فهرست مطالب
Archives of Neuroscience
Volume:7 Issue: 4, Oct 2020
- تاریخ انتشار: 1399/08/17
- تعداد عناوین: 10
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Page 2Background
Migraine is a common disabling and chronic neurological disorder affecting women aged 25 - 55 with a considerably higher frequency. It has been shown that migraine attack rates change according to the hormonal changes during the menstrual cycle. A study showed that reduced progesterone levels, especially during the end days of the luteal phase and menstruation, are associated with increased episodes of attacks in more than half of the migraine patients. Moreover, another study suggested that the melatonin level changes are positively correlated with the progesterone blood level. Previous studies indicated that the level of nocturnal urinary melatonin is lower in patients with menstrual-related migraine than in healthy subjects.
ObjectivesConsidering the potential role of melatonin in the circadian system and its relationship with gonadal steroid blood level changes in patients, we aimed to investigate the therapeutic efficacy of melatonin in patients with menstrual-related migraines.
MethodsAn open-label randomized clinical trial was conducted (IR code: IRCT20121110011424N4). Patients with menstrual-related migraine referring to the Neurology Clinic of Imam Khomeini Hospital were evaluated and randomly assigned to either naproxen (250 mg every 12 hours) or melatonin (3 mg, half an hour before sleep) treatment groups. At the end of the first and third menstrual bleeding phases, the patients were assessed by a migraine diary, Visual Analog scale (VAS) for pain, and the Berlin questionnaire.
ResultsThe study evaluated 56 patients (26 in the melatonin arm and 30 in the naproxen arm). Attack days (P < 0.001) and the headache severity (P < 0.001) improved in both groups compared to baseline. A significant difference was found between the melatonin and naproxen treatment groups in sedative and analgesic drug use (P < 0.05). Also, melatonin significantly changed the snoring rate and post-sleep tiredness compared to baseline (P < 0.05 and P < 0.05, respectively) whereas no improvement was observed in the naproxen treatment group concerning the sleep quality.
ConclusionsWe showed the beneficial role of melatonin in reducing the attack frequency and severity in migraine patients with menstrual-related headaches. Preventive therapy with melatonin also showed a significant reduction in the number of sedative drug use during attacks and improved the patients’ sleep quality when compared to naproxen.
Keywords: Naproxen, Melatonin, Menstrual-Related Headache, Migraine Prophylaxis -
Page 3Background
Studying different pathological aspects of lesions in multiple sclerosis (MS) patients could be useful to modify the diagnosis and treatment of this neurological disorder. Magnetic resonance imaging (MRI) modalities have the potential to investigate variations in brain tissue because of inflammatory and neurodegenerative processes in various types of MS-related lesions.
ObjectivesThis study was done to investigate the quantitative changes in MRI-based parameters, like perfusion and magnetization transfer ratio (MTR) of different types of brain lesions, to demonstrate the ability of MRI to detect structural and pathological differences in MS lesions.
MethodsQuantitative MRI modalities were performed on 18 patients with five different kinds of lesions (T1 holes, acute and chronic white matter (WM), and acute and chronic gray matter (GM) lesions) using a 3 T MRI scanner. The following protocols were used to characterize the pathology of lesions: (I) fluid-attenuated inversion recovery (FLAIR); (II) pre- and post-contrast T1-weighted; (III) dynamic contrast-enhanced (DCE); and (IV) MTR imaging. Quantitative comparison of Ktrans, cerebral blood volume (CBV), cerebral blood flow (CBF), and MTR was done to find the best parameter to distinguish different lesions. Finally, a multivariate classifier was applied to introduce the best parameter to indicate differences in lesions.
ResultsFive lesions were characterized by perfusion and MTR parameters. The pathological changes were measured, including: (I) the highest value of parameters in both acute WM and GM lesions; (II) the lowest value of four parameters in both chronic WM and GM lesions; (III) MTR had the highest rank among parameters using the classifier.
ConclusionsThe degree of pathological alterations due to inflammatory and neurodegenerative processes in MS-related lesions was indicated through the used parameters in different kinds of lesions. Inflammation was the dominant process in acute lesions, while neurodegeneration and tissue loss were observed mostly in chronic lesions. Both inflammation and neurodegeneration were detected in T1 holes. Perfusion parameters and MTR were reasonable parameters to describe differences in brain lesions. Thus, it could be confirmed that magnetization transfer imaging (MTI) and DCE-MRI are high-sensitivity methods to detect microstructural changes in the brain and subtle changes in the blood-brain-barrier. Classification of the parameters indicated that MTR was the best biomarker than others to show variations in lesions pathology.
Keywords: Multiple Sclerosis, DCE-MRI, Multi-Parametric MRI, MTI -
Page 4Background
The MAOA gene is located on the X chromosome (Xp11.23). Several studies have established a VNTR (Variable Number Tandem Repeat) polymorphism in the upstream of the MAOA gene transcriptional initiation region named uVNTR which is correlated with the risk of antisocial behavior.
