mohammad rohani

Islamic mysticism, as a path to uncovering absolute truth and tapping into the hidden capacities of humanity, manifests through the concepts of ṭayy al-arḍ (folding up of the earth or traversing the earth without moving) and karāma (divine grace) in the mystical journey. Karāma represents the manifestation of divine power and love, transcending extraordinary acts to symbolize the spiritual perfection and elevation of the human soul. Ṭayy al-arḍ, as a formal revelation, is an emblem of the mystical journey, allowing the transcendence of material boundaries and entry into realms of knowledge. These concepts are not intended to prove or explain the physical mechanics of ṭayy al-arḍ, but are viewed as outward expressions of spiritual growth, the manifestation of divine names in the hearts of mystics, and stages in the progression of human perfection. A review of religious, philosophical, and mystical texts clarifies the role of these elements in achieving unity of existence and spiritual evolution. Thus, karāma and ṭayy al-arḍ are seen as tools for a deeper understanding and connection to divine truth in the mystical life, leading to human perfection and proximity to God. Despite the prominence of these concepts, there has been little profound research on their philosophical and mystical foundations or their roles. This article aims to thoroughly examine the role of these concepts in the mystical journey and in attaining divine knowledge.
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 Physical activities play a preventive role in Parkinson disease by maintaining the physical fitness and health of the patients. This study aimed to investigate the effect of 8 weeks of Otago exercise on selected walking factors in patients with Parkinson disease. 

 This quasi-experimental study was performed on the experimental and control groups with a pretest-posttest design. The statistical population of the present study comprised all patients with Parkinson disease (with at least stage three on the Hoehn and Yahr intensity scale) referred to the neurologist offices with an age range of 55-75 years. The subjects were randomly divided into groups of Otago exercises (n=16, with Mean±SD age: 63.0±6.4 years, Mean±SD weight: 65.7±5.2 kg, and mean height 1.74±0.07 m) and control (n=16; with Mean±SD age: 63.4±5.7 years, Mean±SD weight: 64.1±5.9 kg, and Mean±SD height: 1.72±0.09 m). Eight weeks of Otago exercise was performed three times a week for 60 minutes at each session. A motion analysis system consisting of 8 cameras and 2 force plates was used to record selected walking factors, including step length, step width, and knee joint extension changes. The paired t test was used to compare each group in the pretest and posttest, and analysis of covariance (ANCOVA) was used to compare between groups.

 The results showed significant differences in the step length, step width, and knee extension changes in patients with Parkinson disease between the experimental and control groups (P<0.001). Also, the results showed that patients with Parkinson disease had longer step length, shorter step width, and greater knee extension in both legs after Otago exercise.

 Otago exercises can be used as one of the easy and low-cost methods in improving the walking components of patients with Parkinson disease.

 Based on literatures, the patients with essential tremor have a thinner Retinal Nerve Fiber Layer (RNFL) layer in Optical Coherence Tomography (OCT) imaging, compared to the healthy population. Thus, we decided to examine the ocular-neural state of patients with essential tremor, by examining RNFL and Retinal Ganglion Cell Layer (RGCL) in the OCT reports of patients referred to Hazrat Rasool Akram Hospital in the years 2020 to 2022.

 This research was implemented in the form of case-control study.50 patients were recruited into each group of tremor, and healthy controls. OCT parameters, including thickness of RNFL and RGCL were evaluated and recorded.

 The study findings revealed a significant difference in the mean superior, superior nasal, superior temporal sections of the right eye and superior temporal and inferior temporal regions of the left eye in RNFL between the control group and all patients (P < 0.01). Moreover, the results showed that there was a significant difference in the GCL in superior 6 mm of the right and left eye between the control group, and all patients (P <0.01).

 Regarding the results this study, it seems that patients with essential tremor have a significant decrease in some RNFL and GCL factors compared to healthy people. However, the majority of variables examined from RNFL and GCL in our study did not show significant differences. Moreover, this thinning could be associated with the neurodegenerative nature of the disease.

Serotonergic system hyperactivity at 5-HT2A receptors on glutamate neurons in the cerebral cortex is one of the pathways that is theoretically linked to psychosis. In addition to neurotransmitter dysfunction, volumetric studies have revealed the loss of cortical gray matter and ventricular enlargement in patients with schizophrenia, although there is no case-control research on patients with schizophrenia to evaluate echogenicity of raphe nuclei (RN) or diameter of the third ventricle (DTV). To address these issues, the present study assessed midbrain RN, as the main source of brain serotonin, and DTV, as an index of atrophy, by transcranial sonography (TCS) in a group of patients with schizophrenia.

