Browsing by Author "Siva, Aksel"
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Item Characterization of migraineurs having allodynia results of a large population-based study(Lippincott Williams & Wilkins, 2015-09-08) Baykan, Betül; Ekizoğlu, Esme; Orhan, Elif Kocasoy; Saip, Sabahattin; Siva, Aksel; Ertaş, Mustafa; Karlı, Necdet; Zarifoğlu, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 6506587942; 6603411305Objective: Allodynia reflects the clinical correlate of central sensitization, but it is usually neglected in clinical headache management. We aimed to report the prevalence and previously unnoticed associations of allodynia in migraineurs by a nationwide face-to-face questionnaire-based study by physicians. Methods: A total of 5323 households were examined for headache according to the diagnostic criteria of International Classification of Headache Disorders-II. Detailed headache features, premonitory signs, demographics, socio-economic status, and hormonal status of female individuals were analyzed with regard to the presence of allodynia in patients with definite migraine. Results: Allodynia was present in 61.1% of migraineurs in the general population of Turkey. The duration and severity of attacks (P < 0.0001), photophobia (P = 0.001), phonophobia, and also osmophobia (P < 0.0001), as well as premonitory signs (P = 0.018), showed significant associations with allodynia. Migraineurs with aura or family history of migraine more often reported allodynia in comparison with those without (P = 0.001 and 0.028, respectively). Allodynic migraineurs had a higher rate of physician consults and high levels on the Migraine Disability Assessment questionnaire, reflecting increased burden of headache. Furthermore, migraineurs with allodynia had high probability of attacks close to menses. Migraine improved during pregnancy, but it worsened after menopause or during oral contraceptive use in individuals experiencing allodynia when compared with those without allodynia. Discussion: The duration, severity, and disability of migraine attacks, photophobia, phonophobia, and osmophobia, as well as premonitory signs, showed significant associations with allodynia in the general population. Moreover, migraineurs with aura or family history of migraine more often reported allodynia, and allodynic migraneurs were more sensitive to hormonal changes. Allodynia, which seems to indicate higher tendency to central sensitization, should be implemented in daily headache practice to predict the prognosis and high levels of migraineous involvement.Publication Course of migraine and TTH over the years - what happens? A longitudinal nationwide study(Lippincott Williams & Wilkins, 2016-04-05) Karlı, Necdet; Baykan, Betül; Zarifoğlu, Mehmet; Ertaş, Mustafa; Uludüz, Derya; Uygunoğlu, Uğur; Ekizoğlus, Esme; Orhan, Elif; Saip, Sabahattin; Siva, Aksel; ZARİFOĞLU, MEHMET; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; EHN-5825-2022Publication Differences between general neurologists and multiple sclerosis specialists in the management of multiple sclerosis patients: A national survey(Aves, 2019-12-01) Kurtuncu, Murat; Tuncer, Aslı; Uygunoğlu, Uğur; Çalışkan, Zeynep; Kokenli Paksoy, Ayşenur; Efendi, Hüsnü; Sağduyu Kocaman, Ayşe; Özcan, Cemal; Terzi, Murat; Saip, Sabahattin; Karabudak, Rana; Siva, Aksel; Turan, Ömer Faruk; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; JHM-3244-2023Introduction: The management of multiple sclerosis (MS) has become more complicated after the introduction of new diagnostic and treatment options. Despite the abundance of guidelines, the experience of physicians still plays a major role in the management of patients. This study aimed to define differences in behavior patterns between general neurologists (GNs) and MS specialists (MSSs).Methods: We conducted a survey of 36 questions to 318 neurologists, including 33 MSSs. The survey covered topics including laboratory investigations, pregnancy, and treatment.Results: Our study found many differences between GNs and MSSs in terms of management, the