Objective: The aim was to evaluate the value of otolith-associated protein otoconin-90 (OC90) and otolin-1 in the pathogenesis research and clinical treatment of benign paroxysmal positional vertigo (BPPV). Material and Method: The study included 50 patients with BPPV admitted to neurology and otorhinolaryngology departments and 30 healthy subjects with no history of dizziness as a control group. Results: BPPV and controls were similar in terms of gender and age. Otolin-1 concentration was significantly greater in the BPPV group than in the controls (710.44 [584.35–837.39] vs 280.45 [212.7–419.61]; p < 0.001). No statistical significance was found, although OC90 was higher in the BPPV group than in the controls. There was a strong positive correlation between otolin-1 and OC90, a moderate negative correlation between otolin-1 and vitamin D, and a strong negative correlation between OC90 and vitamin D in the BPPV patient group. Otolin-1 had high specificity and AUC values for BPPV (AUC: 0.933; 95% CI: 0.881–0.986, 79.2% sensitivity, 100% specificity with a cutoff greater than 525). Conclusions: High serum concentrations of otolin-1 were associated with an increased risk of BPPV, but high concentrations of OC90 were not. Serum concentrations of otolin-1 can potentially be used as a biomarker for the acute onset of inner ear disorders due to the significant increase in patients with BPPV. Vitamin D has high specificity and sensitivity in patients with BPPV. It also provides evidence that BPPV patients with vitamin D deficiency may improve their symptoms with replacement therapy. More large-scale prospective studies are required to confirm these associations and clarify the exact mechanisms.

Background: Epilepsy is a chronic neurological disorder frequently influenced by systemic inflammation, nutritional status, and comorbid conditions, which may worsen seizure outcomes. Given the increasing recognition of these factors in disease progression, this study aimed to investigate the relationship between the Modified Charlson Comorbidity Index (mCCI), inflammatory hematological parameters, and the prognostic nutritional index (PNI) with seizure frequency and clinical prognosis in patients with epilepsy. Methods: A total of 159 participants were enrolled between January 2021 and January 2023, including 53 healthy controls (mean age: 44 ± 14.2 years; female: 21, male: 32), 53 epilepsy patients without comorbidity (mean age: 33 ± 12.5 years; female: 28, male: 25), and 53 epilepsy patients with comorbidities (mean age: 56.2 ± 13.8 years; female: 22, male: 31). The participants were divided into three groups: 53 patients with isolated epilepsy, 53 patients with epilepsy and comorbid conditions, and 53 healthy individuals with no known diseases, matched for age and sex with the patient groups, who presented for routine check-ups. The mCCI was calculated for patients with comorbid epilepsy. Inflammatory hematological parameters and the PNI were assessed in all participants using previously obtained complete blood count data. Results: Inflammatory markers such as white blood cell count, neutrophil count, C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and mean platelet distribution width (PDW) were significantly higher in epilepsy patients with comorbidities compared to other groups. Epilepsy patients with comorbidities had a higher seizure frequency compared to those without comorbidities (75.5% vs. 54.7%, p < 0.001). The PNI was lowest in epilepsy patients with comorbidities, showing a significant difference between all groups (p < 0.001). High comorbidity burden increased seizure risk by 4.56 times (95% CI: 1.30–16.01), each unit increase in the SII raised the risk by 1.13 times (95% CI: 1.08–1.19), and each unit decrease in the PNI increased the risk by 1.14 times (OR = 0.88, p < 0.001). Cerebrovascular disease and hemiplegia were also significant risk factors, increasing seizure risk by 4.15 and 4.48 times, respectively. Conclusions: Our study demonstrates that inflammatory hematological parameters, particularly SII and MCCI scores, are elevated in epilepsy patients and further increase with comorbidities. These markers are strongly associated with seizure occurrence, highlighting the prognostic significance of systemic inflammation and comorbidity burden in epilepsy. Given the frequent observation of low PNI values in patients with comorbid conditions, which may reflect compromised nutritional status, and given associations suggest a role in poor clinical outcomes, comprehensive management is essential. Monitoring the PNI and SII may help stratify high-risk patients for targeted nutritional and anti-inflammatory interventions.

Background: Alzheimer's disease (AD) is a progressive neurodegenerative disorder frequently associated with dysphagia, leading to malnutrition, dehydration, and aspiration pneumonia. The Eating Assessment Tool-10 (EAT-10) is widely used for dysphagia screening; however, its reliability in advanced AD, where cognitive impairments hinder self-reporting, remains uncertain. Objective: This study aimed to evaluate the diagnostic accuracy of EAT-10 in detecting dysphagia and aspiration across different AD stages. Methods: The study included 30 AD patients classified into mild, moderate, and advanced stages based on Clinical Dementia Rating (CDR) scores. Dysphagia was assessed using EAT-10 and validated through Videofluoroscopic Swallowing Study (VFSS) and the Penetration-Aspiration Scale (PAS). Statistical analyses included the Mann-Whitney U test, Spearman correlation, and receiver operating characteristic (ROC) curve analysis (p < 0.05). Results: EAT-10 scores significantly differed across AD stages (p = 0.001), with mean scores of 3.11 ± 1.17 (mild), 11.70 ± 4.64 (moderate), and 18.00 ± 6.90 (advanced). Unsafe swallowing and aspiration were observed in 43.3% and 23.3% of patients, respectively, with higher prevalence in advanced AD. ROC analysis determined an EAT-10 cut-off score of 15 for unsafe swallowing (AUC: 0.96, sensitivity: 88%, specificity: 77%) and 18 for aspiration (AUC: 0.81, sensitivity: 81.2%, specificity: 75%). Strong correlations were found between EAT-10 and PAS scores (r = 0.812, p < 0.001). Conclusions: EAT-10 is an effective screening tool for dysphagia and aspiration risk in early and moderate AD stages. However, in advanced AD, objective assessments like VFSS remain essential to complement EAT-10 results. Integrating EAT-10 into routine evaluations may enhance early detection, enabling timely interventions and improved clinical outcomes.

