Publications by authors named "Nasim Tabrizi"

23 Publications

  • Page 1 of 1

The correlation between cluster seizures and findings of magnetic resonance imaging in drug refractory epilepsy patients.

Am J Clin Exp Immunol 2020 15;9(3):47-52. Epub 2020 Jun 15.

Department of Emergency, Abadan University of Medical Science Abadan, Iran.

Background: Epilepsy is a chronic neurologic condition and affects peoples at all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition.

Method: We designed a study to determine the frequency of seizure cluster and to determine neuroimaging findings in these patients and also to evaluate the Correlation between Cluster Seizures and Findings of Magnetic Resonance Imaging in Drug Refractory Epilepsy patients.

Results: After analyzing data from 568 refractory epilepsy patients, we found that the prevalence of cluster seizure variant is 14.43%. 29.26% of patients with a history of cluster seizure had no obvious abnormal MRI findings whereas 14.40 % of patients without history of cluster seizure had no obvious abnormal MRI findings (-value <0.05). Compared to Drug Refractory Epilepsy patients without history of seizure clusters, patients with a history of seizure clusters had less abnormal MRI findings, less Mesial Temporal Sclerosis, and more Focal Cortical Dysplasia in Magnetic Resonance Imaging ( value <0.05).

Conclusions: Seizure cluster has a significant negative impact on the quality of life of patients. According to results of this study it seems that brain MRI findings of drug refractory epilepsy patients with a history of seizure clusters are different from brain MRI findings of drug refractory epilepsy patients without a history of seizure clusters. mesial temporal sclerosis is less frequent and focal cortical dysplasia is more frequent in brain MRI of drug refractory epilepsy patients with a history of seizure clusters compared to drug refractory epilepsy patients without a history of seizure clusters.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364372PMC
June 2020

Frequency of menstrual abnormalities and their associated neuroimaging findings in women with focal refractory epilepsy.

Acta Neurol Belg 2020 Jun 7. Epub 2020 Jun 7.

Neurology Department, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Patients with refractory epilepsy can suffer from psychological and physical problems. Epilepsy can also be associated with menstruation abnormalities in women. In this paper, we aim to survey women with focal refractory epilepsy who also suffer from menstrual abnormalities. This cross-sectional study was performed in 2018 in Tertiary Epilepsy Center in Kashani Hospital, Isfahan, Iran and Milad hospital, Isfahan, Iran. A total number of 381 patients diagnosed with refractory epilepsy joined the study based on an inclusion and exclusion criteria. Clinical characteristics of epilepsy, menstrual issues and brain MRI findings were assessed. Among 381 women with refractory epilepsy, 250 had refractory focal epilepsy (65.61%), and the others (34.39%) had generalized refractory epilepsy. 132 patients out of 381 had menstrual abnormalities (34.65%). Among 132 women with coexisting refractory epilepsy and menstrual abnormalities, 86 (65.15%) were diagnosed with refractory focal epilepsy, and 46 (34.86%) had generalized refractory epilepsy (p value = 0.041). Oligomenorrhea-hypomenorrhea was the most common type of menstrual abnormality in women with refractory epilepsy seen in 83 (62.87%) (p value = 0.039). The most common brain MRI pathology in women with refractory focal epilepsy was mesial temporal sclerosis (MTS) (39.20%, p = 0.00). We report that almost one-third of women with refractory epilepsy suffer from menstrual disorders, and the most common disorder was Oligomenorrhea-hypomenorrhea, and the most common brain pathology was MTS. It has also been a hypothesis that reproductive dysfunctions are connected to temporal lobe malfunctions, and more specific studies are required in this issue.
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http://dx.doi.org/10.1007/s13760-020-01374-7DOI Listing
June 2020

Frequency of Seizure Clusters and Their Associated Risk Factors in Adult Patients with Epilepsy Referred to Epilepsy Center of Kashani Hospital in Isfahan from 2011 to 2016.

Int J Prev Med 2020 17;11:19. Epub 2020 Feb 17.

Department of Emergency, Abadan University of Medical Science, Abadan, Iran.

Background: Epilepsy is a chronic neurologic condition and affects people of all ages. Seizure clusters are generally referred to seizures that occur at close intervals with complete recovery between attacks. Various studies have reported a variety of frequencies and risk factors for this condition.

