Current Journal of Neurology
Year:2019 | Volume:18 | Issue:1|Papers Count:9

Background: Multiple sclerosis (MS) is a common disease across the world as well as in Iran. Individuals with MS usually experience occupational performance problems that result in limitations in their daily life. This study aimed to determine the occupational performance of individuals with MS based on the disability level in Iran. Methods: In this cross-sectional study, 50 individuals with MS (20 to 50 years old) were recruited through a convenience sampling strategy from different clinics in Arak City, Iran, during 2016-2017. The Persian versions of Canadian Occupational Performance Measure (COPM) and Expanded Disability Status Scale (EDSS) were used to assess the status of occupational performance and level of disability. The data were analyzed using chi-square, Spearman's rank correlation, and Mann-Whitney U tests. Results: The total number of 248 occupations were identified as difficult to perform in the following areas: 125 (50. 40%) in self-care, 58 (23. 38%) in productivity, and 65 (26. 20%) in leisure. In addition, the prioritized occupations (n = 149, median: 3, range: 1-4) had significant difference in the distribution of occupations compared with the nonprioritized occupations (P < 0. 0001) and the ratings for performances and satisfactions were generally low. There were significant differences between the occupational performance and level of EDSS. Conclusion: The findings of current study suggest that individuals with MS suffer from widespread problems in the areas of occupational performance, particularly in self-care. The findings emphasize the need for identifying the problems of daily occupations in individuals with MS.

Background: Alzheimer’ s disease (AD) affects a large number of adults annually all around the world. The monetary cost of this disorder is huge. This study aims to estimate the cost of AD in Iran by considering stages of disease. Methods: A cross-sectional study was designed from July to December 2017 on 300 AD cases who referred to the Iran Alzheimer’ s Association, Tehran, Iran. To calculate costs at different stages of disease, patients were assigned into three groups, based on the Mini-Mental State Exam (MMSE) score. A list of medicines’ prices and health care service costs were prepared. Health care services’ cost was acquired from the book of “ Relative value units of health care services in Iran” and the price of medicines was extracted from "Iran’ s medicine triple prices list". Patients’ medical records and face to face interview with their caregivers were used for data collection. The perspective of present research was societal. Results: Annually, per person cost of AD in mild, moderate, and severe stages of disease were 434 United States dollars (USD), 1313 USD, and 2480 USD, respectively. Direct non-medical costs (DNMC) had the greatest share of total costs (near half of the whole costs) including 263 USD, 641 USD, and 1257 USD for mild, moderate, and severe stages, respectively. Conclusion: The cost of AD in Iran is lower than the average cost of dementia in upper middle-income countries. In all stages, the biggest part of the cost is associated with patient care and nursing services because patients suffering from AD usually require specialized cares.

Background: This study was designed to investigate the difference in the prevalence of neuronal autoantibodies in patients diagnosed with established temporal lobe epilepsy (TLE) of unknown cause with mesial temporal sclerosis (MTS) and patients with TLE without MTS. Methods: In an observational cohort study design, we included thirty-three consecutive adult patients and divided them into two groups with and without MTS. We evaluated anti-neuronal and nuclear antibodies with immunofluorescence (IF) and enzyme-linked immunosorbent assay (ELISA), respectively. Results: From the thirty-three consecutive patients with epilepsy 17 (51. 1%) had MTS of which 12 had unilateral and 5 had bilateral MTS. No significant difference was detected between seropositive and seronegative patients in MTS versus non-MTS groups. The studied autoantibodies were present in 16 patients, including gamma-aminobutyric acid receptor (GABA-R) antibodies being the most common in 11 (33. 3%), followed by N-methyl-Daspartate receptor (NMDA-R) in 2 (6. 1%), glutamic acid decarboxylase receptor (GAD-R) in 1 (3. 0%), antiphospholipid (APL) antibody in 1 (3. 0%), CV2 in 1 (3. 0%), Tr in 1 (3. 0%), recoverin in 1 (3. 0%), and double-stranded deoxyribonucleic acid (dsDNA) antibody in 1 (3. 0%) of our patients with focal epilepsy. In both MTS and non-MTS groups, eight patients were positive for antibodies; four patients were positive for GABA in the MTS group and seven for GABA in the non-MTS group. Conclusion: Neuronal antibodies were presented in half of patients with focal epilepsy, GABA antibody being the leading one. No specific magnetic resonance imaging (MRI) findings were found in the seropositive group. Our results suggest that screening for relevant antibodies may enable us to offer a possible treatment to this group of patients.

