Original Article
Neurocritical Care
Aishwarya Swaminathan; Sanjiv Kumar
Articles in Press, Accepted Manuscript, Available Online from 16 October 2024
Abstract
Background: Comatose is a state of deep unconsciousness in an individual being unresponsive which has an impact on the informal caregivers providing care to their kinships. The validity and reliability of the domains of the Knowledge, Attitude, Awareness-Comatose Caregiver Questionnaire (KAA-CCQ) and ...
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Background: Comatose is a state of deep unconsciousness in an individual being unresponsive which has an impact on the informal caregivers providing care to their kinships. The validity and reliability of the domains of the Knowledge, Attitude, Awareness-Comatose Caregiver Questionnaire (KAA-CCQ) and has been taken into consideration as an outcome measure to assess the level of knowledge, attitude, and awareness among the caregivers of comatose patients.Methods: 68 informal caregivers above the age of 18 years related to comatose patients were included in the study. The self-developed KAA-CCQ was administered on the informal caregivers of comatose patients to assess the level of knowledge, attitude, and awareness regarding coma. Validity and reliability of the questionnaire were calculated by Spearman’s rank correlation and Cronbach΄s alpha, respectively.Results: The reliability of all the three domains and the questionnaire was found to be 0.8 and the item correlation with respect to the domain was above 0.6 for the knowledge whereas it was above 0.6 for the attitude and awareness domains that justified the validity of the questionnaire, and also the questionnaire had an excellent reliability.Conclusion: The KAA-CCQ will be a suitable questionnaire to assess the knowledge, attitude, and awareness in the informal caregivers of comatose patients.
Original Article
Child neurology / Developmental Neurology
Mohammadreza Mirzaaghayan; Sara Memarian; Alireza Abdshah; Mojgan Ghavami; Ghazale Roozbahani; Fatemeh Naseri; Mohammad Sajjad Jolani; Masood Ghahvechi; Behdad Gharib
Articles in Press, Accepted Manuscript, Available Online from 20 November 2024
Abstract
Background: Delirium is a common challenge in pediatric open heart surgery intensive care units (OH-ICU). It is believed that emergence of delirium can lead to extended hospitalization periods. Therefore, we decided to investigate the association between delirium and its inciting factors in OH-ICU.Methods: ...
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Background: Delirium is a common challenge in pediatric open heart surgery intensive care units (OH-ICU). It is believed that emergence of delirium can lead to extended hospitalization periods. Therefore, we decided to investigate the association between delirium and its inciting factors in OH-ICU.Methods: This was a cross-sectional study on 92 pediatric patients admitted to OH-ICU of “Children’s Medical Center” in Tehran, Iran, for more than 48 hours. To screen for delirium, the Cornell Assessment of Pediatric Delirium (CAPD ≥ 9) was utilized. Demographics, length of stay, development of complications, delirium, and factors associated with delirium were recorded.Results: We observed 34 (37%) cases of delirium in patients in OH-ICU. We had 51% male patients and 49% female ones, with a median age of 8 (0.2-144) months. The median length of mechanical ventilation was 11.5 hours (2-405) and they stayed in the hospital for a median of 4 days (2-31). The most common cardiac abnormality was ventricular septal defect (18%), associated with tetralogy of Fallot (TOF) (10%). Most of the patients (71%) experienced no adverse events during their stay; however, among those who did, vomiting and post-operation chorea were the most prevalent. Among the patients in our study, age [adjusted odds ratio (AOR) = 0.91], weight (AOR = 1.34), and sex (AOR = 0.31 for boys vs. girls) were significantly associated with delirium.Conclusion: We observed delirium in 37% of the patients. Development of delirium in patients admitted to pediatric intensive care unit (PICU) was associated with younger age, female sex, and higher weight.
Original Article
Neuroimaging
Yiğithan Güzin; Safa Mete Dağdaş; Pınar Gençpınar; Figen Baydan; Özkan Alataş; Ümit Belet; Gamze Sarıkaya Uzan; Nihal Olgaç Dündar
Articles in Press, Accepted Manuscript, Available Online from 08 December 2024
Abstract
Background: Arachnoid cysts (ACs) are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled cavities lined with arachnoid membranes. Most of them are found incidentally and are asymptomatic. The aim of this study was to describe the clinical and demographic characteristics of ACs and to investigate ...
