Publications by authors named "Mohsen Farazdaghi"

21 Publications

  • Page 1 of 1

Treatment response in newly diagnosed epilepsy: a syndromic approach.

Neurol Res 2022 Jan 17:1-6. Epub 2022 Jan 17.

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

Objective: To investigate the seizure outcome and factors associated with that in patients with newly diagnosed epilepsy, based on a syndromic approach [i.e. idiopathic generalized epilepsies (IGEs) . symptomatic generalized epilepsies (SGEs) . focal epilepsies . unclassified epilepsy].

Methods: This was a retrospective longitudinal study of a prospectively developed database. All newly-diagnoses patients with a diagnosis of IGE, focal epilepsy, SGE, or unclassified epilepsy, who received treatment from 2008 until 2018, were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran. All patients had to be followed at our center for at least 14 months.

Results: Four hundred and ten patients were studied [208 people with focal epilepsy (50.7%), 130 with IGE (31.7%), 49 with SGE (12%), and 23 patients with unclassified epilepsy (5.6%)]. Overall, 216 (52.7%) individuals became seizure-free for at least one year after their first therapeutic plan. The second therapeutic attempt in patients, who did not achieve seizure freedom with the first treatment plan, yielded seizure-free outcome in 52 patients (28.7%). The odds ratio of drug-resistance in patients with focal epilepsy compared with that in those with IGE was 1.816 (95% CI: 1.039-3.171; p = 0.036). The odds ratio of drug-resistance in patients with SGE compared with that in those with IGE was 8.543 (95% CI: 3.993-18.274; p = 0.0001).

Conclusion: Implementation of appropriate personalized treatment plans in PWE is of paramount significance and the primary step towards such a strategy is to making a syndromic diagnosis of the condition.
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http://dx.doi.org/10.1080/01616412.2021.2025319DOI Listing
January 2022

An international study of the effects of the COVID-19 pandemic on characteristics of functional seizures.

Epilepsy Behav 2021 Dec 29;127:108530. Epub 2021 Dec 29.

Department of Neurology, Cairo University Epilepsy Unit (CUEU), School of Medicine, Cairo University, Cairo, Egypt. Electronic address:

Objective: We investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis) in a large multicenter international study.

Methods: This was a retrospective study. We investigated all patients with FS, who were admitted at the epilepsy monitoring units at six centers in the world: 1. Shiraz, Iran; 2. Salzburg, Austria; 3. Nancy, France; 4. Atlanta, USA; 5. Kuwait City, Kuwait; and 6. Cairo, Egypt. Patients were studied during two time periods: admitted in 2018-2019 (pre-COVID era) and 2020-2021 (COVID era).

Results: Three hundred and twenty-six patients were studied. Two hundred and twenty-four (68.7%) patients were diagnosed before and 102 (31.3%) persons during the COVID-19 pandemic. Only, a history of family dysfunction was significantly associated with the COVID-19 pandemic era (Odds Ratio: 1.925, 95% Confidence Interval: 1.099-3.371; p = 0.022). A low level of education might also be associated with FS during the COVID-19 pandemic, at least in some cultures (e.g., the Middle-East).

Conclusion: The COVID-19 pandemic has not affected the clinical characteristics of patients with FS (at the time of diagnosis). However, a history of family dysfunction was significantly more frequently associated with FS during the COVID-19 pandemic. Multiagency integration of law enforcement responses, social services, and social awareness is recommended to address family dysfunction and domestic violence and support the victims during this pandemic.
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http://dx.doi.org/10.1016/j.yebeh.2021.108530DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8714296PMC
December 2021

Cluster analysis: Predicting the seizure outcome in temporal lobe epilepsy.

Epilepsy Behav 2022 Jan 16;126:108495. Epub 2021 Dec 16.

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

Objectives: We applied the Two-Step cluster analysis on a large cohort of patients with temporal lobe epilepsy (TLE). We hypothesized that there are distinct clusters of patients with TLE based on their clinical characteristics and these clusters may predict their seizure outcome.

Methods: This was a longitudinal study of a prospectively developed database. All patients with a diagnosis of TLE were studied at the outpatient epilepsy clinic, Shiraz, Iran, from 2008 until 2021. The Two-Step cluster analysis (Schwarz's Bayesian Criterion: BIC) was applied to the whole dataset considering the demographic data, clinical characteristics, imaging, and electroencephalography data. The seizure outcome was compared between the clusters of patients.

