Person: KAHRAMAN KOYTAK, PINAR
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KAHRAMAN KOYTAK
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Publication Metadata only Peripheral nervous system assessment in acromegaly patients under somatostatin analogue therapy(SPRINGER, 2017) YAVUZ, DİLEK; Alibas, H.; Yavuz, D. Gogas; Koytak, P. Kahraman; Uygur, M.; Tanridag, T.; Uluc, K.Purpose Acromegaly is known to affect peripheral nervous system (PNS) causing carpal tunnel syndrome (CTS) and polyneuropathy. The frequency of these disorders and the evaluation methods vary among studies. In the present study, we aimed to examine PNS of acromegaly patients under somatostatin analogue (SSA) therapy. Methods Forty-eight acromegaly patients (26 F/22 M, 45.58 +/- 11.6 years) under SSA treatment and 44 healthy controls (25 F/19 M, 47.46 +/- 8.7 years) were assessed by symptom questionnaires, neurologic examination and electrophysiological studies. Results 87.5 % of the acromegaly patients had at least one abnormal finding regarding PNS. With the incorporation of palm-wrist median nerve conduction velocity method, we detected CTS in 50 % of patients. Polyneuropathy was less frequent (29.2 %). Both conditions were independent from the coexisting diabetes mellitus (p = 0.22 for CTS, p = 0.71 for polyneuropathy). Polyneuropathy but not CTS was more common among biochemically uncontrolled acromegaly patients rather than those under control (p = 0.03; p = 0.68, respectively). Conculsion Our findings emphasize the high prevalence of peripheral nervous system involvement in acromegaly patients under SSA therapy and importance of neurological evaluation of these patients. Early diagnosis and treatment of the disease may reduce the PNS involvement.Publication Metadata only Medial plantar-to-radial amplitude ratio: does it have electrodiagnostic utility in distal sensory polyneuropathy?(TAYLOR & FRANCIS LTD, 2017) ULUÇ, KAYIHAN; Koytak, Pinar Kahraman; Alibas, Hande; Ozden, Hatice Omercikoglu; Tanridag, Tulin; Uluc, KayihanPurpose of the study: We proposed a new electrophysiological parametermedial plantar (MP)-to-radial amplitude ratio (MPRAR), similar to sural-to-radial amplitude ratio (SRAR), in the diagnosis of distal sensory polyneuropathy (DSP), based on the concept that distal nerves are affected more and earlier than proximal nerves in axonal neuropathies. We aimed to investigate the diagnostic sensitivity of this parameter in diabetic DSP, together with sensitivities of SRAR and MP nerve action potential (NAP) amplitude. Materials and Methods: In 124 healthy controls and 87 diabetic patients with clinically defined DSP and normal sural responses, we prospectively performed sensory nerve conduction studies (NCS), and evaluated the MP NAP amplitude, MPRAR and SRAR values. We determined the lower limits of normal (LLN) of these parameters in the healthy controls and calculated their sensitivities and specificities in detecting DSP in diabetic patients. Results: MP nerve amplitude and MPRAR values were significantly lower in the patient group, compared to controls. However, SRAR values did not differ significantly between the two groups. The LLN of MP NAP amplitude was found to be 4.1 mu V. The cutoff values for SRAR and MPRAR were determined as 0.24 and 0.16, respectively. MPRAR was abnormal in 21.8% of patients. However, the most sensitive parameter in detection of DSP was MP NAP amplitude, which showed a sensitivity of 31% and a specificity of 100%. Conclusions: Although MPRAR is more sensitive than SRAR in detecting DSP, it does not provide additional diagnostic yield to the assessment of MP NCS alone in diabetic DSP patients with normal sural responses.Publication Metadata only Elektromiyografiye pratik yaklaşım: Klinisyenler için resimli bir kılavuz(Ada Yayıncılık, 2014-09-01) KAHRAMAN KOYTAK, PINAR; Kahraman Koytak P.Publication Metadata only The reliability of medial and lateral plantar nerve recordings in healthy elderly individuals(SPRINGER-VERLAG ITALIA SRL, 2015) ULUÇ, KAYIHAN; Keskin, Gokce; Koytak, Pinar Kahraman; Bastan, Birgul; Tanridag, Tulin; Us, Onder; Uluc, KayihanThe aim of this study was to investigate the reliability of medial plantar (MP) and lateral plantar (LP) nerve conduction studies (NCS) in healthy individuals aged > 65 years, and to obtain reference values