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Abstract Background Migraine affects one in ten individuals worldwide and is the second leading cause of disability. Studies have shown an association between migraine and the musculoskeletal system, and myofascial trigger points (MTrPs) play an essential role. Additionally, those with myofascial pain have been proven to experience higher levels of depression and anxiety. Understanding the association between MTrPs and migraine is crucial for developing targeted treatment strategies. Additionally, recognizing the link between MTrPs and migraine-related depression and anxiety underscores the importance of a holistic approach to migraine management. By addressing both musculoskeletal and neurological factors, healthcare providers can provide more effective and personalized care for migraine patients. This study aims to determine the association between MTrPs with migraine-related disability, anxiety, depression, and migraine characteristics. Methods This cross-sectional study included 68 migraine patients from an outpatient neurology clinic. The number of MTrPs was determined through examination by an experienced neurologist during a migraine-free period using the recommended international criteria. We evaluated anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) and disability with the Migraine Disability Assessment Scale (MIDAS). Results We enrolled 68 patients (22 males) with a mean age of 36.23 ± 9.63 years. The mean number of MTrPs was 2.75 ± 2.934. MTrPs were positively correlated with severity (CC: 0.576, P-value

Objective(s): The bio-distribution of Tc-99m HMPAO labeled platelets (LP), which could be used to image subtle thrombosis, is not reported in a human yet, which is the subject of the current study.Method: The platelets were extracted from 49 ml whole blood and labeled with Tc-99m HMPAO, then re-injected to the healthy volunteer. Anterior and posterior whole body imaging was done by a dual-head gamma camera 3, 18, 33, 46, 81, 124, 190 min and 15 hours after injection. Also a whole-body SPECT was done at 137 min post-injection. The area under the curves of the spleen, liver, left kidney, bladder, right lung, brain, and abdominal aorta ROIs was calculated to estimate the accumulation of labeled platelets within the organs.Results: The spleen was the target organ. The kidneys, liver, and heart were also remarkably visualized. The thyroid, stomach, bladder, or gastrointestinal (GI) uptake/activity was not significant. The stomach visualization was enhanced after ingestion at 60 min. The sagittal and lateral sinuses were delineated, and the background of the brain was very low. During the study, the area under the curve of activity was 738, 308, 302, 196, 230, 121, 79, 216, 529, 369, 162, and 54 counts. min/pixel for spleen, liver, heart, right lung, left kidney, right iliac artery, sagittal sinus, thyroid, bladder, stomach, GI, and background, respectively.Conclusion: The quality of the scan with low dose Tc-99m HMPAO LPs is optimal. We documented the bio-distribution of LPs. The optimal imaging time was 80-120 min post-injection when the free Tc-99m and GI transit were negligible. The sagittal and lateral sinuses were visualized enabling detection of possible clots in the vessels.

Abstract The study introduces a new online spike encoding algorithm for spiking neural networks (SNN) and suggests new methods for learning and identifying diagnostic biomarkers using three prominent deep learning neural network models: deep BiLSTM, reservoir SNN, and NeuCube. EEG data from datasets related to epilepsy, migraine, and healthy subjects are employed. Results reveal that BiLSTM hidden neurons capture biological significance, while reservoir SNN activities and NeuCube spiking dynamics identify EEG channels as diagnostic biomarkers. BiLSTM and reservoir SNN achieve 90 and 85% classification accuracy, while NeuCube achieves 97%, all methods pinpointing potential biomarkers like T6, F7, C4, and F8. The research bears implications for refining online EEG classification, analysis, and early brain state diagnosis, enhancing AI models with interpretability and discovery. The proposed techniques hold promise for streamlined brain-computer interfaces and clinical applications, representing a significant advancement in pattern discovery across the three most popular neural network methods for addressing a crucial problem. Further research is planned to study how early can these diagnostic biomarkers predict an onset of brain states.

Summary: Nuclear pore complexes (NPCs) regulate nucleocytoplasmic transport and are anchored in the nuclear envelope by the transmembrane nucleoporin NDC1. NDC1 is essential for post-mitotic NPC assembly and the recruitment of ALADIN to the nuclear envelope. While no human disorder has been associated to one of the three transmembrane nucleoporins, biallelic variants in AAAS, encoding ALADIN, cause triple A syndrome (Allgrove syndrome). Triple A syndrome, characterized by alacrima, achalasia, and adrenal insufficiency, often includes progressive demyelinating polyneuropathy and other neurological complaints. In this report, diagnostic exome and/or RNA sequencing was performed in seven individuals from four unrelated consanguineous families with AAAS-negative triple A syndrome. Molecular and clinical studies followed to elucidate the pathogenic mechanism. The affected individuals presented with intellectual disability, motor impairment, severe demyelinating with secondary axonal polyneuropathy, alacrima, and achalasia. None of the affected individuals has adrenal insufficiency. All individuals presented with biallelic NDC1 in-frame deletions or missense variants that affect amino acids and protein domains required for ALADIN binding. No other significant variants associated with the phenotypic features were reported. Skin fibroblasts derived from affected individuals show decreased recruitment of ALADIN to the NE and decreased post-mitotic NPC insertion, confirming pathogenicity of the variants. Taken together, our results implicate biallelic NDC1 variants in the pathogenesis of polyneuropathy and a triple A-like disorder without adrenal insufficiency, by interfering with physiological NDC1 functions, including the recruitment of ALADIN to the NPC.

Anti-IgLON5 is a neurological condition with neurodegenerative and autoimmune etiology. A 64-year-old man with a 2-year history of aplastic anemia presented with symmetrical parkinsonism, fluctuating consciousness, supranuclear gaze palsy, mild fasciculation, and muscular atrophy. He had disturbances in his sleep cycle and brain MRI. CSF analysis was positive for the IgLON5 antibody. We initiated immunotherapy with high-dose methylprednisolone, intravenous immunoglobulin, and rituximab. The patient showed a mild to moderate response to treatment. We reviewed 29 published case reports regarding anti-Iglon-5 and examined the clinical manifestation. None of the cases showed aplastic anemia, which was the main presentation in our case. All of the patients experienced sleep disturbances, while other symptoms were heterogeneous. Anti-Iglon-5 is usually diagnosed late, leading to a weak prognosis. This study helped us establish a better understanding of the correlation between anti- Iglon5 disease and other autoimmune disorders like anemia.

Alzheimer's disease (AD) is the most widespread and irreversible form of dementia and accounts for more than half of dementia cases. The most significant risk factors for AD are aging-related exacerbations, degradation of anatomical pathways, environmental variables and mitochondrial dysfunction. Finding a decisive therapeutic solution is a major current issue. Nuanced interactions between major neuropathological mechanisms in AD in patients and microbiome have recently gained rising attention. The presence of bacterial amyloid in the gut triggers the immune system, resulting in increased immune feedbacks and endogenous neuronal amyloid within the CNS. Also, early clinical research revealed that changing the microbiome with beneficial bacteria or probiotics could affect brain function in AD. New approaches focus on the possible neuroprotective action of disease-modifying medications in AD. In the present review, we discuss the impact of the gut microbiota on the brain and review emerging research that suggests a disruption in the microbiota-brain axis can affect AD by mediating neuroinflammation. Such novel methods could help the development of novel therapeutics for AD.