Results: Three hundred and seventy-four patients had the inclusion criteria and were studied. The Two-Step cluster analysis showed that there were two distinct clusters of patients with TLE. The most important clinical predictors were the presence (or absence) of focal impaired awareness seizures or focal to bilateral tonic-clonic seizures, aura with seizures, and the brain imaging findings. The seizure outcomes were significantly different between these two clusters (p = 0.008).

Conclusion: The Two-Step cluster analysis could identify two distinct clusters of patients with TLE; these data are helpful in providing prognosis and counseling for patients and their care-givers. These data may also be used to develop a practical outcome prediction tool for patients with TLE.
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http://dx.doi.org/10.1016/j.yebeh.2021.108495DOI Listing
January 2022

Functional seizures: Cluster analysis may predict the associated risk factors.

Epilepsy Behav 2022 Jan 15;126:108485. Epub 2021 Dec 15.

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

Objectives: We applied the Two-Step cluster analysis on a large cohort of patients with functional seizures (FS). We studied whether the background risk factors differed between the patient clusters.

Methods: All patients with a diagnosis of FS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2021. The Two-Step cluster analysis was applied considering the age at onset, sex, and seizure semiology. We also studied whether the background risk factors (e.g., a history of sexual abuse, physical abuse, etc.) differed between these patient clusters.

Results: Three-hundred and fifty four patients were studied. The Two-Step cluster analysis was applied to the 230 patients who reported any associated risk factors; there were three clusters of patients. The most prominent feature of cluster 1 included akinetic seizures. The most prominent features of cluster 2 included motor seizures and no ictal injury. The most prominent features of cluster 3 included motor seizures with ictal injury. Compared with patients in cluster 3, a history of sexual abuse was more often reported by patients in cluster 1 (OR: 3.26, 95%CI: 1.12-9.47; p = 0.03). Compared with patients in cluster 3, a history of physical abuse was less often reported by patients in cluster 2 (OR: 0.45, 95%CI: 0.22-0.90; p = 0.026).

Conclusion: The Two-Step cluster analysis could identify three distinct clusters of patients based on their demographic and clinical characteristics. These clusters had correlations with the associated risk factors in patients with FS.
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http://dx.doi.org/10.1016/j.yebeh.2021.108485DOI Listing
January 2022

Contributions of Iranian Journal of Medical Sciences (IJMS) during the COVID-19 Pandemic.

Iran J Med Sci 2021 11;46(6):503-505

Department of Pharmaceutical Biotechnology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran.

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http://dx.doi.org/10.30476/IJMS.2021.93381.2469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611218PMC
November 2021

Carotid intima-media and epicardial adipose tissue thickness in adult patients with epilepsy taking anti-seizure medication and its long-term significance.

Epilepsy Behav 2021 12 24;125:108432. Epub 2021 Nov 24.

School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Electronic address:

Objectives: We investigated epicardial adipose tissue thickness (EATT), carotid intima-media thickness (CIMT), and lipid profile in adult patients with epilepsy (PWE) taking anti-seizure medication(s) (ASM) and compared with those of the healthy population. We also investigated whether duration of follow-up and number of ASM(s) (mono- vs. polytherapy) affect these risk factors.

Methods: Twenty PWE older than 18 years of age were recruited at the outpatient epilepsy clinic and compared to twenty controls. Patients who were 18 years old and younger, those with cardiovascular risk factors, and patients with follow-up duration less than 2 years were excluded from the study.

Results: Epicardial adipose tissue thickness and CIMT were thicker compared to controls. While patients' low-density lipoprotein (LDL) levels were higher than controls, and high-density lipoprotein (HDL) levels were lower, the levels were in normal ranges. Those patients with duration of follow-up more than five years had thicker EATT. The 5-year LDL was in normal ranges while HDL was abnormally low. Number of ASM(s) was not associated with increased risks of atherosclerosis. Increased CIMT in patients taking ASM(s) was independent of their lipid profile.