Thirty patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and DTV. TCS was done through a temporal bone window via a phased-array ultrasound using a 2.5 MHz transducer in a depth of 14-16 cm. RN echogenicity was assessed by a semi-quantitative visual scale and DTV was measured in the thalamic plane.

Twenty-three patients (76.5%) and 15 controls (50 %) showed hypoechogenicity of RN, which was marginally significant (P=0.06). DTV was on average larger in the experimental group (0.388 cm vs 0.234 cm, P<0.001).

Increased DTV in patients with schizophrenia is consistent with previous neuroimaging findings. However, marginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

chorea-acanthocytosis is a form of the autosomal recessive disease. The onset of disease symptoms usually starts from the third decade of life and presents with chorea, other abnormal movements such as eating dystonia, tongue and lip biting, vocal and motor tics, seizure, and behavioral impairment. In this study, the clinical presentations and brain imaging of these patients were reported.

In this descriptive study, information about patients with a specific movement disorder who were referred to a tertiary center in the Rasool Akram hospital (Tehran) from March 2018 to February 2019 were recorded. The inclusion criteria were the presence of chorea (a form of abnormal movement) and the presents of acanthocyte cells higher than 10% in a peripheral blood smear. The exclusion criteria were the evidence of secondary causes of the chorea or endocrine disorders. The clinical symptoms and brain imaging findings were evaluated by two expert neurologists and recorded in the patient's electronic files.

Twenty-seven eligible patients were included. 18 patients were male and 9 were female. Sixteen patients had seizures and 90% of them were categorized as generalized tonic-clonic seizures. 21 patients had eating dystonia (71 percent were male and 29 percent were female) and 18 patients had complex motor and vocal tics, 11 patients presented extra ocular movement disorders, and 11 patients had evidence of tongue and lip biting. The absence of the deep tendon reflex was detected in 23 patients. Considering all the patients' movement disorders, the prevalence of eating dystonia was significantly higher in men than in women. (P=0.049). Other abnormal movements were not different between men and female. All patients had caudate atrophy and increased signal intensity in T2/Flair sequences in caudate nuclei and putamen in the brain imaging.

The most common abnormal movement after chorea was eating dystonia. The male gender was more susceptible to present eating dystonia than the female. However, this superiority was not seen in other movement disorders.

Nowadays, many neurological conditions, including Parkinson’s disease (PD), are treated with deep brain stimulation (DBS). Life-threatening consequences can occur from DBS hardware failure or sudden implantable pulse generator (IPG) battery depletion. This issue may potentially worsen in concomitance with medical or infectious conditions, requiring stronger emergency management. We present here a 58 year-old PD patient with DBS, whose IPG replacement surgery was complicated by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and we report management of this patient along with recommendations for patients with similar situation. As the newly-emerged coronavirus disease 2019 (COVID-19) is now announced to be pandemic, new protocols and specific measures for each individual group of patients with chronic diseases seem obligatory. Regarding our recent experience with a patient suffering from PD, on DBS treatment, who needed hospitalization, we felt useful to share our experience as a recommended protocol for similar patients in the time of current pandemic. Close monitoring of laboratory and clinical signs should be warranted in patients with PD awaiting IPG replacement in order to be prepared in these novel conditions that may precipitate an akinetic crisis/dystonic storm and to prevent life-threatening complications during the current pandemic.

An impaired sense of smell has a remarkable impact on the quality of life. It is seen in a variety of neurodegenerative diseases such as Parkinson disease. In this study, we assessed the olfactory function in patients with Multiple Sclerosis (MS) by Sniff Magnitude Test (SMT). 

A cross-sectional study was conducted on 48 patients with MS. A questionnaire, including demographic and clinical variables, was completed for each patient. The SMT was used for the evaluation of olfactory function. 

Olfactory dysfunction was found in 14.6% of patients (8.3% hyposmia and 6.3% anosmia). Older age, longer disease duration, higher hospital admission rate, lower mini-mental status examination score, and secondary progressive course of MS were significantly related to olfactory dysfunction. 

Secondary progressive MS and markers of advanced disease toward neurodegenerative phase (including older age, longer disease duration, and lower cognitive function) can be associated with olfactory dysfunction in MS patients.

 The blink reflex recovery cycle indicates the excitability of interneurons in the brainstem. In this study, we aimed to investigate the blink reflex and R2 recovery cycle in patients with benign essential blepharospasm (BEB).

