Current Journal of Neurology

Original Article

Iranian specialists’ approach to treatment escalation in multiple sclerosis patients with cognitive impairment

Fereshteh Ghadiri; Elnaz Asadollahzadeh; Zahra Ebadi; Mohammad Ali Sahraian; Amirreza Azimi; Samira Navardi; Hora Heidari; Zohreh Abna; Marzieh Aboutorabi; Iman Adibi; Seyed Mohammad Baghbanian; Sepideh Paybast; Maryam Poursadeghfard; Samaneh Hosseini; Sareh Shahmohammadi; Mehran Ghaffari; Hamidreza Ghalyanchi-Langroodi; Masoud Ghiasian; Hoda Kamali; Ebrahim Kouchaki; Farzad Mehrabi; Ehsan Mohammadianinejad; Mohammad Ali Nahayati; Abdorreza Naser Moghadasi

Volume 22, Issue 1 , January 2023, Pages 1-7

Abstract

Background: People with multiple sclerosis ‎(MS) and their physicians recognize cognitive retention as an important desired outcome of disease-modifying therapies (DMTs). In this study, we attempted to gather the opinions of Iranian MS experts regarding the treatment approach toward clinical ... Read More

Original Article

Comparison of side effects of the dose-1 of AstraZeneca and Sinopharm vaccines in patients with multiple sclerosis in Kermanshah, Iran (2021)

Nazanin Razazian; Mohammad Ali Sahraian; Mansour Rezaei; Sharareh Eskandarieh; Kianoosh Khamoushian; Seyede Elham Mousavi; Negin Fakhri

Volume 22, Issue 1 , January 2023, Pages 8-15

Abstract

Background: Coronavirus 2019 (COVID-19) vaccination is recommended for people with multiple sclerosis (MS). This study evaluated the side effects of Sinopharm and AstraZeneca vaccines in MS patients.Methods: In this cross-sectional study among MS patients in Kermanshah province, Iran, who received Sinopharm ... Read More

Original Article

Challenges of patients with multiple sclerosis in receiving health care services in Iran

Niloofar Jahromi; Sharareh Eskandarieh; Nazanin Maleki; Narges Sistany-Allahabadi; Mohammad Ali Sahraian

Volume 22, Issue 1 , January 2023, Pages 16-22

Abstract

Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different ... Read More Background: Multiple sclerosis (MS) is a debilitating, non-traumatic, neurological disorder in young adults and can reduce quality of life (QoL) by interfering with the ability to work, leisure activities, and routine living tasks. Various studies have shown the dissatisfaction of people with MS in different areas of care services. Regarding the patients' dissatisfaction with care services, in this study, we sought to identify the care challenges of MS patients in Iran. Methods: This cross-sectional study was conducted in 2016-2018 using a researcher-made questionnaire (designed by MS Specialists in an MS research center). The questionnaire examines the care challenges in four areas: 1) costs of medication, hospitalization, and rehabilitation services, 2) family support, insurance system, and job protection, 3) access to transportation system and treatment team, 4) quality of the provided care and services.Results: Completed questionnaires were received from 945 respondents. The mean age of responders was 35.92 years. In total, 731 (77.8) participants were women and 208 (22.2) were men. Academic education was reported among 615 (65.3) participants and 367 (40.2) were employed during the study, while 99 (10.5) of the subjects were not able to walk a minimum of 20 meters. The prioritization of care services challenges is as follows: the cost of pharmaceutical services (49.1), lack of telephone counseling (47.4), uninsured home rehabilitation (44.7), lack of qualified care centers (41.2), and rehabilitation costs (40.2).Conclusion: We found that patients who could not walk at least 20 meters and unemployed individuals had more problems and lower QoL. The patients who had non-academic education had more challenges with the cost of medication, transportation, and lack of familial support. This study shows the challenges of MS patients in receiving health care in Iran that vary in age, education, employment, and ability to walk. As the abovementioned challenges are of great importance in determining the QoL of people with MS, an appropriate solution is provided in this study to overcome these challenges.

