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Objective: We hypothesized that the international economic sanctions have affected various groups of Iranian people and have compromised their right to access medicines. Methods: Scopus and MEDLINE from their inception to 15 May 2022 were systematically searched for related published original manuscripts. The following keywords were used (title/abstract): "sanction(s)" AND "Iran". The inclusion criteria were all human studies and articles written in English. Results: We could identify 24 articles. Sanctions have severely restricted patients with thalassemia, haemophilia, epilepsy, and multiple sclerosis from receiving their medical needs. Surveys and interviews of patients, healthcare professionals, and policy‐makers have repeatedly shown that sanctions have greatly affected the health system in Iran. Conclusion: International economic sanctions have limited access of the Iranian people to medicines and are associated with the suffering of Iranians. This situation should provide a lesson for policymakers in other similar instances worldwide. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that patients with epilepsy (PWE) perceived significant disruption in the quality and provision of care due to the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to investigate the effect of this pandemic on seizure control status and changes in seizure frequency in PWE. Methods: A consecutive sample of adult PWE registered in the database of Shiraz Epilepsy Center (Shiraz, Iran) was included in the study. In July 2021, phone interviews were conducted with all selected patients. Information such as age, sex, last seizure, seizure type, and frequency during the 12 months before the study, and history of COVID-19 contraction was extracted. The seizure control status of the patients in 2019 (pre-pandemic) was compared with that during the COVID-19 pandemic. Data were analyzed using SPSS software with the Fisher's exact test and Pearson's Chi squared test. P<0.05 was considered statistically significant. Results: A total of 158 patients were included in the study, out of which 62 (39.2%) patients had a stable seizure control status, 47 (29.7%) had fewer seizures, and 50 (31.6%) had more seizures. Breakthrough seizures were reported by 32 (34.4%) patients. Seizure frequency increased in 18 (27.7%) and decreased in 46 (70.7%) patients. Conclusion: Overall, the COVID-19 pandemic has not been a major precipitating factor nor has it affected the seizure control status of PWE. In treated epilepsy, a fluctuating course with periods of seizure freedom followed by relapses is part of its natural history. [ABSTRACT FROM AUTHOR]

Objective: We investigated medical comorbidities in patients with functional seizures (FS) and those with epilepsy (idiopathic generalized epilepsies [IGEs] or temporal lobe epilepsy [TLE]). We hypothesized that the nature of medical comorbidities differs between these three groups. This might be helpful to postulate on the pathophysiology of FS. Materials and Methods: In a retrospective study, all adult patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 until 2020. The three groups of patients were matched with regard to their age. Age, sex, and medical comorbidities were registered routinely for all patients at the time of the first visit. Results: Nine hundred and sixty-six patients were studied (254 patients with IGE, 467 persons with TLE, and 245 individuals with FS). The groups differed significantly with regard to having medical comorbidities. The most striking difference was comorbid thyroid disorders; this was more common among patients with FS. The diagnosis of FS was independently significantly associated with thyroid disorder comorbidity (odds ratio: 2.77, 95% confidence interval: 1.06-7.23; P = 0.038). Conclusion: Thyroid disorders are significantly associated with FS. We can make the following suggestions to advance the field: a. It is necessary to reproduce this observation in larger multicenter studies; b. We recommend to evaluate thyroid function in all patients with FS; c. It might be helpful to design clinical trials to investigate whether correction of any clinical or subclinical thyroid disorders changes the treatment outcome in patients with FS. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine whether COVID-19 is associated with a different presenting clinical picture or a more severe course of illness in people with a past history of chemical war injury. Methods: This is a multicenter retrospective study in Fars Province, Iran, from August 22 to October 4, 2020. People with a past history of chemical war injury and COVID-19 were studied. Two age- and sex-matched control groups, double the size of the patient group each, from the same database of patients with COVID-19 who were hospitalized at the same time (ie, healthy controls and pseudocontrols). Results: A total of 46 people with a past history of chemical war injury, 92 healthy controls, and 92 pseudocontrols were studied. People with COVID-19 and a past history of chemical war injury had a significantly higher rate of chest pain compared with others. There were no other clinical differences between the groups. Mortality rate was 17.39%, 15.21%, and 27.17% in people with a past history of chemical war injury, the control group, and the pseudocontrol group, respectively. Conclusions: A past history of a chemical war injury does not add to the risk of COVID-19 and does not significantly modify its clinical picture either. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the current study was to investigate the prevalence of face mask wearing among different groups of people in south Iran. We also investigated the associations between mask wearing hesitancy and various factors. Methods: We surveyed a sample (convenience sampling) of 5 groups of people: general population, people with epilepsy, people with diabetes mellitus (DM), people with cardiac problems, and people with psychiatric problems. The survey included 4 general questions (age, sex, education, and medical/psychiatric problem) and 4 coronavirus disease 2019 (COVID-19)-specific questions (contracting COVID-19, relatives with COVID-19, wearing a face mask while in crowded places, and the frequency of daily hand washings). Results: A total of 582 people (153 people with epilepsy, 127 patients with DM, 98 people with cardiac problems, 96 patients with psychiatric disorders, and 108 healthy individuals) participated. Twenty-eight (4.8%) people expressed that they do not wear a face mask when at crowded places. A lower education and less frequent daily hand washings had associations with mask wearing hesitancy. Conclusions: Mask wearing hesitancy is a concern during a respiratory viral disease pandemic. Paying attention to personal variables, especially if they are modifiable (eg, education and hygiene), is probably productive and practical in promoting mask wearing culture. [ABSTRACT FROM AUTHOR]

Background Sleep and seizures can affect each other in different ways. Meanwhile, sleep disorders are among the most frequent complaints of patients with epileptic and non-epileptic seizures, with various health outcomes. Objective This study aimed to investigate the psychological symptoms and clinical indicators in patients with/without sleepiness with epileptic/non-epileptic seizures. Methods The present study was a fundamental and descriptive (causal-comparative) research. The study population included all patients with epileptic seizures (temporal and generalized) and non-epileptic psychogenic seizures in Shiraz City, Iran. A total of 68 patients (in two groups with sleepiness and without sleepiness) were selected by the purposive sampling method. The study data were collected using the clinical and demographic inventory, Stanford sleepiness scale, Beck depression and anxiety inventory, perceived stress, mood disorder, bipolar spectrum diagnostic scale, global assessment of the severity of epilepsy, and global assessment of disability-related directly to seizures. The obtained data were analyzed by univariate analysis of covariance, Fisher exact test, and Mann–Whitney U test. Results Analyses showed that patients with seizures who had sleepiness reported higher levels of depression, anxiety, and stress than patients without sleepiness (P<0.05). Also, patients with sleepiness suffer more than their counterparts from the symptoms of bipolar disorder I and II and assess the severity of disease and disability resulting from seizures as worse (P<0.05). Conclusion Sleepiness in patients with epileptic and non-epileptic seizures is associated with increased psychological symptoms and disease severity [ABSTRACT FROM AUTHOR]