Aim: Previous limited studies have indicated that pro-inflammatory cytokines are elevated in patients with essential tremor (ET). This elevation could lead to a more pronounced inflammatory response in these patients. Thus, this study aimed to investigate the relationship between leukocyte-based inflammatory indices and ET. Material and Methods: In this retrospective study, 103 patients diagnosed with ET between January 2021 and December 2023 were included, along with 103 healthy individuals who were matched by age and gender, participated in check-up programs, and had no other comorbidities. To evaluate tremor severity, the Fahn-Tolosa-Marin (FTM) tremor rating scale was utilized. The leukocyte-based inflammatory indices were calculated as follows: NLR= neutrophils / lymphocytes, PLR = platelets / lymphocytes, systemic immune-inflammation index (SII) = platelets × neutrophils / lymphocytes, and systemic inflammatory response index (SIRI) = neutrophils × monocytes / lymphocytes. Results: The ET group exhibited higher levels of leukocytes, their subtypes, CRP and leukocyte-based inflammatory indices compared to the control group. Increased CRP (OR= 3.71, p < 0.001) and SIRI (OR= 11.73, p < 0.001) levels were independent predictors of ET. In predicting ET. SIRI exhibited superior diagnostic performance compared to other inflammatory parameters. The threshold for SIRI levels was set at 7 and above, with a sensitivity of 85.4% and a specificity of 82.5%. There was a positive correlation between SIRI and FTM scores. Conclusion: Among the leukocyte-based inflammation indices, SIRI demonstrated superior diagnostic performance in predicting ET and was associated with higher tremor severity. This suggests that inflammation may play a potential role in the pathophysiology of ET.

Background: Botulinum toxin type A (BoNT-A) is an established preventive therapy for chronic migraine (CM), yet the accompanying neurochemical changes remain incompletely characterized. Objective: To evaluate the effects of BoNT-A on plasma substance P (SP), γ-aminobutyric acid (GABA), glutamate, glutamine, and 5-hydroxytryptamine (5-HT), and on urinary 5-HT, and to explore relationships with clinical outcomes. Methods: In this prospective study, plasma neurotransmitters were analyzed in CM patients (n = 31) at baseline and one month after BoNT-A (155 U; PREEMPT protocol) and in healthy controls (n = 30). Plasma SP was measured using enzyme-linked immunosorbent assay (ELISA); plasma GABA, glutamate, and glutamine were quantified via liquid chromatography–tandem mass spectrometry (LC–MS/MS) with isotopically labeled internal standards; plasma and urinary 5-HT were determined by high-performance liquid chromatography (HPLC). Clinical outcomes included monthly headache frequency, Visual Analog Scale (VAS), and Migraine Disability Assessment (MIDAS). Statistical analyses applied appropriate parametric or non-parametric tests with p < 0.05 considered significant. Results: One month post-BoNT-A, headache frequency, MIDAS, and VAS were significantly reduced (all p < 0.001). SP levels were significantly higher after BoNT-A than at baseline and versus controls. Plasma 5-HT increased post-BoNT-A, while urinary 5-HT decreased. Plasma GABA was elevated in patients versus controls without statistical significance. Glutamine was significantly higher before treatment, whereas the Glu/Gln ratio increased after BoNT-A. Correlations revealed that higher GABA was associated with lower VAS and attack frequency post-treatment. Conclusions: BoNT-A provided short-term clinical improvement with distinct neurochemical changes, including increased plasma SP and 5-HT, decreased urinary 5-HT, reduced glutamine, and a higher Glu/Gln ratio. These biomarkers, particularly Glu/Gln, may serve as indicators of cortical excitability and therapeutic response in CM.

Background: We aimed to investigate the prognostic significance of hematological inflammatory indices and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) in the diagnosis and prognosis of Bell’s palsy. Method: The study included 156 cases diagnosed with Bell’s palsy in the neurology clinic and 156 healthy controls. The patients diagnosed with Bell’s palsy were staged according to the House–Brackmann Scoring system. Hematological inflammatory parameters such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) levels, and MHR were calculated from the parameters in the patient files. Result: Hematological inflammatory parameters such as NLR, PLR, SII, SIRI, and MHR were found to be higher in Bell’s palsy patients. In addition, these parameters were found to be higher in patients with grade V and above Bell’s palsy and in patients who did not respond to treatment, compared to the grade IV group and patients who responded to treatment, respectively. SIRI was an independent predictor of both the diagnosis of the disease and the lack of response to treatment, and this was confirmed by LASSO analysis. Conclusions: This study is among the few that demonstrated predictive models based on hematological inflammatory indices that can aid in both the diagnosis and treatment response assessment of newly diagnosed Bell’s palsy patients, validated using the LOOCV method. The findings highlight the potential clinical utility of simple, inexpensive, and practical biomarkers such as NLR, PLR, SII, SIRI, and MHR. These easily accessible parameters may support early diagnosis and prognostic evaluation in routine clinical settings.