Publications by authors named "Nastaran Majdinasab"

31 Publications

Effects of long-term administration of Multi-Strain Probiotic on circulating levels of BDNF, NGF, IL-6 and mental health in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled trial.

Nutr Neurosci 2020 Jun 5:1-12. Epub 2020 Jun 5.

Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Mental disorders is one of the main causes of disability and lower life expectancy among patients with Multiple Sclerosis (MS). The present trial aimed to examine the efficacy of multi-strain probiotic supplementation on circulating levels of BDNF, NGF, IL-6 and mental health in patients with MS. This trial was conducted among 70 patients with MS that referred to the MS Association. Patients were randomized into intervention and control groups to receive 2 multi-strain probiotic capsules or placebo, daily for six months. Serum BDNF, NGF and IL-6 was measured by ELISA kits. Mental health parameters were assessed by valid questionnaires in the baseline and end of the study. Of the 70 patients enrolled in this study, 65 subjects were included in the final analysis. From baseline to 6 months, probiotic supplementation resulted in a significant increase in BDNF and a significant reduction in the IL-6 levels ( < 0.001). Our findings revealed that probiotic supplementation compared to placebo caused a significant improvement in the general health questionnaire-28 (GHQ-28) (-5.31 ± 4.62 vs. -1.81 ± 4.23;  = 0.002), Beck Depression Inventory-II (BDI-II) (-4.81 ± 0.79 vs. -1.90 ± 0.96;  = 0.001), Fatigue Severity Scale (FSS) (-3.81 ± 6.56 vs. 0.24 ± 5.44;  = 0.007) and Pain Rating Index (PRI) (-3.15 ± 4.51 vs. -0.09 ± 3.67;  = 0.004). However, we not found any significant difference between the two groups in other factors ( > 0.05). Overall, six months of probiotic supplementation resulted in greater improvement in mental health parameters.
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http://dx.doi.org/10.1080/1028415X.2020.1758887DOI Listing
June 2020

Increased frequency of CD4CD25 CD127 regulatory T cells in patients with multiple sclerosis.

Gene Rep 2019 Dec 2;17:100456. Epub 2019 Aug 2.

Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Multiple sclerosis (MS), one of the most common diseases of the central nervous system (CNS), is characterized by demyelination and chronic inflammation of the CNS. Failure of immune tolerance and induced autoimmune processes are involved in MS immunopathogenesis. Regulatory T (Treg) cells play an important role in maintaining peripheral tolerance and immune homeostasis.

Objective: The aim of this study was to evaluate the frequency of CD4CD25CD127Treg cells in MS patients.

Methods: The study population was composed of 25 healthy controls (HCs), 35 patients with relapsing remitting multiple sclerosis (RRMS) and 25 patients with progressive multiple sclerosis (PMS). Frequency of CD4CD25CD127 Treg cells in RRMS and PMS patients was compared with HC by flow cytometry.

Results: Treg cells frequency in PMS patients was significantly higher compared to RRMS patients ( < 0.001) and HCs ( < 0.001). It was lower in RRMS patients than HCs ( = 0.005). A Significant direct correlation between Treg cells frequency and expanded disability status scale (EDSS) in PMS patients ( = 0.001,  = 0.6) was observed. Reverse correlation between Treg cells frequency and EDSS in RRMS patients was found ( = 0.01,  = -0.4).

Conclusion: More de-tailed clarification of the role of Treg cells in MS patients could provide a basis for development of Treg cells-mediated therapeutic strategies.
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http://dx.doi.org/10.1016/j.genrep.2019.100456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7172308PMC
December 2019

Validity and Reliability of the World Health Organization Disability Assessment Schedule 2.0 36-Item Persian Version for Persons with Multiple Sclerosis.

Korean J Fam Med 2020 May 7;41(3):195-201. Epub 2020 Apr 7.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: No previous studies have assessed the psychometric properties of the 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in the Persian language of Iran. This study was designed and conducted to evaluate the validity and reliability of the Persian version using a sample of persons with multiple sclerosis in Ahvaz, Iran.

Methods: The methodological study was conducted in two stages: First, the 36 items of the original WHODAS 2.0 were translated to create a Persian version, after which the translation validity and psychometric properties were tested. The factor structure of the instrument was also tested using exploratory and confirmatory factor analyses.

Results: The intraclass correlation coefficients were very good to excellent, varying between 0.82 and 0.99 for the six domains, and all domains had Cronbach's α reliability values of above 0.70. For construct validity, results showed negative and strong correlation between the total score of WHODAS 2.0 and the Multiple Sclerosis Quality of Life-54. Exploratory factor analysis divided the Persian version of WHODAS 2.0 into seven factors for multiple sclerosis patients.

Conclusion: The results of this study indicate that the Persian version of WHODAS 2.0 is a valid and reliable instrument to study the disabilities of people with multiple sclerosis.
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http://dx.doi.org/10.4082/kjfm.18.0155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272363PMC
May 2020

A comparative double-blind randomized study on the effectiveness of Duloxetine and Gabapentin on painful diabetic peripheral polyneuropathy.

Drug Des Devel Ther 2019 17;13:1985-1992. Epub 2019 Jun 17.