The aim of the current study was to investigate the rates of stress, anxiety, and depression among people in south Iran (a group from the general population without a history of any chronic medical problems, and cohorts of patients were recruited from epilepsy, diabetes, and cardiac disease clinics). We surveyed a sample of people during September 2020: a group of the general population without a history of any chronic medical problems, people with epilepsy, people with diabetes mellitus (DM), and people with cardiac problems. The survey included four general questions and two COVID-19 specific questions [contracting COVID-19, relatives with COVID-19]. Furthermore, the survey included the DASS (Depression-Anxiety-Stress Scale)-21 questionnaire. 487 people were surveyed (154 people with epilepsy, 127 patients with DM, 98 people with cardiac problems, and 108 healthy individuals). Among people without a history of any chronic medical illnesses, 14% had any psychological problems. The highest rates of depression and anxiety were observed among patients with DM (52% and 57%, respectively), and the highest rate of increased stress was observed among people with cardiac problems (40%). The existence of any underlying medical problem was significantly associated with higher rates of depression, anxiety, and stress among the participants. While many patients with underlying chronic medical conditions suffer from depression, anxiety, and stress during the COVID-19 pandemic, we cannot establish a cause and effect relationship between the COVID-19 pandemic and increased psychological problems among these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine whether patients with epilepsy (PWE) are particularly over‐represented in a very large cohort of patients with COVID‐19. We also investigated whether COVID‐19 is associated with a different clinical picture or a more severe course of illness in PWE (compared with others). Methods: All consecutive patients who referred to and admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from February 19, 2020 until November 20, 2020 were included. Results: A total of 37,968 patients were studied. Eighty‐two patients (0.2%) had pre‐existing epilepsy. Seizures were significantly more frequent among PWE as a presenting manifestation of COVID‐19 compared with that in people without epilepsy (Odds Ratio = 27; p = 0.0001). Furthermore, PWE less often reported cough (significantly) and more often had gastrointestinal symptoms (vomiting and anorexia; as trends) compared with those in people without epilepsy. Patients with epilepsy were not differently likely to be intubated or admitted at ICUs. Case fatality rates were not different between the two groups [9.8% in PWE and 8.5% in people without epilepsy; p = 0.690]. Conclusion: Patients with epilepsy are not susceptible to contracting COVID‐19 more than other individuals. Furthermore, COVID‐19 in PWE is not associated with a more severe illness or a poorer prognosis. However, PWE and COVID‐19 may present somewhat differently than others with such an illness. Why PWE less often present with cough and more often present with gastrointestinal symptoms is not clear yet and should be investigated and clarified in the future studies. [ABSTRACT FROM AUTHOR]

This study aimed to systematically review the literature on the epidemiology of epilepsy in Iran and to provide analytical estimates of the prevalence of various epilepsy syndromes. MEDLINE, Scopus, and Embase from inception to 30 July 2020 were systematically searched. These key words were used: "epilepsy" OR "seizure" AND "Iran." In the second part of the study, the prevalence of various epilepsy syndromes in Iran was estimated based on the data from previous studies. We could identify 17 related articles. Three studies had class 2, and the rest provided class 4 of evidence. Two population‐based studies provided the prevalence rate of epilepsy in Iran: 0.8% and 1.2%. In one clinic‐based study, 20.2% of the patients were diagnosed as having idiopathic generalized epilepsy (IGE). In another clinic‐based study, 5.4% of the patients were diagnosed to have Lennox‐Gastaut syndrome. No study has provided data on focal epilepsy syndromes other than temporal lobe epilepsy (TLE) in Iran. While high‐quality data from Iran on the epidemiology of epilepsy syndromes are scarce, based on the available data and extrapolations form other data from other world regions, we can estimate that the prevalence of epilepsy in Iran is about 1% and about 840,000 people currently have active epilepsy. From the whole population of people with epilepsy in Iran, about 168,000 people have IGEs, tens of thousands suffer from symptomatic generalized epilepsies, and approximately, 126,000–226,800 people suffer from TLE. There is a need for well‐designed population‐based epidemiological studies on the topic. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the current study was to determine whether COVID-19 is associated with a different presenting clinical picture or a more severe course of illness in people with Down syndrome (DS). Methods: All consecutive patients who were admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from 19 February 2020 to 20 November 2020 were included. For every patient with DS, three age- and sex-matched patients with COVID-19 and without any underlying medical conditions were selected as controls. Results: During the study period, 37,968 patients were hospitalized with a diagnosis of COVID-19. Eighteen patients had DS. Patients with DS were significantly more likely to be intubated [7 patients (39%)] compared with those without DS [3 patients (6%)]; p = 0.002. Patients with DS significantly more often died of COVID-19 compared with the controls [8 (44.4%) vs. 1 (1.9%); odds ratio: 24.37; 95% confidence interval 2.39–247.94; p = 0.007]. Conclusion: Patients with DS are among the high-risk populations with respect to severe COVID-19 and should receive the vaccine as soon as possible. Furthermore, they should receive more intensive care if they get hospitalized with the illness. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the rate of employment in patients with functional seizures (FS) in a follow‐up study. We also investigated the rate of receiving disability benefits in these patients. Finally, we investigated factors that are potentially associated with their employment status. Methods: In this long‐term study, all patients with FS, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 to 2018, were investigated. In a phone call interview to the patients in February 2020, we tried to obtain the following information: seizure outcome, employment status, receiving disability benefits, and their current drug regimen, if any. The first call was made in the evening and after working hours. In case of no response, we made two more attempts in the following weeks to contact the patients during different time periods of the day. Results: Eighty‐ four patients participated. Thirty‐one patients (37%) were employed, and 53 people (63%) were not; at the first visit, the rate of employment was 23%. Female sex (Odds Ratio [OR]: 12.18; 95% Confidence Interval [CI]: 3.51–42.18; p =.0001), taking psychiatric drugs (OR: 4.93; 95% CI: 1.17–20.73; p =.02), and being employed previously (OR: 0.19; 95% CI: 0.04–0.77; p =.02) were independently significantly associated with the current employment status. Three patients (4%) reported receiving disability social benefits, two women and one man. Conclusion: This study highlights that unemployment is a serious issue in patients with FS and psychiatric comorbidities play a significant role in the employment status in these patients. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the current study was to collect the data on the occurrence of seizures in patients with COVID-19 and to clarify the circumstances of the occurrence of seizures in these patients. Methods: All consecutive patients who referred to healthcare facilities anywhere in Fars province (located in South Iran with a population of 4.851 million people) from February 19 until June 2, 2020, and had confirmed COVID-19 by positive result on polymerase chain reaction testing and seizure were included. Results: During the study period, 6,147 people had confirmed COVID-19 in Fars province, Iran; 110 people died from the illness (case fatality rate 1.79%). During this time period, five people had seizures (seizure rate 0.08%). In four patients, seizure was one of the presenting manifestations, and in one person, it happened during the course of hospital admission. Two patients had status epilepticus. All patients experienced hypoxemia and four of them needed respirator. Two patients had related metabolic derangements and one had cerebrospinal fluid (CSF) lymphocytic pleocytosis. Brain imaging was abnormal in three patients. Four patients died. Conclusion: New-onset seizures in critically ill patients with COVID-19 should be considered as acute symptomatic seizures and the treating physician should try to determine the etiology of the seizure and manage the cause immediately and appropriately. Detailed clinical, neurological, imaging, and electrophysiological investigations and attempts to isolate SARS-CoV-2 from CSF may clarify the role played by this virus in causing seizures in these patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of COVID‐19 pandemic on patients' perceptions of hardship in obtaining their drugs and if this pandemic and the social restrictions in response to that has resulted in any changes in their seizure control status. We also investigated factors potentially associated with the perceptions of difficulty in obtaining their drugs (eg, polytherapy vs monotherapy, taking imported drugs, and seizure status worsening). Methods: We surveyed a random sample of patients with epilepsy, who were registered in our database at Shiraz Epilepsy Center, Iran, on their perceptions on two issues: (a) What has been your experience on obtaining your antiseizure medications in the past 4 weeks (compared to before)? (b) Have you experienced any changes in your seizure control status in the past 4 weeks? Results: We included 100 patients (53 male and 47 female patients). In response to the question "Have you had any difficulties in the past 4 weeks to obtain your drugs?," 31 people (31%) expressed hardship obtaining their drugs. In response to the question "How has been your seizure control status compared with before?," six people (6%) expressed worsening of their seizure control status in the past 4 weeks. None of the patients reported symptoms of coronavirus infection. Conclusion: About one‐third of patients with epilepsy expressed significant hardship obtaining their drugs after the intensification of the COVID‐19 outbreak in Iran. The current COVID‐19 pandemic could be considered as a major shock to a nation that has already been under significant pressure (ie, Iran). [ABSTRACT FROM AUTHOR]