Original Article

The effect of body mass index on the morbidity and outcomes of COVID-19 in Iranian patients with multiple sclerosis

Nasim Rezaeimanesh; Naghmeh Abbasi; Mohammad Ali Sahraian; Amirreza Azimi; Soodeh Razeghi-Jahromi; Abdorreza Naser Moghadasi

Volume 22, Issue 1 , January 2023, Pages 23-29

Abstract

Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship ... Read More Background: It seems that patients with multiple sclerosis (MS) are at a higher risk for coronavirus disease 2019 (COVID-19) implications due to being subjected to immunomodulatory or immunosuppressive treatments. Besides, obesity as a risk factor may lead to more adverse consequences. The relationship between obesity and COVID-19 morbidity and outcomes in Iranian patients with MS still remains unclear.Methods: A cross-sectional study was conducted in Sina Hospital, Tehran, Iran. Patients with MS were asked to complete an online questionnaire in the Google Form format. Demographic information, clinical information including MS disease-related factors, COVID-19-related factors, and anthropometric information were recorded. Totally, 492 patients filled the questionnaire during two weeks in November 2021, by the response rate of 21.6%. Body mass index (BMI) was categorized based on the standard classification of the World Health Organization (WHO). The logistic regression was used to examine the risk of morbidity and chi-square test/one-way analysis of variance (ANOVA) was employed to determine the difference regarding severity and symptoms among groups.Results: In the fully adjusted model, the odds ratio (OR) of COVID-19 morbidity in class II obese participants was significantly 5.41 times higher than that in the normal BMI group [OR: 5.41, 95% confidence interval (CI): 1.00-29.09]. COVID-19 severity was significantly different among BMI groups (P = 0.024). Respiratory symptoms (P = 0.05) as well as gastrointestinal (GI) symptoms (P < 0.01) of COVID-19 were more prevalent among class I and class II obese patients compared with overweight, normal weight, and underweight groups. Moreover, no one in the class I and class II obesity groups reported COVID-19 morbidity without any symptoms (P = 0.04).Conclusion: The results of the current study support the view that obesity could play a key role in susceptibility to COVID-19 morbidity and severity of the symptoms in patients with MS. The findings recommended that neurologists pay more attention to patients' BMI during this pandemic.

Original Article

The association of serum carnitine levels with severity of fatigue in patients with multiple sclerosis: A pilot study

Mohammad Hossein Harirchian; Siavash Babaie; Nika Keshtkaran; Sama Bitarafan

Volume 22, Issue 1 , January 2023, Pages 30-34

Abstract

Background: Fatigue is a common complaint of patients with multiple sclerosis (MS), adversely affecting their quality of life. There is a lot of evidence showing that carnitine deficiency is linked to fatigue development and severity in some conditions. This study aimed to evaluate the association between ... Read More

Original Article

Stability monitoring of patients with myasthenia gravis using a mobile-based application

Emad Alaei Tafti; Marjan Ghazisaeedi; Payam Sarraf

Volume 22, Issue 1 , January 2023, Pages 35-43

Abstract

Background: Failure in early diagnosis of myasthenia gravis (MG) and the risks of taking certain medications and undergoing surgery and anesthesia can lead to severe respiratory disorders and death. However, there are therapeutic measures that significantly control the disease and improve individual’s ... Read More

Original Article

Association analysis of serotonin transporter gene polymorphism among the South-Indian migraineurs

Pallavi Kesavan; Aiswarya Padmaja Satheesh; Akram Husain Rehman Syed Rasheed; Umamaheshwari Veerappan; Subramaniyan Kannaian; Ramakrishnan Veerabathiran

Volume 22, Issue 1 , January 2023, Pages 44-49

Abstract

Background: Migraine is a multifactorial neurological disorder characterized by frequent moderate to severe intensity headaches. The genetic variations in synaptic and post-receptor signalling proteins have direct effect on the process of serotonergic neurotransmission.Methods: We aimed to investigate ... Read More