most important being treatment initiation and switching. GNs had a tendency to initiate treatment later than MSSs however, they tended to switch treatment faster. Our study also showed that GNs ordered magnetic resonance imaging (MRI) more frequently than MSSs, even if patients were clinically stable. Moreover, although GNs more frequently relied on MRI, they did not consider brain atrophy as an important measure in the follow-up of their patients. Furthermore, GNs considered replacement therapy less often than MSSs, even in patients with vitamin D deficiency.Discussion: Our study revealed important discrepancies between the management patterns of GNs and MSSs in MS patients. These findings suggest the need for a national education program for GNs on MSSs.Item Efficacy, safety and tolerability of natalizumab in Turkish multiple sclerosis patients with high disease activity: a prospective, multicentre study(Elsevier, 2009-10) Eraksoy, Mefkure; Akman, Gülşen Demir; Agan, Kadriye; Günal, Dilek İnce; Us, Önder; Şaip, Sebahattin; Demirci, Nuri Onat; Tütüncü, Melih; Boz, Cavit; Terzi, Matthew C.; Onar, Musa; Aydin, H. Güngör; Türk, U. Boru; Soysal, Aysun; Petek, Belgin Balcı; Türkoğlu, Recai; Dib, Hussein; Siva, Aksel; Turan, Ömer Faruk; Taşkapılıoğlu, Özlem; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Item Impact of sex hormonal changes on tension-type headache and migraine: A cross-sectional population-based survey in 2,600 women(Bmc, 2012-10) Baykan, Betül; Ertaş, Mustafa; Siva, Aksel; Saip, Sabahattin; Karlı, Necdet; Zarifoğlu, Mehmet; Özkaya, Güven; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Uludağ Üniversitesi/Tıp Fakültesi/Biyoistatistik Anabilim Dalı.; 0000-0003-0297-846X; A-4421-2016; 6506587942; 6603411305; 16316866500Sex hormones have some implications on headaches. The objective of the study was to investigate the effects of hormonal changes comparatively on tension-type headache (TTH) and migraine, in a population-based sample. A nationwide face-to-face prevalence study was conducted using a structured electronic questionnaire. 54.3 % of the migraineurs reported that the probability of experiencing headache during menstruation was high, whereas 3.9 % had headache only during menstruation. Forward logistic regression analysis revealed that menstruation was a significant trigger for migraine in comparison to TTH. On the other hand, nearly double the number of TTH sufferers reported "pure menstrual headache" compared to migraineurs (p = 0.02). Menstrual headaches caused significantly higher MIDAS grades. One-third of the definite migraineurs reported improvement during pregnancy and oral contraceptives significantly worsened migraine. Menopause had a slight improving effect on migraine compared to TTH. Sex hormonal changes have major impacts particularly on migraine; however, the effects of hormonal fluctuations on TTH should not be underestimated.Item Migraine incidence in 5 years: A population-based prospective longitudinal study in Turkey(BMC, 2015-12-01) Baykan, Betül; Ertaş, Mustafa; Uludüz, Derya; Uygunoğlu, Uğur; Ekizoğlu, Esme; Orhan, Elif Kocasoy; Saip, Sabahattin; Siva, Aksel; Karlı, Necdet; Zarifoğlu, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; JDE-9380-2023; EHN-5825-2022; 6506587942; 6603411305Background: The incidence of migraine has been investigated only in a few studies worldwide and it is not known in our country. We, therefore, aimed to estimate the migraine incidence in a previously accomplished population-based prevalence study sample of 5323 individuals in the year 2008. Methods: The former Turkish headache prevalence study has been completed as a nationwide, randomized, home-based study of face-to-face examination by physicians trained for headache diagnosis by using ICHD criteria. Five years after this study an optimized survey including 50 questions was performed to estimate the migraine incidence in migraine-free individuals in the previous study, with a 56.4 % responder rate. Two validation studies for this survey were performed prior and after the study