Department of Pediatrics, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The most common cause of polyneuropathy is diabetes mellitus. Neuropathic pain is seen in 26% of diabetic population. Therapeutic techniques for this disease can become challenging. This study was a prospective comparative double-blind randomized study which was conducted during an eight-week period. Totally, 104 painful diabetic peripheral polyneuropathy (PDPP) patients who had a minimum Visual Analog Scale (VAS) of 40 millimeters, received no pain-controlling medication, and had no other severe disease at its final stage were randomly assigned to two groups (n=52) through the four block method. One group received Duloxetine and the other received Gabapentin. The effectiveness was measured through primary effectiveness (VAS scale) and secondary effectiveness (Sleep Interference Score, and Clinical Global Impression of Change (CGIC)). Medication compliance was assessed by enumerating the number of patients who refused treatment because of side effects. The Fisher's exact T-test and ANOVA were used for data analysis. This study was approved by the Ethics Committee of Jundishapur, University of Medical sciences Ahvaz, Iran, under reference number: IR.AJUMS.REC.1395.78. In addition, this study was registered and approved in the Iranian Registry of Clinical Trials (IRCT ID: IRCT20161023030455N2) (http://irct.ir/). VAS, Sleep Interference Score, and CGIC were significantly improved (P<0.05) through time in both groups, [For GBP: VAS=64±20.03, VAS=55.32±18.76, VAS=44.68±15.82, VAS=39.43±14.32; For DLX: VAS=62±21.18, VAS=58.76±20.37, VAS=45.84±16.21, VAS=36.78±15.62] while a significant difference between the two groups was not observed (P<0.05). However, such significant improvements were not observed in the Duloxetine group at the end of the first week (P=674). Improvement in Sleep Interference Score and CGIC were similar to the results for the VAS scale. Side effects in the Duloxetine group (n=2) compared to the Gabapentin group (n=9) were significantly less (P<0.001). As a result, medication acceptance in the Duloxetine group (n=47) was significantly better than the Gabapentin (n=41) group (P<0.001). Both Duloxetine and Gabapentin are effective for the treatment of PDPP. On the one hand, Gabapentin shows the effect earlier while has more side effects. Conversely, Duloxetine has better medication compliance. The method of this study was approved by the Ethics Committee of Jundishapur University of Medical Sciences, Ahvaz, Iran, under reference number: IR.AJUMS.REC.1395.78. In addition, this study was registered and approved in the Iranian Registry of Clinical Trials (IRCT ID: IRCT20161023030455N2) (http://irct.ir/).
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http://dx.doi.org/10.2147/DDDT.S185995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588725PMC
February 2020

Association of human leukocyte antigen-DRB haplotype in multiple sclerosis population of Khuzestan, Iran.

Iran J Neurol 2018 Oct;17(4):154-160

Department of Genetics, School of Sciences, Shahid Chamran University of Ahvaz, Ahvaz, Iran.

One of the demyelinating and inflammatory diseases of the central nervous system (CNS) is multiple sclerosis (MS). Though pathogenesis of MS is still unknown, both genetic and environmental factors are involved. The human leukocyte antigen (HLA) class-II alleles including HLA-DRB5*01, DQB1*0602, DRB1*1501, and DQA1*0102 may have remarkable effect in MS risk although it is controversial in studies. As there is no data with respect to the HLA-DRB1*1501-DRB5*01 correlation with MS in Khuzestan Province, Iran, the goal of the survey was to investigate the association of this haplotype with MS in this population. The study focused on DRB5*01-DRB1*1501 haplotype association with MS in 200 patients and 200 healthy individuals. Typing of HLA was carried out by polymerase chain reaction (PCR) amplification with sequence-specific primers (SSP) method. SPSS software was used for the statistical analyses. No association between DRB5*01-DRB1*1501 and MS was found (P = 0.156). Distribution of DRB1*1501-DRB5*01 (carrying DRB1*1501 but not DRB5*01) and DRB1*1501-DRB5*01 haplotypes was statistically different between patients and controls (29.73% vs. 11.81%, P < 0.001) and (42.16% vs. 68.50%, P < 0.001), respectively. However, DRB1*1501-DRB5*01 revealed no association with MS (15.13% vs. 11.81%, P = 0.403). HLA-DRB1*1501-DRB5*01 was significantly more frequent among female patients with MS (16.19% vs. 6.12%, P = 0.019) and Persian group (17.11% vs. 5.79%, P = 0.027). Positive correlation of HLA-DRB1*1501-DRB5*01 haplotype with the expanded disability status scale (EDSS) steps from 5 to 10 was observed (62.50% vs. 25.76%, P = 0.026). Moreover, no meaningful association was shown among the haplotypes with EDSS, course of MS, ethnicity, and gender. Our findings suggest that DRB1*1501-DRB5*01 and DRB1*1501-DRB5*01 haplotypes may have positive association with MS risk. Also, this survey indicates that HLA-DRB1*1501-DRB5*01 is involved in susceptibility of the disease among women and Persians. DRB1*1501-DRB5*01 genotype frequency may have a key role in MS developing.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6555884PMC
October 2018

Dysphonia Characteristics and Vowel Impairment in Relation to Neurological Status in Patients with Multiple Sclerosis.

J Voice 2020 May 19;34(3):364-370. Epub 2018 Oct 19.

Air Pollution and Respiratory Disease Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: In this study, we attempted to assess the phonation and articulation subsystem changes in patients with multiple sclerosis compared to healthy individuals using Dysphonia Severity Index and Formant Centralization Ratio with the aim of evaluating the correlation between these two indexes with neurological status.

Materials And Methods: A sample of 47 patients with multiple sclerosis and 20 healthy speakers were evaluated. Patients' disease duration and disability were monitored by a neurologist. Dysphonia Severity Index and Formant Centralization Ratio scores were computed for each individual. Acoustic analysis was performed by Praat software; the statistical analysis was run using SPSS 21. To compare multiple sclerosis patients with the control group, Mann-Whitney U test was used for non-normal data and independent-samples t test for normal data. Also a logistic regression was used to compare the data. Correlation between acoustic characteristics and neurological status was verified using Spearman correlation coefficient and linear regression was performed to evaluate the simultaneous effects of neurological data.

Results: Statistical analysis revealed that a significant difference existed between multiple sclerosis and healthy participants. Formant Centralization Ratio had a significant correlation with disease severity.

Conclusion: Multiple sclerosis patients would be differentiated from healthy individuals by their phonation and articulatory features. Scores of these two indexes can be considered as appropriate criteria for onset of the speech problems in multiple sclerosis. Also, articulation subsystem changes might be useful signs for the progression of the disease.
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http://dx.doi.org/10.1016/j.jvoice.2018.09.018DOI Listing
May 2020

Effect of Short-Term Interval Exercise Training on Fatigue, Depression, and Fitness in Normal Weight vs. Overweight Person With Multiple Sclerosis.

Explore (NY) 2019 Mar - Apr;15(2):134-141. Epub 2018 Jul 20.

School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.

Context: Excessive weight is a health problem that can exacerbate multiple sclerosis (MS) symptoms and its associated comorbidities such as depression and fatigue. In addition, weight may be a moderator of exercise effects on depression and fatigue symptoms.

Objective: This study aimed to investigate the effects of exercise training on fatigue and depression in normal and overweight individuals with MS.

Methods: Sixty-six persons with MS were randomly assigned into an exercise or control condition based on body weight status (overweight vs. normal weight). The exercise conditions involved 8-weeks of interval exercise at 60%-75% Watt, while the control condition did not involve any exercise. Fatigue, depression, aerobic capacity, time up and go (TUG) and body mass index were measured before and following the 8-week period.