Review Article

The relationship between retinal layer thickness and cognition in patients with multiple sclerosis: A systematic review of current literature

Abdorreza Naser Moghadasi; Omid Mirmosayyeb; Narges Ebrahimi; Mohammad Ali Sahraian; Aida Mohammadi; Mahsa Ghajarzadeh

Volume 22, Issue 1 , January 2023, Pages 50-57

Abstract

Background: This study was conducted to evaluate the relationship between retinal layer thickness (RLT) and cognition in patients with multiple sclerosis (MS).Methods: We searched PubMed, Scopus, Embase, Web of Science, and Google Scholar. The search strategy included the MeSH and text words as [“ora ... Read More

Short Communication

A nomogram-based clinical tool for acute ischemic stroke screening in prehospital setting

Alireza Baratloo; Mahtab Ramezani; Hosein Rafiemanesh; Meisam Sharifi; Somayeh Karimi

Volume 22, Issue 1 , January 2023, Pages 58-62

Abstract

Background: We believe that designing a new tool which is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of acute ischemic stroke (AIS) in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis ... Read More Background: We believe that designing a new tool which is comparable in terms of both sensitivity and specificity may play an important role in rapid and more accurate diagnosis of acute ischemic stroke (AIS) in prehospital stage. Therefore, we intended to develop a new clinical tool for the diagnosis of AIS in the prehospital stage.Methods: This was a cross-sectional diagnostic accuracy study. All patients transferred to the emergency department (ED) who underwent brain magnetic resonance imaging (MRI) with impression of AIS were evaluated by 9 clinical tools for stroke diagnosis in the pre-hospital phase including Rapid Arterial Occlusion Evaluation (RACE), Cincinnati Prehospital Stroke Scale (CPSS), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Medic Prehospital Assessment for Code Stroke (Med PACS), Ontario Prehospital Stroke Screening Tool (OPSS), PreHospital Ambulance Stroke Test (PreHAST), Recognition of Stroke in the Emergency Room (ROSIER), and Face Arm Speech Test (FAST), and totally 19 items were reviewed and recorded. The new clinical tool was developed based on backward method of multivariable logistic regression analysis. The discrimination power of the new clinical tool for diagnosis of AIS was assessed with the area under the receiver operating characteristic curve (AUC-ROC).Results: Data from 806 patients were analyzed; of them, 57.4% were men. The mean age of the study patients was 66.9 years [standard deviation (SD) = 13.9]. In the multivariable model, 8 items remained. The AUC-ROC of the new clinical tool was 0.893 [95% confidence interval (CI): 0.869-0.917], and its best cut-off point was score ≥ 3 for positive AIS. At this cut-off point, sensitivity and specificity were 84.42% and 79.72%, respectively.Conclusion: We introduced a new nomogram-based clinical tool for the diagnosis of AIS in the prehospital stage, which has acceptable specificity and sensitivity; moreover, it is comparable with previous tools.

Letter to the Editor

The prevalence of multiple sclerosis in Tehran, Iran, in 2020

Sharareh Eskandarieh; Saeideh Ayoubi; Mohammad Ali Sahraian

Volume 22, Issue 1 , January 2023, Pages 63-64

Abstract

- Read More

Guillain-Barre syndrome in patients with coronavirus disease-2019: Report of six cases and review of literature

Ali Asghar Okhovat; Behnaz Ansari; Helia Hemasian; Bahram Haghi-Ashtiani; Soroor Advani; Bentolhoda Ziaadini; Siamak Abdi; Hajir Sikaroudi; Shahriar Nafissi; Farzad Fatehi

Volume 19, Issue 3 , July 2020, , Pages 122-130

https://doi.org/10.18502/cjn.v19i3.5425

Abstract

Background: Few studies have reported the association of Guillain-Barre syndrome (GBS) and coronavirus disease-2019 (COVID-19) infection. In this study, we reported GBS in six patients infected with COVID-19 and reviewed all existing literature about GBS in association with COVID-19. Methods: This study ... Read More

