Publications by authors named "Alireza Nikseresht"

26 Publications

  • Page 1 of 1

Management of seizures in patients with multiple sclerosis; an Iranian consensus.

Epilepsy Behav 2019 07;96:244-248

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

Purpose: Cooccurrence of a seizure in a patient with multiple sclerosis (MS) may complicate the management process. Questions, which may complicate the management process of a patient with MS and seizure, include "how should we approach to the patient", "how should we treat the patient", "how should we modify the patient's MS treatment strategy", etc. METHODS: We searched the electronic database PubMed on March 30, 2018 for articles in English that included the following search terms: "epilepsy" AND "multiple sclerosis" or "seizure" AND "multiple sclerosis" since 2013, to obtain the best recent relevant scientific evidence on the topic. A working group of 6 epilepsy and 5 MS experts took part in two consensus workshops in Tehran, Iran, in 2018. The final consensus manuscript was prepared and approved by all participants.

Results: The search with words "seizure" and "multiple sclerosis" yielded 121 entries; 10 were relevant to the topic. The search with words "epilepsy" and "multiple sclerosis" yielded 400 entries; 7 were relevant to the topic. We reviewed these 17 articles and also some other references, derived from these articles or relevant to the topic, for the purpose of our review.

Conclusion: Cooccurrence of a seizure in a patient with MS may complicate the management process. In this review, we tried to provide answers to the frequently asked questions, considering the best available scientific evidence and expert opinion.
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http://dx.doi.org/10.1016/j.yebeh.2019.04.032DOI Listing
July 2019

Polymorphisms of serotonin transporter gene and psychological status in patients with multiple sclerosis.

Iran J Neurol 2018 Jul;17(3):105-110

Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Multiple sclerosis (MS) is the most common neuroinflammatory disease in young adults. Anxiety and depression may predispose individuals to MS and flare-ups. Serotonin transmission is modified in some brain regions of patients with MS, and these changes may contribute to their psychiatric abnormalities. We studied the frequencies of common polymorphisms of the serotonin reuptake transporter (SERT) gene in patients with MS according to their psychological status. The 5-HTTLPR, rs25531, and STin2VNTR polymorphisms of the SERT gene were genotyped by polymerase chain reaction (PCR)-based methods in 100 patients with MS and 100 healthy controls. There were no remarkable differences in SERT gene polymorphisms between patients with MS and healthy controls. Unlike the control group, 41% of the patients showed some degree of depression based on Beck Depression Inventory (BDI), but no association was observed between SERT gene polymorphisms after the patients were stratified by depression status. In addition to SERT gene polymorphisms, modulation of serotonin at the synapses may also be regulated by genetic variations in tryptophan hydroxylase type 2 and serotonin receptors. Further studies with functional brain imaging of the serotonergic system in patients with MS can provide information on the role of serotonin in this disease.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420687PMC
July 2018

Investigation of ischemic and demyelinating lesions by cerebral vasoreactivity based on transcranial Doppler sonography: a comparative study.

Neuropsychiatr Dis Treat 2018 11;14:2323-2328. Epub 2018 Sep 11.

Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Purpose: Variations of cerebral blood flow in response to hypoxia and hyperoxia in different disease conditions can provide new insights into disease etiopathogenesis. This study aimed to determine the characteristics of cerebral vasoreactivity for ischemia and demyelination.

Materials And Methods: This case-control study included: 28 patients with lacunar infarctions verified by history, physical examination, and MRI; 28 age- and sex-matched healthy controls; 28 patients with relapsing-remitting multiple sclerosis (MS), based on McDonald criteria; and 28 age- and sex-matched healthy controls for the MS group. Transcranial Doppler sonography was undertaken in all subjects to calculate the mean flow velocity (MFV) of the right middle cerebral artery (MCA) and, after a breath-holding (BH) maneuver, the breath-holding index (BHI) was determined.

Results: There was no significant difference of BHI and changes of MFV of the MCA in MS patients compared to controls (1.02 ± 0.4 vs 1.02 ± 0.3, = 0.993; and 16.8 ± 8.1 vs 11.3 ± 10.8, = 0.057). BHI in patients with lacunar infarctions was significantly lower (0.8 ± 0.4 vs 1.2 ± 0.3, < 0.001) compared to controls. The BHI ( = 0.040) and variations of MFV of MCA ( = 0.007) in MS patients were significantly higher than in patients with lacunar infarctions. The vasoreactivity of demyelinating lesions was higher than that of ischemic ones.