Abstract Background Migraine is a headache disorder that affects public health and reduces the patient’s quality of life. Preventive medication is necessary to prevent acute attacks and medication overuse headaches (MOH). Agomelatine is a melatonin antagonist. Aims This study aimed to determine the effectiveness of agomelatine on the severity and frequency of migraine attacks. Methods The study is a parallel randomized controlled trial with two groups of intervention and control. 400 patients were evaluated. Eligible individuals, including those with episodic migraine headaches without aura between the ages of 18 and 60 years who did not receive preventive treatment beforehand, were enrolled. Also, patients did not receive any specific medications for other diseases. Among these, 100 people met the inclusion criteria and entered the study. These subjects were randomly assigned to one of the two groups. The intervention group received 25 mg of agomelatine daily and the control group received B1. In this study, the effect of agomelatine on the frequency and severity of attacks, mean monthly migraine days (MMD), and migraine disability assessment (MIDAS), were assessed. The study was triple-blind and after three months, a post-test was performed. Data were analyzed using SPSS software. Results A total of 100 patients were randomly assigned to either intervention or control groups. The prescriber physician and the data collector did not know about the allocation of patients to groups. Before the intervention, there was no significant difference in the headache frequency per month (t=-0.182, df = 98, p = 0.85), mean MMD (p = 0.17), headache severity (p = 0.076), and MIDAS (p = 0.091). After the study, there was a significant difference between the two groups in terms of the headache frequency per month (p = 0.009), and mean of MMD (p = 0.025). There was also a significant difference between pretest and posttest in two groups in the headache severity (p

Background: Stroke is one of the most important causes of chronic pain. In patients with chronic pain medical therapy with analgesic drugs, anti-epileptic drugs, and serotonin receptor modulators is the first choice. However, for patients who are refractory to the usual medical treatments, different strategies have been proposed to treat these pains. One of these treatments involves the implantation of deep brain electrodes and deep brain stimulation in the thalamus nucleouses. In this article we are reviewing the first case done in Iran. Case Presentation: A 51-year-old male presented with sudden-onset left side hemiparesis and impaired sensation on the left side of the body, eight years ago. He complained of gradually developing pain on the left side of the body, adding to his symptoms. In his examination, he had dysarthria and his left extremities were spastic and their forces were decreased. Despite numerous medical treatments with gabapentin, pregabalin, duloxetine, carbamazepine and the replacement of an intrathecal baclofen pump during the last few years, he didn't respond very well. This goes so far as to induce severe depression symptoms, which disturbed his daily routine and even induced suicidal ideas. Due to the debilitating symptoms which were resistant to medical treatment, the patient underwent deep brain electrode implantation and deep brain stimulation in the ventral posterior lateral/posterior medial nucleuses in April 2023 at Imam Khomeini Hospital. No remarkable adverse effects were observed after implantation. In the patient’s follow-up, he had a significant improvement in pain and some other symptoms. Conclusion: Deep brain stimulation of the thalamus nucleus is a known treatment in patients with Parkinson's disease and dystonia. However, for patients with chronic refractory pain, deep brain stimulation is a controversial therapy and has been introduced recently as an effective alternative treatment. In our patient, who suffers from severe unilateral refractory pain after stroke, a deep brain electrode was implanted and after deep brain stimulation significant improvement in pain was seen.

Objective(s): The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use , may contribute to higher CAD risk.In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate.Method: Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal.Results: Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12). In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014).Conclusion: MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD.

Spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome with variable symptoms and complications which is often misdiagnosed at initial manifestations. SIH results from spontaneous CSF leakage leading to brain sag. The typical findings on cranial MR imaging consist of subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain. Subdural hematoma may occur as a result of tearing of bridging veins and usually develop into chronic subdural hematoma. The majority of patients with SDH due to SIH have chronic DSH and, therefore, rarely present with neurological deficits. Evacuation of SDH may be performed for large SDH with ME (mass effects), or when dilated or asymmetric pupil is present. However in most cases, evacuation of the hematoma is not necessary and may result in worsened outcomes. The epidural blood patch (EBP) is a treatment of choice. Fortunately, most of these subdural hematomas can be handled with treatment directed at the underlying spinal CSF leak without the need for surgery. We report the case of 42-year-old man with the chief complaint of orthostatic headache. He was admitted to neurology ward and after imaging studies, it was found that he has bilateral subdural hematoma. Due to the lack of history of trauma, underlying disease, and coagulation disorder, and considering the imaging findings, the patient was referred to the pain department to perform an epidural blood patch. After performing the epidural blood patch, the patient's pain was relieved immediately, and during a three-month follow-up period, the epidural hematoma was completely absorbed. Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed and underdiagnosed disorder and requires a high index of suspicion for diagnosis. During the last decades, a much larger number of spontaneous cases are identified. Literature is a bit confusing, with some authors recommending evacuation of subdural fluid in cases of deteriorating consciousness and few others recommending EBP first even in patients with comatose state but epidural patch is often an important part of treatment.

PurposeDistinguishing functional seizures (FS) from epileptic seizures (ES) poses a challenge due to similar clinical manifestations. The creation of a clinical scoring system that assists in accurately diagnosing patients with FS would be a valuable contribution to medical practice. This score has the potential to enhance clinical decision-making and facilitate prompt diagnosis of patients with FS.MethodsParticipants who met the inclusion criteria were randomly divided into three distinct groups: training, validation, and test cohorts. Demographic and semiological variables were analyzed in the training cohort by univariate analyses. Variables that showed a significant difference between FS and ES were then further scrutinized in two multivariate logistic regression models. The CFSS was developed based on the odds ratio of the discriminating variables. Using the validation group, the optimal cutoff value was determined based on the AUC, and then the CFSS was evaluated in the test cohort to assess its performance.ResultsThe developed score yielded an AUC of 0.78 in the validation cohort, and a cutoff point of 6 was established with a focus on maximizing sensitivity without significantly compromising specificity. The score was then applied in the test cohort, where it achieved a sensitivity of 86.96% and a specificity of 73.81%.ConclusionWe have developed a new tool that shows promising results in identifying patients suspicious of FS. With further analysis through prospective studies, this innovative, simple tool can be integrated into the diagnostic process of FS.

Background: The prevalence of cognitive impairment among patients with epilepsy is about 70%. There is still no approved medication for the treatment of this problem. Objectives: The present study aims to assess the safety and efficacy of memantine in improving the cognitive function of patients with epilepsy. Materials & Methods: This is a pilot, randomized, double-blind, placebo-controlled, parallelgroup clinical trial, conducted in a hospital in Tehran, Iran during 2018-2019. Participants were randomly allocated to receive memantine (5 mg/day in the first eight weeks and 10 mg/day in the second eight weeks) or placebo in a 1:1 ratio. Participants underwent the Mini-mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Frontal Assessment Battery (FAB) before and after the intervention. The primary and secondary measures were safety and change in the cognitive test scores, respectively. Results: Out of 53 allocated participants, 33 completed the study. Drug intolerance including headache, somnolence, and dizziness was not significantly different between the two groups. The Intention-to-Treat analyses demonstrated no significant change in MoCA and FAB scores between the two groups after the intervention, but a significant improvement in the MMSE score of the memantine group (P=0.047) was observed. After controlling confounding factors, there was no significant difference in scores of any cognitive tests between the two groups. Conclusion: Memantine is a safe drug for patients with epilepsy, but it may not exert a beneficial effect on the cognitive function of these patients.