each in 100 subjects by comparing the gold standard of expert diagnosis of headache, showing high rate of reliability (Crohnbach alpha: 0.911 and 0.706, respectively). Results: Migraine incidence was estimated as 2.38 % (2.98 % in women and 1.93 % in men) per year in 2563 migraine-free individuals; if the population at risk is defined as the group without any headaches, the migraine incidence decreased to 1.99 %. The chronic migraine (CM) incidence [without medication overuse (MOH)] was 0.066 % and that of MOH was 0.259 %. We found a significant burden of the disease on the occupational functionality as well as on social and family life, even in the early years of the migraine. The family history of headaches especially in the fathers could be useful to predict new cases of migraine, besides the well-known risk factor, diagnosis of depression, whereas income and education did not seem to relate to migraine onset. Conclusions: Our study with a large population-based nation-wide sample, using ICHD-II criteria, with structured headache interviews as well as blinded re-validation of the questionnaire diagnoses showed a 2.38 % incidence rate of migraine in Turkey, higher than most of the other previous reports; a finding which could be related to genetic factors and also to the methodological differences in the study designs. Moreover the incidence of CM was found to be 0.066 %.Publication MS and COVID-19 challenge: Asymptomatic COVID-19 infection during treatment with cladribine(Springer, 2021-06-24) Seferoğlu, Meral; Ethemoğlu, Özlem; Turan, Ömer Faruk; Siva, Aksel; TURAN, ÖMER FARUK; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı; JHM-3244-2023Background The use of disease-modifying therapies (DMTs) in people with multiple sclerosis (pwMS) may affect COVID-19 infection outcomes due to DMTs' immunomodulatory and immunosuppressive effects on immune response. The yet unknown issues are both the early response to the infection, as well as the post-infection development of immunity against the virus under these treatments due to their interaction with the immune system. Methods We report two asymptomatic cases of COVID-19 in patients with relapsing-remitting multiple sclerosis (RRMS) shortly after starting cladribine therapy, both developed anti-SARS-CoV-2 antibody response. Results Patients with MS who are under newly initiated treatment with cladribine tablets may experience an asymptomatic COVID-19 infection and they may develop immunity against SARS-CoV-2. Conclusion These observations raise the probability that DMTs with immunosuppressive effects, such as cladribine, may be considered as a treatment option for selected MS patients with high disease activity during the COVID-19 pandemic.Item One-year prevalence and the impact of migraine and tension-type headache in Turkey: A nationwide home-based study in adults(BMC, 2012-03) Ertaş, Mustafa; Baykan, Betül; Orhan, Elif Kocasoy; Saip, Sabahattin; Önal, Ayşe Emel; Siva, Aksel; Zarifoğlu, Mehmet; Karlı, Necdet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 6603411305; 6506587942Several studies have shown that the prevalence of migraine and tension-type headache (TTH) varied between different geographical regions. Therefore, there is a need of a nationwide prevalence study for headache in our country, located between Asia and Europe. This nationwide study was designed to estimate the 1-year prevalence of migraine and TTH and analyse the clinical features, the impact as well as the demographic and socio-economic characteristics of the participant households in Turkey. We planned to investigate 6,000 representative households in 21 cities of Turkey; and a total of 5,323 households (response rate of 89%) aged between 18 and 65 years were examined for headache by 33 trained physicians at home on the basis of the diagnostic criteria of the second edition of the International Classification of Headache Disorders (ICHD-II). The electronically registered questionnaire was based on the headache features, the associated symptoms, demographic and socio-economic situation