Publications by authors named "Ahmad Chitsaz"

47 Publications

The effect of fampridine on the risk of seizure in patients with multiple sclerosis.

Mult Scler Relat Disord 2020 Aug 22;43:102188. Epub 2020 May 22.

School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Electronic address:

Background: Fampridine was first approved by the US Food and Drug Administration (FDA) to improve walking in multiple sclerosis (MS) patients, which was demonstrated by an increase in their walking speed. Nevertheless, the medication has been reported to possess an epileptogenic effect since it blocks the voltage-gated potassium channels in neural fibers. Several studies have indicated that the risk of seizure among fampridine consumers is not substantially higher than that in the general MS population, however. The objective of this study is to describe 97 MS patients for whom fampridine was prescribed and to assess the incidence of post-medication seizures.

Methods: This cohort study included 97 MS patients with gait problems who referred to the Isfahan Clinic of MS from August 2017 to September 2019. The exclusion criteria were a previous or family history of seizure or a history of renal impairment. Fampridine was prescribed for all the patients at a dose of 10 mg twice daily (12 hours apart).

Results: three patients (with an approximate incidence rate of 0.015 per 100 patient-years) presented with generalized tonic-clonic seizures, 7, 9, and 14 months after initiating fampridine consumption. The radiological findings revealed significant cortical and subcortical lesions in the three patients. Further, two of them consumed baclofen or fingolimod simultaneously with fampridine.

Conclusion: The reported incidence rate is relatively higher than that in the general MS population. The extensive (sub) cortical lesions and the concomitant medications probably have an important role in the epileptogenesis, regardless of fampridine. However, the potential pro-convulsant properties of fampridine should not be overlooked.
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http://dx.doi.org/10.1016/j.msard.2020.102188DOI Listing
August 2020

The effect of the Mediterranean diet on cognitive function in patients with Parkinson's disease: A randomized clinical controlled trial.

Complement Ther Med 2020 May 4;50:102366. Epub 2020 Mar 4.

Professor of Neurology Isfahan University of Medical Sciences, Iran.

Objectives: Parkinson's disease (PD) is the second most common neurodegenerative disorder. It is proposed that adherence to the Mediterranean diet might have a beneficial effect on the prevention and treatment of PD and its complications. Thus, the aim of this study was to investigate the effects of the Mediterranean diet on cognitive function in patients with PD.

Design: The study was a single-center, randomized clinical trial. Eighty patients with idiopathic PD were randomly allocated to the Mediterranean diet (n = 40) or control (n = 40) group. Patients in the intervention group received an individualized dietary plan based on Mediterranean diet for 10 weeks. The Persian version of Montreal Cognitive Assessment (MoCA) test was used to assess the cognitive function at baseline and the end of the study.

Results: Thirty-five PD patients with a mean age of 59.3 ± 8.3 and 35 patients with a mean age of 58.6 ± 9.3 finished the study in intervention and control groups, respectively. After the intervention, the mean score of the dimensions of executive function, language, attention, concentration, and active memory and the total score of cognitive assessment significantly increased in the intervention compared with the control group (p < 0.05, for all). Nevertheless, the mean of the other scores including spatial-visual ability, memory learning task, and navigation versus time and place did not significantly change in both intervention and control groups.

Conclusions: The findings of this study showed that adherence to the Mediterranean diet remarkably increased the dimensions of executive function, language, attention, concentration, and active memory and finally the total score of cognitive assessment in PD patients.
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http://dx.doi.org/10.1016/j.ctim.2020.102366DOI Listing
May 2020

The effects of Mediterranean diet on severity of disease and serum Total Antioxidant Capacity (TAC) in patients with Parkinson's disease: a single center, randomized controlled trial.

Nutr Neurosci 2020 Apr 22:1-8. Epub 2020 Apr 22.

Department of Epidemiology and Biostatistics, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Parkinson's disease (PD) as one of the most common neurodegenerative disorders may be affected by healthy dietary pattern. The aim of this study was to investigate the effects of the Mediterranean Diet (MeD) on serum Total Antioxidant Capacity (TAC) and disease severity in PD patients. In this single-center randomized clinical trial, patients with idiopathic PD ( = 80) were selected randomly allocated to either MeD or control group (Iranian traditional diet); an individualized dietary plan based on the MeD was designed. Serum TAC and the motor & non-motor disease aspects using the Unified Parkinson's Disease Rating Scale (UPDRS) were evaluated in two groups. Statistical Analysis of data was performed using SPSS 24. 70 PD patients with a mean age of 58.96 ± 8.7 and UDPRS of 41.66 ± 20.19 were analyzed in this study. MeD significantly increased serum TAC ( < 0.001). UPDRS score was also lowered in MeD group ( < 0.05). Mediterranean diet seems to have some benefits in PD. as well, TAC levels can also be affected by MeD. Anyway, further studies are needed to confirm the mentioned outcomes. Iranian Registry of Clinical Trials identifier: IRCT20141108019853N4.
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http://dx.doi.org/10.1080/1028415X.2020.1751509DOI Listing
April 2020

Tongue Protrusion Dystonia in Pantothenate Kinase-Associated Neurodegeneration.

