فهرست مطالب mehrdad emami

Objective (s): From a genetic point of view, epilepsy is a polygenic multifactorial syndrome. The SCN1A and B genes belong to a family of genes that provide instructions for making sodium channels. Understanding the relevance of SCN1A and SCN1B gene polymorphisms to plasma concentration of carbamazepine (CBZ) and its active metabolite carbamazepine 10, 11 epoxide (CBZE), may shed more light on inter-individual variations in response to CBZ. In this cross-sectional study, genotype distribution and allele frequency of six non-synonymous exonic single nucleotide polymorphisms (SNPs) of the SCN1A and B genes were selected and determined using PCR-RFLP in 70 epileptic patients treated with CBZ for at least 6 months. The patients had no hepatic or renal diseases and received no medications known to have a major interaction with CBZ. Serum concentrations of CBZ and CBZE were measured using High-Performance Liquid Chromatography (HPLC). The AA, AG and GG alleles of SCN1A were found in 23, 37 and 10 patients, respectively. There were no statistically significant differences in the mean (± standard deviation) of plasma concentrations of CBZ (P=0.8) and CBZE (P=0.1) among these 3 groups. Likewise, there was no statistically significant relationship between SCN1A polymorphisms and CBZ concentration/dose ratio (P=0.7). A significant association was found between CBZ plasma level and CBZ concentration/dose with CBZ daily dose. All patients had the same genotype of SCN1B gene(CC). and no statistical analysis was performed. No significant association between SCN1A gene polymorphisms and plasma levels of CBZ and CBZE were found.

This study compares the clinical characteristics of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) with those who have temporal lobe epilepsy (TLE) due to other etiologies. In this retrospective study all patients with a clinical diagnosis of TLE were recruited in a referral outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 to May 2013. We classified the patients with TLE as having mesial temporal sclerosis if they had clear signs of mesial temporal sclerosis and/or atrophy in their MRI and others who had any other MRI abnormality. A total of 174 patients were studied (including 105 patients with mTLE-HS and 69 patients with TLE due to other etiologies). Frequency of seizure types was not significantly different between these two groups. Earlier age at epilepsy onset (p= 0.005), a past history of febrile seizures (p= 0.010) and presence of affective auras (p= 0.008) were commonly seen in patients with mTLE-HS, while auditory auras (p= 0.020) were more frequent in those with TLE due to other etiologies. The mainstay for making a correct diagnosis, when evaluating a patient with seizure, is having a standardized approach, particularly with regard to taking a detailed clinical history. One may find important clues in the clinical history (e.g., age at disease onset, detailed seizure description and past history) to make a correct diagnosis.

The aim of the current study was to assess the extent to which complementary and alternative medicine (CAM) has been used in children and adults to treat seizures and to compare the perceptions and usage of CAM between adult patients who decides for themselves and adults who decide for their sick children.In this cross-sectional study, patients who have been treated for epilepsy for at least one year at the outpatient epilepsy clinic at the Shiraz University of Medical Sciences were interviewed from January 2012 through March 2012. The questionnaire collected specific information of CAM perceptions and usage among patients. Pearson Chi-Square and Student’s t- test were used to compare variables among children group with adults group. Ninety-eight children (their caregivers) and 158 adults (themselves) participated. Adult patients (53%) more frequently believed that CAM might be useful in treating seizures than adults with sick kids (35%) (P = 0.0004). Herbal drugs, traditional medicine and exercise were more often considered as being helpful in treating seizures among adult patients compared to adults with sick children. CAM usage was not different among adult patients compared to adults with sick kids (P = 0.3). CAM is an option considered by many people with epilepsy to treat seizures. The individual who makes the decision as to use any of these unconventional treatment options is probably not different when it comes to self (the patient himself) vs. non-self (the parents / care-givers), despite the observed difference that adult patients more frequently believed that CAM might be useful in treating seizures than adults with sick kids.

