Publications by authors named "Sanaz Ahmadi Karvigh"

15 Publications

  • Page 1 of 1

Automatic detection of epileptic seizures using Riemannian geometry from scalp EEG recordings.

Med Biol Eng Comput 2021 Jun 15. Epub 2021 Jun 15.

Department of Biomedical Engineering, Tarbiat Modares University, Tehran, Iran.

This paper proposes a new framework for epileptic seizure detection using non-invasive scalp electroencephalogram (sEEG) signals. The major innovation of the current study is using the Riemannian geometry for transforming the covariance matrices estimated from the EEG channels into a feature vector. The spatial covariance matrices are considered as features in order to extract the spatial information of the sEEG signals without applying any spatial filtering. Since these matrices are symmetric and positive definite (SPD), they belong to a special manifold called the Riemannian manifold. Furthermore, a kernel based on Riemannian geometry is proposed. This kernel maps the SPD matrices onto the Riemannian tangent space. The SPD matrices, obtained from all channels of the segmented sEEG signals, have high dimensions and extra information. For these reasons, the sequential forward feature selection method is applied to select the best features and reduce the computational burden in the classification step. The selected features are fed into a support vector machine (SVM) with an RBF kernel to classify the feature vectors into seizure and non-seizure classes. The performance of the proposed method is evaluated using two long-term scalp EEG (CHB-MIT benchmark and private) databases. Experimental results on all 23 subjects of the CHB-MIT database reveal an accuracy of 99.87%, a sensitivity of 99.91%, and a specificity of 99.82%. In addition, the introduced algorithm is tested on the private sEEG signals recorded from 20 patients, having 1380 seizures. The proposed approach achieves an accuracy, a sensitivity, and a specificity of 98.14%, 98.16%, and 98.12%, respectively. The experimental results on both sEEG databases demonstrate the effectiveness of the proposed method for automated epileptic seizure detection, especially for the private database which has noisier signals in comparison to the CHB-MIT database. Graphical Abstract Block diagram of the proposed epileptic seizure detection algorithm.
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http://dx.doi.org/10.1007/s11517-021-02385-zDOI Listing
June 2021

COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report.

Neurol Sci 2021 Apr 15. Epub 2021 Apr 15.

Department of Infectious Disease, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.
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http://dx.doi.org/10.1007/s10072-021-05239-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049392PMC
April 2021

Ischemic Stroke in Patients with COVID-19 Disease: A Report of 10 Cases from Iran.

Cerebrovasc Dis 2021 15;50(2):239-244. Epub 2020 Dec 15.

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

Ischemic stroke seems to be one of the most serious neurologic complications in patients with COVID-19 infection. Herein, we report a series of 10 ischemic stroke patients with concomitant COVID-19 disease. Out of 10, 8 had large infarcts (3 massive middle cerebral artery, 2 basilar artery, 2 posterior cerebral artery, and 1 internal carotid artery infarct territory). Two had cardiogenic embolic stroke due to atrial fibrillation. Almost half of our patients did not have a vascular risk factor. Nine did not have fever and were diagnosed with COVID-19 upon admission for stroke. Stroke occurred in the first week of respiratory symptoms with moderate pulmonary involvement. Most Patients did not have hypoxia and did not establish respiratory failure or acute respiratory distress syndrome. The blood pressures were low and hemorrhagic transformation did not occur even after antiplatelet or anticoagulant therapy. Patients had markedly increased levels of lactate dehydrogenase, C-reactive protein, and D-dimer. Three patients died. It seems that ischemic strokes in COVID-19 patients tend to occur as large infarct and can be seen in patients with mild to moderate pulmonary involvement.
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http://dx.doi.org/10.1159/000513279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801957PMC
April 2021

Identification of Serum Biomarkers for Differentiating Epileptic Seizures from Psychogenic Attacks Using a Proteomic Approach; a Comparative study.

Arch Acad Emerg Med 2020 29;8(1):e87. Epub 2020 Oct 29.