Purpose: We investigated medical comorbidities in patients with psychogenic non-epileptic seizures (PNES). We hypothesized that these patients commonly have significant medical comorbidities. Methods: In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were investigated. Age, gender, age at seizure onset, seizure semiology, and characteristics, known medical (organic) comorbidities reported by the patients and video-electroencephalography recordings of all patients were registered routinely. Results: During the study period, 272 patients with PNES-only had the inclusion criteria and were studied. Sixty-five patients (24%) reported having a medical (organic) comorbidity. The most commonly reported medical comorbidity was thyroid disorder. Age at onset (OR: 1.058; 95% CI: 1.026–1.090; p = 0.0001), duration of disease before the diagnosis (OR: 1.071; 95% CI: 1.025–1.119; p = 0.002), and sex (female) (OR: 1.97; 95% CI: 1.016–3.834; p = 0.04) were significantly associated with having medical comorbidities. Conclusion: While we did not have a control group to provide the number and type of medical problems that are expected in the general population, and therefore our results should be interpreted with caution, we had some intriguing observations. About one quarter of patients with PNES reported having medical comorbidities. The exact nature of the relationship between medical illnesses and PNES is not clear; however, hypothetically they could have a complex relationship. This study provides valuable information on the frequency and nature of medical comorbidities in patients with PNES and opens new horizons for future research. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the relationship between the clinical features of patients with psychogenic nonepileptic seizures (PNES) and referrals for brain imaging tests. We also hypothesized that some clinical factors might be associated with structural brain imaging abnormalities in these patients.Methods: In this retrospective study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were studied.Results: One hundred thirty-two patients had a brain magnetic resonance imaging (MRI) study available. Forty-seven patients (36%) had abnormal finding(s) in their MRI. Age (odds ratio = 1.040, p = 0.02), and comorbid epilepsy (odds ratio = 3.006, p = 0.005) were significantly associated with having an abnormal brain MRI. In a subanalysis, we excluded the patients with comorbid epilepsy (46 patients). From the remaining 86 patients (with PNES only), 23 patients (26.7%) had abnormal findings on their MRIs. Common epileptogenic structural brain abnormalities (e.g., tumors, mesial temporal sclerosis, encephalomalacia, and developmental anomalies) were common in patients with comorbid PNES and epilepsy (in 19 out of 46 patients; 41%), but not in those with PNES only (in 4 out of 86 patients; 5%) (p = 0.00001).Conclusion: While the evidence is convergent on the relatively high prevalence of structural brain abnormalities in patients with PNES, the data so far is suboptimal. In order to investigate the significance of structural brain abnormalities in the development of PNES, future well-designed multicenter studies, which include a large number of patients with a unified methodology of imaging, are desirable. [ABSTRACT FROM AUTHOR]

The aim of this multicenter international cross-cultural study was to compare clinical variables in a large sample of people with adult-onset psychogenic nonepileptic seizures (PNES). In this retrospective study, we evaluated persons with documented PNES, who were older than 16 years of age at the onset, from four countries (i.e., Iran, Brazil, Venezuela, and Argentina) regarding their age, gender, PNES semiology, and possible predisposing factors. We included 389 patients (244 from Iran, 66 from Brazil, 51 from Venezuela, and 28 from Argentina). Age at diagnosis was 32 ± 9 years (range: 17–64 years), and age at the onset of seizures was 27 ± 8 years (range: 17–49 years). There was a female predominance in all countries. The demographic characteristics and factors associated with PNES were similar among the countries. However, there were significant semiological differences among the countries. This study corroborates the notion that PNES share more similarities than differences cross-culturally and across international borders. However, the background determined by cultural, ethnic, and religious differences may influence the semiology of PNES. Further cross-cultural studies involving more than two continents may advance our understanding of PNES. • We included 389 patients (244 from Iran, 66 from Brazil, 51 from Venezuela, and 28 from Argentina). • There was a female predominance in all countries. • The demographic characteristics and factors associated with PNES were similar among the countries. • However, there were significant semiological differences among the countries. [ABSTRACT FROM AUTHOR]

Objective: We investigated the frequency of reported sexual abuse in patients with psychogenic nonepileptic seizures (PNES) in a Middle-Eastern culture (Iran) and tried to characterize the association between a history of sexual abuse and the clinical characteristics of PNES in these patients.Methods: In this retrospective database study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 until 2018, were studied. Patients were categorized into two groups: (1) those with a history of sexual abuse and (2) those without such a history.Results: A total of 314 patients were studied. Twenty-six patients (8.3%) had a history of sexual abuse, while 288 patients (91.7%) denied having such an experience. Sex ratio (OR: 3.53; 95% CI: 1.14-10.89; p = 0.02) and a history of child abuse (OR: 4.85; 95% CI: 1.82-12.96; p = 0.002) were significantly associated with a history of sexual abuse.Conclusion: Some people with a history of sexual abuse are at risk of developing PNES later in their lives. While social, cultural, and even genetic predisposition may be interacting for such an association to come to play, there is no concrete direct evidence to clarify this link yet. This should be investigated in future international cross-cultural studies and also highlights the need for planning genetic studies in patients with PNES. [ABSTRACT FROM AUTHOR]

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. 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. 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. 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. • Cooccurrence of a seizure in a patient with MS may complicate the management process. • The objective of our endeavor was to reach to a consensus on how to manage seizure(s) in patients with MS. • We reviewed these 17 articles and also some other references for the purpose of our review. [ABSTRACT FROM AUTHOR]

• Those with late-onset FS were more likely to have medical comorbidities. • Those with late-onset FS more likely had a history of head injury. • Duration of illness was significantly longer in patients with childhood-onset FS. We investigated childhood-onset functional seizures (FS) and late-onset FS and hypothesized that there are differences in their characteristics. In this retrospective study, we investigated all patients with confirmed FS with an age at onset of 14 years or younger and those with an age at onset of 50 years or older, who were admitted to the epilepsy monitoring units at one center in Iran (Shiraz Comprehensive Epilepsy Center, from 2008 until 2022) and one center in the USA (Vanderbilt University Medical Center, from 2011 until 2022). One-hundred and forty patients were included. They included 80 patients with childhood-onset FS and 60 with late-onset FS. Those with late-onset FS were more likely to have medical comorbidities compared with the patients with childhood-onset FS (OR = 13.9). Those with late-onset FS more likely had a history of head injury compared with the patients with childhood-onset FS (OR = 5.97). Duration of illness was significantly longer in patients with childhood-onset FS compared with the patients with late-onset FS (6 years vs. 2 years). Our study identified several similarities and differences in the clinical characteristics and predisposing factors of patients with childhood-onset and late-onset FS. In addition, we found that childhood-onset FS is more likely to remain undiagnosed and thus untreated for many years. These findings provide additional evidence that FS is a heterogenous condition and we propose that a proportion of the differences between patients may be accounted for by age-associated factors. [ABSTRACT FROM AUTHOR]

On May 8, 2018, the United States announced that it was withdrawing from the Iran nuclear deal. This has resulted in reimposition of the economic hardship on Iran. We investigated the patients' perceptions of hardship in obtaining their antiepileptic drugs (AEDs) after the reimposition of sanctions. We surveyed patients with epilepsy visiting three centers in Iran on February 2nd to 6th (easy sampling) on their perceptions on two issues: 1. What has been your experience on obtaining your AEDs in the past six months? 2. Have you experienced any changes in your seizure control in the past six months? Two hundred and forty-four patients participated. Ninety-two patients (37.7%) claimed that they have had significant difficulty obtaining their AEDs, and 37 patients (15.2%) said that their AED(s) was not accessible. Ninety-six people (72%) of those receiving imported AEDs and 33 patients (30%) of those receiving homemade AEDs had significant hardship obtaining their drugs (p = 0.00001). Forty-seven patients (36%) of those who reported significant hardship obtaining their AEDs and 25 (22%) of those who did not, perceived worsening of their seizures (p = 0.017). Sanctions have affected ordinary people, especially those who are vulnerable the most (i.e., patients), significantly. • 244 patients participated. • 92 patients (37.7%) claimed that they have had significant difficulty obtaining their AEDs. • 37 patients (15.2%) said that their AED(s) was not accessible. • 72% of those receiving imported AEDs and 30% of those receiving home-made AEDs had hardship (p = 0.00001). • Sanctions has affected ordinary people, especially those who are vulnerable the most (i.e., patients), significantly. [ABSTRACT FROM AUTHOR]

