Publications by authors named "Mohammad-Reza Najafi"

27 Publications

  • Page 1 of 1

Comparison of the efficacy of Tegatard and Tegretol as a monotherapy in patients with focal seizure with or without secondary generalization.

Am J Clin Exp Immunol 2020 15;9(4):58-63. Epub 2020 Oct 15.

Medical Student, Isfahan University of Medical Sciences, Faculty of Medicine Isfahan, Iran.

Background: Carbamazepine is a first line treatment for focal epilepsy. Tegretol and Tegatard are two trade name of Carbamazepine. Tegretol is produced by Novartis Pharmaceutical Company, Switzerland. Recently, Raha pharmaceutical Company in Iran has produced CBZ which trade named is Tegatard. Extended usage of Tegatard instead of Tegretol has economic benefits for Iranian families. In this clinical trial, we aimed to compare therapeutic efficacy and safety of Tegretol and Tegatard in patients suffering from focal seizures with or without secondary generalization.

Methods: 200 patients with provoked or non-provoked focal seizure with or without secondary generalization were screened and 180 patients were fulfilled the criteria to enter this double blinded clinical trial study. Patients were divided into two groups, the first group (A) received Tegretol and the second group (B) Tegatard. Carbamazepine (CBZ) was prescribed with doses 10-20 mg/kg every 12 hours by neurologists. The patients were visited after 1, 3 and 6 months and the side effects and lab data in patients were investigated.

Results: Patients were divided into two groups, 88 patients in group A (Tegretol) (50 males and 38 females) and 92 in group B (Tegatard) (51 males and 41 females). Mean age of patients was 35.39±11.17 years. There was no significant difference according to age and gender, Carbamazepine dosage, EEG recording, neuroimaging change and adverse effects of antiepileptic drug between two groups (P>0.05). Regarding the drug efficacy, in group A and B, 60 (68%) and 58 (63%) patients were seizure free after 6 month follow up; respectively. The differences between two groups were not statistically significant ( value =0.46).

Conclusion: Tegatard is an effective drug with similar efficacy, similar side effects and cost-effectiveness compared with Tegretol and could be used widely when indicated.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7677516PMC
October 2020

Magnetic resonance imaging and electroencephalography findings in a sample of Iranian patients with epilepsy.

J Res Med Sci 2018 28;23:106. Epub 2018 Dec 28.

Isfahan Neurosciences Research Centre, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The present study is aimed to evaluate the magnetic resonance imaging (MRI) and electroencephalography (EEG) findings based on characteristics variables in patients with epilepsy.

Materials And Methods: In this cross-sectional study, all patients with epilepsy who referred between March 2016 and March 2017 to Al-Zahra and Kashani Hospitals in Isfahan, Iran, were enrolled. The completed files of 199 patients were assessed to collect information about characteristic data and MRI and EEG findings. MRI and EEG findings were recorded as normal or abnormal. The characteristic data and risk factors in patients with normal MRI and EEG were compared with those patients with abnormal MRI and EEG.

Results: History of seizures and trauma are reported in 84 (42.2%) and 47 (23.6%) of patients, respectively. The most frequent type of seizures was generalized. MRI finding in 51 patients (25.6%) was abnormal, and EEG finding in 124 patients (62.3%) was abnormal. Patients with abnormal MRI were significantly older than those with normal MRI (37.3 vs. 31.4, respectively, = 0.024). Abnormal MRI in men patients was significantly more frequent than women (31.2% vs. 18.9%, respectively, = 0.048). In patients with abnormal EEG, seizure was more frequent than patients with normal EEG (50.8% vs. 28%, respectively, = 0.002). Other characteristics and risk factors were not significant differences between patients with normal or abnormal MRI or EEG findings.

Conclusion: In patients with epilepsy, older age and being a male were the risk factors of having abnormal MRI, and seizure was the risk factor of having abnormal EEG.
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http://dx.doi.org/10.4103/jrms.JRMS_163_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6327682PMC
December 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

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

Investigating patterns of memory impairment in ischemic stroke in an iranian population.

Appl Neuropsychol Adult 2018 Sep-Oct;25(5):458-463. Epub 2017 Sep 7.

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

Up until the date of this research, studies have examined poststroke cognitive impairments in attention, memory, and executive functions. In this study, we investigated the occurrence of memory problems in various patterns of memory in ischemic stroke patients in an attempt to determine specific memory profiles of the patients. The goal was to determine the severity and patterns of memory impairments in ischemic stroke patients and to identify specific profiles of memory impairments in stroke patients, in order to help therapists to develop more appropriate memory rehabilitation programs for the patients. The sample consisted of 35 patients with ischemic stroke. Thirty-five individuals who were matched with the patients were selected as the control group. Demographic questionnaires, subscales of the Wechsler Memory Scale-III (WMS-III), including logical memory I and II and visual reproduction I and II, digit span from the Wechsler Adult Intelligence Scale-R (WAIS-R), and the Corsi span test were administered to both of the patients and control groups. Multivariate analysis of covariance (MANCOVA) was carried out to unveil possible differences in memory between the two groups. The mean scores of different memory patterns were significantly higher in the control group comparing to the patient group (p < 0.05). Among different aspects of memory, visual long-term memory and visual short-term memory had the largest effect sizes. Substantial impairments were also found in visual short-term memory, visuospatial short-term memory, and visual long-term memory. The findings suggest that the stroke patients have identifiable patterns of memory impairment.
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http://dx.doi.org/10.1080/23279095.2017.1329144DOI Listing
October 2018

Modified Atkins diet in adult with refractory epilepsy: A controlled randomized clinical trial.