and history. Of 5,323 participants (48.8% women; mean age 35.9 +/- A 12 years) 44.6% reported recurrent headaches during the last 1 year and 871 were diagnosed with migraine at a prevalence rate of 16.4% (8.5% in men and 24.6% in women), whereas only 270 were diagnosed with TTH at a prevalence rate of 5.1% (5.7% in men and 4.5% in women). The 1-year prevalence of probable migraine was 12.4% and probable TTH was 9.5% additionally. The rate of migraine with aura among migraineurs was 21.5%. The prevalence of migraine was highest among 35-40-year-old women while there were no differences in age groups among men and in TTH overall. More than 2/3 of migraineurs had ever consulted a physician whereas only 1/3 of patients with TTH had ever consulted a physician. For women, the migraine prevalence was higher among the ones with a lower income, while among men, it did not show any change by income. Migraine prevalence was lower in those with a lower educational status compared to those with a high educational status. Chronic daily headache was present in 3.3% and the prevalence of medication overuse headache was 2.1% in our population. There was an important impact of migraine with a monthly frequency of 5.9 +/- A 6, and an attack duration of 35.1 +/- A 72 h, but only 4.9% were on prophylactic treatment. The one-year prevalence of migraine estimated as 16.4% was similar or even higher than world-wide reported migraine prevalence figures and identical to a previous nation-wide study conducted in 1998, whereas the TTH prevalence was much lower using the same methodology with the ICHD-II criteria.Item The persistence versus interchangeability of migraine and tension-type headaches in a 5-year population-based validated survey(Sage Publications, 2020-01) Baykan, Betül; Ertaş, Mustafa; Orhan, Elif Kocasoy; Saip, Sabahattin; Siva, Aksel; Akarsu, Emel Oğuz; Zarifoğlu, Mehmet; Karlı, Necdet; Bursa Uludağ Üniversitesi/Uludağ Tıp Fakültesi/Nöroloji Anabilim Dalı.; AAA-8936-2021; EHN-5825-2022; JDE-9380-2023; 55982762500; 6603411305; 6506587942Objective The aim of this population-based validated study was to determine the course of tension-type headache and migraine and to evaluate the predictors of persistence. Methods We evaluated the course of headache in a large population from the first assessment in 2008 through a second assessment in 2013. Then we examined the factors associated with persistent migraine and persistent tension-type headache. Results Our study in 2013 revealed that only 42.9% of definite migraineurs in 2008 received the same diagnosis again, and of the remaining migraineurs 23.3% were newly diagnosed as definite tension-type headache; 11.6% evolved into probable tension-type headache, 6.4% changed to probable migraine, and 15.8% were headache free. The 17.7% of patients with definite tension-type headache in 2008 were newly diagnosed as having probable tension-type headache, 14.7% as having definite migraine, 6.4% as having probable migraine, and 28.9% as headache free in 2013, and only 32.3% received the definite tension-type headache diagnosis again. Binary logistic regression analysis showed nausea, throbbing and severe headache were the significant parameters for persistent migraine. A multiple regression analysis model with stepwise variable selection revealed that nausea, throbbing and severe headache and osmophobia remained in the final model as predictors of migraine persistence. We found no predictive factor for persistent tension-type headache. Conclusion Migraine and tension-type headache did not seem to show a simple bidirectional linear worsening from headache-free state to definite migraine or vice versa, hence the transitions between them are more chaotic, reflecting that there are still unknown modifiers and modulators. Certain headache characteristics of migraine might predict persistent migraine.Item Population-based study of vestibular symptoms in migraineurs(Taylor & Francis, 2015-05-01) Akdal, Gülden; Baykan, Betül; Ertaş, Mustafa; Saip, Sabahattin; Siva, Aksel; Zarifoğlu, Mehmet; Karlı, Necdet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; EHN-5825-2022; JDE-9380-2023; 56604152400; 6506587942Conclusion: The differences between migraineurs with vertigo or motion sickness or both, and migraineurs with neither might reflect differences in migraine pathophysiology. Objective: To assess vestibular symptoms in 871 definite migraineurs. Methods: Data were gathered using a structured questionnaire. We considered responses to only 2/150 questions: (1) 'have you had vertigo with or apart from your headaches?' and (2) 'have you experienced motion sickness most of your life?'