Abstract Purpose We compared various clinical characteristics of psychogenic nonepileptic seizures (PNES) between young patients from Iran, Saudi Arabia, and Canada, three nations with significantly different socioeconomic and demographic characteristics. This international cross-cultural comparative study may advance our knowledge and understanding of PNES in children and adolescents across the cultures and borders. Methods In this retrospective study, we investigated all patients 16 years of age or younger, with PNES admitted to the epilepsy monitoring units at one center in Iran, one center in Saudi Arabia, and one center in Canada. Age, gender, age at seizure onset, seizure semiology, seizure frequency, factors potentially predisposing to PNES, and video-electroencephalography (EEG) recording of all patients were registered routinely and compared between the nations. Results Fifty-one patients were studied (22 from Iran, 14 from Saudi Arabia, and 15 from Canada). Age at the diagnosis was 13.4 ± 2.2 years (range: 8–16 years), and age at the onset of seizures was 12.3 ± 2.7 years (range: 5–16 years). Demographic and clinical characteristics of and associated factors in the patients among the three nations were not significantly different. Twenty-six (51%) patients were taking antiepileptic drugs at the time of diagnosis; the difference was not statistically significant between the nations (13 patients in Iran, 6 in Saudi Arabia, and 7 patients in Canada; P = 0.5). Conclusion Young patients with PNES across borders and between cultures share more similarities than differences with regard to their demographic and clinical characteristics. Highlights • Fifty-one patients were studied (22 from Iran, 14 from Saudi Arabia, and 15 from Canada). • Age at the onset of seizures was 12.3 ± 2.7 years (range: 5–16 years). • Characteristics of and associated factors in the patients among the three nations were not significantly different. • Young patients with PNES across borders and between cultures share more similarities than differences. [ABSTRACT FROM AUTHOR]

• Having any questions about COVID-19 vaccination was significantly associated with not being vaccinated. • Questions about the adverse effects of COVID-19 vaccines were the most common questions. • Other important issues included indications of these vaccines and drug-vaccine interactions. The aim of the current study was to inquire the questions and concerns of people with epilepsy (PWE) about COVID-19 vaccines in order to provide a more realistic list of their frequently asked questions (FAQs). We surveyed all the consecutive PWE or their care-givers who were referred to our neurology clinics (Shiraz University of Medical Sciences) during January-February 2022. We collected their questions and concerns in relation to COVID vaccines based on a predesigned brief questionnaire. Informed consent to participate in the study was obtained from the participants. In total, 452 people participated in the study; 291 people (64.4%) did not have any questions or concerns with regard to the COVID-19 vaccination. Having any questions or concerns about COVID-19 vaccination was significantly associated with not being vaccinated. Questions and concerns about the adverse effects of COVID-19 vaccines [seizure worsening, general adverse effects, long-term effects (e.g., infertility, cognitive dysfunction)] were by far the most common questions by people with epilepsy and their carers. Our findings may be used by policy-makers to prepare appropriate educational materials to provide the best targeted and tailored information to people with epilepsy and their carers to convince them of the necessity and safety of COVID-19 vaccination. Such an educational material must include enough information on the associated adverse effects of COVID-19 vaccines and should also discuss some other important issues such as indications of these vaccines in special populations and drug-vaccine interactions. [ABSTRACT FROM AUTHOR]

Objective This study investigates the awareness and perception on "epilepsy" amongst biology teachers in Fars province, Iran. Materials & Methods A sample of high school biology teachers in Fars province, Iran, filled out an investigator designed questionnaire including questions about their knowledge and attitude concerning "epilepsy". There were 17 questions in the questionnaire. Nine questions addressed the knowledge and the rest were about attitude and perception. Results Forty two teachers completed the questionnaires. More than two-thirds of the participants had a fairly desirable awareness about the definition; whereas, only approximately 40% knew something about the etiology and treatment of epilepsy. More than two-thirds of the participants had a positive attitude towards epilepsy; however, misconceptions and negative attitudes were observed. Conclusion Educational programs for biology teachers and also other teachers are necessary to improve their knowledge, attitude and perception about epilepsy. [ABSTRACT FROM AUTHOR]

Objective: Several antiepileptic drugs (AEDs) such as phenobarbital (Pb), carbamazepine (CBZ), and valproate (VPA) may suppress interictal epileptiform activity. We investigated the effects of AEDs on electroencephalography (EEG) data from patients with idiopathic generalized epilepsy (IGE). Materials & Methods: In this cross-sectional study, all patients electroclinically diagnosed with IGE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 through August 2010. A routine EEG was requested at the time of referral for all patients. Statistical analyses were performed using Chi square and Fisher's exact test. Results: This study comprised of 336 patients. For about 20.8% (70 patients) of them, the initial EEG appeared normal. The first EEG was normal in 14.2% of the patients who had newly diagnosed IGE (19 patients). Normal EEG was also detected for 27.6% of the patients who received VPA monotherapy (16 patients), 31% of the patients who received CBZ monotherapy (9 patients), 29.4% of the patients who received Pb monotherapy (5 patients), and 11.1% of the patients who received lamotrigine (LTG) (1 patient). Conclusion: This study shows that compared to LTG, VPA suppresses generalized interictal epileptiform activity in patients with IGE more effectively. Theoretically, if a drug can frequently induce normalization of EEG, then it may be a better drug for treating IGEs. [ABSTRACT FROM AUTHOR]

Background: World Health Organization declared pandemic phase of human infection with novel influenza A (H1N1) in April 2009. There are very few reports about the neurological complications of H INI virus infection in the literature. Occasionally, these complications are severe and even fatal in some individuals. The aims of this study were to report neurological complaints and/or complications associated with H1N1 virus infection. Methods: The medical files of all patients with H INI influenza infection admitted to a specified hospital in the city of Shiraz, Iran from October through November 2009 were reviewed. More information about the patients were obtained by phone calls to the patients or their care givers. All patients had confirmed H1N1 virus infection with real-time PCR assay. Results: Fifty-five patients with H1N1 infection were studied. Twenty-three patients had neurological signs and/or symptoms. Mild neurological complaints may be reported in up to 42% of patients infected by H1N1 virus. Severe neurological complications occurred in 9% of the patients. The most common neurological manifestations were headache, numbness and paresthesia, drowsiness and coma. One patient had a Guil- lain-Barre syndrome-like illness, and died in a few days. Another patient had focal status epilepticus and encephalopathy. Conclusions: The H1N1 infection seems to have been quite mild with a self-limited course in much of the world, yet there appears to be a subset, which is severely affected. We recommend performing diagnostic tests for H INI influenza virus in all patients r with respiratory illness and neurological signs/symptoms. We also recommend initiating treatment with appropriate antiviral drugs as soon as possible in those with any significant neurological presentation accompanied with respiratory illness and flu-like symptoms. [ABSTRACT FROM AUTHOR]

• Five hundred and seventy-eight trainees and 53 attendings participated in the study. • Trainees had different opinions on their educational needs about epilepsy. • The opinions of the trainees and their attendings were mostly similar. To investigate the opinions of medical students, residents in different disciplines, and clinical attendings in various disciplines on the educational needs and learning objectives about epilepsy at the basic and intermediate levels of medical education. On July 15th, 2021, we posted an online invitation including a questionnaire to all the medical students, residents, and attendings of Shiraz University of Medical Sciences, Iran. The survey anonymously collected data about the participants [sex, age, educational level, and their disciplines (attendings)], and answers to the questions about their opinions about the educational needs and learning objectives of the medical students and residents about epilepsy. Five hundred and seventy-eight trainees and 53 attendings participated in the study. Trainees at different educational levels and in various disciplines had significantly different opinions on their educational needs and learning objectives about epilepsy. At the undergraduate level, the opinions of the trainees and their attendings were similar and the most reported needs by both groups included: Terminology and definitions, Physiopathology and etiology, Semiology and clinical characteristics, Medical treatment, Comorbidities. For the residents in neurology, psychiatry, and neurosurgery, the most reported needs included: all aspects of epilepsy. Trainees at various educational levels/disciplines in medicine have different educational needs and learning objectives with regard to epilepsy and management of PWE. Policy makers in medical education should consider the observations of this study in order to design tailored and targeted educational curricula about epilepsy for various educational levels/disciplines in medicine. [ABSTRACT FROM AUTHOR]