Conclusion: Anti-seizure medications contribute to accelerated atherosclerosis in people with epilepsy. Chronic use of ASMs may increase this chance. It is appropriate to use ASM(s) with lower chances of atherosclerosis in people with epilepsy and encourage them to change their lifestyle in order to modify cardiovascular risk factors. Meantime, it is reasonable to assess the risk of atherosclerosis periodically in these patients by noninvasive methods including lipid profile, CIMT, and EATT.
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http://dx.doi.org/10.1016/j.yebeh.2021.108432DOI Listing
December 2021

Long-term medical and social outcomes of patients with Lennox-Gastaut syndrome.

Epilepsy Res 2021 Dec 13;178:106813. Epub 2021 Nov 13.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Objective: The aim of the current study was to investigate the long-term outcome in a large cohort of patients with Lennox-Gastaut syndrome (LGS).

Methods: This was a longitudinal study (a retrospective database review with a telephone follow-up interview). All patients 18 years of age and older, with a diagnosis of LGS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The inclusion criteria were: multiple seizure types, characteristic electroencephalographic patterns [either bursts of slow spike-waves or generalized paroxysmal fast activity], with or without intellectual disability. Being lost on follow-up was the only exclusion criterion.

Results: 78 patients fulfilled the inclusion criteria. All the patients were followed for one to 12 years (9.3 ± 2.8 years). In the last follow-up (call), 14 patients (17.9%) were seizure-free for at least 12 months. Tonic seizure at diagnosis was associated with a poor seizure outcome (not seizure-free) (p = 0.045). Four patients (5.1%) reported having high school degree (diploma), four patients (5.1%) were married, and one person (1.3%) reported driving a motor vehicle; none of the patients were employed.

Conclusion: A minority of patients with LGS (almost one in six patients) may enjoy a seizure-free state in their adulthood. However, very few of them could enjoy a healthy social life. While intellectual dysfunction may not be evident at the onset of the disease, cognitive impairment usually becomes apparent over time, and almost all patients would suffer from poor social outcomes in their adulthood.
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http://dx.doi.org/10.1016/j.eplepsyres.2021.106813DOI Listing
December 2021

Cluster analysis of a large dataset of patients with Lennox-Gastaut syndrome.

Seizure 2021 Nov 13;92:36-39. Epub 2021 Aug 13.

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

Objectives: We applied the Two-Step cluster analysis on a large cohort of patients with Lennox-Gastaut syndrome (LGS). We hypothesized that there are distinct clusters of patients with LGS based on their clinical characteristics. We also studied whether the seizure outcome differs between these patient clusters.

Methods: This was a longitudinal study of a prospectively developed database. All patients with a diagnosis of LGS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The Two-Step cluster analysis (Schwarz's Bayesian Criterion: BIC) was applied to the whole dataset considering the demographic data, seizure types, and EEG data. In the next step, the seizure outcome was compared between the clusters of patients.

Results: Two hundred and fifty-eight patients were studied. The Two-Step cluster analysis showed that there were three clusters of homogeneous subgroups of patients with LGS, with a fair silhouette measure of cohesion and separation. The seizure outcomes were significantly different between the clusters. In cluster 1, three out of 35 patients (8.6%) were seizure-free; in cluster 2, 13 out of 34 patients (38.2%) were seizure-free; and in cluster 3, nine out of 49 patients (18.4%) were seizure-free (p = 0.009; df: 2).

Conclusion: The Two-Step cluster analysis could identify three distinct clusters of patients with LGS; these data are helpful in providing appropriate prognosis and counselling for patients and their care-givers. Future studies should also investigate the effects of etiology in cluster analysis of patients with LGS.
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http://dx.doi.org/10.1016/j.seizure.2021.08.005DOI Listing
November 2021

Seizure and social outcomes in patients with non-surgically treated temporal lobe epilepsy.

Epilepsy Behav 2021 09 31;122:108227. Epub 2021 Jul 31.

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

Objectives: To investigate the seizure outcome with medical treatment in patients with temporal lobe epilepsy (TLE) and its associated factors. We also investigated the social outcome of the patients.

Methods: This was a retrospective study of a prospectively built electronic database of patients with epilepsy. All patients with a diagnosis of TLE were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2019. In a phone call to the patients, at least 24 months after their diagnosis at our center, we investigated their current seizure control and social status.

