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Öğe An Explainable Approach to Parkinson's Diagnosis Using the Contrastive Explanation Method-CEM(Mdpi, 2025) Cicek, Ipek Balikci; Kucukakcali, Zeynep; Deniz, Birgul; Algul, Fatma EbruBackground/Objectives: Parkinson's disease (PD) is a progressive neurodegenerative disorder that requires early and accurate diagnosis. This study aimed to classify individuals with and without PD using volumetric brain MRI data and to improve model interpretability using explainable artificial intelligence (XAI) techniques. Methods: This retrospective study included 79 participants (39 PD patients, 40 controls) recruited at Inonu University Turgut Ozal Medical Center between 2013 and 2025. A deep neural network (DNN) was developed using a multilayer perceptron architecture with six hidden layers and ReLU activation functions. Seventeen volumetric brain features were used as the input. To ensure robust evaluation and prevent overfitting, a stratified five-fold cross-validation was applied, maintaining class balance in each fold. Model transparency was explored using two complementary XAI techniques: the Contrastive Explanation Method (CEM) and Local Interpretable Model-Agnostic Explanations (LIME). CEM highlights features that support or could alter the current classification, while LIME provides instance-based feature attributions. Results: The DNN model achieved high diagnostic performance with 94.1% accuracy, 98.3% specificity, 90.2% sensitivity, and an AUC of 0.97. The CEM analysis suggested that reduced hippocampal volume was a key contributor to PD classification (-0.156 PP), whereas higher volumes in the brainstem and hippocampus were associated with the control class (+0.035 and +0.150 PP, respectively). The LIME results aligned with these findings, revealing consistent feature importance (mean = 0.1945) and faithfulness (0.0269). Comparative analyses showed different volumetric patterns between groups and confirmed the DNN's superiority over conventional machine learning models such as SVM, logistic regression, KNN, and AdaBoost. Conclusions: This study demonstrates that a deep learning model, enhanced with CEM and LIME, can provide both high diagnostic accuracy and interpretable insights for PD classification, supporting the integration of explainable AI in clinical neuroimaging.Öğe Association between serum uric acid levels and chronic tension-type headache: A case–control study(SAGE Publications Ltd, 2024) Algul, Fatma Ebru; Kablan, YukselBackground: Tension-type headache (TTH) is the most common type of primary headache. Its etiology has not been clearly elucidated, and conflicting results have been reported in studies on oxidative stress. Uric acid is a molecule with antioxidant properties and is the end product of purine catabolism. Total oxidant-antioxidant status may potentially play an important role in the pathophysiology of chronic TTH. In this study, we investigated whether there was a difference in uric acid levels, an oxidative stress marker, between patients with tension-type headache and healthy controls. Methods: The study was designed retrospective observational case–control study. The diagnosis of chronic TTH was made according to the diagnostic criteria established by the International Classification of Headache Disorders. A total of 164 people, including 94 patients with chronic tension-type headache and 70 healthy controls were included in the study. Hemoglobin, blood urea nitrogen (BUN), creatinine, albumin, and serum uric acid levels were studied from the serum of the participants. The Kolmogorov Smirnov Normality test, Mann–Whitney U test, and binary logistic regression test were used for statistical analysis. Results: There was no statistically significant difference between our control and patient groups in terms of age and BUN (p = 0.069 and p = 0.547). The serum albumin (p = 0.000), creatinine (p = 0.047), and hemoglobin levels (p = 0.000) in our patient group were found to be significantly low compared to the healthy control group. The serum uric acid levels in the TTH and control groups were 4.28 ± 1.16 and 5.32 ± 1.31 mg/dL, respectively (p = 0.000). Lower uric acid levels correlate with an increased likelihood of TTH presence in both males and females. Conclusion: We demonstrated that serum uric acid levels in TTH patients were lower than in controls. Further studies with larger populations are needed to determine whether uric acid plays a protective role in the etiology of TTH by reducing oxidative stress. © The Author(s) 2024.