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Background: Falls are a common cause of fractures in older adults. This study aimed to investigate the factors associated with spontaneous falls among people aged ≥ 60 years in southern Iran. Methods: The baseline data of 2,426 samples from the second stage of the first phase of a prospective cohort, the Bushehr Elderly Health (BEH) program, were included in the analysis. A history of spontaneous falls in the year before recruitment was measured by self-report using a standardized questionnaire. Demographic characteristics, as well as a history of osteoarthritis, rheumatoid arthritis, low back pain, Alzheimer's disease, epilepsy, depression, and cancer, were measured using standardized questionnaires. A tandem gait (heel-to-toe) exam, as well as laboratory tests, were performed under standard conditions. A multiple logistic regression model was used in the analysis and fitted backwardly using the Hosmer and Lemeshow approach. Results: The mean (standard deviation) age of the participants was 69.34 (6.4) years, and 51.9% of the participants were women. A total of 260 (10.7%, 95% CI (9.5–12.0)%) participants reported a spontaneous fall in the year before recruitment. Adjusted for potential confounders, epilepsy (OR = 4.31), cancer (OR = 2.73), depression (OR = 1.81), low back pain (OR = 1.79), and osteoarthritis (OR = 1.49) increased the risk of falls in older adults, while the ability to stand ≥ 10 s in the tandem gait exam (OR = 0.49), being male (OR = 0.60), engaging in physical activity (OR = 0.69), and having high serum triglyceride levels (OR = 0.72) reduced the risk of falls. Conclusion: The presence of underlying diseases, combined with other risk factors, is significantly associated with an increased risk of falls among older adults. Given the relatively high prevalence of falls in this population, it is crucial to pay special attention to identifying and addressing these risk factors. [ABSTRACT FROM AUTHOR]

Objectives Understanding the parenting practices of parents of children with epilepsy can be a practical guide for care and education planners to prevent mental disorders in these children. This study aimed to explain the parenting practices of parents of children with epilepsy in Shahrekord. Materials & Methods This study is a qualitative study with conventional content analysis. Participants in the study consisted of 20 mothers with epileptic children in Shahrekord, who were included in the study by purposive sampling method with maximum variance in terms of child age, number of family children, and child sex. The data collection method was a semi-structured interview using the interview guide. Data analysis was performed using a conventional content analysis at the same time as data collection. Interviews continued until data saturation was reached. Results The present study revealed five main themes in discipline methods, including over-support / over-protection, forcing to support, rejecting, parental conflict in discipline methods, and using harmful discipline methods. Conclusion In conclusion, the experiences of mothers in the present study show that using inappropriate discipline methods can have adverse effects on the mental-emotional and social health of the child in the future and raise the need to design educational interventions to empower parents of epileptic children in coping with parenting stress effectively. [ABSTRACT FROM AUTHOR]

Background: The chromodomain helicase DNA‐binding protein 2 (CHD2) is a member of the ATP‐dependent chromatin remodelling family of proteins, which are critical for the assembly and regulation of chromatin. De novo variants and deletions in the CHD2 gene have been associated with childhood‐onset developmental and epileptic encephalopathies type 94 (DEE 94). This study reports a novel deleterious de novo heterozygous frameshift insertion variant in the CHD2 gene. Methods: The causative variant was diagnosed using whole‐exome sequencing. Sanger sequencing and cosegregation analysis were applied to confirm the candidate variant. Multiple in silico analysis tools were employed to interpret the variant using the American College of Medical Genetics and Genomics and the Association for Molecular Pathology guidelines. Results: A de novo deleterious variant, NM_001271.4:c.1570dup (NP_001262.3:p.Ser524PhefsTer30), in the CHD2 gene, was identified in a 16‐year‐old boy with an intellectual and developmental disability, seizures and speech problems. The de novo occurrence of the variant was confirmed by segregation analysis in the family. Conclusion: The findings of this study expand the existing knowledge of variants of the CHD2 gene and provide a detailed phenotype associated with this gene. These data could have implications for genetic diagnosis and counselling in similar conditions. Moreover, this information could be useful for therapeutic purposes, including the proper administration of medication to control epilepsy. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of autism spectrum disorder (ASD) is essential because the challenges that ASD children and their parents face will be managed better by developmental and behavioral intervention at earlier ages. Objectives: This study aims to diagnose ASD based on electroencephalography (EEG) with the help of an artificial neural network (ANN). Materials & Methods: The statistical population includes all girls and boys aged 3 to 7 years referred to child psychiatry and neurodevelopmental centers in Mashhad City, Iran. A total of 34 children with ASD (5 girls and 29 boys) and 11 children without any neurodevelopmental disorders (8 girls and 3 boys) participated in this study. EEG signals were recorded through C3 and C4 channels based on the standard 10-20 system. With the help of programming codes, the absolute power of the frequency bands (delta, theta, alpha, mu rhythm, beta, and gamma) was extracted from the brain signals of the samples. Results: This study showed a significant difference in mu rhythm between the two groups. The classification result based on discriminant function analysis in two groups gave a sensitivity of 67.6% in the third stage of EEG recording. Seven band frequencies were used as features for ANN inputs. The results indicated that the radial basis function network with 402 neurons in the hidden layer accurately diagnosed and classified the EEG signals of ASD children from nonneurodevelopmental children (mean square error=1.22325e-5). Conclusion: It can be concluded that band frequencies are notable features in diagnosing ASD. [ABSTRACT FROM AUTHOR]

Objectives: Long-term video-EEG monitoring (LTM) is a new technique to assess and track fluctuations, classify seizures, identify epileptic syndromes, and determine the number of seizures and epilepsy-simulating disorders. The present study aims to evaluate the concordance of traditional EEG and LTM in assessing childhood epilepsy. Materials & Methods This cross-sectional before-after study was performed on 120 children with epilepsy who were referred to the Epilepsy Monitoring Unit (EMU) at the Children's Medical Center between September 2021 and September 2022 and were monitored for at least eight hours in this unit. The source of the study information collection was the patients' recorded files. A neurologist reviewed the primary EEGs, and two experts blindly reviewed and interpreted the patients' LTMs under a clinical neurophysiologist's supervision. Results The diagnoses changed after employing LTM in most children with epilepsy. Based on the diagnostic agreement analysis between EEG and LTM, the coefficient value for LTM was calculated at -0.37 (p = 0.229), showing that LTM has significantly expanded patients' diagnoses and care plans. Conclusion The use of LTM improves the diagnosis, classification, and monitoring of epilepsy in affected children and can be a reliable supplement to EEG in some instances. [ABSTRACT FROM AUTHOR]

Background: During Coronavirus disease-2019 (COVID-19) pandemic, patients with epilepsy (PWE) have faced with delayed outpatient visits, cancellation of their para-clinic tests, and problems in accessing to emergencies. Regarding to the previous studies, PWE are at increased risk of psychological disorders than healthy persons. Objectives: This study aimed to compare psychological distress between PWE and a healthy control group. Materials & Methods: This study was performed in the sixth wave of COVID-19 in Mashhad, Iran. We evaluated 132 PWE who consecutively referred to the Neurology Clinics of 22 Bahman Hospital. Also, 132 age and sex matched-healthy persons were included as the control group. Demographic and epilepsy related-data were collected through a questionnaire. The 6-item Kessler questionnaire was used to assess psychological distress. Results: The included PWE and the control groups were similar among all demographic variables, unless monthly income. We found that PWE had significantly higher psychological distress level (P=0.03) and spent significantly more time following the COVID-19-related news (P=0.000). By using ANCOVA test we found that PWE have significant higher levels of concerns about COVID-19 (P=0.03) and spend more time following COVID-19-related news (P=0.04). Logistic regression revealed that PWE 1.124 times more concern about COVID-19 outbreak and 0.294 time pay less attention to COVID-19 related news. Conclusion: During public health emergencies, health care professionals should focus not only on seizure control but also on the mental health status of PWE, particularly those with higher number of seizures. [ABSTRACT FROM AUTHOR]

