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To evaluate the performance and reference reliability of three large language models in neurology using a national board examination framework. A total of 803 validated multiple-choice questions from Turkish National Neurology Board Examinations (2015-2024) were administered to ChatGPT Plus, Gemini Advanced, and Microsoft Copilot Pro using a standardized prompt requiring an answer and a supporting reference. Model performance was compared with overall examinee performance and analyzed by neurological subspecialty, question type, and presence of visual content. References provided for incorrectly answered questions were independently evaluated by three board certified neurologists. Mean accuracy rates were 87% for Gemini, 86% for Copilot, and 85% for ChatGPT, significantly outperforming the human examinee average of 65% (p&#x2009;<&#x2009;0.001), with no significant differences among models. Accuracy did not differ by question type or neurological subspecialty. All models outperformed examinees on non-visual questions, whereas no performance advantage was observed for visually based items. Reference evaluation revealed substantial limitations: ChatGPT frequently provided insufficient citations (39.6%), while fabricated references predominated in Gemini (53.0%) and Co-pilot (42.1%). Large language models demonstrate high and consistent accuracy on neurology board examination questions, with performance exceeding that of the average examinee. On visually based questions, accuracy was lower than for non-visual items, and the performance advantage over examinees disappeared. High rates of insufficient referencing indicate a clear need for expert oversight, supporting the use of LLMs as complementary tools in neurology education rather than autonomous sources of clinical or academic authority.

Understanding the availability of various supportive care services for patients and caregivers is essential for informing national healthcare strategies and research priorities. Given the crucial role of healthcare professionals (HCPs) in delivering supportive care, this study examined their perspectives on assessing cancer-related unmet needs and differences in service provision for patients versus caregivers in T&#xfc;rkiye, a lower-middle-income country. Data were drawn from the Turkish subsample of the International Psycho-Oncology Society Survivorship Online Survey who provided valid responses (n&#xa0;=&#xa0;52). Participants reported on institutional practices related to the assessment and service provision for 13 kinds of unmet needs for patients and caregivers. Most institutions systematically assessed (&#x2265;&#xa0;50%) and provided services to address unmet needs (&#x2265;&#xa0;51.9%) for patients, whereas only few did so for caregivers (19.2%, &#x2264; 23.1%, respectively). Medical concerns for patients (78.8%) and psychosocial issues for caregivers (19.2%) were most frequently assessed, and services for emotional distress were most frequently provided for both patients and caregivers (82.7% and 23.1%, respectively). Sexuality/intimacy and financial concerns were least assessed and addressed (&#x2264; 50.0% for patients, &#x2264; 15.4% for caregivers). Differences in assessments and service provision between patients and caregivers were significant across all unmet needs with large effect sizes (all p&#xa0;<&#xa0;0.001, Cramer's V&#xa0;=&#xa0;0.52 - 0.62). Findings highlight both strengths and gaps in supportive care service provision and guide the development of integrated, comprehensive, and equitable programs for populations affected by cancer in T&#xfc;rkiye. These results also provide an initial foundation for future large-scale and longitudinal studies aimed at addressing the unmet needs of individuals affected by cancer.

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Sex, body size and environmental conditions are key determinants of home range size in large mammals, yet their relative importance within populations remains unclear for many wide-ranging carnivores such as brown bears. This study combined GPS-collar data and detailed morphometrics from 69 free-ranging brown bears (46 males, 23 females) in T&#xfc;rkiye to test how home range size relates to sex, body mass, and body dimensions. Individual home ranges were estimated using 95% minimum convex polygon (MCP95) and kernel utilisation distribution methods, and the MCP95 area was log-transformed and analysed with linear models that included sex, log body mass, representative linear size measures, sampling effort covariates, and principal component scores derived from a multivariate analysis of eight morphometric traits. Home range size varied markedly among individuals (5.1-203.9&#x2009;km2), with males consistently having nearly twice the MCP95 area of females, with sex accounting for most of the variance in log home range size. In contrast, neither body mass nor linear body dimensions showed significant within-sex relationships with home range size, and sex &#xd7; mass interactions were not supported. Principal component analysis revealed a dominant body size axis, but this multivariate size component, as well as a secondary shape axis, did not explain additional variation once sex was included. Models that accounted for the number of GPS fixes, tracking duration, and influential points confirmed the robustness of the sex effect and indicated only modest contributions of sampling effort. Overall, the results showed that sex, rather than fine-scale variation in body size or shape, is the primary intrinsic driver of home range size in this southern brown bear population, highlighting the need for sex-specific but not size-specific spatial planning and conservation strategies in the future.

