Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Large language model-based chatbots are increasingly used by the public to access medical information. While these tools offer considerable potential in terms of accessibility and scalability, their accuracy, transparency, and clarity remain insufficiently evaluated for rare and diagnostically complex conditions such as myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Objective: This study aimed to evaluate the quality, comprehensibility, transparency, and readability of responses generated by widely used AI chatbot platforms in response to a standardized, patient-centered question about MOGAD. Methods: We conducted a cross-sectional content analysis using the query: “What is MOGAD, and how is MOGAD treated?” Ten widely used chatbot platforms were selected to reflect diversity in architecture, access model, and functional design. Responses were collected on the same day, anonymized, and independently evaluated by seven blinded neurologists. Validated instruments were used, including DISCERN (treatment quality), PEMAT-P (understandability), Web Resource Rating (WRR; citation transparency), and two readability metrics: Flesch–Kincaid Grade Level (FKGL) and Coleman–Liau Index (CLI). Chatbots were also compared by access type (free vs paid) and functional focus (conversation-based vs search-based). Inter-rater reliability was assessed using intraclass correlation coefficients (ICCs). Results: Significant differences were observed across platforms in DISCERN, PEMAT-P, and WRR scores (all p < 0.001). Paid chatbots demonstrated higher treatment quality (p = 0.020) and citation transparency (p = 0.001) compared to free versions. Search-based models produced more understandable responses than conversation-based ones (p = 0.035). However, none of the chatbot responses achieved the recommended readability threshold for public-facing health communication (FKGL < 8). Inter-rater agreement was excellent across all expert-rated measures (ICC ≥ 0.838). Conclusions: AI chatbot responses to patient queries about MOGAD vary widely in quality, clarity, and transparency. These findings highlight the need for structured benchmarking, transparent evaluation frameworks, and thoughtful oversight in the use of generative AI tools for digital health communication, particularly in the context of rare and clinically complex diseases.

Background/Aim: Epilepsy is one of the most common chronic neurological diseases. Epilepsy can affect the entire life, including childbearing age. It is estimated that epileptic women give three to five births per thousand births. Although the use of antiepileptic drugs (AEDs) during pregnancy has been associated with major congenital malformations in the fetus, many patients cannot discontinue the drugs before pregnancy due to the risk of seizures that may harm the mother as well as the children. In this study, our aim is to examine the follow-up findings of pregnant women who are epileptic and use AEDs during pregnancy and delivery, and to contribute to the literature on this subject, for which the studies are on-going.Materials and methods: 60 epileptic pregnant and 60 healthy pregnant women were included in our study. These women gave birth at Zekai Tahir Burak Women's Healthcare Training and Research Hospital and applied to the Neurology outpatient clinic on 01/04/2018-01/04/2019, and were previously diagnosed with epilepsy by a neurologist, and have started to use AED before pregnancy, and have used AEDs in the first trimester.Results: While the number of pregnancies in the case group (1.75±0.77) was significantly lower than in the control group (2.25±1.17), the rates of caesarean section and neonatal intensive care need were found to be statistically significantly higher in the case group (68.3% and 20.0%, respectively) than in the control group (43.3% and 5.0%, respectively) (p<0.05). There was no statistically significant difference between the groups in terms of birth week and birth weight rates.Conclusion: As a result, epileptic pregnancies have their own risks, differing from normal pregnancies. It is important that the epileptic pregnant woman is followed closely from the pregnancy planning period to the delivery in cooperation with the physician.