Assessment of computed tomography perfusion RAPID estimated core volume accuracy in patients following thrombectomy

Riwaj Bhagat; Allison Muha; Kerri Remmel; Wei Liu

Volume 21, Issue 1 , January 2022, , Pages 17-22

https://doi.org/10.18502/cjn.v21i1.9356

Abstract

Background: Computed Tomography Perfusion (CTP) maps ischemic core volume (CV) and penumbra following a stroke; however, its accuracy in early symptom onset is not well studied. We compared the accuracy of CTP RAPID estimated CV with diffusion weighted imaging (DWI) infarct volume (IV) in patients following ... Read More

Effect of energy conservation strategies on fatigue, function, and quality of life in adults with motor neuron disease: Randomized controlled trial

Hamid Reza Fateh; Reihaneh Askary-Kachoosangy; Niloofar Shirzad; Alireza Akbarzadeh-Baghban; Farzad Fatehi

Volume 21, Issue 2 , April 2022, , Pages 83-90

https://doi.org/10.18502/cjn.v21i2.10491

Abstract

Background: Fatigue is one of the most frequent complaints in patients with motor neuron diseases (MNDs), with a significant impact on the quality of life (QOL). Current pharmacological or non-pharmacological treatments of fatigue in this population lack enough evidence to be applied in the clinical ... Read More

B vitamins and their combination could reduce migraine headaches: A randomized double-blind controlled trial

Shiva Nematgorgani; Soodeh Razeghi-Jahromi; Elham Jafari; Mansoureh Togha; Pegah Rafiee; Zeinab Ghorbani; Zeynab Sadat Ahmadi; Vali Baigi

Volume 21, Issue 2 , April 2022, , Pages 105-118

https://doi.org/10.18502/cjn.v21i2.10494

Abstract

Background: The B vitamins can potentially help prevent migraine. This study was designed to examine the effects of supplementation with thiamine (B1), pyridoxine (B6), cobalamin (B12), folic acid (B9), and a combination of these vitamins on women with episodic migraine (EM).Methods: This study was a ... Read More

A randomized controlled trial investigating the effects of a mediterranean-like diet in patients with multiple sclerosis-associated cognitive impairments and fatigue

Soodeh Razeghi-Jahromi; Rozita Doosti; Zeinab Ghorbani; Roghayyeh Saeedi; Maryam Abolhasani; Naeemeh Akbari; Fatemeh Cheraghi-Serkani; Abdorreza Naser Moghadasi; Amirreza Azimi; Mansoureh Togha; Mohammad Ali Sahraian

Volume 19, Issue 3 , July 2020, , Pages 112-121

https://doi.org/10.18502/cjn.v19i3.5424

Abstract

Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory ... Read More Background: Among multiple sclerosis (MS) related symptoms and complications, fatigue might impact roughly 90% of patients. Decline in cognitive function is one of the other complications that occur in the first years after disease onset. The Mediterranean diet is one of the well-known anti-inflammatory dietary approaches. Therefore, this study aimed to explore the effects of a modified Mediterranean-like diet on cognitive changes and fatigue levels in comparison with a conventional standard diet over a 1-year follow-up. Methods: In the current single-blind randomized controlled trial, 34 MS patients in the Mediterranean- like diet group and 38 patients in the standard healthy diet group were studied for 1 year. The dietary interventions were modified each month by an expert nutritionist. MS-associated fatigue level was evaluated using the Modified Fatigue Impact Scale (MFIS). Cognitive assessment was also performed using Minimal Assessment of Cognitive Function in MS (MACFIMS). Results: Intergroup ‎comparisons demonstrated that after considering confounding variables in ANCOVA, fatigue scores appeared significantly lower in patients who were treated with the Mediterranean-like diet than those in the standard healthy diet group [Mean 95% confidence interval (CI)}: 33.93 (32.97-34.89) and 37.98 (36.99-38.97), respectively; P < 0.001]. However, the intergroup ‎analysis of cognitive status only showed a difference in the mean score of Brief Visuospatial Memory Test-Revised (BVMT-R) subtest of the MACFIMS. The BVMT-R‎ was higher among standard healthy diet patients compared to the Mediterranean-like diet group after the intervention following adjustment for covariates [Mean (95% CI): 23.73 (21.88-25.57) and 20.56 (18.60-22.51), respectively; P = 0.020]. Conclusion: In conclusion, the results of this study highlighted the higher protective effects of the Mediterranean-like diet against MS-related fatigue than the standard healthy diet. However, no significant improvement was observed in the cognitive status of MS patients after a 1-year treatment with the Mediterranean-like diet. More randomized clinical trials with larger sample sizes are needed to elucidate the effects of dietary modifications on MS-associated symptoms and complications.