ObjectivesThis study aimed to investigate the association between MAOA genotypes and the risk of violent behavior in a cohort of violent and age-matched non-violent individuals.
MethodsIn the current case-control study, MAOA uVNTR was genotyped in a cohort of 88 violent and 95 age-matched non-violent individuals. Individuals were genotyped for the MAOA uVNTR by performing PCR, gel electrophoresis, and sequencing. Furthermore, a chi-square test was performed using SPSS, and a p-value of less than 0.05 was considered statistically significant.
ResultsWe identified three MAOA uVNTR allelic variants: They were harboring 3.5, 4.5, and 5.5 repeated sequences. Alleles with 2, 3, 4, 5, and 6 repeats were not observed in any of the two examined groups.
ConclusionsWe did not detect a statistically appreciable association between antisocial behavior and allele frequencies in the studied population in central Iran.
Keywords: Antisocial Behavior, MAOA Gene, uVNTR Polymorphism -
Page 5Background
Mitochondrial dysfunction may be involved in the process of degradation and death of gray matter cells of the central nervous system (CNS) in patients with multiple sclerosis (MS). MS is known as a chronic, progressive demyelinating disease of the CNS.
ObjectivesExperimental autoimmune encephalomyelitis (EAE) mouse model of MS is the best method for extracting data trend for diagnosing this disorder. The aim of this study was to evaluate the specific activity of the Cytochrome oxidase (COX), ATP, and hypoxia-inducible factor 1 alpha (HIF-1α) in brain tissues of the EAE mice model.
MethodsTwenty-one female mice (C57BL/6) were used, 9 for inducing the EAE model and 6 for each of both negative and sham control groups. The specific activity of the COX, ATP, and HIF-1α levels were evaluated in the whole brain of all 3 mice groups.
ResultsAccording to the findings, specific COX activity and ATP levels were decreased significantly, which could be due to the mitochondrial dysfunction and neuronal loss in MS lesions, whereas HIF-1α levels increased significantly in the EAE mice group, compared to the sham and negative control groups. The significant increase of HIF-1α levels reinforces the hypothesis that the HIF-1α induction may provide prevention of neuronal death by compensating energy loss under hypoxia-like conditions in EAE mice brains.
ConclusionsThe results of this study suggest that HIF-1α induction may also be a potential target for controlling the progression of MS, or the development of HIF-1α inducing compounds could be a potential candidate for the management of this disease and provide a rationale to conduct further research in this area.
Keywords: HIF-1α, MS, Cytochrome Oxidase, EAE, Mitochondrial Dysfunction, ATP -
Page 6Background
Traumatic brain injury (TBI) is the leading cause of morbidity and mortality. Each year near 1.5 million Americans experience a TBI. Of which about 235,000 are hospitalized. Also, TBI claims 50 000 American lives each year. TBI causes mechanical damage to the blood-brain barrier and white blood cells (WBCs) entry to the brain.
ObjectivesThe current study aimed to evaluate the efficacy of low-dose Atorvastatin on inflammatory factors in patients with traumatic brain injury (TBI).
MethodsThis double-blind, randomized clinical trial study was conducted in the ICU ward of Golestan Hospital in the city of Ahvaz (Iran) from April 2019-May 2020. Sixty patients with moderate to severe TBI were studied. Patients were randomly assigned into two groups of Atorvastatin and control. The main outcomes included the amount of CRP and ESR as well as white blood cells in the first 14 days of hospitalization. Glasgow Coma Score, the length of ICU stay, and the duration of mechanical ventilation were secondary outcomes.
ResultsThe amount of CRP in the Atorvastatin group on the 14th day of hospitalization was significantly lower than those in the control group (31.99 ± 8.38 vs 59.65 ± 10.43) (P < 0.0001). On the same day, the Atorvastatin group had lower levels of ESR than the control group (14.28 ± 4.18 vs 25.57 ± 5.18) (P < 0.0001). The Atorvastatin group had significantly lower levels of white blood cells than the control group (5247.53 ± 751.93 vs 7143.94 ± 907.64, P < 0.0001). Glasgow Coma Score at the time of discharge from the ICU in the Atorvastatin group was more than control (14.06 ± 1.45 and 11.85 ± 0.75, respectively) (P < 0.05). A significant difference was found concerning the ICU stay between the two groups (P = 0.03).
ConclusionsThis study demonstrated that Atorvastatin could reduce the rate of inflammatory factors in TBI patients. The inflammatory condition of TBI patients heavily determines their prognosis. Inflammation leads to several reactions as well as interactions between different cells and chemical mediators. The Atorvastatin could reduce the rate of inflammatory factors and improved GCS in TBI patients.
