Ulnar sinir tuzak nöropatileri, üst ekstremitede karpal tünel sendromundan sonra ikinci s›kl›kta ... more Ulnar sinir tuzak nöropatileri, üst ekstremitede karpal tünel sendromundan sonra ikinci s›kl›kta görülen tuzak nöropatilerdir. Anatomik özelli¤i nedeniyle ulnar sinir en s›k dirsek bölgesinde bas›ya u¤ramak-tad›r. Dirsek bölgesindeki potansiyel tuzaklanma bölgeleri Struthers arkad›, medial intermüsküler septum, retroepikondiler oluk, kubital tünel (humeroulnar arkad) ve fleksör pronator aponöroz olup, en s›k kubital tünel ve retroepikondiler olukta tuzaklanma görülmektedir. Ulnar sinir daha nadir olarak el bile¤i düzeyinde Guyon kanal›nda tuzaklanabilir. Ulnar sinir tuzak nöropatilerinin tan›s›, semptomlar, fizik muayene bulgular› ve elektrodiagnostik incelemelere dayan›r. Tedavi hastan›n durumuna ve hastal›¤›n fliddetine göre planlan›r. Konservatif tedaviye yan›t olmad›¤› durumlarda, progresif paralizi ve uzun süreli lezyon varl›¤›n› gösteren kan›tlar varl›¤›nda cerrahi tedavi düflünülür. Bu derlemede, ulnar sinirin potansiyel tuzaklanma yerleri, tuzak nöropatinin patofizyolojisi, klinik ve elektrofizyolojik tan›s› ve konservatif tedavisi gözden geçirilecektir. Türk Fiz T›p Rehab Derg 2010;56:190-5. A An na ah ht ta ar r K Ke el li im me el le er r: : Ulnar sinir, tuzak nöropati, kubital tünel, Guyon kanal› S Su um mm ma ar ry y Ulnar neuropathy is the second most common entrapment neuropathy in the upper extremity after carpal tunnel syndrome. Because of the anatomic positioning of the ulnar nerve, the most common site of entrapment is at the elbow region. Potential compression sites at the elbow are the arcade of Struthers, medial intermuscular septum, retroepicondylar groove, the cubital tunnel (humeroulnar arcade) and flexor-pronator aponeurosis, with the most common sites of entrapment at the cubital tunnel and the retroepicondylar groove. The second most likely location of entrapment is in the Guyon's canal at the wrist. The diagnosis is based on symptoms, physical examination findings and electrodiagnostic studies. Treatment is planned according to the patient's symptoms and severity of disease. Surgical treatment should be considered if there is no response to the conservative treatment and if there is evidence for the presence of progressive paralysis and long-term lesion. In this paper, potential anatomical sites for entrapment of the ulnar nerve, pathophysiology, clinical and electrophysiological diagnosis and conservative treatment of the ulnar nerve entrapment neuropathies are reviewed.
Objective : To examine the agreement between clinical and electromyographic assessments during th... more Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. Design : Serial clinical and electromyographic assessments were performed. Settings : Physical Medicine and Rehabilitation Department of a university hospital. Subjects : Thirty patients with acute complete idiopathic facial paralysis were included. Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa ( κ) statistics were performed to measure the agreement between clinical and electromyographic assessments. Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall κ value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles. Conclusions : Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
American Journal of Physical Medicine & Rehabilitation, Jul 1, 1999
This preliminary study was designed to investigate the effects of botulinus toxin Type A and phen... more This preliminary study was designed to investigate the effects of botulinus toxin Type A and phenol treatments on electrophysiologic tests evaluating spinal afferent and efferent motor pathways involved in spasticity. The questions posed were whether different types of mechanisms act on reducing spasticity with these different treatment modalities and whether the tests are correlated with clinical recovery. Twenty patients with lower limb spasticity secondary to stroke were randomly assigned to receive 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. The amplitudes of the Achilles tendon response, M response, H reflex response, and maximum H:M ratio and Achilles tendon response to H response ratio were recorded from the soleus muscle at baseline and at Weeks 2, 4, and 12. The most obvious change was a reduction in the amplitude of the tendon response in the group that received botulinus toxin Type A, and it was a reduction in the M response amplitude in the group that received phenol. The decrease in the tendon response amplitude and tendon response to H ratio in the group that received botulinus toxin Type A and the decrease in the M response amplitude in the phenol group were found to be well correlated with clinical recovery as assessed by the Ashworth scale. The findings suggested that botulinus toxin Type A injection decreases spasticity primarily by affecting the fusimotor system and muscle spindle, and the involvement of the alpha-motor fibers within the tibial nerve is the most likely factor contributing to the reduction of spasticity after phenol blockade. The therapeutic effectiveness of these agents could be assessed and followed up by the changes in electrophysiologic responses matching their mechanisms of action. The findings should be supported by further electrophysiologic techniques.