. The target groups were: (a) migraineurs with either vertigo or motion sickness, 'migraine with vestibular symptoms' (MwVS), their control group being migraineurs with neither vertigo nor motion sickness, 'migraine without vestibular symptoms' (MwoVS); (b) migraineurs who reported vertigo, 'migraine with vertigo' (MwV); their control group being migraineurs without vertigo (MwoV). Results: Among the 871 definite migraineurs, 534 had MwV, 337 had MwoV, 663 had MwVS, and 208 had MwoVS. The MwVS group had more headache, aura, nausea, vomiting, osmophobia, allergy, allodynia, headache increasing with head motion, noise as trigger for headache, days needing analgesics, and higher migraine disability scores than the MwoVS group. The pattern was the same in the MwV vertigo group as in the MwVS group, apart from migraine disability scores, which were no different.Item Potential risk factors for migraine: Data from a population-based incidence study(Lippincott Williams & Wilkins, 2016-04-05) Baykan, Betül; Ertaş, Mustafa; Ekizoğlu, Esme; Uludüz, Derya; Uygunoğlu, Uğur; Orhan, Elif Kocasoy; Saip, Sabahattin; Siva, Aksel; Karlı, Necdet; Zarifoğlu, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0002-7734-6451; JDE-9380-2023; EHN-5825-2022Item Prevalence of migraine in Turkey: A nationwide home based study(Elsevier, 2009-10) Ertaş, Mustafa; Baykan, Betül; Orhan, Elif Kocasoy; Saip, Sebah; Önal, Emel; Siva, Aksel; Zarifoğlu, Mehmet; Karlı, Necdet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Item Prevalence of migraine in Turkey: A nationwide home-based study(Sage Publications, 2009-10) Ertaş, Mustafa; Baykan, Betül; Orhan, Elif Kocasoy; Saip, Sebah; Siva, Aksel; Önal, Emel; Zarifoğlu, Mehmet; Karlı, Necdet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Item Sex differences of migraine: Results of a nationwide home-based study in Turkey(Türk Nöropsikiyatri Derneği, 2018-06-01) Baykan, Betül; Ertaş, Mustafa; Kocasoy Orhan, Elif; Saip, Sabahattin; Siva, Aksel; Önal, Ayşe Emel; Akarsu, Emel Oğuz; Zarifoğlu, Mehmet; Karlı, Necdet; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; AAA-8936-2021; EHN-5825-2022; FFR-9874-2022; 55982762500; 6603411305; 6506587942Introduction: The prevalence of migraine was found to be more than three-fold higher in women as compared with men, and in addition to differences in prevalence rates, the characteristics and associated features might also differ between the sexes. The aim of this study was to compare sex-specific features of migraine and demographic parameters in a nationwide population-based study in Turkey. Methods: Among 5323 subjects, a total of 871 patients who were diagnosed as having definite migraine according to the diagnostic criteria of the International Classification of Headache Disorders-III (ICHD-III) were included in our study. The demographic characteristics, associated features, and triggers of migraine were examined with regard to sex. Results: The study group comprised 640 women (73.5%) and 231 men (26.5%), with a female to male ratio of 2.8:1. Attack duration, mean migraine disability assessment scores (MIDAS), frequencies of nausea, vomiting, osmophobia, vertigo/dizziness, and allodynia were found significantly different between women and men. When we compared these parameters between men and postmenopausal women, all these parameters were still significant except nausea. Odor was statistically more frequent as a reported trigger in women, whereas excessive sleep was