Öğe Associations Between Dopamine Beta-Hydroxylase Gene Polymorphisms and Restless Legs Syndrome: A Case-Control Study(Int Scientific Information, Inc, 2025) Algul, Fatma Ebru; Tatli, Sinan; Yesilada, ElifBackground: Restless legs syndrome (RLS) is a chronic condition that affects movement and sensation, making it one of the most common nerve-related disorders. Single-gene polymorphisms (SNP) that alter the expression of the dopamine beta-hydroxylase (DBH) enzyme gene, which converts dopamine to noradrenaline, also appear to affect the disease. In this study we investigated the relationship between polymorphisms in DBH gene SNPs (rs129882, rs161115, and rs732833) and the susceptibility to RLS among the Turkish population. Material/Methods: This prospective, case-control study included 103 Turkish patients with RLS and 100 healthy individuals of similar age. The study included RLS patients who met the criteria set by the International RLS Study Group (IRLSSG). DNA was extracted from blood samples taken from the participants, and all cases and controls were genotyped. Results: We found the rs732833 DBH CT and homozygous TT genotype frequency was significantly different between the patient and control groups (P<0.05). Patients with mild disease severity showed a statistically significant variation between C and T alleles of rs1611115 DBH (P=0.008). The C allele is more associated with mild severity compared to the T allele. Conclusions: We showed that the rs732833 DBH polymorphism predisposes individuals to RLS and mild disease severity is more commonly associated with the C allele of rs1611115 DBH than with the T allele. To the best of our knowledge, this is the first study investigating the relationship between RLS and DBH gene polymorphisms.Öğe A Case of Isolated Central Nervous System Rosai-Dorfman Disease(Turkish Neuropsychiatry Assoc-Turk Noropsikiyatri Dernegi, 2024) Algul, Fatma Ebru; Erdem, Beguem Y. E. N., I; Yegen, Guelcin; Yolbas, ServetRosai-Dorfman disease (RDD) is a benign histiocytosis with unknown etiology. It generally occurs in cervical lymph nodes. Isolated central nervous system (CNS) RDD is very rare in the literature. We reported a case of no systemic involvement Rosai-Dorfmann which is rarely seen and shows CNS involvement by mimicking meningioma. A 32 -year -old man presented with diplopia and a headache he has been experiencing for the past two years. His neurological examination showed left facial paresthesia, consistent with trigeminal nerve trace. Tendon reflexes were increased at the right side and the right plantar reflex was extensor. Brain magnetic resonance imaging demonstrated irregularly shaped, tumorlike lesions in the bilateral cerebellopontin area that were compressing pons. Rosai-Dorfman disease can be differentiated from IgG4 related disease (IgG4-RD) by its characteristic features such as plasma cell density and emperipolesis seen in its histopathology. Rosai-Dorfman disease can be confused with other diseases radiologically and histopathologically, especially the IgG4-RD, so be careful about differential diagnosis.Öğe Cerebral venous thrombosis: Diagnosis, medical and endovascular treatment(Nova Science Publishers, Inc., 2024) Algul, Fatma EbruCerebral venous thrombosis (CVT) is a rare cause of stroke that often affects young women. Magnetic resonance imaging or computed tomography angiography is recommended at the diagnosis phase. First parenteral anticoagulant therapy is recommended first and decompressive surgery is recommended in appropriate cases to prevent brain herniation. Antiepileptic therapy is recommended for patients with epileptic seizures. It is recommended to switch to warfarin after the acute period; there is no clear information on the initiation of direct-acting oral anticoagulants (DOACs). Routine endovascular treatment has not been associated with positive results. International, large-scale studies will provide us with more precise information on this subject. © 2024 Nova Science Publishers, Inc. All rights reserved.