Results: There were no significant relationship's revealed for weight status interactions for any of the variables examined. There were significant condition main effects for fatigue, depression, aerobic capacity and TUG, and significant improvements were noted for the exercise conditions, but not in the non-exercising control group.

Conclusion: The results from this study confirm that exercise is an effective therapeutic intervention for improving fatigue, depression and functional parameters, independent of initial weight status, in persons with MS.
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http://dx.doi.org/10.1016/j.explore.2018.07.007DOI Listing
June 2019

Effects of exercise training on cytokines and adipokines in multiple Sclerosis: A systematic review.

Mult Scler Relat Disord 2018 Aug 28;24:91-100. Epub 2018 Jun 28.

Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Hamilton, Lanarkshire, Scotland, United Kingdom.

Background: Physical activity, particularly exercise training, is an evidence-based approach for managing symptoms, restoring function and improving overall wellness in people with multiple sclerosis (MS). Several recent studies have argued for a potential disease modifying effect of exercise in people with MS, and among the potential mediating mechanisms are exercise training effects on both cytokines and adipokines. The objectives of this study were to perform a systematic review of exercise training effects on cytokine and adipokine profiles in persons with MS.

Methods: We conducted open-dated searches of PubMed, Cochrane Library, EMBASE and PEDro using the terms 'Multiple sclerosis' or 'MS' AND 'exercise' OR 'training' OR 'physical activity' AND 'cytokine' OR 'inflammatory' OR 'immune' OR 'adipokine'. Included studies were written in English; comprised of humans with MS, and evaluated the effects of regular physical activity or exercise on pro-inflammatory, anti-inflammatory cytokines or adipokines. Two authors independently scanned titles and abstracts, and read the studies included. All studies were rated on the PEDro scale and further classified based on American Academy of Neurology criteria.

Results: Twelve studies were included of which 10 studies focused on cytokines, 1 study focused on adipokines, and 1 study included both cytokines and adipokines. The selected studies included 3 Class I studies, 7 Class II studies, and 2 Class IV studies and had average PEDro scores of 6.9 ± 1.6. Studies included endurance (n = 5), resistance (n = 3), combined (n = 3), and vibration (n = 1) training. Overall, there is a general lack of standardization of procedures across studies and inconsistent evidence for the effects of physical activity and exercise on cytokine and adipokine profiles in MS, with a general pattern indicating a lack of effect.

Conclusion: Research regarding the effects of exercise training on cytokines and adipokines in MS is in its infancy, but exercise represents an adjuvant therapy in MS, and future studies are essential for clarifying the role of exercise on cytokines and adipokines in MS.
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http://dx.doi.org/10.1016/j.msard.2018.06.008DOI Listing
August 2018

The effect of evening primrose oil on fatigue and quality of life in patients with multiple sclerosis.

Neuropsychiatr Dis Treat 2018 12;14:1505-1512. Epub 2018 Jun 12.

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Multiple sclerosis (MS) is a chronic progressive and inflammatory disease of the central nervous system that is characterized by demyelination in the central nervous system. In regard to the prevalence of diseases and enormous costs imposed on society and the health system, finding a way to stop the progression of the disease using drugs with fewer side effects seems a serious sanitation issue to the health of the international community. This study aimed to evaluate the effect of evening primrose oil (EPO) on fatigue and quality of life in patients with MS.

Materials And Methods: In this double-blind randomized clinical trial, 52 patients with MS were chosen and categorized into 2 groups which received 2 doses of EPO and placebo. In addition, the quality of life and fatigue scale in these patients were investigated before the treatment and again 3 months after therapy. The findings were then compared between the 2 groups.

Result: EPO consumption significantly increased cognitive function, vitality, and overall life satisfaction and also reduced pain and fatigue compared to placebo (<0.05).

Conclusion: Our findings indicated that EPO consumption had no impact on the quality of life in general; however, it had a significant effect on several important aspects of life quality such as the increase of cognitive function, vitality, and overall life satisfaction. It also reduced the pain and fatigue in comparison to the placebo consumption. Herbal medicines are brittle and have fewer side effects than chemical drugs. With use of this plant, reduced fatigue and improved quality of life were observed in MS patients. But the drug did not prevent the progression of the disease.
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http://dx.doi.org/10.2147/NDT.S149403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003444PMC
June 2018

Exercise-induced changes in neurotrophic factors and markers of blood-brain barrier permeability are moderated by weight status in multiple sclerosis.

Neuropeptides 2018 Aug 31;70:93-100. Epub 2018 May 31.

Department of Sport Physiology, Shahid Chamran University of Ahvaz, Ahvaz, Iran.

Blood-brain barrier (BBB) and neurotrophic factors seemingly have an important role in multiple sclerosis pathology. Physical activity may influence blood-brain barrier function and levels of neurotrophic factors, and such effects might be moderated by body weight status. This study investigated the effect of exercise training on markers of blood-brain barrier permeability and neurotrophic factors as a function of weight status in multiple sclerosis patients. Sixty three persons with relapsing remitting multiple sclerosis who were normal weight (n: 33) or overweight (n: 33) were randomly assigned into groups of exercise (normal weight training, n: 18; overweight training group, n: 18) or no exercise (normal weight control, n: 15; overweight control group, n: 15). The intervention consisted of 8 weeks (3 days per week) of cycling undertaken at 60-70% peak power. Resting blood concentrations of s100 calcium-binding protein B (s100b) and neuron-specific enolase as BBB permeability markers, neurotrophic factors and cytokines (Interleukin-10 and tumor necrosis factor alpha) were evaluated before and after the intervention. There were significant weight, training, and interaction effects on brain-derived neurotrophic factor and platelet-derived growth factor; however, ciliary neurotrophic factor and nerve growth factor did not demonstrate any effect. Brain-derived neurotrophic factor and platelet-derived growth factor were significantly increased from pre-post in normal weight exercise. Significant weight, training, and interaction effects were found for s100b. In detail, s100b was significantly increased from pre-post in normal weight exercise. In contrast, neuron-specific enolase and cytokines did not demonstrate any effect. Generally, Exercise training may alter markers of BBB permeability and neurotrophic factor status in normal weight persons with multiple sclerosis; however, overweight participants may be more resistant to these effects of exercise.
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http://dx.doi.org/10.1016/j.npep.2018.05.010DOI Listing
August 2018

Acute responses of cytokines and adipokines to aerobic exercise in relapsing vs. remitting women with multiple sclerosis.