Co-produced by LGBTIQ+ activists and academic researchers, this study gave voice to an understudied LGBTIQ+ community in Turkey to narrate their lived experiences and examined their exposure to discrimination in various areas of their lives in relation to their mental health. The study utilized a mixed-method design, where 61 individuals who identified as LGBTIQ+, aged 18-47, responded to an online survey. The quantitative tools included questionnaires assessing mental well-being, psychological symptoms, resilience, and perceived discrimination. Qualitatively, participants responded to open-ended questions regarding their lived experiences, such as coming out, access to healthcare, and self-care practices. Participants were frequently exposed to various forms of discrimination, which were associated with lower mental well-being and higher psychological symptoms. However, personal resilience factors lowered or diminished the negative role of discrimination on mental health. Identity-based lived experiences and practices further provided an in-depth picture of life of LGBTIQ+ individuals in this community and how they overcome adversity.

Background and Objectives: Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancers and remains a leading cause of cancer-related mortality worldwide. EGFR-targeted tyrosine kinase inhibitors (TKIs) have substantially improved outcomes in EGFR-mutant NSCLC; however, primary and acquired resistance continues to limit their long-term efficacy. HER3 (receptor tyrosine-protein kinase ErbB3), a member of the ErbB receptor family, has been implicated in TKI resistance through heterodimerization with EGFR and HER2, leading to downstream PI3K/AKT pathway activation. Despite its biological plausibility as a resistance mediator, the clinical significance of HER3 expression as a prognostic and predictive biomarker in EGFR-mutant NSCLC has not been thoroughly characterized in real-world cohorts. Materials and Methods: This retrospective, single-center study included 52 patients diagnosed with EGFR-mutant NSCLC who received TKI therapy at Afyonkarahisar Health Sciences University between January 2011 and September 2023. HER3 protein expression was evaluated by immunohistochemistry (IHC) on formalin-fixed, paraffin-embedded tumor tissue sections using the Huabio anti-HER3 antibody (clone PD00-44, 1:2000 dilution). Staining in more than 30% of tumor cells was considered HER3-positive; membranous staining intensity was scored on a 1-3 scale. Progression-free survival (PFS1, PFS2) and overall survival (OS) were analyzed using the Kaplan-Meier method and log-rank test. Statistical significance was set at p < 0.05. Results: Of 52 patients (55.8% female; mean age 64.5 years), 59.6% received chemotherapy and 40.4% received an EGFR TKI as first-line treatment; erlotinib constituted 71.2% of targeted therapies. In the first-line TKI group, HER3-negative patients had a numerically longer median PFS1 compared with HER3-positive patients (14.0 vs. 7.1 months; p = 0.285); however, this difference did not reach statistical significance and should be interpreted with caution given the small sample size. In contrast, among patients receiving first-line chemotherapy, HER3 staining status did not meaningfully affect PFS1 (4.1 vs. 2.5 months; p = 0.063). In second-line treatment, HER3-positive patients who received TKI after prior chemotherapy demonstrated a PFS2 comparable to or slightly exceeding that of HER3-negative patients (21.8 vs. 19.8 months; p = 0.49), suggesting that the sequencing of chemotherapy before TKI may attenuate the adverse effect of HER3 positivity. Median OS was 15.1 months in HER3-negative patients and 12.7 months in HER3-positive patients (p = 0.824); this numerical difference of approximately 3 months did not reach statistical significance and should therefore be interpreted cautiously. Among patients receiving TKI in the first line, HER3-positive patients had a shorter median OS than HER3-negative patients (9.6 vs. 14.2 months), whereas those receiving TKI in the second line showed a trend toward longer OS in HER3-positive patients (20.5 vs. 17.2 months). Conclusions: HER3 expression was associated with reduced first-line TKI efficacy in EGFR-mutant NSCLC, suggesting a possible role for HER3 in primary TKI resistance; however, these findings are exploratory and did not reach statistical significance. The observation that HER3-positive patients who received chemotherapy before TKI demonstrated outcomes comparable to HER3-negative patients raises the hypothesis that treatment sequencing may potentially influence the impact of HER3 positivity, though this requires prospective validation before any clinical conclusions can be drawn. These results suggest that HER3 expression may warrant further investigation as a candidate biomarker for treatment sequencing decisions and as a potential therapeutic target in EGFR-mutant NSCLC. Prospective studies evaluating chemotherapy-TKI sequencing and HER3-directed agents such as patritumab deruxtecan (HER3-DXd) in HER3-positive patients are needed to confirm these preliminary observations.