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

Introduction: Differentiating actual epileptic seizures (ESs) from psychogenic non-epileptic seizures (PNES) is of great interest. This study compares the serum proteomics of patients diagnosed with ESs and PNES.

Methods: Eight patients with seizure (4 with PNES and 4 with TLE (temporal lope epilepsy)) were enrolled in this comparative study. Venous blood samples were drawn during the first hour following the seizure. Standard protein purification technique was employed and proteins were subsequently separated via 2-D electrophoresis. After comparison of the serum proteomes from the two groups, protein expression was analyzed. The differentially expressed bands were determined using both matrix-assisted laser ionization time-of-flight (MALDI/TOF) and electrospray ionization quadruple mass spectrometry (MS).

Results: This study identified 361 proteins, the expression of 110 proteins increased, and 87 proteins decreased in the PNES group compared with TLE group. Four separate proteins were finally identified with MALDI/TOF MS analysis. Compared with PNES group, alpha 1-acid glycoprotein, ceruloplasmin, and S100-β were down-regulated and malate dehydrogenase 2 was up-regulated in the serum of TLE patients.

Conclusion: Our results indicated that changes in serum levels of S100-β, ceruloplasmin, alpha 1-acid glycoprotein 1, and malate dehydrogenase 2 after seizure could be introduced as potential markers to differentiate ES from PNES; however, more advanced studies are required to reach a better understanding of the underlying mechanisms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7682629PMC
October 2020

Psychogenic Non-Epileptic Seizures; a Narrative Review.

Arch Acad Emerg Med 2020 20;8(1):e10. Epub 2020 Jan 20.

Department of laboratory science,chalous branch,islamic azad iniversity,chalous,iran.

Psychogenic non-epileptic seizures (PNES) are paroxysmal changes that mimic epileptic seizures, so often misdiagnosed and treated for epilepsy. PNES are considered a psychiatric illness, personality pathology, and experiential and behavioral manifestation of depression. Despite studies over the past two decades, the pathological mechanisms of this disorder are unclear. In this paper, we critically review the current literature about the definition, epidemiology, diagnosis, treatment, related genes, and biomarkers of PNES and provide suggestions for future research. Further studies are needed for more information and knowledge on PNES to determine the appropriate psychotherapies and development of clear treatment guidelines.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286438PMC
January 2020

Proteomic Analysis of patients with Epileptic Seizure and Psychogenic Non-epileptic Seizure; a Cross-Sectional Study.

Arch Acad Emerg Med 2020 11;8(1):e18. Epub 2020 Mar 11.

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

Introduction: There is an increasing interest in the use of different biomarkers to help distinguish psychogenic non-epileptic seizure (PNES) from epileptic seizures (ES). This study aimed to evaluate the patterns of differentially expressed serum proteins in ES and PNES cases.

Methods: In this cross-sectional study, 4 patients with mesial temporal lobe epilepsy and 4 patients with PNES were selected from patients with history of recurrent seizures. Venous blood samples were obtained within 1 hour after seizure and serum proteomes as well as the extent of protein expression were analyzed.

Results: 361 proteins were identified; of these, expression of 197 proteins had altered. 110 (55.9%) proteins were down-regulated and 87 (44.1%) were up-regulated in the PNES samples compared to ES samples. The mean pI for deregulated proteins with 1.5 to 3 fold changes were 6.69 ± 1.68 in proteins with increasing expression in ES group and 5.88 ± 1.39 in proteins with increasing expression in PNES group (p = 0.008). The median and interquartile range (IQR) of molecular weight changes in proteins with 1.5 to 3 fold changes were 64 (22.0-86.0) in proteins whose expression had increased in ES group and 39.5 (26.0-61.5) in proteins whose expression had increased in PNES cases (p = 0.05).