Romatolojik hastalıklarda fibromiyaljinin payı The role of fibromyalgia in rheumatic diseases Arz... more Romatolojik hastalıklarda fibromiyaljinin payı The role of fibromyalgia in rheumatic diseases Arzu On Ege Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı Öz Fibromiyalji sendromu (FMS), kronik yaygın kas-iskelet ağrısı, yaygın hassas noktalar, multipl somatik ve bilişsel problemlerle karakterize, spesifik laboratuvar ve görüntüleme bulgusu olmayan klinik bir sendromdur. Kronik romatolojik hastalıklarda FMS prevalansının genel popülasyona göre daha yüksek olduğu gösterilmiştir. Komorbid FMS hastalık aktivite skorlarının yükselmesine, dolayısıyla romatolojik hastalığın şiddetinin yanlış değerlendirilmesine ve gereksiz tedavilerin verilmesine neden olabilir. Bu nedenle eşlik eden FMS'nun tanınması, romatolojik hastalığın optimal tedavisi için önem taşır. Komorbid FMS olan olgularda hastalık aktivite göstergeleri dikkatle yorumlanmalı, objektif klinik ölçütler göz önünde bulundurulmalıdır. Bu derlemede, değişik romatolojik hastalıklarda komorbid FMS prevalansı, patofizyolojisi ve altta yatan inflamatuvar hastalık üzerindeki etkileri gözden geçirilecektir.
The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of ... more The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of chronic widespread pain (CWP) have remained challenging after decades of research and several diagnostic criteria that have attempted to clarify FMS. A recent study has raised more challenges on the issue, proposing that diagnosis of FMS in patients representing with CWP is not informative or helpful for clinical practice and such a differentiation will provide little or no significance regarding the choice of effective and safe therapies. This proposal will be further discussed here by reviewing the recent advances in the field of pain medicine. These advances have collectively provided compelling evidence that all individuals with chronic pain, even those classically categorized as originating from peripheral/nociceptive origins have common central contributions to their pain and associated comorbidities. The recent understanding of the pain mechanisms has also provided important implications on classification and management of pain. Centrally acting agents have been recommended as first-line treatment options for FMS and potential use of these agents has been expanded to other chronic pain disorders. After having reviewed the recent advances in the pain field, distinction between CWP and FMS still seems not to be useful in clinical practice, as effective treatment in an individual patient might be much guided by dominant underlying mechanisms rather than specific diagnosis the patient is suffering. The conditions representing with CWP in the absence of definitive objective confirmation may then be classified under one heading such as "CWP", "chronic pain syndrome" or "central pain", when considering their similar pattern of clinical presentation, commonality of central sensitization to their pathophysiology and their similar response to centrally acting analgesics. Future research should be directed toward classification of CWP based on the validated measurements of different aspects of pain. Such a classification may help clinicians identify the patients who will preferentially respond to peripheral or centrally acting analgesics and may therefore assist in advancing a more individualized and pain mechanism focused treatment in the clinical setting.
horn cells infected. [2] After the acute period, patients usually show either a full or partial r... more horn cells infected. [2] After the acute period, patients usually show either a full or partial recovery of strength, as a result of collateral reinnervation or "sprouting" from the surviving motor units. The degree of resultant paralysis or paresis is determined by the proportion of infected cells that survive. [1,3] Although paresis is an obvious clinical marker of previous
Botulinum toxin induces chemodenervation of extra-and intramuscular muscle fibers. H-reflex bypas... more Botulinum toxin induces chemodenervation of extra-and intramuscular muscle fibers. H-reflex bypasses and stretch reflex activates muscle spindles. Intrafusal effects can be isolated from extrafusal effects. Intrafusal effects are change in stretch reflex minus change in H-reflex size.
