Person: TÜTÜNCÜ TOKER, RABİA
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TÜTÜNCÜ TOKER
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RABİA
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Publication Multiple sclerosis in childhood: Single center experience(Bursa Uludağ Üniversitesi, 2021-08-01) Bodur, Muhittin; Toker, Rabia Tütüncü; Okan, Mehmet Sait; BODUR, MUHİTTİN; TÜTÜNCÜ TOKER, RABİA; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tip Fak/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Noroloji Bilim Dalı; 0000-0002-2588-8195; 0000-0002-3129-334X; 0000-0002-9303-5768; AAH-2684-2021; IZP-6290-2023; JAN-9435-2023Introduction: In this study, clinical and demographic features of childhood multiple sclerosis(MS) diagnosed in a single center for 10 years are presented.Materials and Methods: In this study files of 2.3 patients with multiple sclerosis who were admitted to Department of Pediatric Neurology between January 2006 and January 2016 were investigated retrospectively. The data of 19 cases were evaluated since 3 cases were excluded due to lack of attending the control visits for more than 2 years and 1 case died in a traffic accident. Gender, current age, family history of MS, onset ages of symptoms, age at diagnosis, duration of disease follow-up, initial symptoms, magnetic resonance(MR) findings, cerebrospinal fluid(CSF) oligoclonal band positivity, visual evoked potential(VEP), somatosensory evoked potential(SEP) findings, treatments and a number of attacks were evaluated.Results: Of the 19 patients diagnosed with multiple sclerosis, 13 were female (68.4%), 6 were male (31.5%), and the female/male ratio was 2.16. The mean age of onset of symptoms was 1409 years. The mean age of diagnosis was 15.2 years, and the mean follow-up period was 2.17 years. Family history was positive in 3 patients (15.7%). When the initial symptoms of our patients were examined, motor, sensory and brainstem findings were present in 11(57.8%), 9 (47.3%) and 7 cases (36.8%), respectively. Two patients (10.5%) presented with cerebellar findings and 6 patients (31.5%) with visual impairment. The oligoclonal band of CSF was found to be positive in 17 (89.4%) of the cases.Conclusions: In this study, gender, age, family history, age at onset of symptoms, initial symptoms, MR findings, CSF findings, VEP, SEP findings, treatments used, and the number of episodes were evaluated. Multicenter, prospective, and longitudinal studies with larger study populations are needed to understand multiple sclerosis onset in the pediatric period.Publication A rare case of juvenile amyotrophic lateral sclerosis(Türk Pediatri Dergisi, 2021-05-01) Bodur, Muhittin; Toker, Rabia Tütüncü; Başak, Ayşe Nazlı; Okan, Mehmet Sait; BODUR, MUHİTTİN; TÜTÜNCÜ TOKER, RABİA; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Nörolojisi Anabilim Dalı; 0000-0002-2588-8195; 0000-0002-3129-334X; 0000-0002-9303-5768; JAN-9435-2023; AAH-2684-2021; IZP-6290-2023; DKC-6496-2022Background. Amyotrophic lateral sclerosis (ALS) is a chronic motor neuron disease characterised by progressive weakness in striated muscles resulting from the destruction of neuronal cells. The term juvenile ALS (JALS) is used for patients whose symptoms start before 25 years of age. JALS may be sporadic or familial.Case. Here, we present a sporadic case of JALS because of its rarity in children. The heterozygous p.Pro525Leu (c.1574C>T) variation was identified in the fused in sarcoma (FUS) gene.Conclusion. The p.Pro525Leu mutation in the FUS gene has been detected in patients with ALS, characterised by early onset and a severely progressive course.Publication Evaluation of patients admitted to pediatric emergency outpatient clinic with non-traumatic neurological complaint(Bursa Uludag Univ, 2020-12-01) Toker, Rabia Tutuncu; TÜTÜNCÜ TOKER, RABİA; Bodur, Muhittin; BODUR, MUHİTTİN; Özmen, Abdullah Hakan; ÖZMEN, ABDULLAH HAKAN; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0002-3129-334X; 0000-0002-2588-8195; 0000-0002-9303-5768; JAN-9435-2023; AAH-2684-2021; AAE-2163-2022; IZP-6290-2023; AAF-8981-2020INTRODUCTION: Pediatric Emergency Outpatient Clinic are the units where treated the entire range of emergent and urgent medical conditions. Patients present with a wide range of complaints. Determining the general distribution, frequency and density of Pediatric Emergency Outpatient Clinic applications is of great importance in order to make appropriate future plans. In this study, it was aimed to evaluate the clinical features of patients presenting with non-traumatic neurological complaints.MATERIALS and METHODS: The files of the patients who applied to the Pediatric Emergency