Pediatr Neurol 2020 02 13;103:76-78. Epub 2019 Jun 13.

Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Tongue protrusion dystonia is an uncommon focal dystonia involving the lingual muscles. Causes of tongue protrusion dystonia include tardive dystonia, posthypoxic dystonia, neuroacanthocytosis, pantothenate kinase-associated neurodegeneration, and Lesch-Nyhan syndrome.

Method: We summarize three children with pantothenate kinase-associated neurodegeneration and tongue protrusion dystonia. All three patients underwent careful neurological examination, brain magnetic resonance imaging, and genetic testing.

Results: Tongue protrusion dystonia was a prominent and disabling symptom in all three patients. Brain magnetic resonance imaging revealed a typical eye of the tiger sign in all patients. Two patients had the same genetic mutation (c.1168 A>T mutation, p.I390F).

Conclusions: Tongue protrusion dystonia may be a clue to the underlying etiology of dystonia, including hereditary forms of dystonia. Among them, pantothenate kinase-associated neurodegeneration is an important cause, especially in children.
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http://dx.doi.org/10.1016/j.pediatrneurol.2019.06.004DOI Listing
February 2020

Association of dietary patterns with systemic inflammation, quality of life, disease severity, relapse rate, severity of fatigue and anthropometric measurements in MS patients.

Nutr Neurosci 2020 Dec 21;23(12):920-930. Epub 2019 Mar 21.

Department of Neurology, Isfahan University of Medical Sciences Isfahan, Iran.

Multiple sclerosis (MS) is associated with changes in quality of life, disability, fatigue and anthropometric measurements. The important relationship of dietary patterns with such clinical manifestations was not completely investigated. The goal of this study was to define the dietary patterns and their association with systemic inflammation, Health-Related Quality Of Life, disease severity, Relapse Rate, severity of fatigue and anthropometric measurements in MS subjects. This cross-sectional study was conducted in 261 MS patients (mean age 38.9 ± 8.3). Dietary patterns were explored by a Food Frequency Questionnaire. Serum hs-CRP, Multiple Sclerosis Quality Of Life-54 item questionnaire, Extended Disability Status Scale, Fatigue Severity Scale and Visual Analog Fatigue Scale, Relapse Rate, Height, Weight and Deurenberg Equation were also used as tools. Data were analyzed by SPSS, and using ANOVA, Tukey, Chi-square and ANCOVA tests. Fruits, Vegetables, Low fat dairy-based pattern and Mediterranean-Like pattern were associated with lower serum hs-CRP ( = 6.037,  < 0.01), higher Physical and Mental Health Composite Scores ( < 0.001), lower attacks ( = 4.475,  < 0.05), lower acute and chronic fatigue ( = 5.353 and  = 7.011, respectively,  < 0.01), lower BMI ( = 7.528,  < 0.01) and Percent Body Fat ( = 6.135,  < 0.01); but no difference was observed about EDSS across the patterns. Adherence to healthy dietary patterns may reduce systemic inflammation, severity of fatigue, MS attacks, improved quality of life and balance weight especially body fat in MS patients.
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http://dx.doi.org/10.1080/1028415X.2019.1580831DOI Listing
December 2020

Predicting Long-Term Cardiovascular Events after Transient Ischemic Attacks: Carotid Artery Intima-Media Thickness or ABCD2 Score or Both?

Int J Prev Med 2018 15;9:102. Epub 2018 Nov 15.

Department of Neurology, School of Medicine, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Patients who experienced transient ischemic attack (TIA) are at high-risk for cardiovascular events. This study aims to evaluate diagnostic value of carotid artery intima-media thickness (CIMT) and ABCD2 score for predicting cardiovascular events in long-term follow-up after TIA. We prospectively included sixty patients with TIA who admitted to hospital from March 2016 to August 2016.

Methods: Duplex ultrasonography of internal carotid arteries was performed. ABCD2 scores were evaluated for each patient. At a median follow-up of 20 months, patients were asked about new cardiovascular events. We used IBM SPSS software version 22.0 with Chi-squared, -test, ANOVA, receiver operating characteristic, and area under the curve (AUC) analysis for our work.

Results: Sensitivity and negative predictive value of the combined score (ABCD2+CIMT) was the highest (96.3% and 90.9%, respectively), and the specificity and positive predictive value of the CIMT were the highest (57.5% and 63.1%, respectively) to predict cardiovascular events in long-term.

Conclusion: Compared to ABCD2 score, CIMT proved to be more accurate to predict cardiovascular events in long-term follow-ups (AUC = 0.736 vs. AUC = 0.640). However, adding CIMT value to ABCD2 score was even better (AUC = 0.750). Therefore, CIMT measurement in the ABCD2 score after TIA enables prediction of long-term cardiovascular events.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_415_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6259433PMC
November 2018

Demographic features and clinical characteristics of patients with Parkinson's disease in Isfahan, Iran.

