فهرست مطالب

Current Journal of Neurology
Volume:20 Issue: 1, Winter 2021

  • تاریخ انتشار: 1400/03/19
  • تعداد عناوین: 10
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  • Alireza Eishi Oskouei, Keivan Basiri * Pages 1-7
    Background

    This parallel-group single-blind trial evaluates the safety and efficacy of Edaravone, as a free radical scavenger, in a highly selective subgroup of Iranian patientswithamyotrophic lateral sclerosis (ALS).

    Methods

    The study was registered in ClinicalTrials.gov (registration number: NCT03272802) and Iranian Registry of Clinical Trials (registration number: IRCT20190324043105N). Patients were included into the study, who were diagnosed as probable or definite ALS (according to revised El Escorial criteria), mildly to moderately affected by the disease [according to Amyotrophic Lateral Sclerosis Health State Scale (ALS/HSS)], scored ≥ 2 points on all items of the Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R), and had forced vital capacity (FVC) of at least 80%. 20 patients (10 cases, 10 controls) were observed for 12 cycles (each cycle lasted four weeks). Cases received Edaravone for the first 14 days in the first cycle and for the first 10 days in the next cycles. In addition, all patients received Riluzole. The 40-item Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-40), ALSFRS-R, and Manual Muscle Testing (MMT) scores were measured every 3 cycles to evaluate the physical and functional status of the patients. Besides, injection reactions, adverse events (AEs), and serious adverse events (SAEs) were measured during the study.

    Results

    ALSAQ-40, ALSFRS-R, and MMT scores were not significantly different between cases and controls in 5 different time points. During the study, no injection reactions were observed. AEs and SAEs were not significantly different between cases and controls.

    Conclusion

    Our data did not demonstrate efficacy of Edaravone in ALS treatment, but showed its safety for use in patients with ALS. Further studies are necessary to investigate Edaravone efficacy in patients with ALS before prescribing this new drug outside Japan.

    Keywords: Amyotrophic Lateral Sclerosis, Radicava, Clinical Trial, Single-Blind Method
  • Omidvar Rezaei, Mahtab Ramezani, Mehrdad Roozbeh, Bahareh Fazeli, Mohammadreza Hajiesmaeili, Hossein Pakdaman, Leila Simani * Pages 8-14
    Background
    Clinical studies have reported improved neurological outcomes in patients who were taking vitamin D supplements. This study investigates the effect of intramuscular (IM) vitamin D supplementation in patients with acute ischemic stroke (AIS) on neurological outcomes and inflammatory marker levels.
    Methods
    This study included patients diagnosed with AIS (n = 60) from the Neurology Unit of Loghman Hakim Hospital, Tehran, Iran, during the year 2019. Patients with AIS were allocated randomly into two groups who received a single dose of 300000 IU IM vitamin D and a control group that did not receive vitamin D supplementation. Serum vitamin D concentration, interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α) levels, as primary outcomes, and the Modified Rankin Scale (MRS), the National Institute of Health Stroke Scale (NIHSS), and the Mini-Mental State Examination (MMSE), as secondary outcomes, were measured at the baseline and the end of the study (6 weeks).
    Results
    Eventually, 59 patients with AIS completed the intervention study. A single dose of 300000 IU increased vitamin D level; moreover, vitamin D supplementation improved MRS and IL-6 levels significantly (P = 0.01, P = 0.02, respectively). There were reverse correlations between serum vitamin D and NIHSS and TNF-α after vitamin D administration. However, no statistically significant effect of vitamin D on the TNF-α or NIHSS and MMSE was seen compared to the control group.
    Conclusion
    Vitamin D probably due to a single dose and short duration of administration, as well as a short follow-up period, had no favorable effects on TNF-α level and NIHSS score.
    Keywords: Vitamin D, Ischemic Stroke, Neurologic Manifestations, Inflammation, Cognitive Function
  • MohammadAli Sahraian, Abdorreza Naser Moghadasi, Sharareh Eskandarieh * Pages 15-22
    Background

    After intensified economic sanctions against Iran, decreased welfare of patients were more recognizable. The present study was aimed at identifying the challenges and stress level experienced by patients with multiple sclerosis (MS) regarding treatment and health care services in 2018-2019 after strengthening of economic sanctions against Iran.

