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Background: Acute disseminated encephalomyelitis (ADEM) is an uncommon monophasic disease often with good prognosis. It is a differential diagnosis of multiple sclerosis (MS). Accurate distinction between acute disseminated encephalomyelitis and multiple sclerosis is important for prognosis and treatment; as many patients with multiple sclerosis may benefit from early disease-modifying therapy to suppress ongoing and future relapses. Methods: In a retrograde study, all the patients presented to Alzahra hospital (Isfahan, Iran) with definite diagnosis of acute disseminated encephalomyelitis during a 10-year period were included. Demographic data, clinical signs and symptoms, and laboratory and imaging findings were collected and analyzed using t and chi-square tests via SPSS software. Findings: Forty-two patients with mean age of 20.05 ± 10.04 years and a female-predominance of 64.3% participated in the study. Thirty-three patients (78.6%) had a recent history of infectious disease. A seasonal pattern of distribution in spring (31%) and autumn (31%) was seen. The cerebrospinal fluid (CSF) analysis findings showed pleocytosis and increased protein in 26 (61.9%) and 25 (59.6%) cases, respectively. First magnetic resonance imaging (MRI) findings revealed that most of the lesions were in the periventricular (83%) and re-imaging in 25 cases showed completely or partially resolution of previous lesions with no new lesion in 18 (72%) and 7 (28%) patients, respectively. Conclusion: We found some controversies to previous studies in epidemiological and imaging studies which could be of a significant role in detecting and accurate diagnosis of acute disseminated encephalomyelitis which can significantly impact on physicians’ view of the disease.

Background: Multiple sclerosis (MS) is an autoimmune disease that is associated with demyelination of the neurons axon in the central nervous system. The predominant age range of this disease is related to adolescence and its prevalence rate in women is two to three times more than in men. Indentifyingthe factors and conditions cause diseases recurrence and in other words providing disease conditions can be effective in the prevention of diseases occurrence or recurrence. One of these conditions and requirements is menstrual cycle of women and hormonal changes that can be effective on the occurrence or recurrence of the disease and therefore indentifying the relationship between hormonal changes during menstruation seem necessary for the disease recurrence. Methods: In this study, 196 women with MS, who had regular menstrual cycle had referred due todisease attack, were studied in terms of the time of occurring the attack in menstrual cycle. Menstrual cycle of the patients was divided into three phases based on the estrogen and progesterone levels. The first phase is three days after onset of menstrual cycle until the time of ovulation and is simultaneous with increased estrogen. The second phase is since probable ovulation time (Approximately 14th day in a 28-day cycle or 14 days before the period in the other cycles) until three days before onset of the next menstruation; in this phase, the levels of both estrogen and progesterone increase. The third phase is equal to three days before bleeding until three days after the onset (decreased estrogen and progesterone levels). According to the LMP date of patients and time of attack, the phase of attack occurrence in menstrual cycle was determined for each of them. Findings: The highest recurrence rate of attack (99 attacks which was equal to 50.6% of the total attacks) occurred at the third phase of menstrual cycle in which the levels of both estrogen and progesterone was low. Twenty-seven percent of the attacks recurrence occurred at the first phase (which the estrogen level is high) and 22.4 percent of the attacks recurrence occurred at the second phase (which both estrogen and progesterone levels are high) that the results showed no significantdifference. Conclusion: The disease might be influenced by the female sex hormones and sex steroids can alter the disease activity. Estrogen may play a protective role in the disease and reduce estrogen is associated with increased recurrence of attacks.

Background: Multiple sclerosis and ulcerative colitis are two chronic and disabling disease that cause many problems to patients. Until now there is not a good study to determine relation and similarity between this disease. The aim of this study is to compare the prevalence of ulcerative colitis in general population with MS patients. Methods: In this cross-sectional study from March 2008 to September 2009, 250 patients with MS were compared with 250 persons of general population without MS, to evaluate the prevalence of ulcerative colitis. Finding: The mean of age was not different in two groups. 2% (5 persons) of patients with multiple sclerosis had ulcerative colitis, but general population had not ulcerative colitis. This difference was clearly, significant (P = 0.03). Conclusion: In this study as the other study reports, the prevalence of ulcerative colitis among patients with multiple sclerosis is more than normal population and it seems that some predisposing factors are responsible in two diseases. So more gastrointestinal evaluation should be done in MS patients with gastrointestinal sign and symptoms to rule out ulcerative colitis.