Conclusion: Therefore, cerebral vasoreactivity determined by transcranial Doppler could be utilized for differentiating demyelinating from ischemic lesions.
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http://dx.doi.org/10.2147/NDT.S150062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6141114PMC
September 2018

Gender-Specific Association of Leptin and Adiponectin Genes With Multiple Sclerosis.

Am J Med Sci 2018 08 6;356(2):159-167. Epub 2018 Mar 6.

Neurology Department, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Immunology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran; Autoimmune Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Background: Adipocytokines such as leptin (LEP) and adiponectin (ADIPOQ) represent a link between metabolism, nutritional status and immune responses. The present study aimed to determine the possible association between single nucleotide polymorphisms of LEP and ADIPOQ genes with multiple sclerosis (MS).

Materials And Methods: Single nucleotide polymorphisms in LEP (rs2167270 or 19G > A and rs7799039 or -2,548G > A) and ADIPOQ (rs1501299 or +276G > T and rs266729 or -11,377C > G) were genotyped in 305 patients and 255 healthy individuals using polymerase chain reaction-restriction fragment length polymorphism. Sera levels of leptin and adiponectin were measured using enzyme-linked immunosorbent assay.

Results: The frequencies of low leptin producer rs2167270GG genotype and rs2167270G allele were significantly lower in patients with MS compared to those of controls (for GG genotype: 39.7% and 49.8%, respectively; P = 0.01; for G allele: 63.3% and 68.8%, respectively; P = 0.05). Both polymorphisms in ADIPOQ did not show any significant association with disease susceptibility, though after gender categorization the frequency of high adiponectin producer rs1501299TT genotype and rs1501299T allele were significantly higher in male controls compared to male patients (TT genotype: P = 0.006; T allele: P = 0.006). Additionally, rs1501299TT genotype in ADIPOQ was associated with susceptibility to primary progressive multiple sclerosis (PP-MS) (P = 0.02). Moreover, while the sera levels of leptin were only different between male patients and controls (P = 0.05), adiponectin levels were significantly higher in total and female healthy controls (P < 0.001, P = 0.002, respectively).

Conclusions: Our findings provide evidence to support the hypothesis that functional ADIPOQ and LEP gene polymorphisms are associated with susceptibility to MS and its clinical forms.
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http://dx.doi.org/10.1016/j.amjms.2018.03.008DOI Listing
August 2018

Peripheral Neuropathy in Multiple Sclerosis: An Electrophysiologic Study in Iranian Patients.

Acta Med Iran 2017 Aug;55(8):496-501

Department of Physical Medicine and Rehabilitation, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Multiple sclerosis (MS) is the most common cause of disability after trauma in young adults in Northern Hemisphere; it imposes a major burden on the affected young people. A significant association between MS and demyelinating peripheral neuropathy which might be due to common pathogenesis for the central and peripheral nerves demyelination has been reported in several studies. We aimed to assess if there is any peripheral nervous system involvement in a sample of Iranian MS population. Extensive nerve conduction studies (NCS) were conducted in 20 MS patients according to McDonald criteria, and 20 age and gender matched healthy appearing controls. The F-wave ratio was calculated through placing the minimum amount of F-wave proximal latency after 10 stimuli and median or tibial nerves compound motor action potential (CMAP) proximal latency in the corresponding formula. Data were compared between groups. Finally, we found the significantly lower median and tibial nerves conduction velocities (NCV) in MS patients than healthy controls (P=0.008 and 0.003 respectively, Independent Samples t-test). Also, tibial NCV had a significant statistical correlation with Kurtzke's expanded disability scale score (EDSS) as patients with higher EDSS had lower tibial NCV (Pearson's correlation coefficient, r2=0.8). No statistical relationship was found between MS subtypes and NCS parameters. Although we found some electrodiagnostic abnormalities in Iranian MS patients in comparison to the healthy participants, these differences were small and inconclusive. More extensive well-designed electrodiagnostic studies for evaluation of peripheral nervous system involvement and its probable pattern in these patients seems to be needed.
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August 2017

Comparison of diffusion-weighted imaging and enhanced T1-weighted sequencing in patients with multiple sclerosis.