 This prospective case-control study compared the blink reflex and R2 recovery in 18 BEB patients with 18 age- and gender-matched healthy individuals. The blink reflex was measured in a stimulation duration of 0.2 ms, and R1, R2, and R2’ were recorded for all subjects. The R2 recovery cycle was measured by stimulation of the supraorbital nerve at four interstimulus intervals (ISI) of 200, 300, 500, and 1000 ms, with the same intensity as the previous test. The R2 recovery index was calculated and compared with the control group via independent sample t-test. Two-tailed P-value less than 0.05 was considered statistically significant.

 The blink reflex (R1, R2, and R2’ responses) distal latencies and amplitudes in the BEB group were not significantly different from the control group (P>0.05). The R2 recovery index in all intervals was significantly higher in the BEB group than the control group (P=0.00). The most significant difference between the BEB and control groups regarding the R2 recovery indices was observed at ISIs of 300 and 200 ms (80.36 vs. 16.99 and 75.70 vs. 12.57, respectively). There was a negative correlation between the patient’s age at the onset of disease and the R2 recovery index; however, it was not statistically significant (P>0.05).

 Our findings showed that the R2 recovery reflex was higher in BEB patients than the normal population. Therefore, it can be a helpful index for differentiating BEB cases from psychogenic or malingering ones.

Freezing of gait (FOG) is accompanied by various complications, reduced quality of life, and increased risk of mortality and morbidity in patients with Parkinson’s disease. The incidence of this disabling phenomenon can be predicted in at least one-third of patients with Parkinson’s disease. Therefore, the current study aimed to investigate the prevalence of FOG among Iranian patients with Parkinson’s disease and to determine the predictors of this phenomenon in these patients.

This cross-sectional study was performed on 135 patients with Parkinson’s disease, referred to Rasoul Akram Hospital, Tehran, Iran. The subjects were selected using the convenience sampling method. FOG was confirmed via clinical examination by two fellows of the movement disorder fellowship program. Variables were evaluated using bivariate and multivariate logistic regression analyses, receiver operating characteristics (ROC) curve analysis, and measurement of the area under the ROC curve (AUC).

Out of 135 patients with Parkinson’s disease, 36 (26.7%) had FOG. Based on the results, FOG had a significantly higher prevalence in older patients, compared to younger patients. According to the results, FOG had no significant relationship with other baseline variables, including gender, disease duration, and disease manifestations. According to the multivariate logistic regression model, advanced age (OR: 0.915; P=0.031) and longer disease duration (OR: 0.992; P=0.019) predicted the incidence of FOG in the presence of underlying factors.

The prevalence of FOG among patients with Parkinson’s disease was estimated at 26.7%, which is within the global range. The results revealed that age and duration of disease were two factors, which could predict the occurrence of FOG with high sensitivity and specificity.

Neurodegeneration with brain iron accumulation (NBIA) is a rare set of inherited neurodegenerative disorders with abnormal accumulation of iron in basal ganglia. It is a clinically and genetically heterogeneous disorder that is characterized by movement disorders, dystonia, dysarthria, Parkinsonism, intellectual disability, and spasticity. The age at onset varies from childhood to adulthood and the rate of progression is different among affected individuals. Although there is no information about the exact prevalence of NBIA in the world-wide, it is estimated less than 1/1,000,000 in population. NBIAs are inherited in autosomal recessive, autosomal dominant or X-linked fashions. Until now more than 10 genes have been identified for this group of disorders. Among these, only two genes encode proteins that directly involved in iron metabolism. Therefore, how iron contributes to the pathogenesis of NBIA remains unknown. The remaining NBIA-causing genes participate in lipid metabolism, lysosomal functions or autophagy process, and the roles of some of them remain unknown. NBIA is categorized based on the genetic cause of the disease. PKAN, PLAN, MPAN, and BPAN are the most common forms of the disease result from mutations in the PANK2, PLA2G6, C19orf12, and WDR45 genes, respectively. The diagnosis of NBIA is usually based on clinical features and a specific pattern of brain MRI which results from the abnormal accumulation of iron. For example, the pattern of “eye of the tiger” is observed in the brain MRI of PKAN cases. Since, clinical evaluations and neuroimaging have failed in the diagnosis of the disease in some NBIA cases, genetic testing will be helpful. Development of whole-exome sequencing (WES) has facilitated the identification of disease-causing genes but it seems some of NBIA-genes have remained unknown, yet. Identification of novel genes and molecular pathways will enable a deeper understanding of the underlying molecular bases and our knowledge about the pathogenesis of the disease. There is currently no comprehensive study about the NBIA in Iran, however, the latest discovered NBIA gene, GTPBP2, has been identified in an Iranian family.