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Background: Arachnoid cysts (ACs) are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled cavities lined with arachnoid membranes. Most of them are found incidentally and are asymptomatic. The aim of this study was to describe the clinical and demographic characteristics of ACs and to investigate the frequency of complications.Methods: ACs were classified as cerebral and cerebellar, and were evaluated according to location and size using the Galassi classification.Results: Evaluation was made of 103 patients with AC admitted to the pediatric neurology department. The patients comprised 62.1% boys and 37.9% girls with a mean age of 10.1 ± 4.9 years. Headache was present in 33% of patients, epileptic seizures in 22.3%, and neuromotor developmental delay in 14%. Spontaneous intracranial hemorrhage (ICH) was observed in 6 patients (5.8%), with 3 (50%) having a cyst diameter ≥ 5 cm. ACs frequently involved the retrocerebellar and temporal lobes. Epilepsy was diagnosed in 26 patients (25.2%) and in only one of them, epileptic discharge and AC originated from the same region. The risk of bleeding was found to be higher in patients with cyst diameter ≥ 5 cm (P = 0.032).Conclusion: Although ACs are generally considered harmless, a cyst size ≥ 5 cm is important in terms of the risk of bleeding and should be followed up regularly. Although it has been reported in the literature that ACs may be associated with epilepsy, no significant correlation was found between seizure type and electroencephalography (EEG) recordings in this study.
Original Article
MS and Related Disorders
Mohammadreza Etemadifar; Masoud Etemadifar; Seyyed Ali Alaei; Mahdi Norouzi
Articles in Press, Accepted Manuscript, Available Online from 08 December 2024
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, ...
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Background: Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory disease predominantly affecting the central nervous system (CNS). Headaches, although common in patients with multiple sclerosis (MS), have been less studied in NMOSD. This study aimed to investigate the prevalence, characteristics, and associated symptoms of headaches in patients with NMOSD.Methods: This cross-sectional study included 120 patients with NMOSD recruited from MS clinics in Isfahan City, Iran, between 2023 and 2024. Patients were assessed for headache prevalence and characteristics. An expert neurologist conducted examinations to exclude secondary causes of headaches and classified headache types according to the International Classification of Headache Disorders (ICHD-3).Results: Eighteen patients (15%) reported headaches, all of whom were women. The average age of these patients was 41.27 ± 11.33 years, and the average onset age of NMOSD was 34.60 ± 12.12 years. Of the 18 patients, 14 were diagnosed with migraine and 4 with tension headaches. Patients with migraine reported more severe pain (severity score: 6.00 ± 1.42) than those with tension headaches (4.20 ± 1.35). Headache onset was equally likely to occur before or after an NMOSD diagnosis. Significant associated symptoms included photophobia, phonophobia, and nausea in patients with migraine, with a substantial impact on occupational disability reported by 57% of migraine sufferers and 50% of tension headache sufferers.Conclusion: Headaches, particularly migraines, are prevalent in patients with NMOSD and significantly impact their quality of life (QOL) and occupational functioning. These findings emphasize the need for clinicians to recognize headache patterns in NMOSD for accurate diagnosis and effective management. Further longitudinal studies are warranted to explore causal mechanisms and develop targeted interventions.
Original Article
Headache and Pain
Hamed Cheraghmakani; Mehrdad Afzalinezhad; Monireh Ghazaeian; Parham Mortazavi; Narges Karimi; Sahar Fallah
Articles in Press, Accepted Manuscript, Available Online from 08 December 2024
Abstract
Background: Mitochondrial metabolism disruption increases neuron excitability and reduces migraine attack threshold. This study investigates whether serum fibroblast growth factor-21 (FGF-21) levels in chronic migraine relate to headache severity and response to sodium valproate treatment.Methods: This ...
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Background: Mitochondrial metabolism disruption increases neuron excitability and reduces migraine attack threshold. This study investigates whether serum fibroblast growth factor-21 (FGF-21) levels in chronic migraine relate to headache severity and response to sodium valproate treatment.Methods: This pilot study involved 30 patients with chronic migraine treated with sodium valproate. Serum FGF-21 levels were assessed at baseline and after 12 weeks of treatment. Pain severity and disability were evaluated using visual analogue scale (VAS) and Migraine Disability Assessment (MIDAS). Paired t-test was used for the quantitative variables. The qualitative variables were evaluated using Pearson’s chi-square test and Fisher’s exact test. Moreover, correlation coefficients were calculated. A P < 0.05 was considered statistically significant.Results: Mean age of the patients was 42.9 ± 11.3 years. There was a significant reduction in headache severity between baseline and the end of the study regarding VAS scores (8.50 ± 1.50 vs. 5.30 ± 2.20, P < 0.001). The same reduction was observed in MIDAS during the study (61.20 ± 33.20 vs. 20.31 ± 17.07, P < 0.001). However, there was no significant changes in serum levels of FGF-21 over three months (299.53 ± 479.80 vs. 491.33 ± 456.64, P = 0.810), nor any relationship between these levels and headache severity scores (MIDAS: P = 0.658, VAS: P = 0.708).Conclusion: The results of this study did not show a significant correlation between FGF-21 serum levels and changes in VAS and MIDAS throughout the study. Further research on various mitochondrial pathways can provide valuable insights into the migraine pathophysiology and help identify more effective biomarkers for monitoring therapeutic regimens.
