Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 57 63 Bahaadin Siroos Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Harirchian Department of Neurology, School of Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 14 Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disorder of the central nervous system (CNS) which preferentially involves young women in early child bearing age. Opposite to traditional view emphasized on discouraging female patients from enduring pregnancy, recent investigations showed that pregnancy-related physiological alterations, especially during the third trimester, reduce the annual relapse rate of multiple sclerosis up to 80% which is comparable with conventional disease modifying drugs. Nowadays, expert's viewpoint is that female patients should not be discouraged from having children. Nonetheless, who and when should be allowed to endure gestational period is a complex decision which should be taken for every patient individually. It necessitates that neurologists be aware of updated information regarding pregnancy-related fetal and maternal considerations in patients with MS. In this brief review, it was tried to discuss this topic according to available data and guideline-based recommendations. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/621 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/621/181

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 64 49 Fahimeh Abdollahi Department of Internal Medicine, School of Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Seyed Aidin Sajedi Department of Neurology, School of Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. 2015 10 14 Background:Recently, we introduced solar related geomagnetic disturbances (GMD) as a potential environmental risk factor for multiple sclerosis (MS). The aim of this study was to test probable correlation between solar activities and GMD with long-term variations of MS incidence. Methods:After a systematic review, we studied the association betwee n alterations in the solar wind velocity (VSW) and planetary A index (AP, a GMD index) with MS incidence in Tehran and western Greece, during the 23(rd) solar cycle (1996-2008), by an ecological-correlational study. Results:We found moderate to strong correlations among MS incidence of Tehran with VSW (rS = 0.665, P = 0.013), with 1 year delay, and also with AP (rS = 0.864, P = 0.001) with 2 year delay. There were very strong correlations among MS incidence data of Greece with VSW (r = 0.906, P < 0.001) and with AP (r = 0.844, P = 0.001), both with 1 year lag. Conclusion:It is the first time that a hypothesis has introduced an environmental factor that may describe MS incidence alterations; however, it should be reminded that correlation does not mean necessarily the existence of a causal relationship. Important message of these findings for researchers is to provide MS incidence reports with higher resolution for consecutive years, based on the time of disease onset and relapses, not just the time of diagnosis. Then, it would be possible to further investigate the validity of GMD hypothesis or any other probable environmental risk factors. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/620 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/620/182

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 70 76 Sheyda Shaafi Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Ehsan Sharifipour Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Rouhollah Rahmanifar Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. SeyedShamseddin Hejazi Department of Neurology, School of Medicine, Qom University of Medical Sciences, Qom, Iran. Sasan Andalib Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Masoud Nikanfar Department of Neurology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Behzad Baradarn Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Robab Mehdizadeh Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. 2015 10 14 Background: Interleukin-6 (IL-6) is one of the inflammatory mediators characterized by elevated levels in ischemic stroke (IS) patients. The present study set out to assess the role of IL-6, as a marker for inflammation, in the severity and prognosis of acute IS. Methods:In a cross-sectional descriptive study, 45 patients with acute IS were selected. Patients with their first day of stroke were included in the study. National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) for stroke severity were evaluated on Days 1, 5, 90, and 365. Serum IL-6 level was measured by enzyme-linked immunosorbent assay (ELISA) on days 1 and 5. Results:In the present study, 45 patients with a mean age of 77.6 ± 4.9 including 32 (71%) men and 13 (28.9%) women were studied. Death occurred in 2 (4.4%) patients before discharge from the hospital; the others, be that as it may, followed the study until Day 365 with a mortality rate of 6 (13.3%). A positive significant correlation was found between IL-6, and NIHSS and mRS of the patients from the time of admission to the end of the follow-up period (P < 0.001, r = 0.6). Moreover, there was a significant correlation between IL-6 and infarction size in brain magnetic resonance imaging (MRI) scan (P < 0.001, r = 0.7). Conclusion:The evidence from the present study suggests that IL-6 contributes to determination of severity of ischemic stroke. In addition, IL-6 concentrations affect clinical outcomes in ischemic stroke. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/619 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/619/183

