Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 37 41 Mohammad Reza Najafi Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan AND Isfahan Neuroscience Research Center, Isfahan, Iran. Behnaz Ansari Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan AND Isfahan Neuroscience Research Center, Isfahan, Iran Mohammad Zare Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan AND Isfahan Neuroscience Research Center, Isfahan, Iran Farzad Fatehi Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran AND Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran Ali Sonbolestan Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan AND Isfahan Neuroscience Research Center, Isfahan, Iran 2015 10 17 Background: Diminished libido and sexual dysfunction are unusually common among male epileptic patients. The most important etiologic factor may be antiepileptic drugs (AEDs)-induced androgen deficiency. We compared reproductive hormone levels among men with epilepsy taking various AEDs and normal controls. Methods: Subjects were 59 male epileptic patients who aged 24 ± 5 years. They had been receiving lamotrigine (LTG) (n = 17), carbamazepine (CBZ) (n = 18), and sodium valproate (VPA) (n = 15) for at least 6 months. We also recruited 23 healthy controls. Testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), androstenedione (AND), luteinizing hormone (LH), and follicle stimulatin hormone (FSH) levels and gonadal efficiency (testosterone/LH) were compared between the four groups. The patients and the control group were examined and evaluated for male reproduction by urology and endocrinology services. Results: Subjects receiving CBZ, VPA, and LTG had significantly lower mean testosterone levels than the control group (P < 0.01). In addition, patients receiving LTG had significantly higher mean testosterone levels than CBZ and VPA groups (P < 0.01) and controls (P < 0.05). There were not any significant differences between the groups in mean estradiol levels. The mean AND level in VPA was higher than CBZ, LTG, and control groups (P < 0.01). Men receiving CBZ had significantly lower DHEAS levels than the other groups (P < 0.01). Testosterone/LH ratio in the control group was more than other groups (P < 0.01). On the other hand, this value in LTG group was higher than CBZ and VPA groups (P < 0.01). However, CBZ and VPA groups were not significantly different in terms of testosterone/LH ratio. Conclusion: Although the mean levels of reproductive hormones were lower in the LTG group compared to the controls, among traditional antiepileptic drugs, LTG had fewer side effects on reproductive hormones. Therefore, it is a good adjuvant and substitute drug for epilepsy control instead of CBZ and VPA. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/832 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/832/97

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 42 46 Mahboobeh Yaghoobi Resident, Iranian Center of Neurological Research, Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Harirchian Professor, Iranian Center of Neurological Research, Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran Kavous Firouznia Associate Professor, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Somayeh Behzadi Resident, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Hassan Hashemi Associate Professor, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences,Tehran, Iran Hossein Ghanaati Professor, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Madjid Shakiba Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Amir Hossein Jalali Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran Shahrzad Mohebbi Resident, Iranian Center of Neurological Research, Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran 2015 10 17 Background: Magnetic resonance imaging (MRI) is the standard method for observing brain plaques and contrast material injection is necessary for demonstrating the active plaque.This study compared the rate of enhancement of plaques with Gadovist and Magnevist in relapse phase of MS. Methods: In this double blind study, after neurological examination of 62 patients in the attack phase of MS, two consecutive MRIs were performed with Gadovist and Magnevist with 48 hours interval. The two contrast materials were injected in first and second imaging randomly and the reporting radiologist was blind about the contrast material. Results: With both contrast materials, the probability of enhancement of supratentorial plaques was higher than the infratentorial ones. The probability of observing a symptomatic infratentorial enhanced plaque was higher than the supratentorial region and when the symptoms were due to supratentorial lesions, the corresponding enhanced plaque was more probable. It was detected that the number of enhanced plaques was the highest if the imaging was performed in the second week after the relapse, although there was no statistically significant difference when the imaging was done within the first month after the beginning of the symptoms. Conclusion: It seems that both Magnevist and Gadovist could be used as the contrast material to detect enhancing plaques in relapse phase of multiple sclerosis. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/831 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/831/96