Iran J Neurol 2017 Apr;16(2):72-77

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

The usefulness of the modified Atkins diet (mAD) in refractory epilepsy in adults has been rarely investigated. We aimed to evaluate the efficacy of mAD in adult with refractory epilepsy. In a controlled randomized clinical trial, we enrolled 66 refractory adult epileptic cases from February 2010 to December 2012. The patients were randomly divided into two groups, case groups (22 patients) used antiepileptic drugs and mAD and control group (32 patients) only use antiepileptic drugs. The primary outcome was at least 50% decrement in seizure frequency after 2 months of therapy. No significant difference was shown in our data between groups regarding baseline characteristic. The differences of mean seizure attack after 2 months (P < 0.001). (17.6%) had > 50% seizure decrease at 1 and after 2 months and 12 (35.3%) had 50% decrease in seizure frequency. Furthermore, in mAD group, the mean urinary ketone positivity was 1.75 ± 0.28 and increasing liver enzyme was shown 5 cases (14.7%) in mAD group and 5 cases (15.6%) in control group (P < 0.050). The mAD may be effective as a cotherapy treatment for adults with refractory epilepsy and decrease 2.19 times seizure frequency in comparison with control groups. Trials with the more tolerant dietary regime, with larger sample size and longer duration, should be performed in future.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5526780PMC
April 2017

The Investigation of Insulin Resistance in Two Groups of Epileptic Patients Treated with Sodium Valproate and Carbamazepine.

Adv Biomed Res 2017 7;6:25. Epub 2017 Mar 7.

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

Background: Valproic acid (VPA) is a widely used broad-spectrum antiepileptic drug for therapy of generalized and focal epilepsies. Cross-sectional studies have suggested that valproate treatment may be associated with hyperinsulinemia. We decided to investigate hyperinsulinemia as a health-threatening side effect of VPA in Iranian epileptic patients.

Materials And Methods: Body mass index (BMI), lipid profile, fasting serum insulin, fasting blood glucose (FBS), and homeostatic model assessment-insulin resistance (HOMA-IR) were measured in 30 VPA-treated epileptic patients and 30 controls (CBZ-treated). The Chi-square test, -test, and Pearson correlation test were used.

Results: BMI was higher in VPA group than in control group (25.7 ± 3.5 > 21.7 ± 4.1) (0.000 < 0.05). Prevalence of obesity was 16.6% in VPA group that was almost the same and even lower than general Iranian population. Serum triglyceride (TG) (150 ± 77.2) was higher than CBZ group (114 ± 35.2) ( = 0.023 < 0.05). However, serum high-density lipoprotein level was lower in VPA group than controls (45.2 ± 11.7 < 54.4 ± 13.9) ( = 0.008 < 0.05). Serum insulin, FBS, HOMA-IR, cholesterol, and low-density lipoprotein did not demonstrate statistically significant differences between the two groups ( > 0.05).

Conclusion: Despite the majority of previous studies that are against VPA and according to our study, VPA could be prescribed safely and it may not cause IR and its complications.
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http://dx.doi.org/10.4103/2277-9175.201689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5359994PMC
March 2017

Diagnosis and Management of Multiple Sclerosis in Children.

Iran J Child Neurol 2016 ;10(3):13-23

Medical student, Isfahan University of Medical Sciences, Faculty of Medicine, Isfahan, Iran.

Growing evidence indicates the safety and well toleration of treatment by Disease-modifying in children suffering multiple sclerosis (MS). The treatment is not straight forward in a great number of patients, thus patients with pediatric MS must be managed by experienced specialized centers. Common treatments of multiple sclerosis for adults are first-line therapies. These therapies (firstline) are safe for children. Failure in treatment that leads to therapy alteration is almost prevalent in pediatric MS. Toleration against current second-line therapies has been shown in multiple sclerosis children. Oral agents have not been assessed in children MS patients. Although clinical trials in children are insufficient, immunomodulating managed children, experience a side effect similar to the adult MS patients. However, further prospective clinical studies, with large sample size and long follow-up are needed to distinguish the benefits and probable side effects of pediatric MS therapies.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928611PMC
July 2016

Association of Family History of Epilepsy with Earlier Age Onset of Juvenile Myoclonic Epilepsy.