Human-wolf conflicts in T&#xfc;rkiye pose significant challenges to both biodiversity conservation and rural livelihoods. This research analyzes the spatiotemporal patterns of wolf attacks on livestock and threats to human safety over the past two decades. Using georeferenced conflict reports and advanced spatial modeling techniques, we identify key environmental and anthropogenic factors influencing conflict hotspots. Our results show that the majority of attacks occur at night, are concentrated along habitat edges near rural settlements-particularly in eastern and central Anatolia-and have resulted in over 12,000 livestock casualties between 2004 and mid-2025. Seasonal variation shows increased conflicts in autumn and spring, aligning with livestock grazing periods. Additionally, the spatial models highlight the importance of landscape features such as land cover type, road density, and proximity to protected areas in shaping conflict risk. These insights are vital for developing targeted mitigation strategies, including habitat management, community engagement, and conflict prevention measures. Promoting coexistence between humans and wolves in T&#xfc;rkiye requires integrating ecological understanding with socio-economic considerations and implementing effective policy and community-based solutions for sustainable wildlife management.

Efforts to improve outcomes for patients with metastatic colorectal cancer (mCRC) treated with bevacizumab are limited by the lack of validated predictive biomarkers. To overcome this challenge, our study prospectively assessed the combined prognostic and predictive significance of circulating angiogenic biomarkers and T-cell subsets. Eighty-eight patients with unresectable mCRC were prospectively enrolled. Pre-treatment serum levels of VEGF, bFGF, PDGF-B, and endothelin-1 (ET-1) were measured by ELISA, nitric oxide by colorimetric assay, and T-cell subsets by flow cytometry. Bevacizumab trough levels and anti-bevacizumab antibodies were assessed by ELISA. Higher baseline levels of proangiogenic factors, including VEGF, PDGF-B, and ET-1, were associated with improved survival. Based on these findings, we developed a novel Angiogenesis Index (AI) using the cut-off values for VEGF, PDGF-B, and ET-1. This AI was a significant predictor of efficacy for bevacizumab-based therapy for both PFS and OS. Furthermore, bevacizumab trough levels exceeding 25&#x2009;&#x3bc;g/mL on day 14 were associated with improved OS. Likewise, patients with lower baseline circulating FoxP3+ regulatory T cells (Treg) tended to have improved survival. The AI, bevacizumab trough levels, and baseline Treg levels are promising biomarkers for predicting efficacy and refining patient selection for bevacizumab therapy in mCRC.

Convergence between species and entire clades can occur due to shared environmental conditions and shared resource use. Comparisons of biogeography between convergent clades and taxa may reveal some of these properties unique to each taxon. We sought to characterize and compare the global scale biogeography of hummingbirds (family Trochilidae), which possess unique adaptations for nectar feeding, with sunbirds (family Nectariniidae), which also feed on nectar but are more generalist in their feeding ecology. We collected the latitudinal and elevational range of all species in both clades to create species distributions along those gradients by way of empirical cumulative distribution functions. We compared those distributions to see 1) if they differed, by way of minimum difference estimation and 2) how they differed, by way of non-linear regression. Hummingbirds are shown to extend into higher elevations and latitudes compared to sunbirds, and better maintain their species number in these more extreme environments. We provide possible reasons for these patterns including dispersal limitation, land area, diversity of resources, and climatic conditions. In one particularly interesting hypothesis, we propose that hummingbirds' unique adaptations for nectar feeding allow them to exploit resources more efficiently, gain higher intrinsic fitness, and therefore speciate and spread into more extreme climates than less efficient nectar feeding sunbirds.