Neuroradiol J 2017 Aug 28;30(4):347-351. Epub 2017 Apr 28.

1 Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz Iran.

Introduction The purpose of this study was to assess whether demographic, brain anatomical regions and contrast enhancement show differences in multiple sclerosis (MS) patients with increased diffusion lesions (ID group) compared with diffusion restriction (DR group). Method MRI protocol comprised T1- and T2-weighted sequences with and without gadolinium (Gd), and sagittal three-dimensional FLAIR sequence, DWI and ADC maps were prospectively performed in 126 MS patients from January to December 2015. The investigation was conducted to evaluate differences in demographic, cord and brain regional, technical, and positive or negative Gd contrast imaging parameters in two groups of ID and DR. Statistical analysis was performed by using SPSS. Results A total of 9.6% of patients showed DR. In the DR group, 66.6% of the patients showed contrast enhancement of plaques, whereas 29.2% of the IR group showed enhancement of plaques. The most prevalent group was non-enhanced plaques in the ID group, followed by Gd-enhanced plaques in the ID group. Patients in the ID group (90.4%) were significantly more than in the DR group (9.6%). Out of the 40 patients with Gd-enhanced plaques, 80.5% was from the ID group and 19.5% from the DR group. Conclusion MRI of the brain, unlike of the cord, with Gd demonstrates significant difference in enhancement between the two groups ( p < 0.05). No significant difference was seen in demographic, cord and brain regional, and technical parameters, EDSS, disease duration, and attack rate as well as demographic and regional parameters between the ID and decrease diffusion groups ( p > 0.05).
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http://dx.doi.org/10.1177/1971400916678224DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5524272PMC
August 2017

The Prevalence and Factors Contributing to Hemodynamic Depression in Patients Undergoing Carotid Angioplasty and Stenting.

J Vasc Interv Neurol 2015 Oct;8(4):5-10

Departments of Neurology and Psychiatry, Saint Louis University, Saint Louis, MO, USA.

Background: Hemodynamic depression, including bradycardia and hypotension, is among the most common complications of carotid angioplasty and stenting.

Methods And Material: A prospective, cross-sectional study was conducted at Shiraz University of Medical Sciences in southern Iran from 2011 to 2013. Consecutive patients undergoing carotid angioplasty and stenting were included. Demographic data, atherosclerotic risk factors, preprocedural blood pressure, the site of stenosis, the degree of stenosis, and data regarding technical factors were recorded. Hemodynamic depression was defined as a systolic blood pressure less than 90 mmHg and/or heart rate less than 50 beat/min.

Results: About 170 patients (67% male, mean age: 71+9.8, 55.9% right side, 82.9% symptomatic) were recruited. Mean degree of stenosis was 79.4% in operated side and 40.7% in nonoperated side. Predilation, postdilation, or both were conducted in 18(10.5%), 141(83%), 11(6.5%) patients respectively. Thirteen (7.6%), 41(24%), and 12(7%) of patients developed postprocedural bradycardia, hypotension or both, respectively. Two patients had a stroke after CAS and periprocedural mortality was 0%. Hemodynamic depression after CAS had a significant association with preprocedure blood pressure and the use of an open cell stent design, but not with atherosclerotic risk factors, site and/or degree of stenosis, predilation, or postdilation. Hemodynamic depression significantly increased hospital stay too.

Conclusion: Preprocedural hydration and close-cell stents may decrease the risk of poststenting hemodynamic depression.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4634774PMC
October 2015

Association Between Urinary Symptoms and Urinary Tract Infection in Patients With Multiple Sclerosis.

Glob J Health Sci 2015 Sep 28;8(4):120-6. Epub 2015 Sep 28.

Clinical Neurology Research Center, Department of Neurology, shiraz,iran.

Background & Objective: Urinary dysfunctions occur in the majority of MS patients and these patients are at higher risks of developing UTI due to multiple reasons. We determined to study the association between different urinary symptoms and UTI in MS patients.

Material & Method: Eighty seven MS patients that referred to our medical care center with an acute attack of the disease, from November 2012 to April 2014, were included in the study. Patients were classified into two groups based on their urine culture results: UTI positive and non-UTI patients. The prevalence of different types of urinary symptoms was then compared among the two groups.