Outpatient Clinic within one year were evaluated retrospectively. Patients with a known neurological disease who presented to the Pediatric Emergency Outpatient clinic with non neurological complaints, those in the neonatal and trauma patients were not included in the study.RESULTS: It was found that the main complaint of 628 of the patients who applied to the Pediatric Emergency Outpatient Clinic within a year was neurological symptoms. % 50,3 of the patients were found as girls and %49,7 as boys. Seizure was the most common neurological complaint. It was found that %83,1 of the patients who presented with seizures for the first time presented with a febrile seizures and %16,9 with febrile seizures. Status epilepticus rate was found to be %4,5 in patients presenting with seizuresCONCLUSIONS: Seizure was the most common non-traumatic neurological presentation to Pediatric Emergency Outpatient Clinic. We believe that updating knowledge and skills on emergency approach to seizures in Pediatric Emergency Outpatient Clinic will increase the quality of healthcare services to be provided.Publication Etiology, clinic and prognosis of seizures in preterm and term neonates: A retrospective study(Bursa Uludag Üniversitesi, 2021-08-01) Cakir, Salih Cagri; ÇAKIR, SALİH ÇAĞRI; Toker, Rabia Tutuncu; TÜTÜNCÜ TOKER, RABİA; Koksal, Nilgun; Ozkan, Hilal; ÖZKAN, HİLAL; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Kocael, Fatma; KOCAEL, FATMA; Yoruk, Gulce; YÖRÜK, GÜLCE; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dali; 0000-0001-5761-4757; 0000-0002-3129-334X; 0000-0002-9303-5768; 0000-0002-1787-6872; IZP-6290-2023; HJZ-4508-2023Introduction: The seizure is one of the most common neurological problems in neonatal intensive care units (NICU). Its frequency and etiology differ between preteen and term babies. This study aimed to investigate the properties, causes, response to treatment, and prognostic factors of neonatal seizures in term and preterm babies.Materials and Methods: The files of patients with a diagnosis of neonatal seizure in the NICU between 01/01/2014 and 01/09/2019 were analyzed retrospectively. Gross motor function classification, hearing test results and epilepsy rates were examined for neurological outcomes.Results: A total of 86 patients (43 preterm and 43 term infants) were included in this study. The most common etiological factors were hypoxic-ischemic encephalopathy (HIE) (35%) in term infants and intraventricular hemorrhage (IVH) in preterm infants (54%). The most common seizure type was subtle seizures in preterm babies and clonic seizures in term babies. The first seizure day was more on the first day and between the 4-7 days in term babies and after seventh days in preterm babies (p <0.05). The onset time of seizures in preterm babies was more after seven days at IVH, and on the first day at HIE (p<0.05). Status epilepticus frequency is higher in preterm (30%) than term (9.3%) (p = 0.015). The response rate to phenobarbital treatment was 71% in term infants and 50% in preterm infants (p = 0.06). According to the criteria (death, epilepsy, hearing loss, autism and gross motor function scale> 2) in our study, the poor prognosis rates were (52%) in term infants and (75%) in preterm infants (p = 0.051).Conclusion: In the etiology of neonatal seizures, IVH in preterm infants and HIE in term infants were the first. The neurological outcomes of patients who had convulsions in the neonatal period should be followed closely.Publication Etiologies of convulsive status epilepticus in children(Galenos Yayınevi, 2023-08-01) Toker, Rabia Tütüncü; Bodur, Muhittin; Okan, Mehmet Sait; TÜTÜNCÜ TOKER, RABİA; BODUR, MUHİTTİN; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Nörolojisi Bilim Dalı.; 0000-0002-3129-334X; 0000-0002-2588-8195; 0000-0002-9303-5768; IZP-6290-2023; JAN-9435-2023; DKC-6496-2022Introduction: Convulsive status epilepticus (CSE) is one of the neurologic emergencies of childhood with varying degrees of impaired consciousness and motor symptoms. The aim of this study was to try to define the etiology of patients with CSE.Materials and Methods: Children aged 1 month to 18 years with CSE were included in the study. The demographic characteristics of the patients, seizure type, seizure etiology, epilepsy history, drugs used, and complications were recorded.Results: One hundred forty-five patients who were diagnosed as having were included in the study, 60.7% of whom were male. The seizure type was focal onset in 55.9% of the patients. According to the etiology of CSE, the most common group was found as unknown group (48%), and 72.9% of those had a history of epilepsy. Febrile (17%) and central