Objective: Psychoses of epilepsy usually have an acute onset, accompanied by brief symptom duration and a risk of recurrence. Managing these conditions can be challenging due to the potential for seizures associated with certain antipsychotic medications, as well as exacerbating psychosis resulting from some antiepileptic medications. Our objective in this study was to assess the occurrence of psychosis among patients with epilepsy, as well as identify the factors linked to the presence and severity of psychosis in this population. Method: In this study, we included a total of 514 subjects diagnosed with epilepsy referring to our neuropsychiatry clinic affiliated with Tehran University of Medical Sciences from April 2011 to December 2021, among whom 57 patients showed psychotic presentations. We compared baseline and clinical characteristics between patients with psychosis of epilepsy and non-psychosis patients who also had epilepsy. Results: Marital status was the sole demographic factor that displayed a statistically significant difference between the psychosis and non-psychosis groups (P = 0.019). There was no significant difference observed between the two groups regarding family history of epilepsy and age at the onset of the epilepsy. Patients with psychosis experienced significantly more frequent seizures and generalized type (P < 0.001). Participants were matched for demographics and other clinical factors between the refractory and controlled psychosis groups, except for the psychosis frequency (P = 0.007). The type of epilepsy was significantly associated with psychosis when adjusted for the covariates (P < 0.001). Conclusion: Patients with psychosis of epilepsy experienced more episodes of epilepsy than non-psychotics. We identified generalized epilepsy as an independent risk factor for the development of psychosis. Additional cohorts are warranted to explore the factors associated with epilepsy-related psychosis across diverse populations. [ABSTRACT FROM AUTHOR]

Major objectives of this work were to: (1) substantiate the 24‐hour pattern in the occurrence of childhood febrile seizures (CFSs) by a novel time series meta‐analysis of past reported time‐of‐day data and (2) discuss its potential circadian rhythm‐dependencies. Comprehensive search of the published literature retrieved eight articles that met inclusion criteria. Three investigations were conducted in Iran, two in Japan, and one each in Finland, Italy, and South Korea, representing a total of 2461 mostly simple febrile seizures of children who were on average about 2 years of age. Population‐mean cosinor analysis validated (p <.001) a 24‐hour pattern in the onset of CFSs, with an approximate four‐fold difference in the proportion of children expressing seizures at its peak at 18:04 h (95% confidence interval: 16:40–19:07 h) vs trough at 06:00 h, in the absence of meaningful time‐of‐day differences in mean body temeprarure. The CFS time‐of‐day pattern likely derives from the actions of multiple circadian rhythms, particularly the cytokines that comprise the pyrogenic inflammatory pathway and melatonin that influences the excitation level of central neurons and helps regulate body temperature. Past laboratory animal and patient investigations document that the vulnerability to a seizure by a provoking trigger of the same intensity is not the same but different in a predictable‐in‐time manner during the 24 h as a circadian susceptibility/resistance rhythm. Knowledge of the marked disparity in the time‐of‐day risk of CFSs can be translated into improved prevention, particularly during the late afternoon and early evening when highest, through proper timing of prophylactic interventions. [ABSTRACT FROM AUTHOR]

Background: It was found that the novel coronavirus disease 2019 (COVID-19) pandemic contributed to changes in the epidemiologic and symptomatic pattern of some neurologic disorders. Objectives: The present study investigated the frequency of seizures and their characteristics from February to August 2020 (the peak of the COVID-19 pandemic) compared to the same period the year before. Materials & Methods: This cross-sectional-analytical study was performed on patients with seizures in Poursina hospital in Guilan province, Iran, between February and August 2020 and the same period the year before. Patients with seizures at the beginning or during hospitalization with at least one seizure in the desired period were included in the study. Results: The increase in seizure frequency during the COVID-19 pandemic versus last year was statistically significant (P=0.014). It also observed a significant difference in seizure etiology (P=0.032), types (P<0.005), and history of seizure (P<0.001). The most prevalent causes of seizures and stroke before and during the COVID-19 pandemic are unknown. The convulsive status epilepticus increased during the COVID-19 pandemic period by 4-fold. Before the pandemic, the patients had a higher prevalence of seizure history. Conclusion: The frequency of seizures, their types, and etiology changed during the COVID-19 pandemic, signifying that COVID-19 can influence on hospital burden of the seizure population. [ABSTRACT FROM AUTHOR]

We present a 10‐year follow‐up and describe our experience in managing a case of neonatal severe primary hyperparathyroidism (NSHPT) for the first time in Iran. Microcephaly, mental retardation, and epilepsy may be long time sequels of NSHPT. The brain MRI findings are compatible with an old hypoxic–ischemic event. [ABSTRACT FROM AUTHOR]

Introduction: Febrile seizures are one of the most common diseases that physicians encounter in pediatric emergency departments. Two important aspects of managing patients presenting with a febrile seizure are meningitis exclusion and co-infection investigation. This study was designed to determine any infection that occurs concomitantly with a febrile seizure episode and also to assess the frequency of meningitis among children presenting with febrile seizures. Methods: This retrospective cross-sectional study was conducted at the Children's Medical Center, an Iranian pediatric referral hospital. All patients aged 6 months to 5 years presenting with febrile seizures from 2020 to 2021 were included. Patients' data were collected from the medical report files. The presence of respiratory, gastrointestinal, and urinary infections was evaluated. Moreover, the detection of SARS-CoV-2 using reverse transcription polymerase chain reaction (RT-PCR) was performed for suspicious cases. The results of urine and stool analysis, as well as blood, urine, and stool cultures were checked. The frequency of lumbar puncture (LP) performance and its results were studied. The relationship between white blood cells (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein in meningitis was evaluated. Results: A total of 290 patients were referred to the Children's Medical Center, Tehran, Iran, due to fever and seizures. The mean age of the patients was 21.5 ± 13.0 months, and 134 (46.2%) were female. Out of 290 patients, 17% presented with respiratory infections. Nasopharyngeal SARS-CoV-2 RT-PCR was requested for 50 patients (17%), of which nine (3%) were reported positive and two patients had multi-inflammatory syndrome in children (MIS-C). Fever without local signs, gastroenteritis, and urinary tract infections were found in 40%, 19%, and 14% of the patients, respectively. LP was requested for 97 participants (33.4%) to evaluate central nervous system infection, of which 22 cases were suggestive of aseptic meningitis. Among laboratory tests, leukocytosis was significantly related to aseptic meningitis (odds ratio = 11.1, 95% CI = 3.0- 41.5). The blood culture testing result was positive in seven patients; all of them were due to skin contamination. Conclusion: Evaluation of patients for possible meningitis is necessary for febrile seizure management. Although the prevalence of bacterial meningitis in these patients is not high, according to this study and other studies conducted in Iran, aseptic meningitis, especially after Measles, Mumps, and Rubella (MMR) vaccination should be considered. Leukocytosis and increased CRP can predict the occurrence of aseptic meningitis in these patients. However, further studies with a larger sample size are highly recommended. Moreover, during the COVID-19 pandemic, it is recommended to pay attention to an acute COVID-19 infection or evidence of MIS-C in children with fever and seizure. [ABSTRACT FROM AUTHOR]