Result: The mean age of our patients was 36.8 years old. From the total 87 patients, 83 (95.4%) were female. Overall 56.3% of patients displayed urinary symptoms. The most prevalent urinary problems were urinary incontinence and frequency (25.3% and 24.1%, respectively). A positive urinary culture was seen in 71.3% of the patients. The prevalence of urinary problems was significantly higher in UTI patients in comparison to non-UTI patients (64.5% and 40% in UTI and non-UTI patients, respectively; p=0.036). Separately none of the different urinary symptoms displayed a significant difference between UTI and non-UTI patients (p>0.05).

Conclusion: Not a single symptom can be diagnostic of UTI, but MS patient with urinary tract infections do present more urinary symptoms and this can be an indication for further urine analysis and screening measures for MS patients who display more urinary symptoms.
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http://dx.doi.org/10.5539/gjhs.v8n4p253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4873596PMC
September 2015

Demographic and Technical Risk Factors of 30-Day Stroke, Myocardial Infarction, and/or Death in Standard- and High-Risk Patients Who Underwent Carotid Angioplasty and Stenting.

Interv Neurol 2015 Jul;3(3-4):165-73

Department of Neurology, Saint Louis University, Saint Louis, Mo., USA ; Department of Psychiatry, Saint Louis University, Saint Louis, Mo., USA.

Background: Carotid angioplasty and stenting (CAS) is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after CAS.

Materials And Methods: This is a prospective study that was conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing CAS were enrolled. Both standard- and high-risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. Thirty-day stroke, myocardial infarction, and/or death were considered as the composite primary outcomes of the study.

Results: A total of 251 patients were recruited (mean age: 71.1 ± 9.6 years; male: 65.3%). Of these, 178 (70.9%) were symptomatic, 73 (29.1%) were diabetic, 129 (51.4%) were hyperlipidemic, 165 (65.7%) were hypertensive, and 62 (24.7%) patients were smokers. CAS was performed for left internal carotid artery (ICA) in 113 (45.4%) patients. Fourteen (5.6%) patients had sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 ± 13.8%. An embolic protection device was used in 203 (96.2%) patients. Pre- and postdilation were performed in 39 (18.5%) and 182 (86.3%) patients, respectively. Composite outcomes were observed in 3.6% of patients (3.2% stroke, 0% myocardial infarction, and 1.2% death). Left-sided lesions and the presence of diabetes mellitus were significantly associated with poor short-term outcome (p = 0.025 and p = 0.020, respectively).

Conclusion: There was a higher risk of short-term major complications in diabetic patients and for left carotid artery intervention.
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http://dx.doi.org/10.1159/000430923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521192PMC
July 2015

Association Between MTHFR Genetic Variants and Multiple Sclerosis in a Southern Iranian Population.

Int J Mol Cell Med 2015 ;4(2):87-93

Autoimmune Research Center, Shiraz University of Medical Sciences, School of Medicine, Shiraz, Iran.

Multiple sclerosis (MS) is a demyelinating neuro- inflammatory autoimmune disease of the central nervous system. Genetic predisposition has long been suspected in the etiology of this disease. The association between MTHFR polymorphisms and MS has been ivestigated in different ethnic groups. We investigated the association between MTHFR C677T and A1298C missense variants and MS in 180 patients and 231 age- and gender-matched healthy controls in a Southern Iranian population. The mutagenically separated PCR (MS-PCR) and PCR-RFLP methods were used to genotype MTHFR at position 677 and 1298, respectively. Compared with controls, we observed a strong association between two MTHFR variants and the risk of developing MS. Subjects carrying 677T allele (CT and TT genotypes) had increased susceptibility to MS as compared to those carrying CC genotype (odds ratio (OR) for CT= 2.9, 95% confidence interval (95% CI)= 1.88-4.49; OR for TT= 6.23, 95% CI= 3.08-12.59). The variant 1298AC genotype also increased the risk for MS among our study population (OR= 2.14, 95% CI= 1.37-3.34). Combined genotype analysis for two MTHFR SNPs revealed that compared to the wild type genotypes (677CC/1298AA), 3 genotypes including TT/AC, CT/AC, and TT/AA were significantly at increased risk for MS development (OR= 13.9, 5.3, and 4.9, respectively). Our results suggest a possible gene dose- dependent association between MTHFR mutrant alleles and the risk of MS development.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499570PMC
August 2015

Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors.