International Journal of Rehabilitation Research, Jun 1, 2016
The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing ... more The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing the quality of life in aphasic patients. Our purpose was to translate the SAQOL-39 into the Turkish language (SAQOL-39/TR) and assess its reliability and validity in patients who had aphasia. SAQOL-39/TR was obtained using the 'translation-backward translation' method and administered to 40 patients with aphasia. The reliability studies were performed by means of internal consistency and test-retest reliability. The validation studies were carried out by means of construct validity using within-scale analyses and analyses against the external criteria. Correlation analysis was performed between scales and the Ege Aphasia Test, the Barthel index, the 12-item General Health Questionnaire and the Brunnstrom recovery stages (BRS) of the arm, hand, and lower extremity. In the results, the scores of the SAQOL-39 were not different between groups. Cronbach's α variables were good for all domains (0.80, 0.88, 0.89, 0.82, and 0.83). Test-retest reliability was also high (0.96, 0.97, 0.91, 0.70, and 0.96). There were significant correlations with coefficients ranging from 0.36 to 0.60 among the domains of scale and other measures. Moderate-high correlations were also seen with BRS-arm, BRS-hand, and BRS-lower extremity (r, 0.27-0.58). It was found that all domains were highly related with all domains of Ege aphasia test, except praxia (P < 0.001). This study showed that the SAQOL-39/TR has acceptable validity and reliability in assessing the quality of life. However, similar results of the scale in patients with dysarthria suggest that the SAQOL-39 may not be specific to only aphasic patients.
American Journal of Physical Medicine & Rehabilitation, Nov 1, 1998
Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage ... more Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A combination of subjective and objective measures were used to assess functional change at baseline and at Weeks 2, 4, 8, and 12. At follow-up, significant improvement (P &amp;amp;lt; 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P &amp;amp;lt; 0.05) but not in the group that received phenol (P &amp;amp;gt; 0.05). When those variables were compared between the two groups, the change in the Ashworth score at Weeks 2 and 4 was significantly better in the group that received botulinus toxin Type A (P &amp;amp;lt; 0.05) but there was not a significant difference between the two groups at Weeks 8 and 12 (P &amp;amp;gt; 0.05). The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P &amp;amp;lt; 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.
Türkiye fiziksel tıp ve rehabilitasyon dergisi, Sep 30, 2015
Objective: In the absence of national or international guidelines, physician approaches to admini... more Objective: In the absence of national or international guidelines, physician approaches to administer botulinum toxin (BTX) injections in patients on an anticoagulant therapy may be variable. We aimed to document the preferences and attitudes of physicians for controlling the bleeding risk of BTX injections in anticoagulated patients. Material and Methods: An electronic survey of physicians across Turkey who practice BTX administration for spasticity management was conducted. Results: In total, 80 physicians participated in the survey. There was a wide variance regarding the type of guidance and needle they used for injecting BTX in their routine practice. Among the respondents, only 7% reported refusing to administer BTX injections in anticoagulated patients, whereas 4% reported performing the injections without controlling the International Normalized Ratio (INR) value. Of the remaining respondents, the safe INR value for BTX injections was reported as ≤2.0 by 45%, ≤2.5 by 38%, and ≤3.0 by 17% respondents. Most of the physicians reported altering some portion of their routine injection technique in anticoagulated patients. Conclusion: A majority of physicians remain cautious and restrict the administration of BTX in some way for anticoagulated patients. Future studies are required to establish a safe INR value and to develop a consensus statement for BTX injections in this patient population.
Türk Ortopedi ve Travmatoloji Birliği Derneği dergisi, 2017
Türk Ortopedi ve Travmatoloji Birliği Derneği ve ayırıcı tanısında değerlidir. Radikülopatiler, E... more Türk Ortopedi ve Travmatoloji Birliği Derneği ve ayırıcı tanısında değerlidir. Radikülopatiler, ENMG laboratuvarlarına en sık başvurulan durumlardan biridir. Ancak, son yıllarda manyetik rezonans (MR) görüntüleme yöntemlerinin yaygınlaşmasıyla, bu incelemelerin tanıdaki yararlılığı sorgulanmaya başlamıştır. Bununla birlikte, radikülopati tanısında altın standart bulunmamaktadır. Bu nedenle, tanıda klinik bulgular, radyografik incelemeler ve ENMG birbirinin yerine geçen değil, birbirini tamamlayan testlerdir.
