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est (RST) is the most commonly used electrodiagnostic test to asses the defect of neuromuscular transmission, which is reported to be positive in the diffuse and restricted ocular forms 60-95% and 14-50%, respectively. In a cross-sectional study, to determine the efficacy of repetitive stimulation test in myasthenia gravis, we evaluated the results in 30 cases who were hospitalized in Imam Khomeini Hospital during 1996-1999. Patients were first selected clinically and then confirmed by Tensilon test.Various clinical types including generalized and restricted ocular forms with different severity and duration were entered in this study. Considering the fact that the positiveness of the test is enhanced by assessment of more muscle groups, we evaluated decremental response in the facial, proximal and distal muscles of limbs. 90% of patients had the generalized form of the disease, whereas ocular myasthenia gravis was seen only in 10% of the cases. 74% of females and 73% of males showed positive response (overall: 73.3%). No significant association was found between the positive response, and age and sex. Peaks of incidences of the disease for the males were in fourth and sixth decades and for the females in thired decades

Background and Aim: Despite the widespread use of whole body vibration (WBV), especially in recent years, its neurophysiological mechanism is still unclear and the results about the facilitatory or inhibitory effects of WBV widely vary in different studies. The aim of this study was to compare between immediate (one session) and short term (12 sessions) effects of WBV on the spinal motor neurons excitability in healthy young men. Materials and Methods: Ten voluntary non-athlete healthy young-men (mean age:26.1±2.23) were participated in this study. In the sham sessions subjects stood on the turned off vibration plate while were maintaining the semi-squat position and then after 2 weeks wash-out, vibration training sessions were done on the same position with frequency of 30 HZ and peak to peak amplitude of 3 mm training sessions (sham & vibration) consisted of 12 sessions (3 sessions per week) and 4 set in each of them, weekly one set added to the training protocol. H reflex recruitment curve of soleus muscle was recorded before and after first and also 12th sessions in both sham and vibration training protocol. Ascending slope of recruitment curve, threshold and peak amplitudes and related intensities, amplitude of Mh and Hmax/Mmax ratio were determined. Results: Immediate effects of vibration training 12th session caused a significant decrease of threshold amplitude and an increase of peak intensity (p=0.05 and p=0.05 respectively). Short term WBV training significantly decreased the threshold intensity of soleus recruitment curve (p=0.01). Conclusion: The results suggest the inhibitory effect of acute WBV training on the spinal motor neurons excitability. It seems that short term WBV training may be effective to facilitate the motor neurons excitability or increase the muscle spindle sensitivity. [ABSTRACT FROM AUTHOR]

Background and Aim: The normal response of H-reflex depression (HD) was reduced in chronic spinal cord injury (SCI) patients. The reduction of this normal response can lead to increase the muscle tone and spasticity. The purpose of this study is to investigate the effect of tripolar cathodal stimulation on HD in SCI patients. Materials and Methods: This study was conducted in 10 volunteered SCI patients and 13 healthy male and female aged 28.91±5.78 years. H-reflexes were elicited at 0.2, 5 and 0.2 Hz and intensity of 65-70 percent of the maximum H-reflex amplitude, before and after tripolar cathodal electrical stimulation of the spinal cord at T 11 level. Results: Before trioplar stimulation, H-reflex amplitude decreased with increasing stimulation frequency only in healthy group. H-reflex amplitude decreased from 2.60±1.48 to1.34±1.30 by 5Hz frequency (P=0.000). After trioplar stimulation in SCI patients group, HD increased with increasing stimulation frequency and H-reflex amplitude decreased significantly from 2.21±1.98 by 0.2 Hz frequency to 1.29±1.50 by 5Hz frequency(P=0.014). Conclusion: Application of one session of cathodal trioplar stimulation can result the returning of normal HD in SCI patients. Cathodal trioplar stimulation is a non-invasive, without side effects, and an inexpensive method that may be a valuable tool to return the normal inhibition and modulating behavior of the spinal cord circuits. [ABSTRACT FROM AUTHOR]

Background and Aim: The Action Observation stimulates mirror neurons. It is the effective acquisition of skills, motor learning and memory formation and this feature can be used to treat injuries such as stroke. The aim of this study was to investigate the effect of action observation on the symmetry of weight distribution in lower limbs and stability indices in semi-dynamic stability. Materials and Methods: This study was conducted in 91 healthy male and female non-athletes aged 20 to 45 years. Data were collected through questionnaires and clinical examinations. Subjects were randomly assigned to men and women with and without film observation. A 3-minute short film was preapared to stimulate mirror neurons in the standing position on the symmetry weight measurement system and Biodex platform system. In film observation group, before and after viewing the film, distribution of weigh bearing on the right and left sides, and dynamic stability indices in two stability levels of 5 and 8 were measured and calculated indices of total, anterior -- posterior and medio- lateral indices were obtained. In without film observation group, measurements were performed at the similar time as a film observation group. Results: Percentage weight distribution showed no significant difference between the two groups. The comparison of percentage changes between two groups showed that observation of the film improved significantly total index (p <0.002) and anterior -- posterior index (p <0.018) in the stability level of 5. Analysis of the results in the separately men and women groups, showed the significant improvement of these parameters only in women group after film observation regardless of film observation, the percentage changes of stability indices showed no significant differences in men groups. Conclusion: Action Observation (by activating the mirror neurons) can be effective methods to improve the balance standing of healthy people on the stable and unstable surfaces. Significant improvement stability indices in women after viewing the film, may suggest the greater sensitivity of women's mirror neurons related to men. [ABSTRACT FROM AUTHOR]