J Vasc Interv Neurol 2015 Feb;8(1):11-6

Departments of Neurology and Psychiatry , Saint Louis University, Saint Louis, USA.

Background: Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA).

Methods: This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects.

Results: A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002).

Conclusion: It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4367801PMC
February 2015

Estimated prevalence and incidence of multiple sclerosis in Iran.

Eur Neurol 2014 18;72(5-6):370-4. Epub 2014 Oct 18.

Isfahan Research Committee of Multiple Sclerosis (IRCOMS), Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Multiple Sclerosis (MS) is a chronic demyelinating disease of the central nervous system and its epidemiology has changed in recent years. Previously, Iran was considered to have a low MS prevalence. In this study, we aimed to update the prevalence and incidence of MS in Iran.

Patients And Methods: This study was conducted based on the data derived from the new report of Iran's Ministry Of Health and Medical Education (MOHME) regarding the patients who have registered to obtain support for treatment in Iran till the end of 2013.

Results: Among the 42,200 registered patients, 32,477 were female and 9,723 were male (sex ratio: 3.34: 1), and 4,545 were diagnosed in 2013. This resulted in a prevalence of 54.51 and an incidence of 5.87 per 100,000.

Conclusion: According to our study results, Iran has a medium-to-high prevalence rate of MS. According to the previous epidemiologic studies from Iran, it seems that the prevalence of MS significantly has increased during recent years. This rate is similar to what is seen in many western countries.
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http://dx.doi.org/10.1159/000365846DOI Listing
July 2015

Is there any relation between cervical cord plaques and discopathy in patients with multiple sclerosis?

Clin Neurol Neurosurg 2014 Jun 19;121:23-6. Epub 2014 Mar 19.

Research Centre for Health Sciences, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Multiple sclerosis (MS) is the most common chronic autoimmune demyelinating disease of the central nervous system. The purpose of this study is to determine the relationship between the site of the cervical discopathy and cervical spinal cord plaque in MS patients.

Methods: This retrospective study included all patients with a definite diagnosis of MS who were treated at an outpatient clinic between September 2004 and September 2011. All patients underwent cervical magnetic resonance imaging (MRI) for primary investigation of the disease. Cervical MRI scans were evaluated for detection of any evidence of cervical discopathy and cervical MS plaques. Any correlation between the site of the MS lesions and discopathy was recorded.

Results: From 536 patients who were involved in the study, 214 patients had both cervical discopathy and cervical cord plaques. In this group 148 (69.1% of patients) had cervical plaque at the same site of cervical discopathy. The number of patients with cervical cord plaque and discopathy at same site was significantly higher than those with plaque and discopathy at different sites (P<0.05).

Conclusion: The study data suggests a possible correlation between cervical discopathy and cervical MS plaque.
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http://dx.doi.org/10.1016/j.clineuro.2014.03.015DOI Listing
June 2014

Month of birth and the incidence of multiple sclerosis in southern iran.

Iran J Med Sci 2014 Mar;39(2 Suppl):232-3

Department of Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993045PMC
March 2014

Significant increase in the prevalence of multiple sclerosis in iran in 2011.

Iran J Med Sci 2014 Mar;39(2):152-3

Department of Transplantation and Special Diseases, Ministry of Health and Medical Education, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3957017PMC
March 2014

Reasons for uncontrolled seizures in adults; the impact of pseudointractability.

Seizure 2013 May 1;22(4):271-4. Epub 2013 Feb 1.

Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: We investigated the various possible reasons for uncontrolled seizures in patients 18 years of age and older to determine the impact of pseudointractability. We also tried to investigate the various forms of pseudointractability.

Methods: In this cross-sectional study, all patients 18 years of age and older with their first seizure occurring at least six months prior to the referral date, taking at least one antiepileptic drug (AED) and having at least one seizure in the past three months were studied. The presumed reason for uncontrolled seizures was arbitrarily considered to be one of these five categories: Poor compliance; Wrong medication (misclassification); Wrong dose of the correct medication; Diagnosis other than epilepsy; and finally, Medically-refractory epilepsy. Statistical analyses were performed using Chi-square and Fisher's exact tests, and a P value less than 0.05 was considered significant.