BackgroundTreatment-resistant epileptic seizures are associated with reduced quality of life (QoL). As polypharmacy with routine antiseizure medications has many side effects, novel add-on treatments are necessary. Recent research showed the efficacy of add-on therapy by cannabidiol (CBD) on refractory epilepsy. We attempted to extend data on the efficacy and safety profile of CBD in patients with frontal lobe treatment-resistant epilepsy.MethodsA total of 27 patients were recruited into two CBD (n = 12) and placebo (n = 15) groups. The CBD group received a highly purified liposomal preparation of the drug in addition to routine antiseizure medications. The placebo group only received antiseizure medications. This experiment followed a triple-blinding protocol. Outcome measures were seizure frequency, the Chalfont seizure severity scale (CSSS), and the quality of life questionnaire score (QOLIE-31) assessed at baseline, 4 weeks, and 8 weeks.ResultsAt 4 weeks, results indicated that a higher fraction of patients in the CBD group (66.67%) showed improvement in seizure, compared to the placebo group (20.00%). Before–after comparison revealed that CBD, unlike routine ADEs, was effective in reducing the occurrence of seizures at the study's final timepoint [mean difference 45.58, 95% CI (8.987 to 82.18), p = 0.009]. Seizure severity was not affected by study groups or time intervals (repeated-measures ANOVA p > 0.05). Post-hoc tests found that the QoLI-31 score was improved at 8 weeks compared to baseline [mean diff. −5.031, 95% CI (−9.729 to −0.3328), p = 0.032]. The difference in cases who experienced enhanced QoL was meaningful between the CBD and placebo groups at 8 weeks [RR: 2.160, 95% CI (1.148 to 4.741), p = 0.018] but not at 4 weeks (p = 0.653). A positive finding for QoL improvement was associated with a positive finding for seizure frequency reduction [r = 0.638, 95% CI (0.296 to 0.835), p = 0.001]. Interestingly, limiting the correlation analysis to cases receiving CBD indicated that QoL improvement was not linked with seizure parameters such as severity and frequency (p > 0.05).ConclusionThe present study suggests the benefit of a purified and highly efficient preparation of CBD for seizure frequency reduction and improvement of QoL in refractory frontal lobe epilepsy. Further study with longer follow-ups and larger sample size is advised.Clinical trial registrationhttps://www.irct.ir/trial/56790, identifier: IRCT20210608051515N1.

The present case report describes a patient who had presented with resistant trigeminal neuralgia and was later discovered to suffer from idiopathic increased intracranial pressure. The related symptoms were resolved by decreasing the intracranial pressure. As in our case, symptom relief can predict a good prognosis in these cases, resulting in an improved quality of life. Although it is not frequently reported, this potential association can be significant as resolving intracranial hypertension can easily improve the symptoms in those suffering from this condition.To our knowledge, no relationship between increased intracranial pressure and trigeminal neuralgia had yet been reported in the literature.

Lafora disease is a rare genetic disease caused by the accumulation of malformed glycogen products in the tissues. The disease usually manifests with idiopathic generalized tonic colonic seizures with poor response to antiepileptic drugs (AEDs). We report the case of a 19-year-old girl with the chief complaint of generalized refractory seizures, jerky movement, and cognitive deterioration with a positive history of epilepsy in her younger brother. The disease onset was at the age of 16 with jerky movement and blurred vision. She was admitted to our ward to have a long-term video EEG monitoring for further evaluation. Clinical presentation accompanied with abnormal EEG characteristics for Lafora disease, and the positive familial history were highly suggestive of Lafora disease. The disease was confirmed with genetic testing by which the mutation of EPM2A was detected.

Abstract Background Epilepsy is a neurological disorder characterized by the potential to induce seizure and accompanied by cognitive, psychological, and social consequences. CACNA1A gene is a voltage-gated P/Q-type Cav2.1 channel that is broadly expressed in the central nervous system, and the pathogenic variants within this gene may be associated with the epileptic phenotype. In the present study, we collected clinical and molecular data related to epileptic patients with CACNA1A pathogenic variants and investigated possible meaningful relationship between age at onset, neurodevelopmental disorders, type of seizures, brain imaging abnormalities, genotype, and protein domains. Results In our retrospective literature studies, from among 890 articles reviewed, a total of 90 individuals were related to epilepsy phenotype. Our findings showed that about 90 percent of patients have shown the first symptoms in childhood and teenage years and different types of neurodevelopmental disorders, such as intellectual disability, developmental arrest, and behavioral disorders, have been common findings for these patients. Further, a wide range of abnormalities have been observed in their brain imaging, and generalized seizures have been the most type of seizures in these patients. However, our data showed no specific genotype–phenotype correlation in epileptic patients with CACNA1A pathogenic alterations. Conclusions Our study focused on epileptic phenotype in patients with CACNA1A pathogenic variants and showed a wide range of clinical and molecular heterogeneity with no specific genotype–phenotype correlation. It seems that incomplete penetrance, de-novo variants, and modifier genes are obstacles in predicting the clinical outcome.

Abstract Intellectual disability (ID) is a highly heterogeneous disorder with hundreds of associated genes. Despite progress in the identification of the genetic causes of ID following the introduction of high-throughput sequencing, about half of affected individuals still remain without a molecular diagnosis. Consanguineous families with affected individuals provide a unique opportunity to identify novel recessive causative genes. In this report, we describe a novel autosomal recessive neurodevelopmental disorder. We identified two consanguineous families with homozygous variants predicted to alter the splicing of ATP9A which encodes a transmembrane lipid flippase of the class II P4-ATPases. The three individuals homozygous for these putatively truncating variants presented with severe ID, motor and speech impairment, and behavioral anomalies. Consistent with a causative role of ATP9A in these patients, a previously described Atp9a−/− mouse model showed behavioral changes.

A 20-year-old woman presented with left eye ptosis without any headache and pupillary dysfunctions. After the radiological examination, the oculomotor nerve compression was detected in the interpeduncular space by the posterior communicating artery (PCoA) with normal size and shape. The patient underwent frontotemporal craniotomy, and during the surgery, the nerve was detached from the PCoA. Immediately after surgery, all symptoms disappeared. Although oculomotor nerve palsy (ONP) owing to internal carotid-PCoA aneurysm is common, vascular compression due to a non- aneurysmal PCoA is very rare. To the extent of our knowledge, this is the first case in which a slightly displaced, otherwise normal, PCoA causes ONP without any pupillary involvement. After ruling out an aneurysmal artery, this should be considered as one of the possible causes of the ONP.