Background: Migraine is increasingly recognized as a neuroinflammatory disorder characterized by trigeminovascular activation and cytokine-mediated nociceptive sensitization. While leukocyte-derived indices such as the neutrophil-to-lymphocyte ratio (NLR) and systemic immune–inflammation index (SII) reflect dynamic inflammatory responses, the hemoglobin–albumin–lymphocyte–platelet (HALP) score represents a composite immunonutritional marker associated with chronic systemic inflammation. However, its potential relevance in migraine remains unclear. Methods: In this retrospective cross-sectional study, 115 patients with migraine were included. HALP, NLR, platelet-to-lymphocyte ratio (PLR), and SII were calculated from laboratory parameters obtained within ± 14 days of clinical evaluation. Associations with clinical variables were analyzed using correlation and regression analyses. Discriminative performance for chronic versus episodic migraine was assessed using receiver operating characteristic (ROC) curve analysis with Youden index estimation. Results: Among the 115 included patients, 99 (86.1%) had episodic migraine and 16 (13.9%) had chronic migraine. HALP was not associated with monthly headache frequency, disease duration, or analgesic use and showed limited discriminative performance. In contrast, NLR and SII were significantly elevated in chronic migraine and demonstrated moderate discriminatory ability for differentiating chronic from episodic migraine (AUC = 0.734 and 0.723, respectively). However, these estimates should be interpreted cautiously given the relatively small chronic migraine subgroup. Conclusion: These findings suggest that migraine-related inflammatory processes may be more sensitively reflected by rapidly responsive leukocyte-derived indices than by composite immunonutritional markers such as HALP. The lack of association between HALP and clinical features may indicate that systemic inflammatory involvement in migraine is limited or variable, rather than persistently elevated.

Aims: This study aimed to evaluate the frequency, laterality, morphology, and coexistence of clinically relevant cranial bony bridges (interclinoid bridge, caroticoclinoid bridge, pterygospinous bridge and pterygoalar bridge ) in dry human skulls. Methods: Forty adult dry human skulls of unknown age and sex were examined. Only specimens allowing visualization of the sphenoid bone were included. The presence and morphology of the caroticoclinoid foramen (CCF), interclinoid foramen (ICF), pterygospinous bridge, and pterygoalar bridge were assessed. Variants were classified according to completeness, laterality, and associated spicules, and all findings were documented photographically.Results: Examination of 40 skulls identified infrequent sphenoidal bony bridges: one specimen showed bilateral complete caroticoclinoid foramina concomitant with bilateral interclinoid foramina, without spicular components. Unilateral pterygospinous bridging occurred in two skulls on opposite sides, whereas pterygoalar bridges were not observed.Conclusion: Cranial bony bridges represent clinically relevant anatomical variants that warrant careful consideration during diagnostic evaluation, particularly in patients presenting with atypical or unexplained neurological symptoms. Recognition of these variations is essential for preoperative planning, as their presence may increase the risk of neurovascular injury and intraoperative complications. A thorough understanding of the incidence and clinical implications of cranial bony bridges, as demonstrated in our laboratory observations and supported by the existing literature, is therefore critical for optimizing diagnostic accuracy and ensuring safe and effective surgical management.

Background/Objectives: Multiple sclerosis (MS) has been associated with subclinical cardiovascular involvement, including impaired myocardial deformation and increased arterial stiffness. However, the local elastic properties of the ascending aorta and their relationship with subclinical left ventricular (LV) longitudinal dysfunction remain insufficiently characterized in MS. Methods: In this prospective cross-sectional study, 67 adults with MS and 67 age-matched controls without cardiovascular disease underwent standardized transthoracic echocardiography. Aortic strain, distensibility and stiffness index (β) were derived from M-mode ascending aortic diameters and simultaneous brachial blood pressure, and LV global longitudinal strain (GLS) was measured by two-dimensional speckle-tracking echocardiography. Multivariable linear regression was utilized to assess associations. Results: LV ejection fraction was similar between groups, while LV GLS was less negative in MS (−17.49 ± 1.81% vs. −19.85 ± 1.80%, p < 0.001). Patients with MS had lower aortic strain (7.54 ± 3.66% vs. 12.91 ± 3.84%) and distensibility (3.81 [2.23–6.06] vs. 5.95 [4.90–9.26] × 10⁻³ mmHg⁻¹) and a higher stiffness index (4.77 [3.10–7.10] vs. 3.44 [2.31–4.05]) (all p < 0.001). After adjustment for age, sex, and body mass index, MS remained independently associated with aortic strain, distensibility, and stiffness index. Within the MS group, aortic strain was independently associated with LV GLS after adjustment for age, sex, body mass index, Expanded Disability Status Scale score and LDL cholesterol (B = −0.276, standardized β = −0.558, p < 0.001). LV GLS was independently associated with log-transformed distensibility (B = −1.021, p = 0.011) and stiffness index (B = 1.095, p = 0.014). Conclusions: Patients with MS show concurrent, inter-related impairment of local ascending aortic elasticity and LV longitudinal deformation despite preserved ejection fraction. Further studies are needed to establish the temporal sequence and prognostic relevance of these findings.