Background: COVID-19 was associated with an increased number of patients with mucormycosis (MCR), followed by septic cavernous sinus thrombosis (SCST). We evaluated the association between anticoagulation (AC) and mortality/morbidity of COVID-19-associated MCR (CAM)-induced SCST. Methods: In this retrospective study, neurological sequelae, functional outcomes, and in-hospital mortality were compared between AC receivers and non-receivers. In addition, the association between AC and survivability was examined. Results: Twenty-nine patients (17 male; mean age: 51.27 years) with CAM-induced SCST were included in the study. The median intervals between COVID-19 and MCR, and COVID-19 and SCST were 19 and 27 days, respectively. Among AC recipients, the interval between SCST and AC initiation was 18 days, with an AC duration of 37 days. Baseline and management-related characteristics were comparable between AC recipients and non-recipients (P > 0.050). AC receivers (n = 15) and non-receivers (n = 14) did not significantly differ in terms of the proportion of sequelae (6/15 vs. 5/14; P = 1.000), complete recovery (2/15 vs. 4/14; P = 0.687), and in-hospital mortality (3/15 vs. 3/14; P > 0.999). Nevertheless, AC recipients had a longer hospital stay (72.0 vs. 35.5; P = 0.016). AC-related characteristics (AC receiving, type, early initiation, and duration) were not significantly different between survivors and non-survivors, or between recovered and disabled patients. Conclusion: In our study, CAM-induced SCST in-hospital mortality/morbidity did not differ between AC receivers and non-receivers. AC characteristics were not different between survivors and non-survivors, or recovered and disabled patients. However, the small sample size may have limited the ability to detect significant differences, leading to inconclusive results., Competing Interests: The authors declare no conflict of interest in this study., (Copyright © 2024 Iranian Neurological Association, and Tehran University of Medical Sciences Published by Tehran University of Medical Sciences.)

Introduction: Chronic low back pain (CLBP) is a global burden with an unknown etiology. Reorganization of the cortical representation of paraspinal muscles in the primary motor cortex (M1) may be related to the pathology. Single-pulse transcranial magnetic stimulation (TMS), commonly used to map the functional organization of M1, is not potent enough to stimulate the cortical maps of paraspinal muscles in M1 in CLBP patients with reduced corticospinal excitability (CSE) with intensities even as high as maximum stimulator output (100% MSO). This makes TMS mapping impractical for these patients. The aim of this study was to increase the practicality of TMS mapping for people with CLBP., Methods: This study included eight men and ten women who had CLBP for over three months. A biphasic paired-pulse TMS paradigm, conjunct anticipatory postural adjustment (APA), and maximal voluntary activation of paraspinal muscles (MVC) were used to facilitate TMS mapping., Results: TMS mapping was possible in all CLBP participants, with TMS intensities <50% of the MSO. Reorganization in terms of an anterior and lateral shift of the center of gravity (COG) of the cortical maps of paraspinal muscles was observed in all participants with CLBP, and a reduced number of discrete peaks was found in 33%., Conclusion: The facilitation of the CSE to paraspinal muscles makes TMS mapping more practical and tolerable in people with CLBP, lowering the risk of seizure and discomfort associated with high-intensity TMS pulses., Highlights: Conventional transcranial magnetic stimulation (TMS) brain mapping is not optimal for patients with Chronic low back pain (CLBP).Paired-pulse TMS dramatically lessens the energy needed for brain mapping.Maximal voluntary contraction of back muscles facilitates TMS mapping.Anticipatory postural activity of back muscles enhances the efficacy of TMS mapping., Plain Language Summary: Chronic low back pain (CLBP) is a social, emotional, and economic burden and the leading cause of disability worldwide. Yet the etiology of the CLBP is unknown. The persistence of aberrant or antalgic movement patterns observed in people with CLBP has been suggested as a possible cause of pain chronification by inducing continuous damage to sensitive structures of the lumbar spine. It is well known that the brain is in charge of the production and planning of movements, so it is likely that abnormal movement patterns also stem from the abnormalities in the brain. However, until recently, human knowledge about the structure and function of the brain has been very limited. The invention of noninvasive and painless brain imaging and stimulating techniques such as transcranial magnetic stimulation (TMS) during the last decades has augmented our knowledge about the structure and function of the brain. Modification in terms of shift, shrinkage, or expansion of areas of the brain devoted to movement control or sensation of the back muscles has been documented in CLBP via these techniques, which are argued to relate to pain chronification but need further clarification. Yet monitoring the course of CLBP via TMS, despite its many potentials, is challenging. This could be due to the reduced cortical drive to back muscles in CLBP patients and the small area devoted to control of back muscles in the brain in general that increases the brain threshold to TMS in people with CLBP. The aim of this study was to tailor an approach to make TMS more applicable for CLBP patients by reducing the threshold to TMS. This could be achieved by engaging back muscles in anticipatory postural activity in combination with maximal voluntary activation of these muscles, along with TMS paradigms that induce intracortical facilitation., Competing Interests: The authors declared no conflict of interest., (Copyright© 2023 Iranian Neuroscience Society.)