Abstract Objective The purpose of this clinical trial was to examine the effect of omega-3 fatty acids (W-3 FAs), nanocurcumin and their combination on serum levels and gene expression of VCAM in patients with episodic migraine. Results In this study, 80 patients were randomly divided in to 4 groups to receive for 2 months. Both serum levels and gene expression of VCAM showed remarkable decreases after single W-3 and after combined W-3 and nanocurcumin interventions. However, a borderline significant change and no remarkable change were observed after single nanocurcumin supplementation and in control group, respectively. While a significant difference between study groups in VCAM concentrations existed, there was no meaningful difference in VCAM gene expression among groups. It appears that the W-3 and combined W-3 and nanocurcumin can relieve VCAM serum level and its gene expression in patients with episodic migraine. Moreover, the combination of W-3 with nanocurcumin might cause more significant declines in VCAM level in the serum of migraine patients than when W-3 is administered alone. Trial Registration: This study was registered in Iranian Registry of Clinical Trials (IRCT) with ID number: NCT02532023.

Abstract This paper proposes a novel method and algorithms for the design of MRI structured personalized 3D spiking neural network models (MRI-SNN) for a better analysis, modeling, and prediction of EEG signals. It proposes a novel gradient-descent learning algorithm integrated with a spike-time-dependent-plasticity algorithm. The models capture informative personal patterns of interaction between EEG channels, contrary to single EEG signal modeling methods or to spike-based approaches which do not use personal MRI data to pre-structure a model. The proposed models can not only learn and model accurately measured EEG data, but they can also predict signals at 3D model locations that correspond to non-monitored brain areas, e.g. other EEG channels, from where data has not been collected. This is the first study in this respect. As an illustration of the method, personalized MRI-SNN models are created and tested on EEG data from two subjects. The models result in better prediction accuracy and a better understanding of the personalized EEG signals than traditional methods due to the MRI and EEG information integration. The models are interpretable and facilitate a better understanding of related brain processes. This approach can be applied for personalized modeling, analysis, and prediction of EEG signals across brain studies such as the study and prediction of epilepsy, peri-perceptual brain activities, brain-computer interfaces, and others.

Abstract Backgrounds The reports of neurological symptoms are increasing in cases with coronavirus disease 2019 (COVID-19). This multi-center prospective study was conducted to determine the incidence of neurological manifestations in hospitalized cases with COVID-19 and assess these symptoms as the predictors of severity and death. Methods Hospitalized males and females with COVID-19 who aged over 18 years were included in the study. They were examined by two neurologists at the time of admission. All survived cases were followed for 8 weeks after discharge and 16 weeks if their symptoms had no improvements. Results We included 873 participants. Of eligible cases, 122 individuals (13.97%) died during hospitalization. The most common non-neurological manifestations were fever (81.1%), cough (76.1%), fatigue (36.1%), and shortness of breath (27.6%). Aging, male gender, co-morbidity, smoking, hemoptysis, chest tightness, and shortness of breath were associated with increased odds of severe cases and/or mortality. There were 561 (64.3%) cases with smell and taste dysfunctions (hyposmia: 58.6%; anosmia: 41.4%; dysguesia: 100%). They were more common among females (69.7%) and non-smokers (66.7%). Hyposmia/anosmia and dysgeusia were found to be associated with reduced odds of severe cases and mortality. Myalgia (24.8%), headaches (12.6%), and dizziness (11.9%) were other common neurological symptoms. Headaches had negative correlation with severity and death due to COVID-19 but myalgia and dizziness were not associated. The cerebrovascular events (n = 10) and status epilepticus (n = 1) were other neurological findings. The partial or full recovery of smell and taste dysfunctions was found in 95.2% after 8 weeks and 97.3% after 16 weeks. The parosmia (30.9%) and phantosmia (9.0%) were also reported during 8 weeks of follow-up. Five cases with mild headaches and 5 cases with myalgia were reported after 16 weeks of discharge. The demyelinating myelitis (n = 1) and Guillain-Barré syndrome (n = 1) were also found during follow-up. Conclusion Neurological symptoms were found to be prevalent among individuals with COVID-19 disease and should not be under-estimated during the current pandemic outbreak.

Abstract There is no biodistribution or imaging data on 99mtechnetium (Tc)-hexamethyl propylamine oxime (HMPAO)-labeled platelets in the literature. The current study aimed to present updated information about the clinical procedures for preparation and use of labeled platelets. Following two-step centrifugation at 1500 and 2500 rpm, the platelets were extracted from whole blood into platelet-rich plasma (PRP) above the buffy coat and then from PRP into a platelet pellet at the bottom of the tube. The 99mTc-HMPAO-labeled platelets were inspected for purity, viability, release of 99mTc from platelets, and sterility. Also, microscopic examination and thin layer chromatography (TLC) were performed. Biodistribution was assessed following necropsy in BALB/c mice and through imaging of New Zealand rabbits. The separation ratio was estimated at 98%, and radiochemical purity was measured to be 80%. The labeling efficiency was above 30% in more than half of the assays (range: 17-43%). The release of 99mTc from platelets was 9% per hour at 37ºC. After 24 hours, stability was estimated at 54% in the human serum. The target organs of mice included the spleen and liver. In rabbits, the imaging results indicated liver as the target organ. Thyroid uptake was negligible up to 90 minutes. Based on the findings, extraction of platelets and labeling them with 99mTc-HMPAO is a feasible and safe approach in routine practice.

Background: Alzheimer's disease (AD) is a chronic neurodegenerative disease characterized by a progressive decline of cognitive performance, which has a harmful impact on social activities. AD is the main cause of dementia and loss of functional independence in the elderly. AD is a worldwide concern because of its adverse consequences and expanding prevalence and incidence. Vitamin D is the most common nutritional deficiency worldwide among children and adults. In addition to its classical function of bone metabolism regulation, vitamin D exhibits multiple biological targets mediated by the vitamin D receptor (VDR). Vitamin D is a risk factor for a wide range of diseases and, as a neurosteroid, has an essential role in nervous system development and protection. Vitamin D regulates mechanisms involved in the pathogenesis of AD, including phagocytosis of amyloid-beta plaques, anti-inflammatory action, antioxidant action, regulation of intraneuronal calcium, ischemic zone size reduction, regulation of choline acetyltransferase enzyme and neurotrophic agents. This study aimed to evaluate the association between AD and vitamin D deficiency. Methods: In this case-control study, 44 Alzheimer’s disease patients (diagnosed based on DSM-IV-TR criteria) compared with 40 patients that had no disease related to vitamin D. This study was performed in the neurology clinics of Roozbeh and Imam Khomeini Hospitals in Tehran, from April to March 2015. The demographic data were collected. After obtaining informed consent, venous blood was taken by clinical staff to measure the level of 25-hydroxyvitamin D3. Statistical analysis was performed on data. Results: The Mean age was 71.55 years old (69.88 for females and 73.74 for males) in the case group. Mean vitamin D levels were 26.31 ng/ml and 36.41 ng/ml in case and control groups, respectively. Vitamin D level was deficient (< 30 ng/ml) in 75% of patients, of which 23% were severely deficient (< 10 ng/ml). Statistical analysis showed no significant relationship between Alzheimer's disease and vitamin D levels (P=0.057), but when participants categorized into three groups based on serum vitamin D levels (deficient, insufficient, sufficient), we found a significant relationship between them (P=0.019). Conclusion: Our results confirm the association between vitamin D deficiency and Alzheimer's disease. Vitamin D supplementation should be considered in individuals at risk of Alzheimer's disease to reach sufficient vitamin D level.