Iran J Neurol 2018 Jan;17(1):6-10

Isfahan Neurosciences Research Center, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Parkinson's disease (PD) is the second most common neurodegenerative disorder. Its worldwide incidence rate varies between 18 and 418 cases per 100000 annually. This cross-sectional study was carried out with the aim to identify the clinical characteristics and demographic features of a huge number of patients with PD in Isfahan, Iran. The study was conducted on 987 patients with PD in Isfahan city and checklists were used to evaluate the demographic features and clinical characteristics of the patients. The mean age of the patients at the time of sampling was 65.40 ± 11.90 years. The study results indicated that the rate of PD among men with 67.3% was twice that of women with 32.7%. The mean duration of the disease was 4.91 ± 4.60 years. This study showed a considerable rate of PD among the individuals in Isfahan city. In addition, the incidence ratio of men to women was more than the previous studies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121204PMC
January 2018

Dietary Intake of Thiamine in Migraine Patients and Healthy Subjects: a Case-Control Study.

Clin Nutr Res 2018 Jan 31;7(1):40-47. Epub 2018 Jan 31.

Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran.

The migraine headache is a disease related to the neurovascular system, which affects 10%-20% of people, worldwide. Recent evidences suggested a relation between thiamine status and migraine headaches. The current study was undertaken to assess dietary intake of the thiamine in migraine patients and to evaluate its association with the frequency of migraine attacks. In a case-control design, the current study was performed on 50 migraine patients and 50 healthy people, 20-60 years old in Isfahan, Iran, in 2017. Information about dietary intake was collected by Food frequency questionnaire and analyzed using the Nutritionist version 4 (N4) software (Tinuviel Software). Information about the history of disease was collected by demographic questionnaire. Analysis of covariance and independent t-test were used for data analysis and p value less than 0.05 was considered significant. Mean age, weight, height, and body mass index of participants were 35.1 ± 9.8 years, 65.3 ± 10.4 kg, 162.5 ± 8.4 cm, and 24.7 ± 4.0 kg/m, respectively. Dietary intake of thiamine among the migraine patients was lower than that in the healthy participants (p < 0.001). Migraine patients with the high frequency attacks had significantly lower intake of thiamine compared with moderate frequency attacks group (p = 0.010), however, it was not significant after adjusting for energy intake (p = 0.410, p = 0.240). Dietary intake of thiamine in migraine patients was not significantly different in comparing with healthy subjects. In addition, no significant correlation between thiamine intake and the frequency of migraine attacks was observed.
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http://dx.doi.org/10.7762/cnr.2018.7.1.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796922PMC
January 2018

Evaluation of non-motor symptoms and their impact on quality of life in patients with Parkinson's disease, Isfahan, Iran.

Iran J Neurol 2017 Jul;16(3):118-124

Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Parkinson's disease (PD) is diagnosed on the basis of motor symptoms, but non-motor symptoms (NMS) have high prevalence in PD and often antecede motor symptoms for years and cause severe disability. This study was conducted to determine the prevalence of NMS in patients with PD. This cross-sectional study was performed in Isfahan, Iran, on patients with PD. The prevalence of NMS was evaluated by the NMS questionnaire, the NMS scale, and Parkinson's disease questionnaire-39 (PDQ-39). The Mini-Mental Status Examination (MMSE) was used for assessing cognition. A total of 81 patients, including 60 men and 21 women, were recruited for this study. The prevalence of NMS was 100%, and the most commonly reported symptom was fatigue (87.7%); there was a strong correlation between NMS and the quality of life (QOL) of patients with PD (P < 0.001). This study showed that NMS are highly prevalent in the PD population and adversely affect QOL in these patients. Early diagnosis and treatment can improve QOL and can help in disability management of patients with PD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5673983PMC
July 2017

The Prevalence of Osmophobia in Migranous and Episodic Tension Type Headaches.

Adv Biomed Res 2017 17;6:44. Epub 2017 Apr 17.

Researcher, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Migraines are a neurological disease, of which the most common symptom is an intense and disabling episodic headache. Many persons experience sensory hyper excitability manifested by photophobia, phonophobia and osmophobia. This study was planned to investigate the prevalence of osmophobia in migranous and episodic tension type headache (ETTH).

Materials And Methods: A semi-structured questionnaire was administered to all patients to evaluate the eventual presence of osmophobia during a headache attack and different characteristics of osmophobia were determined.

Results: Osmophobia reported in 84% with migranous headache with aura, 74% of migranous patients without aura and in 43.3% of those with ETTH. In 50% of patients, osmophobia was present in all of their headache attacks, 11.7% had osmophobia in more than half of their attacks (from 10 attacks they reported osmophobia in 5-9 ones) and others had this sign in less than half of their attacks (from 10 attacks they reported osmophobia in less than 5 ones). Most frequently the offending odors were scents (88%), foods (54.2%) and cigarette smoke (62.5%). Osmophobia starts 30 min before the headache starts in 22.7% of patients.

