فهرست مطالب حامد چراغ مکانی

Migraine is a very debilitating disorder despite medication treatments. The aim of this study was to determine the effect of acupressure on severity of acute migraine headaches.

This randomized controlled trial was performed in 84 migraine sufferers attending the Emergency Department in Sari Buali Hospital, Iran 2019. Patients were randomly divided into three groups (n=28) of acupressure, control, and sham using Random Allocation Software. In intervention group, acupressure was applied to eight points for 8 seconds in each acupoint followed by two-second rest periods and this sequence was repeated for 3 minutes. The control group received only medical treatments and in sham group, acupressure was applied to eight unrelated points. Pain intensity was measured by Visual Analog Scale (VAS) before and 24 minutes after acupressure. Data were analyzed using Kruskal-Wallis test and Mann-Whitney U test.

Before the intervention, the median (Q3-Q1) pain intensity in intervention, sham, and control groups were 6, 5, and 5, respectively (P=0.175). After the intervention, the values were 1.5, 3, and 5 in intervention group, sham, and control groups, respectively (P<0.001). After the intervention, the mean score for pain intensity was significantly lower in intervention group than the sham (P<0.001) and control (P<0.001) groups. This rate was significantly lower in sham group than the control group (P<0.001).

Acupuncture alongside other treatments can be helpful in reducing the severity of pain caused by acute headaches.

Stroke is the most common and debilitating neurologic lesion in adults. Early family-centered stimulation have positive outcomes in stroke patients. The present study was designed to investigate the effect of early family-centered sensory stimulation on restoring function and recognition in stroke patients.

A clinical trial was done in 60 patients with impaired consciousness due to stroke (GCS=5-10) admitted in intensive care unit (ICU). The participants were assigned into control and experimental groups (n=30 per group) using randomized block design. The experimental group received sensory stimulations of the five senses in the first 48-72 hours after the stroke by family members for 14 days. The control group received ICU routine care. At days 5, 10, and 15, the consciousness level was assessed by GCS and FOUR and cognitive function was assessed by Disability Rating Scale.

Sensory stimulations significantly increased the mean score for cognitive function in the experimental group compared to the control group (P<0.001). The effect sizes of cognitive function at days 5, 10 and 15 were 0.45, 0.95, and 1.09, respectively. The effect sizes were small at day 5 and large at days 10 and 15. No significant differences were observed in the level of consciousness (P=0.601) and function (P=0.710).

In current study, early family-centered sensory stimulation in patients with impaired consciousness due to stroke improved their cognitive function but did not significantly influence their disability score.

Sexual dysfunction (SD) is a common symptom of multiple sclerosis (MS). This study was conducted to determine the frequency of sexual dysfunction and its types in women with MS and identifying the related factors.

A descriptive cross-sectional study was done in female patients
(n= 114) attending an outpatient MS clinic in Sari, Iran 2018. The participants included female married patients with no history of relapse and pulse therapy during the past three months, no history of hepatic problem, no history of pschyciateric diseases and pschyciateric medications. Information was collected using the Female Sexual Functioning Index (FSFI). Data analysis was done in SPSS V16 applying correlation test.

All patients (100%) reported sexual dysfunction, including painful intercourse (93%), decreased lubrication (80.7%), lack of arousal (43.9%), lack of desire (38%), difficulty in reaching orgasm (36.8%), and lack of satisfaction (36.8%). In this study, 63.1% of the patients experienced mild depression. Significant associations were seen between depression (P=0.007), sphincter problems (P=0.02), and sexual dysfunction.

Awareness on the high frequency of sexual dysfunction in MS patients helps to eliminate the underlying causes and improving the quality of life in these patients.

Multiple Sclerosis (MS) is a common neurological disease in young adults. This study was performed to determine the prevalence of headache in these patients.

This descriptive-analytic study was carried out using convenient sampling in patients attending neurology clinics affiliated to Mazandaran University of Medical Sciences, 2017. Data analysis was done in SPSS V24.