Methods: We designed a study to determine the frequency of seizure cluster and their associated risk factors in Iranian population for the first time.

Results: Among 40 variables analyzed, 18 of them were significantly associated with seizure clustering. Risk factors including educational level, age of onset, number of drugs, seizure types, perinatal complication, developmental delay, other illnesses, parental consanguinity, systemic diseases, number of drugs used, mentation, motor signs, sensory signs, cranial nerves signs, cerebellar signs, seizure duration, existence of magnetic resonance imaging (MRI) lesion, and type of MRI pathology are significantly associated with clustering of seizures. When associated risk factors were analyzed with multivariate analysis, age of onset of seizures, number of antiepileptic drugs currently used, lack of seizure-free periods, seizure frequency, and type of MRI pathology are significantly defining for anticipating clustering of seizures.

Conclusions: Seizure cluster has a significant negative impact on the quality of life of patients. Important risk factors that are found to be associated are age of onset, parental consanguinity, frequency of seizure, lack of have seizure-free period or periods, pathologies in neurological examination, and MRI findings.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_238_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050217PMC
February 2020

Fitness to drive in seizure and epilepsy: A protocol for Iranian clinicians.

Authors:
Nasim Tabrizi

Iran J Neurol 2019 Oct;18(4):159-171

Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Driving restriction is a well-known undesirable consequence of epilepsy and causes significant problems regarding independence and employment for epileptic patients. Many countries all over the world have provided comprehensive protocols in this regard with the aim of providing the possibility of less restricted, but safe driving for epileptic patients and also providing the opportunity for uniform decision-making for clinicians. However, the available fitness to drive protocol in Iran still lacks sufficient details and clinicians might encounter serious problems in terms of the driving issue in epileptic patients. In order to provide a uniform protocol containing adequate practical data, a systematic review of literature addressing guidelines about driving and epilepsy and driving laws of different countries for epileptic patients was performed and, after consideration of cultural issues, a practical protocol for Iranian neurologists was suggested.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036044PMC
October 2019

Taxane-induced peripheral neuropathy and quality of life in breast cancer patients.

J Oncol Pharm Pract 2020 Sep 14;26(6):1421-1428. Epub 2020 Jan 14.

Medical Toxicology and Drug Abuse Research Center (MTDRC), Faculty of Pharmacy, Birjand University of Medical Sciences, Birjand, Iran.

Purpose: Taxane-induced peripheral neuropathy (TIPN) is a common and bothersome toxicity. This study aimed to determine the incidence and severity of TIPN in patients with breast cancer and to investigate the relationship between TIPN and quality of life.

Methods: A total of 82 breast cancer patients with TIPN symptoms were included in this study. The criteria of National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE v4.03) and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30, version 3.0) were used to evaluate grading of sensory neuropathy and quality of life, respectively. Analysis of the data was done by IBM SPSS statistics version 23.

Results: A total of 346 patients received taxane-based chemotherapy and 82 patients (23.7%) experience TIPN. The mean (SD) global health status/quality of life, physical functioning, role functioning, and pain subscales were 60.63 (5.26), 80.64 (9.05), 81.77 (10.41), and 43.88 (11.27), respectively. There were significant negative correlations between global health status/quality of life, physical functioning, and role functioning subscales with the grade of neuropathy (r = -0.33, -0.80, and -0.61, respectively) and positive correlation between pain subscale and the grade of neuropathy (r = 0.70).

Conclusion: This study shows a clear association between TIPN and worsened quality of life. These findings emphasize on detecting and management of TIPN in an effort to improve the quality of life of breast cancer patients.
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http://dx.doi.org/10.1177/1078155219898511DOI Listing
September 2020

Comparison of the Efficacy and Safety of Pregabalin and Duloxetine in Taxane-Induced Sensory Neuropathy: A Randomized Controlled Trial.

Clin Drug Investig 2020 Mar;40(3):249-257

Department of Clinical Pharmacy, Faculty of Pharmacy, Medical Toxicology and Drug Abuse Research Center (MTDRC), Birjand University of Medical Sciences, Birjand, Iran.

