fereshteh ghadiri

 Every patient diagnosed with definite multiple sclerosis (MS) should begin disease modifying therapies. Cinnomer® contains 40 mg glatiramer acetate (GA) and is available in prefilled syringes and autoinjector devices.

 A phase IV multicenter study was conducted to explore the safety and effectiveness of Cinnomer® in the treatment of MS. Study-related data were collected for 14 months.

 Totally, 368 Iranian relapsing-remitting MS patients in nine cities were enrolled. The patients were either treatment naïve (n=191) or switchers (n=177). Cinnomer® treatment was associated with a significant reduction in annual relapse rate (ARR) (RR: 0.65, 95% CI: 0.43, 0.98). Final mean Expanded Disability Status Scale (EDSS) scores showed improvement from baseline (difference: -0.21, 95% confidence interval (CI): -0.34, -0.08). There was a significant decrease in gad-enhancing lesions during treatment (difference: -0.38, 95% CI: -0.64, -0.12). The mean score for the depression measure (21-item BDI-II questionnaire) significantly improved (difference: -2.39, 95% CI: -3.74, -1.03). There was a significant change in the “psychological well-being” dimension (P=0.02) (in line with BDI-II scores) and “rejection” MusiQoL dimensions (P=0.04). The adverse events documented throughout the study were not unexpected for GA and were principally not serious.

 Safety measures were in line with the known profiles of GA. The results suggest that Cinnomer® is effective with respect to clinical outcomes and from the patient’s perspective and in reducing MRI-measured MS activity.

Multiple sclerosis (MS) may be affected by socioeconomic status (SES). This study aims to explore the determinants of SES among Iranian patients with MS and examine how these factors relate to disability and disease progression.

All patients with MS listed in the nationwide MS registry of Iran (NMSRI) until January 8, 2022, were included in this population-based study.

Among the 5153 patients, most were female (74.5%), married (70.8%), and did not hold an academic degree (53.8%). Unemployment (OR: 3.75) and being unmarried (OR: 2.60) were significantly associated with Expanded Disability Status Scale (EDSS) ≥ 6, and the time to progression was shorter in the unemployed group (P value: 0.03). There was also a significant negative correlation between the time to progression and the age at disease onset.

The study suggests that providing financial and social support to MS patients and their families through investment could reduce both individual and societal burdens.

miRNAs are non-coding RNAs participating actively in the post-translational regulation of oncogenes, tumor suppressor, and DNA repair genes implicated in colorectal cancer (CRC). This study aims to examine the association of the variants miR-27a (rs895819 A > G), miR-196a2 (rs11614913 T > G) and miR-146a (rs2910164 C > G) in Mexican CRC patients.

DNA samples from 183 patients and 186 healthy Mexican subjects were analyzed. Variants were identified by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methodology. Association was calculated by the odds ratio (OR) and adjusted by the Bonferroni test.

Patients carrying the G/G genotype of the rs895819 variant in the miR-27a gene showed an increased risk of CRC (19% vs 12%, P = 0.013). A similar tendency was noticed for patients younger than 50 years carrying A/G (48% vs 41%, P = 0.014). The A/G genotype in TNM stages I + II (55.7% vs 40.8%, P = 0.011) and tumor location in the colon (69.5 vs 40.8%, P = 0.001) were also increased. For the variant rs11614913 of the miR-196a2 gene, carriers of the C/C genotype showed an increased risk of CRC (32% vs 22%, P = 0.009). This genotype was more frequent in TNM stage III + IV (36.8% vs 22.5%, P = 0.007) and the tumor had a more recurrent location in the rectum (31.6% vs 22.5%, P = 0.013). The rs2910164 variant of the miR-146a gene was found to have no significant risk associations.

Our results reveal that the rs895819 variant in miR-27a and rs11614913 in miR-196a2 have a substantial impact on the development of CRC.

Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists’ approach to surgical counseling for patients with MS (PwMS).

21 MS specialists were asked about 11 case scenarios with different MS disease statuses, disease-modifying therapies (DMTs), and urgency of the operation. The reasons for refusing surgery or factors that have to be considered before surgery were studied.

Overall, Fleiss Kappa was estimated to be 0.091 [95% confidence interval (CI): 0.090-0.093, P < 0.001] indicating a very poor level of agreement among responders.

PwMS face surgery for various reasons. Risk assessment of surgery, the effect of various drugs such as anesthetics and DMT on patients, as well as many other aspects of MS are issues challenging the practitioners. Clarifying the various dimensions of these issues requires further research.

Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy measures of this method.

PubMed (Medline®), Web of Science, Embase, Scopus, and the Cochrane Library databases were searched until April 9, 2021. Clinical studies (other than case reports and case series), in English, were included. Then, publications concerning alternate dose fingolimod (including every other day, every two or three days) were selected. Those studies concerning reduced daily dose (any daily dose less than 0.5 mg/day) were excluded to focus on alternate dosing.

