Current Journal of Neurology
Year:2014 | Volume:13 | Issue:1|Papers Count:12

Multiple sclerosis (MS) is a chronic demyelinating disease and also is one of the most common disabling neurological disorders in young and middle-aged adults. The main pathogenesis of MS has long been thought to be an immune mediated disorder of the central nervous system. The function of the immune system is under the influence of vitamin D which as a modulator of immune response could play a role in autoimmune diseases including MS. Deficiency of vitamin D or variations in DNA sequence (polymorphism) of vitamin D receptor gene diminishes its optimal function on immune system that consequently could lead to increasing risk of MS. However, its role in development and modulating the course of MS is still under investigation. In this review we aimed to discuss the role of vitamin D in body, immune system and consequently altering the risk of MS.

Background: Due to underlying autoimmune background of Guillain-Barre syndrome (GBS), the possible role of infectious agents cytomegalovirus (CMV) and Epstein-Barr virus (EBV) and also due to association of anti-ganglioside antibodies with GBS, the present study aimed to investigate the associations between serum anti-ganglioside antibodies (AGA) level, type of infection and electrodiagnostic (ED) findings with the severity and threemonth functional outcome of patients with GBS.Methods: In a prospective study, 30 patients with GBS were selected and before starting the treatment, baseline serum samples of patients were obtained for measuring the serum AGA including the antibodies against GQ1b, GT1b, GD1a, GD1b, GM1, GM2, GM3 and strains of CMV and EBV. All the patients were precisely examined for ED findings. Functional status of patients on admission and three months after admission were recorded according to the modified Rankin scale (mRS).Results: The results of patients' serum assessment revealed that CMV IgM was positive in one patient (3.3%), CMV IgG in 29 patients (96.7%) and EBV IgG in 27 patients (90%). Anti-GM1 was found in 3 patients (10%) and anti-GM3 was found only in one patient (3.3%). However, no statistical significant association was found between the AGA and strain of the disease and ED findings.Conclusion: Despite the coexistence of AGA and serum antibodies against CMV and EBV in some GBS patients, there was not clear association in this regard. However, the AGA was positive in patients who suffered from severe phase of the disease.

Background: Multiple sclerosis (MS) is an unpredictable neurological disease leading to severe disability in young adults. The majority of MS patients use complementary and alternative medicine (CAM) as adjunct to conventional therapies. This study aimed to investigate the prevalence of CAM utilization among Iranian patients with MS and their attitude toward the CAM usage.Methods: A cross-sectional study was conducted on 119 definite MS patients referred to Tehran’s Imam Khomeini and Sina hospitals. A questionnaire was used to examine the association between participants’ health-related factors and usage of CAMs interventions. P value<0.05 was considered statistically significant.Results: Among the enrolled patients, 60% of the participants agreed with using CAM, 42% experienced the usage of these treatments; out of whom 41% believed its efficiency and 18% reported exacerbation of symptoms. The mean duration of disease diagnosis and mean time from symptoms onset were both longer in users of CAM (P=0.001). Most socio-demographic factors had no significant effect on the type of used CAM. However, Yoga was significantly more applied in those with higher degree of education (P=0.002).Conclusion: Regarding the widespread use of CAM by Iranian patients with MS, further researches about the safety and efficacy of each treatment on the special outcomes is recommended.