Background And Objective: Taxane-induced peripheral neuropathy (TIPN) is a main toxicity of taxanes with no effective treatment. This study aimed to compare the efficacy and safety of pregabalin (150 mg daily) and duloxetine (60 mg daily) for managing TIPN in breast cancer patients.

Methods: This randomized, double-blind, Phase II clinical trial was carried out at a chemotherapy center affiliated to Mazandaran University of Medical Sciences. Patients with breast cancer who received paclitaxel or docetaxel and had a grade 1 or more neuropathy (based on the National Cancer Institute Common Terminology Criteria for Adverse Events version (NCI-CTCAE v4.03), and who had score 4 or higher neuropathic pain severity [based on the visual analog scale (VAS)] were enrolled. Response to treatment was assessed based on improvements in the VAS, NCI-CTCAE, and Patient Neurotoxicity Questionnaire (PNQ) scores during a 6-week trial.

Results: Both interventions were effective in decreasing TIPN compared to baseline. At Week 6, the VAS scores were improved in 37/40 (92.5%) and 16/42 (38.1%) of the patients in the pregabalin and duloxetine groups, respectively (p < 0.001). Improvement in NCI-CTCAE sensory neuropathy was also more significant with pregabalin (37/40; 92.5%) in comparison to duloxetine (13/42; 31%) (p < 0.001). Pregabalin was also more beneficial than duloxetine in improving the PNQ scores by 36/40 (90%) and 13/42 (31%), respectively (p < 0.001). Both interventions were tolerated well with mild adverse events.

Conclusions: Both pregabalin and duloxetine were well tolerated and efficacious in relieving neuropathic pain, however a 60 mg dose of duloxetine is inferior to a 150 mg dose of pregabalin.
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http://dx.doi.org/10.1007/s40261-019-00882-6DOI Listing
March 2020

Levetiracetam in genetic generalized epilepsy: A prospective unblinded active-controlled trial.

Epilepsy Res 2019 11 3;157:106214. Epub 2019 Oct 3.

Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Purpose: To compare the efficacy and tolerability of levetiracetam (LEV) versus valproate (VPA) monotherapy in adults with genetic generalized tonic-clonic seizures alone (GTCS) and juvenile myoclonic epilepsy (JME).

Methods: This study was an open-label, active-controlled trial with a two-parallel-group design. Outcome measures including withdrawal rate and seizure freedom rate at 26th weeks and time to withdrawal, and time to first seizure were compared between LEV and VPA groups. Furthermore, tolerability and development of adverse events (AEs) were investigated and analyzed.

Results: One hundred and three patients enrolled the study. 71.1% of patients in LEV group and 29.3% in VPA group were female. By the end of 26 week, seizure freedom rate and withdrawal rate were 88.9% and 8.9% in LEV group and 86.2% and 10.3% in VPA group with no significant difference. Time to first seizure was longer in VPA group (p = 0.32) and time to withdrawal favored LEV (p = 0.51). At least one AE was reported in 37.7% of patients in LEV group and 55.1% in VPA group. The most common AEs were psychiatric symptoms and dizziness in those on LEV and weight gain and dyspepsia in VPA group.

Conclusion: LEV has similar efficacy and acceptable safety in comparison to VPA in short-term treatment of patients with genetic GTCS and JME, and it could be considered as an alternative to VPA particularly in women of reproductive age.
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http://dx.doi.org/10.1016/j.eplepsyres.2019.106214DOI Listing
November 2019

The Role of Interictal Epileptiform Discharges in Epilepsy Surgery Outcome.

Int J Prev Med 2019 7;10:101. Epub 2019 Jun 7.

Department of Neurology, Medical School, Mazandaran University of Medical Sciences, Sari, Iran.

Background: Epilepsy surgery is a fundamental treatment in refractory epilepsy. Video electroencephalographic (v-EEG) monitoring plays an essential role in presurgical evaluation of patients. However there are reports of favorable outcome based on interictal and magnetic resonance imaging (MRI) findings without any need for v-EEG monitoring in patients with temporal lobe epilepsy (TLE). This study aimed to investigate the prognostic effect of concordance between interictal findings and ictal and MRI data on postsurgical outcome of TLE and extratemporal lobe epilepsy (ETLE).