Öğe Evaluation of the performance of pan-immune inflammation value in predicting in-hospital mortality in patients with spontaneous intracerebral hemorrhage(Asean Neurological Assoc, 2025) Daduk, Hazal Zeynep; Algul, Fatma Ebru; Kablan, YukselBackground & Objective: Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and poor functional prognosis. This study aimed to evaluate the prognostic significance of the pan-immune inflammation value (PIV) at admission in predicting in-hospital mortality in patients with spontaneous ICH. Additionally, we compared the predictive performance of PIV with other inflammatory indices such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). Methods: This retrospective study included 102 consecutive patients admitted within 24 hours of the onset of spontaneous ICH. Patients were categorized into two groups: survivors at discharge and those who died in the hospital. The groups were compared based on NLR, PLR, SII index, and PIV. Logistic regression and ROC analyses were performed to evaluate the predictive performance of PIV compared to NLR, PLR, and SII index for in-hospital mortality. Results: Patients who died in the hospital (n=45) had a higher mean age, higher NIHSS score, larger hematoma volumes, and a higher incidence of diabetes, intraventricular extension, and surgical intervention. Additionally, these patients had higher PIV, NLR, PLR, and SII index values (p<0.05). PIV demonstrated superior performance compared to these three markers in predicting in-hospital mortality. Conclusion: The results of our study suggest that PIV may serve as a valuable prognostic indicator for predicting in-hospital mortality in patients with spontaneous ICH. This study is the first to evaluate PIV as a potential predictive marker for mortality in ICH patients.Öğe Ischemic stroke in young adults: Gender-based differences(2020) Algul, Fatma Ebru; Kaplan, YukselAbstract: Stroke is becoming a growingly more prevalent and significant public health problem among young adults around the world. Modifiable lifestyle-related risk factors are the most common cause of stroke in young adults. The aim of this study was to perform a gender-based evaluation of risk factors, stroke subtypes, severity of stroke, level of dependency at hospital discharge, and length of hospital stay among young patients with ischemic stroke in our region. The retrospective study included patients that were diagnosed with ischemic stroke based on patient history and clinical and radiographic findings at Inonu University Medical School Neurology Department between 2015 and 2018. The patients were divided based on gender and the two groups were compared with regard to age, gender, prior stroke, risk factors, neurologic deficits at hospital admission, etiology, radiographic localization, length of hospital stay, and the levels of disability and dependency at hospital discharge were reviewed for each patient. The study included a total of 105 patients diagnosed with ischemic stroke, comprising 65 (61.9%) men and 40 (38.1%) women. Mean age was 46.02±7.29 years in men and 41.18±8.2 years in women and a significant difference was observed between the two groups (p=0.002). The incidence of diabetes mellitus (DM), myocardial infarction (MI), and smoking was significantly higher in men compared to women (p=0.008, p=0.001, and p<0.001, respectively), whereas the incidence of mitral stenosis was significantly higher in women compared to men (p=0.0019). The results indicated that modifiable lifestyle-related risk factors are the most common cause of stroke in young adults and the significance of risk factors associated with stroke in young individuals differs between genders. Future studies with larger patient populations are needed to identify further risk factors and precautions for stroke in young adults.Öğe A Neuromyelitis Optica Spectrum Disorder Case Presenting with the Syndrome of Inappropriate Antidiuretic Hormone Secretion(Gazi Univ, Fac Med, 2019) Algul, Fatma Ebru; Kamisli, SuatThe syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one of the most important causes of hyponatremia. SIADH has been associated many clinical states, syndromes and many other central nervous disorders. Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) are also a few of these. NMO is a demyelinating autoimmune disorder affected the brainstem and hypothalamus where express high levels of aquaporin-4 (AQP-4) protein. Although detecting antiaquaporin-4 antibody positive is important for the diagnosis, some NMO and NMOSD patients show seronegative AQP-4 antibody results. We report a seronegative NMO spectrum disorder case presenting with the SIADH.