Iran J Child Neurol 2016 ;10(2):10-5

Medical Student and Isfahan Neurosciences Research Centre (INRC), Isfahan University of Medical Sciences, Isfahan, Iran

Objective: Juvenile myoclonic epilepsy (JME) is supposedly the most frequent subtype of idiopathic generalized epilepsies (IGE). The aim of this study was to determine the prevalence of JME and comparison of patients' demographics as well as timeline of the disease between positive family history epileptic patients (PFHE) and negative family history epileptic patients (NFHE) among sample of Iranian epileptic patients.

Materials & Methods: From Feb. 2006 to Oct. 2009, 1915 definite epileptic patients (873 females) referred to epilepsy clinics in Isfahan, central Iran, were surveyed and among them, 194 JME patients were diagnosed. JME was diagnosed by its specific clinical and EEG criteria. Patients were divided into two groups as PFHE and NFHE and data were compared between them.

Results: JME was responsible for 10% (194 patients) of all types of epilepsies. Of JME patients, 53% were female. In terms of family history of epilepsy, 40% were positive. No significant differences was found between PFHE and NFHE groups as for gender (P>0.05). Age of epilepsy onset was significantly earlier in PFHE patients (15 vs. 22 yr, P<0.001). Occurrence of JME before 18 yr old among PFHE patients was significantly higher (OR=2.356, P=0.007).

Conclusion: A family history of epilepsy might be associated with an earlier age of onset in patients with JME.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885150PMC
June 2016

Dolichoectasia in vertebrobasilar arteries presented as transient ischemic attacks: A case report.

ARYA Atheroscler 2016 Jan;12(1):55-8

General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Vertebrobasilar dolichoectasia (VBD) is a rare vasculopathy. The etiology of this disease is unknown. Transient ischemic attacks (TIAs) of vertebrobasilar system refer to a transient (< 24 hours) lowering of blood flow in the posterior circulation of the brain. We present a case of dolichoectasia in the vertebrobasilar artery that presented with TIAs.

Case Report: A hypertensive 54-year-old man with true vertigo, nausea, imbalance, dysarthria, dysmetria, horizontal nystagmus, and gait ataxia was referred to Alzahra Hospital, Isfahan, Iran. The symptoms improved in the 1st day, but recurred in the 2nd day, lasting for 6-7 hours. According to clinical manifestations, a diagnosis of TIAs in the vertebrobasilar circulation was made. Imaging studies showed vascular anomaly. The vascular anomaly was considered as the cause of the patient's symptoms. A medical management was started using antiplatelet and antihypertensive drugs. The patient was referred for a more evaluation for other vascular anomalies.

Conclusion: Dolichoectasia usually affects vertebral and basilar arteries and simultaneous involvement of carotid arteries is rare seen in only 0.5% of these patients. The usual symptom of dolichoectasia is ischemia and rarely hemorrhages. The most common type of ischemic stroke is lacunar type. Ischemia evolves from embolic that originate from thrombi or plaques in the walls of the ectatic artery. While hemodynamic effects are the most common cause of the presenting signs and symptoms of the anomaly. We report a case of dolichoectasia that presented with TIAs of the verterbrobasilar artery. VBD is a distinct arteriopathy known as stroke risk.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4834182PMC
January 2016

Early and late posttraumatic seizures following traumatic brain injury: A five-year follow-up survival study.

Adv Biomed Res 2015 11;4:82. Epub 2015 May 11.

Department of Neurology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Background: The main objective of this study was to determine the incidence, time to event, and risk factors for posttraumatic seizures (PTS) following traumatic brain injury (TBI) in a five-year follow-up survival design.

Materials And Methods: In a cohort study, between September 2008 and October 2013, 411 traumatic brain injury patients referring to the Emergency Units (EUs) of the Isfahan University Hospitals, who met the inclusion criteria, entered the study. Follow-up evaluations were conducted by telephone conversation or clinical examination, if needed. The patients were followed for up to five years after TBI or until a first seizure event if it occurred prior to the five-year anniversary. The survival rate data were collected and measured for all patients under follow-up. Survival analysis on PTS and its related predictors was done using the Kaplan-Meier curves and the Cox proportional hazards regression. All analyses were done using STATA and SPSS statistical software, and P-values smaller than 0.05 were considered to be statistically significant.

Results: The median duration of follow-up was 36 months (Interquartile range: 23-50). A significantly greater number of first seizures occurred in the first year after injury than all other years (57.7%). The overall incidence of posttraumatic seizures, in this study population, was 6.33% (95% CI: 3.96-8.69). Among the participants, the incidence rates for early and late posttraumatic seizures were 1.95 and 4.38%, respectively. The result of the Cox regression analysis showed that the Glasgow Coma Scale (GCS) score and trauma severity were associated with PTS.

Conclusion: All in all, the present study highlighted the role of the trauma severity and GCS as effective factors in the incidence of seizure in patients with TBI. Particular care is advised for patients with these risk factors during the primary handling in the Emergency Units.
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http://dx.doi.org/10.4103/2277-9175.156640DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4434449PMC
May 2015

The investigation of correlation between Iminoral concentration and neurotoxic levels after kidney transplantation.