Background: Door-to-needle (DTN) is the duration between patient's arrival at the hospital and receiving intravenous thrombolysis in ischemic stroke settings, for which studies have reported delays in women. The "D's of stroke care" describes 8 steps (D1 to D8) in patients' time tracker. We implemented simple modifications to the "D's of stroke care" by splitting D4 and D6 steps into these substeps: patients' arrival to the emergency room (D4-A), early assessment by a neurologist (D4-B), neurologist decision on patient's eligibility to receive recombinant tissue plasminogen activator (D6-A), and patient's transfer to the stroke unit (D6-B). We evaluated the effect of these changes on reducing DTN time disparity between men and women., Methods: This study was conducted from September 2019 to August 2021, at a comprehensive stroke center. Patients were analyzed in 2 groups: group 1, before, and group 2, after using the modifications. Sex as the main variable of interest along with other covariates was regressed toward the DTN time., Results: In groups 1 and 2, 47 and 56 patients received intravenous thrombolysis, respectively. Although there was a significant difference in DTN≤1 hour between women and men in group 1 (36% vs. 52%, P =0.019), it was not significantly different in group 2 ( P =0.97). Regression analysis showed being female was a significant predictor of DTN>1 hour in group 1 (adjusted odds ratio=6.65, P =0.02), whereas after using the modifications, sex was not a significant predictor for delayed DTN., Conclusions: Implementing these substeps reduced sex disparity in DTN time in our center., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Thrombotic thrombocytopenic purpura (TTP) considers a rare cause of ischemic stroke (IS). We reported a case of a newly diagnosed patient with acquired immune-mediated TTP (iTTP), in whom two IS events developed during 48 h., Case Presentation: A 59-year-old diabetic male was presented to the hospital 24 h after symptoms onset, including left hemiparesis, dysarthria, and decreased consciousness. A brain CT scan was performed with the suspicion of acute IS, indicating infarct lesions in the right middle cerebral artery (MCA) territory. The patient was not eligible for thrombolytic therapy due to admission delay. Over the next 24 h, the patient's neurological condition deteriorated, and the second brain CT scan showed new ischemic lesions in the left MCA territory. Initial laboratory evaluation indicated thrombocytopenia without evidence of anemia. However, in the following days, thrombocytopenia progressed, and microangiopathic hemolytic anemia (MAHA) developed. The ADAMTS-13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and inhibitors assay confirmed the diagnosis of iTTP. The patient underwent plasma exchange activity and inhibitors assay confirmed the diagnosis of iTTP. The patient underwent and pulse IV methylprednisolone. Rituximab was also added due to the refractory course of the disease. After a prolonged hospital course, he had considerable neurologic recovery and was discharged., Conclusions: Clinicians should consider two points. First, TTP should be considered in any patient presenting with IS and having thrombocytopenia or anemia without other symptoms of TTP. Second, worsening the patient's condition during hospitalization may indicate a new stroke and should be investigated immediately., (© 2023. The Author(s).)

[Figure: see text].

Study Design: Randomized controlled trial., Objective: To determine the effects of advanced weight-bearing mat exercises (AWMEs) with/without functional electrical stimulation (FES) of the quadriceps and gastrocnemius muscles on the ability of wheelchair-dependent people with spinal cord injury (SCI) to transfer and attain independence in activities of daily living (ADLs)., Setting: An outpatient clinic, Iran., Methods: People with traumatic chronic paraplegia (N = 16) were randomly allocated to three groups. The exercise group (EX; N = 5) performed AWMEs of quadruped unilateral reaching and tall-kneeling for 24 weeks (3 days/week). Sessions were increased from 10 min to 54 min over the 24-week period. The exercise-FES group (EX + FES; N = 5) performed AWMEs simultaneously with FES of the quadriceps and gastrocnemius muscles. The control group performed no exercise and no FES (N = 6). The primary outcomes were the total Spinal Cord Independence Measure-III (SCIM-III) to reflect independence with ADL, and the sum of the four SCIM-III transfer items to reflect ability to transfer. There were six other outcomes., Results: The mean (95% CI) between-group differences of the four transfer items of the SCIM-III for the EX vs. control group was 1.8 points (0.2-3.4), and for the EX + FES vs. control group was 2 points (0.4-3.6). The equivalent differences for the total SCIM-III scores were 2.7 points (-0.6-6.0) and 4.1 points (0.8-7.4), respectively. There were no significant between-group differences for any other outcomes., Conclusions: Advanced weight-bearing mat exercises improve the ability of wheelchair-dependent people with SCI to transfer and attain independence in ADL.