This case report discusses A 6-year-old boy, a known case of Cri-du-chat (cat's cry) syndrome, who was referred to the epilepsy clinic of Imam Khomeini hospital for further evaluation and performing video EEG monitoring. Video EEG monitoring showed two stereotypical ictal clinical habitual events during sleep. These episodes were sudden and showed hyper motor movements in the left lower extremity. Electrographically, a definite ictal pattern evolved to rhythmic slow activity in the left centroparietal region. Brain MRI with epilepsy protocol was unremarkable. Due to the sudden onset of movements depicting hyper motor activity during sleep and abnormal EEG and the fact that the patient is a known case of the cri-du-chat syndrome, this is reported as having a motor seizure is extremely rare in cat cry syndrome. To our knowledge, this is the first report of motor seizure in cat cry syndrome.

Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.

PR domain-containing member 12 (PRDM12) is a key developmental transcription factor in sensory neuronal specification and survival. Patients with rare deleterious variants in PRDM12 are born with congenital insensitivity to pain (CIP) due to the complete absence of a subtype of peripheral neurons that detect pain. In this paper, we report two additional CIP cases with a novel homozygous PRDM12 variant. To elucidate the function of PRDM12 during mammalian development and adulthood, we generated temporal and spatial conditional mouse models. We find that PRDM12 is expressed throughout the adult nervous system. We observed that loss of PRDM12 during mid-sensory neurogenesis but not in the adult leads to reduced survival. Comparing cellular biophysical nociceptive properties in developmental and adult-onset PRDM12 deletion mouse models, we find that PRDM12 is necessary for proper nociceptive responses throughout life. However, we find that PRDM12 regulates distinct age-dependent transcriptional programs. Together, our results implicate PRDM12 as a viable therapeutic target for specific pain therapies even in adults.

Introduction: Headache is a common problem with intense side effects on quality of life. Dental and maxillofacial problems, including dental infections and temporomandibular disorders may trigger the onset of headache or have direct impact on the intensity of headache. The purpose of this paper is assessment of oral health indexes in chronic headache patients and compare it with a healthy control group. Materials and Methods: Thirty chronic headache patients based on diagnosis by a neurologist were enrolled in our study and thirty healthy volunteers were recruited into the control group. Dental and periodontal examination were carried out in order to evaluate of the decayed, missing and filled teeth (DMFT) index, the assessment of community periodontal index of treatment needs (CPITN) index and determination of tooth wear status and oral health status. Statistical analysis was done using SPSS statistical package (version 20, IBM). Results: Mean age, educational level, tooth brushing, using dental floss and DMFT index was not statistically different between chronic headache patients and control group. There was no statistically significant difference in CPITN index between cases and control group (p-value=0.538). Conclusion: This study suggest that chronic headache patients have an acceptable oral hygiene which may be attribute to their attempts to omit pain from head and oral region. Considering high prevalence of chronic headache, planning a protocol for oral hygiene instruction is necessary. In this regard, coordination between neurologists and oral medicine specialists can be very effective. Keywords: Oral health; Chronic headache; DMFT index; CPITN index.

Disturbances in IP3 receptor-mediated release of Ca2+ from the endoplasmatic reticulum are associated with neurodegenerative disease. Here, the authors identify in four families with hereditary spastic paraplegia biallelic mutations in RNF170 that associate with increased basal levels of IP3 receptors.

Abstract Background Amyotrophic lateral sclerosis (ALS) is a highly progressive and debilitating neurodegenerative disease, which usually leads to the death of affected individuals within a few years after the onset of symptoms. ALS is currently incurable and very little is known about its pathophysiology. Finding validated biomarkers will help us to advance our understanding of ALS etiology and find better strategies for early diagnosis and management of the disease. The main aim of the present systematic review is to evaluate the concentration of 11 frequently reported biomarkers for ALS in peripheral blood and CSF of patients diagnosed with ALS compared with controls. Methods This systematic review protocol has been established according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 guideline. We will include all types of observational studies with human subjects that investigated the concentrations of intended biomarkers (amyloid beta (Aβ-42), tau and phosphorylated tau (p-Tau), neurofilaments, S100β, cystatin C, progranulin (PGRN), glial fibrillary acidic protein (GFAP), monocyte chemoattractant protein-1 (MCP-1), brain-derived neurotrophic factor (BDNF), TAR DNA-binding protein-43 (TDP43), YKL-40, and CHIT1 in CSF or peripheral blood of ALS patients for initial assessment. Also, we will include case series with a minimum of 10 cases and clinical trials which have measured baseline biomarker levels. Case studies, case reports, reviews, letters, and animal and in vitro studies will be excluded. Multiple electronic databases including Cochrane Library, MEDLINE (PubMed), ISI Web of Science, and EMBASE will be searched to find all eligible articles published since 1980. No language restriction will be applied. All titles and abstracts retrieved by searching information sources will be evaluated independently by two authors against the eligibility criteria. The following information will be extracted from each included study by two independent authors: bibliographic details (first author, study title, year of publication, country), demographics and clinical information (number of patients and controls, type of ALS and controls, study design, age, gender, specimen, biomarkers levels, ALS functional rating scale Revised (ALSFRS-R), duration of disease), and measurements (method, value type, biomarkers levels). We will use the extracted mean and standard deviation (SD) of biomarkers concentrations to calculate the standardized mean difference (SMD) and 95% confidence intervals (CI). The primary outcome measures are the mean difference of biomarker levels between ALS patients and controls, different types of ALS, and ALS patients with genetic mutations. Discussion We will systematically review the literature and analyze studies of biomarker level in CSF and peripheral blood of patients with ALS and controls. The results will help us to identify biomarkers with possible diagnostic and prognostic value. Systematic review registration PROSPERO CRD42017078127

Objective: Saffron was found efficient and safe in treatment of neuropsychiatric disorders, in particular depression. We compared the efficacy of saffron with duloxetine in treatment of patients with fibromyalgia. Materials and Methods: In this double-blind parallel-group clinical trial, outpatients with fibromyalgia were randomized to receive either saffron 15 mg or duloxetine 30 mg starting with 1 capsule per day in the first week followed by 2 capsules per day from week 2 until the end of week 8. Participants were men and women aged 18-60 years diagnosed with fibromyalgia based on the American College of Rheumatology 2010 criteria who also had a pain score ≥40 based on visual analogue scale. Participants were excluded in case they had rheumatologic diseases, inflammatory/infectious/autoimmune arthritis, comorbid neuropsychiatric disorders except depressive disorders, pain due to traumatic injuries, drug history of duloxetine or saffron use, current use of psychoactive medications, recent use of muscle relaxants, steroids, opioid analgesics, benzodiazepines, anti-epileptics, or injective analgesics. Primary outcomes included differences in mean score changes from baseline to endpoint between the treatment arms for Hamilton Rating Scale for Depression, Fibromyalgia Impact Questionnaire, and Brief Pain Inventory. Results: Socio-demographic characteristics and baseline scores were similarly distributed between the two treatment arms (2n=46). No significant difference was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms (Mean score changes: -4.26 to 2.37; p-values: 0.182-0.900) nor in terms of time´treatment interactions (p-values: 0.209-0.964). Conclusions: Saffron and duloxetine demonstrated comparable efficacy in treatment of fibromyalgia symptoms.