Results: 350 patients were referred to us due to uncontrolled seizures. One hundred ninety-one (55%) were male and 159 (45%) were female. Twelve percent of the patients had diagnoses other than epilepsy, 40% had indeed medically-refractory epilepsy; 29% were taking the wrong AEDs (misclassified epilepsy); 18% were taking suboptimal doses of AEDs; and 1% had poor drug compliance. The most common reason for uncontrolled seizures among patients with idiopathic generalized epilepsy was taking the wrong AED. However, among patients with focal epilepsy, true medically-refractory epilepsy was the most common reason.

Conclusion: Uncontrolled seizures are a commonly encountered problem, especially at epilepsy clinics and one should consider all possible reasons for these uncontrolled seizures. The mainstay for making a correct diagnosis is a detailed clinical history.
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http://dx.doi.org/10.1016/j.seizure.2013.01.010DOI Listing
May 2013

Early-onset versus typical childhood absence epilepsy; clinical and electrographic characteristics.

Seizure 2012 May 23;21(4):273-5. Epub 2012 Feb 23.

Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: Childhood absence epilepsy (CAE) is characterized by absence attacks with stereotyped electrographic discharges. Epidemiologic data concerning early-onset CAE is scarce. We tried to specifically analyze the early-onset CAE and compare it with typical CAE.

Methods: In this retrospective study, all patients with a clinical diagnosis of CAE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 to 2011. We considered the age of onset at four years or earlier as early-onset and above four years as typical CAE. Age, gender, age at seizure onset, seizure type(s), epilepsy risk factors, and EEG findings of all patients were registered routinely. Statistical analyses were performed using Chi square and Fisher's Exact tests.

Results: Forty-six patients were diagnosed as having CAE. Sixteen patients (35%) had early-onset and 30 (65%) patients had typical CAE. Sex ratio (female to male) in early-onset was 7:9 and in typical CAE was 19:11 (P=0.2). Generalized tonic-clonic and myoclonic seizures were reported in both early-onset and typical CAE. The differences were not statistically significant. Epilepsy risk factors were similarly reported in both conditions. The EEG findings were similar in both groups.

Conclusion: We did not observe any significant differences between early-onset and typical childhood absence epilepsies with respect to the demographic, clinical and electroencephalographic characteristics.
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http://dx.doi.org/10.1016/j.seizure.2012.01.012DOI Listing
May 2012

Physical injuries in patients with epilepsy and their associated risk factors.

Seizure 2012 Apr 29;21(3):165-8. Epub 2011 Nov 29.

Neurosciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objectives: To determine the frequency, nature, and risk factors associated with physical injuries in patients with epilepsy.

Methods: In this retrospective cohort study, patients 18years of age and older with active epilepsy for at least 1year were included. A questionnaire (including age, gender, education, type of epilepsy, seizure frequency, having aura, drug compliance, polypharmacy, comorbidity, type and place of injury) was completed from patients and healthy individuals. Statistical analyses were performed using multiple logistic regression and Chi-square tests.

Results: 264 patients with epilepsy and 289 healthy participants were studied. Among patients, 8.7% reported severe injuries and 44.3% had mild injuries. Most patients reported soft tissue injuries, followed by dental injury, burn, and head injury. Severe injuries were 2.9 times more frequent among patients having generalized tonic-clonic seizures (GTCS) compared to healthy control; this was not statistically significant (P=0.07). No patient reported having severe injuries due to SPS, myoclonic or absence seizures. Mild injuries were 10.3 times more frequent among those with GTCS compared to healthy control (P=0.001). The relative risk for having injury in patients compared to control group was 3.42 (95% confidence interval: 2.50-4.69). Injury was significantly related to having GTCSs, illiteracy, having fall with seizures, comorbidity and having uncontrolled seizures.

Conclusion: Physical injuries are common in patients with epilepsy; however most of these injuries are mild. Severe injuries rarely occur in patients with seizures other than GTCS.
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http://dx.doi.org/10.1016/j.seizure.2011.10.009DOI Listing
April 2012

Cytokine secretion pattern in treatment of lymphocytes of multiple sclerosis patients with fumaric acid esters.

