داریوش سوادی اسکویی

Epilepsy is a chronic condition caused by a dysfunction in brain function, and each episode of the disease has a profound impact on those affected. This study aimed to examine the effect of Acceptance and Commitment Therapy (ACT) group therapy on the quality of life and emotions of patients with epilepsy.

This was a quasi-experimental study with a pre-test and post-test design, including a control group. The sample consisted of 33 participants (16 in the experimental group and 17 in the control group), selected through purposive sampling. The intervention was provided in 9 sessions to the experimental group. The control group received no intervention and was placed on a waiting list for treatment. Data were collected using demographic information questionnaires, the Quality of Life in Epilepsy Patients Questionnaire (P-31-QOLIE), and the Positive and Negative Affect Schedule (PANAS). The data were analyzed using covariance analysis.

The results show a significant difference between the experimental and control groups under the influence of ACT in terms of quality of life (P = 0.001) and negative emotions (P = 0.004), while no significant difference was observed between the two groups in positive emotions (P = 0.573).

Based on the findings of this study, ACT is an effective and non-invasive therapeutic method that can be used alongside medical interventions to improve the quality of life and reduce negative emotions in patients with epilepsy.

Emotional problems are common and annoying for patients affected by epilepsy. Despite the increasing attention of medical science, the neurological aspects of epilepsy and its psychological effects are remained almost unknown.This study aimed to evaluate the impact of cognitive-behavioral stress management on reducing the frequency of seizures in dealing with the type of epilepsy in adolescents with epilepsy.
In this pilot study, 40 patients with epilepsy (20 patients with general epilepsy, and 20 patients with focal epilepsy) were selected by convenience sampling from Tabriz Epilepsy Society, and then they were randomly divided into two groups: Control and Experimental.The rage of their age was 14 to 21 years old. To obtain the data, the frequency of seizures of the patients was collected two months before the intervention). The frequency of attacks was about 3 to 6 times). Before the start of the first session, Lvynda questionnaire was delivered to measure stress, depression and anxiety of the patients. The experimental group )10 patients with General epilepsy, 10 patients with Focal epilepsy) was intervened by cognitive-behavioral stress management intervention for two months. Data analysis was performed using the spss 21software.
The results showed that Cognitive-behavioral stress management intervention in patients with epilepsy resulted in the reducing of the frequency of seizures. There was no significant difference between general and focal epileptic patients. Based on the results of the study, there was a significant relationship between emotional distress and the frequency of seizures.
Psychological interventions to reduce the frequency of the seizures can be an effective factor. So in addition to medicine therapy, this method can be used to improve the condition of in the epileptic patients.

Emotional and cognitive problems are common and annoying problems among patients with epilepsy. This study was carried out with the purpose of examining the cognitive profile and emotional distress of two groups of patients, one with the general and the other with the focal epilepsy.
The method used in this study is descriptive, the causal-comparative kind. The statistical population included all the patients, with epilepsy, who referred to neurology specialist's offices in Ardabil city from April to September, 2015. The sample group consisted of 60 patients (30 focal epilepsy cases and 30 general epilepsy cases) across the age range of 13 to 20 years, which was selected as the sample in access. To study the cognitive profile, subjects under study were asked to answer Andre Ray’s test for visual memory assessment, and to examine immediate and delayed auditory memory subscales, they were asked to answer the Wechsler Memory Scale. Also, in order to examine the patients’ emotional distress, they were asked to answer Lewinda’s depression, anxiety and stress scale. Research data were analyzed by the use of descriptive statistics and multivariate analysis (MANOVA).
The results showed that patients with focal epilepsy, compared with the general epilepsy patients, show poorer performance in cognitive abilities related to auditory and visual memory. Also, patients with focal epilepsy display higher emotional distress than patients with general epilepsy.
The results of this study prove that cognitive profile and emotional distress vary among the two groups of patients one with general and the other with focal epilepsy.