Methods: A retrospective study was conducted on 199 patients with refractory focal epilepsy who were admitted for presurgical evaluation. The concordance between irritative zone (IZ) and seizure onset zone (SOZ) and also IZ and MRI lesion was registered, and subsequently the prognostic effect of relevancy on 1-year follow-up result based on Engel criteria was investigated.

Results: In TLE and ETLE regarding relevancy between IZ and SOZ, 77.8% and 73.2% were concordant, 2.5% and 0% were discordant, and 19.6% and 26.8% had overlap, respectively. Concordance between IZ and MRI lesion was found in 76.6% and 51.2% of patients with TLE and ETLE while discordance was recorded in 2.5% and 12.2% and overlap registered in 20.9% and 36.6%, respectively. The concordance of interictal findings had no effect on postsurgical outcome of patients with TLE and ETLE.

Conclusions: Our study showed that concordance of IZ with SOZ and MRI has no independent effect on postsurgical outcome of patients with TLE and ETLE. We suggest that excluding exceptional cases, v-EEG monitoring should be considered as the mainstay of presurgical evaluation.
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http://dx.doi.org/10.4103/ijpvm.IJPVM_237_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592222PMC
June 2019

Evaluation of dual pathology among drug-resistant epileptic patients with hippocampal sclerosis.

Neurol Sci 2019 Mar 11;40(3):495-502. Epub 2018 Dec 11.

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

Purpose: Dual pathology (DP) is defined as simultaneous presence of hippocampal sclerosis (HS) and any other pathology in the brain. Since this is a less probed concept, we aimed to evaluate the frequency and characteristics of DP among drug-resistant epileptic patients with HS.

Methods: This is a cross-sectional study conducted during 2007-2016 in Kashani Comprehensive Epilepsy Center, Isfahan, Iran. Patients with diagnosis of drug-resistant epilepsy and HS were enrolled in the study, and demographic data, seizure semiology, EEG findings, and MRI findings were collected. We compared these variables between three groups of DP, unilateral HS, and bilateral HS.

Results: Of the 200 enrolled cases, 29 patients (14.5%) had DP and 21 patients (10.5%) had bilateral HS; the remaining patients had unilateral HS. The average age of patients with DP was 30.03, and 65.5% of them were male. Patients with DP had more EEG discharges from regional and multi-focal sites compared to unilateral HS (P value < 0.001). Also, complex partial seizure (CPS) was more commonly presented in patients with unilateral HS (96.8%). Comparison of disease characteristics between DP and bilateral HS showed no difference in most categories (P > 0.05).

Conclusions: We found DP among 14.5% of our drug-resistant epileptic patients with HS. DP patients mostly presented with CPS and had high proportion of ictal and interictal EEG discharges from regional and multi-focal areas. Gliosis and focal cortical dysplasia were the most common pathologies among DP patients. Patients with DP showed a similar behavior to bilateral HS in many features.
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http://dx.doi.org/10.1007/s10072-018-3677-7DOI Listing
March 2019

Seizure in cerebral venous and sinus thrombosis.

Epilepsia Open 2018 Sep 8;3(3):316-322. Epub 2018 Jun 8.

Department of Neurology Mazandaran University of Medical Sciences Sari Iran.

Many conflicting issues exist about seizure in the setting of cerebral venous and sinus thrombosis (CVST). In this article we aimed to address the existing data regarding incidence, characteristics, predictors, treatment, and prognosis of acute and late seizures in patients with CVST and to prepare more practical information for clinicians. PubMed, Embase, Web of science and Cochrane databases were searched within 1966-2016 using relevant keywords. A total of 63 papers met the inclusion criteria. Seizures are classified as acute symptomatic seizures (ASS; first 14 days) and post-CVST epilepsy (PCE; after 14 days). The incidence had been reported in a wide range of 6.9-76% for ASS and 4-16% for PCE. Focal and generalized seizures were observed with different predominance. ASS commonly occurred in patients with loss of consciousness, focal neurological deficits, supratentorial lesions and thrombosis in superior sagittal sinus, straight sinus, and cortical veins. PCE had been predisposed by occurrence of ASS, motor deficit, and supratentorial lesions, particularly hemorrhage. Most experts believe that primary prophylaxis with antiepileptic drugs in the acute phase is not indicated. However, the initiation of prophylaxis after the first seizure in patients with supratentorial lesions or focal neurological deficit should be recommended. The quality of current evidence is low and most conclusions are based on expert opinions. More accurate reports of seizure semiology, detailed antiepileptic treatment plans, and outcomes are necessary to answer the existing questions.
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http://dx.doi.org/10.1002/epi4.12229DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119760PMC
September 2018

The effect of pregabalin and duloxetine treatment on quality of life of breast cancer patients with taxane-induced sensory neuropathy: A randomized clinical trial.

