Person: AĞAN YILDIRIM, KADRİYE
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AĞAN YILDIRIM
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KADRİYE
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Publication Open Access Evaluation of Sleep Structure in Patients with Epilepsy(KARE PUBL, 2019) SÜNTER, GÜLİN; Sunter, Gulin; Agan, KadriyeObjectives: Sleep disorders are more common in patients with epilepsy than in healthy individuals. Epileptic syndromes and antiepileptic drugs can alter the structure of sleep. The aim of this study was to analyze differences in sleep patterns between patients with epilepsy and healthy individuals using subjective tests and polysomnographic evaluation. Methods: The determination of sleep characteristics and the presence of sleep disorders were evaluated using standard questionnaires and polysomnography in 29 patients with epilepsy and 25 controls. The Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI) were administered to assess the participants. Results: The mean PSQI, ESS, and ISI scores in adults with epilepsy were 12.76 +/- 8.93, 5.28 +/- 3.67, and 7.31 +/- 5.39, respectively. Lower sleep efficiency (p=0.046), decreased N1 sleep stage percentage (p=0.001), decreased rapid eye movement sleep stage percentage (p=0.001), and an increased N3 sleep stage percentage (p=0.012) were observed in patients with epilepsy. It was also noted that sleep latency was shorter in patients with epilepsy than in the control group (p=0.027). Conclusion: Sleep architecture has individual variability. Age, comorbidities, medications, and sleep recording methods are some of the factors that contribute to this variability. Both the disease itself and drugs used in the treatment of epilepsy can alter the structure of sleep. Our findings were similar to other studies investigating sleep macrostructure comparing adults with epilepsy and healthy individuals. However, knowledge of how epileptic mechanisms and antiepileptic drugs affect sleep is still insufficient.Publication Open Access Assessment of the Effect of Subthalamic Deep Brain Stimulation on Sleep Quality of Parkinson's Disease Patients(2022-01-01) SÜNTER, GÜLİN; AĞAN YILDIRIM, KADRİYE; GÜNAL, DİLEK; Oner O. G., SÜNTER G., Jafarova S., AĞAN YILDIRIM K., Seker A., GÜNAL D.AIM: To investigate the effects of subthalamic deep brain stimulation (STN DBS) therapy on sleep quality of Parkinson\"s Disease (PD) patients and the relationship between sleep, motor symptoms, depression, and adverse effects of dopamine replacement therapies. MATERIAL and METHODS: A total of 26 PD patients have been included and assessed using various tools both 1 week before and 8 months after the STN DBS therapy. The data collection tools were the Unified Parkinson\"s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), Parkinson\"s Disease Questionnaire (PDQ-39), Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS) and Polysomnography. RESULTS: PSQI, ISI, and ESS scores were found to have significantly improved after the STN DBS therapy (p=0.002, p=0.006, p<0.001, respectively), as were the scores obtained from several PSQI sub-scales, that is, sleep duration, sleep disturbance and daytime dysfunction (p=0.023, p=0.005, p=0.032, respectively). Additionally, Wake Times After Sleep Onset (WASO) (p=0.047) and Rapid Eye Movement (REM) sleep latency values (p=0.005) were found to have decreased after the STN DBS treatment, whereas REM sleep durations (p=0,028) and REM sleep percentages (p=0.007) were found to have increased, after the STN DBS therapy. No correlation was found between the ESS scores and Levodopa Equivalent Dosage (LED) or between the scores obtained from the sleep scales and the scores obtained from the UPDRS and BDI. There was also no correlation between sleep scores and other PD-related factors. CONCLUSION: The findings of this study indicated that STN DBS therapy positively affected the PD patients\" sleep. This result was attributed to the neuromodulatory effects of the STN DBS independent of the motor symptoms, depression levels, and LED decrease.Publication Open Access Real-life outcomes for oral disease-modifying treatments of relapsing-remitting multiple sclerosis patients: Adherence and adverse event profiles from Marmara University(2023-01-01) VURAL, EZGİ; ENGİN, ESİN; SÜNTER, GÜLİN; AĞAN YILDIRIM, KADRİYE; GÜNAL, DİLEK; VURAL E., ENGİN E., SÜNTER G., Ağan K., GÜNAL D.Background/aim: Disease-modifying treatments (DMT) are used to prevent future relapses and disability. High long-term adherence to treatment is important to achieve disease control. This study aims to investigate and compare adherence, adverse event (AE) profiles, and frequencies, main reasons for treatment discontinuation under Teriflunomide (TERI), Dimethyl Fumarate (DMF), and Fingolimod (FNG) for relapsing-remitting MS (RRMS) patients. This study is designed to explore patient-reported experiences in real-life settings. Materials and methods: Patients who were older than 18 years with a definite diagnosis of RRMS and no history of stem-cell transplantation were included. Outpatient clinic data files at the Neurology Department of Marmara University from June 2012 to June 2019 were examined retrospectively. Results: One hundred and ninety MS patients were enrolled. 118 FNG, 51 DMF, 44 TERI treatment cycles were recorded. Time since disease onset, time since diagnosis, and treatment duration were significantly longer for FNG (p = 0.012, p = 0.004, p < 0.001). 72.8% of all the treatment cycles were continued. There was no significant difference in treatment continuity between the 3 DMT groups. The most common reasons for treatment discontinuation in order of frequency were adverse events, the progression of the disease, and the persistence of relapses. No significant difference was found for treatment discontinuation reasons. 