Summary: Background: The importance of consanguinity and its association with epilepsy has been suggested in some studies, but in one study the risk contributed to consanguinity for childhood epilepsy was not significanta. In the present study, there was an attempt to determine if consanguinity has any important association with epilepsy. Methods: All the epileptic children and adolescents up to the age of 18 years, who had been referred to Motahary Clinic in Shiraz, Iran, during a six-month period, were included in this cross-sectional study. The percentage of consanguinity in parents of the epileptic patients was compared to a sample of the general population in the same geographical area. Results: In total, 181 unrelated epileptic children were included in this study. The mean age of these children was 7±4.6 years. The male/female ratio in these patients was 1.29. Overall, 61(33.7%) of the parents were first cousins (OR=2.264, 95%-CI: 1.618–3.169 in comparison to the general population), 37 (20.4%) were second cousins (OR=3.557, 95%-CI: 2.389–5.296), and 83 (45.9%) were not related. Conclusions: The percentage of consanguinity in parents of the epileptic patients was significantly higher in comparison to a sample of the general population (OR=2.612, 95%-CI: 1.929–3.536, P<0.0001) which signifies the importance of consanguinity as a potential risk factor for epilepsy. In this regard, more education and awareness of young individuals about the increased risk of epilepsy after familial marriages (at least by 2.2 folds), as well as pre-marriage counseling for couples who have a family history of epilepsy are necessary as an effective preventive program. [Copyright &y& Elsevier]

• The rates of the married status were not significantly different between the two groups. • One hundred and one patients with FS (52%) and 205 PWE (45%) were married (p = 0.104). • In the general population, 64% of all people older than 16 years of age were married. • This rate is significantly higher than the rate of the married status among patients. We investigated the marital status (married vs. none) among patients with seizures [i.e., epilepsy or functional seizures (FS)]. This was a retrospective study of an electronic database of patients with seizures. All young adult patients, 18 to 45 years of age, with a diagnosis of either epilepsy or FS were studied at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020. The two groups were matched for their age at diagnosis. Age at onset, sex, the marital status, and the final diagnosis were registered routinely. During the study period, 194 patients with FS and 455 patients with epilepsy fulfilled the inclusion criteria. The rates of the married status were not significantly different between the two groups; 101 patients with FS (52%) and 204 PWE (45%) were married (p = 0.103). In the general population in Iran, 42,399,792 out of 66,421,989 (64%) of all people older than 16 years of age were married. This rate is significantly higher than the rate of the married status among patients with FS (p = 0.0006) and also those with epilepsy (p = 0.00001). While the rates of the married status were not significantly different between PWE and those with FS, these rates were significantly lower than that in the general population in Iran. There are intriguing cross-cultural similarities and differences between our observations and those from other nations. These should be investigated in large multicenter international studies in the future. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the rate of consanguinity of parents of the patients with psychogenic nonepileptic seizures (PNES). This would provide important information for future studies on the potential genetic bases of PNES. In this retrospective study, all patients with PNES, who were studied at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, from 2008 to 2018, were recruited. We categorized the patients as (1) no consanguineous marriage of the parents and (2) with consanguineous marriage of the parents. Three-hundred and sixteen patients had the data on their parental consanguinity available and were studied. The sex ratio (female:male) of the patients was 1.92 (208:108). Parents of 110 (35%) patients had consanguineous marriage, and parents of 206 (65%) patients did not. Demographic variables, seizure-related variables, PNES-associated factors, and the use of antiepileptic drugs were not significantly associated with parental consanguinity in the patients. In this study, we observed that more than one-third of the patients with PNES had parental consanguinity. This rate is very similar to the rate of consanguinity in the general population in Iran. • 316 patients with psychogenic nonepileptic seizures (PNES) were studied. • Parents of 110 (35%) patients had consanguineous marriage. • Parental consanguinity in patients with PNES was not different from that in the general population. • No variable was significantly associated with parental consanguinity in the patients. [ABSTRACT FROM AUTHOR]

• Four hundred and forty patients were included. • One hundred and twenty six people (30%) had college education, 142 (33%) were employed, and 101 (28%) drove a motor vehicle. • None of the social characteristics of the patients showed significant differences between the groups. To explore various social aspects of life (i.e., employment, education, and driving) in a large sample of patients with functional seizures (FS) living in seven countries from four continents. In this retrospective study, we investigated adult patients with FS, who were admitted to the epilepsy monitoring units at centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We studied the social aspects of life in the whole cohort. Then, we compared the social aspects of life between different world regions. Four hundred and forty patients were included (241 from Iran, 56 from Qatar, 52 from France, 41 from the USA, 19 from UAE, 18 from Egypt, and 13 from Georgia). One hundred and twenty six people (30%) had college education, 142 (33%) were employed, and 101 (28%) drove a motor vehicle in their routine daily lives. People with FS and college education were more likely to report a history of sexual abuse compared with those with a lower education. Patients with no loss of responsiveness with their FS were more likely to be employed. Male patients and patients without aura were more likely to drive a motor vehicle in their routine daily lives. None of the social characteristics of the patients with FS showed significant differences among the two large culturally different groups (Muslim nations vs. Christian nations). It appears that patients with FS across cultures have significant problems in their social aspects of life. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the marital status in a cohort of patients with functional seizures from seven countries in four continents. Factors associated with marital status were also explored. Adult patients with functional seizures who were admitted to the epilepsy monitoring units at centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE) were retrospectively identified. Marital status was assessed in the whole cohort. Four hundred thirty-two patients were included (241 from Iran, 52 from France, 48 from Qatar, 41 from the USA, 19 from UAE, 18 from Egypt, and 13 from Georgia); 302 were women and 130 were men. One hundred fifty (35%) subjects were single, 245 (57%) were married, and 37 (8%) were separated (31 divorced, 7%; 6 widowed, 1%). Auras with functional seizures were less frequently reported by single people in comparison with that by married patients (54% vs. 61%) [odds ratio (OR) = 0.58]. Separated people compared with those who were married less often had auras with their functional seizures (27% vs. 61%; OR = 0.26) and more often reported a history of sexual abuse (49% vs. 12%; OR = 6.14). The marital status has significant associations with the semiology of functional seizures. A history of sexual abuse is significantly associated with being separated and should be inquired and tackled appropriately during the management process of patients with functional seizures. • Iran: 241 patients, France: 52 , Qatar: 48, USA: 41, UAE: 19, Egypt: 18, and Georgia: 13 patients • One hundred fifty (35%) subjects were single, 245 (57%) were married, and 37 (8%) were separated. • Auras were less frequently reported by single people in comparison with married patients. • Separated people compared with those who were married more often reported a history of sexual abuse. [ABSTRACT FROM AUTHOR]