a statistically more frequent triggering factor in men. The rates of depression and allergy were significantly higher in women when compared with men. Conclusion: Longer attack duration, higher MIDAS scores, and the frequencies of nausea, vomiting, osmophobia, vertigo/dizziness, and allodynia were more significant in women and this variance in sex persisted after menopause. Also, some trigger factors and co-morbidities differed between the sexes. These findings might result from complex genetic factors besides sociocultural influences, biologic, and sociocultural roles. Future studies should continue to explore biologic and genetic factors with respect to sex in migraine.Item Survival and predictors of disability in Turkish MS patients(Lippincott Williams & Wilkins, 1997) Kantarcı, Orhun; Siva, Aksel; Eraksoy, M.; Karabudak, R.; Sütlaş, Nevin; Ağaoğlu, Jale; Özmenoğlu, Mehmet; Toğurul, Erdem; Demirkıran, Meltem; Turan, Faruk; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Objective: To examine the natural history, survival, and prognostic factors in a sample of Turkish MS patients. Method: This multicenter study included 1,259 definite MS patients diagnosed according to the criteria of Poser et al. Actuarial analysis of selected disability levels of 3, 6, 8, and 10 achieved with the Expanded Disability Status Scale (EDSS); a multivariate Cox regression analysis for prognostic factors related to time to reach EDSS greater than or equal to 6; and Pearson's correlation coefficient for individual factors were performed. Results: The survival (+/- SE) at 15 years from onset was 94.6 +/- 2.9%, and at 25 years was 89.0 +/- 5.8%. The disability reached by 15 years was EDSS greater than or equal to 3 in 66.4%, EDSS greater than or equal to 6 in 41.2%, EDSS greater than or equal to 8 in 10.5%, and EDSS = 10 in 5.4%. The most significant unfavorable prognostic factors were progressive course (relative risk [RR], 3.73; CI, 2.71 to 5.13) and sphincter symptoms at onset (RR, 1.86; CI, 1.23 to 2.82), followed by male sex, motor symptoms at onset, and a high attack frequency within the first 5 years. Primary progressive disease was correlated positively with male sex (r = 0.0895, p = 0.001), older age (I = 0.1807, p = 0.000), and motor (r = 0.1433, p = 0.000) or sphincter symptoms (r = 0.1001, p = 0.000) at onset, unlike relapsing-remitting and secondary progressive disease. Conclusions: Although a slightly better prognosis is observed in the Turkish MS population, early prognostic factors are similar to most of the previous Western series. Primary progressive disease, mostly seen in older men with motor and sphincter involvement at onset, has a worse prognosis and may represent a distinct behavioral variant of MS.Publication The complex genetic landscape of hereditary ataxias in Turkey and implications in clinical practice(Wiley, 2021-01-15) Vural, Atay; Şimşir, Gülşah; Tekgül, Şeyma; Koçoğlu, Cemile; Akçimen, Fulya; Kartal, Ece; Şen, Nesli E.; Lahut, Suna; Ömür, Özgür; Şaner, Nazan; Gül, Tuğçe; Bayraktar, Elif; Palvadeau, Robin; Tunca, Ceren; Çetinkaya, Caroline Pirkevi; Eken, Aslı Gündoğdu; Şahbaz, Irmak; Koç, Müge Kovancılar; Çakmak, Özgür Öztop; Hanağası, Haşmet; Bilgiç, Başar; Eraksoy, Mefkure; Gündüz, Ayşegül; Apaydın, Hülya; Kızıltan, Güneş; Özekmekci, Sibel; Siva, Aksel; Altıntaş, Ayşe; Güleç, Zeynep E. Kaya; Parman, Yeşim; Oflazer, Piraye; Deymeer, Feza; Durmuş, Hacer; Şahin, Erdi; Çakar, Arman; Tüfekcioğlu, Zeynep; Tektürk, Pınar; Çorbalı, M. Osman; Tireli, Hülya; Akdal, Gülden; Yis, Uluç; Hız, Semra; Şengün, İhsan; Bora, Elçin; Serdaroğlu, Gül; Özbek, Sevda Erer; Ağan, Kadriye; Günal, Dilek İnce; Us, Önder; Kurt, Semiha G.; Aksoy, Dürdane; Tokcaer, Ayşe Bora; Elmas, Muhsin; Gültekin, Murat; Kumandaş, Sefer; Acer, Hamit; Özçora, Gül D. Kaya; Yayla, Vildan; Soysal, Aysun; Genç, Gencer; Gülluoğlu, Halil; Kotan, Dilcan; Ayas, Zeynep Özözen; Şahin, Hüseyin A.; Tan, Ersin; Topcu, Meral; Topcuoğlu, Esen Saka; Akbostancı, Cenk; Koç, Filiz; Ertan, Sibel; Elibol, Bülent; Başak, A. Nazlı; ERER ÖZBEK, ÇİĞDEM