Health Professionals Education symposium, organized by the Ko&#xe7; Academy of Medical Education Research (KAMER), convened in October 2024 to discuss the evolving role of technology and social accountability in health professions education. The symposium adopted the concept of "healthcare professionals' education" as a unifying framework for synchronizing the training of medical and nursing students within a continuum of holistic healthcare education in low-and-middle income countries. The rationale for the symposium was to call on the dire need to improve healthcare professionals' education to reduce the increasing gap between the global north and global south. The discussion topics involved critical and current issues such as social accountability, health advocacy, and professionalism. Study groups explored aligning education with societal needs, addressing healthcare disparities, and integrating professional values into medical and nursing curricula. Presentations also focused on the integration of technology into healthcare education. Participants examined big data, artificial intelligence, simulation technologies, and digital learning platforms, identifying challenges and opportunities for their implementation. The symposium highlighted the transformative impact of interprofessional education, health advocacy, and technology in shaping socially accountable, patient-centered healthcare systems. Key recommendations included integrating community-oriented curricula, leveraging data-driven strategies for program enhancement, and expanding access to advanced educational technologies. This manuscript summarizes the symposium's conclusions and emphasizes the need to transform healthcare professionals' education in low-and-middle income countries to align with contemporary societal demands and to reduce the disparity gap.

Circadian rhythms are a mechanism by which species adapt to environmental variability and fundamental to understanding species behavior. However, we lack data and a standardized framework to accurately assess and compare temporal activity for species during rapid ecological change. Through a global network representing 38 countries, we leveraged 8.9 million mammalian observations to create a library of 14,587 standardized diel activity estimates for 445 species. We found that less than half the species' estimates were in agreement with diel classifications from the reference literature and that species commonly used more than one diel classification. Species diel activity was highly plastic when exposed to anthropogenic change. Furthermore, body size and distributional extent were strongly associated with whether a species is diurnal or nocturnal. Our findings provide essential knowledge of species behavior in an era of rapid global change and suggest the need for a new, quantitative framework that defines diel activity logically and consistently while capturing species plasticity.

Major depressive disorder (MDD), with its heterogeneous nature and variable course, poses significant challenges for clinicians in treatment planning and clinical decision-making. These challenges are further compounded by the rapid emergence of new treatment options and the uncertainty regarding their place within clinical algorithms. In this context, structured treatment guidelines that offer sequential, evidence-based recommendations based on comparative evaluation of available interventions have become essential reference tools for clinicians. Although various international guidelines offer comprehensive recommendations, the absence of a locally relevant and up-to-date guideline tailored to national clinical needs remains a critical gap. This guideline was developed to address that gap, aiming to provide a scientifically grounded and clinically applicable resource for the treatment of depression in T&uuml;rkiye. This guideline reviews recent developments in MDD treatment and presents evidence-based, sequential recommendations applicable to clinical practice in T&uuml;rkiye. It also systematically covers assessment tools, clinical subtypes, outcome measures and decision-making processes that may guide treatment planning. This article introduces the methodological framework, development process and the core concepts and definitions related to the guideline. Keywords: Psychometric rating, terminology, treatment of depression, treatment resistance.

Trait datasets play a crucial role in advancing ecological, biogeographical and evolutionary studies and in prioritizing global conservation efforts. Birds are the best-known major group of organisms and comprise excellent environmental indicators. With their diverse traits, birds offer valuable insights into the provisioning of critical ecological functions and how animals adapt to global change. BIRDBASE is a global avian trait dataset that provides an up-to-date compilation of ecological traits for all birds. With 78 traits from 11,589 bird species in 254 families, and data on 6%-16% more species than the previous avian trait datasets, BIRDBASE includes all the bird species recognized by the four major avian taxonomies. BIRDBASE is also the first avian trait dataset that covers all the species in AviList, the new unified global avian checklist. As the most comprehensive avian trait dataset, BIRDBASE will enable new meta-analyses in ornithology, conservation biology and macroecology, expand our ability to understand the origins and maintenance of biodiversity, help quantify avian responses to global change, and inform international conservation efforts.

On 06 February 2023, an extreme earthquake affected Hatay province in Turkey. The immediate response consisted of medical teams focusing on traumatology and immediate trauma related care. In the intermediate time period, after days to weeks, more primary health care was needed for displaced populations in tent shelters and in surrounding villages. We are describing the results of a needs assessment intervention and health services provided by an international non-governmental organization. Mobile teams circulated to displaced populations in peripheral locations. Fourty-two representatives of communities were interviewed for rapid needs assessment. After triaging and identification of needs, mobile medical units offered primary health care services. Data was collected digitally, directly by the healthcare workers on basic demographics and health conditions. We are reporting a descriptive overview of the data. Communities showed different degrees and dimensions of need, such as entirely lacking health services, or missing sanitary facilities. Populations in the communities increased in most sites. From 16 February to 06 April 2023, 3,027 patients were attended to. The majority of our beneficiaries were female (61.0%) and of Turkish origin (66.9%). Children under the age of 18 accounted for 41.3%. The most reported health findings were upper respiratory infections (24.9%) and scabies (9.7%). In 68 patients, a primary diagnosis of a mental health condition was made. In the intermediate response after an earthquake-driven disaster, primary healthcare provision becomes a crucial element of humanitarian support. Massive displacement into crowded tent shelters lead to respiratory conditions and contagious ectoparasitism. Organizations engaging in this context need to be prepared accordingly, not the least by sufficient stock keeping.

