Current Journal of Neurology
Year:2009 | Volume:8 | Issue:25|Papers Count:13

Antiepileptic drugs are mainstay of epilepsy treatment. Recently the numbers of antiepileptic drugs have increased. Most patients with epilepsy are controlled by a single antiepileptic drug well. Some of patients that controlled have medication side effects and occasional seizures. Approximately 30% of patients with partial epilepsy and 25% of patients with generalized epilepsy are not well controlled by antiepileptic drugs. These patients are often receiving multiple antiepileptic drugs, and have disabling seizure and side effects. Second generations (newer) of antiepileptic drugs are safer and better tolerated than the older antiepileptic drugs, but this is not enough for epileptic patients. In a big study with established antiepileptic drugs, 40% of patients that uncontrolled with a single drug can be controlled better by two drugs, but 9% of these patients became free seizures. A meta-analysis showed when newer antiepileptic drugs add to older, can be controlled 12-29% more than before in patients and reduced 50% of rate of epileptic attacks. Surgery and Vagus nerve stimulation are important in refractory epileptic patients. Children, elderly, women and patients with developmental delays need special considerations.

Introduction: Different studies have been done on Huntington’s disease which mostly put emphasis on clinical observations and genetic tests. Direct observation is the method with the lowest cost however its problem is giving qualitative results which do not lead to careful diagnosis. Utilizing engineering methods of motion analysis, different movement disorders of these patients can be verified carefully which between all of them gait disorders are of great importance and are studied in this paper.Methods & materials: In this research to achieve quantitative and precise gait analysis of Huntington’s patients, an imaging system has been used and by that, gait of a patient with Huntington’s has been assessed for three years with the interval of two months.Results: With the use of mentioned system, angular changes of joint's lower extremities and time of movement are measured as kinematic parameters.Conclusion: Experiment results illustrated that these parameters can be used to diagnose and evaluate disease process, which means during disease progress, magnitude of changes of joint’s angles in lower extremities decreases and time of movement performance increases.

Introduction: Diabetes mellitus is one of the most prevalent disease in this century. Obove middle age it's prevalence is near twenty percent and it is the most common cause of blindness and renal failure. Polyneuropathy is prevalent in diabetes and can be accompanied by severe polyneuropathic pains.Methods & materials: This clinical trial was conducted from 2005 to 2008 on 75 patients suffering painful diabetic polyneuropathy in shahid Mustafa Khomeini hospital (shahed university). All patients were more than eighteen years old with at least 3 months history of neuropathic pain in one part of body. Patients selected randomly in two groups. One group took nortriptyline 25-50mg/daily for six weeks and another group took lamotrigine 200mg/daily for the same duration all patients visited weekly for evaluation of pain with VAS and drug tolerance and complications. All the data were analyzed with spss software.Results: Seventy-five patients were selected in two groups and sixty patients completed study Twenty-seven patiets took nortriptilye and thirty-three patients took lamotrigine for six weeks.mean age was 61.3±8.2 (68-45) and mean duration of diabetes was12.3±5,3. In nortriptyline group mean VAS in the beginning of study was 68.3±5.3and it was 34.5±4.7 at the end of sixth week.in lamotrigine group VAS was 71.3±8 and 37.6±4.9. At the beginning and end of sixth week respectively. Statistical analysis shows significant difference in each group in comparison of VAS results at beginning and end of sixth week. But there was no significant statistical difference in comparison of two groups respectively.Conclusion: This study shows us that both drugs are effective in reduction of neuropathic pains. Lamotrigine is at least as effective as nortriptilyline and this drug can be a good substitution for this drug especially when complication such as drowsiness appears.