Four observational studies were included. Data on Ohtani et al. study were limited. Three other studies were of good quality based on the Newcastle-Ottawa Scale. A total of 296 patients on the standard dose were compared to 276 patients on the alternate dosage. The most common reason for switching to the alternate dose was lymphopenia, followed by elevated liver enzymes. Two studies concluded that the alternate dosing could be a safe, yet effective strategy in patients with intolerable adverse effects of daily dose. However, Zecca et al. warned about the high possibility of disease reactivation. Due to the differences in outcome measures of the studies, meta-analysis was not applicable.

This systematic review highlights the ambiguity of evidence on safety and efficacy of alternate dosing of fingolimod, encouraging further research on the subject.

People with multiple sclerosis ‎(MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical cases with different physical and cognitive conditions. Opinions of 20 MS specialists regarding the best approach to 6 case scenarios (with different clinical, cognitive, and imaging characteristics) were gathered via a form. The estimated kappa of 0.16 [95% confidence interval (CI): 0.159-0.163; P < 0.001] suggested a poor degree of agreement on the treatment choice among the professionals. Although most specialists agreed with treatment escalation in cases with cognitive impairment, there was no general agreement. Furthermore, there was not enough clinical evidence in the literature to develop consensus guidelines on the matter.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding EPO to intravenous methylprednisolone (IVMP) in patients with acute attacks of NMOSD.

NMOSD cases with acute attacks were included. Cases of optic neuritis (ON) and those with myelitis were separated. After randomization [with block sizes of 2 (1:1 ratio)], the patients in the intervention group received IVMP 1000 mg/day and intravenous (IV) EPO 20000 U/day for five days. IVMP 1000 mg/day and normal saline (NS) were administered in the control group. Staged eye score and motor forces were evaluated in the patients with ON and myelitis, respectively, at the time of the attack and three months later. Primary patient allocation and clinical assessments were blinded to the physicians.

Mean age of participants was 53.87 ± 11.53 years. At follow-up, in the ON arm, the median improvement in staged eye score was 2 in the control and 5 in the intervention group. The difference was significant (P < 0.001). In the myelitis group, none of the patients in the control group had improvement in motor forces. All the patients in the intervention group showed substantial improvement with minimal or no remaining weakness. The difference was statistically significant (P = 0.029).

The results show the possible benefit of adding EPO to the classic IVMP in attacks of NMOSD in both visual and motor aspects.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune rare disorder that involves the endfeet of astrocytes. The role of genetics in the disease is not well known. Rare cases of familial NMOSD were reported worldwide. In this report, first, we presented a young man with myelitis and his cousin who suffered from this disease. Then we reviewed some reports around the world about familial NMO. The prevalence of familial NMO is nearly 3%. First cases are reported from East Asia. Its characteristics are similar to the sporadic type. Recent data suggest genetics play role in NMO.

There are limited data on the possible association between conventional and advanced magnetic resonance imaging (MRI) findings and cognitive function in patients with multiple sclerosis (MS). Therefore, this systematic review and meta-analysis aimed to explore the correlation between MRI-derived metrics and cognitive tests in patients with MS. An electronic literature search of the PubMed, Web of Sciences, Embase, and Scopus databases was performed to identify related studies. The correlation coefficients of the MRI indices and cognitive tests were pooled. Thirteen studies were selected for inclusion of 824 patients diagnosed with MS. Most evaluated patients (60.44%) had relapsing-remitting MS (RRMS). The Paced Auditory Serial Addition Test (PASAT-3), Brief Visuospatial Memory Test (BVMT), and Symbol Digit Modalities Test (SDMT) were inversely correlated with the mean diffusivity (MD) of the brain with pooled correlation coefficient of -0.225, -0.361, and -0.438, respectively (P<0.0001). The SDMT test positively correlated with fractional anisotropy (FA) with a correlation coefficient of 0.351 (P<0.0001) and inversely correlated with T2 lesion volume with a correlation coefficient of -0.367 (P<0.0001). In the case of other tests, there was low number of studies with significant correlations being reported. We found significant correlations between some neuropsychological tests and MRI findings in patients with MS. Brain atrophy might disrupt the process of correct registration between anatomical and MRI diffusion scans. However, we did not have enough studies with exactly matched anatomical areas to evaluate correlations and we recommend that histological validation of diffusion tensor imaging (DTI) findings for brain atrophy is needed as a basis for picture processing procedures and correlation with cognition status.

Cognitive impairments in patients with multiple sclerosis (MS) are suggested as a prognostic factor for disease development, and consequently higher disability and more deficits in daily and social activities. In this regard, we aimed to investigate the association between quality of life (QOL) and cognitive function in patients with MS.

