Person: GÜNAL, DİLEK
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GÜNAL
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DİLEK
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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 Metadata only DBS reimplantation to opposite side as a treatment for DBS-withdrawal syndrome(2022-09-05) SÖNMEZ, ÖZCAN; ÖMERCİKOĞLU ÖZDEN, HATİCE; GÜNAL, DİLEK; BAYRAKLI, FATİH; Sönmez Ö., Ömercikoğlu Özden H., Günal D., Bayraklı F.Objectives: STN-DBS treatment has been effective on motor Parkinson’s Disease symptoms also improvement in motor symptoms ve been shown to be better than medical therapy at an earlier stage of the disease. When STN-DBS treatment is interrupted rare but lifethreatening complication occur known as DBS-withdrawal syndrome. Akinesia, rigidity, dysarthria, dysphagia, and autonomic instability seen in DBS-withdrawal syndrome and ICU setting is necessary. In the light of current knowledge, as soon as possible STN-DBS reimplantation surgery has been shown best treatment for this rare but life-threatening condition. Methods: 33-year-old male, diagnosed with Parkinson\"s disease 10 years ago and started to take bilateral STN-DBS therapy. Had two other operation both due to infected infraclavicular IPG. The cause of the frequent infection was thought to be the patient\"s scratching obsession. After 8 months of the last surgery, the patient was admitted to our clinic with purulent discharge from the IPG pocket extension but not seen any sign of infection. UPDRS-III was 63 points. IPG generator and extension were cut below the connection between lead and IPG cables so that lead tips were preserved from surrounding tissue. After surgery, the patient developed DBS-withdrawal symptoms like akinesia, aphagia, rigidity, and dysarthria, UPDRS-III score rose to 102 points. Levadopa treatment rose to 750 mg but no improvement was seen. Another surgery was planned for the patient because clinical symptoms did not improve. In surgery former cranial and postauricular incisions were combined and reached leads. Leads were dissected from surrounding tissue, from postauricular incision to burr holes until they moved freely. After that new IPG pocket was prepared in the contralateral infraclavicular area and leads and IPG cables were connected. Results: After surgery, the system switched on, and system values and medication were rearranged. The patient’s clinal symptoms improved quickly. On the seventh day after the operation, the patient was discharged when UPDRS-III score was 72 points. Conclusions: Although a limited number of cases have been reported in the literature, we will face this medical emergency more frequently with the increasing use of STN-DBS. In our solution, this life-threatening emergency was resolved by moving the leads to the opposite side.Publication Open Access Developing a wearable device for upper extremity tremors(2024-05-31) AKGÜN, GAZİ; GÜNAL, DİLEK; AKÜNER, MUSTAFA CANER; ŞEHİRLİ, ÜMİT SÜLEYMAN; Yildiz S. D., AKGÜN G., GÜNAL D., Kaplanoglu E., AKÜNER M. C., ŞEHİRLİ Ü. S.Objective: This project aims to develop a wearable device to suppress both the essential and resting tremor and investigate its effectiveness. Materials and Methods: This study details the development and assessment of a wearable device for upper extremity tremors. The wearable device underwent a comprehensive design and a prototype was produced with a 3D-printer. To refine the functionality of the prototype, a motor that mimics tremor was attached to a 3D-printed prototype. Then, the printed prototype was applied to the hand model, and tested its effectiveness for tremor suppressing. The wearable device was further investigated on patients with essential tremor and Parkinson`s disease seeking treatment at Neurology Clinics. We recorded the tremor data and processed and visualized the recorded data by using the MatLab (version R2021a, MathWorks Inc., USA) software. Results: The wearable device effectively decreased the tremors both during the simulation phase and the patient testing phase. The data from the wearable device revealed a notable decrease in the amplitude of the tremor. This decrease signifies an achievement of tremor suppression. Conclusion: The prototype of the wearable device signifies a remarkable efficacy in tremor supression. It holds promise for being a potential solution to alleviate the tremor symptoms of essential tremor and Parkinson`s disease patients.