Current Journal of Neurology
Year:2002 | Volume:1 | Issue:4|Papers Count:28

The Sensitivity of Quantitative electroencephalogram (Brain Mapping) was Compared with Transient ischemic Attack (TIA) and computerized tomography (C.T. Scan) Finding. Twenty Patients were tested with Quantitative EEG (Brain Mapping) within 24h from the onset of neurological symptoms where as CT Scan was performed within 24h from the onset of attack. EEG was recorded from 16 electrodes placed upon the Scale to the international 10-20 system. Spectral analysis was carried out for each channel. Absolute and Relative power were calculated for Delta - Theta -Alpha and Beta frequency bands and such data were successively represented in color coded maps. The results indicated that EEG mapping showed focal abnormality in delta band in 17 of 20 cases.      

We conducted a retrospective study to evaluate the efficacy of levetiracetam as adjunctive therapy in patients with refractory partial onset seizures, and in particular to assess effects following failed epilepsy surgery. Eighty-two patients with uncontrolled partial-onset seizures treated with levetiracetam were identified, of whom 21 failed prior epilepsy surgery (Group I) and 61 had no prior surgery (Group II). Group I patients (11 female, 10 male) ranged in age from 20 to 80 years (mean=40.7); mean age at onset of seizures was 14.4 years. The 61 patients in Group II (37 female, 24 male) ranged in age from 18 to 80 years (mean=41.5) and had mean age of onset of seizures 18.2 years. Patients who had ≥50 % reduction in seizure frequency were considered responders; the remaining patients were considered non-responders. In Group I, responder rate was 76.1 %: 10 patients (47.6 %) were seizures - free, and 6 patients (28.5 %) had ~ 50 % reduction in seizure frequency. In Group II, responder rate was 34.3 %: 9 patients (14.7 %) were seizure - free and 12 patients (19.6 %) had ≥ 50 %  reduction. In Group I, 11 of 12 temporal resection patients (91.6 %) were responders, of whom 8 were seizure-free; of the remaining 9 operated patients, 5 (55.5 %) were responders and 2 patients were seizure-free. Three responders (14.2 %) in Group I developed a severe, delayed psychotic syndrome 4 9 months following levetiracetam introduction, leading to its discontinuation. This impressive data shows adjunctive levetiracetam therapy should be considered early following failed epilepsy surgery (especially temporal resection), and may have implications for its use before surgical intervention. Patients should be under close psychiatric observation in this clinical setting.    

Epilepsy is one of the most important health problems in developing countries. The epilepsy is a chronic disorder with 1% prevalence rate, thus antiepileptic drug treatment is very important. The efficacy, dosages and variety of antiepileptic drugs was studied. Methods: This prospective cross sectional study was done for a decade year from 1367-1377 (1988-1998) on epileptic patients admitted to epilepsy clinic in two groups of age (under 15 years and 15 years old above) in Shafa medical center in Kerman City. Results: The most frequent drugs are carbamazepine, phenobarbital, phenyoin and NA valproate. The efficacy rate are equal for male and female and also equal in two groups of age. Efficacy rate are for carbamazepine 69%, phenobarbital 60%, phenytoin 65% and NA valproate 65%. The mean dosage is for carbamazepine 545 mg/day, phenobarbital 112 mg/day, phenytoin 225 mg/day, NA valproate 821 mg/day. These dosages are equal for male and female. The mean dosage of NA valproate when used with carbamazepine significantly increased, but the mean dosage of phenobarbital when uses with phenytoin or carbamazepine non-significantly increased. Conclusion: The most frequent antiepileptic drugs and efficacy rate of these drugs are equal in world, but dosages of these drugs in this area are lower than some countries.      

The use of antileptic drugs (AEDS) in children may be associated with adverse effects (behavioral, cognitive and teratogenic potential effects). Which factors could be prognostic role in our decision for medical therapy continuation, is the main goal of this study. We studied 106 children who their medication withdrew 2 years after last seizure. Follow up visits were scheduled every 3 months, at least for one year. If seizure replaced, AEDs were resumed and follow up terminated. The overall probability of remaining seizure free was analysed as a function of time by Kaplan - Meier survival analysis. Prognostic factors affecting seizure relapse were evaluated by using the Log - Rank test. Multivariate analysis was under taken using Cox's Proportional hazard regression model to determine in a stepwise fashion the factors that were most strongly related to outcome. The overall probability of remaining seizure free was 74.8 percent (95 % C.I; 72, 76) at 12 months. Factors retained in multivariate analysis were number of seizures before controlling of epilepsies, duration of tapering time and EEG compare with previous times (P < 0.05). According to our study the rate of seizure relapsing after AED withdrawal in children is small. The benefits of continuing AEDs therapy must be weighted against the risk of potential adverse effects. Prognostic factors could be helpful in determination of seizures relapse.    