Myofascial pain syndrome (MPS) is a regional pain, originating from a myofascial trigger point (MTP). The key to diagnosis of MPS is a distance between the pain location and the causative trigger point in skeletal muscle. In the present study, we aimed to evaluate the effect of physiotherapy and acupuncture on relieving the MTP induced headaches. In this study eighty patients with headache associated with the neck region's MTP were enrolled into the study. The mean number of headaches after intervention in the physiotherapy group, was not different from the acupuncture group. The mean reduction of VAS score in the acupuncture group was significantly higher than the physiotherapy group. After treatment, Benchmark of Modified Mc Gill criteria’s in the physiotherapy group was not different from the Benchmark Modified Mc Gill in the acupuncture group. The mean reduction in the HIT in acupuncture group was significantly higher than physiotherapy group, reduction of A-PRI score in the acupuncture group was significantly lower than physiotherapy group. Both physiotherapy and acupuncture are effective for therapeutic approaches relieving MPS related headaches, but endurance of the pain relieving effect is more significant in acupuncture method.

Upper motor lesions may produce muscle spasticity which increases the resistance against normal movements. This study aimed at evaluating the therapeutic efficacy of electrical stimulation (ES) on upper limb spasticity following stroke.

In a randomized clinical trial, 75 patients with post-stroke upper limb spasticity were studied during a 19-month period in Tabriz Imam Khomeini Hospital. These patients were randomized in three 25-patient groups; group E received motor level ES on extensor muscles of affected forearm; group F received sensory level ES on flexor muscles of the affected forearm; and group C or control who received sham ES on the affected forearm. ES was applied for 15 days, 0.5 h daily in the interventional groups. Stretching was also employed for all the patients. The grip index, hand index, passive and active range of motion (ROM) and Ashworth scale was determined and compared between the three groups at baseline, after halting the interventions and 6 weeks afterwards.

Spasticity improvement was significantly more prominent in group F compared to the control group 6 weeks post-intervention. Improvement of upper limb function was better in groups E and F compared to the control group. The gripping force was significantly increased after intervention and 6 weeks afterward in group E and to lesser degree in group F. The active ROM was significantly enhanced in some directions (flexion and extension) 6 weeks after cessation of intervention in group E compared to the control group.

ES on flexor and extensor levels in the upper limb along with stretching techniques may improve the spasticity and hand function after stroke.

Impaired oxygen and glucose delivery to the brain tissue makes neuronal injury and transient focal neurologic signs. When it is prolonged the irreversible changes (infarction) and permanent neurologic injury occur. Increasing the oxygen pressure in the breathing air may be an effective treatment for acute ischemic stroke. The aim of this study was to evaluate the role of normobaric oxygen therapy in the acute ischemic stroke prognosis. In this study, sixty patients with acute ischemic stroke had been studied in two groups. One group received continuous normo baric oxygen during first – three days of stroke and the other group (B) didnt. Brain CT scan findings and stroke scaling in the first and third days of admission were compared. From total number of 60 patients (M/F, 33/27). In A group (M/F, 14/16) mean age was (67.43±15.27) and in the Control group B (M/F, 17/13) age (70±13.28). The NIHSS mean score in group A was 13.46 in the first day and after 3 days of oxygen therapy it reached to 12.03 (P=0.08). In group B first day score was 13.60 that in the third day it reached to 12.06.But Rankin scale had no meaningful relation with oxygen therapy. However the lesion expansion also was reduced in oxygen treated cases. (39.74 cm3) in compare of group B that it was 45.67 cm3 (P>0.05). This recent studies showed that oxygen therapy in the first days of ischemic strokes had some promising results. But we need larger study to reach a conclusive result.

