Archives of Neuroscience
Volume:3 Issue: 1, Jan 2016

Falls are a major risk for Parkinson disease patients (PD). Single falls, in older people may be related to the underlying disease or may be accidental. Recurrent falls are more likely to be related to the underlying disease. To predict falls in patients with Parkinson disease.Patients and Between July 1, 2011 and June 30, 2012 we examined 452 persons with PD in the Muhammad Ali Parkinson Clinic during their outpatient visits. We followed 401 persons with PD for a year, 205 of whom, 51.0% fell: 161 fell once and 44 fell more than once (recurrent fallers). Recurrent fallers had PD significantly longer, 12.6 + 7.0 versus 5.9 + 4.5 years, had significantly higher, worse, motor unified parkinson disease rating scale (UPDRS) scores” 31.2 + 12.7 versus 19.7 + 8.3. The major difference between recurrent and single fallers was an inability of recurrent fallers to stand on one leg for < 3 seconds: 95% versus 11%, odds ratio 178 CI 95% 39.5 - 801.2. Single fallers who are unable to stand on one foot for < 3 seconds may be at risk for recurrent falls. Gait and balance training focused on improving a patient’s ability to stand on one leg may decrease the risk of recurrent falls in PD.

Context: Bothersome relapses or conditions that damage function in patients with multiple sclerosis (MS) need a well-focused strategy of appropriate management to return patients’ function and decrease the disability. A large number of clinical studies are being accompanied to evaluate the effectiveness and adverse effects of rituximab. Deteriorations assist as significant signs of disorder activity. In such conditions B cell-depleting regimens such as rituximab may be considered. To attain major motivation and gather talented satisfying evidence, strong review articles and research could try to focus on the best time to prescribe rituximab in MS.Evidence Acquisition: Clinical trials and review articles to achieve efficacy and safety of rituximab in MS were searched. The current study first offered an outline of the rituximab pharmacokinetics parameters in overall, suggested mechanisms of action that contribute to the beneficial effects of rituximab and the perfect timing of prescription-based therapies for MS. A total of 647 articles (1997 - 2015) were found related to efficacy, safety and pharmacokinetics parameters of rituximab in MS. Six articles (3; 2009, 1; 2010 and 2; 2011) were related to the use of rituximab in: primary progressive MS, autoimmune disease, refractory and autoimmune pediatric disease, 52-week phase II clinical trials and relapsing neuromyelitis optica were studied further. In phase II clinical trials based on blinded radiological end-points pharmacotherapy using rituximab suggested to be effective. There is also report regarding to less increase in T2 lesion volume (P < 0.001) after two years of rituximab management. There was no change in brain volume (P = 0.62). There was a delay in patients less than 51 years related to the disease progression. Adverse effects were reported in < 5% of patients with rituximab. Also it has been reported that in 28 out of 30 patients with neuromyelitis optica, there was a significant reduction in the rate of relapse over two years. The current study aimed to evaluate the efficacy of rituximab in patients with MS. Due to inter and intra individual variability in disease presentation and its progression, rituximab should be prescribed cautiously.

Autoimmune diseases usually affect central or peripheral nervous system and can affect both only in rare cases. A 55-year-old female was referred with symptoms of multiple mononeuritis associated with central signs and she had a dramatic improvement with steroid therapy. An attempt to stop steroid therapy after four years resulted in an almost immediate reappearance of symptoms. Despite some episodes of paresthesias or weakness in the lower limbs, steroid therapy at full dosage prolonged until the age of 76 years allowing an almost normal life. At the age of 86 years, the patient has been relatively well. Overlap syndrome of some autoimmune diseases is discussed; need for a very prolonged therapy, non-response to intravenous immunoglobulin and relatively good prognosis are stressed.

Spinal cord injury (SCI) causes multiple complications, which can be prevented or minimized, through patient education (PE). Individuals with SCI are different, according to culture, socioeconomic status, level of education, access to educational facilities, and geographic region. Therefore, different teaching strategies should be used to increase effectiveness of education. The aim of this study is to evaluate the perspectives of individuals with SCI, about their preferred methods of PE.Patients and This was a descriptive cross-sectional study undertaken at the brain and spinal cord injury research center (BASIR), Tehran university of medical sciences, Tehran, Iran. The participants comprised of 119 SCI persons (81 men and 38 women), with mean age of 32 ± 10.5 years, referred to BASIR clinic to receive outpatient rehabilitation, in 2012. The patients were asked about their views, concerning preferred methods of PE. Most participants (94%) appreciated to be informed concerning their illness. The two most preferred education methods were educational movies by CD or DVD (44%) and lectures or face classes (36%), followed by educational TV programs (30%), brochures (24%), education via internet or computer-aided (14.3%), and, finally, educational books (2%). Health care providers should take into account the differences between individuals with SCI, to use effective teaching strategies. Also, they should apply appropriate teaching methods and more than one teaching strategy, in relation to the different time and situation. Effective PE, in individuals with SCI, can increase their knowledge and motivation in self-care, improve satisfaction, prevent complications and make the PE more effective.