Introduction: Febrile seizure is a temperature-related seizure that affects the QT interval. The purpose of this study was to evaluate the changes in the QT interval caused by febrile convulsion (FC) compared with healthy children. Methods: This case-control study examined 180 children equally distributed between patients and controls. The study was conducted at the Ali Ebne Abi Talib Hospital in Zahedan City, Iran. The disease was diagnosed and confirmed based on standard definitions of FC. QT interval was measured by ECG and interpreted by a pediatric cardiologist, and collected data were analyzed using SPSS software, version 19 with a 0.05 significant level. Results: Among the ECG parameters, HR, R in aVL, S in V3, LVM, QTd, QTc, and QTcd were significantly different in children with FCs compared to their peers. From those who had abnormal QTd, FC children were more frequent which was not significant (χ²=1.053, P=0.248), while children with FC had significantly more abnormality regarding QTc (χ²=13.032, P<0.001) and QTcd (χ²=21.6, P<0.001). In children with FC, those who were less than 12 months had the highest level of HR which was not significant (χ²=4.59, P=0.101). Similar trends occurred for R in aVL and S in V3 that were higher in the age group >24 months (P>0.05). Children in the age group of >24 months had significantly had the highest LVM (χ²=52.674, P<0.001) and the other QT parameters were the same in FC children with different age groups (P>0.05). Conclusion: It is concluded that dispersion corrected QT, corrected QT, and dispersion QT changed significantly in children with FC in comparison with the healthy children with constant values in children with FC in different age groups. [ABSTRACT FROM AUTHOR]

BACKGROUND: Appropriate self-management (SM) is crucial in controlling epilepsy and improving self-efficacy, medication adherence and avoidance of seizure triggers in patients with epilepsy (PWE. The aim of this study was to evaluate SM and its predictors among adult PWE in Iran. METHODS: This cross-sectional study was conducted in 2021. The participants were 335 adult PWEs that were selected from healthcare settings in Hamadan, Iran. Epilepsy Self-Management Scale (ESMS) was used to measure patients' self-management behaviors. Data were analyzed using the independent samples ttest, Pearson's and Spearman's correlation analyses and multiple linear regression analysis. RESULTS: The mean score of SM was 114.37±11, indicating moderate level of SM, and the mean scores of SM in the medication management, seizure management, and safety management subscales were significantly more than the mean scores of the other subscales (P < 0.05). Age, place of residence, marital status, seizure type, seizure frequency, and epilepsy duration significantly predicted 53% of the variance of SM (adjusted R square = 0.532). CONCLUSION: PWEs have moderate SM and need SM-related education, particularly about lifestyle management and information management. Predictors of SM should be considered to boost SM practice. [ABSTRACT FROM AUTHOR]

Objectives Neonatal seizure is a significant problem in this life course, and its timely and effective treatment is crucial. In this study, we compared the efficacy of levetiracetam versus phenytoin for treating the acute phase of neonatal seizures. Materials & Methods In this single-blind case-control study, 60 consecutive children with neonatal seizures referred to the Children's medical center in Tehran, Iran, in 2018 were studied. Those neonates who had at least 30 minutes of seizure after Phenobarbital treatment were assigned to receive either phenytoin (20 mg/kg) or levetiracetam (initial dose of 40-60 mg/kg) through block randomization. The efficacy and safety of the two drugs were compared between the groups. Results The response rate was 83.3% and 86.7% in phenytoin and Levetiracetam groups, respectively, which was not significantly different between groups (P=1.000). Adverse effects were nearly similar between groups (6.7% in the phenytoin group and 3.3% in the Levetiracetam group, P=1.000). Conclusion Levetiracetam and phenytoin are both practical and safe for treating neonatal seizures. [ABSTRACT FROM AUTHOR]

Background & Objective: Febrile seizures are one of the most common neurological disorders in children. The aim of this study was to investigate the extent of abnormal EEG reports and its association with other risk factors of febrile seizures. Materials & Methods: In this prospective observational study, all patients with febrile seizure admitted into Mousavi Hospital in Zanjan, Iran, from April 2015 to March 2016 were enrolled. EEG was carried out for all patients and the clinical data were recorded in the prepared questionnaire .The statistical analysis was performed by using spss.16 software. Results: One hundred seventy patients, 92 (54.1%) male and 78 (45.9%) female with the mean age of 28.57 months were evaluated. The EEG reports were normal in140 (82.4%) cases and 30 (17.6%) cases had abnormal reports including 8 cases(26.6%) of spike & sharp electric discharge, 2 cases (6.6%)of slow activity and 20 cases(66.6%) of nonspecific changes. EEG abnormalities were significantly related with male sex (P = 0.020), history of previous febrile convulsion (p< 0.001), positive family history of epilepsy and febrile seizures (p< 0.001) and complex type of febrile convulsion (p< 0.001). Longer duration of seizure (p< 0.001) and older age of patients (p< 0.033) had significant relation with abnormal EEG. Conclusion: Although EEG is not routinely performed in all patients with febrile seizure, it is recommended for male gender, age over 3 years, complex febrile seizure, previous history of seizure and family history of epilepsy or febrile seizures. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to find the common inborn errors of metabolism in Iranian patients with autism spectrum disorder. Methods: In this cross-sectional multicenter study, 105 children and adolescents with autism spectrum disorder from six centers in different cities of Iran were enrolled between August, 2019 and October, 2020. Metabolic screening, including measuring plasma levels of amino acids, acylcarnitines, creatine, and guanidinoacetate, and urinary levels of organic acids, purines, and pyrimidines was performed. Other data, including age, parental consanguinity, history of seizure, developmental mile-stones, and physical examination, were also recorded. Results: An inborn error of metabolism was found in 13 (12.4%) patients. Five patients (4.8%) had cerebral creatine deficiency syndrome, 4 (3.8%) had arginine succinate aciduria, 2-methylbutyryl glycinuria, short-chain acyl-CoA dehydrogenase deficiency, and combined methylmalonic aciduria/malonic aciduria. There was a strong association between positive metabolic evaluation and parental consanguinity, history of seizures, microcephaly, and delayed development. Conclusions: Our results suggest that metabolic screening should be performed in the cases of autism associated with parental consanguinity, developmental delay, and a history of seizures. The assays to be considered as a screening panel include plasma or blood amino acids, acylcarnitines, creatine and guanidinoacetate, and urinary levels of organic acids. [ABSTRACT FROM AUTHOR]