Understanding the current and future distribution of wildlife species is crucial for effective conservation planning, particularly in the face of climate change and increasing anthropogenic pressures. This study aims to assess the potential distribution of brown bears across T&#xfc;rkiye both presently, by 2050 and 2070, considering various climate change scenarios, evaluating habitat vulnerability, and reassessing the effectiveness of protected areas. Using an ensemble forecasting approach, we modeled brown bears' current and future habitat suitability, incorporating 608 occurrence records along with bioclimatic, topographic, and anthropogenic predictors under climate scenarios. Our model estimates that approximately 17.3% of T&#xfc;rkiye (135,556&#x2009;km2) currently offers suitable habitat for brown bears with the highest suitability found in the Euro-Siberian (46%), Irano-Turanian (43%), and Mediterranean (11%) biogeographic regions. The results indicate that climate change combined with anthropogenic pressures, is expected to reduce brown bear habitat suitability by 40%-48% by 2050, and 40%-67% by 2070 under various scenarios. A significant contraction in the brown bears' range, along with a northward shift in suitable habitats, is projected, reflecting the broader impacts of climate. Additionally, the suitability of brown bear habitats is estimated to be strongly influenced by the changes in altitude. The proportion of suitable habitats under protection is projected to decline from 21.4% to 15%-16.1% by 2050 and further to 11.3%-15.9% by 2070, depending on the scenario. These findings highlight the need for targeted conservation strategies to address the emerging conservation gap for brown bears in the Mediterranean, Irano-Turanian, and Euro-Siberian regions. Enhancing connectivity between fragmented habitats and reassessing the status of protected areas are critical actions to safeguard the brown bear population in T&#xfc;rkiye. This study underscores the pressing conservation challenges and strategic opportunities for securing the future of brown bears in T&#xfc;rkiye.

The heterogeneity of symptoms among patients with fibromyalgia (FM) makes the development of standardized diagnostic criteria challenging. No imaging technique has reliably shown FM-related muscle changes to aid clinical assessment. This study aimed to quantitatively analyze the upper trapezius muscle in FM patients using B-mode ultrasonography and blob analysis and to examine its correlation with clinical parameters. A total of 34 female FM patients and 34 healthy controls were included in this cross-sectional study. B-mode ultrasonography was used to image the dominant-side upper trapezius muscle, and MATLAB-based blob analysis was performed to assess blob size, blob count, and echointensity. These measurements were correlated with disease severity indices, including the Central Sensitization Inventory (CSI), Visual Analog Scale (VAS) for pain, Fibromyalgia Impact Questionnaire (FIQ), 36-Item Short Form Survey (SF-36), and Beck Depression and Anxiety Inventories (BDI, BAI). FM patients had significantly higher total blob size (p&#x2009;<&#x2009;0.001) and blob size per mm&#xb2; (p&#x2009;<&#x2009;0.001) than controls. Echointensity was significantly increased in the FM group (p&#x2009;=&#x2009;0.009). Total blob size showed a moderate positive correlation with CSI scores (p&#x2009;=&#x2009;0.002). Regression analysis indicated that pain-VAS was a significant predictor of total blob size per mm&#xb2; (p&#x2009;<&#x2009;0.001). Blob analysis demonstrated quantifiable muscle alterations in FM, supporting its potential role as an objective assessment tool. Given the correlation between muscle echotexture and FM severity, quantitative ultrasonography may contribute to a better understanding of FM pathophysiology.