Review Article
MS and Related Disorders
Mohammadreza Jamshidi; Milad Abbasian; Ali Ghasemnezhad; Atoosa Keshavarz-Motamed; Zehra Batool; Arian Tavasol; Mahsa Nikfarjam; Mohammad Moein Ashrafi; Atefeh Zare-Ahmadabadi; Seyyed Ali Jalalian
Articles in Press, Accepted Manuscript, Available Online from 13 December 2024
Abstract
Background: Multiple sclerosis (MS) is one of the most common progressive neurological disorders affecting young adults. This study aimed to perform a meta-analysis on the effect of interferon beta (IFN-β) on the quality of life (QOL) of patients with MS.Methods: Using valid keywords and searching ...
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Background: Multiple sclerosis (MS) is one of the most common progressive neurological disorders affecting young adults. This study aimed to perform a meta-analysis on the effect of interferon beta (IFN-β) on the quality of life (QOL) of patients with MS.Methods: Using valid keywords and searching through databases like Medlib, ScienceDirect, PubMed, etc., 10 articles published between 1999 and 2020 were collected. The inclusion criteria were developed based on clinical guidelines, focusing on studies involving adults with MS treated with IFN-β, with outcomes measuring QOL. The exclusion criteria included studies not in English, those involving pediatric populations, or those lacking a control group. In the reviewed studies, 14 scales of QOL were measured at the beginning and the end of treatment with IFN-β. The data were analyzed using the random effects model meta-analysis method with R software and Stata software. Publication bias was not significant. Heterogeneity was evaluated using the Q test and the I2 index. In heterogeneous studies, subgroup analysis and meta-regression were used for meta-analysis. The random-effect model was used for analyses with I2 of more than 50%.Results: A total number of 1320 people with an average age of 32.40 ± 8.77 years were included in this study. On average, there was a slight decline in energy and satisfaction with sexual function scales (SSF), while a slight improvement was seen in the other 12 scales, following the treatment with IFN-β. However, no significant changes were observed in any QOL scales following treatment, except for health distress (HD) (P < 0.001), role limitation due to physical problems (RLPP) (P < 0.001), and role limitation due to emotional problems (RLEP) (P = 0.037), which showed a slight yet considerable improvement. The physical and mental components, showed significant increases of 0.189 [95% Confidence interval (CI): 0.083, 0.295, I2 = 0%] and 0.221 (95% CI 0.119, 0.324, I2 = 0%) in the scores after using IFN-β, respectively.Conclusion: This study's results showed that treatment with IFN-β does not negatively affect the QOL of patients with MS. Moreover, this treatment can slightly improve most QOL scales associated with the disability observed in MS.
Clinical Notes
Child neurology / Developmental Neurology
Sara Memarian; Golazin Shahbodagh-Khan; Masood Ghahvechi-Akbari; Elham Pourbakhtyaran; Saeid Samimiat; Mahmoudreza Ashrafi; Morteza Heidari
Articles in Press, Accepted Manuscript, Available Online from 03 October 2024
Clinical Notes
Cognitive neurology / Neuropsychiatry
Sajad Shafiee; Abbas Tafakhori; Mohammad Sadra Nemati; Saeed Kargar-Soleimanabad; Sobhan Alipour-Kiasar; Reza Yazdani-Cherati; Ahmadreza Hojati-Marvast; Omid Ahmadvand
Articles in Press, Accepted Manuscript, Available Online from 29 September 2024
Letter to the Editor
Ilkin Iyigundogdu; Eda Derle; Fatma Irem Yesiler
Articles in Press, Accepted Manuscript, Available Online from 26 September 2024
Neuroimage/Video
Lisle Blackbourn; Maher Salem; Deepak Nair
Articles in Press, Accepted Manuscript, Available Online from 26 September 2024
Clinical Notes
Marcos R. Flores; Dianella Rente Lavastida; Zachary I. Merhavy; Maryam Ameen; Samir Ruxmohan
Articles in Press, Accepted Manuscript, Available Online from 23 December 2024
Neuroimage/Video
Neuroimaging
Abel Gonzalez-Huete; Beatriz Alba-Perez; Luis Gonzalez-Campo
Articles in Press, Accepted Manuscript, Available Online from 23 December 2024
Original Article
Ghasem Farahmand; Sina Gharehjeh; Seyyed Reza Ebadi; Vahid Zolfaghari; Sara Ranji; Sajjad Shafiee; Abbas Tafakhori; Atefeh Behkar; Mojtaba Shahbazi; Vajiheh Aghamollaii
Articles in Press, Accepted Manuscript, Available Online from 25 December 2024
Abstract
Background: Patients with refractory epilepsy may benefit from epilepsy surgery. However, cognitive decline following epilepsy surgery is a significant concern. In this study, we investigated the effect of epilepsy surgery on cognitive function.Methods: In this pre-post study, we used a census method ...
