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    A RARE ENTITY OF ACQUIRED IDIOPATHIC GENERALISED ANHIDROSIS WHICH HAS BEEN SUCCESSFULLY TREATED WITH PULSE STEROID THERAPY: DOES THE HISTOPATHOLOGY PREDICT THE TREATMENT RESPONSE?
    (Literatura Medica, 2020) Oktem, Ece Ozdemir; Cankaya, Seyda; Uykur, Abdullah Burak; Erdem, Nazan Simsek; Yulug, Burak
    Acquired idiopathic generalised anhidrosis is an uncommon sweating disorder characterized by loss of sweating in the absence of any neurologic, metabolic or sweat gland abnormalities. Although some possible immunological and structural mechanisms have been proposed for this rare entity, the definitive pathophysiology is still unclear. Despite some successfully treated cases with systemic corticosteroid application, the dose and route of steroid application are controversial. Here, we present a 41-year-old man with lack of generalised sweating who has been successfully treated with high dose pulse intravenous prednisolone. We have discussed his clinical and histopathological findings as well as the treatment options in view of the current literature.
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    Bilingualism Is Associated with Significant Structural and Connectivity Alterations in the Thalamus in Adulthood
    (Mit Press, 2025) Ayyildiz, Behcet; Sayman, Dila; Ayyildiz, Sevilay; Oktem, Ece Ozdemir; Arslan, Ruhat; Colak, Tuncay; Bamac, Belgin
    Language is a sophisticated cognitive skill that relies on the coordinated activity of cerebral cortex. Acquiring a second language creates intricate modifications in brain connectivity. Although considerable studies have evaluated the impact of second language acquisition on brain networks in adulthood, the results regarding the ultimate form of adaptive plasticity remain inconsistent within the adult population. Furthermore, due to the assumption that subcortical regions are not significantly involved in language-related tasks, the thalamus has rarely been analyzed in relation to other language-relevant cortical regions. Given these limitations, we aimed to evaluate the functional connectivity and volume modifications of thalamic subfields using magnetic resonance imaging (MRI) modalities following the acquisition of a second language. Structural MRI and fMRI data from 51 participants were collected from the OpenNeuro database. The participants were divided into three groups: monolingual (ML), early bilingual (EB), and late bilingual (LB). The EB group consisted of individuals proficient in both English and Spanish, with exposure to these languages before the age of 10 years. The LB group consisted of individuals proficient in both English and Spanish, but with exposure to these languages after the age of 14 years. The ML group included participants proficient only in English. Our results revealed that the ML group exhibited increased functional connectivity in all thalamic subfields (anterior, intralaminar-medial, lateral, ventral, and pulvinar) compared with the EB and LB groups. In addition, a significantly decreased volume of the left suprageniculate nucleus was found in the bilingual groups compared with the ML group. This study provides valuable evidence suggesting that acquiring a second language may be protective against dementia, due to its high plasticity potential, which acts synergistically with cognitive functions to slow the degenerative process.
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    Cavernous sinus thrombosis due to mucor infection of ethmoid sinus
    (2024) Cankaya, Seyda; Çetin, Bahar Bakır; Oktem, Ece Ozdemir; Özşimşek, Ahmet; Lakadamyalı, Hatice; Yuluğ, Burak
    [Abstract Not Available]
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    Cavernous sinus thrombosis due to mucor infection of ethmoid sinus
    (Galenos Publ House, 2024) Cankaya, Seyda; Cetin, Bahar Bakir; Oktem, Ece Ozdemir; Ozsimsek, Ahmet; Lakadamyali, Hatice; Yulug, Burak
    [Abstract Not Available]
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    Cognitive Function Deficits Associated With Type 2 Diabetes and Retinopathy: Volumetric Brain MR Imaging Study
    (Wiley, 2025) Oktem, Ece Ozdemir; Sayman, Dila; Ayyildiz, Sevilay; Oktem, Caglar; Ipek, Lutfiye; Ayyildiz, Behcet; Aslan, Fatih
    Introduction: Type 2 diabetes mellitus is a ubiquitous chronic inflammatory disease with deleterious effects on various tissues, including the kidney, retina, and peripheral nerves. Studies using histopathology and magnetic resonance imaging have revealed that diabetes-related chronic hyperglycemia may impact the brain's essential functioning by causing microvascular damage. The aim of this study was to examine the cognitive functioning of type 2 diabetic individuals with and without retinopathy by evaluating their morphological, structural, and biochemical differences. Methods: Demographic characteristics, education level, type of diabetes mellitus (DM), disease duration, treatment received, other diabetic complications, such as nephropathy and neuropathy, and detailed medical histories were recorded. All participants underwent an extensive neuropsychological examination with Montreal Cognitive Assessment (MoCA) testing. Brain magnetic resonance imaging was performed to evaluate gray matter volume differences between the groups. Results: Gray matter volume differences between the groups were observed. Differences were observed after multiple corrections (age, education, and total intracranial volume [TIV]). First, the diabetic retinopathy group exhibited a significantly smaller gray matter volume in the right inferior temporal gyrus than the diabetic group (p = 0.032). In addition, the diabetic retinopathy group exhibited a significantly smaller gray matter volume than the control group in the right insula (lateral and central part) (p = 0.011). In addition, MoCA scores exhibited significant correlation with the two regions emerging as statistically significant in our analyses (the right inferior temporal gyrus and right insula) (p = 0.003, p = 0.002, respectively). Conclusion: Our results suggest the presence of a neurodegenerative process associated with cognitive dysfunction that is particularly prominent in the retinopathy stage of DM.