There were 129 MS patients with history of headache, of whom 41.1% had migraine and 56.6% had tension headache. Severe types of headaches were reported by 47% of the patients and migraine was found to have the highest incidence. There were significant correlations between relapsing-remitting MS and tension and migraine headaches (P=0.001). About half of the patients did not mention a history of headache before MS, and there was no relationship between the new migraine headache and its aura (P>0.05).

In current study, tension headaches were found to be the most common types of headaches in MS patients. In relapsing-remitting MS, the most common type of headache was migraine. Given the adverse effects of headache on quality of life, awareness on the common types of headache could help in improving the quality of life of MS patients.

To determine the incidence of macular edema in patients with MS treated with 0.5 mg Fingolimod.

In this prospective descriptive-analytic study a total of 115 patients were enrolled. Patients underwent an ophthalmologic examination before starting the treatment. In the fourth month after starting the treatment for each patient, regardless of whether or not being marked, the ophthalmologic examination and OCT were repeated. The results were analyzed, using SPSS version 19 software.

The mean ± SD age of the patients was 32.68 ± 7. 57 years. The result of the preliminary examination of direct and indirect ophthalmoscopy of the right and left eyes before the onset of treatment in all cases for macular lesions was normal. The average of the secondary ocular examination during the treatment was 4.05±3.18 months. The result of the secondary examination of direct and indirect ophthalmoscopy of the right and left eyes during the treatment in all cases for macular lesions was normal. There was no macular edema in the right or left eye of none of the patients during the treatment.

Based on the results of the present study, Iranian Fingolimod can be used for the treatment of patients with MS with minimal ophthalmic complications and macular edema with considering regular ophthalmologic examinations.

Anti-epileptic drugs (AEDs) can affect cognitive functions. The purpose of this study was to investigate the effects of lamotrigine (LT) on cognitive functions of patients with epilepsy. A study with retrospective cohort design was carried out in which we assessed cognitive functions of 20 IGE patients attending Sari Bu Ali Hospital, and 12 healthy subjects. The control group was matched for age, sex, and educational level. Standardized neuropsychological tests were used to evaluate cognitive functions. The study was analyzed applying one-way ANOVA and Tukey Test in SPSS. Compared with the control group, LT group showed poor performance in Stroop test and verbal fluency test-semantic test (P<0.05). The group on other drugs were also found to have poor performance in verbal fluency test (phonetic and semantic), forward digit span task, and Stroop test compared with those of the control group (P<0.05). Compared with LT, other AEDs had more adverse effects on cognitive functions which could be due to their effect on channels and release changing stimulatory neurotransmitters.

Multiple sclerosis (MS) is an autoimmune demyelinating disease mediated by myelin activated T-cell crossing the blood-brain barrier. This disease starts by an autoimmune attack on the myelin sheath. The characteristic feature of MS is relapsing-remitting neurological signs affecting various parts of the nervous sytem at different times. During the Ramadan month, fasting permission is a common question. According to some evidence, fasting not only has no adverse effect on stable MS disability indicated by expanded status disability scale (EDSS) of 3, but also has regenerative neuroimmunological benefits. Although some MS symptoms, such as blurred vision, spasticity, gait ataxia, fatigue, weakness, and cognitive problems, could exacerbate during fasting, they remit immediately after fasting. Nevertheless, the patients with active MS or history of new attack during or after Ramadan, those on treatment with antispasmodic, anticonvulsive, corticosteroid, and immunosuppressive drugs, and patients with EDSS of > 7 are supposed to abstain from Ramadan fasting, specially in hot summer months.