Studying voice acoustic parameters in vowel production is a crucial component of every standard voice evaluation. Voice Analysis is non-invasive. Nowadays, computerized Voice Analysis is growing rapidly. Therefore, understanding acoustic parameters in healthy and unhealthy individuals is more significant than before. This research is a step toward boosting our knowledge about voice acoustic parameters. The main purpose of this research is to study acoustic characteristics in dysphonic and healthy Iranian individuals. 

The current study was descriptive-analytic. Vowel Analysis was conducted through Praat software. Voices of 50 dysphonic patients and 50 healthy participants were evaluated. The acoustic parameters included average, standard deviation, and range of fundamental frequency, jitter, shimmer, the number and degree of voice breaks, and harmonic to noise ratio.

In all studied acoustic characteristics, patients’ mean scores were higher than controls’ mean scores, except for harmonic to noise ratio which was higher in the healthy individuals. Although, the number of voice breaks in healthy male and female population was zero, it was 1.8 in male patients and 4.4 in female patients (P<0.05).
jitter and shimmer in patients were dramatically higher (P<0.05) than their amount in healthy controls; moreover, patients’ fundamental frequency range (male: 54.6±59.0, female: 78.6±68.4) was extremely broader than individuals with normal voices (male: 9.7±4.1, female: 16.2±7.3).

It was clarified that there are considerably significant differences in some acoustic features. These differences may be used as a foundation for diagnosis and intervention in dysphonic patients. This study illustrated that Acoustic Analysis can differentiate healthy individuals from patients. Hence, it can be used as a non-invasive, fast and accurate method.

Glucocerebrosidase (GBA) mutation is the most common genetic risk factor in Parkinson’s disease (PD). Transcranial sonography (TCS) shows increased substantia nigra (SN) echogenicity in both idiopathic and genetic forms of PD. The goal of this study was to compare maximal area of SN hyperechogenicity (aSNmax) and diameter of third ventricle (DTV) between GBA mutation carriers and healthy controls. Twenty-six carriers of GBA mutation and twenty-six healthy controls underwent TCS. The aSNmax and the DTV were measured. Mini-mental status examination (MMSE) and demographic data of the subjects were recorded, too. Mean aSNmax in GBA mutation carriers was significantly higher (0.31 ± 0.06 cm2) than controls (0.16 ± 0.04 cm2). Moreover, DTV was significantly higher in GBA mutation carriers group (3.98 ± 0.90 vs 3.29 ± 0.56 cm). Increased SN echogenicity and increased third ventricle diameter in GBA mutation carriers may be caused by alterations in iron metabolism with reference to their genetic status

Dysregulation of serotonin system is hypothesized to play the main role in the etiology of obsessive-compulsive disorder (OCD). Transcranial sonography (TCS) is a helpful noninvasive and low-cost tool for the assessment of subcortical brain architectures, mainly basal nuclei, cerebellar central structures, and midbrain. In this study, an ultrasound assessment was performed for a sample of the patients with OCD and healthy control group to evaluate echogenicity of midbrain raphe nuclei (RN). A total of 35 patients with OCD and 35 healthy controls of similar age and sex entered the study. Semi-structured clinical interview was performed according to the DSM IV-TR criteria to verify OCD. Echogenicity of the midbrain RN was assessed by an experienced neurologist applying TCS. The echogenicity of the 2 groups was compared using chi- square test. SPSS software (version 18, PASW) was used for statistical analysis and p-value of less than 0.05 was considered significant. In this study, 15 OCD patients (42.9%) and 11 (31.4%) controls showed decreased echogenicity of midbrain RN. Also, the results of the chi-square test showed that the midbrain RN echogenicity was not significantly lower in patients with OCD compared to the control group (p= 0.322). Although decreased midbrain RN echogenicity is a characteristic of patients with major depression, it was not shown in OCD patients in this study, which can be explained by the involvement of RN projections rather that RN serotoninergic neurons.