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 47 53 Soodeh Razeghi Jahromi Shefa Neuroscience Research Center, Tehran, Iran. Mansoureh Toghae Neurology Ward, Sina Hospital, Tehran University of Medical Sciences, Iranian Center of Neurological Researh, Tehran University of Medical Sciences, Tehran, Iran Mohammad Jamal Razeghi Jahromi Department of Statistics, Islamic Azad University, North Tehran Branch, Tehran, Iran Mahdi Aloosh Research Development Center of Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2015 10 17 Background: It has been suggested that nutrition might play a role in the etiology of multiple sclerosis (MS). However, dietary patterns associated with MS risk are unknown. This study was conducted to compare the dietary patterns of patients with MS and healthy controls to find the relationship between dietary patterns and MS. Methods:Usual dietary intake of 75 women with relapsing/remitting MS (RRMS) and 75 healthy controls were assessed with a food frequency questionnaire consisting of 168 food items. To define major dietary patterns, we used factor analysis. Multivariate logistic regression was used to assess the relationship between dietary patterns and risk of MS. Results:Traditional pattern (high in low-fat dairy products, red meat, vegetable oil, onion, whole grain, soy, refined grains, organ meats, coffee, and legumes) was inversely related to the risk of MS [odds ratio (OR) = 0.15; 95% confidence interval (CI): 0.03-0.18; P = 0.028]. A similar inverse relationship was noted between MS risk and lacto-vegetarian (high in nuts, fruits, French fries, coffee, sweets and desserts, vegetables, and high-fat dairy products) and vegetarian (high in green leafy vegetables, hydrogenated fats, tomato, yellow vegetables, fruit juices, onion, and other vegetables) patterns (OR = 0.31; 95% CI: 0.12-0.82; P = 0.018 and OR = 0.42; 95% CI: 0.19-0.90; P = 0.026, respectively). In contrast, the prevalence of MS was higher in those who had high animal fat dietary pattern (high in animal fats, potato, meat products, sugars, and hydrogenated fats and low in whole grains) (OR = 1.99; 95% CI: 1.63-2.94; P < 0.005). Conclusion: Our findings showed that the risk of RRMS can be affected by major dietary patterns. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/829 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/829/94

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 54 58 Ali Amini Harandi Shahid Beheshti University of Medical Sciences, Tehran, Iran. Saeed Shahbeigi Jondishapour Clinic, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hosein Pakdaman Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed-Mohammad Fereshtehnejad Tehran University of Medical Sciences, Tehran, Iran Elham Nikravesh Jondishapour Clinic, Tehran, Iran Roghie Jalilzadeh Jondishapour Clinic, Tehran, Iran 2015 10 17 Background: There is a known inverse association between solar radiation and the prevalence of multiple sclerosis (MS). Some studies have investigated the link between vitamin D and MS. The aim of this study was to investigate the possible association between serum 25(OH) vitamin D3 concentration and the severity of disease in Iranian patients with MS. Methods:Patients with relapsing-remitting MS underwent neurological examination, including measurement of Expanded Disability Status Scale (EDSS) score, and were categorized by disease severity into mild (0 ≤ EDSS ≤3), moderate (3.5 ≤ EDSS ≤5.5) and severe (6 ≤ EDSS). Serum concentrations of 25(OH) vitamin D3, calcium, phosphorus, magnesium and parathyroid hormone were also measured. Results:A total of 78 (73.1% female) patients with MS were evaluated. The mean (± standard deviation) of age was 33.9 ± 9.2 years. The mean (± standard error) serum concentrations of 25(OH) vitamin D3 were 36.6 ± 5.1 mg/dL, 50.1 ± 12.6 mg/dL and 19.8 ± 6.5 mg/dL in patients with mild, moderate and severe disease, respectively. There was a statistically significant inverse correlation between 25(OH) vitamin D3 concentration and EDSS score (P = 0.016, r= -0.273 by Spearman rank correlation test), which was observed in women only (P = 0.021, r = -0.305). Receiver operating characteristic curve analysis suggested that a serum 25(OH) vitamin D3 concentration cutoff of 16.5 mg/dL could differentiate patients with mild/moderate MS from severe disease with 74.6% accuracy. Conclusion:Our findings further support the association between vitamin D and disease severity in MS. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/827 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/827/92

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 59 64 Shahriar Nikpour Department of Gastroenterology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 2015 10 17 Celiac disease or gluten sensitivity may initially present as one or more neurological signs and/or symptoms. On the other hand, it may be associated with or complicated by neurological manifestations. Neurological presentations are rare in children but as many as 36% of adult patients present with neurological changes. With severe malnutrition after progression of celiac disease, different vitamin deficiencies may develop. Such problems can in turn overlap with previous neurological abnormalities including ataxia, epilepsy, neuropathy, dementia, and cognitive disorders. In this study, we aimed to review the neurological aspects of celiac disease. Early diagnosis and treatment could prevent related disability in patients with celiac disease. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/825 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/825/90