Subarachnoid hemorrhage (SAH) is a common and horrible disease and high rate of neurological complications. Misdiagnosis leads to increased mortality and delayed onset of treatment. This aim of study was to investigate the clinical characteristics of patients with SAH in Mazandaran.
This research is descriptive and retrospective study on 110 non-traumatic SAH. Variables include age, sex, headache, swallowing disorder, speech impairment, syncope, hemiplegia, seizure, nausea and vomiting, as well as risk factors such as hypertension(HTN), diabetes(DM), hyperlipidemia(HLP), alcohol consumption, smoking, Ischemic heart disease(IHD) was extracted from the patients file.
FINDINGS: The mean age of patients was 53±16.92 years. The most common non-traumatic SAH in the age group over 40, especially 40 to 60 years. The average hospital length of stay was 14.7±4.77 days. Hypertension (47.3%) is highest prevalence in the study population compared with other risk factors include DM,HLP,IHD,smoking,alcohol consumption and the headache was 80% and hemiplegia was 11.8%.
All patients with sudden headaches, especially headaches that have a history of hypertension must be accurate and complete evaluation for SAH.

Background and Headache is one of the pain syndromes in multiple sclerosis (MS). Migraine is one of most frequent types of headache among patients with MS. The aim of this study was to investigate the association between MS and migraines.
A cross-sectional study was conducted in 60 patients with definite MS. The brain MRI scans were obtained and the location of lesions and number of lesions and locations were recorded and compared.
The study population included 51 females and 9 males. Among the patients 82% were diagnosed with remitting-relapsing MS and 18% had secondary progressive MS. Patients with headache were found with higher number of lesion locations compared with those without headache (P= 0.0001). Compared with MS patients without migraines, migraineurs with MS had larger sizes of lesions in midbrain, cerebellum, thalamus, frontal and temporal lobes (P The presence of MS plaques in the infratentorial region mainly midbrain and cerebellum and supratentorial region especially the frontal and temporal lobes, and thalamus may contribute to the increase in occurrence of headache with migraine characteristics.

Epilepsy is a chronic disease with onset in infancy affecting 0. 5-1% of the population. One third of the patients are refractory to antiepileptic drugs and they pose a challenge for the health care team. Ketogenic diet is an effective treatment for refractory epilepsy. The ketogenic diet is a very low carbohydrate، high fat، and low to adequate protein diet that includes some restriction of total calories (≈75% of age rec­ommendations). The amount of protein is based on age requirement، carbohydrates are only 5 to 10 g/day، and the remaining calories come from fat. The ratio of fat to protein plus carbohydrate ranges from 2:1 to 4:1. The mechanism of the ketogenic diet is not well under­stood. Its benefit may be related to acidosis، ketosis، calorie restriction and decrease in blood glucose، dehydration، or increase in certain lipids. A ketogenic diet limits blood glucose، and produces ketone bodies from β-oxidation of lipids. Studies have explored changes in ketone bodies and/or glucose in the effects of the ketogenic diet، and glucose is increasingly implicated in neurological conditions. Some studies reveal that a ketogenic diet sensitizes glucose-based regulation of excitability via purinergic mechanisms in the hippocampus. Adverse effects of the ketogenic diet include constipation and worsening of reflux، acidosis، unexplained fatigue and renal calculi. The potential adverse effect of decreased growth is most likely to occur in the youngest chil­dren.

Seizure is a common phenomenon in elderly persons which is important to be diagnosed and treated. In this age group، acute symptomatic seizures are most often seen in the setting of acute stroke and metabolic encephalopathy. Cerebrovascular disease and degenerative dementia are common causes of epilepsy in elderly patients، but one-third of cases are of cryptogenic origin. The majority of late-onset epilepsy is partial with or without secondary generalization and clinicians should maintain a high level of suspicion for possible diagnosis because of atypical presentations. A reliable history taking and paraclinical evaluation is needed to confirm the diagnosis and exclusion of other causes. Antiepileptic treatment in elderly should be started at low dose monotherapy with slow titration to higher doses. Also underlying diseases and other prescribed drugs should be considered. Regular bone mineral density testing and calcium and vitamin D supplementation in need، is recommended.