We conducted a cross-sectional study on patients with relapsing-remitting MS (RRMS). General characteristic variables were carried out, and then all patients underwent assessments such as Multiple Sclerosis Quality of Life-54 (MSQOL-54), Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS), Expanded Disability Status Scale (EDSS), Beck Depression Inventory-II (BDI-II), and North American Adult Reading Test (NAART).

In the present study, a total of 92 patients, including 76 women with a mean disease duration of 6.82 ± 4.80 years were involved. Results of simple Pearson correlation revealed a significant positive relation between California Verbal Learning Test (CVLT) total learning with MSQOL mental health (r = 0.267, P = 0.017) and physical health (r = 0.299, P = 0.007). After adjusting for potential confounders, there was a negative correlation between MSQOL mental health with Delis-Kaplan Executive Function System (D-KEFS) (r = -0.303, P = 0.015) and Judgment of Line Orientation (JLO) (r = -0.310, P = 0.013). Besides, MSQOL physical health was negatively associated with Brief Visuospatial Memory Test-Revised (BVMT-R) in the adjusted model (r = -0.270, P = 0.031).

There is a statistically significant association between specific aspects of cognitive decline and QOL. Therefore, more attention should be paid to cognitive impairment in patients with MS as based on our findings, it is significantly associated with QOL.

Now that the majority of the population has been immunized with two-dose vaccines, debates over the third booster dose have been raised. We studied the viewpoint of cases with multiple sclerosis (MS) on this matter.

In a cross-sectional study, a google form containing questions about participants’ characteristics, the history of coronavirus disease 2019 (COVID-19) infection and vaccination, and opinions on the third dose was designed.

Of 1067 responders, only 16 (1.5%) were not vaccinated at all. The most used vaccine type was Sinopharm BBIBP COVID-19 vaccine (BBIBP-CorV) (n = 1002, 93.9%). Generally, 58 (5.4%) cases were hospitalized due to COVID-19. Of those with full vaccination, 134 (13.3%) got COVID-19 infection after the second dose. Only 13 participants (1%) did not agree with the third dose, while 564 (53.0%) believed that a booster dose was needed. Of all, 488 (45.7%) declared that they did not have a final idea and would follow the instructions by the experts. A significant association was found between not receiving the first two doses and not believing in the third dose (P = 0.001). 692 patients declared their reasoning for the importance of the third dose. All the cases who thought the administered vaccine was not efficient enough had received Sinopharm BBIBP-CorV. Those who got infected after full vaccination were more uncertain about the efficacy of the vaccine [odds ratio (OR): 2.6, 95% confidence interval (CI): 1.6-4.2].

It seems that the majority of the Iranian patients with MS expect the authorities to administer a third booster dose, especially if scientifically validated.

Cognitive dysfunction is one of the problems that patients with neuromyelitis optica spectrum disorder (NMOSD) suffer from. We aimed to assess the association between demographic and clinical features as well as body mass index (BMI) and cognitive function in patients with NMOSD.

A cross-sectional study was performed on 41 patients with definite diagnosis of NMOSD. Serum status of neuromyelitis optica immunoglobulin G (NMO-IgG) was determined using enzyme-linked immunosorbent assay (ELISA) method. Cognitive function was assessed by Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) battery which is validated for Persian people before and North American Adult Reading Test (NAART).

The mean score of NAART test was higher in participants with normal weight compared with overweight patients (40.47 ± 3.51 vs. 36.00 ± 5.74, P = 0.02). Current age was negatively correlated with Delis-Kaplan Executive Function System (D-KEFS)-Sorting (P = 0.05, r = -0.30). The correlation of duration of disease and cognitive performance was not significant (P > 0.05). Higher physical disability based on Expanded Disability Status Scale (EDSS) was correlated with lower results in Brief Visuospatial Memory Test-Revised (BVMT-R) (P < 0.01, r = -0.50), California Verbal Learning Test-second edition (CVLT-II)-Delayed Recall (P = 0.02, r = -0.35), and Symbol Digit Modalities Test (SDMT) (P = 0.03, r = -0.33) subtests of MACFIMS. Annual relapse rate was indirectly correlated with CVLT-II (P = 0.03, r = -0.34) and CVLT-II-Delayed Recall (P = 0.01, r = -0.38). Male participants obtained better scores in Paced Auditory Serial Addition Test (PASAT) subtest (P = 0.05). NMO-IgG seropositive patients had poorer performance in terms of CVLT-II-Delayed Recall, Controlled Oral Word Association Test (COWAT), and D-KEFS-Descriptive (P < 0.05). Participants with bachelor and master education degrees showed significantly better results compared to those with high school degree (P < 0.05).

