فهرست مطالب

Neurology - Volume:17 Issue: 58, 2018
  • Volume:17 Issue: 58, 2018
  • تاریخ انتشار: 1397/01/07
  • تعداد عناوین: 10
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  • Benyamin Seyfari, Farzad Fatehi, Abolfazl Shojaiefard, Mehdi Jafari, Ali Ghorbani-Abdehgah, Shirzad Nasiri, Aidin Yaghoobi-Notash, Behnam Molavi, Amir Hossein Latif, Reza Eslamian, Ali Mir, Ahmadreza Soroush Pages 1-5
    Background
    Myasthenia gravis (MG) is an autoimmune disease affecting acetylcholine postsynaptic receptor of voluntary muscles. Thymectomy is done in these patients and is a mainstay in the treatment of MG; however, the long-term result of surgery is still controversial. This study dealt with the investigation of the results of thymectomy in treatment, recovery and control of the symptoms of these patients.
    Methods
    This study was performed through a retrospective method in patients suffering from MG who underwent trans-sternal thymectomy between 2011 and 2016. We conducted thymectomy, excision of mediastinal mass and contents of tissues between the right and left phrenic nerves for all patients. Then, the effect of various variables including age, sex, time interval between onset of disease and surgery, thymus pathology and the dosage of drug on clinical response after surgery was determined using various statistical tests.
    Results
    47 patients including 26 men and 21 women with the mean age of 33.0 ± 4.6 years have been investigated. The mean age of patients was 36.2 and 29.7 in men and women respectively (P = 0.041). Spiral chest computed tomography (CT) scan was present in 47 patients demonstrating mediastinal mass in 40 (85.1%) patients. Also, our pathological results showed thymic cells in aortopulmonary window contents of 4 patients. According to the results, the younger age of patients at the time of surgery, shorter time between diagnosis and thymectomy, being a woman and non-thymoma pathology were along with better clinical outcomes after thymectomy.
    Conclusion
    Our study shows better clinical results of thymectomy in patients with normal chest CT scan and normal or atrophic thymus in pathologic reports. Generally, it seems that performing thymectomy in a shorter time interval after diagnosis of MG is beneficial. Moreover, in MG patients who do not suffer from thymoma, it is along with positive results.
    Keywords: Thymectomy, Myasthenia Gravis, Clinical Outcome
  • Mehri Salari, Omid Mirmosayyeb, Masoud Etemadifar, Vahid Shaygannejad, Fariborz Khorvash, Mohammad Reza Najafi, Fereshteh Ashtari, Ahmad Chitsaz Pages 6-10
    Background
    Parkinson’s disease (PD) is the second most common neurodegenerative disorder. Its worldwide incidence rate varies between 18 and 418 cases per 100000 annually. This cross-sectional study was carried out with the aim to identify the clinical characteristics and demographic features of a huge number of patients with PD in Isfahan, Iran.
    Methods
    The study was conducted on 987 patients with PD in Isfahan city and checklists were used to evaluate the demographic features and clinical characteristics of the patients.
    Results
    The mean age of the patients at the time of sampling was 65.40 ± 11.90 years. The study results indicated that the rate of PD among men with 67.3% was twice that of women with 32.7%. The mean duration of the disease was 4.91 ± 4.60 years.
    Conclusion
    This study showed a considerable rate of PD among the individuals in Isfahan city. In addition, the incidence ratio of men to women was more than the previous studies.
    Keywords: Parkinson Disease, Demographic, Iran
  • Farzaneh Foroughinia, Elaheh Jamshidi, Haniyeh Javanmardi, Anahid Safari, Afshin Borhani-Haghighi Pages 11-17
    Background
    We aimed to study the possible beneficial effects of omega-3 polyunsaturated fatty acids (PUFAs) in carotid artery stenting (CAS) procedure for decreasing post-procedural ischemic complications. Although previous evidence demonstrated that omega-3 PUFAs, present in fish oil, can significantly enhance platelet response to antiplatelet agents after percutaneous coronary intervention (PCI), it is unknown whether they can be used in patients undergoing CAS.
    Methods
    The single-blind, case-control, pilot randomized trial study was planned to perform on 60 patients undergoing CAS (30 in case and 30 in control group). Patients in both groups were pretreated with dual antiplatelet therapy (aspirin 80 mg/day with a loading dose of 325 mg, and clopidogrel 75 mg/day after a loading dose of 600 mg) at least 48 hours before the CAS. 30 patients randomly received 3000 mg loading dose of omega-3 fatty acids 12 hours before the procedure and 1000 mg omega-3 capsule the day after the procedure. All subjects were planned to be visited by neurologist for any peri- and post-procedural complications immediately after the procedure and on first, seventh, and thirtieth days.