Hypercoagulable state may be an important first presentation in malignancies especially pancreatic cancer. The trousseau syndrome is caused by venous thrombosis, non-bacterial thrombotic endocarditis and arterial thrombosis. We describe a patient who had the cerebral infarction as the initial manifestation of pancreatic cancer and we discuss that full work up for every patient with atypical stroke should be done.
We report a 67-year-old man who developed multiple cerebral infarctions as the initial manifestation of pancreatic cancer. Cancer antigen 19-9 (CA 19-9) was 52,065 U/mL (Normal value: 0 - 33 U/mL), computerized tomography (CT) scan of the abdomen showed multiple hypodensities in both lobes of the liver and Heterogeneous hypodensity was seen in the pancreas that was highly suggestive of pancreas adenocarcinoma and was confirmed with the biopsy.
In the case of multiple brain infarctions in both anterior and posterior circulation, without evidence of common cause, trousseau syndrome and hypercoagulability state should be considered.

Carpal tunnel syndrome (CTS) is a common peripheral entrapment neuropathy in patients with hypothyroid. The diagnosis of CTS is usually clinical and confirmed by electrodiagnostic (EDX) procedures. This study aimed to describe the diagnostic accuracy of high-resolution ultrasonography (US) as an alternative method to nerve conduction study (NCS) for the diagnosis of subclinical CTS in patients with hypothyroidism.
Between April 2013 and November 2014, from the patients with the diagnosis of hypothyroidism referring to the institute of endocrinology and metabolism of Firoozgar Hospital, Tehran, Iran, those who met our inclusion criteria entered this cross-sectional study. The patients divided into two groups of subclinical CTS with the age- and gender-matched control group. US measurements of the median nerve cross-sectional area (CSA) in the CT inlet were compared with the NCS results as the gold standard diagnostic test.
A total number of 152 wrists of 76 hypothyroid patients were examined in this study. The mean of median nerve CSA at the tunnel inlet was 9.96 ± 2.20 mm2 for the CTS group and 7.08 ± 1.38 mm2 for the control group (P According to our findings, US has an acceptable diagnostic value to confirm CTS in hypothyroid patients. However, it may not replace NCS due to low sensitivity.

Subthalamic nucleus (STN) stimulation is the reatment of choice for carefully chosen patients with idiopathic Parkinson's disease (PD) and refractory motor fluctuations. We evaluated the value of intraoperative electrophysiology during STN deep brain stimulation (DBS) procedures in refining the anatomically-defined target. We determined the spatial distance between the anatomical and physiological targets along x, y and z axes in 50 patients with PD who underwent bilateral subthalamic nucleus DBS surgery. The mean spatial distance between anatomical and functional targets was 1.84 ± 0.88 mm and the least distances in different methods were 0.66 mm [standard error (SE): 0.07], 1.07 mm (SE: 0.08) and 1.01 mm (SE: 0.08) on x, y and z axes, respectively, for the combined method. The most physiologically-accurate anatomical targeting was achieved via a combination of multiple independent methods. There was a statistically significant difference between the anatomical and functional targets in all methods (even the combined) on the y coordinate, emphasizing the need for intra- operative electrophysiological monitoring to refine the anatomico-radiologically-defined target.

The common pistachio psylla Agonoscena pistaciae is a key pest of pistachio in Iran. A study was conducted to determine the spatial distribution ofpsyllanymphs and eggs in a 10 ha pistachio orchard in the Rafsanjan region, southeast of Iran. Three rows, each containing 33 trees (totally 99 trees), were randomly selected in the orchard based on a stratified sampling scheme. In each of the selected trees, three positions in the crown (top, middle and bottom) were considered. One leaf from each position as sampling unit (totally 297 samples) was clipped and number of nymphs and eggs were counted. Ordinary kriged maps were achieved for nymphs and eggs of the three positions using a variogram function. Results indicated the highest and lowest density of the nymphs occurred on the top and bottom positions of the crown, respectively. Eggs of the common pistachio psylla were laid mostly on the bottom of the pistachio crown.

Neuroacanthocytosis is an autosomal recessive neurodegenerative disease, characterized by chorea, dementia, seizure, acanthocytes on peripheral blood smear and caudate atrophy on brain magnetic resonance imaging (MRI).1,2These patients have severe orofacial dyskinesia and especially eating dystonia that causes severe eating problems and tongue and cheek biting. Eating or feeding dystonia, in combination with the above-mentioned signs and symptoms is characteristic of neuroacanthocytosis.1-3Here, we present a video clip of a 40-year-old woman with typical eating dystonia. When she puts bolus in the mouth; dystonic movement of the tongue pushes it out (Video 1).She had progressive choreiform movements especially orofacial dyskinesias since 10 years. Her brain MRI showed caudate atrophy and T2 and fluid-attenuated inversion recovery hyperintensity of caudate and putamens. On the peripheral blood smear, there were many acanthocytes.Feeding dystonia is highly suggestive of neuroacanthocytosis and is a hallmark for this rare disease.3