We conducted a multicenter international cross-cultural comparative study to investigate clinical semiology and predisposing factors of functional seizures in a large cohort of patients living in different countries around the world. We hypothesized that semiology and predisposing factors of functional seizures differ between various world regions. We conducted this retrospective observational study in adults with functional seizures admitted to epilepsy centers in Iran, Qatar, USA, France, Georgia, Egypt, and United Arab Emirates (UAE). We assessed and compared the demographic and clinical seizure characteristics of these patients, according to the patients' reports and review of the ictal recordings during video-electroencephalogram (EEG) monitoring. Five hundred nine patients were included (270 from Iran, 74 from Qatar, 63 from France, 43 from the USA, 22 from Egypt, 20 from UAE, and 17 from Georgia). Although all major manifestations of functional seizures (e.g., aura, loss of responsiveness, generalized motor seizures, ictal injury) were seen in all world regions, seizure semiology differed significantly across countries. Auras, ictal urinary incontinence, and ictal injury were more commonly reported by the American patients than patients from other world regions, whereas loss of responsiveness and generalized motor seizures were more frequently observed in the Iranian and American patients than the European and Arab patients. Semiology of functional seizures seems to vary across various regions of the world; socioeconomic, cultural, ethnic, and religious differences may play an essential role in the modulation of functional seizures semiology across different nations and cultures. • We conducted a multicenter international cross-cultural comparative study of functional seizures. • Frequencies of the investigated clinical characteristics of the patients were different between the world regions. • Frequencies of the risk factors were different between the world regions. • Sociocultural background is probably an important determinant of functional seizures semiology. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Psychogenic non-epileptic seizures (PNES) are more prevalent among women. We investigated the potential differences in demographic and clinical characteristics of PNES between women and men. Methods: In this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2012. The epileptologist interviewed all the patients. We compared the demographic and clinical characteristics and seizure semiology of PNES between women and men. Results: Two hundred and twenty-two patients were diagnosed as having PNES. One hundred and eighty-eight patients had video-EEG recordings available and included in the study. One hundred and twenty-nine (69%) were female and 59 (31%) were male. There were no significant differences between women and men with PNES with regard to demographic, clinical and semiological characteristics. Conclusion: We did not observe any significant demographic differences between women and men with PNES. Likewise, seizure characteristics and semiology were very similar in both genders. It appears that an Islamic lifestyle (in Iran) has little influence on the sex ratio and clinical manifestations of PNES compared with the Western studies. [Copyright &y& Elsevier]

Background: The present study was conducted to determine if performing laboratory tests are necessary to exclude other possible diagnoses in a child with limb pains typical for growing pains according to history and physical examination. Methods: A matched case–control study was carried out on children with limb pains who attended the Motahary clinic, Shiraz, Iran, in a 2 year period. The inclusion criteria were limb pains, which were recurrent and lasted for more than 3 months. The exclusion criteria were any abnormal systemic symptoms and signs, localizing signs, joint involvement; and limp or limitation of activity. The controls were clinically normal children matched for age and sex. Laboratory tests including complete blood count, erythrocyte sedimentation rate, serum calcium, phosphorus, alkaline phosphatase and rheumatoid factor were done for all patients and controls. Results: In total, 100 patients and 150 controls were included in the study. There were no significant differences between the patients and controls with regard to all of the measured laboratory tests. Conclusion: Growing pain is a clinical diagnosis and if precise inclusion and exclusion criteria in history and physical examination are considered, there will be no need for laboratory tests in order to make a diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the rate of acceptance of functional seizures (FS) or psychogenic nonepileptic seizures (PNES) diagnosis in a cross-sectional study in a cohort from Iran. We hypothesized that the acceptance of FS diagnosis has association with clinical characteristics of the patients.Methods: In this cross-sectional study, all patients with FS, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2018, were investigated. In a phone call interview in February 2020, we obtained the following information: whether they have accepted the diagnosis that was delivered to them; what is their seizure outcome (seizure-free during the past 12 months or not).Results: 100 patients participated; at the time of the follow-up call, 74 (74%) patients expressed that they have accepted the diagnosis of FS. At the follow-up call, 48 patients (48%) were seizure-free and 52 patients (52%) were suffering from FS yet; 34 of seizure-free patients (71%) and 40 of those patients who still had seizures (77%) expressed that they have accepted the diagnosis of FS (p = .504; Fisher's exact test). Patients' characteristics and seizure semiology were not associated with the acceptance of the diagnosis of FS.Conclusion: That the majority of patients with FS accept their diagnosis if it is delivered to them appropriately, and demographic and clinical characteristics of the patients do not have associations with this. [ABSTRACT FROM AUTHOR]

• During the study period, 274 patients with PNES-only had the inclusion criteria and were studied. • Seventy-seven (28%) patients had a positive family history of seizures and 197 (72%) patients did not have such a history. • There were no demographic or clinical differences between these two groups. If a positive family history of seizures plays a significant role that contributes to the risk for developing psychogenic nonepileptic seizures (PNES) by means of model learning, one would expect that patients with PNES with a family history of seizures show a different semiology than those without such a history. We investigated whether the above hypothesis is valid. In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center at Shiraz University of Medical Sciences, Iran, from 2008 until 2019, were investigated. Demographic and clinical characteristics were compared between patients with a positive family history of seizures and those without such a history During the study period, 274 patients with PNES-only had the inclusion criteria. Seventy-seven (28%) patients had a positive family history of seizures and 197 (72%) patients did not have such a history. There were no significant demographic or clinical differences between the two groups. It seems that a positive family history of seizures and model learning does not play a significant role in the development of PNES. Investigators should explore other potentially significant contributors and risk factors for developing PNES in future studies. [ABSTRACT FROM AUTHOR]

We investigated the rate of driving in patients with psychogenic nonepileptic seizures (PNES) from a large cohort in Iran. We hypothesized that these patients commonly do not drive. We also investigated the potential factors that may be associated with driving in these patients. In this retrospective study, all patients with PNES, who were diagnosed at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 until 2019, were investigated. Age, gender, age at seizure onset, seizure semiology and characteristics, driving history reported by the patients, and video-electroencephalography recordings of all patients were registered routinely. During the study period, 221 patients with PNES only had the inclusion criteria and were studied. Forty-eight patients (21.7%) reported that they were driving a car in their routine daily lives. Male sex (odds ratio: 13.2; 95% confidence interval: 4.98–35.45; p = 0.0001) and being employed (odds ratio: 8.08; 95% confidence interval: 3.16–20.69; p = 0.0001) were independently significantly associated with driving. We observed that only about one-fifth of adult patients with PNES reported driving. It is important for the scientific community to develop practice guidelines on how to counsel patients and also the related authorities (e.g., department of motor vehicle authorities) on driving restrictions in people who are affected with PNES. • Forty-eight patients (21.7%) reported that they were driving a car in their routine daily lives. • Male sex (odds ratio: 13.2; 95% confidence interval: 4.98–35.45; p = 0.0001) was significantly associated with driving. • Being employed (odds ratio: 8.08; 95% confidence interval: 3.16–20.69; p = 0.0001) was significantly associated with driving. [ABSTRACT FROM AUTHOR]

The aim of the current study was to gather the views of healthcare providers practicing in the field of psychogenic nonepileptic seizures (PNES) on the issue of "disability benefits eligibility and PNES". This was a questionnaire study that was sent to all neurologists and psychiatrists practicing in Fars province, Iran. The survey included seven questions: one question about professional qualifications, one question on the participants' personal experience with the topic of interest (i.e., PNES), and five questions probing their opinions about the matter of interest (i.e., the issue of disability benefits eligibility in PNES). The response rate was 72%. Respondents included 32 psychiatrists and 31 neurologists. In response to the question "Do you think that patients with PNES should be counseled to avoid performing all jobs or professions as long as they have active PNES?", 47 (75%) physicians answered "no" (22 neurologists and 25 psychiatrists; P =.5). In response to the question "Do you think that patients with PNES should be qualified for disability benefits?", 47 (75%) physicians answered "Patients with specific jobs or professions should be qualified for disability benefits" (23 neurologists and 24 psychiatrists; P = 1); while, nobody believed that "All of them should be qualified for disability benefits". While collection of the opinions of physicians is valuable, this is just one piece of the puzzle; future studies should investigate the opinions of other stakeholders. More importantly, investigators should explore whether patients with PNES have any job-related difficulties. • Most physicians believed that no all patients with PNES should be counseled to avoid performing all jobs. • In defining active PNES, many endorsed a 6- to 12-month seizure-free period. • Many physicians believed that patients with specific jobs should be qualified for disability benefits. [ABSTRACT FROM AUTHOR]