for this age group. The study included 81 healthy subjects. MP response was absent in only 2 subjects, but LP response could not be obtained bilaterally in 43 of the 81 subjects. Regression analysis showed that MP NCS could be reliably performed in those aged a parts per thousand currency sign72 years and normal values for MP nerve in individuals aged 66-72 years would be strongly against a large-fiber neuropathy. However, LP response was absent in 53.1 % of the healthy elderly subjects; therefore, we think it is unreliable to study the LP nerve in this age group.Publication Open Access Brainstem Reflexes in Systemic Lupus Erythematosus Patients Without Clinical Neurological Manifestations(AVES, 2017-05-08) SÜNTER, GÜLİN; Salcini, Celal; Bastan, Birgul; Sunter, Gulin; Kahraman Koytak, Pinar; Yilmaz, Orhan; Tanridag, Tlin; Us, Onder; Uluc, KayihanIntroduction: We aimed to assess central and peripheral nervous system involvement in systemic lupus erythematosus (SLE) patients without any neurological signs and symptoms by performing electrophysiological investigations. Methods: Thirty-eight SLE patients and 35 healthy volunteers participated in this study. Peripheral nerve conduction and brainstem reflexes were evaluated by performing nerve conduction studies (NCSs) and blink reflex (BR) and masseter inhibitory reflex (MIR) recordings. Results: Eleven patients (29%) had an abnormality in at least 1 NCS parameter, and 1 (2.6%) patient was diagnosed with polyneuropathy. The number of patients with abnormal BR and MIR was 23 (60.5%) and 14 (37%), respectively. The contralateral R2 latency of BR and the silent period 1 (SP1) latency of MIR were significantly prolonged in the patients compared with the controls (p=0.015 and p<0.001, respectively). Conclusion: This study showed that irrespective of peripheral nervous system involvement, brainstem reflexes could be affected in SLE patients even without clinical neurological findings. Brainstem reflex abnormalities suggested that the functional integrity of the inhibitory or excitatory interneurons in the lateral caudal pons and lateral medulla is disturbed in SLE patients.Publication Metadata only Progressive dysarthria and dysphagia in an otherwise healthy girl(PERGAMON-ELSEVIER SCIENCE LTD, 2013) EKİNCİ, GAZANFER; Koytak, Pinar Kahraman; Alibas, Hande; Ekinci, Gazanfer; Uluc, KayihanPublication Metadata only Headache During Air Travel: An Unusual Cause of Reversible Cerebral Vasoconstriction Syndrome(WILEY-BLACKWELL, 2015) MİDİ, İPEK; Alibas, Hande; Ceferova, Shebnem; Koytak, Pinar Kahraman; Uluc, Kayihan; Midi, Ipek; Elmaci, Nese Tuncer; Aktan, Sevinc; Tanridag, TulinPublication Metadata only Heart rate variability analysis in patients with multiple sclerosis(ELSEVIER SCI LTD, 2018) KEPEZ, ALPER; Damla, Ozbek; Altug, Cincin; Pinar, Kahraman Koytak; Alper, Kepez; Dilek, Ince Guna; Kadriye, AganBackground: Multiple sclerosis can cause cardiovascular autonomic dysfunction. It is assumed that is caused by multiple demyelinating plaques localized in the brain stem and spinal cord. Previous studies have determined this using tilt table test, heart rate responses to Valsalva maneuver and deep breathing and heart rate variability analysis with 24 h Holier monitoring. However there is not a consensus regarding the presence of the relationship between autonomic dysfunction and severity of multiple sclerosis, type of multiple sclerosis and expanded disability status scale. The aim of the study is comparison of heart rate variability between recently diagnosed patients with relapsing-remitting multiple sclerosis and healthy controls by using 24 h Holier monitoring. Also we intended to investigate relationship between Expanded Disability Status Scale score, Multiple Sclerosis Functional Composite scores and cranial and spinal magnetic resonance imaging findings and hearth rate variability. Method: Fifty-one patients with newly diagnosed relapsing-remitting multiple sclerosis and 44 age- and sex-matched healthy controls were compared in this study. Patients with multiple sclerosis, who were already under immunomodulatory or immunosuppressive treatment, were excluded from the study. Echocardiography and hearth rate variability analysis using 24 h period Holier monitoring were performed in all of the subjects. Echocardiography was used to detect