Investigating the clinical and demographic factors affecting cognitive impairment can increase the awareness of health care providers for early diagnosis of cognitive impairment in patients with NMOSD and increase the quality of health services.

Shortly after the onset of the coronavirus pandemic, different vaccines were developed to combat it. The vaccines had different mechanisms and triggered cellular and humoral immune responses against the virus. In addition to their positive effects, various side effects have been reported for them. They rarely cause severe complications. They can also rarely trigger latent infections. The present case report presents a patient who developed herpes simplex encephalitis after receiving the second dose of the Covaxin (BBV152).

 Evidence found the most common cognitive problem, learning disabilities, in patients with multiple sclerosis (MS) at the stage of decoding new information. Although, the effectiveness of verbal learning and enactment strategies were evaluated and compared in MS patients, the difference of their effectiveness on cognitive functions was not considered. In the present study, the effect of verbal and active learning was investigated on the change of cognitive functions in MS patients.

The present clinical study included 30 MS patients who were divided into two groups of 15 subjects for verbal and active learning. Participants completed some baseline assessments including initial psychological assessment via the Beck Depression Inventory and the Beck Anxiety Inventory, cognitive assessments in pre- and post-test evaluations by the tests of MACFIMS battery including California Verbal Learning Test, second edition (CVLT-II), Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modality Test (SDMT) and Brief Visuo-spatial Memory Test – Revised (BVMT-R). The treatment consisted of six separate verbal and active learning sessions for each group. Learning materials included six lists containing 16 simple instructions consisting of a noun and a verb.

In the post-test cognitive evaluation, both groups made significant progress (p<0.05) in working memory. In addition, the active coding group showed significant improvement in verbal learning, and the verbal learning group showed significant improvement in processing speed (p<0.05).

Applying a combination of enactment and verbal learning strategies is suggested to reduce learning problems in MS patients.

Emotional intelligence refers to a process through which an individual is not only capable of understanding his/her/others’ emotions, but also is able to manage them. Emotional intelligence can get disturbed due to different neurological diseases. Since cognition and emotion are directly and closely related, the present study aims to evaluate the relationship between emotional intelligence and cognitive disorders in patients with Multiple Sclerosis (MS).
The demographic data of 92 MS patients participating in this study were recorded. The emotional intelligence and cognitive disorders were studied using the Bradberry-Greaves, and MS Neuropsychological Questionnaire (MSNQ) tests, respectively.
16 men and 76 women were considered in this study. The mean age of the participants was 33.4 years, the mean duration of the disease was 6.8 years, the mean of Expanded Disability Status Scale (EDSS) was 1.97, the mean MSNQ was 21.58, and the mean emotional quotient (EQ) of the patients was 74.18. The MSNQ had a significant relationship with the total EQ and its sub-categories (P This study showed that EQ and cognitive disorders are directly relevant to each other; as cognitive disorder increases, the EQ rate decreases. Therefore, cognitive rehabilitation might be effective in enhancing the EQ in these patients.

It is critical to understand how accurately physicians can estimate the importance of each clinical finding in estimating the probability of a specific diagnosis in the process of clinical decision making. This study aimed to investigate whether physicians’ estimates of the importance of various clinical findings of ascites correlated with the positive likelihood ratios of these findings in diagnosis of ascites.
One hundred and ten physicians were asked to respond to a questionnaire. In this questionnaire they were presented with a clinical scenario about a patient suspected of having ascites followed by a list of clinical findings. Participants were asked to assign a weight (between 0 and 100%) to each clinical finding based on their perception of how much the presence of that finding changed the probability of ascites for the patient. Positive likelihood ratios of those findings were extracted from current best evidence. We investigated if the weights assigned by physicians were associated with the positive likelihood ratios of those findings.
Significant differences were discovered between the weights assigned by the physicians and the positive likelihood ratios for each clinical finding. Significant positive correlation was observed between the weights assigned by different groups of physicians.
Physicians inaccurately estimated the importance of various clinical findings in the diagnosis of ascites. Further research is needed to determine if such inaccurate estimations would lead to any adverse clinical outcomes

Considering the prevalence of epilepsy and its great impact on patients’ lives, diverse diagnostic and therapeutic techniques have been developed. Long term monitoring (LTM), simultaneous recordings of seizure attack and electroencephalograms, facilitates achieving definite diagnosis and appropriate treatment.
Therefore, understanding the foundations of this technique helps neurologists and other interested parties to apply it appropriately.

Meningiomas are rare tumors of posterior fossa. Delayed intracranial hemorrhage is a rare complication of surgeries in this territory. Herein, we report a case of status epilepticus asa result of delayed motor cortex hemorrhage, complicating resection of a meningioma arising from foramen magnum.