Immunol Invest 2011 21;40(6):581-96. Epub 2011 Apr 21.

Immunology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

The present study was performed to investigate the effects of dimethylfumarate (DMF) and methylhydrogen fumarate (MHF) on the cytokine pattern of peripheral blood mononuclear cells (PBMCs) of multiple sclerosis (MS) patients. The PBMCs from patients and healthy controls were stimulated with myelin basic protein (MBP) or phytohemagglutinin (PHA) and cultured in the presence of DMF and MHF. The percentage of CD4+IL-4+ and CD4+IFN-γ+ cells was determined by means of intracellular cytokine staining. CD4+IL-4+ cells were significantly increased in the presence of DMF and MHF when PBMCs were stimulated by MBP (P < 0.003). The same significant result was obtained by PHA stimulation (P < 0.049). In terms of CD4+IFN-γ+ cells, the percentage of cells did not significantly differ between the cultures stimulated with MBP or PHA in the presence and absence of the drugs. Results of MBP stimulation in control group also showed a significant increase in CD4+IL-4+ cells in the presence of DMF and MHF. In comparison between patient and control groups, no statistically significant changes were observed. In conclusion, both DMF and MHF effectively increased IL-4 production, whereas they did not significantly change IFN-γ level, indicating the role of these drugs in increasing the production of beneficial cytokines such as IL-4.
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http://dx.doi.org/10.3109/08820139.2011.569626DOI Listing
April 2012

Vasovagal syncope treated as epilepsy for 16 years.

Iran J Med Sci 2011 Mar;36(1):60-2

Department of Neurology,Medical school, Shiraz University of Medical Sciences, Shiraz, Iran. ; Department of Neurology, Thomas Jefferson University, Philadelphia, USA.

The differentiation of vasovagal syncope and epileptic seizure is sometimes problematic, since vasovagal syncope may mimic epileptic seizures in many ways. The present report describes a patient who had been diagnosed and treated as having epilepsy with medically-refractory seizures for 16 years. Often, unlike epileptic seizures, tonic-clonic convulsions and postictal confusion are uncommon features of vasovagal syncope, but these may occur. Our patient was subjected to subcutaneous injection of one ml normal saline, which caused asystole leading to hypoxia and consequently a typical tonic-clonic convulsion. This patient was proved to have vasovagal syncope. The findings in the present case suggest that the possibility of vasovagal syncope should always be taken into consideration when evaluating patients with medically-refractory or unusual pattern of seizures. In such a circumstance, simultaneous video-electroencephalogram/electocardiogram monitoring may help achieve the correct diagnosis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559122PMC
March 2011

The Neurological Manifestations of H1N1 Influenza Infection; Diagnostic Challenges and Recommendations.

Iran J Med Sci 2011 Mar;36(1):36-9

Departments of Neurology, Shiraz University of Medical Sciences,Shiraz, Iran. ; Jefferson Comprehensive Epilepsy Center, Thomas Jefferson University,USA.

Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1) in April 2009. There are very few reports about the neurological complications of H1N1 virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection.

Methods: The medical files of all patients with H1N1 influenza infection admitted to a specified hospital in the city of , from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay.

Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guillain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy.

Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H1N1influenza virus in all patients with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3559119PMC
March 2011

Investigation of Fcgamma RIIA and Fcgamma RIIIA Polymorphism in Multiple Sclerosis: A Case Control Study.

Iran J Immunol 2006 Sep;3(3):136-41

Department of Immunology, Shiraz Medical School, Shiraz, Iran.

Background: Multiple Sclerosis (MS), the most common demylinating disease of the CNS, is immunologically mediated in genetically susceptible individuals. Receptors for the Fc fragment of IgG (FcgammaR) might induce inflammatory responses through linking the humoral and cellular immune responses by targeting immune complexes to effector cells. Polymorphisms in some FcgammaR genes are associated with various infectious and autoimmune diseases, probably due to their effects on different binding capacities of encoded receptors for IgG containing immune complexes.

Objective: To investigate the importance of FcgammaR polymorphisms in susceptibility to MS.

