ÖzetAmaç: Medikal tedaviye dirençli fibromiyalji hastalarında motor korteks alana uygulanan düşük frekanslı tekrarlayıcı transkraniyal manyetik stimülasyonun (tTMS) etkinliğini araştırmak. Gereç ve Yöntemler: Toplam 25 hasta randomize olarak aktif ve plasebo gruplarına ayrılarak çalışmaya alındı. Aktif tTMS grubu için stimülasyon sol primer motor korteks üzerinden motor eşik değerin %90'ı hesaplanarak 1 Hz ve 20 dakika uygulandı. Her seansta 1200 uyarı olmak üzere, iki hafta boyunca toplam 10 seans tedavi uygulandı. Plasebo grup için, parabolik koil 90° açı ile motor kortekse yerleştirildi ve aynı şekilde toplam 10 seans stimülasyon uygulandı. Sonuçlar, ağrı için vizüel analog skalası (VAS), Fibromiyalji Etkinlik Anketi (FIQ) ve Beck Depresyon Skalası (BDS) ile değerlendirildi. Bulgular: Her iki grupta da tedavi sonunda, 1 ve 3. ay sonunda ağrı derecesinde, FIQ ve BDS'de anlamlı iyileşme gözlendi. Ancak, aktif tTMS grubunda iyileşme plasebo gruba göre daha iyiydi. Tedavi sonu FIQ skorlarında aktif grupta, plasebo gruba göre istatistiksel olarak anlamlı iyileşme gözlendi. Diğer değerlendirmelerde gruplar arasında istatistiksel farklılık saptanmadı. Sonuç: Primer motor korteks üzerine düşük doz tTMS uygulamasının uzun süreli takiplerde fibromiyalji hastalarında plaseboya göre anlamlı iyileşme göstermediği görülmüştür. Anahtar Kelimeler: Fibromiyalji, transkraniyal manyetik stimülasyon, ağrı AbstractObjective: To investigate the effectiveness of low-frequency (LF) repetitive transcranial magnetic stimulation (rTMS) to the motor cortex area in fibromyalgia patients who are resistant to medical treatment. Material and Methods: A total of 25 patients were randomly assigned to the study, who were in the active rTMS (n=13) or sham stimulation (n=12) group. For the rTMS group, the main stimulation parameters were 90% of motor threshold for 60 seconds at 1 Hz and a 45-second interval between each train. Ten sessions of low-frequency rTMS, which had a total of 1200 pulses at each session, were applied to the left primary motor cortex area daily over a period of 2 weeks. For the sham group, the same parabolic coil was placed at 90° angles to the motor cortex area, and the patients received 10 sessions of sham stimulation. The outcome parameters were pain intensity, which was measured by visual analog scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), and the Beck Depression Inventory (BDI). Results: A significant improvement in pain intensity, FIQ, and BDI scores was seen at the 10 th day and first and third months in both groups. Although the mean of parameters of the rTMS groups was better than the sham group, the difference did not reach statistical significance, except FIQ scores at the 10 th day in the real rTMS group. Conclusion: Patients with fibromyalgia who enroll in real TMS did not present significant differences in long-term follow-ups with respect to those who enrolled in the sham TMS group.

[Purpose] Postural stability is the ability of to maintain the position of the body within the support area. This function is affected in cerebral palsy. The aim of the present study was to compare static and dynamic postural stability between children with hemiplegic cerebral palsy and healthy controls. [Subjects and Methods] Thirty-seven children between the ages of 5 and 14 diagnosed with hemiplegic cerebral palsy (19 right, 18 left) and 23 healthy gender- and age-matched controls were included in the study. Postural stability was evaluated in both of the groups using a Neurocom Balance. Sway velocity was measured both with the eyes open and closed. Sit to stand and turning abilities were also assessed. [Results] The sway velocities with the eyes open and closed were significantly different between the groups. The weight transfer time in the Sit to Stand test was also significantly slower in children with cerebral palsy. Children with cerebral palsy also showed slower turning times and greater sway velocities during the Step and Quick Turn test on a force plate compared with their healthy counterparts. [Conclusion] Both static and dynamic postural stability parameters are affected in hemiplegic cerebral palsy. Further research is needed to define rehabilitation interventions to improve these parameters in patients.

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SummaryPregnancy associated osteoporosis (PAO) is a rare clinical condition that may affect women during third trimester of pregnancy or after delivery. Little is known about the prevalence, cause, risk factors and prognosis of PAO. It can cause severe, prolonged back pain with one or more vertebral fractures and height loss. Herein we report a case of PAO in a 32 year-old female who presented with severe back pain with multiple vertebral fractures started 1 month after delivery. There were delayed menarche and low dietary calcium intake in history. The radiological examinations have shown compression fracture of 8 th thoracic vertebra and wedging of 11 th and 12 th thoracic vertebras and whole lumbar spine. In the bone mineral density (BMD) testing, total lumbar spine T-score and Z-score were -2,8 and femoral neck T-score and Z-score were -1,2 and -1,1 respectively. There were no abnormalities in laboratory findings except mild alkaline phosphatase elevation and low 25-hydroxy vitamin D level. Three months after delivery for pain reduction T8 kyphoplasty was applied. Along 5-year follow up vitamin D3, calcium, calcitonin, bisphosphonate, GABA anologs, analgesics, physical agents, dry needling were used for treatment. Back pain improved with all kinds of treatments significantly (On the 10-point visual analog scale (VAS) pain scores decreased from 10 to 3). The patient had continued pain in the operated area with decreased intensity (VAS score of 3) along 5-year follow up. There were no new fractures and marked recovery of spine BMD was observed during the same period. Activities of daily living improved permenantly. When back pain occurs in a patient at last trimester of pregnancy or early postpartum period, PAO should be considered in differential diagnosis and long term support should be planned for patient's well being. Gebelik ile İlişkili Osteoporoz: Beş Yıl Takipli Bir Olgu Sunumu Pregnancy Associated Osteoporosis: A Case Report with 5-Year Follow-upGebelik ile ilişkili osteoporoz (GİO) kadınları gebeliğin son üç ayında veya doğumdan sonra etkileyebilen nadir görülen bir klinik durumdur. GİO'nun prevelansı, nedeni, risk faktörleri, prognozu ile ilgili çok az şey bilinmektedir. Bir veya daha fazla vertebral kırığa, şiddetli, uzun süren sırt ağrısına ve boyda kısalmaya neden olabilir. Bu olgu sunumunda doğumdan bir ay sonra başlayan ciddi sırt ağrısı olan, multipl vertebral kırıklı 32 yaşındaki GİO tanılı hasta bildirilmektedir. Özgeçmişinde gecikmiş menarş, diyetle düşük kalsiyum alımı mevcuttu. Radyolojik incelemelerde 8. torakal vertebrada kompresyon fraktürü, 11. ve 12. torakal vertebralarda ve lomber omurgada kamalaşma görüldü. Kemik mineral yoğunluğu (KMY) ölçümünde total lomber bölge T-skoru ve Z-skoru -2,8, femur boynu T-skoru ve Z-skoru sırasıyla -1,2 ve -1,1 idi. Hafif alkalen fosfataz yüksekliği ve 25-hidroksi vitamin D düşüklüğü dışında laboratuvar incelemelerinde anormallik saptanmadı. Doğumdan üç ay sonra ağrıyı azaltmak amacıyla T8 kifoplasti uygulandı. Beş yıl takip boyunca tedavide vitamin...