Invasion of auto-reactive CD4+ T cells especially Th17 into central nervous system (CNS) is an underlying pathogenic mechanism in multiple sclerosis (MS). CD4+ T cells release exosomes which are enriched in microRNAs, reflective of cell's physiological or pathological condition. Thus exosomes could be potent agents to provide quantitative and qualitative information about involved cells in MS. We investigated the expression of pathogenic microRNAs in T cells-derived exosomes of MS patients or healthy controls. Conventional T cells (Tconv) derived from relapsing-remitting (RR) MS patients (n=10) and healthy controls (n=10) were purified and cultured for 3 days by soluble anti-CD3/CD28. Exosomes were purified from cultured-T cells supernatants. The expression levels of exosomal miR-146a, miR-29a, miR-155, and miR-326 were quantified by real-time PCR. A statistically significant increased expression of miR-326 in Tconv-derived exosomes was observed in RRMS patients as compared with controls (7.5±1.88vs 2.51±0.9 p=0.03), On the contrary, no differences were found in the expression levels of miR-155, miR-146a, and miR-29a, in Tconv-derived exosomes of  patients as compared with controls (p>0.05). Our results point to altered expression in exosome-derived microRNAs. MiR-326 was previously shown to play a role in the immunopathogenesis of MS by inducing TH17 differentiation and maturation. Therefore, miR-326 containing exosomes might also be a potential clinical target in course of MS. Moreover, the deregulation of this miRNA in exosomes may serve as a diagnostic and prognostic biomarker.

Quality registry systems are very useful and have many benefits for clinical experts. Assessing the user experience while working with such a system is one of the most important steps in their development. An evaluation of the quality of the user experience allows designers to improve the system's usability and efficiency. Various usability engineering approaches may be used to analyze and improve the functionality of a Web-based registry system. User experience questionnaires (UEQs) are a reliable and validated tool that have been used to evaluate many systems. The UEQ questionnaire can be linked to the system and users can evaluate the system online. Thus, the gathering of questionnaire data can be a continuous process, allowing for ongoing analysis of the quality of the user experience, leading to a more user-friendly system. Our research focused on the evaluation phase of registry system development and indicated how we can evaluate the quality of the user experience of a registry system. In this paper, a Web-based stroke quality registry system was evaluated through a usability assessment methodology with a UEQ. The results may be applicable to other registry systems.

Multiple sclerosis (MS) is an autoimmune disease which is characterized by neuroaxonal degeneration in the central nervous system. Impaired function of regulatory T cells (Tregs) is believed to be an underlying pathogenic mechanism in MS. Tregs is able to release exosomes, which contain a considerable amount of protein and RNA. Exosomes are capable of transporting their content to other cells where the released content exerts biological functions. Here, we investigated whether Tregs exosomes of RRMS patients or healthy controls might regulate the proliferation or survival of T lymphocytes. Regulatory T cells derived from MS patients or healthy controls were cultured for 3 days and exosomes were purified from supernatants. Treg-derived exosomes were co-cultured with conventional T cells (Tconv). The percentages of Tconv proliferation and apoptosis were measured. Our findings showed that the percentage of proliferation suppression induced by exosomes in patients compared to healthy controls was 8.04 ± 1.17 and 12.5 ± 1.22, respectively, p value = 0.035. Moreover, the rate of Tconv apoptosis induced by exosome of MS patient was less than healthy controls (0.68 ± 0.12 vs. 1.29 ± 0.13; p value = 0.015). Overall, Treg-derived exosomes from MS patients and healthy controls suppressed the proliferation and induced apoptosis in Tconv. However, the effect of MS-derived exosomes was significantly less than healthy controls. Our results point to an alternative Treg inhibitory mechanism which might be important in immunopathogenesis of MS. Although, the cause of the exosomal defect in MS patients is unclear, manipulation of patients' Treg-derived exosomes to restore their suppressive activity might be considered as a potential therapeutic approach. Graphical abstract ᅟ.

Background: Stroke is a serious health threat around the world, particularly in developing countries. As a preventive action, disease registries have long been used in developed countries. Based on the globally accepted evidence, disease registries have an impressive positive impact on different dimensions of health care systems. In order to develop an acute stroke registry, acute stroke registry planning experiences in the world are assessed in this paper., Methods: There were 4 main factors in the planning phase to be assessed: determination of goal, scope, registration type, and consideration of technical aspects. Electronic databases were examined to find 27 relevant English-language articles focusing on acute stroke registry development. Based on the literature review, the main data sets and care quality measures of acute stroke registries were identified., Results: The main purposes of developing an acute stroke registry are improvement of care quality, epidemiology assessment, and evaluation of health care system outcomes. Most of the registries focus on improving care quality. The number of multicenter, Web-based, and prospective registries were significantly higher than other types of registries. Only 1 of the registry systems implemented clinical support tools. Among 12 data sets identified to be considered as registry, 7 were highly used. Among the 14 care quality measures in acute ischemic stroke, the mostly used measure was the rate of early thrombolytic therapy., Conclusion: Establishment of a Web-based, prospective registry system for the acute phase of stroke seems useful for monitoring the rate of early thrombolytic therapy. The establishment of a clinical guideline-based support tool for diagnosis of patients' eligibility for thrombolytic treatment is suggested. As observed in this research, time is a very important factor in care quality improvement, particularly in the acute phase of stroke, for achievement of a more qualified care and a more serious surveillance on prehospital and hospital emergency systems.