J Res Med Sci 2018 6;23:52. Epub 2018 Jun 6.

Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran.

Background: The primary side effect of adjuvant chemotherapy with taxanes is the taxane-induced peripheral neuropathy (TIPN), which may have substantial negative impacts on patients' quality of life (QOL). We investigated the effect of pregabalin and duloxetine on QOL of breast cancer patients who experienced TIPN.

Materials And Methods: This was a randomized, double-blind clinical trial conducted at a chemotherapy center of Mazandaran University of Medical Sciences, Sari, Iran. Breast cancer patients 18 or more years old were included if they received paclitaxel or docetaxel and experienced neuropathy grade one or higher; and neuropathic pain score of four or more. Patients were treated with pregabalin or duloxetine until 6 weeks. Assessment of sensory neuropathy and QOL was performed at baseline, and 6 weeks after the initiation of the treatment.

Results: At baseline, the mean score of global health status/QOL scale for pregabalin and duloxetine groups were 61 (standard deviation [SD]; 5.11) and 60.28 (SD; 5.44), respectively ( = 0.54). After 6 weeks, both interventions were associated with improvement of global QOL compared to baseline. The global health status/QOL score was not different between two groups after 6 weeks. While the emotional functioning was improved more favorably with duloxetine ( < 0.001); pregabalin was associated with more improvement in insomnia and pain scores ( = 0.05 and < 0.001, respectively).

Conclusion: Pregabalin as well as duloxetine improve the global QOL of breast cancer patients with TIPN. Different effects of treatments on subscale of QLQ-C30 could help clinicians to select the appropriate agent individually.
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http://dx.doi.org/10.4103/jrms.JRMS_1068_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6040148PMC
June 2018

Prognostic value of ictal onset patterns in postsurgical outcome of temporal lobe epilepsy.

Iran J Neurol 2017 Oct;16(4):185-191

Isfahan University of Medical Sciences, Isfahan, Iran.

To investigate ictal onset patterns (IOP) in scalp electroencephalography (EEG) of patients with temporal lobe epilepsy (TLE) and their prognostic effect on the postoperative outcome. We conducted a retrospective cohort study between 2011 and 2015 in our referral Epilepsy Surgery Center enrolling adult patients with refractory TLE and a visible epileptogenic lesion in magnetic resonance imaging (MRI), who underwent epilepsy surgery. Demographic, clinical and MRI findings were collected and ictal findings during video-EEG monitoring were reviewed in detail. The correlation between preoperative findings and the postsurgical outcome was analyzed. We reviewed 303 seizures in 93 patients. Rhythmic theta and rhythmic spike/sharp and wave were respectively the most common initial ictal pattern and late significant discharges. Engel class I outcome was observed in 88.2% of patients. Female sex, aura, the absence of secondary generalization, rhythmic theta as initial ictal pattern and concordance of ictal-interictal EEG findings were correlated with favorable 1-year postsurgical outcome. Preoperative clinical and EEG findings can provide valuable information regarding postsurgical prognosis in TLE patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937004PMC
October 2017

An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Case Rep Med 2017 26;2017:2432315. Epub 2017 Jan 26.

Isfahan Neurosciences Research Center, Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Kashani Comprehensive Epilepsy Center, Kashani Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. . We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. . In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms.
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http://dx.doi.org/10.1155/2017/2432315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299200PMC
January 2017

Unilateral cortical hyperintensity in diffusion-weighted MRI; New criteria for early sporadic Creutzfeldt-Jakob disease.

Iran J Neurol 2015 Apr;14(2):108-9

Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449391PMC
April 2015

Unilateral cortical hyperintensity in diffusion-weighted MRI; New criteria for early sporadic Creutzfeldt-Jakob disease.