Background: Numerous studies have evaluated the impact of Helicobacter pylori (H. pylori) eradication on the number, severity, and recurrence of migraine attacks. But the association of migraine, H. pylori, and gastrointestinal (GI) presentation is challenging. The aim of the current study was to investigate the correlation between migraine, H. pylori, and peptic ulcers among patients with dyspepsia undergoing upper GI endoscopy. Methods: 305 patients with dyspepsia referring to our endoscopy ward, Shahid Beheshti Hospital affiliated to Qom University of Medical Sciences, Qom, Iran, for upper GI endoscopy filled out the study questionnaire. If a patient was experiencing headaches and the migraine was confirmed by neurologists, he/she was asked to answer the questions related to migraine, which were prepared exactly from Migraine Disability Assessment (MIDAS) questionnaire. The relation between migraine and confirmed H. pylori contamination was investigated using statistical models. Results: Of all the 305 patients, 133 (43. 6%) had confirmed episodic migraine headaches (MHs) and 177 patients (58. 04%) had positive RUT for confirming H. pylori contamination, of which 123 (69. 5%) had confirmed migraine. 52 (17. 0%) had duodenal peptic ulcer(s), of which, 49 (94. 2%) had a positive rapid urease test (RUT) (P < 0. 001). 20 (6. 5%) of all patients had the gastric peptic ulcer(s) which did not have a significant relation with H. pylori contamination. There was a significant relationship between the peptic ulcer site and migraine. In total, 177 patients (58. 0%) had a positive RUT. History of migraine was significantly positive in those with positive H. Pylori contamination. Notably, multivariable analysis demonstrated a significant relation of H. pylori and migraine at younger ages. Conclusion: The prevalence of H. pylori and migraine in patients with dyspepsia seems to be high. Moreover, there is a meaningful association between migraine, duodenal peptic ulcers, and H. pylori infection, too.

Iran is an ancient country, known as the cradle of civilization. The history of medicine in Iran goes back to the existence of a human in this country, divided into three periods: pre-Islamic, medieval, and modern period. There are records of different neurologic terms from the early period, while Zoroastrian (religious) prescription was mainly used until the foundation of the first medical center (Gondishapur). In the medieval period, with the conquest of Islam, prominent scientists were taught in Baghdad, like Avicenna, who referred to different neurologic diseases including stroke, paralysis, tremor, and meningitis. Several outstanding scientists developed the medical science of neurology in Iran, the work of whom has been used by other countries in the past and present. In the modern era, the Iranian Neurological Association was established with the efforts of Professor Jalal Barimani in 1991.

Although cerebral venous sinus thrombosis (CVST) is less common than arterial stroke, it affects younger patients. 1 Few studies have been performed to show the trend of CVST outcome over time. 2 We aimed to assess the trend of CVST epidemiology and its outcome in Namazee hospital, Shiraz, Iran. This is a high volume referral center for cerebrovascular diseases in southern Iran...

There was a 20-year-old man who presented in May 2017 with an acute static and kinetic cerebellar syndrome. Cerebral magnetic resonance imaging (MRI) showed T2 and flair subcortical and periventricular hyperintense lesions, one of them was pseudotumor-like with peripheral contrast enhancement (Figure 1). Lumbar puncture (LP) revealed 10 white blood cells (WBC), proteinorrhachia of 4. 16 g/l, glycorrhachia of 3. 72 mmol/l, normal immunoglobulin G (IgG) index (IgG index: 0. 49), and no oligoclonal bands. Visual evoked potentials showed bilateral axonal-demyelinating optical neuritis. The diagnosis of multiple sclerosis (MS) was retained after excluding other inflammatory diseases (normal immunological assessment, no bipolar aphthous, neither skin lesions nor ocular damage on ophthalmic examination)...

Frontotemporal dementia (FTD) is a neurodegenerative disorder marked by the focal degeneration of frontal and anterior temporal lobes. 1 It is the second most common dementia affecting individuals under 65 years of age, 2 and third most common form of dementia for individuals over 65 years of age. 3 FTD is associated with early behavioural abnormalities, including apathy, disinhibition, obsessive and compulsive behaviours, emotional blunting, and loss of sympathy and empathy. Cognitive functions such as memory are relatively preserved in the early stages of the disease. 4 The current diagnosis is based on the complete clinical presentations, while the subtypes tend to merge as the disease progress...

Acute brain injury is a commonly encountered clinical problem that can make appropriate clinical assessment challenging. A key limitation in the neurological intensive care unit is how examiners assess a patient’ s level of arousal or responsiveness. The vast majority of providers are trained to use either nail bed pressure or a sternal rub technique to achieve such responses. While these noxious stimuli do elicit findings in non-comatose patients, comatose patients may be exposed to unnecessary harm with these techniques. In fact, reports in the literature have shown that sternal rubbing causes iatrogenic complications including skin tears, abrasions, and ecchymosis. 1 Such consequences should be considered during formal neurological assessment. Here, we present a case of repetitive noxious stimuli leading to diffuse sternal bruising, which the authors formally refer to as the “ coma sign” (Figure 1)...