Complement Ther Clin Pract 2018 May 14;31:295-301. Epub 2018 Mar 14.

Institute of Clinical Exercise and Health Sciences, School of Science and Sport, University of the West of Scotland, Hamilton, Lanarkshire, Scotland, UK.

Objective: To examine the acute effect of exercise on cytokines and adipokines during relapse and the remitting phase of multiple sclerosis (MS).

Methods: Thirty women with MS in the relapsing or remitting phase were matched with fifteen healthy controls. Participants performed a single-bout of aerobic exercise at 60-70% maximal heart rate. Furthermore, five women in the relapsing phase were enrolled (control relapse) and did not receive any intervention. Blood samples were taken before, immediately after, 1-h and 6-h after the exercise.

Results: Levels of IL-10 and TNF-α in response to exercise were similar in healthy and MS remitting subjects. Compared to baseline, TNF-α levels in relapsing subjects were significantly decreased immediately after exercise. Immediately following exercise, leptin levels significantly decreased in relapsing subjects. Adiponectin and IL-6 showed no significant difference between groups.

Conclusion: After relapse, exercise does not induce inflammatory cytokine response and temporarily improves both cytokine and adipokine balance.
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http://dx.doi.org/10.1016/j.ctcp.2018.03.004DOI Listing
May 2018

Diagnosis and management of Neuromyelitis Optica Spectrum Disorder (NMOSD) in Iran: A consensus guideline and recommendations.

Mult Scler Relat Disord 2017 Nov 25;18:144-151. Epub 2017 Sep 25.

Scientific Committee, Iranian MS Society, Iran.

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a relapsing neuro inflammatory disease of the central nervous system that typically presents with optic neuritis or myelitis and may cause severe disability. The diagnostic criteria have been updated and several immunosuppressive agents have been demonstrated to prevent acute exacerbations. As the disease rarely develops in a progressive course, management of acute attacks and proper prevention of exacerbations may change the long term out-come and prevent future disability. Consensus recommendations and guidelines will help the physicians to improve their practice and unify the treatment approaches in different communities. In order to develop a national consensus and recommendations for the diagnosis and management of NMOSD in Iran, a group of neurologists with long term experience in management of NMOSD were gathered to develop this consensus based on available national and international data. The primary draft was prepared and discussed to suggest the most appropriate treatment for these patients. We propose strategies for early diagnosis and treatment for prevention of relapses and minimizing consequences of attacks as a primary therapeutic goal. Attacks are currently treated with intravenous corticosteroids and, in refractory cases, with plasma exchange. All participants agreed on preventive treatment with currently available immunosuppressive agents such as azothioprin, rituximab and mycofenolate mofetil based on previous positive data in NMOSD in order to reduce attack frequency. The current consensus reviews the previous data and provides the clinicians with practical recommendations and advices for the diagnosis and management of NMOSD based on scientific data and clinical experience.
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http://dx.doi.org/10.1016/j.msard.2017.09.015DOI Listing
November 2017

Predicting falls among patients with multiple sclerosis: Comparison of patient-reported outcomes and performance-based measures of lower extremity functions.

Mult Scler Relat Disord 2017 Oct 27;17:69-74. Epub 2017 Jun 27.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Accurate fall screening tools are needed to identify those multiple sclerosis (MS) patients at high risk of falling. The present study aimed at determining the validity of a series of performance-based measures (PBMs) of lower extremity functions and patient-reported outcomes (PROs) in predicting falls in a sample of MS patients (n = 84), who were ambulatory independent.

Methods: Patients were assessed using the following PBMs: timed up and go (TUG), timed 25-foot walk (T25FW), cognitive T25FW, 2-min walk (2MW), and cognitive 2MW. Moreover, a series of valid and reliable PROs were filled in by participants including the activities-specific balance confidence (ABC), 12-item multiple sclerosis walking scale (MSWS-12), fall efficacy scale international (FES-I), and modified fatigue impact scale (MFIS). The dual task cost (DTC) of 2MW and T25FW tests were calculated as a percentage of change in parameters from single to dual task conditions. Participants were classified as none-fallers and fallers (⩾1) based on their prospective fall occurrence.

Results: In the present study, 41(49%) participants recorded ≥ 1 fall and were classified as fallers. The results of logistic regression analysis revealed that each individual test, except DTC of 2MW and T25FW, significantly predicted future falls. However, considering the area under the curves (AUCs), PROs were more accurate compared to PBMs. In addition, the results of multiple logistic regression with the first two factors extracted from principal component analysis revealed that both factor 1 (PROs) and factor 2 (PBMs) significantly predicted falls with a greater odds ratio (OR) for factor 1 (factor 1: P = <0.0001, OR = 63.41 (6.72-597.90)) than factor 2 (P <0.05, OR = 5.03 (1.33-18.99)).

Conclusions: The results of this study can be used by clinicians to identify and monitor potential fallers in MS patients.
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http://dx.doi.org/10.1016/j.msard.2017.06.014DOI Listing
October 2017

Diagnostic evaluation of dysphagia in multiple sclerosis patients using a Persian version of DYMUS questionnaire.

Mult Scler Relat Disord 2017 Oct 1;17:240-243. Epub 2017 Sep 1.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Multiple sclerosis is a chronic neurological disease that may cause swallowing disorders. Dysphagia is a common problem, which patients with different levels of disability may encounter, but it is usually underestimated; therefore, effective assessments need to be performed before any serious complications. The aim of this study was to identify the frequency and characteristics of dysphagia in multiple sclerosis patients of Khuzestan MS society, using a Persian version of Dysphagia in Multiple Sclerosis (DYMUS) questionnaire.

Method: 105 consecutive MS patients (84 F and 21 M, mean age 33.8 ± 8.5 years, mean disease duration 3.5 ± 3.1 years, mean Expanded Disability Status Scale (EDSS) 1.8 ± 1.3) participated in the study and the DYMUS questionnaire was administered by a trained speech therapist.

Results: The results have shown that 55 MS patients (52.4%) had dysphagia and the dysphagia was significantly associated with the disease course of MS (p = 0.02). However, significant associations between DYMUS values and EDSS, disease duration, age, and gender were not observed. (Respectively, p = 0.4, p = 0.09, p = 0.1, p = 1.0). In the dysphagia group, based on dysphagia severity, 17.1% and 35.2% of patients had mild and alarming dysphagia, respectively. Although, the patients with alarming dysphagia had longer disease duration, higher EDSS score and more with SP, PP and PR disease course than the patients with mild dysphagia, these differences were not significant.