    Results
    We ended the study after the enrollment of 18 patients because of an unexpected hemorrhagic transformation in case group. Two patients in this group developed hemorrhagic symptoms less than 12 hours after the procedure. One of the failures occurred in a patient with small vessel disease. Except these two cases, no one showed any neurological deficit symptoms in both groups.
    Conclusion
    In patients already receiving dual antiplatelet treatment before CAS, adding omega-3 PUFAs would increase the incidence of hemorrhagic transformation.
    Keywords: Stroke, Intracranial Hemorrhages, Carotid Stenosis, Angioplasty, Stent, Omega-3 Fatty Acids, Platelet Aggregation Inhibitors
  • Normative data for the Pyramids and Palm Trees Test in literate Persian adults
    Azar Mehri, Seyede Zohreh Mousavi, Mohammad Kamali, Saman Maroufizadeh Pages 18-23
    Background
    Semantic test of Pyramids and Palm Trees (PPT) is the most common test for assessing memory. Since this test is related to language and culture, normative data in different populations are needed.
    Methods
    This study was conducted on 270 literate men and women Persian adults aged from 20 to 69 years. Subjects must select a picture or word between two pictures or words that was closer to target.
    Results
    The word score was significantly positively correlated with the picture score (r = 0.508, P
    Conclusion
    Demographic variables such as age, gender, and level of education were not significant predictors for both versions in Persian population.
    Keywords: Semantics, Memory, learning tests, Reference values, Iran, Adult
  • Nazem Ghasemi Pages 24-30
    Background
    Stem cell-based therapy is a new method for the treatment of neurodegenerative diseases such as multiple sclerosis (MS). Human adipose-derived stem cells (hADSCs) are a kind of adult stem cells which have a higher frequency in the fat tissue and have the ability to differentiate into other cell types outside their lineage. Due to some serious adverse events of cell-based therapy such as tumorigenic potential, the aim of this study was to evaluate of hADSCs differentiation into oligodendrocytes as a valuable way for future cell transplantation.
    Methods
    hADSC were isolated from lipoaspirate samples of human abdominal fat. After hADSC characterization via flow cytometry, the cells were induced to oligodendrocytes using a special differentiation medium. Finally, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), immunocytochemistry, and real-time polymerase chain reaction (RT-PCR) techniques were used for the evaluation of differentiated cells.
    Results
    Flow cytometry indicated that hADSCs were CD105- and CD49-positive, but were negative for CD31 and CD45 markers. In addition, immunocytochemistry analysis revealed that a high percent of differentiated cells expressed oligodendrocyte progenitor cells markers [A2B5 and oligodendrocyte transcription factor (Olig2)] which were significantly higher than myelin basic protein (MBP) which is mature oligodendrocytes marker. Moreover, a very low percentage of differentiated cells expressed glial fibrillary acidic protein (GFAP) marker. Finally, real-time reverse transcription PCR analysis confirmed the results of immunocytochemistry.
    Conclusion
    Since hADSCs have the potential to differentiate into multi-lineage cells and due to their additional characteristics such as immunomodulatory and neuroprotective properties, it seems that these cells may be an ideal cell source for oligodendrocytes differentiation.
    Keywords: Adult Stem Cells, Cell Differentiation, Oligodendroglia
  • Elyar Sadeghi-Hokmabadi, Mohammad Yazdchi, Mehdi Farhoudi, Homayoun Sadeghi, Aliakbar Taheraghdam, Reza Rikhtegar, Hannaneh Aliyar, Sahar Mohammadi-Fallah, Rogayyeh Asadi, Elham Mehdizadeh-Far, Neda Ghaemian Pages 31-37
    Background
    Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA.
    Methods
    A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled. Inclusion and exclusion criteria were based on updated guidelines. Probable prognostic variables were examined separately in three distinct groups; the occurrence of ICH within 24 hours after treatment, poor 3-month outcome on the basis of modified Rankin Scale (mRS) and 3-month mortality.
    Results
    Patients were 83 men (62.9%) and 49 women (37.1%) with a median age of 66 years [interquartile range (IQR)of 55-72]. Any type of hemorrhage, symptomatic hemorrhage [based on the European Cooperative Acute Stroke Study III (ECASS III) definition] within 24 hours posttreatment, poor 3-month outcome (mRS 3-6), and 3-month mortality were documented in 10.6%, 4.5%, 53.2%, and 23.6% of patients, respectively. Increased baseline blood glucose was a significant but dependent predictor of hemorrhage within the first 24 hours posttreatment. Dependent predictors of a 3-month poor outcome were high age, the National Institutes of Health Stroke Scale (NIHSS) at baseline, decreased admitting glomerular filtration rate (GFR), and the presence of atrial fibrillation (AF) rhythm, and ICH within 24 hours posttreatment. Only age [Odds ratio (OR) adjusted 1.05] and initial NIHSS (OR adjusted 1.23), however, were recognized as the independent variables in this regard. The only independent predictor of 3-month mortality was the initial NIHSS (OR adjusted 1.18).