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    Different metabolic and clinical profiles between patients with pure Alzheimer dementia and epileptic Alzheimer dementia: a metabolic study
    (2022) Oktem, Ece Ozdemir; Kadak, Kübra Soğukkanlı; Cakır, Tansel; Özşimşek, Ahmet; Cankaya, Seyda; Hanoğlu, Lütfü
    Aim: To investigate the clinical characteristics and cerebral FDG PET metabolisms of dementia patients who were also diagnosed with epilepsy and compare the differences with pure Alzheimer dementia patients.Methods: In this case-control study, a total of 14 patients, 7 patients with pure Alzheimer disease as a control group and 7 age and gender-matched patients with Alzheimer disease and concomitant epilepsy as a study group, were included. Detailed neurocognitive battery and brain fludeoxyglucose positron emission tomography (FDG PET-CT) were performed for all subjects.Results: In comparison of neurocognitive test scores, there was no significant difference between the study and control groups. However, geriatric depression scale scores were significantly lower in study group than the controls (p= 0.026). In cerebral FDG-PET CT profiles of subjects we detected significantly lower metabolism in left and right cerebellum, left lentiform nucleus, right thalamus and vermis in the study group (p=0.008, p=0.023, p=0.003, p=0.002, p=0.002, respectively). In the right parietotemporal cortex and right and left associative visual cortex, we found higher metabolism in the study group than controls (p=0.023, p=0.012, p=0.003, respectively).Conclusion: Epileptic patients with Alzheimer’s dementia may have distinct clinical and metabolic profiles, than pure Alzheimer’s disease patients. Even if there is no difference in the neurocognitive clinical scores of the patients, depression and related functional abnormalities may be a biomarker of epileptic AD.
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    Evaluation of the effect of unilateral late blindness on the retina, optic nerve and choroid parameters in the sighted eye
    (Springer, 2021) Oktem, Caglar; Aslan, Fatih; Oktem, Ece Ozdemir
    Background To investigate whether unilateral late blindness alters the peripapillary retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), central macular thickness (CMT) and choroidal thickness (CT). Methods The 17 healthy eyes of 17 monocular patients with late blindness due to isolated eye trauma in one eye and the 19 eyes of 19 healthy individuals were evaluated in this retrospective study. Patients with at least 10 years of monocular blindness, a refractive error between + 1.5 and -1.5 D in the sighted eye, a best-corrected visual acuity of at least 20/20 and an axial length (AL) < 25 mm were included in the study. Following ophthalmologic examination, the RNFL, GCC, CMT and CT values were measured with spectral domain optic tomography (SD-OCT). Those with ocular, systemic or neurological disease that could influence the measured parameters were excluded from the study. Results A total of 17 (14 males, 3 females) monocular patients [mean age 41.00 +/- 11.95 (24-64)] and 19 (16 males, 3 females) healthy individuals [mean age 39.79 +/- 6.74 (30-56)], similar in age and gender (p = 0.949 and p = 0.881), were included in the study. The mean duration of being monocular was 22.76 +/- 11.76 (10-49) years. No difference was present between the RNFL, GCC, CMT and CT measurements of the monocular patients and the healthy individuals (p = 0.692, p = 0.294, p = 0.113, p = 0.623, respectively). No significant correlation was found between the duration of monocularity and the retinal and optic nerve parameters. Conclusion The results of our study indicate no difference in the optic nerve, retina and choroid OCT findings in the sighted eyes of subjects with long-term monocular blindness compared to subjects with bilateral normal eyes. Although functional and volumetric neuroimaging studies suggest the possibility of compensation in these patients, our findings indicate that this is not at the ocular level.