Results: Two hundred and twenty-two patients were studied; 101 patients (45.5%) were seizure free. A lower number of the prescribed drugs was the only factor with a significant association with the seizure-free outcome (Odds Ratio: 1.460; p = 0.001). At the time of the phone call, 76 patients (37.6%) reported having a college education, 103 patients (51%) were employed, 146 patients (72.3%) were married, and 81 patients (40%) reported driving a motor vehicle. The employment status, college education, and driving a motor vehicle were significantly associated with a seizure-free outcome status. The social achievements of the patients, who were partially responsive to medical therapy, were significantly worse than those who were seizure free.

Conclusion: Many patients with TLE may suffer from drug-resistant seizures. Ongoing seizures in these patients may affect their social lives substantially. Seizure reduction (not freedom) is not good enough to help the patients with TLE enjoy a healthy life with satisfactory social achievements.
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http://dx.doi.org/10.1016/j.yebeh.2021.108227DOI Listing
September 2021

Effects of the COVID-19 pandemic on characteristics of functional (psychogenic) seizures.

J Psychosom Res 2021 08 15;147:110514. Epub 2021 May 15.

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

Objective: We investigated whether the COVID-19 pandemic has affected the clinical characteristics of patients with functional seizure (FS) (at the time of diagnosis).

Methods: In a retrospective study of a prospectively developed and maintained database, all patients diagnosed with FS before and during the COVID-19 pandemic were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from December 2008 until February 2021.

Results: Three hundred and eighty-eight patients were studied. Three hundred and sixty-four patients (94%) were diagnosed before and 24 persons (6%) during the pandemic. Patients diagnosed during the COVID-19 pandemic less frequently had generalized motor seizures [odds ratio (OR): 0.30, 95% confidence interval (CI): 0.12-0.77; p = 0.012] and had higher seizure frequencies (OR: 1.00, 95% CI: 1.00-1.01; p = 0.044). Functional seizures were inversely associated with the education level as a trend during the COVID-19 pandemic (OR: 0.36, 95% CI: 0.13-1.01; p = 0.052).

Conclusion: The COVID-19 pandemic has affected the characteristics of patients with FS (at the time of diagnosis). Larger and multi-center studies are needed to investigate the links and associations between the COVID-19 pandemic and characteristics of FS.
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http://dx.doi.org/10.1016/j.jpsychores.2021.110514DOI Listing
August 2021

Is severe head injury associated with functional (psychogenic) seizures?

Seizure 2021 Jul 1;89:38-40. Epub 2021 May 1.

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

Objectives: The aim of the current study was to compare the frequency of significant head injuries in three groups of people with seizures [idiopathic generalized epilepsies (IGE) vs. temporal lobe epilepsy (TLE) vs. functional seizures (FS)].

Methods: This was a retrospective study. All patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020.

Results: One thousand and four hundred ninety-two patients were studied (559 patients with IGE, 646 people with TLE, and 287 persons with FS). Overall, 77 (5.2%) individuals of the studied people reported experiencing severe head injuries before the onset of their seizures [9 patients (1.6%) with IGE, 56 people (8.7%) with TLE, and 12 persons (4.2%) with FS; p = 0.0001]. Compared to people with IGE, the odds ratio of having a premorbid history of severe head injury in the FS group was 2.67 [95% Confidence Interval (CI): 1.11-6.40; p = 0.0280]. Compared to people with TLE, the odds ratio of having a premorbid history of severe head injury in the FS group was 0.46 (95% CI: 0.24-0.87; p = 0.0170).

Conclusion: Severe head injury is significantly associated with FS. However, since head injury is also a significant risk factor for focal epilepsies, it may be necessary to ascertain the diagnosis of post-traumatic seizures by obtaing a detailed clinical history and also by performing video-EEG monitoring in order to adopt an appropriate treatment strategy in these patients.
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http://dx.doi.org/10.1016/j.seizure.2021.04.018DOI Listing
July 2021

Driving rate in patients with seizures: Epilepsy vs. functional seizures.

Epilepsy Behav 2021 06 30;119:107985. Epub 2021 Apr 30.

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

Objectives: We investigated the rate of driving in patients with seizures [i.e., epilepsy or functional seizures (FS)]. We also investigated the factors that may be associated with NOT driving a motor vehicle.

Methods: This was a retrospective study of an electronic database of patients with seizures that has been built prospectively over more than a decade. All patients, 20 years of age or older, with a diagnosis of idiopathic generalized epilepsy (IGE), focal epilepsy, or FS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020.