Previous studies from a few countries have reported semiological differences in younger children compared with adolescents or adults with psychogenic nonepileptic seizures (PNESs). This study tested the hypothesis that semiological, demographic, and historical risk factors vary with different ages of PNES onset in a large cohort from different countries. In this retrospective study, we investigated patients consecutively referred for PNES, who were admitted to epilepsy monitoring units in Iran, Brazil, Venezuela, Canada, Argentina, and USA. Age, gender, age at seizure onset, seizure semiology, and factors predisposing to PNES (abuse, stressors) were documented according to routine diagnostic practices at each center. Participants were grouped according to their age at onset (i.e., childhood, adolescence, or adulthood). A total of 448 patients were studied. Female predominance was associated with adolescent- (85/122, 70%) and adult-onset (190/270, 70%) but not in childhood-onset PNES (28/56, 50%) (p = 0.011). Event frequency in the month preceding the diagnosis was higher in the childhood- [ x ¯ = 50, standard deviation (sd) = 82, p = 0.025] versus adolescent- (x ¯ = 24, sd = 36) or adult-onset groups (x ¯ = 29, sd = 61). Significant between-group differences were observed for generalized body movements (p = 0.0001) and ictal injury (p = 0.027), suggesting more severe ictal presentations in adult-onset PNES compared with younger ages. Adult-onset patients were also more likely to be taking an unnecessary antiepileptic medication (p = 0.010). While PNES may present at any age, there appear to be notable differences across the lifespan with respect to some of the clinical characteristics. Further international and cross-cultural studies may reveal other interesting characteristics of PNES. • We included 448 patients from 6 countries (Iran = 262, Brazil = 85, Venezuela = 43, Canada = 21, Argentina = 19, and USA = 18). • There was a female predominance in adolescent and adult-onset PNES but not in childhood-onset patients. • Frequency of PNES events was significantly higher in the childhood-onset versus adolescent and adult-onset patients. • Generalized body movements and ictal injury were more common in adult-onset PNES than younger onset age groups. • Unnecessary antiepileptic medication was more likely to be prescribed among adult-onset PNES patients. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to scrutinize factors that are associated with a delay in making the diagnosis of psychogenic nonepileptic seizures (PNES). In this study, patients with PNES, who were investigated at Shiraz Comprehensive Epilepsy Center, Iran, from 2008 to 2019, were studied. We categorized the patients into the following: 1. those with a definite diagnosis of PNES in less than a year since the onset of their attacks; 2. those with a definite diagnosis of PNES later than 10 years since the onset of their attacks. During the study period, 330 patients were recorded. In 98 patients (30%), the diagnosis of PNES was made in less than a year since their seizure onset. In 67 patients (20%), the diagnosis of PNES was made later than 10 years since their seizure onset. Taking antiepileptic drugs (AEDs) (odds ratio (OR) = 6) and a history of ictal injury (OR = 3.6) had a positive association, and age at the onset (OR = 0.8) had an inverse association with a delay in receiving a definite diagnosis of PNES (p = 0.0001). Some demographic variables (i.e., early age at the onset of seizures), patients' clinical variables (i.e., severe seizure manifestations such as ictal injury), and finally, some physician-related variables (i.e., prescribing AEDs) have significant associations with a delay in making a definite diagnosis of PNES. • 330 patients were recorded. • In 98 patients (30%), the diagnosis of PNES was made in less than a year since their seizure onset. • In 67 patients (20%), the diagnosis of PNES was made later than 10 years since their seizure onset. • Taking AEDs and ictal injury had a positive and age at the onset had an inverse association with delayed diagnosis. [ABSTRACT FROM AUTHOR]

Background: Genetic diversity in human leukocyte antigen (HLA) alleles across populations is a significant risk factor for drug-induced severe cutaneous adverse reactions (SCARs), e.g., carbamazepine (CBZ)- and lamotrigine (LTG)-induced Stevens- Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). The present study aimed to investigate the frequency of different HLA alleles in Iranian patients with CBZ- and LTG-induced SJS/TEN. Methods: A case-control study was conducted from 2011 to 2018 at various hospitals affiliated with Shiraz University of Medical Sciences (Shiraz, Iran). A total of 31 patients receiving anticonvulsant drugs (CZB or LTG) were recruited and divided into two groups. The drug-induced group (n=14) included hospitalized patients due to CBZ- or LTG-induced SJS/TEN. The drug-tolerant group (n=17) included individuals receiving CBZ or LTG for at least three months with no adverse effects. In addition, 46 healthy individuals (control group) were recruited. The frequency of HLA-A, -B, and -DRB1 alleles in patients with CZB- or LTG-induced SJS/TEN was investigated. HLA typing was performed using the allele-specific polymerase chain reaction method. The Chi square test and Fisher's exact test were used to determine a potential association between SJS/TEN and HLA alleles. P<0.05 was considered statistically significant. Results: CBZ- or LTG-induced SJS/TEN was not significantly associated with HLA alleles. However, HLA-DRB1*01 showed a significantly higher frequency in patients with CBZ-induced SJS/TEN than the CBZ-tolerant patients (30% vs. 9%, P=0.07). Conclusion: Overall, no significant association was found between CBZ- or LTG-induced SJS/TEN and HLA alleles. Further largescale studies are required to substantiate our findings. [ABSTRACT FROM AUTHOR]

Background: While ventriculo-extracranial shunting procedures have been the standard treatment option for hydrocephalus for a long time, their long-term morbidity, including the development of post-shunt de novo seizures, should be taken into account. This study aimed to investigate the rate and risk factors of the occurrence of de novo post-shunt seizures in patients with hydrocephalus. Methods: In this retrospective longitudinal study, all patients with hydrocephalus who had ventriculo-peritoneal shunt insertion from 2014 to 2017 at Namazi Hospital, (Shiraz, Iran) were studied. Phone calls were made to all patients to obtain their postoperative seizure outcome and other data (e.g., sex, age at surgery, shunt insertion location, history of seizures before surgery, history of seizures after surgery, any other type of brain surgery, and the etiology of their hydrocephalus). The Pearson Chi Square was used for the analysis of binary variable (e.g., sex) differences, and the t test for the analysis of differences in the means of numerical variables (e.g., age). Bonferroni correction tests were also utilized. P values less than 0.05 were considered significant. Results: A total of 114 patients were included in the study. Overall, 68 (60%) patients had a frontal location of shunt insertion and 46 (40%) had a parietal site. Twenty-four (21%) patients reported experiencing de novo post-shunt seizures, 15 of which had a frontal location and nine a parietal location for shunt insertion (P=0.824). Conclusion: De novo post-shunt seizures are common occurrences. However, shunt location is not a significant risk factor for the development of de novo post-shunt seizures. [ABSTRACT FROM AUTHOR]

Opinions of healthcare professionals may shape their attitudes towards any given condition and patient population. The aim of the current study was to gather the views of healthcare providers on some of the issues on symptomatology and terminology of functional seizures (FS). This was a questionnaire study that was sent to all neurologists and psychiatrists practicing in Fars province, Iran. The survey included six questions: one question about professional qualifications, one question on the participants' personal experience with the topic of interest (i.e., FS), and four questions probing their opinions about the matter of interest. Of the 81 physicians approached, 69 responded (response rate: 85%; 32 psychiatrists and 37 neurologists). Physicians held varying opinions on some of the key issues (e.g., terminology, semiology, and driving permission) in this patient population. Participants were almost evenly split on how to make an advice on driving permission in these patients. Most physicians endorsed "psychogenic nonepileptic seizures" to label this condition. This study highlights some of the challenging issues surrounding FS. Investigators should explore the pathophysiology and nature of FS and whether these patients have any difficulties with driving and other important issues in their daily lives. • This study highlights some of the challenging issues surrounding functional seizures (FS). • Physicians held varying opinions on some of the key issues in this patient population. • Participants were almost evenly split on how to make an advice on driving permission in patients with FS. • Most physicians endorsed "psychogenic nonepileptic seizures" to label this condition. [ABSTRACT FROM AUTHOR]