 In multiple sclerosis urinary symptoms are common and constipation is not unusual, loss of libido and ercetion impotence are common problem in men and in women lack of Lubrication and failure to reach orgasm are the major problems. In a cross-sectional study in neurologic clinics in Isfahan on 200 patients with definitely MS that in past history they have not any urogenital problems and no hormonal impairment, diabetes, atherosclerosis or vascular disease, radiation to pelvic, pelvic surgery and use of drugs, after systemic and neurologic exam, by a questionnaires, sphincter disorder and sexual problems, were completion. In 200 patients 10% have dysuria, 11.5% have frequency and 7% have urgency, 65% of patients suffering from constipation 17.1% of patients men have impotence and loss of libido and 11.5% of patients have urinary incontinence.      

Background: Vertigo seems to be a common complaint in patients with CNS disorders. Especially cerebral vascular diseases which con be regarded for early diagnosis and treatment. This study to find out its prevalence relation with sex and age in these patiants in Shahid Beheshti hospital of Kashan. Materials and Methods: 110 Patients were participated in a cross sectional analytic descriptive study in First 6 months of 1995. The data were collected from medical records and analysed by statistical methods. Results: Vertigo was found in 48 patients (%43.6). (24 males %50 and 24 females %50). From  48 patients with vertigo, 19 ones (%39.6) were in age of above than 61-70 years.  Conclusion: Vertigo is one of the common complaints in patients with cerebral vascular diseases which increases with age and has the same rate in both sexes.    

Background: This study was related to determine the frequency kinds of Space Occupying Lesions (SOL) in outpatients neurological department affiliated to Isfahan University Medical Sciences. Methods: In a descriptive retrospective observational study, outpatient neurological clinic in the city of Isfahan. From 57750 patients who attended this clinic in a six year period, 253 (0.43 %) with SOL underwent evaluation. The brain SOL was diagnosed by neurological exam, CT scan and MRI, which confirmed pathological studies in some cases. Results: The common clinical feature consists, headache, generalized seizure, unilateral weakness and vomiting respectively. The most common type of brain SOL was the glioma (32.28) followed by the meningioma (17.72 %), subdural hematoma (15.75), metastases (6.69 %), macroadenoma (5.1 %) and so forth. Conclusion: The brain SOL is one of the causes of etiologic factors in outpatient who attended underwent neurological clinics. Headache, generalized seizures and unilateral weakness are the symptoms and signs of the cases.    

During the recent years, laser therapy has become a common treatment technique in many disorders. The treatment of peripheral and central nerve injuries recently are studied by many researchers. In this study the effects of low power HE-NE laser on the rat injured sciatic nerve were studied. By using closed hemostate the right sciatic nerve was lacerated ipsilaterally, the animals received laser irradiation for 14a, 15b and 21 consecutive days. After that, the animals sactified, the nerves were dissected out and fixed with aldehyde solutions. By using rotatory microtome, 7 µm cross sections were prepared and then stained by Masson's trichrome  technique. Light microscopic examination and quantitative analysis of the results showed notable increase in the number of Schwan cells in the laser irradiated groups comparing with non-irradiated control groups. The results of this study clearly confirm the effects of laser ill therapy in treatment of peripheral nerve injuries.      

Epilepsy is one the most prevalent neurological disorders of mankind and it occurs more in children than adults. Misconception exits about this disease in some places, and lastly it is considered as an unknown, mysterious disease which is untreatable; such view can have irreparable consequences for patients who suffer from this disease. This study was design to assess the view of individuals surrounding these types of patients hospitalized in Shahid Beheshti Hospital of Kashan during the year 1999 to 2000. 393 relatives of epileptic patients participated in this study. 215 of the participants were female and the rest were male. 81 percent of all the participants believed that epilepsy is incurable. Also, 344 respondents (87.5%) believed that epilepsy drugs are lifetime drugs and 329 persons (93.2%) were unaware of the side effects of these drugs. 47 percent of the respondents believed that epilepsy is contagious. 221 people in this study believed in non-pharmaceutical treatment of this disease. 66 percent of respondents believed in prayer-written healing. 41.4 percent believed that the patient must hide his/her disease from others. The rate of awareness about social, individual, and sport restriction was 15 percent and 335 people had no Knowledge about these restrictions. 58 percent of the respondents believed that epileptic patients can continue higher education. Almost none of the respondents had any Knowledge about the consumption of drugs during pregnancy. From the findings of this study, it can be concluded that general Knowledge about epilepsy is very limited. In addition, incorrect believes and attitude related to the disease still exist and it needs extensive efforts and positive public education to increase correct Knowledge of this disease. According to the results of the study, it can be concluded that not only the information of the relatives of the epileptic patients is insufficient, but also it is incorrect in many prospects. Therefore, it is necessary to invest on educating and increasing the public awareness about this disease.      

A prospective study was done on the 28 patients with undetermined cause of spastic paraparesis for evaluation of contamination with HTL-V1 virus from 1997-1999. These patients were all resident in the Fars province (Southern Iran). The results of molecular biologic test (OCR) were negative in all patients, in contrast with endemicity of TSP/HAM in province of khorasan, Iran. This study is the second search for evaluation of TSP/HAM.      