Conclusion: Several spots with differential expression were observed by comparing patients with ES against the PNES groups, which could be potential biomarkers of the disease. Damage to the blood-brain barrier is the most important difference between the two groups, thus identifying total protein changes offers a key to the future of differentiating ES and PNES patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7130442PMC
March 2020

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

Epilepsy Behav 2019 07;96:244-248

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

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

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

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

Total Corpus Callosotomy for Medically Refractory Status Epilepticus Due to Progressive Myoclonic Epilepsy: A Clinically Challenging Case.

World Neurosurg 2019 Jul 28;127:509-513. Epub 2019 Apr 28.

Brain and Spinal Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Background: Progressive myoclonic epilepsy (PME) is a syndrome characterized by development of progressive myoclonus, cognitive impairment, and other neurologic deficits. Despite major advances in medical treatment of epilepsy, some PME patients remain refractory to antiepileptic drugs. This may further accentuate cognitive impairment and deteriorate functional capacity. Corpus callosotomy (CC) is used in patients with drug-resistant epilepsy who are not candidates for either excisional epilepsy surgery or neurostimulation. We report the application of the standard complete callosotomy to control medically refractory status epilepticus in a patient with PME.

Case Description: A 16-year-old boy was referred to the emergency department with generalized tonic-clonic seizures. He was known to have PME since 5 years earlier, with frequent generalized seizures requiring hospitalization and reloading of the drugs. The patient was discussed by the epilepsy surgery working group, and corpus callosotomy was considered as a last resort to control the refractory status epilepticus. The patient experienced no generalized seizures during the 3-month postoperative period (Engel class IIIB).

Conclusions: Inasmuch as surgery was the last resort to control severe disabling status epilepticus, because most of the epileptogenic discharges were originating from the parieto-occipital regions and profound cognitive impairment was present, we decided to perform a complete rather than just an anterior callosotomy. CC may be considered to prevent secondary generalized seizures as the most disabling attacks in patients with certain epilepsy syndromes. Nevertheless, the impact of palliative surgical intervention on the overall disease course of patients with an underlying diffuse pathologic state remains to be determined.
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http://dx.doi.org/10.1016/j.wneu.2019.04.162DOI Listing
July 2019

Therapeutic apheresis in neurological, nephrological and gastrointestinal diseases.

Transfus Apher Sci 2019 Jun 19;58(3):266-272. Epub 2019 Apr 19.

Sina hospital, Tehran university of medical science, Tehran, Iran.

Therapeutic plasma exchange (TPE) is a process in which plasma containing antibodies, immune complexes, inflammatory moderators, paraproteins and other toxins which are believed to be the cause of disease is removed from a patient. TPE is the first-line treatment (category I, level 1A) in all forms of Acute inflammatory demyelinating polyradiculoneuropathy disease (axonal, demyelinating and miller-fisher variant) as well as in acute myasthenic crisis, chronic inflammatory demyelinating polyradiculoneuropathy and Paraproteinemic neuropathies (category I, level 1B). Moreover, TPE in kidney diseases, for instance: desensitization in renal transplantation(ABO compatible) (living donor)and desensitization in deceased donor, desensitization in renal transplantation(ABO incompatible) (living donor), thrombotic microangiopathy complement Mediated (Factor H autoantibodies), Focal segmental glomerulosclerosis(recurrent in transplanted kidney), ANCA-associated rapidly progressive glomerulonephritis(Dialysis dependence, DAH), Anti-Glomerular basement membrane disease Goodpasture's syndrome)(DAH,Dialysis-independence,) has been utilized as an initial treatment. (category I) TPE has been used as the key therapeutic modality to reduce anti-A or anti-B antibody titers in the liver peri-transplant period with the goal of preventing rejection and facilitating graft survival. Also, plasma exchange is the first-line therapy in Wilson's disease (category I, level1C).
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http://dx.doi.org/10.1016/j.transci.2019.04.011DOI Listing
June 2019

Bilateral Ischemic Stroke Due to Carotid Artery Compression by Abnormally Elongated Styloid Process at Both Sides: A Case Report.

J Stroke Cerebrovasc Dis 2018 Jun 19;27(6):e89-e91. Epub 2018 Jan 19.