In a near future, stroke will be the second leading cause of death and disability in many regions of the world. To reduce the overall burden of the disease on society, the development and the establishment of an organized approach for acute stroke care is postulated. The identification of predictors for death and poor outcome might contribute to reduce mortality and morbidity rates after stroke by enhancing the application of specific therapeutic and management strategies to patients at high risk. However, only limited information is available in this regard. Leukocytosis and increased erythrocyte sedimentation rate (ESR) during the early phases of acute ischemic stroke has been proposed to be related with poor prognosis. This study aimed at evaluating these two parameters in patients with ischemic stroke. In an analytic study, 150 patients with confirmed ischemic stroke hospitalized at Tabriz Imam Hospital were reviewed during a 13-month period. The white blood cell (WBC) count and ESR were determined on admitting and 3 days after. Any history of diabetes mellitus (DM), hypertension (HTN), heart disease (HD), hyperlipidemia (HLP), smoking, CT findings, Level of consciousness, and the condition of patient on admission and discharge (according to Rankin's scale) was assessed. The patients categorized into three groups: expired during hospital stay, discharged in good situation (Rankin's scale of 0-2), discharged in poor situation (Rankin's scale of 3-5). One hundred fifty patients, 75 males and 75 females, with the mean age of 67.3±8.2 (48-88) years enrolled in this study. There were 32 (21.3%) expired cases, 26 (17.3%) cases discharged in good condition and 92 (61.3%) cases discharged in poor condition. Leukocytosis on day one was significantly more prevalent in patients passed away during hospitalization or discharged in not-so-well condition. High WBC and ESR levels, altered consciousness, diffused lesions in CT scan, and imperfect neurological condition on day one, as well as positive history of DM and HTN were significantly related with higher in-hospital death rate and/or poor condition at discharge. In a multivariate study, all the mentioned parameters except a positive history of DM were independent predictors of short mortality and morbidity in the patients (p<0.05). This study showed that the raised WBC count and ESR just after an ischemic stroke attack might be related with a poor prognosis and necessitate immediate and meticulous monitoring and therapies.

Cerebrovascular disease mortality rates have declined in some countries during recent decades. Changes in mortality rates over time could be attributed to changes in disease incidence or case fatality rate. Very few studies have provided information regarding survival after stroke. We aimed to determine the case-fatality rate (28 days) among patients with first-ever stroke from a population-based study in Ardabil province, Northwest of Iran. This study was conducted between May 2005 and February 2006, all individuals with an acute stroke who were residents in Ardabil province and hospitalized at Alavi Hospital, were registered prospectively and assessed according to standardized diagnostic criteria. The data were analyzed through SPSS, Chi square and variance analysis. A total of 352 patients with first-ever stroke were registered, and 346 (96%) were followed up. 288 (81.8%) ischemic stroke, 16.2% (57) ICH and 2% SAH. By 28 days, 70 patients (20.3%) had died. Hypertension, diabetes and cardiac disease history were reported in 61.6%, 16.8% and 26.1% respectively and 19.8% of patients were smokers. Mean age of survivors was different from patients who died at 28 days after index event (64.2±12.9 VS 69.1±10.9, p=0.03). The proportion surviving 28 days varied from 16.2% among patients with ischemic stroke to 43% among ICH and SAH. For ischemic stroke, Survival rates were similar for men and women, whereas men with ICH had lower survival than women. Case fatality rate after first-ever stroke is substantial. Rates of mortality differ according to patients diagnosis, age, sex, and heart disease. These data highlight the importance of long-term secondary prevention.