Conclusion: Osmophobia appears structurally integrated into the migraine history of the patient; however, for differential diagnosis with ETTH, other criteria are necessary.
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http://dx.doi.org/10.4103/2277-9175.204587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414411PMC
April 2017

A Clinical and Molecular Genetic Study of 50 Families with Autosomal Recessive Parkinsonism Revealed Known and Novel Gene Mutations.

Mol Neurobiol 2018 Apr 13;55(4):3477-3489. Epub 2017 May 13.

Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

In this study, the role of known Parkinson's disease (PD) genes was examined in families with autosomal recessive (AR) parkinsonism to assist with the differential diagnosis of PD. Some families without mutations in known genes were also subject to whole genome sequencing with the objective to identify novel parkinsonism-related genes. Families were selected from 4000 clinical files of patients with PD or parkinsonism. AR inheritance pattern, consanguinity, and a minimum of two affected individuals per family were used as inclusion criteria. For disease gene/mutation identification, multiplex ligation-dependent probe amplification, quantitative PCR, linkage, and Sanger and whole genome sequencing assays were carried out. A total of 116 patients (50 families) were examined. Fifty-four patients (46.55%; 22 families) were found to carry pathogenic mutations in known genes while a novel gene, not previously associated with parkinsonism, was found mutated in a single family (2 patients). Pathogenic mutations, including missense, nonsense, frameshift, and exon rearrangements, were found in Parkin, PINK1, DJ-1, SYNJ1, and VAC14 genes. In conclusion, variable phenotypic expressivity was seen across all families.
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http://dx.doi.org/10.1007/s12035-017-0535-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5683945PMC
April 2018

Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction.

J Res Med Sci 2017 16;22:19. Epub 2017 Feb 16.

Isfahan Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms' onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients.

Materials And Methods: Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction ( = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications.

Results: The mean age of males versus females was 60 versus 77.5 years (ranged 23-93 . 29-70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8-209.04 min) for door to IV-tPA needle time.

Conclusion: Despite the international guidelines for IV-tPA injection within 3-4.5 h of ischemic stroke symptoms' onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms' onset by consultant neurologist in Isfahan/Iran seem to be advantageous.
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http://dx.doi.org/10.4103/1735-1995.200318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367212PMC
February 2017

Brain regions involved in swallowing: Evidence from stroke patients in a cross-sectional study.

J Res Med Sci 2016 14;21:45. Epub 2016 Jun 14.

Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Limited data available about the mechanisms of dysphagia and areas involving swallow after brain damage; accordingly it is hard to predict which cases are more likely to develop swallowing dysfunction based on the neuroimaging. The aim of this study was to investigate the relationship between brain lesions and dysphagia in a sample of acute conscious stroke patients.

Materials And Methods: In a cross-sectional study, 113 acute conscious stroke patients (69 male mean [standard deviation (SD)] age 64.37 [15.1]), participated in this study. Two neurologists and one radiologist localized brain lesions according to neuroimaging of the patients. Swallowing functions were assessed clinically by an expert speech pathologist with the Mann Assessment of Swallowing Ability (MASA). The association of brain region and swallowing problem was statistically evaluated using Chi-square test.

Results: Mean (SD) MASA score for the dysphagic patients was 139.61 (29.77). Swallowing problem was significantly more prevalent in the right primary sensory ( = 0.03), right insula ( = 0.005), and right internal capsule ( = 0.05).

Conclusion: It may be concluded from these findings that the right hemisphere lesions associated with occurring dysphagia. Further studies using more advanced diagnostic tools on big samples particularly in a perspective structure are needed.
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http://dx.doi.org/10.4103/1735-1995.183997DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122214PMC
June 2016

Association of Helicobacter pylori antibodies and severity of migraine attack.

Iran J Neurol 2015 Jul;14(3):125-9

Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Recent studies have shown a positive correlation between Helicobacter pylori infection and migraine headache. The aim of this study was to evaluate the role of H. pylori infection in migraine headache with (MA) and without aura (MO).

Methods: This is a case-control study containing information on 84 patients (including MA, MO) and 49 healthy individuals. The enzyme-linked immunosorbent assay (ELISA) test was used to measure immunoglobulin G (IgG,) immunoglobulin M (IgM) titer in two groups. Headache severity was evaluated according to Headache Impact Test (HIT6) questionnaire.

Results: Mean ± SD of IgM antibody in Migrainous patients 26.3 (23.1) showed significantly difference with control group 17.5 (11.2) (P = 0.004). In addition, the mean ± SD HIT6 in Migrainous patients differed significantly between MA and MO groups 65.5 (4.7), 54.9 (5.3) respectively, P < 0.001). The only significant correlation was found for IgG antibody and HIT6 in MA patients (r = 0.407, P = 0.011) and MO group (r = 0.499, P = 0.002). The risk of migraine occurrence in patients did not significantly associate with the level of IgG and IgM antibodies.