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 77 82 Fariba Yadegari Department of Speech Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Mojtaba Azimian Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Mahdi Rahgozar Department of Statistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Babak Shekarchi Department of Radiology, School of Medicine, AJA University, Tehran, Iran. 2015 10 14 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  regardin  their underlying brain lesions. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/618 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/618/184

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 83 87 Davood Sobhani-Rad Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran ; Department of Speech Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran. Askar Ghorbani Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Hassan Ashayeri Department of Rehabilitation, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran. Shohereh Jalaei Department of Rehabilitation, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran. Behrooz Mahmoodi-Bakhtiari Department of Performing Arts, School of Fine Arts, Tehran University, Tehran, Iran. 2015 10 14 Background: Pragmatics is appropriate use of language across a variety of social contexts  that  provides accurate interpretation   of   intentions.   The   occurrence    of   the right hemisphere lesions can interfere with pragmatic abilities, and particularly with the processing of nonliteral speech acts. Methods: Since the objective of this study was to assess different  aspects of pragmatic  competence in the  right hemisphere damage (RHD)  patients, 20 Iranian patients with right  hemisphere lesions  were  examined  by adult pragmatic  profile (APP) and a novel  checklist  was introduced for Persian language  speaking individuals. Meanwhile, 40 healthy  adult  individuals, who  were  age and gender  matched  with RHD patients, were considered as the  control  group. After obtaining  video  records, all subjects were evaluated  for 35 pragmatic  skills, including 24 verbal, 5 paralinguistic, and 6 nonverbal  aspects, by a two-point scale system. Results: Studying RHD patients  and their healthy counterparts  revealed  that  the  performance   by participants   with  right  hemisphere  lesions  exhibited  a high  degree   of  inappropriate  pragmatic  abilities compared  with controls in all domains. Furthermore, RHD patients  showed  a  trend  of  increasing  difficulty  in understanding and  producing   different   pragmatic phenomena, including standard  communication acts. Conclusion:  Present  results  indicated  that  the  right hemisphere  lesions  significantly  affected  pragmatic abilities in verbal,  paralinguistic  and  nonverbal  aspects. Such  a  pattern   of  performance,  which  is in  line  with deficits   previously   reported  for  RHD,  proved    the unquestioned role of the right hemisphere in processing nonliteral language. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/617 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/617/185

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 88 93 Masoud Etemadifar Department of Neurology, School of Medicine, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Farshid Afshar Department of Medical Sciences, School of Medicine, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Zahra Nasr Department of Medical Sciences, School of Medicine, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. Mohsen Kheradmand Department of Medical Sciences, School of Medicine, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2015 10 14 Background: Multiple sclerosis (MS) is an autoimmune inflammatory disease  that affects  the  central  nervous system. Except tremor, other movement disorders such as Parkinsonism are less frequent  in MS. However, some investigations  have shown inflammatory and autoimmune aspects of Parkinson’s disease. In this study, we report eight new cases of MS who present Parkinson’s disease. Methods:  This retrospective  population-based study was carried out on Isfahan MS society between April 2003 and July 2012. A total of 3792 patients  with MS were surveyed for Parkinson’s disease. Parkinson’s disease  was approved according  to  “UK  Parkinson disease  Brain  Bank” criteria. Eligible  cases  were  invited  to  have  an  interview with  a neurologist. MRI was carried out according to the baseline. Results: We identified eight patients  (three men and five women)  who  present  MS and  Parkinson’s  disease.  The mean  (±SD) age  of onset  was 33.3  ± 6.5 (range:  24–42) years  for  MS and  39.5  ±  8. (range:  30–55)  years  for Parkinson’s   disease   patients.   In   all  patients,   MS was preceded  Parkinson’s  disease.  Parkinson’s  disease  was developed within mean duration of 6.1 ± 3.4 (range 2–13) years  after  MS.  Focal lesions  was  shown  in  six cases, lesions  of  basal  ganglia   (BG)   in  four,  lesions  of  the thalamus  in two and lesions of mid-brain in five of cases. In four cases, Parkinsonism occurred before age 40 that is considered as Young-Onset Parkinson’s disease. Conclusion: We reported eight  patients with  MS and Parkinson’s  disease. To  the  best  of our  knowledge, 34 cases of Parkinsonism associating with MS are reported so far. Parkinsonism is a movement disorder, defines as deep gray matter  disorder which lead to dopamine deficiency in BG.Investigations have  shown  that  MS could affect deep  gray matter structures. Demyelinated  lesions in MS and  consequence axonal loss in BG and/or  nigrostriatal pathway may be responsible for Parki sonism manifestations  in such cases. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/616 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/616/186

