Current Journal of Neurology
Volume:11 Issue: 2, Spring 2012

Diminished libido and sexual dysfunction are unusually common among male epileptic patients. The most important etiologic factor may be antiepileptic drugs (AEDs)-induced androgen deficiency. We compared reproductive hormone levels among men with epilepsy taking various AEDs and normal controls. Subjects were 59 male epileptic patients who aged 24 ± 5 years. They had been receiving lamotrigine (LTG) (n = 17), carbamazepine (CBZ) (n = 18), and sodium valproate (VPA) (n = 15) for at least 6 months. We also recruited 23 healthy controls. Testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormonebinding globulin (SHBG), androstenedione (AND), luteinizing hormone (LH), and follicle stimulatin hormone (FSH) levels and gonadal efficiency (testosterone/LH) were compared between the four groups. The patients and the control group were examined and evaluated for male reproduction by urology and endocrinology services. Subjects receiving CBZ, VPA, and LTG had significantly lower mean testosterone levels than the control group (P < 0.01). In addition, patients receiving LTG had significantly higher mean testosterone levels than CBZ and VPA groups (P < 0.01) and controls (P < 0.05). There were not any significant differences between the groups in mean estradiol levels. The mean AND level in VPA was higher than CBZ, LTG, and control groups (P < 0.01). Men receiving CBZ had significantly lower DHEAS levels than the other groups (P < 0.01). Testosterone/LH ratio in the control group was more than other groups (P < 0.01). On the other hand, this value in LTG group was higher than CBZ and VPA groups (P < 0.01). However, CBZ and VPA groups were not significantly different in terms of testosterone/LH ratio. Although the mean levels of reproductive hormones were lower in the LTG group compared to the controls, among traditional antiepileptic drugs, LTG had fewer side effects on reproductive hormones. Therefore, it is a good adjuvant and substitute drug for epilepsy control instead of CBZ and VPA.

Magnetic resonance imaging (MRI) is the standard method for observing brain plaques and contrast material injection is necessary for demonstrating the active plaque. This study compared the rate of enhancement of plaques with Gadovist and Magnevist in relapse phase of MS. In this double blind study, after neurological examination of 62 patients in the attack phase of MS, two consecutive MRIs were performed with Gadovist and Magnevist with 48 hours interval. The two contrast materials were injected in first and second imaging randomly and the reporting radiologist was blind about the contrast material. With both contrast materials, the probability of enhancement of supratentorial plaques was higher than the infratentorial ones. The probability of observing a symptomatic infratentorial enhanced plaque was higher than the supratentorial region and when the symptoms were due to supratentorial lesions, the corresponding enhanced plaque was more probable. It was detected that the number of enhanced plaques was the highest if the imaging was performed in the second week after the relapse, although there was no statistically significant difference when the imaging was done within the first month after the beginning of the symptoms. It seems that both Magnevist and Gadovist could be used as the contrast material to detect enhancing plaques in relapse phase of multiple sclerosis.

It has been suggested that nutrition might play a role in the etiology of multiple sclerosis (MS). However, dietary patterns associated with MS risk are unknown. This study was conducted to compare the dietary patterns of patients with MS and healthy controls to find the relationship between dietary patterns and MS. Usual dietary intake of 75 women with relapsing/remitting MS (RRMS) and 75 healthy controls were assessed with a food frequency questionnaire consisting of 168 food items. To define major dietary patterns, we used factor analysis. Multivariate logistic regression was used to assess the relationship between dietary patterns and risk of MS. Traditional pattern (high in low-fat dairy products, red meat, vegetable oil, onion, whole grain, soy, refined grains, organ meats, coffee, and legumes) was inversely related to the risk of MS [odds ratio (OR) = 0.15; 95% confidence interval (CI): 0.03-0.18; P = 0.028]. A similar inverse relationship was noted between MS risk and lacto-vegetarian (high in nuts, fruits, French fries, coffee,sweets and desserts, vegetables, and high-fat dairy products) and vegetarian (high in green leafy vegetables, hydrogenated fats, tomato, yellow vegetables, fruit juices, onion, and other vegetables) patterns (OR = 0.31; 95% CI: 0.12-0.82; P = 0.018 and OR = 0.42; 95% CI: 0.19-0.90; P = 0.026, respectively). In contrast, the prevalence of MS was higher in those who had high animal fat dietary pattern (high in animal fats,potato, meat products, sugars, and hydrogenated fats and low in whole grains) (OR = 1.99; 95% CI: 1.63-2.94;P < 0.005). Our findings showed that the risk of RRMS can be affected by major dietary patterns.