Complementary and alternative medicine is considered and used by many people with epilepsy to treat seizures, despite the lack of enough scientific proof for its efficacy.. The aim of the current study was to assess the extent to which patients with epilepsy use complementary and alternative medicine (CAM), and to assess the perceptions of CAM among these patients..Patients and In this study patients with epilepsy were recruited at two epilepsy centers in Iran (Shiraz and Tehran). The survey collected specific information about CAM perceptions and usage. All independent variables were correlated with the dependent variables: the perception about CAM and the CAM usage. The Pearson Chi-square test and Student’s t-test were used for univariate analyses. Subsequently, multivariate analysis using logistic regression was performed on variables that were significant (P < 0.05) in univariate analysis.. Three hundred and twenty-three patients and / or their caregivers in Shiraz, and 227 people in Tehran were recruited. One hundred and thirty-nine patients (43%) in Shiraz, and 116 (51%) in Tehran and it was thought that at least one of CAM treatments might be helpful to treat seizures. Forty-five patients in Shiraz and 30 people in Tehran had used CAM to treat their seizures. We could not find a model to predict which thinks that CAM is effective in treating seizures. However, we found a model among CAM users. Within this model educational level made a significant contribution. People with epilepsy who had either a low education or, on the contrary, were highly educated more likely used CAM to treat their seizures.. CAM is considered and used by many people with epilepsy to treat their seizures. Cultural issues probably play an important role in having faith in CAM and consequently using a specific method of CAM to treat seizures..

Objective We investigated the correlation between different interictal EEG abnormalities observed in patients with idiopathic (genetic) generalized epilepsies (IGEs) and their seizure types. Material & MethodsIn this cross-sectional study, all patients with the diagnosis of IGE, were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 through 2010. Demographic variables and relevant clinical and EEG variables were summarized descriptively. Statistical analyses were performed using independent samples T-test, Chi square and Fisher's Exact tests to determine potentially significant differences. ResultsThree-hundred thirty-six patients were diagnosed ashaving IGE. Interictal EEG findings in patients with generalized tonic-clonic seizure (GTCS) compared to patients without GTCS were not different. Abnormal EEG findings in patients with myoclonic seizures compared to patients without these were not different either. However, normal EEGs were more frequently observed in patients with history of myoclonic seizures (P = 0.0001). EEG findings in patients with absences compared to patients without absences were not different. ConclusionInterictal EEG cannot differentiate the seizure types and therefore different syndromes of IGEs. Polyspikes, 3-Hz generalized spike-wave (GSW) complexes and 3.5 - 6 Hz GSW complexes, alone or in combinations, could be observed in various seizure types and syndromes of IGE. The key element in making the correct diagnosis is a detailed clinical history.

The main purpose of the current study was to determine the effect of treating helicobacter pylori (HP) infection on seizure frequency in patients with refractory epilepsy. A small sample of adult patients above 18 years of age with a diagnosis of refractory epilepsy was studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from January 2009 through June 2011. If and when urea breath test result was positive, an upper endoscopy with multiple gastric biopsies was requested. Rapid urease test and histopathology examination were performed. For patients with confirmed HP infection, treatment with clarithromycin, amoxicillin and omeprazole was ordered for two weeks. Seizure frequency was recorded before and after HP treatment. Nine patients were recruited. Using Wilcoxon signed ranks test, seizure frequency did not differ significantly after HP treatment compared to the period before treatment (P = 0.6). Treating HP infection in patients with refractory epilepsy did not significantly change the seizure frequency.

ObjectiveSeveral antiepileptic drugs (AEDs) such as phenobarbital (Pb), carbamazepine (CBZ), and valproate (VPA) may suppress interictal epileptiform activity. We investigated the effects of AEDs on electroencephalography (EEG) data from patients with idiopathic generalized epilepsy (IGE).Materials & MethodsIn this cross-sectional study, all patients electroclinically diagnosed with IGE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 through August 2010. A routine EEG was requested at the time of referral for all patients. Statistical analyses were performed using Chi square and Fisher’s exact test.ResultsThis study comprised of 336 patients. For about 20.8% (70 patients) of them, the initial EEG appeared normal. The first EEG was normal in 14.2% of the patients who had newly diagnosed IGE (19 patients). Normal EEG was also detected for 27.6% of the patients who received VPA monotherapy (16 patients), 31% of the patients who received CBZ monotherapy (9 patients), 29.4% of the patients who received Pb monotherapy (5 patients), and 11.1% of the patients who received lamotrigine (LTG) (1 patient).ConclusionThis study shows that compared to LTG, VPA suppresses generalized interictal epileptiform activity in patients with IGE more effectively. Theoretically, if a drug can frequently induce normalization of EEG, then it may be a better drug for treating IGEs.