Results: One thousand four hundred and ninety-two patients were studied (918 patients with focal epilepsy, 338 people with IGE, and 236 individuals with FS). In total, 387 patients (25.9%) reported driving a motor vehicle. Driving rate in patients with IGE was 26.9%, in people with focal epilepsy was 27.0%, and in individuals with FS was 20.3%; the difference was not significant (p = 0.10). Female sex and a younger age at the onset of seizures were significantly associated with not driving a motor vehicle. Being married and having any education were significantly inversely associated with not driving a motor vehicle.

Conclusion: Most patients with seizures (either people with epilepsy or those with FS alike) do not drive a motor vehicle in their routine daily lives. Demographic factors (e.g., sex, marital status, and education) have significant associations with not driving a motor vehicle.
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http://dx.doi.org/10.1016/j.yebeh.2021.107985DOI Listing
June 2021

Aura: epilepsy vs. functional (psychogenic) seizures.

Seizure 2021 May 27;88:53-55. Epub 2021 Mar 27.

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

Purpose: To compare auras between three groups of people with seizures [i.e., Idiopathic generalized epilepsies (IGE) vs. Temporal lobe epilepsy (TLE) vs. Functional seizures (FS)].

Methods: All patients, 10 years of age or older, with a diagnosis of IGE, TLE, or FS were prospectively registered in an electronic database and retrospectively studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020.

Results: One thousand and three hundred ninety-one patients were studied (480 with IGE, 617 with TLE, and 294 with FS). Among patients with TLE, 63.5% of individuals reported auras; this figure was 68% in the FS and 12.7% in the IGE groups (p < 0.00001). Odds ratio of having auras in the TLE group compared with the IGE group was 11.96 (95% CI: 8.73-16.39; p = 0.0001). Odds ratio of having auras in the TLE group compared with the FS group was 0.81 (95% CI: 0.61-1.10; p = 0.1840). Odds ratio of having auras in the FS group compared with the IGE group was 14.61 (95% CI: 10.15-21.02; p = 0.0001). The following auras were more frequent among patients with TLE: emotional, cognitive, epigastric, and olfactory/gustatory. The following auras were more frequent among patients with FS: headache and dizziness/vertigo.

Conclusion: Auras are not specific to focal epilepsies. Future studies should investigate auras in large cohorts of patients with focal or generalized epilepsies and also those with FS to determine the exact clinical value of each aura.
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http://dx.doi.org/10.1016/j.seizure.2021.03.026DOI Listing
May 2021

Clinical significance of bilateral epileptiform discharges in temporal lobe epilepsy.

Acta Neurol Scand 2021 Jun 16;143(6):608-613. Epub 2021 Feb 16.

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

Objective: The aim of the current study was to investigate the rate and clinical significance of bitemporal interictal epileptiform discharges (IEDs) in a large cohort of patients with temporal lobe epilepsy (TLE).

Methods: The data used in this study were collected at the Epilepsy Care Unit, Namazi Hospital, Shiraz University of Medical sciences, Shiraz, Iran, from 2008 to 2020. Inclusion criteria were a confirmed diagnosis of TLE based on the clinical grounds (history and the described seizure semiology) and a 2-hour interictal video-electroencephalography (EEG) monitoring. The EEG recording of each patient included both sleep (about 90 minutes) and wakefulness (about 30 minutes).

Results: 532 patients were included in this study [420 patients (79%) had unilateral IEDs, and 112 patients (21%) had bilateral IEDs]. Patients with bilateral IEDs less often had auras with their seizures and had higher frequencies of seizures (as a trend for focal to bilateral tonic-clonic seizures and significantly in focal seizures with impaired awareness) compared with those who had unilateral IEDs. Patients with bilateral epileptiform discharges showed a trend to experiencing ictal injury more frequently. Brain MRI findings were different between these two groups (p = 0.0001).

Conclusion: It is important to recognize that a patient with TLE has unilateral vs. bilateral IEDs. Bilateral IEDs in a patient with TLE may suggest a more severe disease (with a higher risk for ictal injuries and other significant consequences of frequent seizures). It may also suggest a somewhat different etiology.
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http://dx.doi.org/10.1111/ane.13402DOI Listing
June 2021

Ictal injury: Epilepsy vs. functional (psychogenic) seizures.

Epilepsy Behav 2021 03 21;116:107727. Epub 2021 Jan 21.