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 65 69 Payam Sariaslani Assistant Professor, Kermanshah University of Medical Sciences, Kermanshah, Iran. Ali Ghanbari Assistant Professor, Fertility and Infertility Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Parvin Ghanbari Cardiac Rehabilitation Center, Imam Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran 2015 10 17 Levamisole is an anthelmintic agent and also immunostimulant drug which is used to treat colorectal cancer. The present study aimed to show accidental consumption of levamisole alone induced multifocal inflammatory leukoencephalopathy. A 53-year-old male was admitted to the Neurology Department of Farabi Hospital (Kermanshah, Iran) with walking inability and recognition disorder. Following clinical examinations, the patient diagnosed as multifocal inflammatory leukoencephalopathy following levamisole consumption.The patient was treated with intravenous methylprednisolone followed by prednisolone. The magnetic resonance imaging (MRI) was done 1 month later and did not show a reduction or remission in the lesions. History of the patient showed that he had accidentally consumed levamisole 8 months ago. It seems that the consumption of levamisole can induce multifocal inflammatory leukoencephalopathy and delayed treatment of the patient with corticosteroid cannot diminish the neurotoxicity of levamisole. In addition, the cytotoxic dose of levamisole induces irreversible multifocal inflammatory leukoencephalopathy. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/823 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/823/88

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 11 2 2012 06 15 70 73 Mehrdokht Mazdeh Department of Neurology, Farshchian Hospital, Hamedan University of Medical Sciences, Hamedan, Iran. Ahmad Reza Mobaien Department of Infectious Diseases and Tropical Medicine, Valiasr Hospital, Zanjan University of Medical Sciences, Zanjan, Iran 2015 10 17 Background: Available evidence shows that tetracycline family has cellular and molecular mechanisms to protect neurons and oligodendrocytes by modulating matrix metalloproteinases. We tried to compare the effectiveness of intramuscular and subcutaneous interferon beta-1a (INF-β1a) in combination with oral doxycycline among patient with relapsing remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS). Methods: A double-blind clinical trial study was conducted at Hamedan University of Medical and Health Sciences in Iran. Sixty patients with definite diagnosis of RRMS or SPMS were treated with doxycycline and 44 µg subcutaneous IFN-β1a three times a week or 30 µg intramuscular IFN-β1a once a week for six months. Neuro Aryani Neurologist, Special Medical Center, Tehran, Iran Behnam Mansouri Neurologist, Special Medical Center, Tehran, Iran Nahid Beladi Moghadam Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2015 10 14 Mild (140 to 159/90 to 99 mmHg) or moderate (160 to 179/100 to 109 mmHg) chronic arterial hypertension does not appear to cause headache. Whether moderate hypertension predisposes patients to headache at all remains controversial, but there is little evidence that it does. Ambulatory blood pressure monitoring in patients with mild and moderate hypertension has shown no convincing relationship between blood pressure fluctuations over a 24-hour period and presence or absence of headache. However, headaches are associated to various disorders that lead to abrupt, severe, and paroxysmal elevations in blood pressure. In this paper, the secondary headaches attributed to acute crises of hypertension and the criteria for diagnosing each of them have been reviewed. These are headaches attributed to pheochromocytoma, hypertensive crisis without encephalopathy, hypertensive encephalopathy, pre-eclampsia, eclampsia, and acute pressure response to exogenous agents. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/649 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/649/153

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 111 113 Anahid Safari Department of Pharmacology, School of Medicine, Azad University, Kazerun Branch, Shiraz, Iran. Farhad Emadi Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Elham Jamali Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Afshin Borhani-Haghighi Research Center for Traditional Medicine and History of Medicine AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2015 10 14 A 50 year-old man was referred with history of acute ataxia and lower extremity paresthesia 10 days after general anesthesia with nitrous oxide. Cervical MRI showed long hypersignal lesion in posterior segment of the cord. Blood analysis revealed vitamin B12 deficiency. Nitrous oxide-induced myelopathy should be considered in patients who develop acute neurological manifestation after general anesthesia. It is recommended for physicians to think about symptoms and signs of B12 deficiency when evaluating patients in postoperative visits. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/648 https://ijnl.tums.ac.ir/index.php/ijnl/article/download/648/154

Tehran University of Medical Sciences Current Journal of Neurology 2717-011X 12 3 2013 09 15 114 116 Masoud Mehrpour Assistant Professor, Department of Neurology AND Firoozgar Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Motamed Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mahboubeh Aghaei Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Zahra Badi Research Center for Traditional Medicine and History of Medicine AND Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran 2015 10 14 Stroke is an important cause of disability and death worldwide, with the majority of strokes occurring in older people. Thrombolysis with recombinant tissue plasminogen activator (r-TPA) is the approved treatment for acute ischemic stroke. A major concern of physicians, who treat acute ischemic stroke with recombinant tissue plasminogen activator (r-TPA,) is the risk of intracerebral hemorrhage. However, other adverse reactions, including anaphylaxis and angioedema, can also occur. Here we report an interesting soft tissue reaction to intravenous r-TPA in an 80 year-old male who was treated for acute ischemic stroke. https://ijnl.tums.ac.ir/index.php/ijnl/article/view/647 https://ijnl.tums.ac.ir/