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Background: Patients with refractory epilepsy may benefit from epilepsy surgery. However, cognitive decline following epilepsy surgery is a significant concern. In this study, we investigated the effect of epilepsy surgery on cognitive function.Methods: In this pre-post study, we used a census method to include 15 patients diagnosed with intractable epilepsy based on International League Against Epilepsy (ILAE) criteria, aged 10-65 years, and eligible for epilepsy surgery. We used the Rey Auditory Verbal Learning Test (RAVLT) and Delis-Kaplan Executive Function System (D-KEFS) to evaluate patients’ cognitive function. The Wilcoxon test was used to compare cognitive function before and one month after surgery.Results: Fifteen patients (mean age: 34.2 ± 11.1) were included. The Wechsler Symbol Digit Modalities Test and Wisconsin Card Sorting Test (WCST)/Condition 2-1 (3.26 ± 1.83 to 4.13 ± 2.03, +26.7%, P = 0.01) and WCST/Condition 2-2 (3.33 ± 2.05+ 3.86±2.03 , 15.0%, P = 0.021) were the only tests in the total population that showed significant improvement. RAVLT/Step 1-5 (31.00 ± 10.87 to 33.72 ± 13.12, +8.8%, P = 0.02), RAVLT/Step 6 (6.00 ± 3.06 to 7.36 ± 3.66, +22.7%, P = 0.04). Trail Making Tests (TMT)/Number Sequencing (93.40 ± 52.24 to 68.50 ± 50.54, -26.7%, P = 0.028), WCST/Condition 1-1 (3.63 ± 1.91 to 4.09 ± 2.25, +12.7%, P = 0.023), WCST/Condition 2-1 (2.90 ± 1.70 to 3.72 ± 2.10, +28.3%, P = 0.039), and WCST/Condition 2-2 (3.36 ± 1.91 to 3.90 ± 2.02, +16.1, P = 0.014) demonstrated significant improvements in patients who underwent right-sided surgery. The only significant improvement in the left-sided surgery group was the TMT/switching score (175.50 ± 70.00 to 128.50 ± 74.24, -26.8%, P < 0.05).Conclusion: Surgery can benefit patients with refractory seizures. We observed that surgical treatment of epilepsy did not impair cognitive function. Postponing epilepsy surgery because of concerns about cognitive deterioration is unnecessary. However, it is important to note the limitations of our study, and future larger studies are needed to confirm and extend our findings.
Review Article
Other Neurological Disorders
Fatemeh Nezam Zadeh; Aylin Esmaeilkhani; Mansour Sedighi; Nour Amirmozafari; Mohammad Rahbar; Saeed Soleiman-Meigooni; Abed Zahedi Bialvaei
Articles in Press, Accepted Manuscript, Available Online from 25 December 2024
Abstract
Background: Multiple sclerosis (MS) is a complex autoimmune disease characterized by chronic inflammation, demyelination, and axonal damage in the central nervous system (CNS). This review specifically aims to investigate the role of latent microbial infections-such as those caused by Epstein-Barr virus ...
