Current Journal of Neurology
Volume:23 Issue: 3, Summer 2024

Comatose is a state of deep unconsciousness in an individual being unresponsive which has an impact on the informal caregivers providing care to their kinships. The validity and reliability of the domains of the Knowledge, Attitude, Awareness-Comatose Caregiver Questionnaire (KAA-CCQ) and has been taken into consideration as an outcome measure to assess the level of knowledge, attitude, and awareness among the caregivers of comatose patients. 68 informal caregivers above the age of 18 years related to comatose patients were included in the study. The self-developed KAA-CCQ was administered on the informal caregivers of comatose patients to assess the level of knowledge, attitude, and awareness regarding coma. Validity and reliability of the questionnaire were calculated by Spearman’s rank correlation and Cronbach΄s alpha, respectively. The reliability of all the three domains and the questionnaire was found to be 0.8 and the item correlation with respect to the domain was above 0.6 for the knowledge whereas it was above 0.6 for the attitude and awareness domains that justified the validity of the questionnaire, and also the questionnaire had an excellent reliability. The KAA-CCQ will be a suitable questionnaire to assess the knowledge, attitude, and awareness in the informal caregivers of comatose patients.

Delirium is a common challenge in pediatric open heart surgery intensive care units (OH-ICU). It is believed that emergence of delirium can lead to extended hospitalization periods. Therefore, we decided to investigate the association between delirium and its inciting factors in OH-ICU. This was a cross-sectional study on 92 pediatric patients admitted to OH-ICU of “Children’s Medical Center” in Tehran, Iran, for more than 48 hours. To screen for delirium, the Cornell Assessment of Pediatric Delirium (CAPD ≥ 9) was utilized. Demographics, length of stay, development of complications, delirium, and factors associated with delirium were recorded. We observed 34 (37%) cases of delirium in patients in OH-ICU. We had 51% male patients and 49% female ones, with a median age of 8 (0.2-144) months. The median length of mechanical ventilation was 11.5 hours (2-405) and they stayed in the hospital for a median of 4 days (2-31). The most common cardiac abnormality was ventricular septal defect (18%), associated with tetralogy of Fallot (TOF) (10%). Most of the patients (71%) experienced no adverse events during their stay; however, among those who did, vomiting and post-operation chorea were the most prevalent. Among the patients in our study, age [adjusted odds ratio (AOR) = 0.91], weight (AOR = 1.34), and sex (AOR = 0.31 for boys vs. girls) were significantly associated with delirium. We observed delirium in 37% of the patients. Development of delirium in patients admitted to pediatric intensive care unit (PICU) was associated with younger age, female sex, and higher weight.

Arachnoid cysts (ACs) are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled cavities lined with arachnoid membranes. Most of them are found incidentally and are asymptomatic. The aim of this study was to describe the clinical and demographic characteristics of ACs and to investigate the frequency of complications. ACs were classified as cerebral and cerebellar, and were evaluated according to location and size using the Galassi classification. Evaluation was made of 103 patients with AC admitted to the pediatric neurology department. The patients comprised 62.1% boys and 37.9% girls with a mean age of 10.1 ± 4.9 years. Headache was present in 33% of patients, epileptic seizures in 22.3%, and neuromotor developmental delay in 14%. Spontaneous intracranial hemorrhage (ICH) was observed in 6 patients (5.8%), with 3 (50%) having a cyst diameter ≥ 5 cm. ACs frequently involved the retrocerebellar and temporal lobes. Epilepsy was diagnosed in 26 patients (25.2%) and in only one of them, epileptic discharge and AC originated from the same region. The risk of bleeding was found to be higher in patients with cyst diameter ≥ 5 cm (P = 0.032). Although ACs are generally considered harmless, a cyst size ≥ 5 cm is important in terms of the risk of bleeding and should be followed up regularly. Although it has been reported in the literature that ACs may be associated with epilepsy, no significant correlation was found between seizure type and electroencephalography (EEG) recordings in this study.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD. This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3). Eighteen patients (15%) reported headaches, all of whom were women. The average age of these patients was 41.27 ± 11.33 years, and the average onset age of NMOSD was 34.60 ± 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 ± 1.42) than those with tension headaches (4.20 ± 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis. Significant associated symptoms included photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57% of migraine sufferers and 50% of tension headache sufferers. Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.