SEVDA; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; JGR-7854-2023Background The genetic and epidemiological features of hereditary ataxias have been reported in several populations; however, Turkey is still unexplored. Due to high consanguinity, recessive ataxias are more common in Turkey than in Western European populations.Objective To identify the prevalence and genetic structure of hereditary ataxias in the Turkish population.Methods Our cohort consisted of 1296 index cases and 324 affected family members. Polymerase chain reaction followed by Sanger sequencing or fragment analysis were performed to screen for the trinucleotide repeat expansions in families with a dominant inheritance pattern, as well as in sporadic cases. The expansion in the frataxin (FXN) gene was tested in all autosomal recessive cases and in sporadic cases with a compatible phenotype. Whole-exome sequencing was applied to 251 probands, selected based on the family history, age of onset, and phenotype.Results Mutations in known ataxia genes were identified in 30% of 1296 probands. Friedreich's ataxia was found to be the most common recessive ataxia in Turkey, followed by autosomal recessive spastic ataxia of Charlevoix-Saguenay. Spinocerebellar ataxia types 2 and 1 were the most common dominant ataxias. Whole-exome sequencing was performed in 251 probands with an approximate diagnostic yield of 50%. Forty-eight novel variants were found in a plethora of genes, suggesting a high heterogeneity. Variants of unknown significance were discussed in light of clinical data.Conclusion With the large sample size recruited across the country, we consider that our results provide an accurate picture of the frequency of hereditary ataxias in Turkey.Item The validation of ID Migraine (TM) screener in neurology outpatient clinics in Turkey(BMC, 2007-09) Ertaş, Mustafa; Baykan, Betül; Uzunkaya, Özlem; Saip, Sabahattin; Siva, Aksel; Karlı, Necdet; Zarifoğlu, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 6506587942; 6603411305The aim of this study was to investigate the validity of the ID Migraine (TM) test in neurology outpatient clinics (NOCs), regardless of their presenting complaints. Patients admitted to 41 NOCs were screened. Eligible subjects (n = 3682) were evaluated by a neurologist for headache diagnosis according to the International Headache Society criteria and asked the 3-item screening questions of the ID Migraine (TM) test. Of 3682 patients, 917 (24.9%) were diagnosed as migraine, whereas 1171 (31.8%) were ID Migraine (TM) test positive. The sensitivity of the ID Migraine (TM) test for neurologist's diagnosis of migraine was 91.8%, specificity was 63.4%, positive predictive value was 71.9% and negative predictive value was 88.4%. The ID Migraine (TM) test is easy to use and a practical test that could alert the neurologist to diagnose patients having other complaints. This test would help to increase the diagnosis and treatment rate of undiagnosed migraine patients in NOCs.Item Validity and reliability of the Turkish Migraine Disability Assessment (MIDAS) questionnaire(Wiley, 2004-09) Ertaş, Mustafa; Siva, Aksel; Dalkara, Turgay; Uzuner, Nevzat; Dora, Babür; İnan, Levent; İdiman, Fethi; Sarıca, Yakup; Selçuki, Deniz; Şirin, Hadiye; Oğuzhanoğlu, Atilla; İrkeç, Ceyla; Özmenoğlu, Mehmet; Özbenli, Taner; Öztürk, Musa; Saip, Sabahattin; Neyal, Münife; Zarifoğlu, Mehmet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.Objectives.-The aim of this study is to assess the comprehensibility, internal consistency, patient-physician reliability, test-retest reliability, and validity of Turkish version of Migraine Disability Assessment (MIDAS) questionnaire in patients with headache. Background.-MIDAS questionnaire has been developed by Stewart et al and shown to be reliable and valid to determine the degree of disability caused by migraine. Design and Methods.