The objectives of this study were 1) to review the literature about "job/employment and psychogenic nonepileptic seizures (PNES)" and 2) to gather the views of neurologists and psychiatrists on the issue of job consultation in patients with PNES. Phase one involved a systematic literature review; phase two involved the collection of the views of neurologists and psychiatrists, practicing in Fars province, Iran, on the issue of job consultation in patients with PNES. A questionnaire was designed for the purpose of this study. No studies were identified by the systematic review process on the issue of job consultation in patients with PNES. Of the 87 health-care professionals approached, 63 responded to the survey (response rate: 72%). Respondents included 31 neurologists and 32 psychiatrists. In response to the question "Should all patients with PNES be counseled to pursue any job or profession they would like?", 17 (55%) neurologists and 19 (59%) psychiatrists answered "no" (p = 0.8). While it is possible that some patients with PNES are more likely than other people in the general public to be involved in job-related difficulties (performing duties related to any job, accidents, etc.), there is currently no evidence supporting or refuting this proposition. However, in this study, the majority of the health-care professionals, who often deal with these patients, believed that not all patients with PNES should be counseled to pursue any job or profession they would like (i.e., there should be some restrictions). • No studies were identified by the systematic review process on the issue of job consultation in patients with PNES. • Many physicians believed that not all patients with PNES should be counseled to pursue any job or profession they would like. • There is currently no evidence supporting or refuting this proposition. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Distinguishing epileptic generalized tonic–clonic seizures (GTCS) from either psychogenic nonepileptic seizures (PNES) or vasovagal syncope (VVS) is important. In this study, we investigated the use of postictal serum creatine phosphokinase (CPK) concentrations in distinguishing between these events. Methods: Patients admitted to the Neurology Ward at Namazi Hospital in Shiraz, Iran, with an attack of transient loss of consciousness and abnormal movements witnessed by a neurologist were studied. We categorized the patients into three groups: 20 patients with GTCS, 22 with VVS, and 20 with PNES. A group of 20 normal healthy individuals were included in the study as the control group. Serum CPK concentration was measured 12–15h after the attack in all patients and at one time in the control group. A P value less than 5% was considered significant. Results: There were no significant differences between the four groups with respect to age and sex. Mean CPK concentrations statistically significantly differed between the four groups, with higher levels in patients with GTCS (P =0.0001). Serum CPK concentration had a sensitivity of 75% and specificity of 86% for the diagnosis of GTCS. CPK concentration was above 160mg/dl in 75% of patients with GTCS, 15% of patients with PNES, 13.6% of patients with VVS, and 15% of the control group (P =0.0001). The PNES, VVS, and control groups did not statistically significantly differ with respect to CPK concentrations. Conclusion: In patients with a recent loss of consciousness and abnormal movements, serum CPK concentration is a useful, practical, and relatively accurate parameter to assist in the differentiation of epileptic seizures from either VVS or PNES. [Copyright &y& Elsevier]

Background: The stigma toward epilepsy is a daily challenge for people with epilepsy (PWE) and can influence the well-being and prognosis of these individuals. However, the cultural origins of such stigma have sparsely been examined. In this study, we aimed to investigate the classic Persian literature to gain insight into the historical and cultural beliefs and opinions regarding epilepsy as a determinant in developing stigma towards PWE., Methods: In this narrative review of the classic Persian literature, we investigated the opinions and beliefs regarding epilepsy and PWE. In February 2023, we searched https://ganjoor.net (an open-access database of Iranian literature) for the relevant literary materials (poem and prose) using the Persian translation of the terms epilepsy (Sar'e) and epileptic (Masroo'e). Two clinical researchers went through the results and extracted the related materials under the supervision of two experts in Persian literature. A bilingual academic translated the included literary materials from Persian to English., Results: Our search yielded 57 literature materials by 31 poets and writers from the 4th to 14th Hijri centuries, roughly coinciding with the past Gregorian millennium (1000-2000 AC). We classified the literary concepts related to epilepsy stigma into five subgroups: (i) a simile for pain and suffering; (ii) an atonement for blasphemous beliefs or a disease caused by supernatural power; (iii) a sign of madness, insanity, and lack of wisdom; (iv) a celestial observation; and (v) a subject for jokes., Conclusions: Classic Persian literature considered epilepsy as a simile for suffering and a sign of insanity that is caused by blasphemous beliefs or celestial objects, with PWE classified as insane and unwise. While such depictions became less prevalent after the 14th century CE, they can give rise to misconceptions and negative stigma toward PWE and should be addressed in modern culture. Each society should critically investigate its socio-cultural origins of stigma and rectify such misbeliefs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: To identify the prevalence and also the full spectrum of symptoms/complaints of children and adolescents who are suffering from long COVID. Furthermore, we investigated the risk factors of long COVID in children and adolescents., Methods: All consecutive children and adolescents who were referred to the hospitals anywhere in Fars province, Iran, from 19 February 2020 until 20 November 2020 were included. All patients had a confirmed diagnosis of COVID-19. In a phone call to patients/parents, at least 3 months after their discharge from the hospital, we obtained their current status and information if their parents agreed to participate., Results: In total, 58 children and adolescents fulfilled the inclusion criteria. Twenty-six (44·8%) children/adolescents reported symptoms/complaints of long COVID. These symptoms included fatigue in 12 (21%), shortness of breath in 7 (12%), exercise intolerance in 7 (12%), weakness in 6 (10%), and walking intolerance in 5 (9%) individuals. Older age, muscle pain on admission, and intensive care unit admission were significantly associated with long COVID., Conclusions: Long COVID is a frequent condition in children and adolescents. The scientific community should investigate and explore the pathophysiology of long COVID to ensure that these patients receive appropriate treatments for their condition., (© 2021. Children's Hospital, Zhejiang University School of Medicine.)

Objectives: The aim of the current study was to compare the frequency of significant head injuries in three groups of people with seizures [idiopathic generalized epilepsies (IGE) vs. temporal lobe epilepsy (TLE) vs. functional seizures (FS)]., Methods: This was a retrospective study. All patients with a diagnosis of IGE, TLE, or FS were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2020., Results: One thousand and four hundred ninety-two patients were studied (559 patients with IGE, 646 people with TLE, and 287 persons with FS). Overall, 77 (5.2%) individuals of the studied people reported experiencing severe head injuries before the onset of their seizures [9 patients (1.6%) with IGE, 56 people (8.7%) with TLE, and 12 persons (4.2%) with FS; p = 0.0001]. Compared to people with IGE, the odds ratio of having a premorbid history of severe head injury in the FS group was 2.67 [95% Confidence Interval (CI): 1.11-6.40; p = 0.0280]. Compared to people with TLE, the odds ratio of having a premorbid history of severe head injury in the FS group was 0.46 (95% CI: 0.24-0.87; p = 0.0170)., Conclusion: Severe head injury is significantly associated with FS. However, since head injury is also a significant risk factor for focal epilepsies, it may be necessary to ascertain the diagnosis of post-traumatic seizures by obtaing a detailed clinical history and also by performing video-EEG monitoring in order to adopt an appropriate treatment strategy in these patients., (Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: The aim of the current study was to investigate the risk factors for post-traumatic epilepsy (PTE) in a large cohort of patients after severe non-penetrating civilian traumatic brain injury (TBI)., Methods: This was a longitudinal study. All patients with a severe non-penetrating TBI, who were admitted at the neuro-intensive care unit of Shahid Rajaee Trauma Hospital, affiliated with Shiraz University of Medical Sciences, Shiraz, Iran, from 2015 until 2019, were studied. Severe TBI was defined as a Glasgow Coma Scale-Motor score below six. Post-traumatic epilepsy was defined as any seizures that occurred after being discharged from the hospital., Results: In total, 803 patients with severe non-penetrating TBI were studied; 82 patients (10.2%) reported any late post-traumatic seizures (PTSs). A higher Glasgow outcome scale (extended) at discharge was significantly inversely associated with PTE [Odds Ratio (OR)= 0.76, 95% Confidence Interval (CI): 0.65-0.87; p = 0.0001]. Depressed skull fracture (OR= 1.88, 95% CI: 0.92-3.80; p = 0.081), epi‑dural hematoma (OR= 1.67, 95% CI: 0.93-2.97; p = 0.083), and sub-dural hematoma (OR= 1.64, 95% CI: 0.96-2.78; p = 0.068) were associated with PTE as trends., Conclusion: Our study adds to the literature on the risk of PTE after severe non-penetrating civilian TBI. Our large sample size and also the application of a logistic regression analysis model may suggest that other variables (e.g., depressed skull fracture and intracranial hematoma) are indeed associated with the Glasgow outcome scale (extended) at discharge and that is why they lost their significance in the model., (Copyright © 2021 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)