Mitochondrial metabolism disruption increases neuron excitability and reduces migraine attack threshold. This study investigates whether serum fibroblast growth factor-21 (FGF-21) levels in chronic migraine relate to headache severity and response to sodium valproate treatment. This pilot study involved 30 patients with chronic migraine treated with sodium valproate. Serum FGF-21 levels were assessed at baseline and after 12 weeks of treatment. Pain severity and disability were evaluated using visual analogue scale (VAS) and Migraine Disability Assessment (MIDAS). Paired t-test was used for the quantitative variables. The qualitative variables were evaluated using Pearson’s chi-square test and Fisher’s exact test. Moreover, correlation coefficients were calculated. A P < 0.05 was considered statistically significant. Mean age of the patients was 42.9 ± 11.3 years. There was a significant reduction in headache severity between baseline and the end of the study regarding VAS scores (8.50 ± 1.50 vs. 5.30 ± 2.20, P < 0.001). The same reduction was observed in MIDAS during the study (61.20 ± 33.20 vs. 20.31 ± 17.07, P < 0.001). However, there was no significant changes in serum levels of FGF-21 over three months (299.53 ± 479.80 vs. 491.33 ± 456.64, P = 0.810), nor any relationship between these levels and headache severity scores (MIDAS: P = 0.658, VAS: P = 0.708). The results of this study did not show a significant correlation between FGF-21 serum levels and changes in VAS and MIDAS throughout the study. Further research on various mitochondrial pathways can provide valuable insights into the migraine pathophysiology and help identify more effective biomarkers for monitoring therapeutic regimens.

Multiple sclerosis (MS) is one of the most common progressive neurological disorders affecting young adults. This study aimed to perform a meta-analysis on the effect of interferon beta (IFN-β) on the quality of life (QOL) of patients with MS.

Using valid keywords and searching through databases like Medlib, ScienceDirect, PubMed, etc., 10 articles published between 1999 and 2020 were collected. The inclusion criteria were developed based on clinical guidelines, focusing on studies involving adults with MS treated with IFN-β, with outcomes measuring QOL. The exclusion criteria included studies not in English, those involving pediatric populations, or those lacking a control group. In the reviewed studies, 14 scales of QOL were measured at the beginning and the end of treatment with IFN-β. The data were analyzed using the random effects model meta-analysis method with R software and Stata software. Publication bias was not significant. Heterogeneity was evaluated using the Q test and the I2 index. In heterogeneous studies, subgroup analysis and meta-regression were used for meta-analysis. The random-effect model was used for analyses with I2 of more than 50%.

A total number of 1320 people with an average age of 32.40 ± 8.77 years were included in this study. On average, there was a slight decline in energy and satisfaction with sexual function scales (SSF), while a slight improvement was seen in the other 12 scales, following the treatment with IFN-β. However, no significant changes were observed in any of the QOL scales following treatment, except for health distress (HD) (P < 0.001), role limitation due to physical problems (RLPP) (P < 0.001), and role limitation due to emotional problems (RLEP) (P = 0.037), all of which showed a slight but natable improvement. The physical and mental components, showed significant increases of 0.189 [95% Confidence interval (CI): 0.083, 0.295, I2 = 0%] and 0.221 (95% CI 0.119, 0.324, I2 = 0%) in the scores after using IFN-β, respectively.

This study's results showed that treatment with IFN-β does not negatively affect the QOL of patients with MS. Moreover, this treatment can slightly improve most QOL scales associated with the disability observed in MS.