32% of the patients reported at least one AE. 28% FNG, 49 % DMF, and 27.3% TERI using patients reported AEs. AEs were much more frequently reported for DMF (p = 0.015). The most common adverse events for each DMT were alopecia (n = 6, 13.6%) for TERI, flushing for DMF (n = 20, 39.2%), and persistent lymphopenia for FNG (n = 9, 7.6%). No severe or life-threatening AE was reported for DMF, one patient experienced pancreatitis under TERI, and 11 (9.3%) patients using FNG had to stop treatment due to serious or life-threatening AEs including cardiac adverse events, opportunistic infections, and dysplasia. Conclusion: Overall treatment discontinuation because of AEs is as low as 10.3% in this study. However, AEs are still the main reason for treatment drop-out.Publication Open Access Acquired modification of sphingosine-1-phosphate lyase activity is not related to adrenal insufficiency(BIOMED CENTRAL LTD, 2018-12) BEREKET, ABDULLAH; Sunter, Gulin; Enver, Ece Oge; Akbarzade, Azad; Turan, Serap; Vatansever, Pinar; Gunal, Dilek Ince; Haklar, Goncagul; Bereket, Abdullah; Agan, Kadriye; Guran, TulayBackground: Congenital sphingosine-1-phosphate (S1P) lyase deficiency due to biallelic mutations in SGPL1 gene has recently been described in association with primary adrenal insufficiency and steroid-resistant nephrotic syndrome. S1P lyase, on the other hand, is therapeutically inhibited by fingolimod which is an oral drug for relapsing multiple sclerosis (MS). Effects of this treatment on adrenal function has not yet been evaluated. We aimed to test adrenal function of MS patients receiving long-term fingolimod treatment. Methods: Nineteen patients (14 women) with MS receiving oral fingolimod (Gilenya (R), Novartis) therapy were included. Median age was 34.2 years (range; 21.3-44.6 years). Median duration of fingolimod treatment was 32 months (range; 6-52 months) at a dose of 0.5 mg/day. Basal and ACTH-stimulated adrenal steroid measurements were evaluated simultaneously employing LC-MS/MS based steroid panel. Basal steroid concentrations were also compared to that of sex- and age-matched healthy subjects. Cortisol and 11-deoxycortisol, 11-deoxycorticosterone and dehydroepiandrosterone were used to assess glucocorticoid, mineralocorticoid and sex steroid producing pathways, respectively. Results: Basal ACTH concentrations of the patients were 20.8 pg/mL (6.8-37.8 pg/mL) (normal range; 5-65 pg/mL). There was no significant difference in the basal concentrations of cortisol, 11-deoxycortisol, 11-deoxycorticosterone and dehydroepiandrosterone between patients and controls (p = 0.11, 0.058, 0.74, 0.15; respectively). All patients showed adequate cortisol response to 250 mcg IV ACTH stimulation (243 ng/mL, range; 197-362 ng/mL). There was no significant correlation between duration of fingolimod treatment and basal or ACTH-stimulated cortisol or change in cortisol concentrations during ACTH stimulation test (p = 0.57, 0.66 and 0.21, respectively). Conclusion: Modification and inhibition of S1P lyase activity by the long-term therapeutic use of fingolimod is not associated with adrenal insufficiency in adult patients with MS. This suggests that S1P lyase has potentially a critical role on adrenal development rather than the function of a fully mature adrenal gland.Publication Open Access Status Epilepticus in Patients with Brain Tumours(KARE PUBL, 2018) SÜNTER, GÜLİN; Sunter, Gulin; Gungordu, Ayca Gul; Midi, Ipek; Agan, Kadriye; Aykut Bingol, CananObjectives: Status epilepticus (SE) is a medical and neurological emergency with high morbidity and mortality. There are a variety of potential etiologies. The aim of this study was to evaluate the type of SE episode recorded in patients with brain tumors and to determine the effect of primary and metastatic brain tumors and SE type on response to treatment and mortality. Methods: An SE patient database was examined for individuals with brain tumors diagnosed clinically and electrophysiologically. Demographic features, SE subtype, response to treatment, and mortality rate were recorded. Results: There were 38 (14%) SE episodes in patients with intracranial tumors in the database. Convulsive SE (CSE) was the most common type, with 23 (60%) instances recorded. There was no statistically significant correlation between SE episodes and the intracranial tumor type (p=0.76). In all, 40% (n=15) remained refractory despite appropriate treatment. Six patients died in the hospital. No statistically significant relationship was found between refractoriness and mortality (p=0.737). Conclusion: The most common type of SE episode in patients with brain tumors was CSE. The higher mortality of patients with brain tumors and SE episodes may be a result of systemic complications that can accompany tumors. In addition, the changes in awareness of patients with brain tumors as they experience tumor progression or edema may be misdiagnosed, and if NCSE does not come to mind, the diagnosis is delayed, which can increase mortality.Publication Open Access In vivo corneal confocal microscopy in multiple sclerosis: can it differentiate disease relapse in multiple sclerosis(2023-06-01) DERİCİOĞLU, VOLKAN; AKKAYA TURHAN, SEMRA; SEVİK, MEHMET ORKUN; ERDİL, ESRA; SÜNTER, GÜLİN; AĞAN YILDIRIM, KADRİYE; TOKER, AYŞE EBRU; DERİCİOĞLU V., AKKAYA TURHAN S., Erdem H. E., SEVİK M. O., ERDİL E., SÜNTER G., AĞAN YILDIRIM K., Toker E.PURPOSE: This study aims to investigate the role of in vivo corneal confocal microscopy (IVCCM) in the detection of corneal inflammatory activity and subbasal nerve alterations in patients with multiple sclerosis (MS) and to further determine whether IVCCM can be used to detect (acute) disease relapse.