    Methods

    A cross-sectional study was conducted on MS patients in Tehran, Iran. A structured questionnaire was designed to measure the main variables addressing the challenges and stress level of MS patients with respect to receiving care and treatment services.

    Results

    In total, 1039 MS patients were enrolled into the study. Among the patients who answered yes to the selected questions, 873 (85.8%) and 837 (86%) were concerned about medicine unavailability and supply and purchase of internationally branded medicine, respectively. Moreover, 671 (70.3%) subjects were concerned about replacing their medicines with cheaper alternatives due to financial problems and 427 (41.4%) were unwilling to continue their treatment due to the economic burden of MS. In total, 795 (82%) were concerned about the effectiveness of Iranian drugs in comparison with internationally branded drugs. Generally, 970 (93.53%) subjects had experienced increased current living costs and 711 had experienced (68.82%) reduced nutrition quality, which (OR: 2.68; 95% CI: 1.99, 3.60) was significantly higher among subjects who had an income of less than or equal to 250 US$ per month

    Conclusion

    The sanctions can impose greater stress and hardship on patients due to the unavailability and costs of medicines. Iran should manage health care quality and provide services to prevent the adverse effects of sanctions on MS patients and guarantee patients’ right to receive well-established medication and health services.

    Keywords: Multiple Sclerosis, Sanction, Medicine, Stress
  • Elham Manouchehri, Morteza Saeedi, Khadijeh Mirzaei Najmabadi * Pages 23-31
    Background

    In chronic illnesses, sexual dysfunction (SD) is one of the most prevalent complaints. Sexual self-efficacy (SSE) is an individual’s beliefs about his/her ability to perform an effective sexual function and be favorable to their partner. The aim of the present study was to assess SSE and sexual function in women with multiple sclerosis (MS).

    Methods

    This cross-sectional study was carried out in 2019 on 260 married women referring to the MS clinic and MS society of Khorasan-Razavi in Mashhad, Iran. The research population was selected using convenience sampling. The Sexual Self-Efficacy Questionnaire (SSEQ), Multiple Sclerosis Intimacy and Sexuality Questionnaire‎-19 (MSISQ-19), and the Female Sexual Function Index‎ (FSFI)‎ were completed by the participants who had the inclusion criteria. The collected data were analyzed using descriptive statistics and Spearman's rank correlation coefficient in SPSS software.

    Results

    The participants had a mean age of 35.2 ± 8.4 years and their mean duration of MS was 4.46 ± 3.71 years. The findings showed a negative correlation between SSE and SD (r = -0.606; P = 0.001) and a positive correlation between SSE and sexual function (r = 0.644; P = 0.001). Moreover, MSISQ-19 and FSFI scores supported each other (r = -0.675; P = 0.001).

    Conclusion

    SD is prevalent among women with MS. Moreover, sexual function is substantially associated with SSE in these women.

    Keywords: Multiple Sclerosis, Self Efficacy, Sexual Health, Sexual Dysfunction, Cross-Sectional Studies, Iran
  • Morteza Faghih Jouybari, MohammadTaghi Raof, Sina Abdollahzade *, Sanaz Jamshidi, Tahereh Padeganeh, Saeid Ehteshami, Soroush Fateh Pages 32-36
    Background

    Intracerebral hemorrhage (ICH) is the most common cause of non-ischemic strokes. Considering high mortality and poor functional status following ICH, we investigated factors that can predict short-term outcome and affect recovery of these patients.

    Methods

    In this prospective descriptive study, 100 patients with non-traumatic ICH were included. Clinical and radiographic data were collected and extent of disability was measured by modified Rankin Scale (mRS) at discharge, 1 week, 1 month, and 3 months after discharge.