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    High dose corticosteroid causes bradycardia in patients with multiple sclerosis
    (Wiley, 2024) Sayman, Ceyhun; Celik, Humeyra; Cankaya, Seyda; Oktem, Ece Ozdemir; Yulug, Burak
    [Abstract Not Available]
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    Investigation of the Antiepileptics on Levels of Vitamin D and Calcium
    (2022) Yuluğ, Burak; Özşimşek, Ahmet; Oktem, Ece Ozdemir
    Aim: We investigated the connection between D vitamin and factors such as the type of antiepileptic agent, patient age and gender.Methods: This retrospective case-control study enrolled a total of 301 participants, including 141 epilepsy patients with (n= 120) without drug (n=21) regimens followed up in Alanya Alaaddin Keykubat University neurology outpatient clinic and 160 healthy individuals who applied to the neurology outpatient clinic for different reasons from January 2018 to January 2021. Demographics, detailed history, use of medications, duration of antiepileptic use, plasma 25-hydroxy Vitamin D and calcium levels were determined.Results: The mean level of Vitamin D was 15.46 in the epilepsy group and 16.95 in the control group. Level of D Vitamine did not differ significantly by groups (p>0.05). There were no significant relationship regarding age and vitamin D levels in both groups while decreased Vitamin D levels were detected epileptic women. Vitamin D level was below 20 in 69.6% of healthy control group, 78.9% of carbamazepine users, 62.5% of lacosamide users, all lamotrigine users, 66.7% of levatiracetam users, and 72.4% of sodium valproate users. No significant connection were detected between levels of Vitamin D and the drug used (p>0.05) while a significant association was confirmed only between calcium levels and carbamazepine (p<0.05).Conclusion: Vitamin D and calcium levels can be found to be low in antiepileptic users; however, except for the calcium levels in the carbamazepine group, this decrease does not constitute a significant difference. 
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    Mezensefalik Kanamalı Hastalarda Fonksiyonel Sonuçlara Yönelik Prognostik Faktörler
    (2023) Oktem, Ece Ozdemir; Kumral, Emre; Çetin, Fatma Ece; Özşimşek, Ahmet; Dorukoğlu, Mehmet Mesut; Cankaya, Seyda; Yuluğ, Burak
    Amaç: Mezensefalik kanama (MH), spontan intraparankimal kanamanın nadir görülen bir prezentasyonudur. Bu çalışma, mezensefalik kanamalardaki prognostik parametreleri değerlendirmeyi amaçlamaktadır. Yöntem: Çalışmamızda; izole mezensefalik kanamalı olgular PRISMA (Sistematik İncelemeler ve Meta-Analizler için Tercih Edilen Raporlama Öğeleri) beyanına göre kapsamlı şekilde taranmıştır. Literatürde yer alan BT veya MRG ile kanıtlanmış 62 uygun vaka ve bunlara MRG ile doğrulanmış altı vaka olmak üzere 68 hasta çalışmaya dâhil edildi. Hastalar modifiye Rankin Skalasına göre (mRS), iyi sonlanım (0–2 puan) ve kötü sonlanım (3–6 puan) olarak iki gruba ayrılarak, prognostik parametreler istatistiksel olarak karşılaştırıldı. Bulgular: Çalışılan 68 hastanın 26’sının (%38) bilinci açık, 22’si (%32) letarjik, 20’si (%29) stupor veya koma ile başvurdu. İyi prognoz gösteren olguların 26’sında (%65), kötü prognoz gösterenlerin 12’sinde (%43) idiopatik kanama gözlendi (p=0,059). Tek değişkenli analizlerde, arteriyovenöz malformasyonlar (p=0,33) ve kavernomlar (p=0,19) prognoz ile ilişkili bulunmadı. Çoklu lojistik regresyon analizlerinde; hipertansiyon (OR, 51,22; CI%95, 1,92–1370,24; P=0,019, bilinç durumu (OR, 133,54; CI%95, 1,61–1113,3; p=0,03), başvuru anındaki NIHSS (OR, 57,23; CI%95, 2,87–1141,2; p=0,008) ve ventrodorsal kanama boyutu (?1 cm) (OR, 61,83; CI%95, 2,15–1779,2; p=0,016), kötü prognoz ile ilişkili bulundu. Mezensefalik kanamadan üç ay sonra, 40 hastanın (%59) klinik olarak iyi durumda, 28 (%41) hastanın klinik olarak kötü durumda olduğu, sekiz hastanın ise (%12) kaybedildiği gözlendi. Sonuç: Bu bulgular, hemorajinin ventrodorsal boyutunun ve inme başlangıcındaki klinik şiddetin mezensefalik kanama sonrası fonksiyonel sonuç açısından olası belirleyicileri olduğunu göstermektedir.