Turkiye, a low-to-middle-income country with high cancer rates, faces challenges in providing adequate psycho-oncology services. This study aimed to identify Turkish health care professionals' (HCPs) perspectives on the unmet needs of their cancer patients to fulfil their needs through need-based treatment planning. Turkish HPCs working in the cancer care field in Turkiye (n&#x2009;=&#x2009;484) participated in the IPOS Survivorship Online Survey, which evaluates the perspectives of HCPs on their patients' concerns and unmet needs. Participants were primarily young adults (40.7%) with a medical professional background (43.5%). Most were engaged in clinical work (35%) for 2-10&#xa0;years. HCPs evaluated the unmet needs for medical care (73.8%) and managing emotional distress (71.4%) as the most common across all age groups, whereas sexuality/intimacy (15.9%) as the least common. Additionally, the needs for sexuality/intimacy (57.9%) and financial concerns (54.4%) were evaluated as the most unmet, whereas insomnia/sleep difficulties (26.3%) as the least unmet needs. According to HPC's evaluation, patients' unmet needs for spiritual concern, sexuality/intimacy, and personal care varied by patients' age groups (p&#x2009;<&#x2009;.05). The results were comparable across HCPs' gender and their disciplines. Turkish cancer patients report greater unmet needs in sexuality/intimacy and finances compared to international peers, while needs related to spirituality, physical/cognitive function, insomnia, and social roles are less pronounced. Further investigation of healthcare professionals' workload and the types of services available for cancer patients will help modify healthcare policies to enable equitable quality cancer care in Turkiye and globally when providing care for the Turkish diaspora.

Multiple myeloma (MM) is one of the most frequent hematological malignancies. Most MM cases relapse, which is associated with poor prognosis. MM-related tumor suppressor genes are not totally known yet. SOX7 is one of the tumor suppressor candidates located in 8p23.1, a recurrently deleted region in MM. Here, we evaluated the genetic and epigenetic aberrancies of SOX7 in diagnostic or relapsed MM as well as smoldering MM (SMM) and plasma cell leukemia (PCL). Publicly available datasets were reanalyzed to evaluate SOX7 copy number, promoter methylation, transcript levels in MM or related neoplasms and to evaluate mutation rates in MM cases. qPCR and qRT-PCR with an in-house MM cohort were performed to cross-validate SOX7 copy number and transcript level estimates. SOX7 deletions were frequent in newly diagnosed and relapsed MM cases. SOX7 promoter hypermethylation was observed in MM cell lines, MM cases, and PCL cases. Importantly, SOX7 was transcriptionally silent in MM cell lines and underexpressed in MM and high-risk SMM cases. Integrative analyses of patient-matched diagnostic and relapsed MM tumor tissues revealed moderate positive correlations between SOX7 copy numbers. SOX7 deletion and promoter methylation levels had a tendency to be mutually exclusive. SOX7 promoter methylation levels were significantly higher in relapsed cases compared to the diagnostic ones. SOX7 mutations were rare in MM cases. SOX7 underexpression may be due to genetic and/or epigenetic alterations in newly diagnosed and relapsed MM. These genetic and epigenetic aberrations can serve as diagnostic or prognostic biomarkers for MM and allied neoplasms. Future research will reveal whether SOX7 inactivation has a role in development of these plasma cell neoplasms.

There is growing evidence that botulinum neurotoxin (BoNT) can mediate changes at the central level through peripheral mechanisms, leading to alterations in central sensorimotor integration. However, the effect of BoNT on brainstem excitability in patients with hemifacial spasm(HFS) is not yet fully understood, and its long-term effects remain unknown. This study aims to investigate the impact of BoNT on the excitability of the facial nucleus in patients with idiopathic HFS. In order to evaluate the peripheral effect of the toxin, the amplitude of compound muscle action potential (CMAP) of orbicularis oculi (OOc) muscles was evaluated. To investigate the effects of locally injected BoNT on the brainstem, particularly the facial motor nucleus, we evaluated the amplitude and latency of the blink reflex (BR), the synkinetic responses (SR) and the ratio of contralateral R2 (cR2) amplitude of BR/CMAP amplitude in 16 patients with HFS. These measurements were performed before and after the 1 and 4&#xa0;month BoNT injection. Following BoNT therapy there was a significant amplitude reduction and latency prolongation of R1, iR2, cR2 and SR elicited by the stimulation of the side of BoNT injection. The mean CMAP amplitude of OOc muscle was significantly lower after BoNT injection. The ratio of cR2 amplitude/CMAP amplitude of OOc showed a significant decline after BoNT therapy. Our study demonstrated that BoNT suppresses the excitability of facial motor neurons in idiopathic HFS via the trigeminal afferent mechanism. These effects persisted during the fourth month, despite BoNT's diminished activity.