There is a known inverse association between solar radiation and the prevalence of multiple sclerosis (MS). Some studies have investigated the link between vitamin D and MS. The aim of this study was to investigate the possible association between serum 25(OH) vitamin D3 concentration and the severity of disease in Iranian patients with MS. Patients with relapsing–remitting MS underwent neurological examination, including measurement of Expanded Disability Status Scale (EDSS) score, and were categorized by disease severity into mild (0 ≤ EDSS ≤3), moderate (3.5 ≤ EDSS ≤5.5) and severe (6 ≤ EDSS). Serum concentrations of 25(OH) vitamin D3, calcium, phosphorus, magnesium and parathyroid hormone were also measured. A total of 78 (73.1% female) patients with MS were evaluated. The mean (±standard deviation) of age was 33.9±9.2 years. The mean (±standard error) serum concentrations of 25(OH) vitamin D3 were 36.6 ± 5.1 mg/dL, 50.1 ± 12.6 mg/dLand 19.8 ± 6.5 mg/dL in patients with mild, moderate and severe disease, respectively. There was a statistically significant inverse correlation between 25(OH) vitamin D3 concentration and EDSS score (P = 0.016, r= –0.273 by Spearman rank correlation test), which was observed in women only (P = 0.021, r = –0.305). Receiver operating characteristic curve analysis suggested that a serum 25(OH) vitamin D3 concentration cutoff of 16.5 mg/dL could differentiate patients with mild/moderate MS from severe disease with 74.6% accuracy. Our findings further support the association between vitamin D and disease severity in MS.

Celiac disease or gluten sensitivity may initially present as one or more neurological signs and/or symptoms. On the other hand, it may be associated with or complicated by neurological manifestations. Neurological presentations are rare in children but as many as 36% of adult patients present with neurological changes. With severe malnutrition after progression of celiac disease, different vitamin deficiencies may develop. Such problems can in turn overlap with previous neurological abnormalities including ataxia, epilepsy, neuropathy, dementia, and cognitive disorders. In this study, we aimed to review the neurological aspects of celiac disease. Early diagnosis and treatment could prevent related disability in patients with celiac disease.

Levamisole is an anthelmintic agent and also immunostimulant drug which is used to treat colorectal cancer. The present study aimed to show accidental consumption of levamisole alone induced multifocal inflammatory leukoencephalopathy. A 53-year-old male was admitted to the Neurology Department of Farabi Hospital (Kermanshah, Iran) with walking inability and recognition disorder. Following clinical examinations, the patient diagnosed as multifocal inflammatory leukoencephalopathy following levamisole consumption.The patient was treated with intravenous methylprednisolone followed by prednisolone. The magnetic resonance imaging (MRI) was done 1 month later and did not show a reduction or remission in the lesions. History of the patient showed that he had accidentally consumed levamisole 8 months ago. It seems that the consumption of levamisole can induce multifocal inflammatory leukoencephalopathy and delayed treatment of the patient with corticosteroid cannot diminish the neurotoxicity of levamisole. In addition, the cytotoxic dose of levamisole induces irreversible multifocal inflammatory leukoencephalopathy.

Available evidence shows that tetracycline family has cellular and molecular mechanisms to protect neurons and oligodendrocytes by modulating matrix metalloproteinases. We tried to compare the effectiveness of intramuscular and subcutaneous interferon beta-1a (INF-β1a) in combination with oral doxycycline among patient with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). A double-blind clinical trial study was conducted at Hamedan University of Medical and Health Sciences in Iran. Sixty patients with definite diagnosis of RRMS or SPMS were treated with doxycycline and 44 μg subcutaneous IFN-β1a three times a week or 30 μg intramuscular IFN-β1a once a week for six months. Neurologic examinations were performed monthly until the end of the treatment. Changes in expanded disability status scale (EDSS) scores, brain magnetic resonance images (MRIs), and frequency of receiving corticosteroid pulse were evaluated before and after the treatment. Women constituted 88.3% of the participants. The mean age of the patients was 32 years. The mean EDSS scores reduced from 4.5 to 3.0. Based on the frequency of receiving corticosteroid pulse, relapse rate decreased from 3.2 to 0.8. MRI showed that the number, volume, and activity of the lesions decreased among 13.3% of the participants, increased among 15%, and remained persistent among 71.7%. Combination of doxycycline and IFN-β1a can decrease relapse rate and improve EDSS scores in patients with RRMS and SPMS. However, it does not affect MRI changes. Further controlled clinical trials on greater number of patients with MS are needed to evaluate the efficacy of combination therapy.

Available evidence shows that tetracycline family has cellular and molecular mechanisms to protect neurons and oligodendrocytes by modulating matrix metalloproteinases. We tried to compare the effectiveness of intramuscular and subcutaneous interferon beta-1a (INF-β1a) in combination with oral doxycycline among patient with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). A double-blind clinical trial study was conducted at Hamedan University of Medical and Health Sciences in Iran. Sixty patients with definite diagnosis of RRMS or SPMS were treated with doxycycline and 44 μg subcutaneous IFN-β1a three times a week or 30 μg intramuscular IFN-β1a once a week for six months. Neurologic examinations were performed monthly until the end of the treatment. Changes in expanded disability status scale (EDSS) scores, brain magnetic resonance images (MRIs), and frequency of receiving corticosteroid pulse were evaluated before and after the treatment. Women constituted 88.3% of the participants. The mean age of the patients was 32 years. The mean EDSS scores reduced from 4.5 to 3.0. Based on the frequency of receiving corticosteroid pulse, relapse rate decreased from 3.2 to 0.8. MRI showed that the number, volume, and activity of the lesions decreased among 13.3% of the participants, increased among 15%, and remained persistent among 71.7%. Combination of doxycycline and IFN-β1a can decrease relapse rate and improve EDSS scores in patients with RRMS and SPMS. However, it does not affect MRI changes. Further controlled clinical trials on greater number of patients with MS are needed to evaluate the efficacy of combination therapy.