Background & Aims: Most cardiovascular diseases have a genetic background. Many of these diseases have a Mendelian (single gene disorders) inherited pattern. For instance, among the arrhythmias, long QT syndrome could be named. This syndrome is a fatal ventricular arrhythmia characterized by an increase in QT interval on the electrocardiogram. An increase in QT may lead to torsade de points and premature heart death. Long QT syndrome has two dominant autosomal inherited patterns (commonly Romano-Ward syndrome) and an autosomal recessive form with congenital deafness (less commonly Jerrvel-Lange-Nielsen syndrome which is characterized by congenital deafness, prolongation of the QT interval, syncopal attacks due to ventricular arrhythmias, and a high risk of sudden death). The prevalence of this disease is one person per 2000 and it usually affects children and adolescents in the age group of 14 years. In addition to the congenital form that occurs due to variants in genes encoding sodium, potassium, and calcium ion channels, the consumption of certain drugs or electrolyte disturbances can also increase the QT intervals. About 20 genes are known to cause long QT syndrome the KCNQ1 gene causing LQTS1; KCNH2 causing LQT2; SCN5A causing LQT3; ANK2 causing LQTS4; KCNE1 causing LQTS5; KCNE2 causing LQT6; KCNJ2 causing LQTS7; CACNA1c causing LQTS8; CAV3 causing LQTS9; SCN4B causing LQTS10; AKAB9 causing LQTS11; SNTA1 causing LQTS12; KCNJ5 causing LQTS13; CALM1 causing LQTS14; CALM2 causing LQTS15; CALM2 causing LQTS16; and TRDN causing atypical type of LQTS (LQTS17), among which variants in the KCNE1 and KCNE2 genes encoding Potassium voltage-gated channel subfamily E member 1 and 2 account for less than 2 % of the genotype. KCNE1 and 2 proteins act as ancillary proteins assembling as a beta subunit of a voltage-gated potassium channel complex of pore-forming alpha subunits. Jerrvel-Lange-Nielsen syndrome is due to KCNQ1 (JLNS1) KCNE1 (JLNS2). Here, KCNE1 and KCNE2 variants are studied among Iranian affected families. Methods: Genomic DNA was extracted from peripheral whole blood by salting out method. A pair of primers was designed for each gene and checked using the Primer blast and Nucleotide blast sites. The coding regions of each gene were amplified by polymerase chain reaction (PCR). Sanger sequencing was applied to find out the variants. Results: In this study, a total of 50 patients (ages from 7 months to 25 years) with QTc between 338 ms to > 600 ms including 37 patients with Romano-Ward Syndrome phenotype and 4 patients with Jerrvel-Lange-Nielsen Syndrome phenotype were studied. The most common symptoms and signs were syncope (in 23 cases), premature heart death (in 11 cases), palpitations (in 11 patients), notched T-wave (in 6 cases), chest pain (in 5 cases) of and epilepsy (in 5 cases). p.Ser38Gly (c.112 A > G) in KCNE1 was seen in 18 homozygous cases and 22 heterozygous cases followed by the next variant (c. * 132 A > G) in the 3 ′ UTR region in 2 patients; a 19-month-old boy with Romano-Ward Syndrome phenotype and a history of palpitations (Schwartz Score3, QTC524ms) and the other patient was a 3-year-old boy with a Jerrvel-Lange-Nielsen Syndrome phenotype and a history of syncope with stress, deafness and notched T-wave (Schwartz score 7.5, QTC > 600 ms). The variant (c. * 124 A > G) located in the 3 ′ UTR region was seen in 11 patients (3 patients with Jerrvel-LangeNielsen Syndrome phenotype). Given that variant (c. * 132A> G) KCNE1 is predicted by the HSF site to be in a region that is a potential enhancer, it may break Exonic Splicing Enhancers. c.29 C > T (p.Thr10Met) in heterozygous form was found in a 5-year-old Kurdish male with a history of cardiac pacemaker, cardiac arrest and stress syncope (QTC > 500 ms, Schwartz Score 5) which was affected by congenitally lack of right kidney. Another heterozygous variant was observed in (c.325 G > A) (p.Val109Ile) in a 12-year-old boy with a history of ICD implantation and stress syncope (QTc > 480 ms, Schwartz Score 5). The patient's family history showed that one of the family members had proband-like symptoms and the other two had atherosclerosis. KCNE2 variants were also found in our patients; c.-12-44 C > T was found in 6 cases, 2 of which had Schwartz score zero and 2 others had Schwartz score 4, 5. In addition, one patient had JERRVEL-LANGE-NIELSEN SYNDROME phenotype and 5 had Romano-Ward Syndrome . Another intron variant (c.-12-16 A > G) was detected in 2 cases, one patient with Schwartz score zero and the other one with Schwartz score five. The heterozygous exon variant was also found in 2 unrelated patients (p.Thr8Ala, c.22 A > G), case number 15, a 3.5-yearold boy with a history of 2 fainting and sinus tachycardia and taking a quarter of captopril twice a day which undergone mitral valve repair. Case number 50 was also a 3.5-year-old boy from Tehran with a history of syncope, epilepsy and taking propranolol at a dose of 10 mg every 8 hours (Schwartz score 5). 3 members of this recent family had a heart attack, one of whom died at the age of 16. Also, proband's father had epileptic seizures before puberty. A heterozygous variant, p.Ile57Thr (c.170 T > C) was found in a 13-year-old boy with a history of chest pain, palpitations and anemia (QTc 371 – 546 ms, Schwartz score 3). Briefly, fifty patients referring to Rajaei Cardiovascular Hospital who negative for common genes were selected. Coding regions of KCNE1 and KCNE2 genes were amplified and directly sequenced to find possible variants of these genes. Bioinformatic tools were used to predict pathogenicity of the variants. KCNE1 variants included c. * 132 A > G and c. * 124 A > G in 3’ UTR and c. 325 G > A and c. 112 A > G in exonic regions were found. In addition, two intronic variants, c. -12-16 A > G and c.-12-44 C > T and two exonic variants c.170 T > C and c.22 A > G were observed in KCNE2 gene. Bioinformatics analysis showed pathogenicity of the variants. The exon variant (c. 112A > G ; p. Ser38Gly) and 2 regulatory variants (c. * 132 A > G) and (c. * 124 A > G) were benign and 2 exon variants (c.29 C > T and c 325 G > A) showed conflicting interpretations of pathogenicity and uncertain significance, respectively. In the case of the KCNE2 gene, two exonic variants (c. 22 A > G) and (c. 170 T > C) are categorized as disease causing variants based on the predictions of SIFT, Polyphen2 and Mutation Taster. Conclusion: KCNE1 and KCNE2 variants have a high frequency among Iranian patients with Long QT syndrome. Therefore, study of pathogenicity of these two genes and other KCNE gene family is recommended to include in genetic tests for Iranian patients. Due to the fact that the Iran population is composed of different ethnicities and subpopulations and the frequency and type of causative mutations may be different . Therefore, it is suggested that it be studied separately in different subpopulations and ethnicities of Iran. [ABSTRACT FROM AUTHOR]

Aims Post-traumatic epilepsy is one of the most common and disabling sequels of traumatic brain injury and is defined as repeated unprovoked seizures seven days after traumatic brain injury. The present study aimed to determine the late consequences of epilepsy in veterans with traumatic brain injury during the imposed Iran-Iraq war. Instruments & Methods This study was observational cohort research in 2022. The sample of the study included all living veterans with a history of Post-traumatic epilepsy who were covered by the sendees of the "Veterans Affairs Foundation" of Isfahan, Iran. 218 veterans with epilepsy, who were available, were identified, 100 of them had a traumatic brain injury, and 118 did not have any traumatic brain injury. Data were collected using the Mini Mental State Examination (MMSE) and Instrumental Activities of Daily Living and Physical SelfMaintenance Scale (IADL-PSMS). Findings There was a significant difference between veterans with and without traumatic brain injuries in the age at post-traumatic epilepsy debut (p<0.05). Epilepsy characteristics were not significantly different between the two groups (p>0.05). The mean score of MMSE in veterans with and without traumatic brain injuries was significantly different (p<0.05). The Recall and Registration subscales were significantly different in veterans with/without traumatic brain injuries (p<0.05). Conclusion The ability to perform daily activities and cognitive function are lower in veterans with epilepsy with traumatic brain injuries compared to veterans with epilepsy without traumatic brain injuries. [ABSTRACT FROM AUTHOR]