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 94 100 Nahid Ashjazadeh Department of Neurology, School of Medicine, Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Golnaz Yadollahikhales Department of Neurology, School of Medicine, Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Anaheed Ayoobzadehshirazi Department of Neurology, School of Medicine, Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Nazanin Sadraii Department of Neurology, School of Medicine, Shiraz Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Negin Hadi Department of Community Medicine, School of Medicine, Research Center for Psychiatry and Behavioral Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. 2015 10 14 Background: Epilepsy is defined as recurrent unprovoked febrile  seizures, which  cause  disability in patients.  This study  aims  to  assess  the  health-related  quality-of-life (QOL) in epileptic patients in Fars Province, southern  Iran. Methods: One-hundred epileptic  patients, above 18 years, referred to Shiraz University of Medical Sciences affiliated clinics, were included. The QOL of patients with generalized  and  partial seizure were assessed using the Iranian valid and  reliable  Sf-36 questionnaire. Patients’ socio-demographic and  their disease  features were also compared  with each other using a questionnaire. Results: In partial epilepsy group (n = 24), the  married patients in social functioning (SF) aspect  of  QOL (64.42 ± 14.29) (P = 0.024), the  patients  on antiepileptic drugs  (AEDs) monotherapy in both  physical functioning (PF) (88.75  ±  11.57)  (P =  0.030) and  SF (75.00  ±  6.68) (P = 0.022) aspects, the employed patients in PF aspect of QOL ( = 0.023) (91.87 ± 8.83) and those with high income in mental health aspect of QOL (P = 0.036 and correlation coeDcient = 0.413) got better  scores compared  with the partial epileptic patients who were single, on polytherapy, unemployed and had low to moderate income. In generalized epilepsy  group  (n = 76), patients  on AEDs monotherapy in PFaspect  of QOL (P = 0.025) (78.33 ± 24.36) and  employed  patients in vitality aspect (P = 0.023) (57.00 ± 28.25) had better  scores.Data were analyzed using SPSS for windows. Conclusion: Epilepsy can affect patient’s life in a number of ways  such as  their  lives, marriage, occupation, and education. We can encourage patients  to find a partner, continue higher education  and try to find a job. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/615 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/615/187

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 101 104 Humain Baharvahdat Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Hamid Etemadrezaie Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Samira Zabyhian Department of Neurosurgical, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Zahra Valipour Neurology Research Group, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Babak Ganjeifar Department of Neurosurgery, School of Medicine, Emdadi Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Seyed Mohammad Mousavi Mirzaye Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Payam Sasannejad Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Kavian Ghandehari Department of Neurology, School of Medicine, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 14 Background:  Intravenous  recombinant  tissue plasminogen  activator  (rt-PA) is an approved  treatment for acute ischemic stroke within 4.5 h of symptoms onset. Decompressive craniectomy (DC) has been  shown  as an effective  therapeutic  modality in malignant  middle cerebral  artery (MCA) infarction. As rt-PA could result in hemorrhagic  complication during or after any surgery DC may be associated with severe bleeding after intravenous thrombolysis. Case Description: A 57-year-old woman was presented 90 min after the sudden  onset of left hemiplegia. Despite intravenous  thrombolytic therapy, she lost consciousness within 48 h and brain CT scan showed a right malignant MCA infarction associated  with a small bleeding. DC was performed  without  any complication. The patient improved dramatically. Conclusion: DC could be done safety for malignant  MCA infarction after unsuccessful intravenous thrombolytic therapy  even  the later was complicated  with  intra- infarction hemorrhage. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/614 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/614/188