Recently, the importance of targeting structures during botulinum neurotoxin applications has bee... more Recently, the importance of targeting structures during botulinum neurotoxin applications has been discussed in a variety of disorders, including spasticity and dystonia. In this respect, the advantages of ultrasound imaging to traditional techniques have been emphasized. We would like underscore the importance of ultrasound guidance, with targeting innervation zone(s) of the over-active muscles to achieve effective clinical outcomes. Additionally, we also clarify the difference between the terms-innervation zone (motor end plate) and motor point-which have been used by the authors as if they were the same. Further, we disagree with the authors about the intramuscular botulinum neurotoxin application techniques i.e., in-plane vs. out-of-plane whereby the former is, for sure, superior.
Objectives: The aim of this study was to examine the localizing value of short segment conduction... more Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.
Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central n... more Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods: Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results: FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although nonsignificant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions: ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.
American Journal of Physical Medicine & Rehabilitation, May 1, 2000
Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on th... more Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on the electrophysiologic findings, 35 cases referred to our electromyography laboratory have been diagnosed as tourniquet paralysis within a 3-yr period. This preliminary report suggests that tourniquet paralysis should be considered during clinical and electrophysiologic evaluations after primary nerve repairs.
Study design: Survey. Objectives: To determine associations between sexual dysfunctions and elect... more Study design: Survey. Objectives: To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients.
Ulnar sinir tuzak nöropatileri, üst ekstremitede karpal tünel sendromundan sonra ikinci s›kl›kta ... more Ulnar sinir tuzak nöropatileri, üst ekstremitede karpal tünel sendromundan sonra ikinci s›kl›kta görülen tuzak nöropatilerdir. Anatomik özelli¤i nedeniyle ulnar sinir en s›k dirsek bölgesinde bas›ya u¤ramak-tad›r. Dirsek bölgesindeki potansiyel tuzaklanma bölgeleri Struthers arkad›, medial intermüsküler septum, retroepikondiler oluk, kubital tünel (humeroulnar arkad) ve fleksör pronator aponöroz olup, en s›k kubital tünel ve retroepikondiler olukta tuzaklanma görülmektedir. Ulnar sinir daha nadir olarak el bile¤i düzeyinde Guyon kanal›nda tuzaklanabilir. Ulnar sinir tuzak nöropatilerinin tan›s›, semptomlar, fizik muayene bulgular› ve elektrodiagnostik incelemelere dayan›r. Tedavi hastan›n durumuna ve hastal›¤›n fliddetine göre planlan›r. Konservatif tedaviye yan›t olmad›¤› durumlarda, progresif paralizi ve uzun süreli lezyon varl›¤›n› gösteren kan›tlar varl›¤›nda cerrahi tedavi düflünülür. Bu derlemede, ulnar sinirin potansiyel tuzaklanma yerleri, tuzak nöropatinin patofizyolojisi, klinik ve elektrofizyolojik tan›s› ve konservatif tedavisi gözden geçirilecektir. Türk Fiz T›p Rehab Derg 2010;56:190-5. A An na ah ht ta ar r K Ke el li im me el le er r: : Ulnar sinir, tuzak nöropati, kubital tünel, Guyon kanal› S Su um mm ma ar ry y Ulnar neuropathy is the second most common entrapment neuropathy in the upper extremity after carpal tunnel syndrome. Because of the anatomic positioning of the ulnar nerve, the most common site of entrapment is at the elbow region. Potential compression sites at the elbow are the arcade of Struthers, medial intermuscular septum, retroepicondylar groove, the cubital tunnel (humeroulnar arcade) and flexor-pronator aponeurosis, with the most common sites of entrapment at the cubital tunnel and the retroepicondylar groove. The second most likely location of entrapment is in the Guyon's canal at the wrist. The diagnosis is based on symptoms, physical examination findings and electrodiagnostic studies. Treatment is planned according to the patient's symptoms and severity of disease. Surgical treatment should be considered if there is no response to the conservative treatment and if there is evidence for the presence of progressive paralysis and long-term lesion. In this paper, potential anatomical sites for entrapment of the ulnar nerve, pathophysiology, clinical and electrophysiological diagnosis and conservative treatment of the ulnar nerve entrapment neuropathies are reviewed.