the presence of cardiac pathology. One multiple sclerosis patient with right ventricular dilatation and mobile intratrial septum was excluded from the study. All the patients underwent cranial and cervical spinal magnetic resonance imaging to determine the relationship between autonomic abnormalities and magnetic resonance imaging. Results: Our results showed that hearth rate variability values were significantly lower in patients with multiple sclerosis when compared with healthy controls: SDNN index (the mean of all the 5 min standard deviations of normal RR intervals during the 24 h period) (59.80 +/- 17.33 vs. 67.20 +/- 21.28, p = 0,044), the root-mean-square successive difference (rMSSD) (34.40 +/- 17.50 vs. 38.25 +/- 12.95, p = 0,042), spectral hearth rat variability total power (3738.84 +/- 2085.51 vs. 4427.44 +/- 1965.71, p = 0,037), spectral hearth rate variability low frequency (852.03 +/- 450.54 vs. 1011.75 +/- 370.06, p = 0,018). Ten patients (20%) had brainstem lesion, 25 patients (50%) had cervical lesions and 10 patients (20%) had thoracic spinal lesions on magnetic resonance imaging. There was no significant relationship between location of the lesions and heart rate variability analyses. Also there was no significant relationship between hearth rate variability values and Expanded Disability Status Scale score, Multiple Sclerosis Functional Composite scores or number of multiple sclerosis attack (p > 0,05). Conclusion: These findings reveals that our study population with multiple sclerosis had decreased heart rate variability compared to healthy controls. This was reflected by dysfunction of both parasympathetic and sympathetic parameters of hearth rate variability analysis. However, there is no significant relationship between hearth rate variability analysis and the findings on cranial, cervical, thoracic spinal magnetic resonance imaging findings, number of attack, Expanded Disability Status Scale score or Multiple Sclerosis Functional Composite scores in patients with multiple sclerosis.Publication Open Access Motor-Unit Number Estimation Is Sensitive in Detecting Motor Nerve Involvement in Patients with Carpal Tunnel Syndrome(KOREAN NEUROLOGICAL ASSOC, 2016) SÜNTER, GÜLİN; Yilnnaz, Orhan; Sunter, Gulin; Salcini, Celal; Koytak, Pinar Kahraman; Tanridag, Tulin; Us, Onder; Uluc, KayihanBackground and Purpose We compared the motor-unit number estimation (MUNE) findings in patients who presented with signs and/or findings associated with carpal tunnel syndrome (CTS) and healthy controls, with the aim of determining if motor-unit loss occurs during the clinically silent period and if there is a correlation between clinical and MUNE findings in CTS patients. Methods The study investigated 60 hands of 35 patients with clinical CTS and 60 hands of 34 healthy controls. Routine median and ulnar nerve conduction studies and MUNE analysis according to the multipoint stimulation method were performed. Results The most common electrophysiological abnormality was reduced conduction velocity in the median sensory nerve (100% of the hands). The MUNE value was significantly lower for the patient group than for the control group (p=0.0001). ROC analysis showed that a MUNE value of 121 was the optimal cutoff for differentiating between patients and controls, with a sensitivity of 63.3% and a specificity of 68.3%. MUNE values were lower in patients with complaints of numbness, pain, and weakness in the median nerve territory (p<0.05, for all comparisons), and lower in patients with hypoesthesia than in patients with normal neurological findings (p=0.023). Conclusions The MUNE technique is sensitive in detecting motor nerve involvement in CTS patients who present with sensorial findings, and it may be useful in detecting the loss of motor units during the early stages of CTS. Larger-scale prospective clinical trials assessing the effect of early intervention on the outcome of these patients would help in confirming the possible benefit of detecting subclinical motor-unit loss in CTS.Publication Open Access A case report: Successful treatment of influenza B associated acute necrotizing encephalopathy in an adult using combination of high dose oseltamivir-ivig-pulse metylprednisolone(ELSEVIER, 2019-10) TUNCER, EMİNE NEŞE; Erdil, E.; Vural, E.; Koytak, P. Kahraman; Tuncer, E. N.