Soluble forms of nonclassical human leukocyte antigen (HLA)-G have recently been suggested as immunomodulatory factors in multiple sclerosis (MS). HLA-G inhibits the effecter function of T cells and natural killer (NK) cells. Also regulatory T cells (Treg) are considered as pivotal players in MS pathogenesis. Thus, we aimed to evaluate the presence of HLA-G molecules and Treg cells in Relapsing-Remitting Multiple Sclerosis (RRMS) patients and compare it to healthy controls.Patients with RRMS (n=205, mean age=31.32±8.53) and healthy subjects (n=205, mean age=32.2±7.48) were studied. The patients subgrouped to untreated and treated with Interferon beta. Then sHLA-G levels (sHLA-G1 and sHLA-G5) were measured using ELISA method. Treg (CD4+CD25+ Foxp3+) cells in patients who had sHLA-G>10 U/ml were characterized by using flow cytometry.Our data showed that there was no significant differences between RRMS patients and healthy controls in sHLA-G concentration (p>0.05). Treg cell frequencies were higher in the patients who had sHLA-G >10 U/ml compared to healthy subjects (p

Background: One of the frequent symptoms of Multiple Sclerosis (MS) is tremor which can severely cause disability. Treatment of tremor in MS patients is still very challenging to manage. In this study, we sought to determine the efficacy of Levetiracetam on treatment of MS-related tremor. Materials and Methods: This clinical trial study was conducted among 22 patients from July 2012 to April 2012 in Alzahra-Hospital, Isfahan, Iran. Patients were given 500 mg Levetiracetam twice a day for 1 week. The drug dosage increased 1000 mg per week until reaching the peak dose of 50 mg/kg. After a 2 week period of washout, first phase was repeated. The subjects were assessed at baseline, after first intervention, after wash-out period, and after second intervention. Results: A total of 20 patients (17 females and 3 males) were enrolled in our study. There was a significant difference among tremor rate before and after intervention (P = 0.001). The drug was well tolerated and without any serious side effect during follow-up. Conclusion: Our findings suggest that although Levetiracetam caused a decrease tremor rate in MS it surged again after washout period.

Background: The aim of the study was to determine the relative frequency of abnormal urodynamic findings in new multiple sclerosis (MS) cases without micturition complaints and to find its correlation with the number of MS plaques on magnetic resonance imaging (MRI), urinary tract involvement and the number of disease episodes. Methods : In this prospective study, 50 new female case of multiple sclerosis were enrolled. Age, urodynamic findings, micturition complaints and number of plaques on MRI were recorded on admission. Occurrence of urinary symptoms and number of episodes of the disease were recorded every three months during one-year follow-up. Results : The mean patients′ age was 32.4 ± 7.2 years and all patients were female. Of the 50 patients, 19 (38%) had a normal urodynamic test and 31 (62%) had abnormal urodynamic findings at the beginning of the study. The occurrence of micturition complaints during follow-up in patients with abnormal urodynamic findings (94%) was significantly higher (p < 0.0001) than patients with normal urodynamic findings (37%). In addition, the number of plaques on MRI at the beginning of the study in patients with abnormal urodynamic finding was significantly higher (p < 0.004) compared to patients with a normal urodynamic study. The number of episodes during follow-up was not statistically different between patients with normal and abnormal urodynamic findings (p = 0.46). Conclusions : According to this study, 62% of all new MS patients had an abnormal urodynamic test. This is a considerable proportion of patients and it seems urodynamic studies can be used when MS is first diagnosed.

مقدمه: مولتیپل اسکلروزیس (MS یا Multiple sclerosis) یک بیماری خودایمن مزمن در سیستم عصبی مرکزی (CNS یا Central nervous system) است که با پاسخ سلول‌های لنفوسیت T به آنتی‌ژن‌های میلین ایجاد می‌شود. یکی از انواع گیرنده‌های سطح سلولی لنفوسیت‌های T مولکول‌های خانواده‌ی TIM (T-cell immunoglobulin and mucin domain) هستند که SNPهای (Single nucleotide polymorphisms) متعددی در ژن مربوط به آن‌ها شناسایی شده است. این SNPها همواره با بیماری‌های خودایمن مختلفی در ارتباط بوده‌اند. هدف از این مطالعه، مقایسه‌ی فراوانی پلی‌مورفیسم +4259A>C ژن 3-TIM در بیماران دچار مولتیپل اسکلروزیس و افراد سالم در اصفهان بود تا مشخص شود که آیا این پلی‌مورفیسم زمینه‌ساز بیماری فوق در اصفهان می‌باشد؟ روش‌ها: DNA سلول‌ها با استفاده از کیت استخراج DNA، از خون افراد جدا شد. در این مطالعه، از روش PCR-RFLP (Polymerase chain reaction-restriction fragment length polymorphism) استفاده کردیم. ابتدا ژن 3-TIM تکثیر شد؛ سپس، در مجاورت آنزیم خرد کننده قرار گرفت. با تکنیک الکتروفورز، قطعات حاصل از هضم آنزیمی تفکیک شد و مورد بررسی قرار گرفت. یافته‌ها: تفاوت معنی‌داری بین فراوانی ژنوتیپ‌ها و الل‌های پلی‌مورفیسم +4259A>C در بیماران و افراد سالم مشاهده شد (029/0 = P). شانس ابتلا به بیماری در افرادی که حامل الل C بودند، حدود 2 برابر افراد فاقد این الل بود (010/0 = P). نتیجه‌گیری: پلی‌مورفیسم +4259A>C ممکن است در ابتلا به بیماری مولتیپل اسکلروزیس نقش داشته باشد. برای درک بیشتر می‌توان، اثر این پلی‌مورفیسم را بر بیان و نحوه‌ی عمل مولکول 3-TIM بررسی کرد.