Background: Usual dosage of morphine (10 mg/kg) induces analgesia and ultra-low dose (ULD) of morphine (1 mg/kg); hyperalgesia, and C-fibers are also bearing μ- opioid receptors; here the importance of C-fibers on pain and morphine induced analgesia/hyperalgesia is questioned and investigated using pain evaluation methods and infant capsaicin treating for C-fibers lesioning.Methods: Wistar male rats (200-250 grams) were assigned to three categories i.e. control, sham (receiving neonatal capsaicin vehicle) and c-lesion (receiving neonatal capsaicin), each one with three groups (n=7). They were injected intraperitoneally with single dosage of saline, 10 mg/kg or 1 mg/kg morphine, respectively. Thermal pain threshold was evaluated using the tail flick test before and 30 minutes after the injections. Chemical pain was assessed using the formalin test (FT) 30 minutes after the administrations.Results: Results indicated that thermal (P<0.001) and chemical pains in both neurogenic and inflammatory phases of FT (P<0.05) were reduced in C-lesion animals. In the C-normal and C-lesion animals, 10 mg/kg morphine exerted analgesia both in thermal (P<0.001) and two phases of FT (P<0.01), but it was more potent in C-lesion animals (P<0.05). Although ULD of morphine in C-normal animals produced hyperalgesic effect in thermal and chemical pains (P<0.001), in C-lesion animals, it produced analgesia (P<0.05) at the neurogenic phase of FT.Conclusion: Results can raise the C-fibers involvement for a significant portion of nociceptive transmission, because C-lesioning potentiated morphine induced analgesia and eliminated ULD of morphine induced hyperalgesia. Therefore C and Ad fibers can be involved in morphine analgesia; while, just C-fibers are possibly responsible for only presynaptically hyperalgesic/excitatory action of ULD in morphine.

Background: The role of nutrition in the progression of multiple sclerosis (MS) and related complications such as fatigue has been reported by several studies. The aim of this study is the assessment of nutritional status and its relationship with fatigue in multiple sclerosis patients.Methods: This is a cross-sectional study, in which 101 relapsing-remitting MS patients were enrolled. The fatigue status was determined using the validated Persian version of of the Modified Fatigue Impact Scale (MFIS). Dietary intake was assessed using a 3-day food record questionnaire and compared to dietary reference intake (DRI) values. Association between variables was determined using Pearson Correlation Coefficient.Results: In the preset study, 25 men and 76 women (total=101) were enrolled. Analysis of dietary intake showed that daily intake of vitamin D, folate, calcium, and magnesium were significantly lower than DRI in all of patients. In men, zinc intake was significantly lower than DRI; while, in women, iron was significantly below the DRI level. After adjusting for energy, MFIS and its physical subscale were highly correlated with intake of folate and magnesium.Conclusion: Our findings support that lower magnesium and folate diets are correlated with higher fatigue scores in MS patients.

Background: Meniere’s disease has been remained as a difficult therapeutic challenge. The present study aimed to determine the effects of one-shot low-dosage intratympanic gentamicin on vertigo control, auditory outcomes and findings of computerized dynamic posturography and vestibular evoked myogenic potentials in patients with unilateral Meniere’s disease.Methods: In a prospective clinical study, 30 patients with unilateral Meniere’s disease were treated with one-shot intratympanic injection of 20 milligrams gentamicin. Main outcome measures included clinical, audiometric, postural and vestibular outcomes evaluated 1 and 9 months after the treatment.Results: Mean vertigo attacks frequency, pure tone average threshold and functional level scale significantly decreased after the treatment (P<0.05). Effective vertigo control (class A and B) obtained in 95.8% of the patients. In total, 75% of patients reported decrease in both aural fullness and tinnitus. Vestibular evoked myogenic potentials became absent in all the patients but four of them. Posturographic scores were improved after the treatment.Conclusion: One-shot low-dosage gentamicin was effective in controlling vertigo attacks in Meniere’s disease and has useful effects on aural fullness and tinnitus of patients as well. Postural and vestibular tests only have adjunctive role for monitoring therapeutic responses in intratympanic gentamicin-therapy.

Background: Myasthenia gravis (MG) is an autoimmune disorder characterized by weakness and fatigability of skeletal muscles. The aim of this study was to determine if pathological characteristics in non-thymomatous patients of MG would correlate with prognosis in a three year follow up.Methods: Patients who had had their thymectomy at least three years prior to the study were selected from three hospitals and were followed for 3 years. Prognosis was assessed via a devised prognostic scoring system. A pathological exam of the specimen from the thymus was done using the following immunohistochemical markers: Bcl2, CD 3, CD 4, CD 5, CD 7, CD 10, CD 20cy, CD 23, CD 43, and Ki67.Results: Fifteen patients fulfilled the inclusion criteria and had a complete follow-up. This included 3 males and 12 females with a mean age of 36.6 years at the start of the study. The dominant cell population was T lymphocytes. All T cells expressed CD 3, CD 43, CD 5, and Bcl-2. In 2 patients, CD 10 marker was positive in T cells. B cells were negative for activation marker CD 23, except for germinal center dendritic cells. Due to the limited number of patients in the study, the power of the study would not allow for an analysis to assess correlation between histopathological data and prognosis.Conclusion: This pilot study was an attempt to discover any prognostic indices from the histopathological examination of the resected thymic tissue in the patients with myasthenia gravis.