Department of Neurosurgery, Sina hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Abnormal elongation of styloid process (Eagle syndrome) may cause compression of the adjacent structures in the neck, the most important of which is the carotid artery. This condition may cause damage to the wall of carotid artery and result in cerebrovascular ischemic event. Bilateral carotid artery damage and cerebral stroke because of overgrown styloid processes at both sides is a rare condition. In this article, we report a case of bilateral ischemic stroke because of carotid compression by elongated styloid process at both sides treated by surgical resection of both processes.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.018DOI Listing
June 2018

HD-tDCS in refractory lateral frontal lobe epilepsy patients.

Seizure 2017 Apr 14;47:74-80. Epub 2017 Mar 14.

Department of Psychology, Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran. Electronic address:

Purpose: To evaluate the anticonvulsant effect of the novel high definition transcranial direct current stimulation (HD-tDCS) method on patients with refractory lateral frontal lobe epilepsy. The effects of HD-tDCS on working memory were also examined.

Method: 10 adult patients with intractable lateral frontal lobe epilepsy were studied. A central cathode electrode was placed on the epileptogenic zone according to LTM, and 20-min sessions of 2mA HD-tDCS were applied for 10 consecutive days. The primary endpoint was to make changes in the epileptiform discharges (EDs) during a 1-h EEG. Moreover, the seizure frequency based on seizure diary and neuropsychiatric parameters was evaluated.

Results: All patients tolerated HD-tDCS stimulation course without any adverse reaction. The frequency of EDs increased immediately and one month after the stimulation course by an average of 6.4% and 1.2%, respectively. However, these changes in the EDs frequency were not statistically significant (p-value >0.05). The mean seizure frequency changes showed decrement by an average of 17.9% immediately, and increment by an average of 38.1% one month after the HD-tDCS. These changes were not significant statistically (p-value >0.05). One patient experienced exacerbation of seizures during the stimulations hence dropped out of the study. Attention and working memory improved significantly immediately and one month after the HD-tDCS in all patients.

Conclusion: Changes of EDs and mean seizure frequency caused by HD-tDCS were not statistically significant for the whole group; however, this method could improve the patients' working memory scores.
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http://dx.doi.org/10.1016/j.seizure.2017.03.005DOI Listing
April 2017

Age-related serum vitamin B12 concentrations in epileptic patients receiving valproate monotherapy.

Iran J Neurol 2013 ;12(1):37-8

Professor, Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829275PMC
November 2013

Autologous mesenchymal stem cell therapy in progressive multiple sclerosis: an open label study.

Curr Stem Cell Res Ther 2012 Nov;7(6):407-14

Immunogenetics Research Centre, Department of Immunology, Tehran University of Medical Sciences, Tehran, Iran.

Despite updating knowledge and a growing number of medications for multiple sclerosis (MS), no definite treatment is available yet for patients suffering from progressive forms of the disease. Autologous bone marrow derived mesenchymal stem cell (BM-MSC) transplantation is a promising method proposed as a therapy for MS. Although the safety of these cells has been confirmed in hematological, cardiac and inflammatory diseases, its efficacy in MS treatment is still under study. Patients with progressive MS (expanded disability status scale score: 4.0 -6.50) unresponsive to conventional treatments were recruited for this study. Twenty-five patients [f/m: 19/6, mean age: 34.7±7] received a single intrathecal injection of ex-vivo expanded MSCs (mean dose: 29.5×10(6) cells). We observed their therapeutic response for 12 months. Associated short-term adverse events of injection consisted of transient low-grade fever, nausea /vomiting, weakness in the lower limbs and headache. No major delayed adverse effect was reported. 3 patients left the study for personal reasons. The mean (SD) expanded disability status scale (EDSS) score of 22 patients changed from 6.1 (0.6) to 6.3 (0.4). Clinical course of the disease (measured by EDSS) improved in 4, deteriorated in 6 and had no change in 12 patients. In MRI evaluation, 15 patients showed no change, whereas 6 patients showed new T2 or gadolinium enhanced lesions (1 lost to follow-up). It seems that MSC therapy can improve/stabilize the course of the disease in progressive MS in the first year after injection with no serious adverse effects. Repeating the study with a larger sample size, booster injections and longer follow-up using a controlled study design is advised.
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http://dx.doi.org/10.2174/157488812804484648DOI Listing
November 2012

Simvastatin treatment in patients with relapsing-remitting multiple sclerosis receiving interferon beta 1a: a double-blind randomized controlled trial.

