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Background: In this study, we aimed to evaluate the association of lamina cribrosa thickness (LCT) and lamina cribrosa depth (LCD), as determined by spectral domain optical coherence tomography (SD-OCT), with visual evoked potentials (VEPs) in patients with multiple sclerosis (MS)., Materials and Methods: Patients enrolled in this prospective, cross-sectional study were divided into three groups. Group 1 consisted of 25 relapsing-remitting MS patients with VEP pathology in one or both eyes. In patients with VEP pathology in both eyes, one eye was chosen randomly. Group 2 comprised 25 relapsing-remitting MS patients with no VEP pathology or optic neuritis history. A randomly selected single eye of each patient was evaluated. Group 3 consisted of 25 age- and sex-matched healthy volunteers; a randomly selected single eye of these participants was examined. LCT, LCD, and retinal nerve fiber layer (RNFL) thickness measurements were determined in four quadrants (superior, inferior, nasal, and temporal) by SD-OCT., Results: The three groups were similar in terms of age and sex. The mean LCT was lower in Group 1 than in Group 2, but the difference was not statistically significant (268.80 ± 36.69 μm [min-max = 222-394 μm] versus 285.80 ± 12.00 μm [min-max = 249-338 μm]; P = 0.148). The mean LCT was significantly lower in Group 1 than in Group 3 (268.80 ± 36.69 μm [min-max = 222-394 μm] versus 294.80 ± 12.00 μm [min-max = 232-351 μm]; P = 0.012). There was a weak positive correlation between LCT and RNFL-inferior, RNFL-nasal, and RNFL-temporal., Conclusion: We found that the lamina cribrosa was thinner in MS patients with VEP pathology. To the best of our knowledge, this is a novel finding. Our results imply that LCT could be used as an indicator of optic neuritis in MS patients., Competing Interests: None

Purpose: To measure the duration of nasolacrimal transition in patients with Multiple Sclerosis (MS), to compare the findings with the healthy population and to investigate the relationship between MS-related disability and nasolacrimal transition time., Methods: A total of 73 individuals including 37 patients with relapsing-remitting MS and 36 healthy volunteers were included in the study. In both groups the nasolacrimal transition time was measured using flurosein drops. The degree of disability of MS patients was calculated according to the Expanded Disability Status Scale (EDSS)., Results: There was a significant difference between MS patients and control group in terms of the median value of nasolacrimal transition time in (240 s (min: 85, max: 724) and 58.5 s (min: 21, max: 428), respectively) (p < 0.001). A positive correlation was found between EDSS scores and nasolacrimal transition time of MS patients (r = 0.384, p = 0.019)., Conclusion: This study showed that nasolacrimal transition time is prolonged in MS patients and there is a relationship between the degree of MS-related disability and the nasolacrimal transition time. This is the first study in the literature on this subject and the results of our study have the potential to shed light on the causes of common infections in MS patients. Long-term prospective studies are needed to further investigate the relationship between prolonged nasolacrimal transition and infections in MS patients., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Objective: This study aims to investigate the relationship between work-related stress and sleep disorders in healthcare personnel working in emergency department and in other departments., Material and Methods: This cross-sectional study included 34 emergency department healthcare personnel (emergency group [EG]) and 35 healthcare personnel working in other departments (non-emergency group [NEG]) and was conducted between November 10, 2019 and March 1, 2020. All participants were administered the following questionnaires: work-related strain inventory (WRSI), Epworth sleepiness scale (ESS), Berlin questionnaire, insomnia severity index (ISI), Pittsburgh sleep quality index (PSQI), Beck depression inventory (BDI), and Beck anxiety inventory (BAI)., Results: While the mean WRSI score of EG was 39.53±7.77, the mean WRSI score of NEG was 30.06±7.26 (t=5.236, p<0.001). According to PSQI, 79.4% of EG and 57.1% of NEG were found to have poor sleep quality (X 2 =3.938, df=1, p =0.047). Median PSQI overall score was 12 (IQR 25th-75th percentiles: 10-14) in EG, and 7 (IQR 25th-75th percentiles: 4-9) in NEG (U=285.5, p <0.001). While the mean anxiety score of EG was 13.35±5.70, the mean anxiety score of NEG was 9.06±6.00 (t=3.046, p =0.003). Median depression score was 12 (IQR 25th-75th percentiles: 10-16) in EG, and was 8 (IQR 25th-75th percentiles: 4-12) in NEG (U=354, p =0.004). A significant positive correlation was found between work-related strain scores and sleep quality, sleepiness, and insomnia severity scores (r=0.541, p <0.001; r=0.310, p =0.010; r=0.357, p =0.004; respectively)., Conclusion: It was determined that healthcare personnel working in the emergency department were at higher risk of developing sleep disorders compared to healthcare personnel working in other departments and that there was a significant relationship between sleep disorders and work-related stress.