    Results

    32 of 100 cases died at hospital and 6 more expired during 3-month follow-up. Risk factors of in-hospital mortality were warfarin use, surgical intervention, and high ICH score. Functional status of patients significantly improved 3 months after discharge. Factors associated with poor recovery were age older than 70, history of coronary artery disease (CAD), low Glasgow Coma Scale (GCS) at admission, elevated mean arterial pressure (MAP), longer hospitalization, and high ICH score.

    Conclusion

    ICH was associated with high rate of mortality (36%). Warfarin use, surgical intervention, and high ICH score were predictive of mortality during hospitalization and 3-month follow-up. Improvement of functional status began after 1 month and significantly improved 3 months after discharge.

    Keywords: Cerebral Hemorrhage, Mortality, Morbidity
  • Motahareh Afrakhteh, Sara Esmaeili, Mohsen Shati, Seyedeh Fahimeh Shojaei, Maryam Bahadori, Babak Zamani, Mostafa Almasi Doghaee, Bahram Haghi Ashtiani * Pages 37-42
    Background

    Amyotrophic Lateral Sclerosis-Specific Quality of Life-Revised (ALSSQOL-R) encompasses 50 items which assess quality of life (QOL) in patients with amyotrophic lateral sclerosis (ALS) in six major domains. This study aims to translate the ALSSQOL-R into Persian and evaluate its reliability and validity among Iranian patients.

    Methods

    ALSSQOL-R was translated by the standard multi-step forward-backward method. Content validity was calculated using item content validity index (I-CVI). Three items in the “intimacy” domain were deleted considering Iranian culture. Cronbach’s alpha was used for all 6 dimensions to calculate the internal consistency reliability. Test-retest reliability was evaluated using intraclass correlation coefficient (ICC) with one-month interval. Concurrent validity was measured by the validated version of 36-Item Short Form Health Survey (SF-36) questionnaire.

    Results

    Sixty-three patients with ALS were enrolled in the study. I-CVI was 70%, promoted to 85% after modifications (acceptable). Regarding internal consistency reliability, Cronbach’s alpha in all six domains was ³ 0.70 and total Cronbach’s alpha was 0.89 which is assumed as good. In terms of test-retest reliability, ICC [95% confidence interval (CI)] was 0.91 (91%) and Pearson correlation coefficient (r) was 0.90 (P < 0.001), all indicating an excellent reliability. The concurrent validity was established based on a strong correlation with SF-36 (r = 0.744, P < 0.001).

    Conclusion

    The findings show that the modified Persian version of ALSSQOL-R is a valid and reliable QOL questionnaire which can be used for Iranian patients with ALS in both clinical and research settings.

    Keywords: Amyotrophic Lateral Sclerosis, Quality of Life, Validity, Reliability
  • Shima Zareh Shahamati, Mahyar Noorbakhsh, Hadi Digaleh, Behnam Safarpour Lima * Pages 43-48

    Based on previous studies, seizure has been reported to accompany coronavirus disease 2019 (COVID-19). Underlying mechanisms are those leading to the direct central nervous system (CNS) invasion through hematogenous spread or trans-synaptic retrograde invasion, causing meningoencephalitis. On the other hand, there are pathophysiologic mechanisms that seizure would be one of their early consequences, such as cytokine storm, hypoxemia, metabolic derangement, and structural brain lesions. Herein, we focused on available evidence to provide an insight into the pathophysiologic mechanisms that link seizure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as a better understanding of pathophysiology would lead to better diagnosis and treatment.

    Keywords: SARS-CoV-2, Covid-19, Seizures, Neurology
  • Morteza Sanei Taheri, Zahra Mahboubi Fooladi *, Reza Soleimani Pages 49-51
  • Cannane Seetharaman, Haritha Vasudev, Virna Shah * Pages 52-53
  • Payam Sarraf *, Ali Goudarzi Pages 54-55