nervous system infections (8.3%) were found to be the most common in acute etiology, respectively. Pulmonary complications developed most frequently. The mortality rate was 0.7%.Conclusion: The "unknown etiology" is found as the most common etiology of CSE in children. Febrile seizure and central nervous system infections are common in acute etiologies.Publication Neuro-behcet is a rare disease but should be considered in all kinds of neurological findings, even in childhood(Clinical & Exper Rheumatology, 2022-08-01) Toker, Rabia Tütüncü; Bodur, Muhittin; Demir, Aylin Bican; Okan, Mehmet Sait; TÜTÜNCÜ TOKER, RABİA; BODUR, MUHİTTİN; BİCAN DEMİR, AYLİN; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Nörolojisi Bilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; 0000-0002-3129-334X; 0000-0002-2588-8195; 0000-0001-6739-8605; 0000-0002-9303-5768; IZP-6290-2023; JAN-9435-2023; KHB-9765-2024; DKC-6496-2022Objective: Behfet's disease (BD) is a vasculitis characterised by eye, musculoskeletal, neurological and gastrointestinal involvement, in addition to recurrent oral ulcers. Neuro-Behvet is the term used to define the nervous system involvement in BD and is very rarely seen in childhood. This study aims to show that neuro-Behret can manifest a clinical course involving all kinds of neurologic findings in the paediatric population.MethodsThe Clinic of Paediatric Neurology at Uludag University provides tertiary treatment for children up to eighteen years of age in Bursa, Turkey. Five patients who were clinically diagnosed with Neuro-Beket in the last 5 years were included in the study. Results: Seizure, myopathy, transverse myelitis, polyneuropathy, venous thrombosis and facial nerve paralysis were respectively seen in the patients. ConclusionNeuro-Behfet is rare in children, but it is important to know that it can cause various neurological findings, and also systemic findings should be taken into consideration in the diagnosis of neurological diseases. Studies on the neurological involvement of BD in children are inadequate. We believe that paediatric neurologists should be more aware of the neuro-Behfet condition.Publication Awareness of sleep and narcolepsy in children(Galenos, 2020-06-01) Demir, Aylin Bican; Okan, Mehmet Sait; Tütüncü, Rabia Toker; TÜTÜNCÜ TOKER, RABİA; Demir, Aylin Bican; BİCAN DEMİR, AYLİN; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Nöroloji Anabilim Dalı.; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0002-3129-334X; 0000-0001-6739-8605; 0000-0002-9303-5768; IZP-6290-2023; V-7170-2017; JCE-6657-2023Objective: This study aimed to increase the awareness of narcolepsy in children and emphasize the reduction of the socioeconomic burden caused by the delayed or incorrect diagnosis.Materials and Methods: Demographic characteristics, clinical features, and electrophysiological studies of children diagnosed with narcolepsy in the Bursa Uludag University, Health Practice and Research Hospital, Clinic of Pediatric Neurology, were obtained from medical records.Results: Six children were included in the study. The average age at which the initial symptoms were observed was 11.5 years, whereas the average age of diagnosis was 13.5 years. Daytime sleep was accompanied by cataplexy in five cases and hypnogogic hallucinations in one case. Notably, the seizure was primarily considered in the differential diagnosis before diagnosing narcolepsy.Conclusion: It is crucial to increase the awareness of narcolepsy by physicians. Although families and children cannot express sleep disorders, we believe that questioning of sleep patterns during anamnesis in routine neurology practice could prevent delayed diagnosis.Publication Facial colliculus syndrome due to a Herpes simplex virus infection following Herpes labialis(Turkish J Pediatrics, 2021-07-01) Bodur, Muhittin; Toker, Rabia Tütüncü; Özmen, Abdullah Hakan; Okan, Mehmet Sait; BODUR, MUHİTTİN; TÜTÜNCÜ TOKER, RABİA; ÖZMEN, ABDULLAH HAKAN; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı/Çocuk Nörolojisi Bilim Dalı.; 0000-0002-2588-8195; 0000-0002-3129-334X; 0000-0002-9303-5768; IZP-6290-2023; AAF-8981-2020; AAH-2684-2021; AAE-2163-2022; JAN-9435-2023; DKC-6496-2022Background. The facial colliculus is an elevated area that is formed by fibers from the motor nucleus of the 7'th cranial nerve as they loop over the abducens nucleus. Clinical signs and symptoms of facial colliculus lesions occur primarily due to injury to the abducens nerve nucleus, the facial nerve fibers around the abducens nucleus, paramedian pontine reticular formation, and the medial longitudinal fasciculus. The etiology of facial colliculus lesions varies by age. While