Context: The production of thrombolytic agents started in 1930s and thrombolytic therapy for stroke began in 1958, on a case by case basis, and, in 1963, a small trial performed.Evidence Acquisition: Intravenous tissue plasminogen activator (t-PA) was recognized and approved as the thrombolytic agent for acute ischemic stroke that can improve patients’ outcome and resolve their neurological deficits. The main reason for the difficulty of stroke treatment is the narrow time window, which leads to a small proportion of eligible patients to be treated with t-PA. The cost-effectiveness and feasibility of intravenous t-PA for treatment of acute stroke in 3 - 4.5 hour time window, after symptom onset, have been confirmed in previous studies. Data about thrombolytic therapy, at the national level, are scarce in Asia and developing countries, compared to developed world. Thrombolytic therapy using t-PA is used in few low-income countries, including Iran. According to estimations of Iranian stroke patients, eligible for thrombolysis therapy, only 30% of Iranian stroke patients received t-PA. The high cost of t-PA and lack of appropriate infrastructure are the main barriers for thrombolytic therapy, in developing countries like Iran. On the other hand, most stroke units and centers, which have the infrastructure to deliver thrombolysis, are predominantly available only in large urban areas.

Context: Multiple sclerosis (MS) is an autoimmune and inflammatory disease that affects the central nervous system (CNS). In MS, activated T-cells for self-antigens, such as myelin, attack erroneous targets in the CNS and result in axonal demyelination and neurological disability. Stem cell (SC) therapy has potential applications in treating neurological disorders.Evidence Acquisition: The reasoning for use of SCs from different sources, as a therapeutic option in MS, arose from the expectation that they have the capacity to remyelinate and differentiate into oligodendrocyte precursor cells. Many SC types are under testing for treating MS and, the most common, are neural SC (NSC), embryonic SC (ESC), mesenchymal SC (MSC) and hematopoietic SC (HSC). The NSCs, namely adult NSCs, bone marrow-derived-NSCs and neural progenitor cells, are capable of differentiation into oligodendrocytes and induce remyelination. The MSCs influence on the rate of repair of all endogenous progenitors. The autologous HSC transplantation is an option in cases that do not respond to standard therapy and also meliorate the symptoms and limit progression of disease. The ESCs have shown neuroprotection in cases of MS, through a yet unclear immunosuppression mechanism. Recently, cell transplantation has introduced a novel approach for treatment of neurological disorders, such as MS. Therefore, focusing on safety issues, while bridging from the basic SC sciences to the clinical transplantation trials, has a crucial role in cellular therapy programs. This review will discuss in detail the experimental and clinical use of these SC populations and their probably mechanisms in the treatment of multiple sclerosis.

In the first three months of pregnancy, 23.8% of females experience migraines, and 63.6% have episodes of dizziness, with the most frequent symptom being (35.7%) vertigo. Therefore, vestibular migraine is expected to occur in pregnant women, yet studies in this regard are limited in the literature. We studied such a case in order to determine the safest treatment for patients with possible pregnancy. The studied case was a 37-year-old female, who had a history of migraines. She had had vestibular migraines eight times since she was 29 years old. During the second attack, she had been conservatively treated with several anti-vertigo and anti-emetic medications. Because her menses was a little out of schedule, she receive pregnancy test, and to our surprise, the test showed positive results. Afterwards, she was transferred to an obstetric hospital for prenatal examinations and had follow-ups for ten months. Eight months after delivery, the third vestibular migraine occurred. Because of lactation, she did not take any medications; vertigo continued for half a day, and dizziness remitted over the following two days. Pregnancy is expected to occur together with vertigo in females of the childbearing age, even if they have been diagnosed with sterility. Any anti-vertiginous medication with teratogenic risk should be avoided if pregnancy is not completely excluded, antihistamine diphenhydramine (FDA class B) are recommended first for symptomatic control.