Massive ischemic stroke causes significant mortality and morbidity in stroke patients. The main treatments for massive ischemic stroke are recombinant tissue plasminogen activator (rtPA), craniotomy, and endovascular interventions. Due to destructive effects of bradykinin on the nervous system in ischemic stroke, it seems reasonable that using Noscapine as a Bradykinin antagonist may improve patients’ outcome after ischemic stroke. The effect of Noscapine on massive ischemic stroke was shown by the previous pilot study by our group. This pseudo-randomized clinical trial study was designed to assess the result of the pilot study. Patients who had clinical symptoms or computed tomography scan indicative of massive stroke (in full middle cerebral artery territory) were entered to the study. The cases received the drugs according to their turns in emergency ward (pseudo-randomized). The patient group received Noscapine, and the control group received common supportive treatments. The patients and data analyzer were blinded about the data. At the end of the study, to adjust confounding variables we used logistic regression. After 1-month follow-up, 16 patients in the control group and 11 patients in the case group expired (P = 0.193). Analyzing the data extracted from Rankin scale and Barthel index check lists, revealed no significant differences in the two groups. Despite the absence of significant statistical results in our study, the reduction rate of 16% for mortality rate in Noscapine recipients is clinically remarkable and motivates future studies with larger sample sizes.

Restless legs syndrome (RLS) is the most common movement disorder in pregnancy, which can be idiopathic or secondary. There are limited comparative data regarding these two forms of RLS. The aim of this study was to compare clinical features of idiopathic and secondary RLS in pregnant women. Over a period of 3 months, 443 women who admitted for delivery in two clinical centers were screened for RLS using four diagnostic criteria of the international RLS study group. A total of 79 subjects diagnosed with RLS were consecutively enrolled in the present study. All of them were interviewed for medical history and complaints during pregnancy and responded to self-administer international RLS rating scale. Ten subjects (12.9%) out of 79 pregnant women with RLS had idiopathic form, and their mean age was significantly higher than patients with secondary RLS (30.6 ± 7.3 years vs. 26.4 ± 4.6 years, P = 0.0260). Compared with women with secondary RLS, sleep duration in pregnancy was significantly decreased in idiopathic RLS group (P = 0.0460), whereas RLS severity score was similar in both groups. No significant difference was observed between the two groups in terms of other sleep complaints, the positive family history of RLS, parity, duration of pregnancy, or frequency of cesarean section (P > 0.0500). Idiopathic and secondary RLS have relatively similar courses and features during pregnancy. However, the idiopathic form may have more negative impact on sleep in pregnancy. Careful screening and effective treatment of idiopathic RLS before pregnancy is recommended to limit these disturbances.

The rapidity of progression of amyotrophic lateral sclerosis (ALS) to death or respiratory failure impacts patients, clinicians, and clinical investigators. The aim of this study is to evaluate of the pulmonary function tests (PFTs) in patients with ALS and the association between these PFTs and survival A total of 36 ALS patients who PFTs, including vital capacity (VC), maximum mid-expiratory flow rate (MMEFR), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV1), were available from the time of diagnosis were included in this study. Non-pulmonary characteristics assessed at the time of PFTs. Data were analyzed using chi-square, Student’s independent t-test, Kaplan-Meier, correlation, and receiver operating characteristic (ROC) curve. The mean age of subjects was 55.36 (SD = 12.24) year, and the male to female ratio was 2.6. Twenty-five (69.4%) were died in 5 years period of our study. The mean and median survival time (In months) was calculated as 42.51 (95% confidence interval [CI] 33.64-51.39) and 38 (95% CI 27.23-48.77) months, respectively. The rate of ALS survival was 74% at 1st year, 41% at 3rd year and 10% at 5th year of starting symptoms. The results of Kaplan-Meier test showed survival was significantly longer in the group with PFTs closer to normal. In addition, ROC analysis showed that FVC < 50% could potentially be a predictor of death in ALS patients (P = 0.003, area under curve = 0.649). We found single measures of upright FVC, FEV1 to be significantly associated with survival, even after controlling for relevant non-pulmonary patient characteristics. Our study demonstrated that upright FVC, FEV1, VC, and MMEFR are useful non-invasive measures in the prediction of survival in ALS.