Original Article

Factors associated with the number of months of delaying in multiple sclerosis diagnosis: Comparison of count regression models

Abolfazl Hosseinnataj; Roya Nikbakht; Seyed Nouraddin Mousavinasab; Sharareh Eskandarieh; Mohammad Ali Sahraian; Seyed Mohammad Baghbanian

Articles in Press, Accepted Manuscript, Available Online from 26 March 2023

Abstract

Background: It may take a long time to diagnose multiple sclerosis (MS) since the emergence of primary symptoms. This study aimed to use count regression models to compare their fit and to identify factors affecting delay in the diagnosis of MS.Methods: Data were collected from the Nationwide MS Registry ... Read More

Original Article

Waterpipe and cigarette smoking and drug and alcohol consumption, and the risk of primary progressive multiple sclerosis: A population-based case-control study

Seyyed Hosein Mortazavi; Abdorreza Naser Moghadasi; Amir Almasi-Hashiani; Mohammad Ali Sahraian; Hooman Goudarzi; Sharareh Eskandarieh

Articles in Press, Accepted Manuscript, Available Online from 03 April 2023

Abstract

Background: Multiple sclerosis (MS) is a chronic central nervous system disease, and primary progressive multiple sclerosis (PPMS) is one the main types of MS, which has unknown environmental risk factors. The present study was conducted with the aim to identify the association of waterpipe and ... Read More

Original Article

Fear of re-infection, relapse, and anxiety during COVID-19 pandemic in patients with multiple sclerosis: A multi-center study

Abdorreza Naser Moghadasi; Saeed Vaheb; Sara Hamtaei-Ghashti; Aysa Shaygannejad; Mozhdeh Askari; Vahid Shaygannejad; Mohmmad Ali Sahraian; Mahsa Ghajarzadeh

Articles in Press, Accepted Manuscript, Available Online from 18 March 2023

Abstract

Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS.Methods: ... Read More Background: Fear of relapse and re-infection during the coronavirus disease 2019 (COVID-19) pandemic can affect people with chronic relapsing diseases, such as multiple sclerosis (MS). We evaluated fear of re-infection, anxiety, and relapse during the COVID-19 pandemic in Iranian people with MS.Methods: This multicenter, cross-sectional study was performed in the MS clinic of Sina Hospital, Tehran, Iran, and Hakim Private Hospital, Isfahan, Iran, between January and April 2022. We asked the participants to fill out validated Persian versions of Fear of Relapse Scale (FoR), and Beck Anxiety Inventory (BAI) questionnaires and answer a binary question about their fear of getting reinfected with COVID-19. Results were reported as mean ± standard deviation (SD) for continuous variables or frequencies for categorical variables. For continuous variables which did not have a normal distribution, we reported the median and interquartile range (IQR). Spearman correlation coefficient between anxiety score and FoR score was calculated. An independent samples t-test was used to compare continuous variables.Results: Three hundred and sixty-eight patients participated in this study. The median scores of FoR and BAI were 49.7 and 34.3, respectively. Fifty-three had new relapses in their last infection. Thirty-six percent of the patients had a fear of getting COVID-19 again, and 43% had a fear of relapse during infection. Three hundred and twenty-three had two doses of COVID-19 vaccine; the most frequent type of vaccine was Sinopharm. There was a significant difference between the median FoR scores among patients with and without relapse during the last COVID-19. There was also a significant positive correlation between anxiety score and FoR (r = 0.49, P < 0.001).Conclusion: More than one-third of enrolled cases had fear of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-infection. Patients who experienced exacerbation of symptoms even in the form of relapse or pseudo relapse (possible clinical relapse) had a higher fear of infection.