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 105 107 Mojtaba Azimian Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Azam Shahvarughi-Farahani Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Mahdi Rahgozar Department of Clinical Sciences, School of Medicine, Tehran University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. Masoud Etemadifar Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Zahra Nasr Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran ; Department of Medical Sciences, School of Medicine, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. 2015 10 14 Background: Fatigue, depression, and physical impairment are common  among  multiple  sclerosis (MS) patients. The aim  of  this  study was to  determine  the   relationship between depression,  physical impairment,  and  fatigue  in an Iranian MS cohort. Methods: Fifty consecutive  relapsing-remitting MS patients and  50 age- and  sex-matched healthy  controls (HCs) were recruited  from Sina Rehabilitation Clinic,Tehran, ran. The depression  substance of Hospital Anxiety and  Depression Scale (HADS), Expended Disability Status Scale, and Fatigue Severity Scale questionnaires were used  to  assess depression, physical impairment, and fatigue, respectively. Results: This study included 38 (76%) females and 12 (24%) males  in  both  patients and  HC groups. The  depression substance of the  HADS  in MS and  HCs showed  a mean value of 1.92 ± 0.80 and 1.17 ± 0.38, respectively (P < 0.001). Pearson’s correlation analyses showed that in the MS group depression    was  associatedwith fatigue (r  =  0.54, P =  0.01),  but  not  with  physical  impairment  (r =  0.16, p =   0.01),while fatigue   was   associated with both depression  (r = 0.54, P = 0.01) and  physical impairment (r =  0.36,  P =  0.01).  Depression  in HCs group  was  also associated with fatigue (r -0.64, P = 0.01). Conclusion: Fatigue  is associated   with  both  depression and  physical  impairment, and  an  intervention  in one  of these conditions might improve others. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/613 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/613/189

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 108 109 Fahmi Nasrallah Department of Biology, School of Medicine, Laboratory of Biochemistry, Rabta Hospital, Jebbari, 1007 Tunis, Tunisia. Joseph Vamecq Department of Biochemistry, School of Medicine, Molecular Biology and Metabolic Diseases, CHRU, 57039 Lille, France ; Department of Biochemistry and Molecular Biology, School of Medicine, Laboratory of Biochemistry, Molecular Biology and Metabolic Diseases, CHRU, 57039 Lille, France. Ichraf Kraoua Department of Child and Adolescent Neurology, School of Medicine, Mongi Ben Hmida Institute of Neurology, 1700 Tunis, Tunisia. Marie Joncquel-Chevalier Curt Department of Biochemistry and Molecular Biology, School of Medicine, Laboratory of Biochemistry, Molecular Biology and Metabolic Diseases, CHRU, 57039 Lille, France. Moncef Feki Department of Biology, School of Medicine, Laboratory of Biochemistry, Rabta Hospital, Jebbari, 1007 Tunis, Tunisia. Souheil Omar Department of Biology, School of Medicine, Mongi Ben Hmida Institute of Neurology, 1700 Tunis, Tunisia. Gilbert Briand Department of Biochemistry and Molecular Biology, School of Medicine, Laboratory of Biochemistry, Molecular Biology and Metabolic Diseases, CHRU, 57039 Lille, France. Ilhem Turki Ben Youssef Department of Child and Adolescent Neurology, School of Medicine, Mongi Ben Hmida Institute of Neurology, 1700 Tunis, Tunisia. Naziha Kaabachi Department of Biology, School of Medicine, Laboratory of Biochemistry, Rabta Hospital, Jebbari, 1007 Tunis, Tunisia. 2015 10 14 ###No Abstract### https://ijnl.tums.ac.ir/index.php/ijnl/article/view/612 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/612/190

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 13 2 2014 06 15 110 111 Mohammad Rohani Department of Neurology, School of Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran. 2015 10 14 ###No Abstract### https://ijnl.tums.ac.ir/index.php/ijnl/article/view/611 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/611/191