Methods: One hundred and fifty MS patients and 136 age and sex matched controls were genotyped for FcgammaRIIA and FcgammaRIIIA gene polymorphisms using PCR-RFLP method.

Results: The allelic and genotypic frequencies of the FcgammaRIIA and FcgammaRIIIA did not differ significantly between the MS patients and controls. There was no association between allelic polymorphism of FcgammaRIIIA and severity of disease based on Expanded Disability Status Scale (EDSS) score. However, significant association between inherited FcgammaRIIA genotype and disease activity (p=0.001) or progression index was revealed (p=0.014). EDSS values showed that FcgammaRIIA (H/H) and (H/R) genotypes were associated with a lower EDSS score in relapsing-remitting MS and in the total MS population (p=0.001) but not (R/R) genotype.

Conclusion: Considering the detrimental role of autoantibodies in the pathogenesis of MS, our results suggest that the inherited FcgammaRIIA alleles could affect the severity of MS by influencing the clearance rate of immune complexes and autoantibodies. The results of the present study add the FcgammaRIIA gene to the gene networks which determine the severity of MS in southern Iran.
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http://dx.doi.org/IJIv3i3A6DOI Listing
September 2006

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery and delayed contrast-enhanced brain MRI in multiple sclerosis.

Acad Radiol 2008 Jan;15(1):15-23

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

Rationale And Objectives: In brain MRI of multiple sclerosis (MS) patients, enhancement of the lesions is usually evaluated in early contrast-enhanced T1-weighted images (CE-T1WI). The objective of this study is to determine the sensitivity of contrast-enhanced fluid-attenuated-inversion-recovery (CE-FLAIR) and delayed contrast-enhanced MRI in evaluation of MS brain lesions.

Materials And Methods: Brain MRI examination including early and delayed CE-T1WI and early and delayed CE-FLAIR images was performed for 46 patients with clinically definite MS disease. Number, size, location, degree, and pattern of enhancement of the enhanced lesions in each sequence were recorded separately.

Results: A total number of 87 enhanced lesions was detected in 30 patients. Early CE-T1WI could detect only 63 lesions (72.4% of total) in 24 patients, while delayed CE-T1WI and early and delayed CE-FLAIR images showed 85 (97.7%), 84 (96.6%), and 81 (93.1%) lesions in 28, 28, and 26 patients, respectively. A greater degree of enhancement and larger lesion size were observed in the additional sequences compared with the early CE-T1WI.

Conclusions: The sensitivity of early CE-T1WI for the detection of enhanced MS lesions is significantly lower than that for other additional sequences. Delayed CE-FLAIR images could not add significant information to other sequences. Therefore, early CE-FLAIR and delayed CE-T1WI brain MRI can be considered as part of the evaluation of MS patients, especially if, despite clinically suspected active disease, no enhanced lesion is found in the routine CE-T1WI.
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http://dx.doi.org/10.1016/j.acra.2007.07.022DOI Listing
January 2008

Neurological manifestations of Behçet's disease.

Saudi Med J 2006 Oct;27(10):1542-6

Department of Neurology, Nemazee Hospital, Nemazee Square, Shiraz, Iran.

Objective: To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behçet's disease.

Methods: This prospective study was carried out in the Behçet's Research Clinic in Shiraz (south-west Iran) and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed.

Results: Eighteen (15 males and 3 females) out of 690 Behcet s patients (2.6%, 95% CI = 1.4-3.8%) were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes.

Conclusion: Neuro-Behçet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies.
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October 2006

Neurological manifestations of Behcet`s disease.

Neurosciences (Riyadh) 2006 Oct;11(4):260-4

Department of Neurology, Shiraz University of Medical Sciences, Shiraz, Iran. Tel/Fax. +98 (711) 6261089. E-mail:

Objective: To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behcet`s disease.

Methods: This prospective study was carried out in the Behcet`s Research Clinic in Shiraz (south-west Iran) and included the patients referred from 1990-1999. The patients` clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed.

Results: Eighteen (15 males and 3 females) out of 690 Behcet`s patients (2.6%, 95% CI = 1.4-3.8%) were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7+/-8.6 years. All fulfilled the criteria of the International Study Group of Behcet`s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes.

Conclusion: Neuro-Behcet`s disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies.
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October 2006