Conclusion: The oropharyngeal dysphagia in MS patients is very common even in early stages of the disease; therefore, it is important to assess these patients carefully and to initiate a treatment program if needed.
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http://dx.doi.org/10.1016/j.msard.2017.08.012DOI Listing
October 2017

Effect of aerobic interval training on serum IL-10, TNFα, and adipokines levels in women with multiple sclerosis: possible relations with fatigue and quality of life.

Endocrine 2017 Aug 14;57(2):262-271. Epub 2017 Jun 14.

Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran, Iran.

Purpose: Multiple sclerosis is associated with immune system dysfunction and chronic inflammation; however, possible relations between immunologic and metabolic factors and some psychological indexes such as fatigue and quality of life, especially in relation to exercise training, have not yet been investigated. The present study was designed to investigate the effect of aerobic interval training on interleukin-10/tumor necrosis factor ratio and adipokine (leptin and adiponectin) concentrations in women with multiple sclerosis. Furthermore, the relationship between these factors with fatigue and quality of life were assessed.

Methods: Forty women with multiple sclerosis (Expanded Disability Status Scale ≤3) were randomized into either a non-exercising control or training group. The training group performed 8-weeks of upper and lower limb aerobic interval training. Serum concentrations of tumor necrosis factorα, interleukin-10, leptin, and adiponectin were measured before and after the 8-week intervention. Moreover, antropometric measures and measures for fatigue and quality of life were determined at the onset of and after exercise training.

Results: The results revealed that leptin and tumor necrosis factorα levels significantly decreased subsequent to the aerobic interval training. Although blood adiponectin levels considerably increased in the training group, interleukin-10 and interleukin-10/tumor necrosis factorα ratio underwent no substantial change after the exercise training. In addition, the aerobic interval training was associated with improvement in fatigue, quality of life, and maximal oxygen consumption.

Conclusions: Our findings suggested that aerobic interval training can be an effective strategy for managing the immune system at least by its significant impact on inflammatory cytokines and adipokines levels in women with multiple sclerosis. Additionally, this positive impact improved fatigue and adipose tissue indicators.
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http://dx.doi.org/10.1007/s12020-017-1337-yDOI Listing
August 2017

Long-term disability trajectories in primary progressive MS patients: A latent class growth analysis.

Mult Scler 2018 04 6;24(5):642-652. Epub 2017 Apr 6.

Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy.

Background: Several natural history studies on primary progressive multiple sclerosis (PPMS) patients detected a consistent heterogeneity in the rate of disability accumulation.

Objectives: To identify subgroups of PPMS patients with similar longitudinal trajectories of Expanded Disability Status Scale (EDSS) over time.

Methods: All PPMS patients collected within the MSBase registry, who had their first EDSS assessment within 5 years from onset, were included in the analysis. Longitudinal EDSS scores were modeled by a latent class mixed model (LCMM), using a nonlinear function of time from onset. LCMM is an advanced statistical approach that models heterogeneity between patients by classifying them into unobserved groups showing similar characteristics.

Results: A total of 853 PPMS (51.7% females) from 24 countries with a mean age at onset of 42.4 years (standard deviation (SD): 10.8 years), a median baseline EDSS of 4 (interquartile range (IQR): 2.5-5.5), and 2.4 years of disease duration (SD: 1.5 years) were included. LCMM detected three different subgroups of patients with a mild ( n = 143; 16.8%), moderate ( n = 378; 44.3%), or severe ( n = 332; 38.9%) disability trajectory. The probability of reaching EDSS 6 at 10 years was 0%, 46.4%, and 81.9% respectively.

Conclusion: Applying an LCMM modeling approach to long-term EDSS data, it is possible to identify groups of PPMS patients with different prognosis.
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http://dx.doi.org/10.1177/1352458517703800DOI Listing
April 2018

Effects of dual-task balance training on postural performance in patients with Multiple Sclerosis: a double-blind, randomized controlled pilot trial.

Clin Rehabil 2017 Feb 10;31(2):234-241. Epub 2016 Jul 10.

4 Neurologist, Department of Neurology, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: To investigate the effects of dual-task balance training on postural performance in patients with multiple sclerosis as compared with single-task balance training.

Design: Double-blind, pretest-posttest, randomized controlled pilot trial.

Setting: Local Multiple Sclerosis Society.

Subjects: A total of 47 patients were randomly assigned to two equal groups labeled as single-task training and dual-task training groups.

Interventions: All patients received supervised balance training sessions, 3 times per week for 4 weeks. The patients in the single-task group performed balance activities, alone. However, patients in dual-task group practiced balance activities while simultaneously performing cognitive tasks.

Main Measures: The 10-Meter Walk Test and Timed Up-and-Go under single-task and dual-task conditions, in addition to Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment were assessed pre-, and post intervention and also 6-weeks after the end of intervention.

Results: Only 38 patients completed the treatment plan. There was no difference in the amount of improvement seen between the two study groups. In both groups there was a significant effect of time for dual-10 Meter Walk Test (F=11.33, p=0.002) and dual-Timed Up-and-Go (F=14.27, p=0.001) but not for their single-tasks. Moreover, there was a significant effect of time for Activities-specific Balance Confidence, Berg Balance Scale, and Functional Gait Assessment ( P<0.01).

Conclusions: This pilot study did not show more benefits from undertaking dual-task training than single-task training. A power analysis showed 71 patients per group would be needed to determine whether there was a clinically relevant difference for dual-task gait speed between the groups.
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http://dx.doi.org/10.1177/0269215516639735DOI Listing
February 2017

A descriptive study of prevalence, clinical features and other findings of neuromyelitis optica and neuromyelitis optica spectrum disorder in Khuzestan Province, Iran.

Iran J Neurol 2015 Oct;14(4):204-10

Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Neuromyelitis optica (NMO) is an uncommon neuro-inflammatory syndrome that has shown to be distinct from multiple sclerosis (MS) and associated with the autoantibody marker NMO-immunoglobulin G (IgG). There are still only a few studies regarding the epidemiology of NMO in Iran. In the present study, we tried to describe the epidemiology of NMO in Khuzestan as one of the densely populated regions in Iran.