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    Prognostic Factors For Functional Outcome in Patients with Mesencephalic Hemorrhage
    (Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2023) Oktem, Ece Ozdemir; Kumral, Emre; Bayam, Fatma Ece; Ozsimsek, Ahmet; Dorukoglu, Mehmet Mesut; Cankaya, Seyda; Yulug, Burak
    Introduction: Mesencephalic hemorrhage (MH) is a rare presentation of spontaneous intraparenchymal hemorrhage. This study aims to evaluate prognostic parameters of the MH outcome. Methods: We conducted an extensive search in the literature for cases with spontaneous, isolated mesencephalic hemorrhage. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Sixty-two eligible cases have been reported in the literature as proven by CT or MRI, and to these, we added six cases confirmed by MRI. The modified Rankin Scale (mRS) was dichotomized into two groups as the favorable outcome (FO; score, 0-2) and unfavorable outcome (UO; score, 3-6). Results: Of the 68 patients studied, 26 (38%) presented with normal consciousness, 22 (32%) with lethargy, and 20 (29%) with stupor or coma. There was no cause of hemorrhage in 26 (65%) patients with FO and 12 (43%) with UO (p=0.059). In univariate analyses, neither arteriovenous malformations (p=0.33) nor cavernomas (p=0.19) were associated with outcome. Multiple logistic regression analysis revealed that hypertension (OR, 51.22; CI95%, 1.92-1370.24; P=0.019), consciousness (OR, 133.54; CI95%, 1.61-1113.3; P=0.03), NIHSS at admission (OR, 57.23; CI95%, 2.87-1141.2; p=0.008), and ventrodorsal hemorrhage size (=1 cm) (OR, 61.83; CI95%, 2.15-1779.2; p=0.016) were significantly associated with UO. Three months after stroke, 40 patients (59%) had FO, 28 (41%) had UO, and 8 (12%) died. Conclusion: These results suggest that ventrodorsal size of hemorrhage and clinical severity at stroke onset are possible predictors of functional outcome after mesencephalic hemorrhage.
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    The Role of Willpower in Major Depressive Disorder: An fMRI Study
    (Wiley, 2025) Yulug, Burak; Uygur, Burak; Sayman, Dila; Cankaya, Seyda; Ayyildiz, Behcet; Ayyildiz, Sevilay; Oktem, Ece Ozdemir
    Introduction The brain network correlates of personality traits in major depressive disorder (MDD) have not yet been investigated. Furthermore, it is still unclear whether personality traits relate to the depressive episode.Methods This study assessed network properties, depression severity, and personality traits in patients with MDD (n = 25) compared with age- and sex-matched healthy controls (n = 22). We performed TCI questionnaire which assesses novelty seeking (NS, an urge to explore new experiences with heightened emotional responses), harm avoidance (HA, the tendency to hold back when faced with unpleasant situations), reward dependence (RD, a tendency to seek and value rewards rooted in social recognition), persistence (P, an individual's ability to remain focused and driven toward goals despite encountering challenges), self-directness (SD, an expression of willpower that enables individuals to adapt their behavior to situational demands while remaining focused on their personal goals and values), cooperativeness (C, a behavioral trait reflecting a person's general approach to others; ranging from friendly and cooperative to hostile), and self-transcendence (ST, lessening of self-centeredness, allowing for expanded empathy) traits of participants.Results MDD patients with distinctive character traits exhibited significant differences in terms of depression diagnosis and severity of Hamilton Depression Rating Scale scores compared to the controls. The MDD patients also exhibited reduced resting-state network activity between the posterior default mode network, right putamen, and right frontal pole, while SD was significantly less frequently diagnosed in MDD patients. In evaluating the network correlates, differences in the SD traits were significantly associated with critical brain network alterations that were not evident in other traits.Discussion To the best of our knowledge, this is the first study to provide preliminary evidence of an abnormal connectome in the SD trait in MDD, thus providing convincing evidence for personalized antidepressant treatment strategies in MDD. A small sample size and our depression group being not drug-naive were our limitation for this research.