Adv Biomed Res 2015 23;4:59. Epub 2015 Feb 23.

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

Background: Neurotoxicity side effects related to cyclosporine kinetics could lead to dysfunction of kidney graft and patient outcome after transplantation. The aim of this study was evidence-based pharmacotherapy of kidney transplant recipients and to investigate neurotoxic levels of Iminoral.

Materials And Methods: The results of 2239 cyclosporine trough levels obtained from 743 patients were studied. Seventy-five adult kidney recipients who received Iminoral were studied for neurotoxicity symptoms. Demographic, clinical, hematology and biochemical data were recorded in d-base and analyzed using SPSS application for windows.

Results: The mean value related to cyclosporine C0 was 246.3 μg/l. In the 48% the signs of neurotoxicity such as tremor and headache were noted, but only in 9% the levels of cyclosporine C0 were >400 μg/l. Further studies on 75 patients showed that the incidence of neurotoxic side effects were as follows: Tremor in 35, headache in 24 and anxiety in 34 recipients of kidney. The prescribed drug regimens from the day of transplant in most patients were based on mycophenolic acid or cellcept, pulse therapy using methylprednisolone (daily from kidney transplant up to 3 days after transplant), cyclosporine or Iminoral plus other drugs related to each individual. Administrations of ganciclovir, thymoglobulin, clotrimazol and prednisolone were also distinguished with immunosuppressant-based therapy simultaneously.

Conclusion: Evidence-based study related to pharmacotherapy of Iminoral showed that clinical presentation related to neurotoxic side effects such as tremor, headache and anxiety might be due to many factors such as polypharmacy. Planning immunosuppression to individual patients based on programmed therapeutic Iminoral monitoring, avoiding polypharmacy in terms of removal or drug minimization and focusing on first week after transplant seem to be a realistic option.
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http://dx.doi.org/10.4103/2277-9175.151876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4361960PMC
March 2015

Multiple sclerosis and hyperprolactinemia: a case-control study.

Acta Neurol Belg 2015 Sep 14;115(3):253-7. Epub 2014 Dec 14.

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

Unlabelled: Multiple sclerosis (MS) is an autoimmune disease of central nervous system which is characterized with demyelination. Prolactin, synthesized in the anterior pituitary cells, has a role in maturation of immune cells, suggesting its possible implication in autoreactivity. The aim of the current study is to investigate the role of hyperprolactinemia in MS. Twenty-two MS patients with hyperprolactinemia diagnosed with pituitary adenoma and 66 MS patients without hyperprolactinemia were enrolled in our case-control study. They were matched with regard to age, gender, and MS subtypes. Patients with other concomitant autoimmune diseases and pregnancy were excluded. Statistical analyses were carried out using SPSS (SPSS statistic package, version 21.0.0) statistical software. The Pearson Chi-square test and the t test were used to determine whether there were any significant differences. The level of significance was set at p < 0.05. Greater value of relapse rate among hyperprolactinemic MS patients in comparison to non-hyperprolactinemic MS patients was statistically significant (p < 0.001). Statistically significant difference between the two groups in terms of EDSS was observed (case group vs.

Control: 1.3 vs. 1.9; p = 0.007). The correlation between MS duration and duration of hyperprolactinemia was significant in the case group (p < 0.05, R = 0.752). No statistically significant difference was found between two groups regarding duration of MS. This study suggested a protective role of prolactin in demyelinating procedure of MS.
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http://dx.doi.org/10.1007/s13760-014-0403-yDOI Listing
September 2015

Reliability and validity of the migraine disability assessment scale among migraine and tension type headache in Iranian patients.

Biomed Res Int 2014 16;2014:978064. Epub 2014 Jan 16.

Albert Einstein College of Medicine, Bronx, NY, USA ; Montefiore Medical Center, Bronx, NY, USA.

Introduction: MIDAS is a valid and reliable short questionnaire for assessment of headache related disability. Linguistic validation of Persian MIDAS and assessment of psychometric properties between tension type headache (TTH) and migraine were the aims of this study.

Methods: Patients with migraine or TTH were included. At the first visit, we administered a headache symptom questionnaire, MIDAS, and SF-36. Patients filled out MIDAS in second and third visit within three and eight weeks after base line visit. Internal consistency (Cronbach α ) and test-retest reproducibility (Spearman correlation coefficient) were used to assess reliability. Convergent validity and MIDAS capability to differentiate between chronic and episodic headaches (migraine and TTH) were also assessed.

Results: The 267 participants had episodic migraine (EM-64%), chronic migraine (CM-13.5%), episodic TTH (ETTH-13.5%), and chronic TTH (CTTH-9). Internal consistency reliability was 0.8 for the entire sample, 0.72 for TTH, and 0.82 for migraine. Test-retest reliability for all questions between visit 1 and visit 2 varied from 0.54 to 0.71. Convergent validity was assessed using SF-36 as an external referent. Patients with episodic headaches (EM and ETTH) had significantly lower MIDAS scores than chronic headaches (CM and CTTH).