Methods: A cross-sectional study was performed during the period 2013-2014. Multiple regional sources of data were used including hospital records, details from neurologists and MS society database. The diagnosis of NMO was based on clinical presentation, abnormal findings on neuroimaging and serological tests.

Results: A 51 Caucasian patients (36 patients with NMO and 15 with NMO-spectrum disorder) were identified with a female/male ratio of 7.5:1.0. The crude prevalence of NMO was 1.1/100,000 population. The mean age at onset was 29.2 ± 6.1 years and the mean duration of symptoms was 5.0 ± 0.4 years. The majority of patients (60.8%) were classified as having mild disability (Expanded Disability Status Scale = 0-3.5). Among of 35 patients whose titer of NMO-IgG was measured, 19 (54.2%) were seropositive.

Conclusion: Our study suggests that NMO prevalence rate in South West Iran (Khuzestan Province) is much lower than that reported for MS prevalence rate (16.2/100,000) and our patients had a lower age at onset presentation and milder course of the disease than western countries.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4754599PMC
October 2015

Several food items and multiple sclerosis: A case-control study in Ahvaz (Iran).

Iran J Nurs Midwifery Res 2014 Nov;19(6):659-65

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Multiple sclerosis (MS) is a complex inflammatory disease of the central nervous system. Despite extensive research, its exact cause is unknown. One of the roles of nurses is discovery and prevention of factors related to the disease. This study aimed to investigate several food items concerning the etiology of MS in a population of Ahvaz (Iran).

Materials And Methods: This case-control study was conducted on 113 MS patients and 113 healthy women. Food information was collected through interviews using a standard designed questionnaire. Statistical analysis was performed by adopting descriptive tests (mean, frequency, standard deviation) and inferential tests (Chi-square test, Fisher's exact test, logistic regression, and multivariate conditional logistic regression with a significance level of 0.05 and 95% confidence interval) through SPSS version 19.

Results: Univariate regression analysis showed a significant association between MS and consumption of solid vegetable oil (P = 0.004), fruits (P = 0.002), vegetables (P = 0.016), dates (P = 0.02), and low-fat dairy (P = 0.009) more than five times a week. According to multivariate conditional logistic regression analysis, consumption of fruits (P = 0.03) and low-fat dairy (P = 0.04) more than five times a week had a protective role and solid vegetable oil consumption was significantly associated with a risk for MS (P = 0.01).

Conclusions: This study suggests a protective role of consumption of fruits and low-fat dairy in MS and an increased risk of MS with solid vegetable oil consumption in Ahvaz (Iran).
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4280733PMC
November 2014

Association of interleukin 7 receptor gene polymorphism rs6897932 with multiple sclerosis patients in Khuzestan.

Iran J Neurol 2014 Jul;13(3):168-71

Departmanet of Genetic, School of Sciences, Shahid Chamran University, Ahvaz, Iran.

Background: Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system with unknown causes. Etiology of MS involves both genetic and environment factors. The interleukin 7 receptor (IL7R) gene is a promising candidate for MS, because its involvement in the autoimmunity, regulation of the T-cell homeostasis, proliferation, and anti-apoptotic signaling.

Methods: We investigated the association of the IL7R gene polymorphism rs6897932 in MS patients in a case and control study. In this case and control study participating, 127 relapsing-remitting MS (RRMS) patients (mean age: 32.25, age range: 16-57) selected according McDonald criteria, and 109 ethnically, sex and age matched healthy control (mean age: 27.44, age range: 14-63) with no personal or family history of autoimmune diseases were studied. DNA was extracted from whole blood using high pure polymerase chain reaction template preparation kit from Roch Company. Amplification refractory mutation system method was applied to define the genotyping C/T within exon 6 of the IL7R gene among individuals.

Results: Evaluation of the IL7R gene polymorphism revealed that the T allele and the C/T and T/T genotypes are present in 53.5%, 42.5%, 4.0%, and 68.8%, 26.6%, 4.6% in MS patients and controls, respectively. Comparison between alleles and genotypes in the MS patients and healthy controls show significant differences (P = 0.038).

Conclusion: The distribution of the rs6897932 polymorphism is significantly different in our case/control study in Khuzestan Province. This single nucleotide polymorphism causes alternative splicing in exon 6 of the IL7R gene with possible influence of the autoimmunity.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240935PMC
July 2014

A study on the direct and indirect costs of multiple sclerosis based on expanded disability status scale score in khuzestan, iran.

Int J Prev Med 2014 Sep;5(9):1131-8

Department of Health Economic and Management, School of Public Health, Tehran University of Medical Sciences Tehran, Iran.

Background: Multiple sclerosis is a common and chronic neurologic disorder. This disorder imposes physical, economic, and psychosocial burden on individuals, their families and society. This study aims to analyze the costs of multiple sclerosis disease based on the severity of disability.

Methods: We performed a cross-sectional cost of illness study. This study was conducted in 332 patients of Khuzestan province of Iran. Data were included: Patient's characteristics, disability status, medical, and nonmedical costs and were gathered by using the questionnaire during 3 months period. Costs analysis was performed in the basis of expanded disability status scale (EDSS). Data were analyzed by using SPSS 18 software.

Results: Mean age of the patients was 33.5 (standard deviation [SD]: 9.1) and 70.5% of patients were female. Mean EDSS score of the patients was 2.2 (SD: 1.6). Most patients (92.1%) had relapsing remitting multiple sclerosis (MS) form of the disease. Costs mean per patients was 8.6 ± 7.9 million Rial. The direct and indirect costs were 93.1% and 6.9% of total costs, respectively. The major cost of the disease belongs to the pharmaceutical treatment (22% of costs). The majority costs (approximately 62%) attributed to EDSS of 6-7 and >7. Furthermore, there was strong significant relationship between cost of illness and disability severity of patients (P < 0.05).

Conclusions: Cost mean per MS patients was relatively high. Furthermore, the results showed that cost of disease had positive and significant relationships with EDSS score that is, progression of disability increase costs of patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192775PMC
September 2014

Riboflavin supplementation to patients with multiple sclerosis does not improve disability status nor is riboflavin supplementation correlated to homocysteine.

Int J Vitam Nutr Res 2013 ;83(5):281-90

Department of Health Education, Academic Center for Education,Culture and Research (ACECR)-Khuzestan, Ahvaz, Khuzestan, Iran.