-This study was designed as a national multicenter study to demonstrate the reliability and validity of Turkish version of MIDAS questionnaire. Patients applying to 17 Neurology Clinics in Turkey were evaluated at the baseline (visit 1), week 4 (visit 2), and week 12 (visit 3) visits in terms of disease severity and comprehensibility, internal consistency, test-retest reliability, and validity of MIDAS. Since the severity of the disease has been found to change significantly at visit 2 compared to visit 1, test-retest reliability was assessed using the MIDAS scores of a subgroup of patients whose disease severity remained unchanged (up to +/- 3 days difference in the number of days with headache between visits 1 and 2). Results.-A total of 306 patients (86.2% female, mean age: 35.0 +/- 9.8 years) were enrolled into the study. A total of 65.7%, 77.5%, 82.0% of patients reported that "they had fully understood the MIDAS questionnaire" in visits 1, 2, and 3, respectively. A highly positive correlation was found between physician and patient and the applied total MIDAS scores in all three visits (Spearman correlation coefficients were R = 0.87, 0.83, and 0.90, respectively, P <.001). Internal consistency of MIDAS was assessed using Cronbach's and was found at acceptable (>0.7) or excellent (>0.8) levels in both patient and physician applied MIDAS scores, respectively. Total MIDAS score showed good test-retest reliability (R = 0.68). Both the number of days with headache and the total MIDAS scores were positively correlated at all visits with correlation coefficients between 0.47 and 0.63. There was also a moderate degree of correlation (R = 0.54) between the total MIDAS score at week 12 and the number of days with headache at visit 2 + visit 3, which quantify headache-related disability over a 3-month period similar to MIDAS questionnaire. Conclusion.-These findings demonstrated that the Turkish translation is equivalent to the English version of MIDAS in terms of internal consistency, test-retest reliability, and validity. Physicians can reliably use the Turkish translation of the MIDAS questionnaire in defining the severity of illness and its treatment strategy when applied as a self-administered report by migraine patients themselves.Item Validity of the ID-migraine screener in the workplace(Lippincott Williams & Wilkins, 2008-04-15) Siva, Aksel; Ertaş, Mustafa; Saip, Sabahattin; Baykal, Betül; Keskinaslan, Abdulkadir; Şenocak, Mustafa Şükrü; Zarifoğlu, Mehmet; Karlı, Hamdi Necdet; Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 6603411305; 57193973560Objective: The impact of migraine on physical, social, and emotional performance is considerable, yet it remains an underdiagnosed disorder. ID-Migraine is a validated migraine-screening tool developed to facilitate diagnosis. This study evaluated the validity and use of the Turkish version of the ID-Migraine screener ( ID-Ms) in the workplace, and measured the impact of headache on disability, productivity, and quality of life among the workforce. Methods: A total of 465 employees from four companies were interviewed for screening with the ID-Ms. Subjects were included in the study if they reported two or more headaches in the past 3 months and gave a positive answer to one of the two ID-Ms prescreening questions. Eligible subjects completed the ID-Ms, the Migraine Disability Assessment Questionnaire, and the Medical Outcomes Study 36-Item Short Form Health Survey. Subjects were then evaluated for confirmation of their diagnosis according to the International Classification of Headache Disorders, 2nd edition ( ICHD-2) criteria. Results: A total of 227 subjects ( mean age 31.9 +/- 5.9 years; 65.6% women) completed the study. Migraine was diagnosed in 106 of the 227 subjects ( 46.7%) according to the ID-Ms and in 117 of the 227 subjects ( 51.5%) according to ICHD-2 criteria. The sensitivity of the ID-Ms was 70.9%, specificity was 79.1% and Cohen kappa value was 0.50. Workdays lost over the previous 3 months due to headache amounted to 8.7 +/- 9.5 days for migraine-positive and 4.9 +/- 6.6 days for migraine-negative subjects. Conclusion: The Turkish version of the ID-Migraine screener is a valid tool for identifying subjects with migraine in the workplace.