Introduction: Developmental stuttering is a speech fluency disorder that has been attributed as movement disorder and no unique factor has been known. In recent years, neurological factors and neuro-motor theory have attracted more agreement. In this time, developmental stuttering has been considered as a neuro-motor disorder result from abnormal motor control and propose its cause as basal ganglia involvement that involve all of speech production systems, specially larynx and vocal fold mechanism. The aim of present study was investigation of the cause of developmental stuttering using investigation of vocal fold movements as fine and sequence movements.Methods & materials: Present study performed on two groups- 16 stutterers and 16 health normal- that there is no significant difference between them in terms of age, sex, education and laterality.Results: showed there isn’t significant difference between both groups on contact quotient (CQ) (p=0.461). Interestingly, there was significant difference on perturbation contact quotient between both groups (p=0.043).Conclusion: With all of investigations on relationship between stuttering and basal ganglia involvement and with consideration regulation vibratory disorder in vocal fold of subjects with stuttering and that regulation of movement is one of the most function of basal ganglia, therefore, we can claim that there is relationship between stuttering and basal ganglia.

Introduction: Head injury has rarely been reported in association with the onset of obsessive-compulsive disorder (OCD). In this report a patient who exhibited obsessive-compulsive disorder after a closed head trauma is presented. Case presentation: The patient was a 18 years old man who was admitted to the hospital due to seizure and loss of consciousness following falling down from the horse back. After five days of admission in ICU ward and improving the level of consciousness, he began to experience the slowing rate of processing data, decreased concentration, and difficulty in solving problems, amnesia, bizarre behaviors, aggression and obsession with laughing as its compulsion. He was referred to a psychiatric hospital with the diagnosis of obsessive compulsive disorder and amnesia. After twelve days, he was discharged from the hospital with the approximate amelioration of the symptoms and signs of obsessive compulsive disorder and improvement in his memory.Conclusion: Despite the rare incidence of obsessive compulsive disorder following head trauma, it must be considered in patients with psychiatric complaints after such trauma.

Introduction: Nowadays coronary artery bypass graft (CABG) surgery is a common operation and postoperative complications are inevitable. Among the important complications are neurologic and cognitive ones. These problems have a significant role in the disability and the mortality of patients. The present study was designed to detect the frequency of postoperative cognitive complications, and the correlation of it with different risk factors such as age, sex, history of cerebrovascular disease, preoperative cerebrovascular hemodynamic state, intraoperative variables and neurologic complications. Methods & materials: In this descriptive, analytic, and prospective study, 201 elective patients, with normal sinus rhythm, ejection fraction of more than 30%, and isolated CABG, during a period of about one year were included. Neurologic examination, cognitive evaluation (by mini-mental state examination or MMSE), intracranial arteries study (by transcranial Doppler or TCD) and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up to discharge time. About one month later neurologic examination and MMSE were repeated.Results: Two hundred and one patients (158 male, 43 female) with the average age of 57.29±9.67 were studied. The history of cerebrovascular disease in 4.5% was detected. Out of them, 131 patients had three-coronary- vessel disease, 64 had two-vessel-disease, 5 one-vessel-diseases, and 1 patient had diffuse coronary disease. TCD was performed in 183 patients and showed abnormal state in 23 and normal in 160 cases. The total number of involved arteries was 36, among which basilar artery was the most common (12 numbers). In 154 patients carotid duplex was performed, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in 1, and 75-90% stenosis in 2 cases. Abnormal intima media thickness (>0.7 mm) reported in 86 patients. Postoperative neurologic complication occurred as follows: 4 stroke, 7 deliriums, and 3 amnesia. One of the operated patients died. Postoperative MMSE can be performed in 154 patients, among them 45 showed decrement of MMSE (mean: 2.29). There were no significant correlations between MMSE decrement and age, sex, previous cerebrovascular disease, preoperative hemodynamic state. Difference of MMSE changes in CABG patients with neurologic complication (0.078) and the patients without complication (0.863) was noticeable, but was not statistically significant.Conclusion: This study shows that post operative cognitive complications in elective, normal sinus rhythm, ejection fraction of more than 30% and isolated CABG patients appears to be due to CNS structural lesions, but further study with larger sample is needed.