Conclusion: The results give a hope that definite treatment and eradication of this bacterium could be a cure or to reduce the severity and course of migraine headaches.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662684PMC
July 2015

Preliminary analysis of month of birth in Iranian/Isfahan patients with multiple sclerosis.

Adv Biomed Res 2015 10;4:166. Epub 2015 Aug 10.

Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Previous publications reported that an individual's month of birth (MOB) might have an important correlation to that consequent risk of multiple sclerosis (MS).

Aim: The aim of this preliminary study was to investigate the distribution of different MOBs inpatients with MS in Isfahan, Iran.

Materials And Methods: This investigation was conducted to the Isfahan Neurosciences Research Centre. 1283 patients with MS were studied. Clinical data were recorded in d-Base and analyzed using SPSS (version 18) for Windows.

Results: Of the total population studied there were 979 females and 304 males. The mean age of all the patients was 34.6 years (range 10-87 years). Within the total population, the MOBs in the 62% of patients were in the season's spring and summer, and in 38% of patients they were in the season's autumn and winter. As the MOB might be recognized to have a bearing on an individual's risk of contracting MS, the highest and lowest correlations seem to be linked with April, September, May (↑), and November (↓), respectively.

Conclusions: The seasonal relationship between MOBs and MS risk might be pointed toward a potential function for vitamin D throughout pregnancy or the early life of the newborn. Further studies are needed to confirm these correlations.
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http://dx.doi.org/10.4103/2277-9175.162543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581128PMC
October 2015

The association between saliva control, silent saliva penetration, aspiration, and videofluoroscopic findings in Parkinson's disease patients.

Adv Biomed Res 2015 29;4:108. Epub 2015 May 29.

Mahoor Clinic of Speech and Language Pathology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Dysphagia is a common disorder among patients with Parkinson's disease (PD). It occurs in up to 80% of all (PD) patients during the early stages of the disease and up to 95% in the advanced stages; but professionals may not hear from the patients about dysphagia symptoms until these symptoms reach an advanced stage and lead to medical complications.

Materials And Methods: Thirty-three PD patients (mean age 66.09 ± 9.4 years; 24 men, nine women) participated in this study at our Neurology Institute, between April 20, 2013, and October 26, 2013. They were asked two questions; one about saliva control and the other about silent saliva penetration and aspiration. Next, they underwent the videofluoroscopic swallowing study (VFSS).

Results: The Pearson Correlation coefficient between the Penetration-Aspiration Scale (PAS) scores and question 1 scores was 0.48 (P < 0.05, =0.25), and there was a significant correlation between the PAS scores and question 2 scores, and also question 1 scores + question 2 scores (r = 0.589, P < 0.05, =0 and r = 0589, P < 0.05, =0).

Conclusions: This study showed a significant correlation between the questions about saliva control, silent saliva penetration, and aspiration, and laryngeal penetration and aspiration during VFSS. Therefore, by using these two questions, the potential silent laryngeal penetration and aspiration during meals could be detected before it led to aspiration pneumonia. Taking the benefit of these questions, as a part of the swallowing assessment of PD patients, is recommended.
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http://dx.doi.org/10.4103/2277-9175.157815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513306PMC
August 2015

The effect of group psycho-education program on the burden of family caregivers with multiple sclerosis patients in Isfahan in 2013-2014.

Iran J Nurs Midwifery Res 2015 Jul-Aug;20(4):420-5

Department of medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Lack of adequate training and support of primary caregivers of multiple sclerosis (MS) patients is the major factor in causing stress, anxiety, and increase of burden. Therefore, the treatment team members such as psychiatric nurses can help these vulnerable people overcome psychiatric pressures effectively not only through their care and referral role but also through their supportive characteristic, which helps the patients improve their clinical status, together with their social, familial, and work adaptation. Therefore, the researcher tried to identify the effect of a group psycho-education program on the burden family caregivers with MS patients.

Materials And Methods: This is a two-group three-stage clinical trial. The researcher referred to the heads of neurology clinics to present the purpose of the study and to start the sampling. The neurology clinics of AL Zahra University Hospital, and also a Private Neurology Clinic were selected to collect the data of the study. The subjects were randomly selected, and then, assigned to two groups of study and control.

Results: Independent t-test showed a significant reduction in family caregivers' burden immediately after and 1-month after intervention in the study group, compared to control. Repeated measure ANOVA showed a significant reduction in caregivers' burden mean score in the study group (P < 0.001).

Conclusions: As group psycho-education reduced family caregivers' burden, it is recommended to develop and design other programs for the family caregivers of the patients with MS.
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http://dx.doi.org/10.4103/1735-9066.161000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525337PMC
August 2015

Supratentorial cortical ependymoma: An unusual presentation of a rare tumor.

Adv Biomed Res 2015 25;4:72. Epub 2015 Mar 25.

Resident of Pathology, Isfahan University of Medical Sciences, Isfahan, Iran.