Conclusion: Persian MIDAS is a valid and reliable questionnaire for migraine and TTH that can differentiate between episodic headache and chronic headache.
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http://dx.doi.org/10.1155/2014/978064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914354PMC
September 2014

Psychometric properties and validation of Persian version of quality of life in epilepsy inventory (QOLIE-89).

J Res Med Sci 2013 Nov;18(11):990-4

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

Background: Several epilepsy-specific quality of life questionnaires have been developed. One of them is quality of life in epilepsy-89 version. The objective of this study was to develop a Persian version of QOLE-89 and confirm its psychometric properties.

Materials And Methods: Participants were 75 patients with epilepsy. The quality of life questionnaire was adapted to Persian language through a translation and translation-back procedure. Internal consistency by Cronbach's α, was determined and construct validity was assessed by correlation with GHQ-12 and BDI-PC and discriminant validity was confirmed by comparing scores for known groups.

Results: Reliability based on internal consistency (Cronbach's α) for QOIE-89 was 0/96 and for 17 subscales was varied form 0/70 to 0/89 and Test-retest reliability (Pearson's correlation coefficient) for the Farsi version of the QOLIE-89 ranged from 0.75 to 0.88. Total score of QOLIE-89 discriminated well between the patients according to depression severity and drug resistance and seizure controllability. Correlation between the total scores, BDI-PC and GHQ-R to confirm construct validity was 0/55 and 0/63, respectively.

Conclusion: In this cross-sectional survey, Persian version of the QOLIE-89 was reliable and showed properties supporting the construct and discriminant validity at a level comparable with the original and some other versions. Thus, this questionnaire has suitable properties in Iranian population and can be used in clinical trials with epileptic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906792PMC
November 2013

The psychometric properties of the persian migraine-specific quality of life questionnaire version 2.1 in episodic and chronic migraines.

ScientificWorldJournal 2013 27;2013:950245. Epub 2013 Aug 27.

Department of Physiology, Physiology Research Center, Isfahan University of Medical Sciences, Isfahan 81745-319, Iran ; Medical Student Research Center, Isfahan University of Medical Sciences, Isfahan 81745-319, Iran.

Background: Migraine-specific quality of life (MSQ) is a valid and reliable questionnaire. Linguistic validation of Persian MSQ questionnaire, analysis of psychometric properties between chronic and episodic migraine patients, and capability of MSQ to differentiate between chronic and episodic migraines were the aims of this study.

Method: Participants were selected from four different neurology clinics that were diagnosed as chronic or episodic migraine patients. Baseline data included information from MSQ v. 2.1, MIGSEV, SF-36, and symptoms questionnaire. At the third week from the baseline, participants filled out MSQ and MIGSEV. Internal consistency (Cronbach alpha) and test-retest reproducibility (intraclass correlation coefficients) were used to assess reliability. Convergent and discriminant validities were also assessed.

Results: A total of 106 participants were enrolled. Internal consistencies of MSQ among all patients, chronic and episodic migraines, were 0.92, 0.91, and 0.92, respectively. Test-retest correlation of MSQ dimensions between visits 1 and 2 varied from 0.41 to 0.50. Convergent, item discriminant, and discriminant validities were approved. In all visits MSQ scores were lower in chronic migraine than episodic migraine; however, the difference was not statistically significant.

Conclusion: Persian translation of MSQ is consistent with original version of MSQ in terms of psychometric properties in both chronic and episodic migraine patients.
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http://dx.doi.org/10.1155/2013/950245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3771439PMC
April 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

A quick review of carbamazepine pharmacokinetics in epilepsy from 1953 to 2012.

J Res Med Sci 2013 Mar;18(Suppl 1):S81-5

Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Carbamazepine has been used as AEDs since 1965, and is most effective against partial seizures. Two basic mechanisms of action have been proposed: 1) enhancement of sodium channel inactivation by reducing high-frequency repetitive firing of action potentials, 2) and action on synaptic transmission. The aim of this study was to provide a review of carbamazepine pharmacokinetics and its management guidelines in Iranian epileptic population.

Materials And Methods: Directory of Open Access Journals (DOAJ), Google Scholar, Pubmed (NLM), LISTA (EBSCO), Web of Science were searched; 1600, 722 and 167 research and review articles relevant to the topics; carbamazepine pharmacokinetics, carbamazepine pharmacokinetics in epilepsy and review on carbamazepine pharmacokinetics in epilepsy were found, respectively.

Results: Carbamazepine is highly bound to plasma proteins. In patients the protein-bound fraction ranged from 75-80% of the total plasma concentration. Bioavailability ranges from 75-85%. The rate or extent of absorption was not be affected by food. It is completely metabolized and the main metabolite is carbamazepine-epoxide (CBZ-E). Carbamazepine induces its own metabolism, leading to increased clearance, shortened serum half-life, and progressive decrease in serum levels. Increases in daily dosage are necessary to maintain plasma concentration. Severe liver dysfunction may cause disordered pharmacokinetics. In cardiac failure, congestion of major vital organs, including kidneys, may result in abnormally slow absorption and metabolism.