Epilepsy is a chronic disease, which has a major influence on the quality of life in the epileptic. Considering many aspects of epilepsy one can conclude that it has influential effects in multiple aspects of life in these patients. These aspects include physical and mental health, activities of daily living and social relations, mental capabilities, learning and different type of skills, etc. The aim of this research was to study the quality of life of the epileptic patients in our society, and compare these result with that of similar studies in other centers all around the world. This was a descriptive- cross sectional type of study. One hundred eight nine patients were enrolled according to the criteria of the International league Against Epilepsy (ILAE) for diagnosis of epilepsy. The inclusion criteria were, 1) the age over 18 years old 2) absence of mental or physical disabilities, so that precluding the study. The patients selected accordingly were interviewed using a standard questionnaire, Quality of life in Epilepsy (QOLIE- 31-P). Among 189 patients were 106 males (56.1%) and 83 females (43.9%). Total quality of life according to the score of QOLIE- 31-P was minimally 16.20 and maximally 87.5 with a mean of (50 14.59 SD).the mean score for men was (50 16.11 SD 16.2-85.35) and for females (49.28 14.47 SD 24.14-87.5), which showed no significant difference between sexes cp Value= 0.549). The mean score in the monotherapy group (52.95 16.22 SD) showed a significant difference in comparison to the poly therapy group with a mean score of (46.98 12.07 SD), (P Value=0.005), indicating a favorable profile for the former. There was no significant difference statistically with regard to age groups and educational status, but duration of the epilepsy less than one year had statistically significant better quality of life. The results of this study were compared with similar studies in other centers all over the world. The findings on the role of the sex of the patients was the same as the studies in the India and Georgian University, but were different to that of a European study of 15 countries. This may stem form cultural differences and beliefs. The effect of number of drugs used in treatment was similar to other studies. The care of the epileptic patients must take into account the many factors influencing the quality of life in these patients. Adhering to a monotherapy regimen by the physicians has an important role in improving the quality of life in the epileptics. The epilepsy because of its chronic course has an unfavorable long- term influence on the quality life of the patients.

Stroke is the third cause of mortality after cardiovascular diseases and cancer. It is also the most common debilitating neurologic disorder. Considering the high prevalence of intracerebral hemorrhage (ICH) and its mortality, it seems quite necessary to study the frequency of ICH risk factors and its mortality related to size and region of hemorrhage.

157 ICH patient units were studied to determine hemorrhage size and region via CT Scan reports. Patients were followed to record the mortality and a questionnaire was filled out for them. The data were analysed by SPSS version 13.

Females constituted 57.9% of the 157 patients and the rest were males. Mortality rate was 37.6%. Most of the patients were in 70-79 years age group. Hemorrhage had the highest frequency found in putamen (39.4%). Hemorrhage size less than 20 cm3 had the highest frequency among living patients and hemorrhage size in a range of 20-100 cm3 was most common among expired patients. There was a statistically significant relationship between mortality and hemorrhage size (P<0.05). Intraventricular hemorrhage was more frequent among expired patients (p<0.05). There was also a statistically significant relationship between a history of cardiovascular disease and mortality rate (P<0.05).

Intraventricular hemorrhage and hemorrhage size were significantly related to mortality rate.

The ischemic stroke is defined as cerebral dysfunction due to brain infarct which is induced by vascular obstruction. The related risk factors including hypertension, diabetes mellitus, cardioembolism and hyperlipidemia are investigated in several studies. The aim of this study was to determine the etiology of cerebral infarction in young adults (- year-olds). All the patients in the age rang of - admitted to the neurology ward of Alavi Hospital in Ardabil between 2004 and 2005 with a diagnosis of cerebral infarction were included in this study. A questionnaire including demographic data, personal and family history of stroke and cardiac infarct, hypertension, diabetes, smoking and hyperlipidemia was filled out for all patients. Blood sugar, cholesterol, anticardiolipin antibody and beta- glycoprotein were examined. The patients underwent echocardiography. The data were analyzed using SPSS software (release). The total number of the patients was, including females (71.1%) and males (28.9%). The mean age was (SD=). The etiologic factors based on their frequency were: cardioembolism (40%), positive antiphospholipid antibodies (35.5%), hyperlipidemla (22/2%), smoking (22/2%), hypertension (20%), oral contraceptive use (15/6%) and diabetes mellitus (13.7%). The most frequent etiologies of the cerebral infarcts in the young adults in this study were cardiogenic embolism and positive antiphospholipid antibodies. Other background factors were hyperlipidemia, smoking, hypertension, oral contraceptive use and diabetes mellitus respectively. Most of these etiologies can be intervened and prevented. The identification of these factors before occurrence of cerebral infarction can prevent this debilitating event.