Introduction: Epilepsy in humans is characterized by seizures companied partly by mental and emotional deficits. The most commonly forms of affective psychopathology accompanying seizure disorders in humans are depression and anxiety. Neuroinflammation is implicated in etiology or neuropathology of not only neurodegenerative disease but also a number of psychiatric disorders. Kindling is a chronic model of epilepsy. The aim of present study was to explore the effect of aspirin an anti-inflammatory drug on anxiety-like behavior in kindled rat.Methods & materials: Three groups of male rats (8 in each group) were administered daily with vehicle, aspirin 15 and 30 mg/kg, orally. Kindling was induced by subconvulsive dose of pentylenetetrazol (PTZ; 40 mg/kg,i.p). Kindling parameters in the control and aspirin treated groups were determined. One separate group of rats received vehicle only throughout the study and served as control group. The elevated plus maze was used in combination the percentage of time spent in the open arms of the maze (OAT%) and percentage of entries in to the open arms (OAE %) to measure anxiety increase in OAT% and OAE% indicate an anxiolytic effect (reduction in anxiety).Results: Kindling significantly (P<0.05) results in increased anxiety response in rats for at least 24h following the last seizure (Decrease in OAT% and OAE % ).Daily aspirin (15,30 mg/kg) treatment induced a significant (P<0.05) increase in OAT% and OAE%, there by displaying decreased anxiety in kindled rats. Also significant change in the activity of animals was observed.Conclusion: Results of the present study show that aspirin could improve elevated levels of anxiety in kindled rats.

Introduction: To investigate the Effect of Aphrodit on induced penile erection by apomorphine in the rat. Aphrodit made by Tribulus terrestris (contain flavenoids), Cinnamomum zeylanicum (contain cinnamic aldehyde), Zingiber officinalis (contain zingiberene) and Crocus Stivus (contain Crocin).Methods & materials: Adult male Sprague-Dawley rats were used. Penile erection induced by apomorphine plus differrent doses of Aphrodit compared with Penile erection induced by apomorphine (ED50) without Aphrodit. We assess grooming, licking and yawning too.Results: Aphrodit has no effect on induced erection by apomorphine in any doses.Conclusions: These results suggest that Aphrodit has no effect on impotency.

Introduction: The most common anomalous innervation in the lower exterimity in nerve conduction studies(NCS) is the accessory peroneal nerve (APN), that originates from distal superficial peroneal nerve. It travels down the lateral calf, posterior to lateral malleolus; innervates extensor digitorum brevis (EDB). This anomaly should be suspected when proximal stimulation of common peroneal nerve at the knee elicites higher amplitude compound muscle action potential (CMAP) than distal stimulation. Posterolateral ankle stimulation over the APN is confirmatory. Our purpose of this study is determining the relative frequency of APN generally, in any gender and foot laterality separately; comparison of innervatory pattern of deep peroneal nerve (DPN) and APN to EDB.Methods & materials: In this study, we tested 224 (112 men and 112 women) asymptomatic subjects without risk factors for neuropathy. Recording electrodes were placed on the belly of EDB with a supramaximal stimulation to the anterior and lateral ankle and below fibular neck; CMAP of each site was recorded. Chi square test was used for data analysis.Results: The existence of APN was found in 39 subjects (17.41%) and 72 legs (16.07%). The anomaly was bilateral in 33 subjects (84.61%). One patient had complete innervation of EDB by APN in both legs (a rare condition). In 64 legs (88.9%) CMAP Amp of DPN was larger than or equal to CMAP Amp of APN. In only 8 legs (11.1%) CMAP Amp of APN obviously exceeded the CMAP Amp of DPN. In subjects with APN 56.41% were men and 43.59% were women. This difference wasn't statistically significant. (P value=0.423). The laterality of APN was 51.38% in left and 48.62% in right side. This difference wasn't significant too (P value=0.814).Conclusion: The results of this study show that APN is not uncommon and we must pay attention to its presents in electrodiagnostic studies.