Objective : To examine the agreement between clinical and electromyographic assessments during th... more Objective : To examine the agreement between clinical and electromyographic assessments during the course of facial paralysis, in order to determine whether electromyography adds more information to the clinical examination in determining voluntary and synkinetic movement. Design : Serial clinical and electromyographic assessments were performed. Settings : Physical Medicine and Rehabilitation Department of a university hospital. Subjects : Thirty patients with acute complete idiopathic facial paralysis were included. Main measures : Voluntary and synkinetic movements of the orbicularis oculi and orbicularis oris muscles were graded by Facial Grading System and by needle electromyography at three weeks, and two, three and six months after the onset of paralysis. Weighted kappa ( κ) statistics were performed to measure the agreement between clinical and electromyographic assessments. Results : Agreement between assessments yielded an overall κ value of 0.87 for the orbicularis oculi and 0.59 for the orbicularis oris in identifying voluntary movement. electromyography revealed no voluntary movement in the orbicularis oculi, in 65% of the patients in whom slight movement was considered by clinical assessment. In identifying synkinetic movements, an overall κ value was 0.70 for the orbicularis oculi and 0.85 for the orbicularis oris. Electromyography demonstrated many cases of slight synkinesis that were missed through visual inspection in both muscles. Conclusions : Clinical evaluation provides sufficient information about recovery in voluntary movement in the orbicularis oris, whereas, in the orbicularis oculi, electromyography adds to the clinical evaluation in determining the extent of paralysis.
American Journal of Physical Medicine & Rehabilitation, Jul 1, 1999
This preliminary study was designed to investigate the effects of botulinus toxin Type A and phen... more This preliminary study was designed to investigate the effects of botulinus toxin Type A and phenol treatments on electrophysiologic tests evaluating spinal afferent and efferent motor pathways involved in spasticity. The questions posed were whether different types of mechanisms act on reducing spasticity with these different treatment modalities and whether the tests are correlated with clinical recovery. Twenty patients with lower limb spasticity secondary to stroke were randomly assigned to receive 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. The amplitudes of the Achilles tendon response, M response, H reflex response, and maximum H:M ratio and Achilles tendon response to H response ratio were recorded from the soleus muscle at baseline and at Weeks 2, 4, and 12. The most obvious change was a reduction in the amplitude of the tendon response in the group that received botulinus toxin Type A, and it was a reduction in the M response amplitude in the group that received phenol. The decrease in the tendon response amplitude and tendon response to H ratio in the group that received botulinus toxin Type A and the decrease in the M response amplitude in the phenol group were found to be well correlated with clinical recovery as assessed by the Ashworth scale. The findings suggested that botulinus toxin Type A injection decreases spasticity primarily by affecting the fusimotor system and muscle spindle, and the involvement of the alpha-motor fibers within the tibial nerve is the most likely factor contributing to the reduction of spasticity after phenol blockade. The therapeutic effectiveness of these agents could be assessed and followed up by the changes in electrophysiologic responses matching their mechanisms of action. The findings should be supported by further electrophysiologic techniques.