The present study aimed to assess the effectiveness of mindfulness-based stress reduction (MBSR) intervention on cognitive emotion regulation and cognitive reactivity in patients suffering from epilepsy. The study employed a quasi-experimental design in which 24 epilepsy patients, administered by the Isfahan Epilepsy Society in Iran, were recruited through the convenient sampling method in 2015. The participants were randomly assigned into two groups of experimental (N = 12) and control (N = 12). The control group was as waitlist. In addition to the demographic information, Garnefski's Cognitive Emotion Regulation Questionnaire (2001), Beck's Depression (1979), Dysfunctional Attitudes (1978), and Automatic Thoughts (1980) were administered to the patients in three stages encompassing pretest, posttest, and the follow-up period (75 days). The collected data were then analyzed with repeated measurement of variance ANOVA. Results showed that MBSR intervention significantly increased the use of positive strategies and decreased the implementation of negative strategies in cognitive emotional regulation (p < 0.05). Moreover, the intervention led to a significant decline in depression, dysfunctional attitudes, and negative automatic thoughts. The results support the idea that mindfulness could positively affect the patient's cognitive emotion regulation and cognitive responsiveness. [ABSTRACT FROM AUTHOR]

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

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

Background: In patients with drug-resistant epilepsy (DRE), the composition of the gut microbiome changes compared to drug-sensitive patients and healthy individuals. Synbiotics, a mixture of probiotics and prebiotics, aim to improve the balance of bacteria in the gut microbiome. This study aimed to assess the effect of synbiotics on the treatment of DRE and the burden on caregivers., Methods: This one-group pretest-posttest quasi-experimental study was conducted in Arak, Iran. Thirty children with DRE, diagnosed by a pediatric neurologist and meeting the inclusion criteria in 2021-22, were included in the study. In addition to anticonvulsant drugs, infants were administered PediLact at a dose of 5-15 drops per day for eight weeks, and KidiLact at a dose of one sachet per day for eight weeks for children aged 2-15 years. Both PediLact and KidiLact are synbiotics. To investigate the burden on caregivers (parents), the Zarit Caregiver Burden Interview was conducted. In addition, the number of epileptic seizures was assessed from mothers before and immediately after the intervention over one month., Results: The mean age of the participants in the study was 8.6 years (SD: 3.4). Eighteen participants (60%) were boys, and 12 (40%) were girls. The results of the study showed a statistically significant decrease in the mean burden on caregivers, from 34.20 (SD: 14.4) before the intervention to 30.26 (SD: 15.8) after the intervention (P = 0.017). The mean frequency of seizures decreased significantly, from 15.83 (SD: 12.9) before the intervention to 12.73 (SD: 12.8) after the intervention (P = 0.001). Following the intervention, the seizure frequency stopped in two patients, decreased by 50% in six patients, increased in one patient, and remained unchanged in 21 patients., Conclusion: The results suggest that Symbiotics in DRE patients are associated with a lower parental burden of caregivers and seizure frequency. Well-designed randomized clinical trial studies are recommended to generate rigorous causal evidence and conclusions., (© 2024. The Author(s).)

Objectives: We hypothesized that the frequency (in Hertz) of generalized spike-waves (GSWs) in patients with idiopathic generalized epilepsy (IGE) has associations with the syndromic diagnosis as well as with the prognosis of patients (their response to medical treatment)., Methods: This was a retrospective study of a prospectively developed database. All patients with a diagnosis of IGE were studied at the epilepsy center at Shiraz University of Medical Sciences, Shiraz, Iran, from 2008 until 2022. Patients were classified into four IGE syndromes: childhood absence epilepsy; juvenile absence epilepsy; juvenile myoclonic epilepsy; and generalized tonic-clonic seizures alone., Results: Five hundred and eighty-three patients were studied. GSWs were commonly observed in all four syndromes of IGE. Frequency of GSW (in Hertz) did not have a significant association with the syndromic diagnosis of the patients (p = .179). The presence of GSW did not have a significant association with the seizure outcome (becoming seizure free or not) of the patients (p = .416). Frequency of GSW did not have a significant association with the seizure outcome of the patients either (p = .574)., Conclusion: GSWs are the hallmark electroencephalographic footprints of idiopathic generalized epilepsies; however, neither their presence nor their frequency has practical associations with the syndromic diagnosis of IGEs or their outcome (response to treatment)., (© 2024 The Author(s). Brain and Behavior published by Wiley Periodicals LLC.)

Background. Mothers caring for children with epilepsy are commonly exposed to feelings such as guilt, failure, sadness, isolation and lack of interest in interaction with others. Objectives. The present study aims to examine the relationship between perceived social support and self-care and marital satisfaction in mothers of children with epilepsy in one hospital in Shiraz, Iran. Material and methods. In this descriptive correlational study, the sample included 98 mothers caring for children with epilepsy admitted to Namazi Hospital. For data collection, four questionnaires were used including demographics, perceived social support, self-care and marital satisfaction. After completion of the questionnaires, the data was analysed using SPSS Statistics 21.0. A significance level of 0.05 was considered in the study. Results. The mothers had an average perceived social support score of 30.48 ± 7.04. The average self-care score of the mothers of epileptic children was 87.45 ± 14.41. Concerning marital satisfaction, the mothers had an average score of 118.93 ± 19.6. The research findings indicated a positive and significant correlation between perceived social support and self-care in the mothers. In other words, the self-care scores were increased with an increase in the perceived social support score (r = 0.332; p = 0.001). Furthermore, a positive and significant correlation was also found between perceived social support and marital satisfaction, i.e. with an increase in the perceived social support score, the marital satisfaction scores of the mothers also increased (r = 0.201; p = 0.047). Conclusions. The results of the current study indicated that perceived social support has a positive relationship with self-care and marital satisfaction in mothers. Therefore, the provision of social support by the family, friends and society will result in better self-care and higher marital satisfaction in mothers caring for children with epilepsy, which in turn can improve the quality of the care provided to these children by their mothers. [ABSTRACT FROM AUTHOR]