Iran J Neurol 2015 Apr;14(2):108-9

Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449391PMC
April 2015

Combination therapy with mitoxantrone and plasma exchange in aggressive relapsing remitting multiple sclerosis: A preliminary clinical study.

J Res Med Sci 2012 Sep;17(9):828-33

Department of Neurology, Isfahan neuroscience research center, school of medicine, Iran.

Background: The efficacy of mitoxantrone induction therapy in rapidly worsening multiple sclerosis (MS) is well established. Plasma exchange is also applied as an adjuvant in exacerbations of relapsing MS. The aim of this study was to compare the efficacy of combination therapy with mitoxantrone and plasma exchange versus mitoxantrone alone in patients with aggressive MS.

Materials And Methods: Forty patients with aggressive relapsing remitting MS were randomly put into two groups. The first group underwent monthly plasma exchange for three successive months, followed by 12 mg/m(2) mitoxantrone at the end of each course and two more doses of 6 mg/m(2) mitoxantrone in 3-month intervals. The second group received the same doses of mitoxantrone only without plasma exchange. At the end of 8 months treatment course, clinical reassessment and neuroimaging was performed and treatment was continued with interferon-β.

Results: At the end of induction therapy, Expanded Disability Status Scale score was significantly improved in both groups (P < 0.001). Number of demyelinating and gadolinium-enhancing plaques in brain magnetic resonance imaging (MRI) was prominently reduced in group 2(P ≤ 0.05), but the changes were not statistically significant in group 1, except for juxtacortical plaques.

Conclusion: Administration of mitoxantrone as an induction therapy in patients of aggressive relapsing remitting MS results in significant improvement of their clinical state and MRI activity. However, combination of plasma exchange with mitoxantrone gives no more benefits than mitoxantrone alone and sometimes worsens the situation possibly by reduction of mitoxantrone efficacy as a result of plasma exchange.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697206PMC
September 2012

Pediatric multiple sclerosis with primary progressive course--report of a retrospective cohort study in Iran.

Neuropediatrics 2013 Jun 19;44(3):167-70. Epub 2012 Dec 19.

Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran.

The aims of this study were to suggest the rate of primary progressive (PP) subtype of pediatric onset multiple sclerosis (MS) in Isfahan, Iran, and describe its clinical and paraclinical features. The data of patients were retrieved from Isfahan MS Society (IMSS) database from April 2003 to August 2011. Among 3,843 MS patients of Isfahan who have been registered in IMSS, 260 patients had onset symptom when younger than the age of 18 years, of whom, 11 patients had a PP course (4.23%). The mean age at onset in pediatric primary progressive multiple sclerosis (PPMS) was 16 years (range: 13 to 17) with female preponderance (2.66:1) and disease duration of 4.73 ± 3.03 years. Ataxia was the most frequent initial symptom (7/11). Additionally, the mean Expanded Disability Status Scale and progression index was 4.31 ± 0.60 and 1.50 ± 1.21, respectively. Cerebrospinal fluid analysis showed oligoclonal immunoglobulin G bands in seven patients. Magnetic resonance imaging (MRI) demonstrated periventricular lesions in all 11 patients and spinal lesions in 9 patients. Exposure to parental smoking was recorded in seven individuals. In conclusion, PPMS is an uncommon subtype of pediatric onset MS. Cerebral lesions are more common MRI findings in pediatric PPMS patients than that in adults. The course of PPMS seems to be more progressive in the pediatric population than in adults.
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http://dx.doi.org/10.1055/s-0032-1329614DOI Listing
June 2013

Preventive effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a double blind, randomized, placebo-controlled pilot clinical trial.

Acta Neurol Belg 2013 Sep 19;113(3):257-63. Epub 2012 Dec 19.

Isfahan Eye Research Center (IERC), Feiz Hospital, Isfahan University of Medical Sciences, SHARNOS Co. No. 9, Boroomand. Seyed-Alikhan, Chaharbagh Abbasi, 81448-14581, Isfahan, Iran.