Ependymomas are glial tumors derived from ependymal cells lining the ventricles and the central canal of the spinal cord. Two thirds of ependymomas arise in the infratentorial or intraventricles, whereas one-third are located in supratentorial space. But supratentorial "cortical" ependymomas are very rare. We report a case of a cortical ependymoma in a 17-year-old boy. The patient presented with transient recurrent right weakness and diplopia. This tumor was located in the left parieto-occipital region and he had gross total excision. Microscopy and immunohistochemistry showed grade III differentiation ependymoma.
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http://dx.doi.org/10.4103/2277-9175.153896DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386199PMC
April 2015

Effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level.

Iran J Nurs Midwifery Res 2015 Mar-Apr;20(2):275-81

Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Hezarjrb Ave., Isfahan, Iran.

Background: Stroke is a stressful event with several functional, physical, psychological, social, and economic problems that affect individuals' different living balances. With coping strategies, patients try to control these problems and return to their natural life. The aim of this study is to investigate the effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level.

Materials And Methods: This study is a clinical trial in which 50 patients, affected by brain stroke and being admitted in the neurology ward of Kashani and Alzahra hospitals, were randomly assigned to control and study groups in Isfahan in 2013. Roy adaptation model care plan was administered in biological dimension in the form of four sessions and phone call follow-ups for 1 month. The forms related to Roy adaptation model were completed before and after intervention in the two groups. Chi-square test and t-test were used to analyze the data through SPSS 18.

Results: There was a significant difference in mean score of adaptation in physiological dimension in the study group after intervention (P < 0.001) compared to before intervention. Comparison of the mean scores of changes of adaptation in the patients affected by brain stroke in the study and control groups showed a significant increase in physiological dimension in the study group by 47.30 after intervention (P < 0.001).

Conclusions: The results of study showed that Roy adaptation model biological dimension care plan can result in an increase in adaptation in patients with stroke in physiological dimension. Nurses can use this model for increasing patients' adaptation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387655PMC
April 2015

Validation of the persian translation of the swallowing disturbance questionnaire in Parkinson's disease patients.

Parkinsons Dis 2014 27;2014:159476. Epub 2014 Oct 27.

Department of Neurology, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran.

Dysphagia, as a common finding in Parkinson's disease (PD) patients, was estimated to be present in 80-95% of this population during different stages of the disease. The Swallowing Disturbance Questionnaire (SDQ) was created as a self-rated dysphagia screening tool in PD. According to the guidelines for cross-cultural adaptation, Persian version of this questionnaire (SDQ-P) was developed. 59 Persian patients (39 men and 20 women) participated in the study. They responded to the SDQ-P and underwent videofluoroscopic swallowing study (VFSS). Aspiration during VFSS was compared with questionnaire results for each individual. Cronbach's alpha coefficient for the questionnaire was 0.86 and based on SDQ-P 15 patients (25.4%) were dysphagic, while 10 patients (16.9%) showed aspiration during VFSS. SDQ-P sensitivity and specificity in predicting aspiration were 96.7 and 91.2%; therefore, the SDQ-P could be a prognostic tool for aspiration. The positive predictive value (PPV), the negative predictive value (NPV), and the pre- and posttest probabilities of aspiration were 0.67, 1, 16.9%, and 66.7%, respectively. In summary, this study demonstrated the reliability and also the feasibility of SDQ-P for screening of aspiration in Iranian patients with PD. Further evaluation of SDQ-P in larger subject population would be suggested.
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http://dx.doi.org/10.1155/2014/159476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227361PMC
November 2014

Hallervorden-Spatz disease.

Adv Biomed Res 2014 12;3:191. Epub 2014 Sep 12.

Department of Neurology, Shahid Sadooghi Hospital, Isfahan, Iran.

Hallervorden-Spatz disease (HSD) is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. Hallervorden and Spatz first described the disease, in 1922 as a form of familial brain degeneration characterized by iron deposition in the brain. Here we present four HSD cases with different clinical pictures.
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http://dx.doi.org/10.4103/2277-9175.140623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190451PMC
October 2014

Vogt-Koyanagi-Harada syndrome presenting with encephalopathy.

Ann Indian Acad Neurol 2014 Jan;17(1):128-9

Neurology Department, Isfahan University of Medical Sciences, Isfahan, Iran.

Vogt-Koyanagi-Harada (VKH) is a rare syndrome affecting tissues containing melanocytes. The possibility of its autoimmune pathogenesis is supported by high frequent HLA-DR4 presentation, commonly associated with other autoimmune diseases. Eyes are the main affected organs, resulting in blindness. Brain disease is a late-onset event, and is extremely rare. Here, we are reporting a 57-year-old woman, a known case of VKH syndrome, presenting with brain encephalopathy several decades after the initial presentation. We think this long period between initial presentation and presentation of encephalopathy due to VKH syndrome has not been described before. She was treated with corticosteroids and discharged home with a good general condition.
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http://dx.doi.org/10.4103/0972-2327.128585DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992754PMC
January 2014

Stroke in a patient with pulmonary arteriovenous fistula: A case report study.