Conclusion: Carbamazepine shows variability due to its narrow therapeutic window. Therefore clinical management in a3n Iranian epileptic population should focus on results derived from therapeutic drug monitoring in order to reduce inter and intra- individual variability in plasma drug concentrations.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743329PMC
March 2013

Circadian rhythm sleep disorders in patients with multiple sclerosis and its association with fatigue: A case-control study.

J Res Med Sci 2013 Mar;18(Suppl 1):S71-3

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

Background: Circadian rhythm sleep disorders are a presentation of sleep disorders in patients with multiple sclerosis (MS). This study aims to compare this problem in MS patients with healthy people and to determine its association with chronic fatigue in MS patients.

Materials And Methods: A case-control study was performed on 120 MS patients and 60 healthy subjects matched for age and sex, in 2009 in MS Clinic Alzahra Hospital. Sleep quality, rhythm and fatigue severity were assessed using PSQI (Pittsburgh sleep quality index) and FSS (Fatigue severity Scale) questionnaires, respectively. Its reliability and validity has been confirmed in several studies (Cronbach's alpha = 0.83). This index has seven sections including patient's assessment of his/her sleep, sleep duration, efficacy of routine sleep, sleep disorders, use of hypnotic medication, and dysfunction in daily activities.

Results: Circadian rhythm sleep disorder was more frequent in MS patients relative to healthy subjects (P: 0.002). It was higher in MS patients with severe fatigue relative to MS patients with mild fatigue (P: 0.05). Fatigue severity was 49.9 ± 8.2 and 22.5 ± 7.4 in the first and second group, respectively. PSQI index was 7.9 ± 4.5 in patients with severe fatigue and 5.9 ± 4.5 in patients with mild fatigue and 4.5 ± 2.4 in the control group (P: 0.0001).

Conclusion: Circadian rhythm sleep disorders are more frequent in MS patients and those with fatigue. Recognition and management of circadian rhythm sleep disorders in MS patients, especially those with fatigue may be helpful in improving care of these patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3743326PMC
March 2013

Preliminarily Analysis of Carbamazepine (CBZ) C0 in Patients Visited Isfahan Epileptic Clinics.

Int J Prev Med 2013 May;4(Suppl 2):S343-6

Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Carbamazepine (CBZ) is mostly considered as the first line of effective treatment against simple or complex partial seizure and primary-secondary generalization. To prevent side-effects related to higher amount of CBZ minimum concentration (C0) in body fluid or seizure attacks associated to lower amount of CBZ-C0, the suggested minimum therapeutic concentrations range from 4 to 12 ng/ml (according to previous publications). The aim of this preliminarily study was to investigate the scope of discrepancy associated to the C0of CBZ in patients visited Isfahan Epileptic Clinic.

Methods: A cross-sectional study of 22 patients located in neurology ward of Isfahan Neurosciences Research Centre (INRC) was carried out between April 1, 2012 and December 31, 2012. Female (n = 9) and male subjects (n = 13) with a mean age of 27.4 years (range; 16-38 years) were studied. Pharmacological (CBZ-C0) and demographical variables were recorded and processed in excel.

Results: The results of CBZ-C0 showed wide inter-individual variability. The mean value of CBZ-C0 was 7.2 ng/ml. In 10 out of 22 patients, CBZ-C0 were lower than the suggested therapeutic window (4-12 ng/ml). CBZ-C0 in nine patients was non-detectable and in one patient was 0.5 ng/ml (45% < 4 ng/ml). In 55% of the patients, CBZ-C0 ranged from 4.8 to 12 ng/ml.

Conclusions: A schedule therapeutic drug monitoring based on measurement of CBZ-C0for individual patient could be a practical marker to achieve therapeutic objectives. Further study related to correlating of CBZC0to clinical events in Iranian Epileptic population seems to be valuable.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678243PMC
May 2013

Antiepileptic drugs: a consideration of clinical and biochemical outcome in patients with epilepsy.

Int J Prev Med 2013 May;4(Suppl 2):S330-7

Isfahan Neurosciences Research Centre, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: The challenge of antiepileptic drugs (AEDs) management is to attain the best compromise between the desire to maximize seizure control and the need to keep side-effects within tolerable limits for the individual patient. To reduce devastation in Iranian epileptic patients, the aim of this study was to explore the overall outcome following AEDs prescription.

Methods: A cross-sectional study of 36 patients located at the epilepsy ward, conducted to Isfahan Neurosciences Research Centre was carried out during the year 2011. Female (n = 17) and male subjects (n = 19) with a mean age of 27 years (range; 7-74 years) were studied. Variables including, sex, age, age of seizure onset, type, and number of AEDs, biochemical and hematological data were recorded in d-Base and statistical analyses were performed using SPSS (version 18) for windows.