Introduction: Stroke is one of the most important health problems around the world. Care quality improvement in the acute phase is significantly influential on stroke prognosis. An acute stroke quality registry that is integrated with a guideline-based support tool is a powerful system for measuring and improving care quality. As the first step in registry system design, the goal of this study was to identify relative data elements., Methods: A list of common data elements taken from the National Institute of Neurological Disorders and Stroke and a list of data elements for paper-based medical records were first evaluated, then compared with each other. In parallel, a literature review was conducted to explore the main data elements in acute stroke registries. Considering quality improvement as the main purpose, a second study was undertaken to identify the measures of acute stroke care quality. For guideline-based smart diagnosis of patients' eligibility for thrombolytic treatment (as a clinical support tool), clinical guidelines of the American Heart Association were assessed, and appropriate eligibility criteria were identified. Finally, a questionnaire was prepared based on the identified data elements. The questionnaire was distributed among 17 neurology physicians for identification of essential data elements (minimum data sets)., Results: Patient-centric data elements were identified and classified into 3 categories: (1) data elements identified based on acute stroke care quality measures; (2) data elements for diagnosis of patients' eligibility for tissue plasminogen activator treatment based on clinical guidelines; and (3) essential data elements based on paper medical records. After duplication removal, the 3 categories of data elements were integrated. Finally, essential data elements were identified using the neurology clinical experts' survey., Conclusion: Compared to traditional disease registries, quality improvement registries cover much more detailed data elements. Integration of medical record data elements with care quality measures, as well as guideline-based criteria, results in a powerful source of data for more exact studies and analysis by clinical support tools. Identifying essential data elements as a mandatory part of the system helps with more accurate data entry, and can also be considered a ready-to-use item for other relative systems.

Context: Despite the widespread use of whole-body vibration (WBV), especially in recent years, its neurophysiological mechanism is still unclear and it is yet to be determined whether acute and short-term WBV exposure produce neurogenic enhancement for agility., Objective: To compare the acute and short-term effects of WBV on the H-reflex-recruitment curve and agility., Design: Cross-over study., Setting: Clinical electrophysiology laboratory., Participants: 20 nonathlete male volunteers (mean age 24.85 ± 3.03 y)., Main Outcome Measures: Subjects were randomly divided into 2 groups, H-reflex and agility. In the sham protocol, subjects stood on the turned-off vibration plate while maintaining the semisquat position, and then, after a 2-wk washout, vibration-training sessions were performed in the same position with a frequency of 30 Hz and an amplitude of 3 mm. H-reflex-recruitment curve was recorded and the agility test of a shuttle run was performed before and after the first session and also 48 h after the 11th session in both sham and vibration-training protocols., Results: Acute effects of WBV training caused a significant decrease of threshold amplitude and H-max/M-max (P = .01 and P = .04, respectively). Short-term WBV training significantly decreased the threshold intensity of the soleus H-reflex-recruitment curve (P = .01) and caused a decrease and increase respectively, in the threshold intensity and the area under the recruitment curve., Conclusions: The results suggest an inhibitory effect of acute WBV training on the H-reflex response.

The purpose of this study was to compare the specific activity of proteinase A in Candida albicans (C. albicans) between multiple sclerosis (MS) patients and controls. A total of 135 and 100 C. albicans strains were isolated from superficial surfaces of MS patients and healthy controls. Analytical models (regression and neural network) were applied to predict the severity of MS considering specific enzyme activity (SEA) and other factors which affect the expanded disability status scale (EDSS). The SEA of C. albicans in MS patients (3466.95 ± 277.25 μmol min -1 mg -1 ) was significantly more than that of healthy controls (1108.98 ± 294.51 μmol min -1 mg -1 ) that was confirmed by regression model (P < 0.001). The SEA had a positive correlation with the severity of MS (P < 0.001, r = 0.65). Analytical models showed that SEA played the most important role (among all included factors that affect on EDSS) in the severity of MS. The SEA of C. albicans in MS patients was significantly more than the healthy controls. The results suggest that the level of SEA of proteinase A and probably the capacity of C. albicans isolates to invade the host tissue is associated with the severity of MS., (© 2016 Blackwell Verlag GmbH.)

BACKGROUND It is hypothesized that migraine may be related to inflammatory bowel disease (IBD), therefore in this cross-sectional study we evaluated the prevalence of migraine in patients with IBD. METHODS In this cross-sectional study 80 patients with IBD and 80 patients without IBD referring to a private gastroenterology clinic from May to January 2014 were evaluated regarding the prevalence of migraine, severity of migraine based on Headache Impact Test (HIT-6), and habits related to headache. RESULTS 160 participants with the mean age of 35 years were evaluated. The prevalence of migraine in the case group was significantly higher than the control (21.3% vs. 8.8%, p =0.027). Moreover, duration of each attack (hours) in IBD group was significantly higher than the control group ( p <0.001) while the duration of migraine involvement (months) and number of attacks was higher in the control group ( p =0.019 and 0.048, respectively). Headache other than migraine in the control group was significantly higher than the IBD group( p <0.001). Disability in the case group was more than the control group but the difference was not significant. The correlation between the severity of disability related to migraine (based on HIT-6) and severity of IBD (based on May oscore & Crohn's disease activity index (CDAI)) was not significant (r=0.16, p =0.58). Moreover the correlation between the duration of IBD and migraineprevalence was not significant (r=-0.14, p =0.19). CONCLUSION We found that the prevalence of migraine in patients with IBD is significantly more than normal population. More studies are needed to highlight the correlation between migraine and IBD.