Objectives Epilepsy is the most prevalent chronic neurologic disorder in children. One-third of patients with epilepsy do not respond to antiepileptic drugs. This condition is known as intractable epilepsy. Previous studies have shown the beneficial effects of curcumin in the treatment of epilepsy. There are no randomized controlled clinical trials assessing the use of curcumin in epilepsy. This study aimed to evaluate the effects of nanomicelle curcumin on intractable pediatric epilepsy. Materials & Methods This double-blinded randomized crossover clinical trial was performed by a consecutive sampling to select 22 patients with intractable epilepsy divided into two groups. Patients received a daily dose of 4 mg/kg of curcumin or placebo as add-on therapy for 4 weeks. After a 2-week washout period, the treatment was replaced, and the new treatment was given for another 4 weeks. The SPSS software version 16 was used for statistical analysis. The study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Iran. Results A total of 22 children were enrolled in this study, 11 of which were boys. The mean age of the patients was 4.28±5 years. A female patient taking a placebo was excluded in the first week of the trial due to parental dissatisfaction. The most common type of seizure among our patients was a generalized myoclonic seizure (42.9%). The mean number of seizure attacks among the subjects was 68.76±69.26 preintervention and 39.85±39.41 at the end of the intervention, which represents a statistically significant difference (P=0.01). Conclusion Nanomicelle curcumin reduced the number of seizures significantly. Our results imply that curcumin treatment can help treat patients with intractable pediatric epilepsy. [ABSTRACT FROM AUTHOR]

Background: Adult eating behavior questionnaire (AEBQ) is an age upward extension tool that measures appetite traits in individuals. This instrument was developed by Hunot in 2016. The present study aimed to determine the psychometric properties of the Persian version of AEBQ in adults with epilepsy. Methods: The current research is a cross-sectional study conducted in 2019 in Iran. 700 adults with epilepsy completed the 35-item AEBQ. Qualitative face validity, qualitative content and structure validity (exploratory factor analysis [EFA], N=400, and confirmatory factor analysis [CFA], N=300) appetitive traits were evaluated. Reliability was also measured using Cronbach's alpha, Construct reliability (CR), and Intra-Class Correlation (ICC). The SPSS 26-AMOS24 software was employed to analyze the data with a significance level of 0.05. Results: The EFA and CFA results comprised eight factors, namely enjoyment of food, emotional over-eating, food responsiveness, hunger, satiety responsiveness, emotional undereating, food fussiness, and eating slowly. Indices of root mean square error of approximation=0.068, parsimonious normed fit index=0.644, parsimonious comparative fit index=0.671, adjusted goodness of fit index=0.618, goodness of fit index=0.911, and Chi square degree-of-freedom ratio (normalized Chi square CMIN/ DF=2.842) confirmed the fitness of the final model. Convergent and divergent validity was acceptable for all the factors. The results revealed that the internal stability>0.8 and CR>0.7 of the eight extracted AEBQ structures are confirmed. The ICC was 0.899 (95% CI: 0.878-0.917; P<0.001). The results also showed that AEBQ has acceptable convergent and divergent validity. Conclusion: The eight-factor structure of AEBQ can measure eating behavior traits and is of good validity and reliability for assessing the eating behavior of Iranian adults with epilepsy. [ABSTRACT FROM AUTHOR]

Objectives Academic difficulties are common in epileptic children. A learning disability (LD) is a reduction in the learning capacity of children or the intellectual ability of adults, which is different from mental retardation or dementia. Materials & Methods The participants were 56 patients, of whom 35 were males (62.5%), and 21 were females (37.5%). The participants attended the Neurology Outpatient Clinic, the Sohag University Hospital, between December 2016 and May 2017. Children with chronological age between 7 and 16 years with idiopathic focal and normal mental and motor developmental history were enrolled in this cross-sectional study. The Revised Quick Neurological Screening Test was used to assess different types of LD. Results LDs were present in 67.9% of our participants with a statistically significant association between LDs in one arm and younger age, earlier age of onset of epilepsy, frequent seizures, and seizure semiology, particularly of temporal lobe origin, in the other arm. In addition, left epileptic focus on EEG, prolonged treatment duration with antiepileptic drugs (AED), and polytherapy were significantly correlated with LDs. Conclusion Many factors are significantly correlated with LDs in children with idiopathic focal epilepsy, like age of the patient, age of epilepsy onset, seizure semiology, prolonged AED treatment, and polytherapy. [ABSTRACT FROM AUTHOR]

Objective One-third of epilepsy of children is refractory, and this study was conducted to evaluate the efficacy and adverse events of levetiracetam as add-on therapy in the treatment of refractory epilepsy of children. Materials & Methods In this quasi-experimental study, seizures frequency and side effects of 314 children aged 1-14 years with refractory epilepsy were referred to the Pediatric Neurology Clinic of Shahid Sadoughi Medical Sciences University, Yazd, Iran, and treated with levetiracetam for six months, were evaluated. Results We evaluated 142 girls and 172 boys with a mean age of 6.78±2.12 years. At the end of six months of treatment with levetiracetam, 20% became seizure-free, 28% had more than 50% decrease in seizure frequency, 38% did not have a notable change in seizure frequency, and 14% experienced an increase in seizure frequency. Good response (stopping of all seizures or more than 50% reduction in seizure frequency) was seen in 51% of mixed types, 61% of myoclonic seizures, 64% of generalized tonic-clonic seizures, 69 % of partial seizures, 100 % of tonic seizures, and in 40 % of atonic seizures. Levetiracetam was significantly more effective in partial seizures, idiopathic epilepsies, and children with normal developmental status and normal brain MRI. Twelve children discontinued the treatment due to severe drowsiness, restlessness, and exacerbation of seizures. Transient and mild side effects, including somnolence, anorexia, fatigue, headache, ataxia, and diplopia, were seen in 9% (N=28) of patients. Conclusion Levetiracetam could be considered an efficient and safe adjunct therapy in treating refractory epilepsy in children. Keywords: Levetiracetam; Refractory Epilepsy; Children; Side effects [ABSTRACT FROM AUTHOR]