This cross-sectional study is aimed at assessing the effects of opium use disorder (OUD) on attention, working memory, and information-processing speed. Thirty outpatients with OUD and 20 healthy controls (HCs) were assessed using a neuropsychological battery consisted of Auditory Verbal Learning Test-Revised (AVLT-R), Brief Visuospatial Memory Test-Revised (BVMT-R), Digit Forward and Backward Tests (DFT and DBT), and WAIS-R Digit Symbol Substitution Test (DSST). The most affected cognitive functions in patients with OUD were detected by DBT and DSST. However, we found no significant difference between patients according to the route of administration. Within patients with OUD, DBT score was associated with opium use quantity (OUQ) (r=−0.385), and DBT (r=0.483) and DSST (r=0.542) scores were correlated with duration of use. Our findings indicated that working memory and information-processing speed are the most affected domains of cognitive functioning. DBT and DSST could be used as brief assessments in clinical settings to screen for cognitive deficits in patients with OUD.

Objective. In this study, we aimed to evaluate the executive profile of juvenile myoclonic epilepsy (JME) patients using the Frontal Assessment Battery (FAB) as a bedside screening tool and investigate its association with seizure proximity, family history of epilepsy, and polytherapy/monotherapy with antiepileptic drugs (AEDs). Background. JME patients have deficits in various aspects of executive functions. FAB has proved to be a useful tool for evaluating executive functions in clinical settings. Methods. Thirty-one JME patients and 110 healthy controls (HCs) were enrolled in this study. The participants were assessed using six subsets of FAB, including conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. Results. Compared to HCs, JME patients showed lower scores in conceptualization, mental flexibility, programming, sensitivity to interference, and total FAB. The number of AEDs (polytherapy versus monotherapy) and duration of time since the last seizure had no significant effect on FAB scores in JME patients. We found significant associations between disease duration and conceptualization, mental flexibility, inhibitory control, and total FAB score only in JME patients with recent seizure. Finally, receiver operating characteristic (ROC) analysis showed area under the curve (AUC) of 0.971 (95% confidence interval (CI): 0.947–0.994) for FAB total score, 0.933 for conceptualization (95% CI: 0.973-894), and 0.836 for mental flexibility (95% CI: 0.921-751). Conclusions. In summary, JME patients had deficits in different aspects of executive functions. FAB is a useful clinical tool for evaluation of executive functions in JME patients.

Abstract Hereditary spastic paraplegias are a rare group of clinically and genetically heterogeneous neurodegenerative diseases, with upper motor neuron degeneration and progressive lower limb spasticity as their main phenotypic features. Despite that 76 distinct loci have been reported and some casual genes identified, most of the underlying causes still remain unidentified. Moreover, a wide range of clinical manifestations is present in most hereditary spastic paraplegias subtypes, adding further complexity to their differential clinical diagnoses. Here, we describe the first exon rearrangement reported in the SPG45/SPG65 (NT5C2) loci in a family featuring a complex hereditary spastic paraplegias phenotype. This study expands both the phenotypic and mutational spectra of the NT5C2-associated disease.

Antiepileptic drugs (AEDs) have repeatedly shown inconsistent and almost contradictory effects on the neurocognitive system, from substantial impairments in processing speed to the noticeable improvement in working memory and executive functioning. Previous studies have provided a novel insight into the cognitive improvement by bumetanide as a potential antiepileptic drug. Through the current investigation, we evaluated the longitudinal effects of bumetanide, an NKCC1 co-transporter antagonist, on the brain microstructural organization as a probable underlying component for cognitive performance. Microstructure assessment was completed using SPM for the whole brain assay and Freesurfer/TRACULA for the automatic probabilistic tractography analysis. Primary cognitive operations including selective attention and processing speed, working memory capacity and spatial memory were evaluated in 12 patients with a confirmed diagnosis of refractory epilepsy. Participants treated with bumetanide (2 mg/ day) in two divided doses as an adjuvant therapy to their regular AEDs for 6 months, which followed by the re-assessment of their cognitive functions and microstructural organizations. Seizure frequency reduced in eight patients which accompanied by white matter reconstruction; fractional anisotropy (FA) increased in the cingulum-cingulate gyrus (CCG), anterior thalamic radiation (ATR), and temporal part of the superior longitudinal fasciculus (SLFt) in correlation with the clinical response. The voxel-based analysis in responder patients revealed increased FA in the left hippocampus, right cerebellum, and right medial temporal lobe, while mean diffusivity (MD) values reduced in the right occipital lobe and cerebellum. Microstructural changes in SLFt and ATR accompanied by a reduction in the error rate in the spatial memory test. These primary results have provided preliminary evidence for the effect of bumetanide on cognitive functioning through microstructural changes in patients with drug-resistant epilepsy.

Introduction: Hemothorax is one of the most prevalent injuries caused by thoracic traumas. Early detection and treatment of this injury is of utmost importance in prognosis of the patient, but there are still controversial debates on the diagnostic value of imaging techniques in detection of hemothorax. Therefore, the present study aimed to evaluate the diagnostic value of chest ultrasonography and radiography in detection of hemothorax through a systematic review and meta-analysis. Methods: Two independent reviewers performed an extended systematic search in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Data were extract and quality of the relevant studies were assessed. The number of true positive, false positive, true negative and false negative cases were extracted and screening performance characteristics of two imaging techniques were calculated using a mixed-effects binary regression model. Results: Data from 12 studies were extracted and included in the meta-analysis (7361 patients, 77.1% male). Pooled sensitivity and specificity of ultrasonography in detection of hemothorax were 0.67 (95% CI: 0.41-0.86; I2= 68.38, p

Introduction: Ultrasonography is currently being used as one of the diagnostic modalities in various medical emergencies for screening of trauma patients. The diagnostic value of this modality in detection of traumatic chest injuries has been evaluated by several studies but its diagnostic accuracy in diagnosis of pulmonary contusion is a matter of discussion. Therefore, the present study aimed to determine the diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion through a systematic review and meta-analysis. Methods: An extended systematic search was performed by two reviewers in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. They extracted the data and assessed the quality of the studies. After summarization of data into true positive, false positive, true negative, and false negative meta-analysis was carried out via a mixed-effects binary regression model. Further subgroup analysis was performed due to a significant heterogeneity between the studies. Results: 12 studies were included in this meta-analysis (1681 chest trauma patients, 76% male). Pooled sensitivity of ultrasonography in detection of pulmonary contusion was 0.92 (95% CI: 0.81-0.96; I2= 95.81, p