Background: Intracellular aspartic proteinase A enzyme is expressed by the APR1 gene and is one of the important factors in the development of systemic candidiasis caused by Candida albicans., Objectives: The aim of this study was to evaluate the expression of the APR1 gene in C. albicans isolates obtained from patients with multiple sclerosis (MS) and from controls., Patients and Methods: The samples were obtained from 135 MS patients with candidiasis and 100 matched controls of healthy individuals during 2010 - 2011. The clinical and control isolates of C. albicans obtained from individuals were cultured onto sabouraud dextrose agar (SDA). The evaluation of APR1 gene expression was performed using the reverse transcriptase-polymerase chain reaction (RT-PCR) method., Results: There was a statistically significant difference in APR1 gene expression of C. albicans strains between MS patients (mean ± SD: 0.5208 ± 0.11518) and the control group (mean ± SD: 0.7603 ± 0.11405) (P = 0.000). Significant correlations were found between the APR1 gene expression of C. albicans strains from MS patients with regard to age and the expanded disability status scale (EDSS) (P = 0.000). The mean values of EDSS were 1.6074 ± 0.1081 after antifungal treatment and 2.2519 ± 0.1323 before antifungal treatment (P = 0.000). No significant correlation was observed between the APR1 gene expression with regard to sex and MS subtypes., Conclusions: The results suggested that APR1 gene expression in C. albicans strains isolated from MS patients may be an important factor for invasive C. albicans strains in the progression of MS disease.

Background: Considering the higher activity of mirror neuron system in females, they frequently have better performance in empathy, interpersonal sensitivity, and emotional recognition compared to males., Objectives: The purpose of this study was to assess whether gender difference in neuroanatomy of the human mirror neuron system has any impact on functional recovery of ischemic hemiparetic patients., Patients and Methods: This single-blind clinical trial was conducted on 24 patients with cerebrovascular accident (CVA) in the age range of 45 - 60 years, referring at a rehabilitation center in Tehran, Iran, during 2013 - 2014. Sampling method was stratified random sampling. The subjects were assigned to 2 groups of 12 males and 12 females. Then, each group was randomly divided into 2 groups (totally 4 groups, n = 6 for each group): women watching functional movies, control women, men watching functional movies, and control men. Movies were shown to patients and then, they were evaluated by Timed Up and Go (TUG), Six-minute walk test (SMW), Barthel index (BI), and Berg balance scale (BBS)., Results: Comparison of all variables related to functional activities of all groups before and after watching movies revealed significant differences. The highest percentage of change and improvement was observed in groups 1 and 3 watching the functional movies (P = 0.0001). Percentage of improvement in women of groups 1 and 2 was higher than men in groups 3 and 4 (P = 0.0003). The changes in group of females watching the functional movies (group 1) were significantly greater than in other groups (P < 0.0001)., Conclusions: The Sex differences in the neuroanatomy of the human mirror neuron system affect functional recovery of patients with hemiparesis. The improvement in studied women was found to be significantly greater than studied men. The results indicate a higher chance of recovery among hemiparetic women, especially those watching functional movies.

We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r (2) = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05-1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction.

Objectives: The aim of the current study was to design a new simpler form of National Institutes of Health Stroke Scale (NIHSS) for use in emergency settings, and compare its predictive ability with original NIHSS score for mortality., Methods: A total of 152 consecutive patients with first ever ischemic stroke admitted to a university affiliated hospital were recruited. NIHSS score on admission was estimated and the predictive ability of NIHSS items for mortality at 28 days was evaluated by logistic regression. Stepwise discriminant analysis was performed on NIHSS items to obtain a discriminant function with the best discriminative ability for mortality. Further, receiver operating characteristics (ROC) curves were depicted to compare the new determined discriminant function with the original NIHSS score., Results: Cumulative rate of mortality was 11.8% for 28-day follow-up period. Among NIHSS items, scores of visual field, limb ataxia and extinction neglect were not associated with mortality (P>0.05). On the contrary, level of consciousness-commands, language and gaze were determined as independent indicators of mortality (P<0.05), and their coefficients on discriminant function were equal to 0.65, 0.44 and 0.30, respectively. In addition, area under the ROC curve of the calculated discriminant function was not statistically different from NIHSS score (P>0.05)., Conclusions: The suggested discriminant function, comprising NIHSS items of level of consciousness-commands, language and gaze, can predict 28-day mortality after ischemic stroke in a similar way to the original NIHSS score and can provide a baseline for stroke severity in emergency settings., (Copyright © 2012 Elsevier B.V. All rights reserved.)

The new-AEDs, whose developments were motivated following the discovery of the valproate and its marketing in the U.S in 1978, have presented more therapeutic options. There are approximately twenty four FDA-approved antiepileptic drugs for use in patients with epilepsy, five of which were identified and have come on to the market between 2009 and 2012. The new-AEDs are of interest, not due to their efficacy, but rather owing to better tolerance, favorable pharmacokinetic profile, fewer interactions, and in some instances, lesser protein binding. No standard AED or those in developing have all properties of an ideal antiepileptic drug, thus to achieve desirable outcome, physicians should be aware of pharmacokinetics (PKs) and pharmacodynamics (PDs) of drugs. This review describes briefly the major features of the new AEDs.