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

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

Background & Aims: Sleep and epilepsy are complex interactions and are completely interdependent, so that some patients experience seizures while asleep or deprived of sleep or when waking up, and for some they occur during the day or night (1). The American Psychiatric Association defines sleepiness as symptoms of excessive quantity of sleep (e.g., extended nocturnal sleep or involuntary daytime sleep), deteriorated quality of wakefulness (i.e., sleep propensity during wakefulness as shown by difficulty awakening or inability to remain awake when required), and sleep inertia (i.e., a period of impaired performance and reduced vigilance following awakening from the regular sleep episode or from a nap) (2). Its prevalence is higher in seizures than in the control group (3, 4) and in different groups seizures have been reported between 31 to 60% (5-7). According to common clinical beliefs, sleep disruption can have a significant effect on memory, as REM sleep or slow-wave sleep is essential for optimal cognitive function (3), and excessive daily sleepiness can increase seizures (8, 9) and pain (10) in patients; However, the exact function of sleep remains unclear, and the findings have not always been consistent. These discrepancies require the conduct of research in which, through a comprehensive look, a large number of parameters related to sleepiness are present in seizures. In other words, the heterogeneity of the previous findings highlights the variability of the course of the disease as a result of the interaction of sleepiness and seizures, which makes it necessary to conduct more research to better understand the problems of patients. Therefore, the aim of the present study was to investigate the comorbidity effect of sleepiness and epilepsy on cognitive functions, quality and severity of pain and disease severity markers in patients with epilepsy. Methods: The present research was conducted as a case-control study in 2020 in Shiraz Namazi Hospital. The statistical population of this study included all patients with focal epileptic seizures (temporal lobe epilepsy) (n = 30) and generalized (idiopathic generalized epilepsy) (n = 21) and psychogenic non-epileptic seizures (n = 17) in Shiraz. Through their follow-up treatment process, they referred to the epilepsy and seizure ward of Shiraz Namazi Hospital, from which 68 patients with inclusion criteria were selected through purposive sampling method. According to the inclusion and exclusion criteria, each patient completed a comprehensive list of demographic and clinical variables, the Stanford Sleepiness Scale, the Montreal Cognitive Assessment, the McGill Pain Questionnaire, and the Visual Analogue Scale under the supervision of an on-site clinical psychology PhD student. After collecting research data, patients with seizures were divided into two groups with sleepiness (n = 45) and no sleepiness (n = 23) through a cut score equal to or greater than 3 on the Stanford Sleepiness Scale. Data were analyzed using parametric and non-parametric tests in version 24 of SPSS software. Results: Preliminary findings showed that there was a significant difference between the two groups of patients with epilepsy with and without sleepiness in terms of mean age and frequency of antiepileptic drugs (P <0.05); While there was no difference between the two groups in terms of type of seizure, education, gender, marital status and employment status. In order to investigate the effect of sleepiness on cognitive function and components related to pain quality, multivariate and univariate analysis of covariance was used to control age variables and use antiepileptic drugs. The results showed that patients with sleepiness in functions of language, Abstraction, delayed recall, as well as achieving the overall Montreal Cognitive Assessment score performed worse. These patients had higher sensory perception of pain experience, rated their pain higher, scored higher in pain quality, and chose more words to describe their pain (P<0.05). Evaluations of disease severity markers through nonparametric tests also showed that compared to patients without sleepiness, patients with epilepsy with sleepiness have experienced more pain, more seizures, a higher incidence of comorbid physical diseases, a longer history of psychiatric diagnoses, and they have more concomitant use of antiepileptic and psychiatric drugs (P<0.05). Conclusion: The results showed that patients with epilepsy with sleepiness had lower mean scores on some cognitive subscales than their counterparts without sleepiness; However, the two groups did not differ in terms of spatial visual function, naming, attention, and orientation. Using a methodology similar to this study, Vascouto et al. Found that there was no difference between the two groups of patients with seizures with and without sleepiness in most cognitive components such as attention and spatial visual skills; Only from the point of view of the total score of auditory verbal learning, there is a significant difference (11) that is relatively consistent with the present study. Although more research is needed to draw more detailed discussions, the discrepancies in some findings can be explained by differences in the type of patient samples in the two studies and the reduction in attention and performance resulting from sleepiness. The results also showed that patients with epilepsy with sleepiness compared to their counterparts, evaluated the qualitative dimensions of their pain higher and experienced more severe pain. Consistent with these findings, Gutter et al. Found that sleepiness comorbidity in epileptic seizures leads to increased chronic pain in patients (10) and Jaussent et al. Also reported that chronic pain is a significant predictor of sleepiness (12). In this regard, potential underlying mechanisms such as structural and functional changes in the prefrontal cortex (13), anterior cingulate cortex (14), hippocampus (15), amygdala (16), insula (17), subcortical regions (17) and shock spinal cord passages (18); Neural-glial interactions; Abnormalities in autonomic function and hypothalamic-pituitary-adrenal axis and other biological factors may contribute to the relationship between sleepiness and pain. Finally, the results showed that the frequency of seizures, the presence of comorbidities of physical disease, the history of psychiatric diagnoses and the simultaneous use of antiepileptic and psychiatric drugs in patients with epilepsy with sleepiness were higher than their counterparts. In this regard, Pizzatto et al. (19) and Xu et al. (20) evaluated patients with epileptic seizures and did not find a relationship between daily sleepiness scores and the frequency of seizures. But Lee et al. Showed that the presence of psychiatric symptoms is an independent predictor of sleepiness in patients (21). It seems that sleepiness reduces the ability to control seizures in patients (22) and contributes to their recurrence and worsening of the disease. Disruption of patients' circadian rhythms can also be involved as a consequence of sleepiness; Because circadian rhythms affect the frequency of seizures depending on the epileptogenic region (23,24). According to the findings, measuring sleep habits, sleep hygiene and comorbidity of sleepiness is an unavoidable necessity. In particular, early diagnosis and treatment of comorbid sleepiness and seizures can improve the prognosis and reduce the negative health consequences in patients (25). Lack of objective measurements of sleepiness and self-reported nature of the data are the limitations of the present study. Future studies can complement these findings by using objective measures of sleepiness. Patients with epilepsy with sleepiness have a poorer cognitive and clinical status than their counterparts. [ABSTRACT FROM AUTHOR]

Background: Epilepsy, febrile convulsion, and breath-holding spells are neurological diseases affecting the heart. Objectives: This study aimed to evaluate electrocardiography alterations in children with epilepsy, febrile convulsion, and breath-holding spells compared to controls. Methods: This case-control study was conducted on 360 children aged 0.5 - 5 years in Zahedan, Iran. The children with epilepsy, febrile convulsion, and breath-holding spells were diagnosed by a single neurologist based on the standard definition. Electrocardiography was also performed by a pediatric cardiologist. The data were analyzed using the SPSS 20.0 software, and P < 0.05 was considered statistically significant. Results: Among the participants, 160 (44.4%) were female. Females also comprised 45.6%, 42.2%, 38.9%, and 51.1% of the participants in the epilepsy, febrile convulsion, breath-holding spells, and control groups, respectively. QTd was different in the epilepsy group compared to the controls and patients with breath-holding spells (P < 0.001). Additionally, QTc was significantly different in the epilepsy group in comparison to the controls (P < 0.001) and patients with breath-holding spells (P = 0.020), in the controls compared to the patients with febrile convulsion (P < 0.001), and in the controls in comparison to the patients with breath-holding spells (P < 0.001). QTcd was also different in the epilepsy group compared to the controls (P < 0.001), patients with breath-holding spells (P < 0.001), and those with febrile convulsion (P = 0.006) as well as in the controls in comparison with the patients with febrile convulsion and breath-holding spells (P < 0.001). Finally, QT was different in the patients with breath-holding spells compared to those with epilepsy (P = 0.005), in the patients with breath-holding spells in comparison with the controls (P = 0.002), and in the patients with breath-holding spells compared to those with febrile convulsion (P < 0.001). Conclusions: The present study findings indicated that QT dispersion was different in the epilepsy group compared to the patients with breath-holding spells, corrected QT was different in the epilepsy group compared with the patients with breath-holding spells, QTc dispersion was different in the epilepsy group in comparison with the patients with breath-holding spells and febrile convulsion, and QT was different in the patients with breath-holding spells compared to those with epilepsy and febrile convulsion. [ABSTRACT FROM AUTHOR]

Mental and neurological diseases including depression, Parkinson's disease, dementia, epilepsy, anxiety disorders and bipolar disorders account for a considerable amount of the world's disease burden. Unfortunately, drugs used in the treatment of neurological diseases are expensive, symptomatic and they produce undesirable side effects. People from different cultures prefer to use medicinal plants for the treatment of various ailments ranging from plain to perplex disorders because they are most affordable, cost effective and easily accessible source of treatment in the primary healthcare system throughout the world. Withania coagulans, an erect grayish under-shrub belongs to family Solanaceae. It is common in Pakistan, East India, Iran and Afghanistan. The objective of this study was to analyze the anti-seizure activity of crude methanolic extract of Withania coagulans fruits (MeWc). For screening of this activity, maximal electroshock seizures model (MES) and chemically-induced seizures models were used. In maximal electroshock seizures test MeWc showed significant dose dependent percent protection against hind-limb tonic extension; significant and dose-dependent increase in latency to myoclonic jerks and tonic clonic convulsions and decrease in seizures duration were observed in PTZ-induced seizures. In strychnine-induced convulsions MeWc significantly increased latency to hind-limb tonic extension and percent protection from death in a dose-dependent manner. Thus, it was inferred from the experiments that extract of Withania coagulans showed anticonvulsant activity. [ABSTRACT FROM AUTHOR]