Objective: Headache continues to be a common cause of emergency admissions. At first glance, primary headaches may not be distinguished from secondary headaches. This study aimed to evaluate the use of ultrasonic measurement of optic nerve sheath diameter (ONSD) in the clinical diagnosis of migraine patients during attack and during periods without attacks., Patients and Methods: This prospective study was conducted at the emergency department and neurology outpatient clinic of a tertiary hospital between October 2019 and January 2020. Patients diagnosed with episodic migraine and between ages 18-60 were included in the study. Migraine diagnosis and classification were based on criteria from the 2018 International Classification of Headache Disorders. ONSD measurement was performed with ultrasonography. ONSD measurements of the same migraine patients during attack and attack-free periods were compared with measurements of healthy volunteers., Results: A total of 82 participants consisting of 42 migraine patients and 40 control subjects were evaluated. In the control group, mean ONSD of the right eye was 4.88 ± 0.31 mm and mean ONSD of the left eye was 4.86 ± 0.31 mm. Mean ONSD measurement of the left eye was 4.80 ± 0.36 mm and mean ONSD of the right eye was 4.82 ± 0.37 during the attack period of the migraine patients. There was no significant difference between the migraine patients and the control group according to right and left eye ONSD measurements (attack-free period: p = 0.200, p = 0.448; attack period: p = 0.338, p = 0.660, respectively). There was no significant difference between ONSD measurements during the attack period and attack-free period in migraine patients (right eye p = 0.32; left eye p = 0.532)., Conclusion: The results of our study indicate that ONSD measurements may provide clinical insight into differential diagnosis preceding neuroimaging in migraine patients. On the other hand, since our study is the first on this topic, it should be noted that further studies are needed to come to a conclusion., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Migraine coexistence, which is high in multiple sclerosis (MS), is reported. To better understand the etiology of the coexistence of MS and migraine and the outcomes of this relationship, the vitamin D, vitamin D-binding protein (VITDBP), vitamin D receptor (VITDR), high-sensitivity C-reactive protein (hs-CRP), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), total antioxidant status (TAS), total oxidant status (TOS), and Oxidative Stress Index (OSI) values were examined in patients with the coexistence of relapsing-remitting multiple sclerosis (RRMS) and migraine., Methods: This study was conducted between January 1, 2019, and July 25, 2019, at the neurology and biochemistry clinics of two different tertiary hospitals simultaneously. Overall, 50 RRMS patients with migraine, 50 RRMS patients without migraine, and 50 healthy volunteers were included in the study. The participants' vitamin D, VITDBP, VITDR, hs-CRP, SOD, CAT, GSH-Px, TAS, TOS, and OSI values were measured., Results: The vitamin D and VITDR values of the RRMS patients with migraine were lower than those of the RRMS patients without migraine (respectively, p = 0.014, p < 0.001). There was no significant difference between the RRMS patients with and without migraine in terms of their VITDBP values (p = 0.570). The SOD, CAT, GSH-Px, and TAS values of the RRMS patients with migraine were lower than those without migraine (all p < 0.001). The hs-CRP and TOS values of the RRMS patients with migraine were higher than those without migraine (all p < 0.001)., Conclusion: To the best of our knowledge, this is the first study on this topic to date. Based on the results, our study may shed light on the etiopathogenesis of the coexistence of MS and migraine and new treatments. However, more studies are needed to better understand the etiology of this relationship and its negative effects., Competing Interests: Declaration of Competing Interests None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objective : This study aimed to compare cognitive skills in epilepsy patients and psychogenic non-epileptic seizures (PNES) patients who have no history of frequent seizures to those of a healthy control group. Methods : This prospective cross-sectional study was conducted between January 2017 and June 2019 and included 103 epilepsy patients, 100 PNES patients, and 101 healthy controls, aged 18 to 60 years. Patients with fewer than 12 annual seizure episodes and no history of seizures during the last 30 days were added to the study. A sociodemographic data form, the Beck Anxiety and Depression Scales, Montreal Cognitive Assessment, Digit Span test, and Stroop Color-Word Interference Test were used. Results : Compared to the control group, sub-component scores were significantly lower in naming, attention, abstract thinking, and delayed recall for the epilepsy and PNES groups. Sub-component scores in orientation, executive functioning, and delayed recall were significantly lower in the epilepsy group compared to the PNES group. Digits Backward subtest scores and total Digit Span test scores were significantly lower in the epilepsy and PNES groups. Patients in the epilepsy and PNES groups took longer to complete the Stroop test and made more errors and corrections compared to the healthy controls. There was a negative correlation between the duration of the disease and the total Digit Span score in the epilepsy group. Conclusion : These findings suggest that the epilepsy group showed reduced cognitive scores even though they did not suffer from frequent seizures and were not drug-resistant.