Multiple sclerosis (MS) presents with optic neuritis (ON) in 20 % of cases and 50 % of ON patients develop MS within 15 years. In this study, we evaluated the preventive effects of vitamin D3 administration on the conversion of ON to MS (primary outcome) and on the MRI lesions (secondary outcome) of ON patients with low serum 25 (OH) D levels. Thirty ON patients (15 in each of 2 groups, aged 20-40 years) with serum 25 (OH) D levels of less than 30 ng/ml were enrolled in a double blind, randomized, parallel-group trial. The treatment group (cases) received 50,000 IU of vitamin D3 weekly for 12 months and the control group (controls) received a placebo weekly for 12 months. Finally, the subsequent relapse rate and changes in MRI plaques were compared between the two groups. Risk reduction was 68.4 % for the primary outcome in the treatment group (relative risk = 0.316, p = 0.007). After 12 months, patients in the treatment group had a significantly lower incidence rate of cortical, juxtacortical, corpus callosal, new T2, new gadolinium-enhancing lesions and black holes. The mean number of total plaques showed a marginally significant decrease in the group receiving vitamin D3 supplementation as compared with the placebo group (p = 0.092). Administration of vitamin D3 supplements to ON patients with low serum vitamin 25 (OH) D levels may delay the onset of a second clinical attack and the subsequent conversion to MS.
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http://dx.doi.org/10.1007/s13760-012-0166-2DOI Listing
September 2013

Hemiballismus, Hyperphagia, and Behavioral Changes following Subthalamic Infarct.

Case Rep Med 2012 18;2012:768580. Epub 2012 Oct 18.

Department of Neurology, Medical School, Isfahan University of Medical Sciences, Isfahan 81744-176, Iran.

The function of subthalamic nucleus (STN) which is a part of the basal ganglia system is not clear, but it is hypothesized that this component might be involved in action selection. Unilateral damage to STN, which can commonly occur due to the small vessel stroke mainly, causes hemiballismus and sometimes hemichorea-hemiballismus. This paper deals with a 60-year-old patient with sudden onset of abnormal movements in his right limbs. He had increased appetite and hyperphagia and also developed mood and behavioral changes (aggressiveness, irritability, anxiety, and sometimes obscene speech). The magnetic resonance imaging revealed infarct area in left subthalamus. In our case, hemiballismus is caused by infarction in left subthalamic area. Occurrence of irritability, anxiety, and some behavioral changes such as aggressiveness and obscene speech can be explained by impairment of STN role in nonmotor behavior and cognitive function as a result of infarct.
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http://dx.doi.org/10.1155/2012/768580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3484407PMC
November 2012

Late-onset multiple sclerosis in Isfahan, Iran.

Arch Iran Med 2012 Oct;15(10):596-8

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

Background: Multiple sclerosis (MS) typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS (LOMS). 

Methods: In this retrospective study, we extracted the records of 3522 MS patients (2716 females and 806 males) registered in the Isfahan MS Society (IMSS) from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database.

Results: We found 48 LOMS patients (28 females and 20 males), which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males (2.4%) was significantly greater than in females (1.0%, P = 0.002). The mean age at onset was 55.1 ± 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects (3.37:1, P = 0.003). The leading pattern of MS was relapsing-remitting (RR) in 62.5%, followed by primary progressive (PP) in 27.1%, and secondary progressive (SP) in 10.4%. Predominant presenting symptoms and signs were motor disturbances (35.4%), followed by brainstem (25%), optic neuritis (22.9%), and sensory related deficits (18.7%). The mean progression index (PI) in LOMS patients (0.88 ± 0.48) was significantly higher than in non-LOMS cases, 0.37 ± 0.17 (P < 0.0001).

Discussion: In comparing LOMS patients with the non-LOMS cohort, there was a higher frequency of the PP pattern and a higher PI in the LOMS group. In comparing other high-risk populations with the Isfahan cohort, LOMS formed a lower percentage of the total Isfahan MS population.
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http://dx.doi.org/0121510/AIM.004DOI Listing
October 2012

Epileptic seizures in early-onset multiple sclerosis.