Introduction: Hemodialysis is considered as a routin treatment for end stag renal disease (ESRD). However several early complications such as headache, nausea & vomiting, seizure, etc. are obserbed. Dementia is also a late and rare but fatal complication. Therefore, we carried out a study to fined out a bether way to reduce these complications.Methods & materials: In a cross sectional study 120 patients treated with dialysis were naurologically examined and their blood samples were checked for Sodium (Na) and Blood urea nitrogen (BUN) before and after dialysis. The results of the tests were statistically analysed in SPSS software using X2 & student t-test.Result: Out of 120 patients, 56 (46.7%) had no dialysis complication but the rest of patients had complications as follows: headache 54 (45%) Nausea and vomiting 31 (25.8%), agitation 21 (17.5%), unconsciousness 12 (10%), seizure 5 (4.2%) and dementia 3 (2.8%). The patients with dementia had dialysis experience mor than 52 months. The results showed significant relationship between complications and beginning of dialysis (p<0.05). the mean of dialysis period from beginning of dialysis was 31.75 months and dialysis speed was 220.78ml/min.results also showed that BUN amount decreased in half but Na amount increased in this patients. There were no significant relationship between mean of Na and BUN and neurological complications befor and after dialysis (p>0.05).Conclusion: those patients with tendency to dialysis complications (dialysis disequilibrium syndrome) are recommend have dialysis with lower speed and for the adequacy of dialysis a shorter period but frequent dialysis is sugested. Since aluminum ion is considered as the agent for pathogenesis of dementia, further studies need to be carried out to identify the pathogenesis.

Introduction: Multiple sclerosis [MS] is an acquired chronic neurological disease that it's prevalence is more in some areas of Iran like Azerbaijan and Isfahan Of its significant features is that most patients are young adults and it's disabling nature. Psychiatric disorders such as Depression and anxiety are seen in MS patients considerably. Written Emotional Expression [WEE] is one of cost-effective self helper methods that its efficacy has been studied on mental and physical health and survival in chronic patients. This method is not studied on MS patients Yet. Objectives: Study of effects of WEE on Anxiety and Depression and General health score in MS patients.Methods & materials: This study has been done in ''CLINICAL TRIAL'' and before-after method, on patients with (MS) coming to RAZI HOSPITAL,MS ASSOSIATION, HELAL E AHMAR CENTER in TABRIZ,IRAN within (2004-6). After getting written consents from patients, candidates were asked to complete first GHQ questionnaire and then write negative feelings and emotions about a traumatic event, 30 minutes a day for continuous 4 days. After 15 days they were wanted to complete another GHQ questionnaire. Finally Data of questionnaire were analyzed.Results: Depression and anxiety and GHQ scores are higher in MS patients. Mean of depression and anxiety and social function and GHQ scores of [WEE] was significantly better than before WEE (P< 0.05). WEE was more effective in high scores of depression and anxiety on GHQ. (p<0.05). WEE efficacy was not dependent in sex and age of patients. But candidates with high level education benefited more than others from WEE. Conclusion: Written emotional expression is effective on GHQ and depression and anxiety scores in patients with MS especially in high scores.

Introduction: Speech is not a simple process. It requires rapid and intricate movements of the tongue, lips, jaw, vocal cords, and teeth. In addition, precise timing of the muscles for breathing and sound production is necessary to speak. Many factors can interrupt this process. Stuttering is characterized by a repetition of sounds or syllables, usually at the beginning of words.Methods & materials: This study was based on previous information and experiments of authors along with literatures review.Results: Stuttering can be divided into three groups: developmental, neurogenic and psychogenic. Despite decades of research, there are no clear-cut answers to questions about the causes of stuttering. After stuttering has begun, there are some factors that maintain or exacerbate an existing stuttering problem.Conclusion: There is not definite and complete treatment. However, early intervention and continued therapy can control and minimize the stuttering that can lead to fluent speech.