Adv Biomed Res 2013 30;2:84. Epub 2013 Nov 30.

Medical students' research center, Isfahan University of medical sciences, Isfahan, Iran.

Pulmonary arteriovenous fistula (PAVF) is a venous malformation that permits right to left shunting of blood, bypassing the pulmonary capillary bed. Often PAVFs are seen in association with hereditary conditions. On the other hand, isolated PAVFs are rare and asymptomatic. There have been few reports of isolated PAVF related complications. A patient was referred to us with dysarthria and diplopia and history of surgically-treated PAVF. Further evaluations revealed a stroke in thalamic region. We found an open PAVF in a case of thalamic stroke.
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http://dx.doi.org/10.4103/2277-9175.122499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3908485PMC
February 2014

Jacksonian seizure as the relapse symptom of multiple sclerosis.

J Res Med Sci 2013 Mar;18(Suppl 1):S89-92

Department of Neurology, Isfahan Neurosciences Research Center, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran.

Epilepsy is more common in patients with multiple sclerosis (MS) than in the general population, occurring in 2-3% of patients. Convulsions may be either tonic-clonic in nature or partial complex. In these individuals, seizures most likely result from lesions present in the cerebral cortex and subcortical white matter. A Jacksonian seizure is a type of simple partial seizure characterized by abnormal movements that begin in one group of muscles and progress to adjacent groups of muscles. We describe a case of Jacksonian seizure as the relapse symptom of MS. Focal motor seizures of this patient have been observed before and presumably marking the clinical onset or during acute bouts of MS. In this case, Jacksonian seizures appear to be the sign of a flare of MS, while the majority of seizures had been reported occur unrelated to MS relapses.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743331PMC
March 2013

Does levetircetam decrease of the rubral tremor in patients with multiple sclerosis.

J Res Med Sci 2013 Mar;18(Suppl 1):S78-80

Department of Neurology, Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: One of the frequent symptoms of Multiple Sclerosis (MS) is tremor which can severely cause disability. Treatment of tremor in MS patients is still very challenging to manage. In this study, we sought to determine the efficacy of Levetiracetam on treatment of MS-related tremor.

Materials And Methods: This clinical trial study was conducted among 22 patients from July 2012 to April 2012 in Alzahra-Hospital, Isfahan, Iran. Patients were given 500 mg Levetiracetam twice a day for 1 week. The drug dosage increased 1000 mg per week until reaching the peak dose of 50 mg/kg. After a 2 week period of washout, first phase was repeated. The subjects were assessed at baseline, after first intervention, after wash-out period, and after second intervention.

Results: A total of 20 patients (17 females and 3 males) were enrolled in our study. There was a significant difference among tremor rate before and after intervention (P = 0.001). The drug was well tolerated and without any serious side effect during follow-up.

Conclusion: Our findings suggest that although Levetiracetam caused a decrease tremor rate in MS it surged again after washout period.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743328PMC
March 2013

Association between serum biochemical levels, related to bone metabolism and Parkinson's disease.

J Res Med Sci 2013 Mar;18(Suppl 1):S39-42

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Tehran, Iran ; Department of Medical Sciences, Islamic Azad University, Najaf Abad Branch, Tehran, Iran.

Background: Vitamin D insufficiency and serum calcium disturbance have been reported to be more common in Parkinson's disease (PD) patients than in healthy control subjects, which may be due to a chronic disease or reduced mobility contributes to these relatively disturbances. Because of the high-vitamin D insufficiency in our population, we aimed to compare a biochemical levels which are related to bone metabolism, in PD patients in comparison with age-matched healthy controls, for the 1(st) time in a Middle East population.

Materials And Methods: This case-control study was involved 105 (20 were excluded) PD patients, who were age- and -sex matched with 112 controls. 25-hydroxyvitamin D (25OHD) and parathyroid hormone analyzed by enzyme immunoassay; another laboratory data including, calcium, phosphorous, and alkaline phosphatase were performed by spectrophotometric methods.

Results: There was no significant difference in 25OHD between PD patients and control group (P = 0.071). 25OHD level was not significantly different in PD patients compared to controls {odds ratio 1.003, (confidence interval [CI], 0.98-1.02), P value 0.793}. None of the other biochemical levels did not induce more chance for PD, only we observed in men has more risk of PD than women (odds ratio 2.53, [CI, 1.27-5.03], P value 0.008).

Conclusion: Our data do not support a possible role of vitamin D insufficiency in PD. Regarding to variable changes in biochemical markers in PD patients than in controls; further studies are suggested to determine any plausibility role of them as a causal relationship or as an outcome of PD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743317PMC
March 2013

Transcranial sonography on Parkinson's disease and essential tremor.

J Res Med Sci 2013 Mar;18(Suppl 1):S28-31

Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The study on transcranial sonocraphy (TCS) as a diagnostic test for Parkinson's disease (PD) has been neglected in some hospitals. The current study was conducted as the first study to investigate the utility of TCS for diagnosis of PD and its ability to distinguish PD from essential tremor (ET) in an Iranian population.