Introduction: Hemothorax is one of the most prevalent injuries caused by thoracic traumas. Early detection and treatment of this injury is of utmost importance in prognosis of the patient, but there are still controversial debates on the diagnostic value of imaging techniques in detection of hemothorax. Therefore, the present study aimed to evaluate the diagnostic value of chest ultrasonography and radiography in detection of hemothorax through a systematic review and meta-analysis. Methods: Two independent reviewers performed an extended systematic search in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Data were extract and quality of the relevant studies were assessed. The number of true positive, false positive, true negative and false negative cases were extracted and screening performance characteristics of two imaging techniques were calculated using a mixed-effects binary regression model. Results: Data from 12 studies were extracted and included in the meta-analysis (7361 patients, 77.1% male). Pooled sensitivity and specificity of ultrasonography in detection of hemothorax were 0.67 (95% CI: 0.41-0.86; I2= 68.38, pConclusion: The results of this study showed that although the sensitivity of ultrasonography in detection of hemothorax is relatively higher than radiography, but it is still at a moderate level (0.67%). The specificity of both imaging modalities were found to be at an excellent level in this regard. The screening characteristics of ultrasonography was found to be influenced of the operator and frequency of transducer.

Introduction: Epilepsy is one of the most common chronic neurologic diseases. It has a great influence on quality of life, as it engages 1-3% of a society. Normally, 10% of the people of the society have experienced seizure once or several times during their lives. Regardingalldentistry aspects, they receive insufficient treatments, which might be due to the medical and economic status of them. Oral health is of paramount importance. Objective: This research aims at examining oral health status of the patients with epilepsy, comparing them with the non-patient ones from systemic point of view, and evaluating periodontal treatment needs. Materials and Methods: Sixty patients were randomly includedin this cross-sectional study. They were divided into 2 subgroups of partial and general (based on frequencies of seizures, type of seizure, and mental status). Sixty systemically non-patient people who referred to the Imam Khomeini Hospital for blood donation were randomly included in the study as the control group. They were medical and epilepsy history. Oral examinations were carried out. The Simplified Oral Hygiene Index (OHI-S), decay-missing-filled tooth (DMF-T), normal teeth abrasion rate (Abrasion Index), Prosthetic Index; periodontal treatment needs (CPITN) and Muhleman index were evaluated and a statistical comparison was made between the patient group and the control group and between the epilepsy subgroups. Results: OHI-S index, DMF-T index, Muhlemman index and Prosthetic index of the patient group was considerably higher than the one of the control group. About CPITN index, In mandible, the patient group has a significant difference with the control group, except in the area of the second left molar. Conclusion: Several factors contributed to worsening oral health status in the patient group as compared with the control group. For example, the effect of seizure itself, negative attitudes of dentists, and social and economic conditions. We propose to start oral treatments concurrent with the treatments concerning epilepsy. Some special dental interventions were proposed for each subgroup. Keywords: Epilepsy, Oral healt, Periodontal.

Identifying a reliable biomarker may accelerate diagnosis of multiple sclerosis (MS) and lead to early management of the disease. Accumulating evidence suggest that cerebrospinal fluid (CSF) and peripheral blood concentration of osteopontin (OPN) may have diagnostic and prognostic value in MS. We conducted a systematic review and meta-analysis of studies that measured peripheral blood and CSF levels of OPN in MS patients and controls to evaluate the diagnostic potential of this biomarker better. We searched PubMed, Web of Science and Scopus databases to find articles that measured OPN concentration in peripheral blood and CSF samples from MS patients up to October 19, 2016. Q statistic tests and the I2 index were applied for heterogeneity assessment. If the I2 index was less than 40%, the fixed-effects model was used for meta-analysis. Random-effects meta-analysis was chosen if the I2 value was greater than 40%. After removal of duplicates, 918 articles were identified, and 27 of them fulfilled the inclusion criteria. We included 22 eligible studies in the final meta-analysis. MS patients, in general, had considerably higher levels of OPN in their CSF and blood when compared to all types of controls (p

Objectives: Stroke is a major event in one's life, and patients will inevitably require the use of coping strategies in order to try to reestablish acceptable life equilibrium. Due to the extensive role that nurses can be active members in the patient's rehabilitation plan, the Mauk model is a model that focuses on stroke patients. For each stage of this model, Mauk has developed appropriate rehabilitation nursing interventions. This study aimed to analyze the effect of implementation of the Mauk nursing rehabilitation model (Agonizing phase, Fantasy phase, Realizing phase) on the coping strategies of stroke patients. Methods: This study is a quasi-experimental one-group pre-test-post-test study. The interventions are identified and coping strategies for patients based on the Mauk model have been trained. Convenience sampling has been done in Imam Khomeini hospital and Tabassom rehabilitation center in 1392. Data collection instruments included a demographic questionnaire and a coping strategies questionnaire for stroke patients. The educational program was implemented in sessions of 45 minutes. The patients’ coping strategies, before and after training, were assessed. Data was statistically analyzed using descriptive and inferential tests in SPSS software 16. Results: The mean score for coping strategies before intervention was 111.42±11.71, and after intervention was 102.14±12.45 (P

Objectives: Stroke is a neurological syndrome with sudden onset or gradual destruction of brain vessels, which may take 24 hours or more. Complications of stroke effect in the variation aspects of the individual. According to De Spulveda and Chang’s Studies, disability reduced the effective adjustment. This study aimed to overview the adjustment of stroke patients based on the main concepts of rehabilitation nursing Mauk model. Methods: In a quasi-experimental one group pre-posttest design study, data was collected in the neurology clinic of Imam Khomeini hospital and stroke patient rehabilitation centers in Tehran (Tabassom). Data collection included demographic and adjustment questionnaires of stroke patients. The intervention included seven sessions as Mauk model, each session with one hour training, for seven patients. Data analysis performed with SPSS software with paired t-test and was compared with previous results. Results: There were significant differences between the mean scores of patients with stroke adjustment questionnaire in the pre-test-post-test. But in the adjustment sub-scales, except for relationship with wife and Personal adjustment, in other areas, there is no statistically significant difference between the pre and posttest. Discussion: The results indicated that training has been affected on some aspects of adjustment of stroke patients in order to, as improving functions, complications and its limitations. Nurses can help then with implementing of plans such as patients education in this regard.