Romatolojik hastalıklarda fibromiyaljinin payı The role of fibromyalgia in rheumatic diseases Arz... more Romatolojik hastalıklarda fibromiyaljinin payı The role of fibromyalgia in rheumatic diseases Arzu On Ege Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı Öz Fibromiyalji sendromu (FMS), kronik yaygın kas-iskelet ağrısı, yaygın hassas noktalar, multipl somatik ve bilişsel problemlerle karakterize, spesifik laboratuvar ve görüntüleme bulgusu olmayan klinik bir sendromdur. Kronik romatolojik hastalıklarda FMS prevalansının genel popülasyona göre daha yüksek olduğu gösterilmiştir. Komorbid FMS hastalık aktivite skorlarının yükselmesine, dolayısıyla romatolojik hastalığın şiddetinin yanlış değerlendirilmesine ve gereksiz tedavilerin verilmesine neden olabilir. Bu nedenle eşlik eden FMS'nun tanınması, romatolojik hastalığın optimal tedavisi için önem taşır. Komorbid FMS olan olgularda hastalık aktivite göstergeleri dikkatle yorumlanmalı, objektif klinik ölçütler göz önünde bulundurulmalıdır. Bu derlemede, değişik romatolojik hastalıklarda komorbid FMS prevalansı, patofizyolojisi ve altta yatan inflamatuvar hastalık üzerindeki etkileri gözden geçirilecektir.
The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of ... more The question whether Fibromyalgia syndrome (FMS) is a distinct clinical entity in the context of chronic widespread pain (CWP) have remained challenging after decades of research and several diagnostic criteria that have attempted to clarify FMS. A recent study has raised more challenges on the issue, proposing that diagnosis of FMS in patients representing with CWP is not informative or helpful for clinical practice and such a differentiation will provide little or no significance regarding the choice of effective and safe therapies. This proposal will be further discussed here by reviewing the recent advances in the field of pain medicine. These advances have collectively provided compelling evidence that all individuals with chronic pain, even those classically categorized as originating from peripheral/nociceptive origins have common central contributions to their pain and associated comorbidities. The recent understanding of the pain mechanisms has also provided important implications on classification and management of pain. Centrally acting agents have been recommended as first-line treatment options for FMS and potential use of these agents has been expanded to other chronic pain disorders. After having reviewed the recent advances in the pain field, distinction between CWP and FMS still seems not to be useful in clinical practice, as effective treatment in an individual patient might be much guided by dominant underlying mechanisms rather than specific diagnosis the patient is suffering. The conditions representing with CWP in the absence of definitive objective confirmation may then be classified under one heading such as "CWP", "chronic pain syndrome" or "central pain", when considering their similar pattern of clinical presentation, commonality of central sensitization to their pathophysiology and their similar response to centrally acting analgesics. Future research should be directed toward classification of CWP based on the validated measurements of different aspects of pain. Such a classification may help clinicians identify the patients who will preferentially respond to peripheral or centrally acting analgesics and may therefore assist in advancing a more individualized and pain mechanism focused treatment in the clinical setting.
horn cells infected. [2] After the acute period, patients usually show either a full or partial r... more horn cells infected. [2] After the acute period, patients usually show either a full or partial recovery of strength, as a result of collateral reinnervation or "sprouting" from the surviving motor units. The degree of resultant paralysis or paresis is determined by the proportion of infected cells that survive. [1,3] Although paresis is an obvious clinical marker of previous
Botulinum toxin induces chemodenervation of extra-and intramuscular muscle fibers. H-reflex bypas... more Botulinum toxin induces chemodenervation of extra-and intramuscular muscle fibers. H-reflex bypasses and stretch reflex activates muscle spindles. Intrafusal effects can be isolated from extrafusal effects. Intrafusal effects are change in stretch reflex minus change in H-reflex size.
International Journal of Rehabilitation Research, Jun 1, 2016
The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing ... more The Stroke and Aphasia Quality Of Life Scale (SAQOL-39) is a widely used instrument in assessing the quality of life in aphasic patients. Our purpose was to translate the SAQOL-39 into the Turkish language (SAQOL-39/TR) and assess its reliability and validity in patients who had aphasia. SAQOL-39/TR was obtained using the 'translation-backward translation' method and administered to 40 patients with aphasia. The reliability studies were performed by means of internal consistency and test-retest reliability. The validation studies were carried out by means of construct validity using within-scale analyses and analyses against the external criteria. Correlation analysis was performed between scales and the Ege Aphasia Test, the Barthel index, the 12-item General Health Questionnaire and the Brunnstrom recovery stages (BRS) of the arm, hand, and lower extremity. In the results, the scores of the SAQOL-39 were not different between groups. Cronbach's α variables were good for all domains (0.80, 0.88, 0.89, 0.82, and 0.83). Test-retest reliability was also high (0.96, 0.97, 0.91, 0.70, and 0.96). There were significant correlations with coefficients ranging from 0.36 to 0.60 among the domains of scale and other measures. Moderate-high correlations were also seen with BRS-arm, BRS-hand, and BRS-lower extremity (r, 0.27-0.58). It was found that all domains were highly related with all domains of Ege aphasia test, except praxia (P < 0.001). This study showed that the SAQOL-39/TR has acceptable validity and reliability in assessing the quality of life. However, similar results of the scale in patients with dysarthria suggest that the SAQOL-39 may not be specific to only aphasic patients.