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Background: Multiple sclerosis (MS) is a complex autoimmune disease characterized by chronic inflammation, demyelination, and axonal damage in the central nervous system (CNS). This review specifically aims to investigate the role of latent microbial infections-such as those caused by Epstein-Barr virus (EBV), Chlamydia pneumoniae, and others-in contributing to myelin and axon damage in MS.Methods: We evaluated recent studies from PubMed, Google Scholar, and Scopus databases that focus on the relationship between latent microbial infections and MS pathogenesis.Results: In MS, emerging evidence suggests that latent microbial infections play a significant role in triggering and perpetuating the inflammatory processes associated with the disease. The potential mechanisms by which these infections contribute to the pathogenesis of MS, highlighting the interplay between the immune system, microbial agents, and the CNS are evaluated. These include molecular mimicry, where similarities in sequence or structure between viral, bacterial, or self-peptides can activate autoreactive T or B cells through cross activation by pathogen-derived peptides, chronic inflammation triggered by persistent infection, leading to immune-mediated damage, and disruption of the blood-brain barrier, allowing microbial agents or immune cells to infiltrate the CNS.Conclusion: This review underscores the critical role of latent microbial infections in MS pathogenesis. By elucidating these mechanisms, we provide new insights that could inform the development of innovative therapeutic interventions and preventive strategies for MS.
Original Article
Headache and Pain
Maryam Ghods; Mansoureh Togha; Elham Jafari; Morvarid Noormohammadi; Zhale Salami; Maryam Nilghaz; Behnaz Narimani; Mahshad Shafiee; Mahdieh Tabesh; Soodeh Razeghi-Jahromi
Articles in Press, Accepted Manuscript, Available Online from 29 December 2024
Abstract
Background: Migraine, a prevalent neurological condition, is recognized as the sixth leading cause of global disability. The proposed mechanism involves a combination of diminished energy reserves and heightened sensory stimulation activating the trigeminovascular system. Thiamine, essential for energy ...
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Background: Migraine, a prevalent neurological condition, is recognized as the sixth leading cause of global disability. The proposed mechanism involves a combination of diminished energy reserves and heightened sensory stimulation activating the trigeminovascular system. Thiamine, essential for energy generation in various tissues including the nervous system, is hypothesized to be involved. This study aims to examine the effects of administering a high dose of thiamine to women with episodic migraine.
Methods: A randomized, controlled clinical trial was conducted involving 40 women with episodic migraine. Participants were divided into two groups: one receiving 990 milligrams of thiamine three times daily, and the other receiving 990 milligrams of maltodextrin over 12 weeks. Headache frequency, duration, severity, and disability were evaluated through questionnaires. Initial and final measurements of serum calcitonin gene-related peptide (CGRP) were taken.
Results: Thiamine supplementation resulted in a significant reduction in Migraine Disability Assessment (MIDAS) scores, migraine frequency, duration, and intensity compared to the placebo group. However, both groups experienced a decline in serum CGRP levels, with no significant difference between them.
Conclusion: This study suggests that high-dose thiamine supplementation may offer a beneficial adjunctive treatment for episodic migraine. Further investigations with prolonged intervention periods are necessary to validate these findings.
Original Article
MS and Related Disorders
Aleksandra Kozlova; Taras Simaniv; Daria Eliseeva; Evgenii Nuzhnyi; Inessa Zakroyshchikova; Rodion Konovalov; Ekaterina Baydina; Maria Zakharova
Articles in Press, Accepted Manuscript, Available Online from 01 January 2025
Abstract
Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential trigger for central nervous system (CNS) autoimmune disorders. The most common type of spinal cord pathology following novel coronavirus infection is immune-mediated/autoimmune transverse myelitis (TM); however, ...
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Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential trigger for central nervous system (CNS) autoimmune disorders. The most common type of spinal cord pathology following novel coronavirus infection is immune-mediated/autoimmune transverse myelitis (TM); however, there are also rare forms of spinal cord pathology ‒ tract-specific myelitis ‒ previously considered as non-autoimmune-originated.
Methods: The current study includes case series of 5 patients with a rare type of myelitis with predominant involvement of the dorsal and lateral columns following coronavirus disease 2019 (COVID-19). We aimed to analyze cytokines parameters in cerebrospinal fluid (CSF) of affected patients. In order to support the autoimmune origin of the disease, CSF cytokine profiles were compared to patients with TM following COVID-19 (n = 12). Scale variables were compared between two independent groups using t-test or Wilcoxon-Mann-Whitney test depending on the distribution.
Results: In contrast to patients with TM, patients with tract-specific myelitis demonstrated higher levels of a proliferation-inducing ligand (APRIL), B cell activating factor (BAFF), interleukin (IL)-11, and thymic stromal lymphopoietin (TSLP). The BAFF/APRIL system is renowned for its involvement in the genesis and advancement of autoimmune disorders, and its pronounced increase in this case supports the autoimmune origin of the disease.
Conclusion: The heightened activation of BAFF and APRIL cytokines, which promote B-cell maturation, suggests an autoimmune origin of tract-specific myelitis, thereby informing prognosis and treatment strategies for affected patients.
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