. Cases with possible etiological diagnoses that might cause mononeuropathy or detected motor conduction block or developed ALS during follow-ups were excluded from the study. Results: All fourteen patients had onset in the upper limb. The female to male ratio was 4: 10, the mean age of the onset was 24 +/- 8.64 years (mean +/- Standard deviation), minimum-maximum age of onset was 16-40 years, with median value being 21. C8-T1 segments were involved in all cases except one. Follow-up EMG studies demonstrated denervation, fasciculations, and reduced compound muscle action potential amplitudes. Electrophysiologically, our three asymptomatic cases had moderate involvement in the contralateral limb without any complaints. Conclusion: Cases with MA can be distinguished from ALS by symptom onset at younger ages in men, its benign course and generally with stabilization of clinical and EMG findings in 2 to 4 years. Asymptomatic side should also be considered to be affected electrophysiologically.Öğe Myasthenia gravis and thymoma coexisting with myotonic dystrophy type 1(Pergamon-Elsevier Science Ltd, 2014) Ekmekci, Ozgul; Karasoy, Hatice; Bademkiran, Fikret; Akkus, Dilek Evyapan; Yuceyar, NurWe describe a 34-year old man presenting with subacute generalized myasthenic symptoms. His clinical features and laboratory investigations demonstrated both myasthenia gravis and myotonic dystrophy type 1. The computerized tomography of chest revealed anterior mediastinal mass. The lymphocyte-rich thymoma was removed surgically and he received radiotherapy. Recent observations suggested that the patients with myotonic dystrophy may have an increased risk of benign and malignant tumours but its coexistence with thymoma is very rare. The risk of thymoma associated with myotonic dystrophy is unknown. (C) 2013 The Authors. Published by Elsevier B.V. All rights reserved.Öğe Peripheral Neuropathy Is More Common in Microscopic Polyangiitis Than in Granulomatosis with Polyangiitis: Data from a Single Tertiary Referral Center(Wiley, 2018) Tas, Mehmet Nedim; Kara, Mete; Ketenci, Sertac; Pekdiker, Mete; Durusoy, Raika; Bademkiran, Fikret; Keser, Gokhan; Aksu, KenanÖğe Proximal Conduction Time Along The Lumbar Plexus(Journal Neurological Sciences, 2012) Uysal, Hilmi; Bademkiran, Fikret; Albayrak, Nural; Esmer, Ali Firat; Keles, Nigar; Sindel, Muzaffer; Tekdemir, Ibrahim; Kizilay, Ferah; Ertekin, CumhurScientific Background: One of the matters in clinical neurophysiology is evaluation of the proximal conduction time along the lumbar plexus. Objectives: Instead of investigating only distal segment of the nerve from the groin as is generally done we aimed to investigate both proximal and distal parts of the nerves originating from the lumbar plexus. Material and Methods: In this paper different proximal conduction methods were studied in 109 healthy adult human subjects by measuring proximal motor conduction time of femoral, obturator and genitofemoral nerve along the lumbar plexus using both by using lumbar magnetic and peripheral electrical stimulation and by using the H-reflex methods in adductor and quadriceps muscle group. The anatomical parts of the study were applied on 20 human adult cadavers, dissecting femoral, obturator genitofemoral nerve and roots proximally. Results: The total distance from ligamentum inguinale to spinal level was 392.4 +/- 13.3mm in femoral nerve. The total distance was approximately 382.8 +/- 11.1mm in obturator nerve and the total distance was approximately 353.1 +/- 12.5 mm in genitofemoral nerve. With the H reflex method, using the distance obtained from the cadaver, femoral and obturator nerve proximal conduction velocity were determined to be 62.5 +/- 6.1 m/sec and 53.6 +/- 7.4 m/sec, respectively. Using lumbar magnetic stimulation and the peripheral electrical stimulation, proximal conduction velocities in femoral, obturator and genitofemoral nerves were determined to be 59.1 +/- 13.3m/sec, 52.7 +/- 14.9 and 58.7 +/- 0.8 m/sec, respectively. Conclusions: No statistical differences were found between the proximal conduction velocities elicited by both methods. Either approach is preferable to evaluate proximal conduction time.Öğe The relationship between lower urinary tract symptoms associated with benign prostatic hyperplasia and erectile dysfunction: the role of autonomic hyperactivity(Tubitak Scientific & Technical Research Council Turkey, 2014) Umul, Mehmet; Altay, Ahmet Baris; Bademkiran, Fikret; Turna, Burak; Semerci, Mehmet Bulent; Apaydin, Erdal; Cikili, NecmettinBackground/aim: To investigate whether autonomic nervous system (ANS) hyperactivity may be a potential cause for the relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). Materials and methods: Twenty-four patients were recruited for this study. Complete physical examinations, urine analysis, uroflowmetry, and postvoid residual urine volume (PVRU) analysis were performed. The potential impact of some factors such as hyperglycemia, obesity, and hyperlipidemia were analyzed. These values were correlated with the various symptom scores. We performed an electromyographic and an electrocardiographic evaluation. The alterations after treatment with 2 different alpha-blockers were also analyzed. Results: The electromyographic and electrocardiographic assessments revealed a minimal increase in ANS activity and it did not change significantly after treatment (P > 0.05). After treatment, maximum flow rate increased and PVRU decreased significantly (P < 0.001 and P < 0.001, respectively); total and free testosterone levels increased significantly (P = 0.0068 and P = 0.0071, respectively). There was a statistically significant difference between the 2 treatment groups regarding the outcomes of the Danish Prostate Symptom Score questionnaire (P = 0.047). Conclusion: This current study suggested that the effect of ANS hyperactivity is not the fundamental factor underlying the relationship between LUTS and ED.