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Riboflavin is involved in myelin formation in nerve cells. Riboflavin is a precursor of flavin adenine D-nucleotide (FAD), which is a coenzyme of methylene tetrahydrofolate reductase (MTHFR), which is an important enzyme for remethylation of homocysteine. Riboflavin supplementation has been shown to affect the serum levels of homocysteine in healthy volunteers. The aim of the present study was to test the effect of riboflavin supplementation on the status and disability of patients with MS and whether this effect could be mediated by serum homocysteine levels.

Materials And Methods: This was a randomized, double-blind, controlled trial in which 29 MS patients with a mean age of 33 were tested with riboflavin, and the placebo group, with a mean age of 31, received either riboflavin supplementation (10 mg) or the placebo daily for six months. Disability, measured by the Expanded Disability Status Scale (EDSS) scores, erythrocyte glutathione reductase activity coefficient (EGRAC), and serum homocysteine levels were measured before and after the study.

Results: The mean ± SD of EDSS score was significantly decreased in both groups over the six months of the study (2.3 ± 0.7 vs. 1.6 ± 0.6 for the riboflavin group and 2.8 ± 1.1 vs. 2.3 ± 1.3 for the placebo groups. The comparison across both groups yielded a non-significant change (P = 0.001 and 0.02, respectively). No significant differences were observed between the two groups in terms of EGRAC, riboflavin deficiency levels by EGRAC category, and serum homocysteine levels before and after the study.

Conclusion: Riboflavin supplementation (10 mg/day) to patients with MS does not improve disability status. It appears that this effect is not related to serum homocysteine levels.
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http://dx.doi.org/10.1024/0300-9831/a000170DOI Listing
January 2015

Uses of complementary and alternative medicine in multiple sclerosis.

J Tradit Complement Med 2014 Jul;4(3):145-52

School of Pharmacy, Jundishapur University of Medical Sciences, Ahvaz, Iran.

Multiple sclerosis (MS) is a chronic, disabling, recurrent demyelination of the central nervous system (CNS). It could affect different regions in the brain and spinal cord, and according to the domain which is affected, it could cause different symptoms such as motor, sensory, or visual impairment; fatigue; bowel, bladder, and sexual dysfunction; cognitive impairment; and depression. MS patients also face reduced quality of life. Drugs that are used in MS are not fully efficient and patients suffer from many symptoms and adverse effects. Today there is an increasing trend of using complementary and alternative medicine (CAM). People are more likely to use this type of treatment. Using appropriate lifestyle and CAM therapy can subside some of the symptoms and could improve the quality of life in these patients. Many people with MS explore CAM therapies for their symptoms. This review is aimed to introduce CAM therapies that could be used in MS patients.
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http://dx.doi.org/10.4103/2225-4110.136543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142451PMC
July 2014

The effect of lithium in post-stroke motor recovery: a double-blind, placebo-controlled, randomized clinical trial.

Clin Neuropharmacol 2014 May-Jun;37(3):73-8

Departments of *Neurology and †Internal Medicine, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Objective: Evidences from cultured cells and animal models of ischemia suggest that lithium has neuroprotective and neurotrophic effects and may play a desirable role in reducing infarct volume and even improving the brain insults from stroke. The aim of this study was to evaluate the efficacy of lithium in early motor recovery of patients after ischemic stroke.

Methods: Eighty patients with first ever stroke, allocated randomly in lithium, 300 mg twice daily, or placebo. Treatment was initiated 48 hours after stroke and continued for 30 days. Modified National Institute of Health Stroke Scale (mNIHSS) and hand subsection of Fugl-Meyer Assessment (hFMA) were used to evaluate impairment on the fifth and 30th day of treatment.

Results: Sixty-six subjects (32 subjects in the lithium group and 34 subjects in the placebo group) completed the study. There were no significant differences in the improvement in mNIHSS (P=0.40) and hFMA (P=0.07) after 30 days. However, a subgroup analysis showed that patients with cortical strokes in the lithium group had significantly better improvement in both mNIHSS and hFMA in comparison to the placebo group (P=0.003). Approximately 44% (n=14) of patients in the lithium group, mainly from the cortical stroke subgroup, regained more than 25% of full function based on hFMA, whereas this rate in the placebo group was 14.7% (n=5; P=0.009).

Conclusion: The observed discrete difference between the lithium group and the placebo group in the cortical stroke subgroup may suggest an enhanced motor recovery after stroke by using an early treatment with a low dose of lithium carbonate. However, a larger trial with more patients with cortical stroke is needed to investigate this effect better.
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http://dx.doi.org/10.1097/WNF.0000000000000028DOI Listing
December 2014

The Persian version of Community Integration Questionnaire in persons with multiple sclerosis: translation, reliability, validity, and factor analysis.

Disabil Rehabil 2013 Aug 21;35(17):1453-9. Epub 2013 Jan 21.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Purpose: To culturally translate and validate the Community Integration Questionnaire (CIQ) in persons with multiple sclerosis (MS).

Methods: After a forward-backward translation, 105 persons with MS completed the Persian versions of the CIQ and MS Quality of Life (MSQOL) questionnaires in the first visit. The CIQ was re-administered to a sample of 45 persons with MS 7-10 days after the first session. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's α coefficient, respectively. Construct validity was assessed by measuring associations between subscales of the Persian CIQ (including Home Integration (HI), Social Integration (SI), and Productivity (P)) and MSQOL (including Physical and Mental Components). Dimensionality was assessed through two methods of corrected item-subscale correlation and factor analysis.

Results: The acceptable level of test-retest reliability (ICC ≥0.70) was obtained for the Persian CIQ. However, Cronbach's α coefficient of ≥0.70 was only seen for the HI. The correlations between the Persian CIQ and the Physical MSQOL were higher than those of Persian CIQ and the Mental MSQOL. The corrected item-subscale Spearman's correlation coefficient of 0.40 was exceeded by most items of the HI and 2 items of P. A total of four factors were detected and similar to the results of item-subscale correlation, the most variability was seen for the items of SI which loaded on different factors.

Conclusions: Persian CIQ seems to be a reliable and valid instrument for monitoring the level of community integration following rehabilitation in persons with MS. Some modifications need to be made in the SI of the Persian CIQ to improve extraction of information regarding community integration of persons with MS.
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http://dx.doi.org/10.3109/09638288.2012.741653DOI Listing
August 2013

The influence of ethnicity on the characteristics of multiple sclerosis: a local population study between Persians and Arabs.