Hypokalemic paralysis is a relatively uncommon syndrome which is potentially dangerous. If it is diagnosed and treated timely, the patients will be saved without any side effects. Various diseases can lead to this syndrome which is characterized with decreasing of serum potassium and acute systemic paralysis. In hypokalemic paralysis, the serum level of potassium reaches to less than 3.5 Mmol/lit. This may be caused by transferrence of K to intracellular department, (periodic hypokalemic paralysis and periodic thyrotoxic paralysis). The aim of this study was to determine sex and age prevalence of these patients as well as other features of the patients suffering from periodic hypokalemic paralysis. 55 patients participated in this prospective, descriptive and cross-sectional study which was conducted from 1999 to 2003. These patients were referred to the neurological department with hypokalemic diagnosis on the basis of laboratory and clinical examinations. The data were collected using a questionnaire. Also the serum level of K was measured. The data were analyzed by SPSS software. from 50 patients, 46 (92%) were male and others were female. The patients were in 19-60 age range (Mean=33.16 SD=9.1). Mean serum level of K+ was 2.37 Mmol/lit (SD= 0.49) in the first hospitalization. The incidence of hypokalemia increased with aging, but majority of the patients (76%) were in age range 20-40. In 86% of the patients the time of hypokalemia crisis was at night and early morning. 11 patients had a high consumption of rich carbohydrate foods previously and 11 others had consumed corticosteroids. There was relapse of disease in 21 patients. 40 patients had paralysis in 4 extremities and 12 patients in 2 extremities. 4% of the patients were hypertensive and 4 patients were hyperthyroid. EKG was normal in 8 patients but in other cases there were abnormal changes. Despite the international references, the incidence ratio of male to female is high but the decreasing of K is more severe in female. Asetazolamide and oral KCL therapy not only decrease the period of hospitalization, but also are more effective in treatment of the disease.

Studying the epidemiology and impact of headache can help improve patient care, estimation of burden of disease and classification systems. Migraine is common worldwide and has a geographically variable prevalence in the world. Moreover, its peak of incidence is the age of 20-30. The aim of this study was to determine the prevalence of migraine among the medical students in order to plan for future health interferences. In this cross-sectional study 631 students filled out a questionnaire designed according to the criteria of the international headache society. The data were analyzed using SPSS software (release 12) and descriptive statistics. 76.6% of the subjects were female and 23.4% of them were male. The females were 20.6 and males were 21.4 years old on average. The total prevalence of migraine was 7.3% (1.6% with aura, 5.4% without aura and 0.3% with both of them). Moreover, females, single subjects and students of medicine, except the migraine with aura that was more prevalent among students of associate degrees. A positive family history of headache was found in 45.6% of the students. 65.2% of those suffering from migraine had not referred to a physician and were unaware of their headache. Compared to similar researches there is a low prevalence of migraine among the students but most of the students do not take measures to cape with and treat them in the proper manner. This requires necessary health interferences

Bell ’ s palsy (BP) is a relatively common disease characterized by the sudden onset of facial paralysis. In this disease, the facial muscle is paralyzed and the patient cannot close the eye or control the saliva in the involved side. The incidence rate of this disease in the world is between 11.5-40.2 cases per 100,000. The cause of this disease is yet to be found. This study is an attempt to investigate the demographic. Characteristics of these patients as well as the environmental factors involved in this disease in Ardabil. In this cross-sectional study which was cauducted in Ardabil province during a 2-year period (2001-2003) all the patients referring to neurology clinics were evaluated by a questionuaire in terms of demographic features and whether they were affected by the disease. 140 cases (out of 6550) were affected by Bell ’ s palsy. The incidence rate was high among 20-30 year-olds (17.85%) and was equal among females and males. Incidence of BP was higher in cold seasons. A high incidence was also observed among farmers, who sweat abundantly due to their job nature. The results are consistent with hypotheses regarding viral etiologies [e.g., reactivation of herpes simplex] of Bell ’ s palsy and it can be activated by cold exposure. The results also indicated that the disease is more prevalent in cold seasons.