Background: Circadian rhythm sleep disorders are a presentation of sleep disorders in patients with multiple sclerosis (MS). This study aims to compare this problem in MS patients with healthy people and to determine its association with chronic fatigue in MS patients. Materials and Methods: A case-control study was performed on 120 MS patients and 60 healthy subjects matched for age and sex, in 2009 in MS Clinic Alzahra Hospital. Sleep quality, rhythm and fatigue severity were assessed using PSQI (Pittsburgh sleep quality index) and FSS (Fatigue severity Scale) questionnaires, respectively. Its reliability and validity has been confirmed in several studies (Cronbach's alpha = 0.83). This index has seven sections including patient's assessment of his/her sleep, sleep duration, efficacy of routine sleep, sleep disorders, use of hypnotic medication, and dysfunction in daily activities. Results: Circadian rhythm sleep disorder was more frequent in MS patients relative to healthy subjects (P: 0.002). It was higher in MS patients with severe fatigue relative to MS patients with mild fatigue (P: 0.05). Fatigue severity was 49.9 ± 8.2 and 22.5 ± 7.4 in the first and second group, respectively. PSQI index was 7.9 ± 4.5 in patients with severe fatigue and 5.9 ± 4.5 in patients with mild fatigue and 4.5 ± 2.4 in the control group (P: 0.0001). Conclusion: Circadian rhythm sleep disorders are more frequent in MS patients and those with fatigue. Recognition and management of circadian rhythm sleep disorders in MS patients, especially those with fatigue may be helpful in improving care of these patients.

Background: The efficacy of Mycophenolate mofetil (MMF) plus interferon beta-1a (IFNB-1a) in treatment of relapsing-remitting multiple sclerosis (RRMS) was evaluated. Methods: This was a pilot study with randomized, double-blinded, placebo-controlled design. Patients with RRMS and Expanded Disability Status Scale score (EDSS) of < 6.0 were included. Those with relapse within the previous two months and prior use of immunomodulatory/immunosuppressive drugs were excluded. Patients were randomized into MMF (n = 13) and placebo (n = 13) groups and received weekly intramuscular IFNB-1a plus either MMF or placebo. MMF started by 500 mg/d for one week and weekly escalated by 500 mg/d, until target divided dose of 2000 mg/d and continued for 12 months. Radiologic and clinical assessments were performed at baseline and then at month 12. Results: After one year of therapy, difference between the two groups in number of new T2 lesions was not statisti-cally significant (0.54 ± 0.77 in MMF vs. 1.85 ± 3.2 in placebo group, p = 0.169). Two patients in the placebo group had gadolinium-enhanced lesions and one patient had relapse. There were 3 patients in each group with more than one point progression in EDSS. Common side effect in the MMF group included gastrointestinal upset, but no patient dis-continued the treatment. Conclusions: Combination of MMF with IFNB-1a in patients with RRMS is well tolerated, but the efficacy of such combination was not statistically significant in this pilot study and deserves further investigation with a larger sample size and a longer follow-up.

Multiple sclerosis (MS) is a complex, demyelinating disease of the central nervous system (CNS) with variable phenotypic presentations, while Guillain-Barre Syndrome (GBS) is the prototypic acute inflammatory disorder that affects the peripheral nervous system. Myasthenia gravis (MG) is a T cell dependent and antibody mediated autoimmune disease. Although it has been shown that complement plays a critical role in the pathogenesis of MS, GBS, and MG, the role of mannose-binding lectin (MBL) as a biomarker of immunopathogensis of these diseases and also its association with the severity of them have been poorly investigated. Therefore, in this study we aimed to measure plasma levels of MBL in patients with MS, GBS, and MG. In a case-control study, plasma was obtained from healthy controls (n=100) and also patients with MS (n=120), GBS (n=30), and MG (n=30). Plasma level measurement of MBL was performed using enzyme-linked immunosorbent assay (ELISA). The mean serum level of MBL was significantly different between groups of patients and healthy controls (p