Original Article

Association of dietary patterns with migraine: A matched case-control study

Fahimeh Martami; Mansoureh Togha; Mostafa Qorbani; Donya Shahamati; Zhaleh Salami; Sakineh Shab-Bidar

Articles in Press, Accepted Manuscript, Available Online from 09 April 2023

Abstract

Background: Little is known about the association between dietary patterns and odds of migraine. We aimed to investigate the association between posteriori dietary patterns and migraine odds and migraine-related outcomes using principal component analysis (PCA).Methods: A total of 500 participants enrolled ... Read More

Original Article

Iranian specialists’ approach to surgery in patients with multiple sclerosis

Fereshteh Ghadiri; Zahra Ebadi; Elnaz Asadollahzadeh; Mohammad Ali Sahraian; Amirreza Azimi; Samira Navardi; Hora Heidari; Zohreh Abna; Marzieh Aboutorabi; Iman Adibi; Seyed Mohammad Baghbanian; Sepideh Paybast; Maryam Poursadeghfard; Samaneh Hosseini; Sareh Shahmohammadi; Mehran Ghaffari; Hamidreza Ghalyanchi-Langroodi; Masoud Ghiasian; Hoda Kamali; Ebrahim Kouchaki; Farzad Mehrabi; Ehsan Mohammadianinejad; Mohammad Ali Nahayati; Abdorreza Naser Moghadasi

Articles in Press, Accepted Manuscript, Available Online from 10 April 2023

Abstract

Background: Data on perioperative risk stratification in patients with multiple sclerosis (MS) are limited. In this regard, the present study was conducted to investigate Iranian specialists’ approach to surgical counseling for patients with MS (PwMS).Methods: 21 MS specialists were asked about ... Read More

Original Article

Epidemiological parameters of multiple sclerosis in Chaharmahal and Bakhtiari Province, Iran

Mohammad Amin Omrani; Asghar Bayati; Mohammad Ali Sahraian; Sharareh Eskandarieh

Articles in Press, Accepted Manuscript, Available Online from 16 April 2023

Abstract

Background: Multiple sclerosis (MS) is a neurological disease with a high burden and disability. There are reports of various medications’ side effects on patients with MS. The aim of the study is to determine the characteristics and medicine usage distribution among patients with MS in Chaharmahal ... Read More

Review Article

Alternate dosing of fingolimod in relapsing-remitting multiple sclerosis: A systematic review

Fereshteh Ghadiri; Omid Mirmosayyeb; Mohammad Ali Sahraian; Abdorreza Naser Moghadasi; Mahsa Ghajarzadeh

Articles in Press, Accepted Manuscript, Available Online from 13 March 2023

Abstract

Background: Fingolimod is approved in relapsing-remitting multiple sclerosis (RRMS) with the recommended dose of 0.5 mg daily. To tackle possible adverse events, some clinicians may reduce the dose of fingolimod, mainly in the alternate-day form. We systematically reviewed the literature for efficacy ... Read More

Review Article

Adverse side effects of Glatiramer acetate and Interferon beta-1a in patients with multiple sclerosis: A systematic review of case reports

Mohsen Rastkar; Mahsa Ghajarzadeh; Mohammad Ali Sahraian

Articles in Press, Accepted Manuscript, Available Online from 11 May 2023

Abstract

Background: Glatiramer acetate (GA) and Interferon (IFN) beta-1a are used as first-line disease-modifying treatments for multiple sclerosis (MS). In this systematic review, we summarized case reports and case series of adverse side effects of GA and IFN beta-1a in MS patients.Methods: Without any restrictions, ... Read More