tumors, demyelinating lesions, and viral infections can be involved in young individuals' etiology, vascular ischemia is a common causative factor in older people. Case. In this paper, we present a case of facial colliculus syndrome due to its rare occurrence in a young patient; who developed the signs and symptoms after a herpes infection. Conclusion. Facial colliculus syndrome is rare and the treatment is based on etiology.Publication Short-term clinical outcomes of newborns who have neural tube defects(Galenos Yayincilik, 2018-01-01) ÇAKIR, SALİH ÇAĞRI; Dorum, Bayram Ali; TAŞKAPILIOĞLU, MEVLÜT ÖZGÜR; Özkan, Hilal; ÖZKAN, HİLAL; Taşkapılıoğlu, Özgür; Köksal, Nilgün; Toker, Rabia Tütüncü; TÜTÜNCÜ TOKER, RABİA; Okan, Mehmet Sait; OKAN, MEHMET SAİT; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; 0000-0001-5761-4757; 0000-0002-2823-8454; 0000-0001-5472-9065; 0000-0002-3129-334X; 0000-0002-9303-5768; A-5375-2017; ABB-8161-2020; AEZ-2469-2022; AAG-8393-2021; IZP-6290-2023; HJZ-4508-2023INTRODUCTION: Neural tube defects (NTD) are one of the most common congenital anomalies of the newborns. The incidence of NTD in Turkey is 3/1000. Various types of NTD appear depending on the part affected by the closure of the neural tube. The etiology of NTD is multifactorial, and a significant portion of them can be prevented by folic acid supplementation. Patients with NTD need long-term medical, surgical and care support.METHODS: In this study, antenatal, natal and postnatal characteristics of NTD patients who were admitted to the NICU between 2013-2017 were examined retrospectively.RESULTS: Twenty-nine NTD patients were included in this study. Sixteen (55%) of the patients were male and 13 (45%) were female. Mean gestational age was 37.5 +/- 1.97 weeks, mean birth weight was 3050 +/- 703.29 grams. Six patients had the following maternal risk factors for NTD development: diabetes, obesity, smoking, and the use of valproic acid. None of the patients used preconceptional folic acid. Of the NTD, 23 were meningomyelocele, 1 was meningocele, 3 were encephalomyelocele, 1 was encephalocele, and 1 was acrania. NTD was the most common at the lumbosacral region (n=10) and the other regions were lomber (n=8), thoracic (n=5), occipital (n=4) and cervical (n=1). While the complete loss of leg movements was seen in eleven of the patients, partial loss was seen in nine of them. The lesion level was higher than L4 in all of those with complete motor dysfunction and in 4 (44%) with partial motor dysfunction. Meningomyelocele sacs were ruptured in seven patients. Shunt procedures were required in 18 of 19 patients with hydrocephalus. Shunt placement and meningomyelocele operations were performed simultaneously in 11 patients.DISCUSSION and CONCLUSION: The preventable etiologic risk factors of NTDs should be known especially by the parents who are considering having a child.Publication Evaluation of parents' health literacy in chronic neurological diseases of childhood(Galenos Publ House, 2023-08-01) Şahin, Nilufer Ülkü; Şahin, Nihal; Toker, Rabia Tütüncü; TÜTÜNCÜ TOKER, RABİA; Karali, Yasin; KARALI, YASİN; Bursa Uludağ Üniversitesi/Tıp Fakültesi/Çocuk Sağlığı ve Hastalıkları Anabilim Dalı.; IZP-6290-2023Introduction: Health literacy is defined as the degree to which individuals can make appropriate health decisions, access health services, and understand and apply the treatment given. The aim of this study is to evaluate the health literacy level of the parents of patients diagnosed with one of the chronic neurological diseases of childhood.Materials and Methods: The study was conducted by applying a questionnaire containing the Turkish Health Literacy Scale-32 (TSOY-32) to the parents of pediatric patients followed up for chronic neurological diseases.Results: Three hundred thirty eight people (53.3% female, 46.7% male) participated in the study. According to the participants' health literacy level according to the TSOY-32 scale; 15.4% (n=52) were inadequate, 24.6% (n=83) problematic/limited, 34% (n=115) adequate, 26% (n=88) excellent. The health literacy level of 40.2% of the parents of the patients followed up with epilepsy, 58.8% of the parents of the patients followed up with neuromuscular disease and 52.6% of the parents followed up with neurodegenerative diseases was found to be insufficient or problematic-limited.Conclusion: 40% of parents of children with chronic neurological diseases do not have sufficient health literacy. This rate increases in cases where the incidence of chronic neurological disease is low. It would be appropriate to organize training programs to increase social awareness and health literacy in chronic neurological diseases.