The underlying structure of National Institutes of Health Stroke Scale (NIHSS) as the most widely used scale in clinical trials has been the focus of little attention. The aim of the current study was to elucidate the clustering pattern of NIHSS items in ischemic stroke patients. A series of 152 consecutive patients with first-ever ischemic strokes admitted to a university affiliated hospital were enrolled. NIHSS score was estimated on admission and correlation coefficients between its items were calculated. Further, exploratory factor analysis was used to study the clustering pattern of NIHSS items. Extinction neglect, visual field, and facial palsy were weakly associated with other NIHSS items. Factor analysis led to a four-factor structure. Factors 1 and 3 were determined by left brain function as items of right arm and leg motor, language and dysarthria loaded on both of them. By contrast, factor 2 reflected right brain involvement. Since visual field and ataxia loaded on factor 4, this factor was primarily associated with posterior strokes. Our study shows that a four-factor structure model is plausible for NIHSS. Further, for the first time, a single distinct factor is identified for posterior strokes.

Background: High sensitive C-reactive protein (hs-CRP) is a systemic inflammatory marker that is produced in a large amount by hepatocytes in response to interleukin-1 (IL-1), IL-6 and tumor necrosis factor after ischemic stroke., Methods: Measurement of hs-CRP in the first 24 hours of onset in 162 patients suffering from ischemic stroke was done. Relation of CRP with the risk of early mortality, National Institutes of Health Stroke Scale (NIHSS), stroke subtypes and other factors was determined., Results: Regarding to ROC curve analysis, appropriate cut-off point for predicting patients' short time mortality was equal to 2.15 mg/dl in this study. Significantly increased rate of mortality by 13.3 times was seen in patients with simultaneous CRP > 2.15 mg/dl and NIHSS > 10., Conclusion: The Result of this study showed that there is a direct association between hs-CRP and mortality within the first week after stroke. Measuring hs-CRP within the first hours after stroke increases the predicting rate of early mortality risk with cut-off point of 2.15.

Primary angiitis of the central nervous system (PACNS) is an idiopathic disorder (vasculitis) restricted to the central nervous system (CNS). It often presents with focal neurological deficits suggesting stroke or a combination of confusion and headache. We herein report three cases with various combinations of fever, partial seizure, encephalopathy, paresis, headache and ataxia. One of them was initially treated as herpes simplex meningoencephalitis, but further investigations revealed primary angiitis. Primary angiitis of the CNS has protean manifestations and should always be considered in patients suspicious to have CNS infection or stroke, particularly who does not respond to the routine treatments. Clinical data, exclusion of differential diagnoses and typical angiography seem to be enough to justify the diagnosis in the majority of cases.

Spreading depression (SD) is an intrinsic bioelectrical property of the human central nervous system, which plays a key role in neurological disorders. In the present study, we investigated whether experimentally induced repetitive SD caused neuronal death in cortical and subcortical regions of the juvenile rat brain. The animals were anesthetized and the electrodes as well as a cannula were implanted over the brain. Repetitive cortical SD events were induced by KCl injection. The brains were removed after 4 weeks. Repetitive SD enhanced the production of dark neurons, reduced the mean volume of normal neurons, increased the number of apoptotic neurons, and enhanced expression of the NR(2B) subunit of NMDA receptors as well as the GluR1 subunit of AMPA receptors in various regions of the juvenile rat brain. In addition, induction of repetitive SD enhanced long-term potentiation in CA1 hippocampal area. We observed a correlation between cell injury/neuronal death induced by repetitive SD and changes in glutamate receptor expression. The data indicate that repetitive cortical SD in juvenile rats causes neuronal damage in both cortical and subcortical areas of the brain. This may play an important role in the pathophysiology of SD-related neurological disorders, especially in children., (Copyright © 2011 Elsevier Inc. All rights reserved.)

In this case-control study, ELISA and Western blot with whole bacterial protein lysate were performed on serum and cerebrospinal fluid (CSF) of 15 controls and 15 patients. According to Griffin subtypes, 10 of our patients were in acute inflammatory demyelinating polyradiculoneuropathy (AIDP) group, 3 in acute motor axonal neuropathy (AMAN) group, and 2 in acute motor sensory axonal neuropathy (AMSAN) subtype. 86.6% of patients were positive for Helicobacter pylori (H. pylori) IgG. Serum anti-H. pylori IgG of patients and controls were significantly different. CSF anti-H. pylori IgG was significantly higher in patients than controls. In patients, the titer of anti-H. pylori IgG in serum was significantly higher than CSF, which may indicate extra-neural antibody synthesis. CSF IgG titer was higher in patients having axonal pattern. Western blot was positive in CSF of 13 patients and negative in all controls. There was a correlation between the number of antibody types against H. pylori particles and the titer of anti-H. pylori IgG in CSF and serum. Also, antibody against cytotoxin associated protein (CagA) was associated with primary axonal pattern. The association between the presence of anti-CagA and primary axonal pattern, is in favor of the relation between axonal neuropathy and H. pylori infection.