Hallevorden - spatz disease is an inherited metabolic disorder with autosomal recessive trait. Onset is in late childhood or early adolescence. Clinical manifestation is variable but pyramidal extrapyramidal symptoms (1). Ataxia or myoclonus is reported in the course of disease in individual cases. Focal dystonia including tongue, eyelids (blepharospasm) and optic atrophy, retinitis pigmentosa, rarely familial parkinsonism are also reported (2). Pathologically pigmentary degeneration of globus pallidus, substantia nigra (pars reticular) and red nucleus is charateristic. In our case the main clinical feature was multifocal dystonia without obvious pyramidal or other extrapyramidal symptoms, and diagnosis was based on clinical and MRI findings.      

Transcranial Doppler Sonography (TCD), is an non-inasive technique that allows assessment of cerebral circulation. This technology recently develops in our country and our attempt was made to applied this method for clinical and research purposes. TCD flow velocities such as peak velocity and mean velocity and pulsatility index (PI) has been measured as an own normal values in our TCD Laboratories. Our experiences in patient with stroke disclose the most stenotic portion are in the carotid siphon, distal vertebral artery and proximal of basilar artery. These studies are consistent with more frequent intracranial occlusion in Asian population.      

A 53 year old man was admitted with headache, nausea, vomiting and fever. Except meningeal Irritations sings, no other problems were seen. Erythrocyte Sedimentation Rate (ESR) was 95 mm/1hr and CSF analysis showed 98 WBC (80% lymphocyte). Brain MRI, CT paranasal sinuses and CXR was found to be normal. In bone scan, no sign of occult malignancy was reported. CSF analysis for BK, PCR, fungal and cytology was negative. While in cytology of inflammatory cells no sign of vasculitis disease was seen. He had a positive PPD test about 20 mm. Treatment with I.V Ampicilline and Ceftriaxone was taken for duration of 10 days. A dramatic improvement was seen in days 4/5 after treatment. Serial ESR was high. In second week of admition, LP was repeated and the results showed that WBC is decreased to 10. The patient was discharged with clinical improvement, while his ESR was high. The follow up was continued with no more treatment. During follow up, CSF culture for TB was found to be positive. The patient had no symptom. He readmitted and LP was repeated. The CSF results showed no RBC, WBC. Sugar and protein were normal. The ESR was repeated twice, and it was 90 and 95 1hr. CSF culture was done for TB and patient was given anti- TB treatment.      

We report a case of methanol intoxication with characteristic bilateral putaminal necrosis. A 52 years old alcoholic male had headache, impaired consciousness, neck stiffness, roving eyes with dilated pupils and vomiting after a binge. The initial CT scans showed few subcortical white matter lucencies. However, Magnetic Resonance Imaging (MRI) at 4th day showed the typical putaminal lesions of methanol intoxication and peripheral white matter lesions. A blood test for methanol was performed on the 2nd day, and its result was positive. After regaining his consciousness the patient had poor vision and levodopa parkinsonian symptoms which did not respond to levedopa. White matter and putaminal lesions correspond well to lesions previously described in pathologic specimens.      

The aim of this study was to compare the efficacy and tolerability of Topiramate (TPM) as first drug in complex partial seizures with Sodium Valporate (VPA) and Carbamazepine (CBZ). In treating epilepsy, the drug chosen need to be matched to individual patient and the type of epilepsy; so far CBZ and VPA are used as first line treatment in complex partial seizures by many neurologists, many patients are allergic to CBZ and develop a rash but systemic symptoms are not usually severe. CBZ causes enzyme induction which result in drug interaction for example with contraceptive pill, CBZ may also be the victim in drug interactions that arise through enzyme inhibition, (for example with erythromycin), the drug has teratogenic effects. It is implicated in spina bifida. VPA does not cause enzyme induction but is teratogenic and is implicated in spina bifida. TPM widely approved as add-on therapy for epilepsy treatment of partial seizures with or without secondary generalization, its mechanism consists of stopping the voltage gated sodium channels reducing the activation of some glutamate receptors and strenthening the inhibition effect of 8-amino butyrate. It is also a weak inhibitor of carbonic anhydrase enzyme. The expected side effects are drowsiness, asthenia, dizziness, loss of weight, headache, psychomotor agitation, anorexia and nephrolithiasis.    

Vasccular malformation in brainstem consists of "Venous malformations", "Cavernous angiomas", "Telangiectasis" and "AVMs". The most devasting consequences of these lesions occur as a result of intracranial hemorrhage.This article has review in history of two patients with similar clinical manifestation at the same time with brainstem hemorrhage. The location of the lesions was in the pons. Both patients were operated successfully.    

We describe a 72 years old lady with chief complain of headache, ptosis, partial 3rd nerve palsy and visual loss of left eye, biochemistrywas normal except to mild hyperglycemia, work up of vasculitis was negative with normal E.S.R. MRI showed sphenoid mucocel, orbit at sign was improved with nasal endoscopic drainage of mucocel.