Keywords: Traumatic Brain Injury, Atorvastatin, Inflammatory Factors -
Page 7
Dear Editor, One of the most frequently asked questions of multiple sclerosis (MS) patients in these days is the need to discontinue or continue their medications used for MS at the time of the Coronavirus Disease 2019 (COVID-19) outbreak. Since some drugs used for MS are immunosuppressive and can increase the incidence and severity of infectious diseases (1), asking the above-mentioned question is very logical; so, it must be addressed with sufficient evidence. So far, no evidence has been published on the effects of MS drugs on the incidence or exacerbation of COVID-19. Therefore, the guidelines published by various MS associations (2, 3) are solely based on their personal experience and clinical evidence of other infections. Currently, no one knows what symptoms the coronavirus will have in a patient with MS who is consuming these medications. However, some points should be taken into account by physicians to decide whether to continue or discontinue the prescribed medications. It is not logical to discontinue the medications in a patient who is not infected by the coronavirus. Discontinuation of treatment can increase the risk of attack in MS patients, leading to hospitalization, increased exposure to the coronavirus, and consequently increased risk of COVID-19. Paying attention to the immunopathology of the virus can give us a relative understanding of the behavior of the virus in the presence of MS medications. Beta interferons are common drugs that can be used for the treatment of MS; accordingly, these drugs are not only immunomodulatory but also antiviral (4). Previous evidence has also shown that beta interferons can prevent the spread of the severe acute respiratory syndrome coronavirus (SARS-CoV) (5). Hence, studies are performed to evaluate the efficacy of this drug on the treatment of COVID-19 (6). The other drug to be considered in the treatment of COVID-19 is fingolimod, which is the first oral medication used to treat MS. It can prevent the outflow of activated lymphocytes from the lymph nodes and their entry into the central nervous system (7). Since COVID-19 pneumonia has shown to be caused by an exaggerated immune system response and a cytokine storm (8), the use of drugs that can modulate this severe immune response has been considered in the treatment of severe cases of lung involvement by COVID-19, and one of the drugs studied for this purpose is fingolimod (9). Other drugs used in MS can also modulate the immune system, and one of these drugs widely used in Iran is rituximab (10). It has been shown that Tumor Necrosis Factor-α (TNF-α) levels are elevated in COVID-19 patients in response to the exaggerated immune system response in them (11). Therefore, the use of anti-TNF-α drugs like adalimumab has been considered in the treatment of this enhanced immune system response in COVID-19 patients (12). Although rituximab is an anti-CD20 drug, it has been used for patients with rheumatoid arthritis are not responding to anti-TNF-α drugs; it has also shown a good effect on the immune system modulation in the immune system of these patients (13). Although no study has been conducted on the efficacy of these types of immunosuppressive medications in severe cases of COVID-19, the possibly positive effect of these kinds of medication can be a hypothesis that needs further research. On the other hand, the possibility of depressing immune response and consequent development of more aggressive forms of COVID-19 after administration of immunosuppressant should be considered. However, it seems that MS patients are not more susceptible to be infected by the coronavirus than are normal populations (14). To sum up, there is no reason to discontinue MS drugs at the time of the COVID-19 pandemic. Future studies may discuss the positive effects of these drugs on MS patients with COVID-19 disease, which requires a great deal of research evidence.
Keywords: Multiple Sclerosis, Medication, Pandemic, COVID-19 -
Page 10Background
Substance-use related disorders (SUD) are a major public health concern worldwide, especially in developing nations. Currently, it is characterized by high rates of mortality and morbidity. Moreover, through increased utilization of healthcare services, it causes both direct and indirect significant medical expenditures.
ObjectivesThe current study aimed to evaluate the pattern of Substance abuse in the department of psychiatry of a Tertiary Care Hospital, Srinagar, Jammu, and Kashmir, India.
MethodsThis is a descriptive, cross-sectional, and open study conducted in the psychiatry inpatient department of a tertiary care hospital, Srinagar, Jammu, and Kashmir, India, for 7 months (January to May 2020).
ResultsOver a period of seven months, a total of 135 participants were recruited (105 males and 30 females). Most of them were Muslim (96.29%), married (68.14%), and living as a nuclear family (75.55%). Tobacco (Nicotine) was the most commonly used substance by those admitted to the psychiatry ward (62.96%), followed by cannabis (11.11%) and opioids (11.11%). The most comorbidity associated with substance abuse was psychiatric disorders (36.84%), followed by neurological disorders (21.05%), and gastrointestinal disorders (7.89%). Among those with psychiatric disorders, 14 (10.37%) had mood (bipolar) disorders. A total of 1129 medicines were prescribed for 135 patients. The mean ± standard error of the mean (SEM) of the prescribed medicines was 8.48 ± 3.3. The average number of drugs per encounter was 8.48%.
ConclusionsIn this study, cigarette smoking (nicotine) was the most commonly abused substance. It can be justified by the fact that Kashmir is a conflict zone, and many people suffer from the post-traumatic stress disorder. Hence, a collaborated effort is necessary to improve the prescribing pattern and to enhance the rational use of medications for better treatment outcomes.
Keywords: Psychiatry, Nicotine, Cigarette Smoking, Abuse, Substance Use, Opioids