Öğe The relationship between obesity and restless legs syndrome(2019) Algul, Fatma Ebru; Sertkaya, Ayse Cikim; Altınayar, SibelRestless legs syndrome (RLS) has been shown to be more common in obese than in non-obese people in many studies. The aim of this study was to investigate passible relationship between obesity and seconder RLS prevalence and severity in the Turkish population. Method: A total of 70 volunteers were included in the study. Of these 44 were obese (BMI?30 kg/m2) and 26 were non obese(BMI <30 kg/m2. The International RLS Study Group (International Restless Legs Study Group, IRLSS) diagnosis criteria were used for the RLS diagnosis and International RLS criteria to determine the severity. 17 subjects had RLS and of these 13 were in the obese group and 4 in the non-obese group. No significant difference was found between obese and non-obese groups in terms of RLS prevalence (p:0.165) and RLS severity (p:0.918). Our study on a small sample from the Turkish population showed no significant relationship between obesity and RLS presence and severity. The reason may be the small numbers of obese and control group subjects in our study.Öğe Serum adropin levels in patients with migraine(Bayrakol Medical Publisher, 2024) Algul, Fatma Ebru; Tosun, HaticeAim: In this study, we aimed to investigate the relationship between migraine and serum adropin levels. Material and Methods: This is a randomized control study. The study was conducted for 6 months starting from January 2021. Fifty-four migraine patients were selected for the study as a case group and matched with 35 healthy participants for the control group. We compared serum adropin, high -density lipoprotein (HDL-C), low -density lipoprotein (LDL-C), total cholesterol (TC) and triglyceride (TG) concentration and body -mass index (BMI) between the case and control groups. In addition, the relationship between migraine disease duration, monthly pain frequency and pain duration, and serum adropin level in the patient group was analyzed. Results: There was no significant difference between the two groups regarding age, gender, triglyceride, LDL-C, HDL-C, BMI levels and serum adropin levels (p<0.05). Also, there was no significant difference in migraine disease duration, frequency of headache (within a month) and headache duration depending on serum adropin levels. A negative correlation was determined between adropin levels and age and BMI (p<0.05). Discussion: Serum adropin concentrations are not associated with migraine in our population. Besides, serum adropin levels decrease with increasing BMI and with age. With this knowledge, however, it is difficult to make a definitive conclusion. Further studies with larger populations are needed.Öğe Serum salusin-? and -ß levels in patients with parkinson?s disease(Springer-Verlag Italia Srl, 2024) Algul, Fatma Ebru; Koc, Emine; Kaya, Hatice TosunBackground The etiology of Parkinson ' s disease (PD) is not well known and there is increasing evidence that oxidative stress also plays an important role in its pathogenesis. Salusins alpha (salusin-alpha) and beta (salusin-ss) affect the central nervous system, vasculature, and kidneys to increase the inflammatory response in endothelial cells, stimulate oxidative stress, and increase monocyte-endothelial adhesion. Neuroinflammation and oxidative stress play roles in the etiopathogenesis of PD. Purpose To investigate whether salusin-alpha and -ss are related to PD and whether they are correlated with the development of atherosclerosis, body mass index, disease duration, and the Parkinson ' s Hoehn and Yahr stage. Results The low-density lipoprotein cholesterol (LDL-C), total cholesterol, and salusin-ss levels were significantly lower and age was significantly higher in Parkinson patients compared to healthy controls (p < 0.005). We found a negative linear correlation between salusin-ss and the Hoehn and Yahr stage (p < 0.001, r = -0.515) in the patients. Conclusions There was a relationship between salusin-ss and PD and a correlation between the salusin-ss levels and Parkinson's stage. A possible underlying disease mechanism is an increase in oxidative stress and decrease in neuroprotective effects due to low salusin-ss levels. Therefore, the effects of salusin-ss in treating Parkinson disease should be evaluated. Further studies are needed to understand the effects of salusin-ss treatment on preventing or slowing the course of PD.