American Journal of Physical Medicine & Rehabilitation, Nov 1, 1998
Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage ... more Locally acting treatments for spasticity such as nerve and motor point blocks have the advantage of reducing harmful spasticity in one area, while preserving useful spasticity in another area. This randomized, double-blind study is the first trial that was designed to find out whether botulinus toxin Type A and phenol relieves the signs and symptoms of ankle plantar flexor and foot invertor spasticity after stroke and if either of these methods offers any advantages and disadvantages over the other. Twenty patients who were included in this preliminary study were randomly assigned to receive a single treatment of 400 mouse units of botulinus toxin Type A injected into the calf muscles or to receive a tibial nerve blockade with 3 ml of 5% phenol. A combination of subjective and objective measures were used to assess functional change at baseline and at Weeks 2, 4, 8, and 12. At follow-up, significant improvement (P &amp;amp;lt; 0.05) in the Ashworth score for dorsiflexion was observed in both groups. The change in the Ashworth score for eversion was significant in the group that received botulinus toxin Type A (P &amp;amp;lt; 0.05) but not in the group that received phenol (P &amp;amp;gt; 0.05). When those variables were compared between the two groups, the change in the Ashworth score at Weeks 2 and 4 was significantly better in the group that received botulinus toxin Type A (P &amp;amp;lt; 0.05) but there was not a significant difference between the two groups at Weeks 8 and 12 (P &amp;amp;gt; 0.05). The decrease in clonus duration that was detected by electromyography was significant in both groups at all visits, but the decrease in the group that received botulinus toxin Type A was significantly better at Weeks 2 and 4 (P &amp;amp;lt; 0.05). It is concluded that both motor point injections with botulinus toxin Type A and tibial nerve blockade with phenol are effective in plantar flexor spasticity, but the changes were more significant in the group that received botulinus toxin Type A at Weeks 2 and 4, whereas there was not a significant difference between the two groups at Weeks 8 and 12. Future research should explore the long-term effect of these two treatment modalities.
Türkiye fiziksel tıp ve rehabilitasyon dergisi, Sep 30, 2015
Objective: In the absence of national or international guidelines, physician approaches to admini... more Objective: In the absence of national or international guidelines, physician approaches to administer botulinum toxin (BTX) injections in patients on an anticoagulant therapy may be variable. We aimed to document the preferences and attitudes of physicians for controlling the bleeding risk of BTX injections in anticoagulated patients. Material and Methods: An electronic survey of physicians across Turkey who practice BTX administration for spasticity management was conducted. Results: In total, 80 physicians participated in the survey. There was a wide variance regarding the type of guidance and needle they used for injecting BTX in their routine practice. Among the respondents, only 7% reported refusing to administer BTX injections in anticoagulated patients, whereas 4% reported performing the injections without controlling the International Normalized Ratio (INR) value. Of the remaining respondents, the safe INR value for BTX injections was reported as ≤2.0 by 45%, ≤2.5 by 38%, and ≤3.0 by 17% respondents. Most of the physicians reported altering some portion of their routine injection technique in anticoagulated patients. Conclusion: A majority of physicians remain cautious and restrict the administration of BTX in some way for anticoagulated patients. Future studies are required to establish a safe INR value and to develop a consensus statement for BTX injections in this patient population.