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

Objective: The aim of the current study was to compare the risk and also the types of ictal injuries in three groups of people with seizures [i.e., IGE vs. TLE vs. FS].

Methods: This was a retrospective study. All patients with an electro-clinical diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. Age, sex, age at seizure onset, seizure type(s), and occurrence of ictal injury at any time since the onset of the seizures and its characteristics were registered routinely for all patients at the time of the first visit.

Results: One thousand and one hundred seventy-four patients were studied (481 patients with IGE, 402 people with TLE, and 291 persons with FS). While the groups differed in their demographic and clinical characteristics, the rates of ictal injury did not differ significantly between the groups. Tongue injury was more frequently reported by patients with TLE compared with that by people with IGE or FS. Other types/locations of ictal injury were more or less reported by all three groups of the patients.

Conclusion: Ictal injuries may happen with more or less similar rates among people with epilepsy (IGE and TLE) and those with FS. Ictal injury (rate, type, or location) should not be used as a marker for any specific diagnosis among people with seizures.
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http://dx.doi.org/10.1016/j.yebeh.2020.107727DOI Listing
March 2021

Seizure in patients with COVID-19.

Neurol Sci 2020 Nov 19;41(11):3057-3061. Epub 2020 Sep 19.

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

Objective: The purpose of the current study was to collect the data on the occurrence of seizures in patients with COVID-19 and to clarify the circumstances of the occurrence of seizures in these patients.

Methods: All consecutive patients who referred to healthcare facilities anywhere in Fars province (located in South Iran with a population of 4.851 million people) from February 19 until June 2, 2020, and had confirmed COVID-19 by positive result on polymerase chain reaction testing and seizure were included.

Results: During the study period, 6,147 people had confirmed COVID-19 in Fars province, Iran; 110 people died from the illness (case fatality rate 1.79%). During this time period, five people had seizures (seizure rate 0.08%). In four patients, seizure was one of the presenting manifestations, and in one person, it happened during the course of hospital admission. Two patients had status epilepticus. All patients experienced hypoxemia and four of them needed respirator. Two patients had related metabolic derangements and one had cerebrospinal fluid (CSF) lymphocytic pleocytosis. Brain imaging was abnormal in three patients. Four patients died.

Conclusion: New-onset seizures in critically ill patients with COVID-19 should be considered as acute symptomatic seizures and the treating physician should try to determine the etiology of the seizure and manage the cause immediately and appropriately. Detailed clinical, neurological, imaging, and electrophysiological investigations and attempts to isolate SARS-CoV-2 from CSF may clarify the role played by this virus in causing seizures in these patients.
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http://dx.doi.org/10.1007/s10072-020-04731-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501768PMC
November 2020

Impacts of the COVID-19 pandemic on Iranian patients with epilepsy.

Acta Neurol Scand 2020 Oct 22;142(4):392-395. Epub 2020 Jul 22.

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

Objective: To investigate the effects of COVID-19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (eg, polytherapy vs monotherapy, taking imported drugs, and seizure status worsening).

Methods: We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: (a) What has been your experience on obtaining your antiseizure medications in the past 4 weeks (compared to before)? (b) Have you experienced any changes in your seizure control status in the past 4 weeks?

Results: We included 100 patients (53 male and 47 female patients). In response to the question "Have you had any difficulties in the past 4 weeks to obtain your drugs?," 31 people (31%) expressed hardship obtaining their drugs. In response to the question "How has been your seizure control status compared with before?," six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection.

Conclusion: About one-third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID-19 outbreak in Iran. The current COVID-19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (ie, Iran).
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http://dx.doi.org/10.1111/ane.13310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362008PMC
October 2020

Effects of carbamazepine on semen parameters in men with newly diagnosed epilepsy.

Iran J Neurol 2015 Jul;14(3):168-70

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

Background: We investigated the effects of carbamazepine (CBZ) on semen parameters in men with newly diagnosed epilepsy, by performing semen analysis before starting any antiepileptic drugs, and then after starting CBZ, to determine the role and effects of CBZ in creating abnormalities in sperm analysis in these patients.

Methods: In this prospective study, eight male patients 20-40 years of age who were referred to the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2009 to 2012, due to new-onset seizure(s) were studied. A semen analysis was performed. CBZ was started and after at least 3 months of taking CBZ, another semen analysis was requested to determine the changes in semen quality. Statistical analyses were performed using non-parametric Wilcoxon test.