Medication adherence is of utmost importance in achieving the desired therapeutic outcome and effectively managing seizures in patients with epilepsy (PWE). It is imperative to recognize self-esteem as a psychological determinant that potentially influences the optimal compliance with anti-seizure medications (ASMs) among PWE. The objective of this study was to explore medication adherence and its relationship with self-esteem among individuals diagnosed with epilepsy in Isfahan, Iran., Methods: This descriptive-analytical study was conducted in the year 2021, encompassing a cohort of 250 PWE who were referred to designated medical facilities in Isfahan, Iran, and were selected by the consecutive sampling technique. A 3-part instrument including demographic components, the Rosenberg Self-Esteem Scale, and the Morissky Drug Adherence Questionnaire employed for data collection., Results: The mean and standard deviation of adherence to the medicinal regimen in the participants were 6.9 ± 2.02, and 46.4 % had a low level of adherence to the medication regimen (total score 0-6). At the same time, the mean and standard deviation of self-esteem in these patients was 5.11 ± 2.11. There was a statistically significant and direct correlation between adherence to the prescribed drug regimen and self-esteem (rs = 0.464, p = 0.00)., Conclusion: Based on the findings of the study that showed a statistically significant and positive correlation between self-esteem and adherence to the medication regimen, it is advisable to enhance and advocate for these factors in PWE., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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

Background: Women with epilepsy face many physical and psychological problems due to their illness. Epilepsy affects women's motherhood, parenting role, and quality of life. Thus, in addition to medical interventions, their recovery programs should also cover psychological therapies. Accordingly, this study aimed to examine the effectiveness of humor training on happiness and life satisfaction of female patients with epilepsy. Methods: This study was conducted using a quasi-experimental method with a pretest-posttest design and control group. The research population included all female patients who were members of the Iranian Epilepsy Association, Tehran, in 2020. The subjects were selected using convenience sampling. To this end, 30 women who met the inclusion criteria were randomly assigned into the intervention and control groups. The intervention group attended eight 2-hour humor training sessions and the control group did not receive any training. The Oxford Happiness Questionnaire and the Satisfaction with Life Scale (SWLS) were completed by the subjects before and after the intervention. The collected data were analyzed by one-way Analysis of Covariance (ANCOVA) using SPSS software (version 24). Results: According to the findings, the patients who received humor training reported significantly higher levels of happiness and life satisfaction compared to the control group. There was a significant difference between the pre-test and post-test mean scores of happiness (pretest: 38.20±3.59; post-test: 45.27±4.18) (F=26.37; P=0.001) and also, there was a significant difference between the mean scores of pre-test and post-test of life satisfaction (pre-test: 13.01±6.16; post-test: 18.67±5.70) (F=30.07; P=0.001) in the intervention group. This difference was not significant in the control group (P>0.05). Conclusion: Humor training increased happiness and life satisfaction among women with epilepsy. This low-cost and easy-to-implement training is recommended to be used by psychologists and psychiatric nurses as a non-pharmacologic alternative along with other treatment options. [ABSTRACT FROM AUTHOR]

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

Objectives Epilepsy is a chronic disease of the nervous system, which remarkably affects children's performance and behaviors. Epileptic children are at greater risk of cognitive and behavioral disorders compared to healthy children. In this regard, a variety of factors associated with this disease may affect the patients' families. Materials & Methods The present study was a randomized controlled clinical trial, which aimed to evaluate the effect of family empowerment on the quality of life in epileptic children referred to the concerned centers (the Bessat Clinic affiliated to the Kerman University of Medical Sciences and Shiraz's Imam Reza Clinic). The participants, who were 80 parents with epileptic children meeting the inclusion criteria, were assigned into two experimental and control groups. In this study, the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE) was used to collect the required data from the parents. Results The studied children's age ranged from 4-8 years. These results revealed a statistically significant difference between the two groups regarding the level of changes in all dimensions, indicating that the experimental group's mean score of quality of life in different dimensions increased (P <0.05 in all dimensions). Conclusion The implementation of the family-centered care plan by care providers, based on patient-family support relationships, the detection of their strengths and weaknesses, prioritization of the provided services, and effective interaction with the health team would increase the family and staff's satisfaction, reduce the costs, and improve the outcome of the disease. [ABSTRACT FROM AUTHOR]

Background: Epilepsy is a chronic disorder that affects both sexes and causes some physiological and psychological disabilities. The present study aimed to examine the effects of transcranial direct current stimulation (tDCS) on the psychological profile of patients with epilepsy. Methods: The design of the present study was a randomized clinical trial with a pretest-posttest and a control group. The statistical population comprised patients with epilepsy, who were referred for treatment to a private health center in Urmia in 2019. The sample consisted of 30 patients with epilepsy selected via the convenience sampling method. Data collection was performed through the use of the Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire. After the pretest, 15 subjects were randomly assigned to the intervention group, and 15 subjects were placed in the control group. The intervention was performed in 10 sessions, and the duration of stimulation was 20 minutes. The anode was placed in the F3 region (left hemisphere), the cathode in the F4 (right hemisphere), and the current intensity was 1.5 mA. After the intervention, the posttest was conducted for both groups, and the data were analyzed using a univariate covariance analysis in the SPSS software, version 23. A P value of less than 0.05 was considered statistically significant. Results: The results of the ANCOVA analyses revealed significant differences between the intervention and control groups. The tDCS group represented a significant decrease in the scales of depression, anxiety, and stress in the posttest in comparison with the pretest (P≤0.001). Conclusion: The results showed that tDCS could reduce depression, anxiety, and stress with the changes caused in the brain system. [ABSTRACT FROM AUTHOR]

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

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

Epilepsy has garnered increased public health focus because patients who suffer from epilepsy experience pronounced and persistent health and socioeconomic disparities despite treatment and care advances. The epidemiology of epilepsy is diverse in different countries and regions. This nationwide population-based cross-sectional study was conducted to determine the life time prevalence and health related factors of epilepsy for the first time in Iran through a two-phase door-to-door survey method. In phase I, a screening for epilepsy was performed on 68,035 people. Then in phase II, after the neurological evaluation of participants and reviewing medical records, 1130 subjects with epilepsy was confirmed. The life time prevalence of epilepsy was achieved to be 16.6 per 1000 people (95% CI 15.4–17.8) with the average age onset 19.1 ± 21.1 (active prevalence 9.5 per 1000 people). Focal seizure (59.3%), generalized epilepsy (38%) and unknown types of epilepsy (2.7%) were detected among participants. The overall life time prevalence of febrile convulsion was 4.1 per 1000 people. The frequency of attacks per year and per month were 3.0 ± 1.6 and 0.5 ± 0.1, respectively. Age-specific life time prevalence was highest among the age group of 15–19 years old [32.7 per 1000 persons (95% CI 29.1–36.8)] and it was higher in male (53.8%) than female (46.2%) participants. Our results showed that the life time prevalence of epilepsy in Iran is higher than worldwide average. [ABSTRACT FROM AUTHOR]

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