    Conclusion
    According to the findings of the present study, advanced age and high baseline NIHSS are two independent prognostic factors in patients with AIS treated with tPA.
    Keywords: Acute Ischemic Stroke, Tissue Plasminogen Activator, Outcome, Risk Factors
  • Ozgur Zeliha Karaahmet, Ebru Umay, Eda Gurcay, Azize SerÇe, Ibrahim Gundogdu, Aytul Cakci Pages 38-46
    Background
    A wide variety of factors influence stroke prognosis, including age, stroke severity, stroke mechanism, infarct location, comorbid conditions, clinical findings, and related complications. The aim of this study was to detect the prognostic determinants in patients with acute stroke for guiding rehabilitation.
    Methods
    Patients with ischemic acute stroke were included in the study. Patients’ age, sex, education level, and marital status, premorbid personality traits, comorbidities such as current smoking status and alcohol consumption, regular exercise habits, and sleeping disorder were recorded. Motor assessment and daily activity skills were evaluated according to the Brunnstrom staging and Functional Independence Measure (FIM), respectively.
    Results
    A total of 85 patients were studied. All patients’ motor and functional stages were significantly improved with the rehabilitation. The improvements in the upper extremity motor levels were less in whom over 76 years and smokers, in patients who had 4 and more comorbidities and sleep disorders. The functional improvement was less in whom over 76 years and men, and in patients who had 4 and more comorbidities and sleep disorders.
    Conclusion
    The significant post-stroke predictor of insufficiency in functioning was having 4 or more risk factors.
    Keywords: Stroke, Rehabilitation, Cerebral Infarction, Prognosis, Rehabilitation Outcome
  • Farzad Rahmani, Reza Rikhtegar, Alireza Ala, Aysan Farkhad-Rasooli, Haniyeh Ebrahimi-Bakhtavar Pages 47-52
    Background
    Different criteria have been proposed to determine the mortality rate of primary intracerebral hemorrhage (ICH). This study aimed to evaluate ICH and Modified New ICH scores in predicting 30-day mortality in patients with primary ICH.
    Methods
    In this prospective cohort study, 107 patients diagnosed with primary ICH were enrolled at an interval of six months (October 2015-March 2016). They were evaluated using Modified New ICH and ICH scores. The Modified New ICH score was different from the New ICH score since the National Institute of Health Stroke Scale (NIHSS) variables were replaced by Modified Rankin Scale (MRS) in the modified score.
    Results
    A total of 61 patients (57%) died, and 46 (43%) survived during the 30-day hospitalization. ICH ≥ 2 and Modified New ICH ≥ 3 scores predicted 30-day mortality rate in patients with the sensitivity and specificity rates of 87 and 63 percent, and 88 and 53 percent, respectively.
    Conclusion
    The current study showed that both ICH and Modified New ICH scores were almost equally effective in determining the mortality rate in patients with primary ICH, and both criteria had acceptable value in determining the mortality rate of patients. Therefore, routine assessment of ICH and Modified New ICH scores in patients with ICH in emergency wards is recommended.
    Keywords: Intracranial Hemorrhages, Mortality, Prognosis, Emergency Departments
  • Kaveh Shafiei, Mahdiyeh Khazaneha Pages 53-55
    Background
    The extent to which a publication attracts scientific attention by virtue of its focus, provides clues about the trend and volume of scientific production in a particular field. Bibliometric analysis is a method to quantify aspects of a specific research area. This article focused on publication on the movement disorders.
    Methods
    The bibliometric data on movement disorder were retrieved in relation to set of keywords from the Thomson Reuters Web of Science (WOS) available by January 2017. As many bibliometric statistics, such as citation indexes change during time, it was decided to compare two successive 5-years periods, 2007-2011 and 2012-2016. In addition, the citation classics publications with more than 100 times cited were taken into consideration.
    Results
    In total, the number of movement disorder papers rose from 49,444 to 61,942. Clinical neurology was the most studied WOS subfield at 35.6%. About 12.0% of these studies were published by the Movement Disorders Journal. Original papers accounted for 63.7% of publications. The United States of America was the leading country as the source of these publications followed by China. University College London (UCL) was associated more than any other university regarding these publications whereas the National Institute of Health (NIH) was the major source of funding. The number of papers with more than 100 citations totaled 87, out of which only one paper had more than 400 citations.
    Conclusion
    This study demonstrates that the total number of publications in movement disorders has increased remarkably during the past decade.
    Keywords: Bibliometric Analysis, Movement Disorders, Medical Journalism
  • Mohammad Paktinat, Soroor Inaloo, Zahra Serati, Eslam Shorafa Pages 56-57