Clin Neurol Neurosurg 2013 Aug 27;115(8):1271-5. Epub 2012 Dec 27.

Neurology Department, Jondi-Shapoor University of Medical Sciences, Ahwaz, Iran.

Background: Based on previous studies, Iran is located in a low risk area in terms of multiple sclerosis (MS). The objective of this study was to determine and compare the incidence, prevalence and demographic characteristics of MS in two ethnic groups of Persian and Arab over the period spanning 2009 in the Khuzestan province, in the Southwest of Iran.

Methods: A cross-sectional case register study was conducted between January and August 2009. All cases in the region whom were referred to the MS society in the city of Ahwaz were participants in the study. The population data from the Iranian Bureau of Statistics were used to calculate the population at risk based on the 1996 and 2006 census data.

Results: A total of 696 patients were identified according to the McDonald criteria during the last 12 years of which 569 patients were Persian. In 2009 the total prevalence and incidence rates of MS were 16.28 and 2.20 per 100,000 individuals. Based on these values, the female to male ratios were 3.11. The Persians manifested more sensory signs and symptoms (40.2%) but motor deficits (19.1%) and cerebellar findings (18.2%) were seen as being more manifest in Arab individuals. The main difference was observed in the progressive types of MS in which 24.7% of the Arab patients showed progressive type symptoms as compared to 15.9% of the cases in the Persian population.

Conclusion: According to this study the authors conclude that the prevalence and incidence of MS were higher in Persians; however progressive forms of MS with motor and cerebellar signs are more frequent in the Arab ethnic group.
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http://dx.doi.org/10.1016/j.clineuro.2012.11.027DOI Listing
August 2013

The effect of NeuroAiD™ (MLC601) on cerebral blood flow velocity in subjects' post brain infarct in the middle cerebral artery territory.

Eur J Intern Med 2011 Oct 4;22(5):509-13. Epub 2011 Feb 4.

Neurology Department, Golestan Hospital, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran.

Background: Stroke is the third common cause of mortality and the most common cause of morbidity in adults. MLC601 (NeuroAiD™) is a treatment indicated for post stroke recovery. An increase of impaired cerebral blood flow may be an important parameter for recovery processes. The aim of this study was to investigate the effect of MLC601 on cerebral blood flow velocity as an indirect evidence of cerebral blood flow increase in post stroke subjects.

Methods: This is a double-blinded, placebo controlled, randomized study of 80 subjects included within a week of stroke onset. All subjects were given either MLC601 or placebo, 4 capsules, 3 times a day for 3 months. Cerebral blood flow within the middle cerebral artery, with blood flow velocity measured by transcranial Doppler (TCD), and Barthel index was assessed at baseline and at 3 months.

Results: The mean change in cerebral blood flow velocity in the MLC601 treatment group (15.9) was significantly increased (p=0.009) compared to the placebo group (9.6). Subjects in the treatment group also showed a significant difference in the mean rank of modified ranking scale (p<0.001) and mean change of the Barthel Index: 36 vs. 29 in the placebo group (p<0.001).

Conclusion: This is the first study suggesting that treatment with MLC601 may increase cerebral blood flow in stroke subjects. This may be mediated by an effect on stimulating microcirculation, an important process contributing to neuroplasticity in the central nervous system. This effect on cerebral blood flow may be associated with improvement in measures of functional recovery.
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http://dx.doi.org/10.1016/j.ejim.2011.01.002DOI Listing
October 2011

The effects of cognitive loading on balance control in patients with multiple sclerosis.

Gait Posture 2011 Oct 28;34(4):479-84. Epub 2011 Jul 28.

Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

The aim of this study was to compare the effects of concurrent cognitive task (silent backward counting) on balance performance between two groups of multiple sclerosis (MS) (n=23) and healthy (n=23) participates. Three levels of postural difficulty were studied on a force platform, i.e. rigid surface with eyes open, rigid surface with eyes closed, and foam surface with eyes closed. A mixed model analysis of variance showed that under difficult sensory condition of foam surface with eyes closed, execution of concurrent cognitive task caused a significant decrement in variability of sway velocity in anteroposterior direction for the patient group (P<0.01) while this was not the case for healthy participants (P=0.22). Also, the variability of sway velocity in mediolateral direction was significantly decreased during concurrent execution of cognitive task in patient group (P<0.01) and not in healthy participants (P=0.39). Furthermore, in contrast to single tasking, dual tasking had the ability to discriminate between the 2 groups in all conditions of postural difficulty. In conclusion, findings of variability in sway velocity seem to confirm the different response to cognitive loading between two groups of MS and healthy participants.
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http://dx.doi.org/10.1016/j.gaitpost.2011.06.023DOI Listing
October 2011

Zonisamide versus topiramate in migraine prophylaxis: a double-blind randomized clinical trial.

Clin Neuropharmacol 2011 Jul-Aug;34(4):174-7

Department of Neurology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.

Background: Topiramate is an antiepileptic drug that has been approved for migraine prophylaxis. Despite appropriate efficacy for migraine prophylaxis, some patients cannot tolerate its adverse effects. The aim of this study was to compare the efficacy of zonisamide, another antiepileptic drug, with topiramate in decreasing the frequency and severity of migraine attacks to determine whether it could be used as an alternative for noncompliant patients to topiramate.

Methods: Eighty patients, recruited from referred migraineurs to our neurology clinic, who met the diagnosis and inclusion criteria were allocated randomly to group A (50-mg/d zonisamide, gradually titrated up to 200 mg/d) and group B (25-mg/d topiramate, gradually titrated up to 100 mg/d). Each patient was followed for 12 weeks and was assessed at entrance, in the fourth week and twelfth week for frequency of attacks, headache severity, need for acute medication, migraine disability assessment score, and adverse effects. A P < 0.05 was considered as the level of significant difference in all tests.

Results: Both drugs caused a significant decrease in frequency, severity, need for acute medication in migraine attacks, and migraine disability assessment score (P < 0.05). Except headache severity that was reduced significantly better by zonisamide (P < 0.008), there were no significant difference between the 2 groups in other items. Except for 2 cases of intolerable paresthesia, both drugs were tolerated well during the study.

Conclusion: Our results indicated that zonisamide is as effective as topiramate in migraine prophylaxis and can be considered as an alternative treatment when topiramate is not tolerated well.
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http://dx.doi.org/10.1097/WNF.0b013e318225140cDOI Listing
December 2011