The role of circulating lipids in the pathogenesis of ischemic stroke remains unclear despite 3 decades of research. Since ischemic stroke is one of the important causes of death or disability in the world. Finding its risk factors can play a crucial role in health interferences.This study was conducted to investigate the relationship between blood lipids and ischemic stroke. This wasa case-control study conducted in 2002. The case group were patients who were definitely diagnosed to have ischemic stroke for the first time. An equal number of control subjects (with the same age and sex) were selected from other hospital wards. These two groups were compared in terms of the blood lipids. The collected data were analyzed using SPSS software (release 12) and statistical methods such as ANOVA and multivariate regression. In this research 132 cases were compared with equal number of control subjects. The subjects in both groups were 64.1 years old on average. The mean level of total cholesterol was significantly higher in case group (p=0.001). The mean level of Triglycerides had no significant difference in two groups. Regarding the findings of the present research, offering strategies to lower the chlestrol level through primary prevention as well as drug interferences especially in the groups with other risk factors of stroke, seems to have a significant role in the prevention of ischemic stroke.

Temporal arthritis (TA) is a systemic inflammatory vasculitis with unknown etiology, which involves large and medium sized arteries. A wide spectrum of systemic, neurological and ophthalmological complications appears in the course of the disease the most serious of which is visual impairment leading to permanent blindness in 60% of the cases. TA is diagnosed through an elevated ESR (>60 mm/Hg) and pathological findings of arterial biopsy. It is considered as one of the urgent neurological cases in which the patient should be treated with corticostroid immediately after diagnosis. The subject of this research was a 62-year-old male who had had headache associated with fatigue, night sweats and low mood for four month. The diagnosis of TA was made considering an elevated ESR and temporal artery biopsy findings. Treatment with prednisolone was initiated and continued for 19 months resulting in complete recovery.

Despite the ever increasing use of oral contraceptives there is uncertainty about the stroke risk associated with their use. Some cases of pulmonary Emboli and stroke have been reported among women taking these pills. The present research was conducted to investigate the relationship between taking contraceptive pills and the risk of ischemic stroke. In a case-control study, women with definite ischemic stroke were selected from Alavi Hospital in Ardabil who had no prior stroke. The control group was age-matched (± 3years) to cases and were selected from other wards of the same hospital. A questionnaire was administered to elicit information about prior exposure to various risk factors, including the oral contraceptive pill (OCP). The data were analyzed by SPSS software (Ver. 12) and statistical methods such as chi-square, multivariate regression and ANOVA. The risk factor were estimated by odds ratio. OCP consumption was associated with an increased risk of ischemic stroke (OR=5.4 95% CI=1.1-5.3), and after adjustment for other risk factors of stroke it was OR=2.7 (95% CI=0. 95-7.2) with p=0.05. According to this study there was weak evidence for an association between ischemic stroke and OCP consumption. Extended studies are needed to clarify the relationship between risk of stroke and the present/ past use of OCP.

Stroke is a leading cause of death and disability worldwide. It is more common in men than in women, however more than half total stroke death occur in women. Several conditions and lifestyle factors have been well established as risk factors for stroke. The purpose of this study was to asses the magnitude of classic stroke risk factors and its pattern in women. A total of 62 patients with first-onset ischemic stroke were accrued from neurology unit of Alavi hospital during 2002 and compared with their age-matched controls from other units of same hospital. Information concerning potential risk factor exposure status was collected by structured questionnaire at interviews. Stroke risks were estimated by calculating the odds ratios. Significantly increased risk of stroke was found among women with hypertension (OR=8.4 CI=3.7-1.8), current smoking (OR=4.2 CI=1.1-16), diabetes (OR=3.7 CI=1.4-9.7) and heart disease (OR=3.2 CI=1.2-8.4). Association of other factors (passive smoking, Hypercholestrolemia) with stroke was not significant. Hypertension, diabetes, current smoking and heart disease are major risk factors for stroke in women. Given that the majority of these factors are either correctable or modifiable, prevention strategies should be planned in accordance with this point in order to reduce the occurrence of stroke in women.