Objectives: The aim of the present study was to measure nasal mucociliary clearance (NMC) time in the patients with MS and to compare the findings with healthy population., Methods: Totally 97 individuals including 47 patients with relapsing-remitting multiple sclerosis and 50 healthy volunteers were enrolled into the study. Saccharin clearance test was performed on both groups and NMC time was measured. Data analysis was performed by SPSS version 24.0 statistics program (SPSS Inc., Chicago, Illinois, USA). Statistical tests were interpreted at p < 0.05 significance level., Results: The NMC time averages in MS patients and healthy control group were 12.43 ± 4.05 min and 8.14 ± 2.87 min, respectively; the difference between the groups was significant (p < 0.001). There was a statistically strong association between NMC time values and Expanded Disability Status Scale (EDSS) values in MS patients (r = 0.817, p < 0.001)., Conclusion: We found nasal mucociliary transport time longer in MS patients than healthy population in the present study. To the best of our knowledge, there is not any study conducted about this topic in the literature. We believe that our findings would shed a light on further studies.

Purpose : To evaluate the effect of multiple sclerosis (MS) on the amplitude of accommodation (AA) and retinal nerve fiber layer (RNFL) thickness. Materials and Methods : A total of 25 MS patients with visual-evoked potential (VEP) abnormalities (MS/+VEP Group), 25 MS patients without VEP abnormalities (MS/-VEP Group), and 25 controls (Control Group) were enrolled. Only findings from the right eye of the participants were included in the analysis. Each participant underwent a pattern-reversal visual-evoked potential (PVEP) recording, an RNFL thickness analysis by optic coherence tomography (OCT) in all quadrants, and a measurement of amplitude of accommodation (AA) with minus lens technique. The AA and the RNFL thickness were compared between the groups. Results : The mean age and sex distributions did not differ significantly across the groups ( p = .788, p = .906, respectively). The mean AA was 5.36 ± 0.7 D in MS/+VEP group, 6.06 ± 1.4 D in MS/-VEP group, and 6.4 ± 0.9 D in control group ( p = .002). The difference in the mean AA values between MS/+VEP and control groups were significant ( p = .002). AA was significantly correlated with age, P100 latency and amplitude values in MS/+VEP group ( r = -0.832, p < .001; r = -0.596, p = .002 and r = 0.498, p = .011, respectively). In a multivariable regression model, age and P100 latency were significant parameters for affecting AA in patients with MS ( p < .001 and p = .001). In another multivariable regression model, age and average RNFL thickness were significant parameters for affecting AA in patients with MS ( p < .001 and p = .010). Conclusions : We found that the AA was lower in MS patients with VEP abnormalities compared to age-matched healthy individuals. P100 latency was a significant parameter for predicting AA in MS/+VEP group. These results suggest that MS patients with VEP abnormalities might experience presbyopia earlier in life than people without MS, probably due to the chronic demyelination of neural pathways.

Objective: The objective of this study was to evaluate the spouses of people with epilepsy with and without a history of seizures during sleep in terms of depression, anxiety, and sleep quality., Methods and Materials: This prospective, cross-sectional study was conducted in three groups of 18-55 year olds, who were at least primary school graduates. The 1st group consisted of healthy spouses of 30 healthy volunteers with age and sex matched with the other groups. The 2nd group comprised spouses of 30 people with epilepsy who had been married for at least one year and had no history of seizures during sleep. The 3rd group consisted of spouses of 30 people with epilepsy who had been married for at least one year and had a history of at least one seizure during sleep in the course of the previous year. The questionnaire including demographic data, Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) was applied to all participants., Results: The mean age of the 1st group was 35.07 ± 8.33 years, that of the 2nd group was 36.47 ± 7.63 years, and that of the 3rd group was 35.33 ± 6.05 years. There was no significant age difference between the groups (p = 0.740). The depression scores of the 2nd and the 3rd groups were significantly higher than that of the 1st group (p < 0.001, for both). The anxiety scores of the 3rd group were significantly higher than those of the 1st and the 2nd groups (p < 0.001 and p = 0.001, respectively). Thirty percent (n = 9) of the 1st group, 40% (n = 12) of the 2nd group, and 70% (n = 21) of the 3rd group had poor sleep quality. The sleep disorder rate in the 3rd group was significantly higher than in the 1st and the 2nd groups (p = 0.002 and p = 0.020, respectively). When the PSQI subscales were examined, the sleep quality, sleep latency, usual sleep efficiency, daytime dysfunction, and the total sleep total score were significantly higher in the 3rd group than the 1st and the 2nd groups. The patients in the third group had significantly higher scores of sleep duration, sleep disturbance, and sleep medication use than those in the 1st group., Conclusion: We found out that the PSQI score, which reflected the sleep quality, was poor in the spouses of people with epilepsy, who had seizures during sleep. To the best of our knowledge, these findings are the first in the literature on this subject., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Competing Interests: There are no conflicts of interest.

Opercular syndrome, also known as Foix-Chavany-Marie syndrome, is a paralysis of the facial, pharyngeal, masticatory, tongue, laryngeal, and brachial muscles. It is a rare cortical form of pseudobulbar palsies caused by vascular insults to bilateral operculum. Its clinical presentations include anarthria, weakness of voluntary muscles involving face, tongue, pharynx, larynx, and masticatory muscles. However, autonomic reflexes and emotional activities of these structures are preserved. In the present case, an 81-year-old male presented with acute onset of anarthria with difficulties in chewing, speaking, and swallowing that was diagnosed with opercular syndrome.