Results: Mean age of the patients was 28.5 ± 3.5 years. 7 (87.5%) patients had temporal lobe epilepsy and 1 (12.5%) had parietal lobe epilepsy. The mean follow-up period was 5.5 ± 0.9 months. We observed that semen quality (concentration, progressive motility, morphology) has significantly changed in patients with newly-diagnosed epilepsy after being treated with CBZ (P = 0.012 for all indices).

Conclusion: This study shows the direct effects of CBZ in causing changes in semen quality in men with epilepsy. Abnormalities in sperm concentration, morphology and motility, which were observed in the current study, might play a significant role in causing reduced fertility in men with epilepsy.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4662691PMC
July 2015

Seizure outcome in patients with juvenile absence epilepsy.

Neurol Sci 2016 Feb 3;37(2):289-92. Epub 2015 Nov 3.

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

The purpose of this study was to identify seizure outcome and factors potentially predictive for seizure outcome in patients with juvenile absence epilepsy (JAE). In this case-control study all patients with JAE were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2008 till 2012. All patients had to be under the care of the epileptologist for at least 18 months. We divided the patients into two groups: patients who were seizure free in the last 12 months of their follow-up period and those who had any seizures. During the study period, 2750 patients with epilepsy were registered at our epilepsy clinic; 641 patients (23.3 %) had idiopathic generalized epilepsy (IGE). Among patients with IGE, 81 patients (12.6 %) were diagnosed as having JAE and of these, 33 patients (20 women and 13 men) were eligible to enter into the study. Ten patients (30.3 %) were seizure free in the last 12 months of their follow-up and 23 (69.6 %) patients reported at least one seizure of any type. We could not identify any factor to be associated with seizure outcome in these patients. All studies in the literature suffer from small number of patients; so does our study. Besides, they used different methodologies. A large multicenter study is required to explore the variables that predict seizure outcome in patients with juvenile absence epilepsy. This is particularly needed to provide an appropriate counselling for patients and their families and also to formulate better individualized treatment plans for the patients.
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http://dx.doi.org/10.1007/s10072-015-2411-yDOI Listing
February 2016

Management of epilepsy in resource-limited areas: establishing an epilepsy surgery program in Iran.

Med J Islam Repub Iran 2014 16;28(1):24. Epub 2014 Mar 16.

10. MD., Department of Radiology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran.

Background Of about 40 million people with epilepsy, who live in developing countries, the majority do not receive appropriate treatment. Nonetheless, there are striking disparities among the so-called developing countries, however generally speaking, access to and availability of epilepsy management programs in developing countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated, appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon the accurate identification of good surgical candidates based on the available resources and technologies without jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program in Iran, despite all short-comings and limitations and try to provide some answers to those challenges, which helped us establish our program.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154273PMC
September 2014

Comparison of medical treatments in cryptogenic stroke patients with patent foramen ovale: A randomized clinical trial.

J Res Med Sci 2013 Feb;18(2):94-8

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

Background: This randomized clinical trial compared rates of stroke or transient ischemic attack recurrence or death in patients with cryptogenic stroke and patent foramen ovale (PFO) who received medical treatment with aspirin or warfarin.

Materials And Methods: Forty-four Iranian patients with cryptogenic stroke and patent foramen ovale participated in this randomized, single-blind trial between July 2007 and June 2010. All patients underwent transesophageal echocardiography and contrast-transcranial Doppler sonography to confirm the presence of patent foramen ovale. The patients were randomly assigned to receive aspirin or warfarin and were followed for 18 months for the recurrence of ischemic events or death. The principal investigator was blind to the group assignment. This trial is registered under number IRCT138805192323N1.

Results: Five (11.4%) patients had a stroke, 2 (4.5%) had a transient ischemic attack and 2 (4.5%) died. There was no difference in the rate of ischemic events or death between the aspirin- and warfarin-treated groups (hazard ratio: 0.45; 95% CI: 0.1-1.8; P = 0.259).

Conclusion: There was no difference in ischemic event recurrence, death rates or side-effects between patients with cryptogenic stroke and patent foramen ovale who were treated with aspirin vs. warfarin.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3724385PMC
February 2013
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