Arch Iran Med 2012 Jun;15(6):381-3

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

Early-onset multiple sclerosis (EOMS) is defined as the first presentation of symptoms in childhood (before the age of 16 years). EOMS occurs in about 0.4% to 10.5% of multiple sclerosis (MS) patients. In this retrospective population-based study we aimed to describe the clinical/paraclinical details and frequency of epileptic seizures in Iranian EOMS patients registered with the Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to July 2010. EOMS cases were extracted from the Isfahan total MS cohort and included 3522 patients. A total of 117 EOMS patients (19 males and 98 females) with a mean age at onset of 14.2 ± 2.0 years (range: 7-16 years) were extracted from our database (3.3% of the total cohort). Of cases, ten (one male and nine females) had experienced at least two epileptic seizures, providing a crude prevalence of 8.5%. The frequency of epilepsy in EOMS patients (8.5%, 10/117) was significantly greater (P < 0.001) than that of non-EOMS cohort (2.0%, 71/3405). Epileptic seizures occurred before MS onset in two patients, after MS onset in seven, and at MS onset in one as the presenting symptom of the disease. Our findings mostly indicate an excessive prevalence of epileptic seizures in Iranian EOMS patients (8.5%), which is higher than any other report concerning seizures or epileptic seizures in a large MS series.
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http://dx.doi.org/012156/AIM.0014DOI Listing
June 2012

Myasthenia Gravis during the Course of Neuromyelitis Optica.

Case Rep Neurol 2011 Sep 21;3(3):268-73. Epub 2011 Oct 21.

Medical School, Isfahan University of Medical Sciences, Isfahan.

Neuromyelitis optica (NMO) is an inflammatory demyelinating disorder of the central nervous system that has been thought to be a severe subtype of multiple sclerosis for a long time. The discovery of aquaporin-4 (AQP4) antibody as a highly specific marker responsible for the pathogenesis of NMO, not only has made a revolutionary pace in establishing a serologic distinction between the two diseases, but it has also classified NMO as an antibody-mediated disorder. Similarly, myasthenia gravis (MG) is a well-known antibody-mediated disorder. In this report, we describe the case of a middle-aged female patient who experienced definite MG with an unclear clinical picture of chronic demyelinating disease that initially reflected the diagnosis of MS, but further imaging and paraclinical workup (e.g. positive AQP4 antibody test) revealed NMO. The coexistence of NMO and MG is previously described. However, this is the first case with NMO symptoms preceding the onset of MG. Of note, the development of MG occurred after a 2-year period of interferon β-1b (IFN β-1b) administration. This calls the question to mind of whether in our case MG is induced by the administration of interferon, instead of an original pathogenic link between MG and NMO. In other words, immunomodulatory treatments can slip the immunity towards T-helper II predominant pathways that can trigger MG. However, if we assume that such an explanation (i.e. increased susceptibility to autoantibody-mediated disorders) is true, our case can be considered the first case of NMO who developed MG following IFN β-1b treatment.
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http://dx.doi.org/10.1159/000334128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224523PMC
September 2011

Myasthenia Gravis during the Course of Neuromyelitis Optica.

Case Rep Neurol 2011 Sep 21;3(3):268-73. Epub 2011 Oct 21.

Medical School, Isfahan University of Medical Sciences, Isfahan.

Neuromyelitis optica (NMO) is an inflammatory demyelinating disorder of the central nervous system that has been thought to be a severe subtype of multiple sclerosis for a long time. The discovery of aquaporin-4 (AQP4) antibody as a highly specific marker responsible for the pathogenesis of NMO, not only has made a revolutionary pace in establishing a serologic distinction between the two diseases, but it has also classified NMO as an antibody-mediated disorder. Similarly, myasthenia gravis (MG) is a well-known antibody-mediated disorder. In this report, we describe the case of a middle-aged female patient who experienced definite MG with an unclear clinical picture of chronic demyelinating disease that initially reflected the diagnosis of MS, but further imaging and paraclinical workup (e.g. positive AQP4 antibody test) revealed NMO. The coexistence of NMO and MG is previously described. However, this is the first case with NMO symptoms preceding the onset of MG. Of note, the development of MG occurred after a 2-year period of interferon β-1b (IFN β-1b) administration. This calls the question to mind of whether in our case MG is induced by the administration of interferon, instead of an original pathogenic link between MG and NMO. In other words, immunomodulatory treatments can slip the immunity towards T-helper II predominant pathways that can trigger MG. However, if we assume that such an explanation (i.e. increased susceptibility to autoantibody-mediated disorders) is true, our case can be considered the first case of NMO who developed MG following IFN β-1b treatment.
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http://dx.doi.org/10.1159/000334128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3224523PMC
September 2011