Mult Scler 2010 Jul 20;16(7):848-54. Epub 2010 May 20.

Sina Hospital, Tehran, Iran.

Objectives: This study was conducted to evaluate the effect of simvastatin (40 mg/day) as an adjuvant therapy to interferon beta (IFNb 1a, 30 microg once weekly) in relapsing-remitting multiple sclerosis patients, compared with placebo.

Methods: We enrolled 85 patients with relapsing-remitting multiple sclerosis (71% female) who were already receiving IFNb 1a (Avonex), with Expanded Disability Status Scale score of less than 5.0. The patients were assigned (in random and double-blinded fashion) into the two groups of simvastatin and placebo. All patients continued to receive their current IFNb treatment. The outcome measures were total relapse rate, Expanded Disability Status Scale score, and the number of gadolinium-enhanced (Gd+) and new T2 lesions in magnetic resonance imaging after a 1-year follow-up. We used Mann-Whitney and one-way multivariate analysis of variances to analyze the data.

Results: Four patients in the placebo and two in the simvastatin group prematurely withdrew from the study due to experiencing two attacks. The total attack number in the simvastatin group was significantly lower than placebo group (moderate effect size r = 0.29) (p = 0.01). The final Expanded Disability Status Scale scores were lower in the simvastatin group (1.01 +/- 1.40, mean +/- SD) than in the placebo group (1.73 +/- 1.49, mean +/- SD), but this difference was not significant after controlling the baseline Expanded Disability Status Scale score (p = 0.07). In the simvastatin group, the mean +/- SD of gadolinium-enhanced and new T2 lesions were 0.66 +/- 1.18 and 3.39 +/- 3.55, respectively, (compared with 0.74 +/- 1.21 and 3.39 +/- 3.55 in the placebo group). Although there was a decreasing trend in lesions on magnetic resonance imaging, this difference was not statistically significant (p = 0.62). The combination therapy was safe and well tolerated, and no serious adverse effect was noted.

Conclusion: Our study supports the safety and efficacy of simvastatin as an add-on therapy to INFb 1a in patients with relapsing-remitting multiple sclerosis.

Trial Registration: ClinicalTrials.gov NCT00668343. This interventional study provides Class I evidence stating that adding simvastatin 40 mg/day to IFNb 1a 30 microg a week in patients with relapsing-remitting multiple sclerosis may reduce the relapse rate (moderate effect size r = 0.29) (p = 0.01) compared with treatment with IFNb 1a alone.
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http://dx.doi.org/10.1177/1352458510369147DOI Listing
July 2010

Lamotrigine and twin pregnancy, incidental event or possible correlation?

Seizure 2009 Oct 8;18(8):580-2. Epub 2009 Jul 8.

Sina Hospital, Tehran University of Medical Sciences, Department of Neurology, Immam Khomini Street, Hassan abad square, Tehran, Iran.

Lamotrigine is frequently used to manage epilepsy during pregnancy. However, some major and minor birth defects are reported with lamotrigine monotherapy. This study is a case series report on 20 epileptic women who were receiving lamotrigine in their pregnancy. Apart from the normal pregnancies and births, in our study three patients gave birth to healthy twins, two vanished twin syndromes occurred and one patient had abortion. Twin pregnancy in association with lamotrigine therapy has not been clearly described before. Our observational study raises the idea that lamotrigine may induce twin pregnancy but larger studies need to investigate the presence or absence of such association more decently.
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http://dx.doi.org/10.1016/j.seizure.2009.06.004DOI Listing
October 2009