Türk Ortopedi ve Travmatoloji Birliği Derneği dergisi, 2017
Türk Ortopedi ve Travmatoloji Birliği Derneği ve ayırıcı tanısında değerlidir. Radikülopatiler, E... more Türk Ortopedi ve Travmatoloji Birliği Derneği ve ayırıcı tanısında değerlidir. Radikülopatiler, ENMG laboratuvarlarına en sık başvurulan durumlardan biridir. Ancak, son yıllarda manyetik rezonans (MR) görüntüleme yöntemlerinin yaygınlaşmasıyla, bu incelemelerin tanıdaki yararlılığı sorgulanmaya başlamıştır. Bununla birlikte, radikülopati tanısında altın standart bulunmamaktadır. Bu nedenle, tanıda klinik bulgular, radyografik incelemeler ve ENMG birbirinin yerine geçen değil, birbirini tamamlayan testlerdir.
Recently, the importance of targeting structures during botulinum neurotoxin applications has bee... more Recently, the importance of targeting structures during botulinum neurotoxin applications has been discussed in a variety of disorders, including spasticity and dystonia. In this respect, the advantages of ultrasound imaging to traditional techniques have been emphasized. We would like underscore the importance of ultrasound guidance, with targeting innervation zone(s) of the over-active muscles to achieve effective clinical outcomes. Additionally, we also clarify the difference between the terms-innervation zone (motor end plate) and motor point-which have been used by the authors as if they were the same. Further, we disagree with the authors about the intramuscular botulinum neurotoxin application techniques i.e., in-plane vs. out-of-plane whereby the former is, for sure, superior.
Objectives: The aim of this study was to examine the localizing value of short segment conduction... more Objectives: The aim of this study was to examine the localizing value of short segment conduction studies (SSCSs) by comparing pre-surgical SSCS findings with intraoperative findings in patients with ulnar neuropathy of the elbow. Patients and Methods: Pre-surgical SSCSs were performed in 20 patients and compared with the intraoperative findings. Functional and electrophysiological recoveries were assessed at postoperative month 3. Overall, compressed nerve segments identified by SSCSs were compatible with the intraoperative findings in 90% of patients. Results: The success rate of surgery was higher in the patients with SSCS-determined single-level compression as compared to multi-level compression. SSCS abnormalities persistent in six patients with poor functional recovery. Conclusion: SSCSs are valuable for localizing compressed segments, thus they can be used as a guide for minimalist surgical techniques. These studies also appear valuable for predicting surgical outcome in patients with ulnar neuropathy of the elbow.
Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central n... more Background: The pathophysiology of fibromyalgia (FM) involves many mechanisms including central nervous system sensitization theory, autonomic nervous system (ANS) dysfunction, and recently small fiber neuropathy. While the small fiber neuropathy itself can cause ANS dysfunction and neuropathic pain (NP), it is still unknown whether ANS problems have an association with severity of disease and NP in patients with FM. The aim of this study was to evaluate ANS dysfunction in FM patients and to explore possible associations of ANS dysfunction with disease severity and NP. Methods: Twenty-nine FM patients and 20 healthy controls were included in this cross-sectional study. Participants were tested using sympathetic skin responses (SSR) and R-R interval variation analyses for sympathetic and parasympathetic ANS dysfunction, respectively. Disease severity and somatic symptoms of patients with FM were evaluated using the ACR-2010 scales and Fibromyalgia Impact Questionnaire, and NP symptoms were evaluated using the Pain Detect Questionnaire and Douleur Neuropathique questionnaire. Results: FM patients were found to have ANS dysfunction characterized by increased sympathetic response and decreased parasympathetic response. SSR amplitudes were found to be correlated with a more severe disease. Although nonsignificant, NP severity tended to be associated with a decrease in sympathetic and parasympathetic activities. Conclusions: ANS dysfunction may play a role in the pathophysiology of FM. The trend of decreased ANS functions in FM patients exhibiting NP contradicts the notion that FM is a sympathetically maintained NP and may be explained with small fiber involvement.
American Journal of Physical Medicine & Rehabilitation, May 1, 2000
Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on th... more Paralysis after use of a tourniquet during surgery is a well recognized complication. Based on the electrophysiologic findings, 35 cases referred to our electromyography laboratory have been diagnosed as tourniquet paralysis within a 3-yr period. This preliminary report suggests that tourniquet paralysis should be considered during clinical and electrophysiologic evaluations after primary nerve repairs.
Study design: Survey. Objectives: To determine associations between sexual dysfunctions and elect... more Study design: Survey. Objectives: To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients.
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