Öğe Sacrolumbar intersegmental reflex circuit in men and its relation to the ejaculatory process(Elsevier Ireland Ltd, 2007) Ertekin, Cumhur; Uysal, Hilmi; Bademkiran, Fikret; Altay, BarisObjective: We aimed to investigate electrophysiologically the intersegmental reflex circuit from sacral to lumbar cord segments in normopotent adult men, in patients with spinal cord injury and in patients with premature ejaculation. Methods: Reflex EMG activity of the cremasteric (CM) and bulbocavernosus (BC) muscles was recorded simultaneously by needle electrodes during electrical stimulation of the upper lumbar and sacral dermatomes, respectively. Thirty-three healthy male volunteers, 16 patients with spinal cord injury (SCI) at the thoracic or cervical levels, and 26 men with premature ejaculation (PME) were included in the study. Results: In controls, upper lumbar dermatomal stimulation (ULS) at the inner side of thigh only elicited a reflex response from the CM muscle and did not produce a regular response from the lower sacral myotomes such as in the BC muscle. However lower sacral dermatomal stimulation (LSS) at the dorsal nerve of penis consistently evoked reflex responses from both CM and BC muscles. These basic electrophysiological features were not different in patients with SCI. LSS did not elicit a reflex response from the CM muscle in about 39% of patients with PME, while the BC reflex was obtained from all patients with PME. Conclusions: The neurophysiological pattern in BC and CM muscles during sacral or lumbar dermatomal stimulation reflects the sacrolumbar intersegmental reflex linkage that may be related to the ejaculatory process in men. The intersegmental sacrolumbar reflex circuit may be functionally disturbed in some patients with PME. Significance: Interaction between the reflex activity of sacral to lumbar dermatomes could prove useful in defining electrophysiological mechanisms related to ejaculation in men. (c) 2007 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.Öğe Sensory conduction study of the infrapatellar branch of the saphenous nerve(Wiley, 2007) Bademkiran, Fikret; Obay, Basra; Aydogdu, Ibrahim; Ertekin, CumhurAlthough neuropathies of the infrapatellar nerve (infrapatellar branch of the saphenous nerve, IPBSN) have been reported clinically, no electrophysiological method has been defined to evaluate IPBSN conduction. We therefore studied a total of 60 saphenous nerves and 60 IPBSNs from 36 volunteers. The IPBSN was stimulated medially with a surface electrode 2 cm below the patella. The response was recorded with a needle electrode located close to the nerve 1 cm lateral to the femoral artery in the inguinal region. Sensory nerve action potentials were obtained from each subject; mean latency of the first positive peak was 8.1 +/- 0.9 ms, conduction velocity was 54 +/- 4.4 m/s, and response amplitude was 1.3 +/- 1.1 mu V. The method that we describe may be an easy and useful electrophysiological test for neuropathies of the IPBSN.Öğe Sensory Nerve Conduction in Branches of Common Interdigital Nerves: A New Technique for Normal Controls and Patients With Morton's Neuroma(Lippincott Williams & Wilkins, 2010) Uludag, Burhanettin; Tataroglu, Cengiz; Bademkiran, Fikret; Uludag, Irem Fatma; Ertekin, CumhurIn this article, a new electrodiagnostic approach is described for patients with Morton's neuroma. The new method is based on the anatomic fact that the two branches of the common plantar interdigital nerves innervate the lateral side of one toe and the medial side the next one. This study included 20 normal subjects (aged 28-58 years, 10 men and 10 women) and 4 patients with Morton's neuroma (aged 44-52 years, 4 women). The branches of adjacent common plantar interdigital nerves that innerve one toe were stimulated superficially and separately with half of one toe covered with a piece of medical tape. The recordings were obtained on the posterior tibial nerve at the medial malleolus with needle electrodes. Thus, the difference in latencies of obtained sensory nerve action potentials on the posterior tibial nerve with needle electrode was measured. From normal subjects' data, it was determined that a latency difference value of above 0.17 milliseconds (mean +/- 2.5 SD) in one toe was abnormal. All of the patients with Morton's neuroma showed abnormal interlatency difference values. This new method, which we have developed, is more sensitive, simple to use, does not require extra equipment, and does not cause excessive pain. We suggest that interlatency difference between branches of the common plantar interdigital nerves is a useful and sensitive method for the diagnosis of Morton's neuroma.