Results: The main drug to control seizure attack was carbamazepine and valproic-acid. The following tests were the most frequently influenced; alkaline phosphatase (AP), lymphocyte (Lymph), white blood cell (WBC) counts and hemoglobin (Hgb). There was a significant increase in (AP) (mean; 534.6 u/l(↑); [P = 0.02] in three patients and (Lymph) (55%(↑); [43-84] %(↑); [P = 0.04] in seven patients. WBC was lower than 4400 mm(3↓) (P = 0.02) in six patients. Hgb was significantly lower in 70.6% of women (11.8(↓); [10-14.2] g/dl(↓); [P = 0.04] and 68.4% of men population (12.3(↓); [9.7-13.8] g/dl(↓); [P = 0.01]. Mean age of epilepsy onset was 15.6 years (range: Birth-74 years). Analysis of drug prescriptions showed that the incidence of monotherapy and polypharmacy (2 up to six AEDs simultaneously) was 19.4% plus 80.6% respectively.

Conclusions: In Iranian epileptic population, effectiveness of treatment should be attributed by the close supervising of AEDs in relation to clinical circumstance, laboratory data, and therapeutic drug monitoring. Any significant change in patients' biochemical and hematological data may require close verifying for the rapid detection of severe anemia, leukopenia, lymphocytosis, osteomalacia, or liver failure.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678241PMC
May 2013

Quality of sleep in patients with Parkinson's disease.

Int J Prev Med 2013 May;4(Suppl 2):S229-33

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

Background: Parkinson's disease (PD) is a progressive neurodegenerative disorder causing motor and non-motor symptoms. The latter are common and include autonomic dysfunction, cognitive impairment, and sleep difficulties. Many of the non-motor aspects of PD such as sleep disturbance are more common and significantly affect the day-to-day activities of patients and their quality of life. The most important aim of this study was to evaluate the sleep quality in patients with PD.

Methods: This case-control study was performed on patients with PD referred to the Neurology Clinic of our teaching hospital in 2011. Thirty-four patients with PD and 34 healthy people as control group were enrolled in this study. Sleep quality of patients and control was evaluated by Parkinson's disease sleep scale (PDSS) questionnaire. PDSS is a reliable and valid tool to measure sleep disorders in PD.

Results: The mean total PDSS score in patient group was 55.29 (SD = 26.92) indicating moderate to severe sleep disturbances whereas, the mean total score in control group was 20.34 (SD = 10.65). Difference between the two groups' mean scores was significant (P < 0.05).

Conclusions: Our study demonstrated that patients with PD experienced poorer nocturnal sleep quality than the control group.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678223PMC
May 2013

A comparative assessment the efficacy of intravenous infusion of sodium valproate and phenytion in the treatment of status epilepticus.

Int J Prev Med 2013 May;4(Suppl 2):S216-21

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

Background: Status epilepticus (SE) is a type of persistent lasting seizure with high mortality and morbidity. Numerous medications are suggested for the treatment of SE, two of which are sodium valproate and phenytoin. The purpose of this study is to conduct a comparison between the efficiencies of intravenous sodium valproate and phenytoin in the treatment of this type of epilepsy.

Methods: This is a clinical trial study conducted on SE-suffering patients admitted to the emergency departments of Al-Zahra and Ayatollah Kashani Medical Centers of Isfahan in 2009 and 2010. The patients were randomly assigned into two groups and taken under treatment, separately by intravenous infusion sodium valproate and phenytoin.

Results: No significant difference was observed between the two groups (at P = 0.06). In terms of incidence of the clinical complications, the incidence of clinical complications in the two groups was significantly different (at P = 0.03).

Conclusions: Based on the findings the efficiency of sodium valproate is larger than that of the phenytoin, and thus, the treatment by sodium valproate is preferred over the treatment by phenytoin.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3678221PMC
May 2013

The course and outcome of pregnancy and neonatal situation in epileptic women.

Adv Biomed Res 2012 28;1. Epub 2012 Mar 28.

Department of Neurology, Alzahra Hospital, Isfahan, Iran.

Background: Epilepsy is a rare neurologic disorder during pregnancy. Despite its rarity, it could cause different clinical problems in this natural phenomenon of a woman's life. The aim of this study was to evaluate and compare the course of pregnancy and labor and their outcome in epileptic and healthy women.

Materials And Methods: This study was performed during years 2009--2011 in Alzahra and Beheshti hospitals affiliated to Isfahan University of Medical Sciences. A total of 51 pregnant women, who were known cases of epilepsy and were on antiepileptic drugs treatment for at least 3 months, were compared with 47 matched healthy pregnant women without epilepsy. They were followed before and during their pregnancy in several visits and all of their neurologic and obstetric information were collected. For statistical analysis of continuous variables, the t-test was used. The chi-square test was used for dichotomous variables.

Results: The rate of monotherapy was more than polytheraphy especially during the pregnancy. The epileptic attacks stopped in majority of patients during the pregnancy. Vaginal bleeding (P=0.020) and abortion (P=0.015) were significantly more frequent among epileptic mothers. The gestational age was lower meaningfully (P= 0.010) in epileptic patients' neonates and the first minute Apgar score was lower in these babies too (P=0.028).