Oxidative stress through the changes in the levels of reactive oxygen species and antioxidative parameters can cause various neurological disorders. The aim of the present study was to show antioxidant activity (AOA) and malondialdehyde (MDA) levels in affected people with Guillain-Barre syndrome (GBS) and multiple sclerosis (MS). A total of 15 GBS patients, 13 MS patients, and 15 age and sex matched controls were included in this study. MDA and AOA values were determined in both cerebrospinal fluid (CSF) and serum, spectrophotometrically. We have shown an increase in the values of MDA in the CSF of both GBS and MS patients (0.32 +/- 0.073 and 0.22 +/- 0.06 micromol/L) compared to the control (undetectable levels). Furthermore, a significant decrease in the serum MDA levels was shown in both GBS and MS patients (0.81 +/- 0.18 and 0.73 +/- 0.18 micromol/L) when compared to the control (1.7 +/- 0.46 micromol/L). A decrease was shown for serum AOA in both GBS (1.7 +/- 0.21 mmol/L) and MS patients (2.6 +/- 0.62 mmol/L) when compared to the control (3.2 +/- 0.17 mmol/L). However, a significant increase in the values of CSF AOA was shown in both MS and GBS patients (1.47 +/- 0.19 and 1.42 +/- 0.26 mmol/L) compared to the control (0.71 +/- 0.19 mmol/L). An imbalance between the levels of AOA and MDA in both CSF and serum can be followed in both MS and GBS patients.

Interferon-beta (IFN-beta) is an immunomodulatory drug of choice to control relapsing-remitting multiple sclerosis (RR-MS), although its function is still unclear. A reduced suppressive function of CD4(+)CD25(+) regulatory T cells (T(reg)) has been shown in RR-MS patients. In this study, to understand the effect of IFN-ss on CD4(+)CD25(+) regulatory T cells, we analyzed the frequency and function of these cells and Foxp3 gene expression before and after treatment. We evaluated the frequency and function of CD4(+)CD25(+)Foxp3(+) regulatory T cells by flow cytometry and co-culture inhibition test respectively and gene expression of Foxp3 by real-time PCR in a longitudinal follow-up study in 18 relapsing-remitting MS patients. Our data revealed that IFN-beta significantly improved frequency and suppressive function of T(reg) cells (P<0.05) without any significant effect on gene expression of Foxp3 after 6 months. The results of the present study indicate that IFN-beta therapy in some of patients with RR-MS may restore function of regulatory T cells and control the unchecked immune cascade activity. Larger longitudinal studies on more MS patients are required to confirm our findings., (Copyright 2009 Elsevier B.V. All rights reserved.)

As multiple sclerosis (MS) has long been known to be associated with Leber, hereditary optic neuropathy (LHON), a disease caused by mitochondrial (mtDNA) mutations, in this study we assessed possible involvement of mtDNA point mutation in MS patients. Fifty-two MS patients whose disease was confirmed with revised McDonald criteria and referred to Iranian Center of Neurological Research of Imam Khomeini hospital during 2006-2007 entered the study. Secondary mtDNA mutations, age, gender, clinical disability according to expanded disability status scale (EDSS), course of the disease, and presenting symptoms were the variables investigated in this study. DNA purification was performed by Diatom DNA Extraction Kit. Analysis of data was done by SPSS V11.5. The prevalent mutations with frequency of 19.2% were J, L, and T haplogroups. Haplotype A was more prevalent in patients with younger age of onset (P-value = 0.012) and high proportion of haplogroup H was associated with optic nerve involvement (P-value = 0.015). No motor symptoms were seen in haplogroup H patients. There is no significant relationship between duration of the disease and EDSS in different mutation of mtDNA.

Multiple sclerosis (MS) is prototype of inflammatory demyelinating disease of the central nervous system .The etiology of MS remains unclear, but according to current data the disease develops in genetically susceptible individuals and may require additional environmental triggers. The human leukocyte antigen (HLA) class II alleles (DRB1*1501, DQA1*0102, DQB1*0602) may have the strongest genetic effect in MS. In this study, the role of these alleles were investigated in 183 Iranian patients with multiple sclerosis and compared with 100 healthy individuals. HLA typing for DRB1*1501, DQA1*0102, DQB1*0602 was performed by polymerase chain reaction (PCR) amplification with sequence-specific primers (PCR-SSP) method. The results show that, HLA DR B1*1501 was significantly more frequent among MS patients (46% vs. 20%, PV = 0.0006) but DQA1*0102 haplotype was negatively associated with MS (30% vs. 50%, PV = 0.0049) and no significant association was found with DQB1*0602 and MS patients in comparison with control group (24% and 30%, PV = 0.43). No significant correlation was observed among these alleles with sex, type of disease; initial symptoms, expanded disability status scale (EDSS), as well as age at onset and familial MS. This study therefore indicates that there is no association of above HLA haplotypes with clinical presentation, disease duration, and disability in Iranian patients with MS which is in line with other previous studies in different ethnic groups.

: Multiple Sclerosis (MS) is a multifocal demyelinating central nervous system disorder in which interplay between genes and the environment are supposed to be involved. Mitochondrial DNA (mtDNA) has the only non-coding regions at the displacement loop (D-loop) region that contains two hypervariable segments (HVS-I and HVS-II) with high polymorphism. mtDNA has already been fully sequenced and many subsequent publications have showed polymorphic sites, haplogroups and haplotypes. Haplogroups could have important implications to understand association between mutability of the mitochondrial genome and disease. To assess relationship between mtDNA haplogroups and MS, we have sequenced the mtDNA HVS-I in 54 MS patients and 100 control subjects. We have found that haplogroups A and K are significantly more abundant in MS patients (P=0.042 for haplogroup A and P=0.0005 for haplogroup K). Thus, these two haplogroups might act synergistically to increase the penetrance of MS disease.