Background: Scuba divers work in high pressure conditions which may cause some changes in physiological status to adapt to this situation. In this study, the carotid intima-media thickness (CIMT) was assessed in divers as a risk factor of cerebrovascular and cardiovascular disorders.Methods: This historical cohort study was performed on 16 male professional scuba divers as case group and 30 healthy people as controls with age range of 26-66 years. CIMT of both carotids of supine participants was measured by a 10 MHz linear ultrasonic probe quantitatively. Relationship between experience of diving and carotid IMT was evaluated.Results: All the participants were males (mean age 42.9±10.58. and for the control group was (47.05±12.31 years). The mean right CIMT in divers and control group was 524.31±149.40 and 443.66±59.62 micrometer, respectively. Furthermore, the mean left CIMT in divers and control group was 624.57±116.15 and 458.44±49.56 micrometer, respectively.Conclusion: The findings demonstrated that long-term occupational diving leads to increased intima-media thickness in scuba divers.

Alois Alzheimer, the Bavarian neuropathologist, first introduced the Alzheimer's disease (AD) in 1906 following detection of amyloid plaques, neurofibrillary tangles, and arteriosclerotic changes in the brain of his patient. AD is known as the most frequent global form of dementia, these days, representing 50-80% of all cases1 with huge patient maintenance costs (i.e.172 billion US dollars in 2010 at the United States1 predicting to reach 1 trillion dollars by 2050).2 The most well recognized hallmarks of AD neuropathology known now are the extracellular amyloid plaque burden, intracellular neurofibrillary tangles, and microtubule destabilizations.3 Misfolding each of these proteinaceous entities have their specific mechanisms to contribute to neuronal cell death and have been the subject of plethora of researches in the last decade.3

Lhermitte’s sign (LS) is one of the sensory injuries of the spinal cord which is frequent in some demyelinating diseases. The sign refers to a transient electric-shock like sensation and sometimes tingling or buzzing in the neck that runs down the spine and into limbs. It is triggered by movement including the flexion and rarely by extension or rotation of the neck, walking and bending and even sometimes it is spontaneous and can be attend by a sense of intend pain.1, 2 Although LS is not limited to multiple sclerosis (MS), it is highly prevalent in MS and other similar demyelinating disorders e.g. neuromyelitis optica (NMO).3 This cross-sectional study was conducted in Isfahan MS Society (IMSS) from April 2003 to July 2010. This study aimed to inspect the prevalence of LS among MS and NMO patients. All the patients were asked for the history of LS at presentation or during subsequent clinical surveillance. LS was considered to be positive if a transient electric shock sensation, tingling, rippling or other feelings had travelled rapidly along the neck and limbs.3

“Neurotheology” refers to the multidisciplinary field of scholarship that seeks to understand the relationship between the human brain and religion. In its initial development, neurotheology has been conceived in very broad terms relating to the intersection between religion and brain sciences in general. The author's main objective is to introduce neurotheology in general and provides a basis for more detailed scholarship from experts in theology, as well as in neuroscience and medicine.

Background: As both oral and verbal apraxia are related to vocal orofacial musculature, this study aimed at identifying brain regions impaired in cases with oral and verbal apraxia.Methods: In this non-experimental study, 46 left brain damaged subjects (17 females) aged 23–84 years, were examined by oral and verbal apraxia tasks. Impaired and spared Broca’s area, insula, and middle frontal gyrus in the left hemisphere were checked from magnetic resonance imaging and computed tomography scans utilizing Talairach Atlas. Data were analyzed using chi-square test.Results: Insula was significantly impaired in both forms of oral and verbal apraxia and different severities and prominent forms of both apraxias (P<0.05). Broca’s area was slightly less involved than insula in two forms of apraxia.Conclusion: As the damage of insula was more prominent in both forms of apraxias, it seems that oral and verbal apraxia may have commonalities regarding their underlying brain lesions.