Objective: Botulinum toxin type A is widely used for the treatment of spasticity, focal dystonia, hemifacial spasm, hyperhidrosis, strabismus, chronic migraine, and also cosmetic purposes. Therapeutic use is commonly effective and safe. However, if toxin enters the vascular space and gets through to peripheral cholinergic nerve terminals, it may lead to iatrogenic botulism. Method: We presented a patient who is diagnosed as iatrogenic botulism and treated with antitoxin at the 15th day of the exposure. Results: After the antitoxin administration, dramatical response to the treatment was observed. Conclusions: In this report, we want to evaluate a new case of iatrogenic botulism and emphasize the importance of antitoxin administration regardless the timing of the exposure for patients with progressing paralysis.

Purpose: The aim of this study was to comprehensively assess the neurophyschiatric symptoms of multiple sclerosis (MS) such as apathy and pseudobulbar affect and their correlation with other concomitant factors. Materials and Methods: Montreal Cognitive Assessment (MoCA), Apathy Evaluation Scale (AES), Fatigue severity scale (FSS), Center for Neurologic Study-Lability Scale (CNS-LS), Beck Depression Inventory (BDI) are applied to 258 MS patients. Correlation and regression analysis are conducted between scales and other possible causers. Results: 53.6% of the patients have psuedobulbar affect, 76.2% of patient population have fatigue. Pseudobulbar affect had positive correlation with fatigue and also depression while apathy negatively correlate with pseudobulbar affect or fatigue. Additionally, apathy and depression correlated negatively. There was no relation between cognition and depression and/or disease duration and/or other scales’ scores. Conclusion: Pseudobulbar affect and apathy are quite common symptoms in MS patients, that are cross-cutting issues. Also, apathy may be an independent neuropyschiatric symptom of MS that need to be approached separately.

AIM: To investigate the impact of subthalamic deep brain stimulation (STN DBS) on apathy and the possible relationship between apathy, depression, and levodopa equivalent dosage (LED) in Parkinson's Disease (PD) patients. MATERIAL and METHODS: A total of 26 patients have been evaluated via the Unified Parkinson Disease Rating Scale (UPDRS), Beck Depression Inventory (Beck D), and Beck Anxiety Inventory (Beck A), Montreal Cognitive Assessment (MoCA), Parkinson Disease Questionnaire (PDQ-39) just before and 6 months after DBS. RESULTS: Apathy scores (AES) showed a slight decrease from 54.00 +/- 10.30 to 52.69 +/- 8.88 without any statistical significance (p=0.502) after DBS therapy. No correlation was detected between the post -treatment changes in apathy and UPDRS scores, Beck D, Beck A. Although the direction of the correlation between changes in AES scores and LED values was negative, the results did not reach statistical significance. CONCLUSION: STN DBS therapy does not have a negative effect on apathy in PD Patients. Despite the satisfactory motor improvement, conservative dopaminergic dose reduction after surgery seems to be the main point to prevent apathy increase in PD patients after STN DBS.

Objective: Drug‐induced myoclonus is a rare adverse effect associated with several drug classes, including antipsychotics. This case report describes a patient who developed generalized myoclonic jerks while on long‐term risperidone therapy, in the context of concomitant sertraline use, without fulfilling clinical criteria for serotonin syndrome. Case Presentation: We present a 73‐year‐old male patient with a history of cerebrovascular disease and behavioral symptoms treated with sertraline and risperidone. The patient developed sudden, generalized myoclonic movements. Neurological examination and imaging studies excluded acute structural pathology and metabolic or infectious causes. Serotonin syndrome was ruled out based on clinical findings. The myoclonus resolved rapidly after discontinuation of risperidone, without any specific symptomatic treatment, suggesting a potential drug‐related mechanism. Conclusion: This case highlights the importance of recognizing antipsychotic‐related myoclonus as a potentially reversible condition. Clinicians should consider drug‐induced myoclonus in the differential diagnosis and pay special attention to the risks posed by polypharmacy involving psychotropic agents.

Purpose: It is not clear whether cognitive functions are impaired in young patients with acute coronary syndrome (ACS). This study aims to detect whether or not there is cognitive impairment and cerebral changes in young patients with ACS undergoing percutaneous coronary intervention (PCI). Patients and Methods: All 50 patients with ACS who were treated with primary PCI were eligible for this prospective study. All participants had normal cognitive function before ACS. Brain magnetic resonance imaging (MRI) was performed to quantify changes in brain white and gray matter. Cognitive functions (CFs) were evaluated by seven cognitive tests. Patients were categorized by MRI findings and test scores were compared from the first day to after the first month. Results: We determined 25 patients with impaired CFs on the first day. After the first month, we identified 18 patients with transient impaired CFs. No structural difference was observed between impaired CF and normal CF. While 25 patients had a score of 1 according to Fazekas, 10 patients had a score of 1 according to MTLA. While the mean Stroop test completion time and Stroop test error rate scores were significantly higher on the first day than after the first month in the Fazekas+ group (p = 0.003, p < 0.001, respectively), other cognitive test scores—except clock drawing test, digital span forwards, and backwards—were significantly lower on the first day compared to after the first month in the Fazekas+ group (p < 0.05). Conclusions: Patients with ACS have transient impairment in cognitive functions. Acute coronary syndrome is not associated with structural changes in the brain.