Conclusions: Antiepileptic drugs could have some unsuitable effects on pregnancy course especially by increasing the rate of abortion, preterm labor, and vaginal bleeding. Their adverse effects on neonates' health could not be neglected.
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http://dx.doi.org/10.4103/2277-9175.94426DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507034PMC
December 2012

Isolated third nerve palsy from mild closed head trauma.

Arch Iran Med 2012 Sep;15(9):583-4

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

Head injury is a common occurrence in motor vehicle accidents. There are numerous causes for cranial nerve injury that include head trauma or other lesions. Few studies regarding cranial nerve injury following mild head trauma (GCS: 14 - 15) exist in the literature. The oculomotor nerve is a somatic and visceral motor nerve. When it is completely injured the result is ptosis, pupils that are non-reactive to light and a lack of eye movement. We report the case of a completely isolated oculomotor nerve palsy associated with minor head injury.
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http://dx.doi.org/012159/AIM.0015DOI Listing
September 2012

CD24 gene allele variation is not associated with oligoclonal IgG bands and IgG index of multiple sclerosis patients.

Neuroimmunomodulation 2012 18;19(3):195-9. Epub 2012 Jan 18.

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

Objective: Multiple sclerosis (MS) shows evidence of many distinctive aspects of an autoimmune disorder, including a polygenic inheritance. A recent candidate gene for susceptibility to MS is CD24, which has also been shown to be associated with disease progression. This study was designed to examine whether there is a relationship between the CD24 genotype, oligoclonal band (OCB) status and IgG index in the cerebrospinal fluid (CSF) of MS patients.

Methods: A total of 27 definite MS patients were enrolled in this cross-sectional study. Blood samples were collected from a peripheral vein, and CSF was obtained by lumbar puncture. The CD24 gene was sequenced in the blood specimen, and albumin and IgG concentrations were measured in both CSF and serum. We compared both IgG index and OCB status in patients with and without CD24V/V. The correlation between MS severity score (MSSS), OCB status, CD24 genotype and IgG index was studied.

Results: Only 15 patients were OCB positive. Among patients with negative OCBs, only 2 patients had the V/V genotype. Furthermore, in those with the V/V genotype, IgG index was not significantly elevated (p = 0.322). Patients with the V/V genotype had a significantly higher MSSS (p = 0. 04), but neither the presence of OCBs nor the IgG index showed significant correlation with MSSS (p = 0.379 and 0.20, respectively).

Conclusion: We could not show any relationship between the CD24V/V genotype, OCB status and IgG index. This could be interpreted as indicating that the CD24V/V allele exerts its effects on the disease course independently of CSF IgG synthesis.
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http://dx.doi.org/10.1159/000332011DOI Listing
July 2012

Effects of antiepileptic drugs on sexual function and reproductive hormones of male epileptic patients.

Iran J Neurol 2012 ;11(2):37-41

Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan AND Isfahan Neuroscience Research Center, Isfahan, Iran.

Background: Diminished libido and sexual dysfunction are unusually common among male epileptic patients. The most important etiologic factor may be antiepileptic drugs (AEDs)-induced androgen deficiency. We compared reproductive hormone levels among men with epilepsy taking various AEDs and normal controls.

Methods: Subjects were 59 male epileptic patients who aged 24 ± 5 years. They had been receiving lamotrigine (LTG) (n = 17), carbamazepine (CBZ) (n = 18), and sodium valproate (VPA) (n = 15) for at least 6 months. We also recruited 23 healthy controls. Testosterone, estradiol, dehydroepiandrosterone sulfate (DHEAS), sex hormone-binding globulin (SHBG), androstenedione (AND), luteinizing hormone (LH), and follicle stimulatin hormone (FSH) levels and gonadal efficiency (testosterone/LH) were compared between the four groups. The patients and the control group were examined and evaluated for male reproduction by urology and endocrinology services.

Results: Subjects receiving CBZ, VPA, and LTG had significantly lower mean testosterone levels than the control group (P < 0.01). In addition, patients receiving LTG had significantly higher mean testosterone levels than CBZ and VPA groups (P < 0.01) and controls (P < 0.05). There were not any significant differences between the groups in mean estradiol levels. The mean AND level in VPA was higher than CBZ, LTG, and control groups (P < 0.01). Men receiving CBZ had significantly lower DHEAS levels than the other groups (P < 0.01). Testosterone/LH ratio in the control group was more than other groups (P < 0.01). On the other hand, this value in LTG group was higher than CBZ and VPA groups (P < 0.01). However, CBZ and VPA groups were not significantly different in terms of testosterone/LH ratio.

Conclusion: Although the mean levels of reproductive hormones were lower in the LTG group compared to the controls, among traditional antiepileptic drugs, LTG had fewer side effects on reproductive hormones. Therefore, it is a good adjuvant and substitute drug for epilepsy control instead of CBZ and VPA.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829242PMC
November 2013