Materials And Methods: TCS of substantia nigra (SN) was performed on 50 PD, 48 ET, and 50 healthy controls by two blinded investigators.

Results: Bilateral SN margin over 0.20 cm(2) was found in 39 (90%) and 7 (15%) in PD and ET patients, respectively. Furthermore, 4 (8%) of healthy control displayed this particular echo feature as well (false positives). SN hyperechogenicity ≥0.20 cm(2) was considered as a cut-off point to detected PD. Accordingly, TCS proved 90% (95% confidence interval [CI]: 77.85-97.35) sensitive and 92% (95% CI: 80.75-97.73)specific for the detection of PD by visualizing the SN.

Conclusion: SN hyperechogenicity ≥20 cm(2) is a specific feature of PD. Since, the symptoms of PD and ET might be overlapping; this method seems to be reliable to confirm PD diagnosis in doubtful clinical cases. Further studies in years to come are warranted to shed light on standardized data for Iranian to enhance the validity of TCS.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743314PMC
March 2013

Malnutrition is associated with depression in rural elderly population.

J Res Med Sci 2013 Mar;18(Suppl 1):S15-9

Department of Epidemiology, Isfahan university of Medical Science, Isfahan, Iran.

Background: Aging induces physiological changes and affects all of organs. Nutritional status and mental health deteriorate with aging. As malnutrition and depression are main problem in elderly this study was performed to assess the association between malnutrition and depression among rural elderly.

Materials And Methods: Three hundred and seventy rural elderly aged over 60 years were examined in a cross-sectional study by systematic sampling method and using mini nutritional assessment (MNA), which is a standard questionnaire for evaluating nutrition status. Depression was evaluated by a validated questionnaire in the elderly. Correlation between Socio-demographic characteristic, diseases, and nutrition status was obtained by t-test, Chi-square test and logistic regression in elderly population.

Results: Mean ± SD age was 70.6 ± 7.3 years. Frequency of malnutrition was similar in both genders. According to MNA, 3.8% of subjects suffered from malnutrition, 32.7% were at risk of malnutrition and 63.5% were well-nourished. Nutrition status correlated with body mass index (P = 0.028) and depression (P = 0.001). The risk of severe depression in patients with malnutrition was 15.5 times higher than non-depressed persons (odd ratio: 15.5; 95% CI: 2.9-82.5).

Conclusion: Depression could act as a powerful risk for malnutrition in elderly population that it should be controlled by physicians.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743311PMC
March 2013

25-hydroxyvitamin d and severity of Parkinson's disease.

Int J Endocrinol 2013 17;2013:689149. Epub 2013 Jul 17.

Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, 8174675731 Isfahan, Iran ; Department of Neurology, Medical School, Isfahan University of Medical Sciences, 8174675731 Isfahan, Iran.

Introduction. A role for vitamin D deficiency in Parkinson's disease (PD) has recently been proposed. Given the growing body of evidence for the association of vitamin D with several neurodegenerative disorders and unavailability of any published study in the Middle East, the present study is aimed to determine the associations of circulating 25-hydroxyvitamin D (25OHD) levels with the severity of PD in an Iranian sample. Methods. In 109 patients, the severity of PD was evaluated by using Hoehn & Yahr (HR) stages and Unified Parkinson's Disease Rating Stage (UPDRS) Part III compared with 25OHD level in a double-blind and cross-sectional study. Results. Mean ± SD levels of 25OHD were 28.5 ± 1.4 and 27.1 ± 1.5, for males and females, respectively. Also, 38.4% of the patients showed deficiency levels of 25OHD (<20 ng/mL), and 72.8% had insufficient levels (<30 ng/mL). High prevalence of 25OHD insufficiency in subjects with early disease was not associated with HR stage and UPDRS scores even after multivariate adjustment for possible confounders including disease duration. Conclusions. These findings are consistent with the possibility that vitamin D status does not seem to deteriorate during the early disease stages of PD. Further studies are needed to reveal the natural role and significance of vitamin D insufficiency in PD.
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http://dx.doi.org/10.1155/2013/689149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730208PMC
August 2013

Vogt-Koyanagi-Harada syndrome presenting with encephalopathy.

Ann Indian Acad Neurol 2013 Apr;16(2):264-5

Department of Infectious and Tropical Diseases, Isfahan University of Medical Sciences, Isfahan, Iran.

VogtKoyanagi-Harada (VKH) is a rare syndrome affecting tissues with melanocytes. The possibility that VKH syndrome has an autoimmune pathogenesis is supported by the high frequency of human leukocyte antigen-DR4 commonly associated with other autoimmune diseases. Eyes are the main affected organ, resulting in blindness. Brain disease as a late onset event is extremely rare. Here, we are reporting a 57-year-old woman with previously diagnosed VKH syndrome, presenting with a late-onset brain encephalopathy. She was treated with corticosteroids and discharged from hospital with good general condition.
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http://dx.doi.org/10.4103/0972-2327.112490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724089PMC
April 2013