Background and Objectives: Temporomandibular disorder (TMD) refers to chronic pain of the temporomandibular joint (TMJ) associated with headache, neck pain, shoulder pain or back pain. The origin of these pains may be related to TMD. Many patients with chronic headache undergo different treatments for long periods of time with no cure. These headaches can be treated with proper diagnosis. This study aimed to assess the prevalence of TMD in patients with chronic pain. Materials and Methods: In this cross-sectional study, the prevalence of TMD was evaluated in 119 patients with chronic headache. Patients with headache for more than 6 months and those whose headache did not improve with medication were included. The research diagnostic criteria for temporomandibular disorders RDC/TMD (AXIS I, AXISII) questionnaire was used for assessment of TMD. Independent t-test was used to assess the correlation of TMD with headache and age. Chi square test was used to compare males and females. Results: A total of 119 patients with a mean age of 36.14±10.86 years (range 18-65 years) were evaluated. Of patients, 30% were males and 70% were females. The prevalence of TMD was 66%.The prevalence of mayofacial pain dysfunction syndrome (MPDS) was 11%. The prevalence of pain, clenching, trismus and clicking was 15.1%, 4.2%, 5% and 10.1%, respectively. Conclusion: The prevalence of TMD was high in patients with chronic headache. Thus, assessment of TMJ is recommended in diagnostic workup and treatment of patients with chronic headache. Keywords: Temporomandibular disorder; Chronic pain, Headache.

To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning.

Introduction: Stroke patients often experience falls with potentially serious consequences. Associated factors with falling in stroke patients have already been identified. The present study was conducted to find a better assessment tool for measuring the risk of falling, Fear of Falling (FOF), and balance between Falls Efficacy Scale-International (FES-I) and Berg Balance Scale (BBS). Materials and Methods: One hundred stroke patients were recruited from the physiotherapy clinics affiliated to Tehran University of Medical Sciences (TUMS) based on inclusive criteria to administer two predictive scales; FES-I and BBS. In 16-item FES-I, face to face interview provide information on FOF in daily life activities. BBS is used to measure the FOF during sitting, standing, and postural changes (reaching, balancing on one limb and transferring). Data were analyzed on the basis of age, post stroke duration, history of falling since disease onset and in the last 6 months as well as risk of falling. Results: Based on FES-I scale, the majority (69.8%) of old patients (50-64 years) showed low risk of falls and according to BBS, the majority of the stroke patients older than 64 years had high concern for falling. Both genders showed low concern for falling on FES-I and BBS scales and the results were not significant. On BBS, the falling concern was more among those who had one falling during the last 6 months. Conclusion: BBS is more relevant to predict the risk of falls among Iranian stroke patients and is also easy to administer at the stroke centers with minimum equipment.

Background: Impaired quality of life (QOL) is an issue considered in patients with multiple sclerosis (MS). There are limited studies evaluated poor sleep and impaired QOL in these cases. The aim of this study was to evaluate quality of sleep and poor sleep in Iranian patients with MS and the relationship between Pittsburgh Sleep Quality Index (PSQI) score and QOL subscales. Methods: One-hundred and fourteen cases with definite MS due to MC Donald criteria enrolled who referred to MS clinic of Sina and Imam Hospitals were enrolled. Patients asked to fill valid and reliable Persian versions of PSQI and MSQOL-54 questionnaires. Demographic data (sex, age), duration of the disease, education level and marital status were extracted from patients medical files. After neurological examination, Kurtzke Expanded Disability Status Scale (EDSS) was assessed. Results: Ninety-one (79.8%) patients were female and 23 (20.2%) were male. Mean age and EDSS was 34.7 ΁ 9.6 years and 2.3 (median: 1.5). Mean PSQI score and overall QOL score were 4.5 and 57. Sixty-seven cases were good sleepers (PSQI ≤ 5) and 47 were poor sleepers (PSQI > 5). Except five subscales, all others were significantly different between good and poor sleepers. There was significant positive correlation between PSQI score and EDSS (r = 0.24, P < 0.001) and negative correlation between EDSS and physical and mental health (r = −0.48, P < 0.001, r = −0.43, P < 0.001). EDSS and total PSQI score were independent predictors of physical and mental health composites. Conclusions: Sleep quality as a factor which affecting QOL should be considered and evaluated properly in MS patients.

Background and Aim: Electrical discharges in temporal lobe epilepsy can cause disorders in auditory pathways. Staggered spondaic word test (SSW) is one of the most common behavioral tests to evaluate the central auditory nervous system. This study aimed to evaluate and compare auditory processing problems in temporal lobe epileptic patients and normal subjects with Persian SSW test. Methods: This cross-sectional descriptive-analytic study was conducted on 25 patients with left temporal lobe epilepsy aged 18-46 years and 25 controls aged 18-42 years using SSW test. Corrected spondaic word test (C-SSW) was compared between groups. Results: Significant differences were found in the mean scores of right non-competitive, left non-competitive, right competitive, left competitive, right ear, and left ear between groups (p

Introduction: Despite the vast number of surveys, no consensus has been reached on the optimum timing of spinal decompression surgery. This systematic review and meta-analysis aimed to compare the effects of early and late spinal decompression surgery on neurologic improvement and post-surgical complications in patients with traumatic spinal cord injuries.Methods: Two independent reviewers carried out an extended search in electronic databases. Data of neurological outcome and post-surgery complication were extracted. Finally, pooled relative risk (RR) with a 95% confidence interval (CI) was reported for comparing of efficacy of early and late surgical decompression.Results: Eventually 22 studies were included. The pooled RR was 0.77 (95% CI: 0.68-0.89) for at least one grade neurological improvement, and 0.84 (95% CI: 0.77-0.92) for at least two grade improvement. Pooled RR for surgical decompression performed within 12 hours after the injury was 0.26 (95% CI: 0.13-0.52; pConclusion: The findings of this study indicate that early spinal decompression surgery can improve neurologic recovery and is associated with less post-surgical complications. The optimum efficacy is observed when the procedure is performed within 12 hours of the injury.

Multiple sclerosis is a chronic inflammatory disease of the central nervous system characterized by a complex immune response. Because of the complex nature of MS pathogenesis, a panel of biomarkers derived from different platforms will be required to reflect disease-related alterations. Monitoring and evaluation of molecules associated with the pathogenesis of the disease would provide useful information on disease progression and therapeutic assessment. In view of this, we evaluated the mRNA expression levels of B-cell activating factor (BAFF), high mobility group box 1 (HMGB-1), Toll like receptor (TLR) 4 and TLR7 in MS. These molecules are implicated in the pathogenesis of MS; however, they havereceived little attention. PBMCs were isolated from whole blood of 84 Relapsing Remitting Multiple Sclerosis patients and 70 healthy controls. Relative quantitative RT-PCR was applied to quantify the transcriptional levels of the immune markers. The mRNA expression levels of TLR7 were significantly elevated in RRMS patients than healthy controls. Whereas, TLR4 expression was found to be significantly lower in the patients than control group. We found no difference analyzing the mRNA levels of BAFF and HMGB1. Our data highlights the immune marker correlates in RRMS patients. However, further in-depth studies are warranted to check for their reliability of biomarkers in autoimmune diseases such as MS.

A 40-year-old woman visited our emergency department due to a 3-day history of headache. She was found to have deep cerebral vein thrombosis, which was worsened after initiation of heparin treatment. We present her as the only reported case of unilateral thalamic and basal ganglia edema in the setting of deep vein thrombosis secondary to bacterial meningitis.