Current Journal of Neurology
Volume:21 Issue: 4, Autumn 2022

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding EPO to intravenous methylprednisolone (IVMP) in patients with acute attacks of NMOSD.

NMOSD cases with acute attacks were included. Cases of optic neuritis (ON) and those with myelitis were separated. After randomization [with block sizes of 2 (1:1 ratio)], the patients in the intervention group received IVMP 1000 mg/day and intravenous (IV) EPO 20000 U/day for five days. IVMP 1000 mg/day and normal saline (NS) were administered in the control group. Staged eye score and motor forces were evaluated in the patients with ON and myelitis, respectively, at the time of the attack and three months later. Primary patient allocation and clinical assessments were blinded to the physicians.

Mean age of participants was 53.87 ± 11.53 years. At follow-up, in the ON arm, the median improvement in staged eye score was 2 in the control and 5 in the intervention group. The difference was significant (P < 0.001). In the myelitis group, none of the patients in the control group had improvement in motor forces. All the patients in the intervention group showed substantial improvement with minimal or no remaining weakness. The difference was statistically significant (P = 0.029).

The results show the possible benefit of adding EPO to the classic IVMP in attacks of NMOSD in both visual and motor aspects.

The purpose of this study was to evaluate the validity and reliability of the Persian version of Patient Determined Disease Steps (PDDS) in both patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). One hundred and forty-five patients were enrolled between May and September 2020 by consecutive sampling. Participants were asked to complete timed 25-foot walk (T25FW), 12-item Multiple Sclerosis Walking Scale (MSWS-12), and Multiple Sclerosis Quality of Life-54 (MSQOL-54). Patients also completed Timed Up and Go (TUG) and six-minute walk (6MW) tests. Construct validity was assessed by calculating correlation between PDDS and ambulatory and demographic items. The intra-class correlation coefficient (ICC) was used to evaluate reliability. One hundred and eleven patients with MS and 34 with NMOSD with disease duration of 7.6 ± 5.8 years were enrolled. Twenty-seven percent were men and mean Expanded Disability Status Scale (EDSS) was 1.8 ± 1.8.There was a significant positive correlation between EDSS and PDSS (rho = 0.64, P < 0.001) which was evident in MS subgroups and NMOSD [secondary progressive MS (SPMS): rho = 0.64, P < 0.001; relapsing-remitting MS (RRMS): rho = 0.47, P < 0.001; NMOSD: rho = 0.52, P = 0.001]. PDDS had also significant positive correlation with TUG, T25FW, and MSWS-12. PDDS had also significant negative correlation with 6MW test. PDDS had weak correlation with demographic variables. The ICC was calculated as 0.99 for PDDS. The Persian version of PDDS provides valid and reliable instrument to assess MS/NMOSD-related disability.

Fatigue is a common complication associated with multiple sclerosis (MS). The aim of this study was to evaluate the impact of dalfampridine and amantadine on fatigue in patients with MS. This was a randomized, double-blind, clinical trial on patients with MS. The recruited patients were adults (≥ 18 years old) diagnosed with MS; their Expanded Disability Status Scale (EDSS) was between 0.0 and 5.5, and their fatigue was confirmed by the Modified Fatigue Impact Scale (MFIS). They were randomly assigned to the amantadine (100 mg twice daily) and dalfampridine (10 mg twice daily) for eight weeks. The primary outcome was the improvement of fatigue score, and the secondary outcome was assessment of quality of life by the Short-Form Health Survey (SF-36) and any reported side effects. A total of 69 patients were recruited, and 54 of them were analyzed. The mean MFIS significantly improved in both groups after one and two months compared to baseline: amantadine: first month: 40.63 ± 14.35 (P = 0.040), second month: 36.56 ± 17.12 (P = 0.010); dalfampridine: first month: 38.29 ± 15.23 (P = 0.001), second month: 34.26 ± 18.30 (P = 0.001). However, the amount of changes from baseline was not significantly different (amantadine, P = 0.090; dalfampridine, P = 0.130). The amount of changes in quality of life showed no significant improvement (P = 0.210). The results showed that dalfampridine was not different with amantadine in improving fatigue in patients with MS; besides, it showed an acceptable safety profile. Therefore, it can be considered as a possible beneficial therapeutic agent in MS fatigue.

Brain and central nervous system (CNS) cancers make up about 3% of all cancers around the world and are more common among men than women. Present study aimed to evaluate the occurrence trend of brain and CNS cancers in Iran from 1990 to 2017. This study using global burden of disease (GBD) 1990 to 2017 data demonstrated the trend of incidence and mortality of brain and nervous system cancer in Iran. All-age, sex-based, age-standardized, age-specific (from 1990 to 2017), and age distribution of incidence and mortality rates of brain and nervous system cancer were estimated in Iran during 2017. Both incidence and mortality rates of brain and nervous system cancer increased from 1990 to 2005 in Iran, Eastern Mediterranean Region, and global level. During 1990, incidence and mortality rates of brain and nervous system cancer were higher in women than men, but gradually both rates increased in men and exceeded women in Iran. From 1990 to 2017, the value of age-adjusted rate was higher than all-age rate of brain and nervous system cancer. The most incidence and mortality of brain and nervous system cancer from 1990 to 2017 occurred in age group of > 70 and the least values were seen in15-49-year-old group in Iran. The brain tumor occurrence and mortality in Iran was higher than other Eastern Mediterranean Region countries. Incidence and mortality of this cancer has an increasing trend in Iran and this trend somewhat was independent from population aging.

Levetiracetam (LEV) is approved for treating epilepsy. The current evidence shows that LEV can cause behavioral problems such as depression. It is well-known that depression is associated with oxidative stress. Therefore, we conducted this study to assess the influence of LEV on depression severity and anti-oxidant status.

In this prospective longitudinal study, 50 patients with diagnosis of epilepsy on LEV were included. We used Beck Depression Inventory-II (BDI-II) to assess depression severity. The serum levels of zinc and glutathione were measured as anti-oxidant markers. These variables were evaluated at the baseline and 3 months after the commencement of LEV.

A total of 30 patients finished the follow-up. Among them, 21 patients were women. The mean age at baseline was 28.76 ± 11.37 (range: 16-68 years). The severity of depression at the last follow-up was significantly higher than the baseline. We observed a decrease in the serum levels of zinc and glutathione, though they were not statistically significant.

Our results suggest that LEV can increase the risk of depression in patients with epilepsy. This study also suggests that zinc depletion can be induced through act of LEV. Further studies are needed to validate these findings

Despite special global considerations which have been made to prioritize vaccination of people with multiple sclerosis (MS), some are reluctant to get vaccinated. This study was aimed to evaluate the attitude toward coronavirus disease-2019 (COVID-19) vaccine and its probable correlations.

Considering the study objectives, two valid questionnaires including Fear of COVID-19 Scale (FCV-19S) and attitude questionnaires were administered pre and post COVID-19 vaccination among people with MS.

The questionnaires were administered among 349 people with MS pre and post vaccination. The mean age of participants was 38.78 ± 8.68 (range: 19 to 64) years. They all received the first dose of COVID-19 vaccine (Sinopharm). Although about 90% of participants felt satisfied after getting vaccinated and respected the preventive actions like social distancing and wearing face mask after vaccination, about 40% of them did not recommend vaccination to other patients. None of the demographic data was predictor of attitude score in COVID-19 vaccine and the only effective factor regarding fear of COVID-19 among people with MS was gender (P = 0.001). It was found that the more a patient’s fear score was, the more he/she felt satisfied after vaccination. Those patients who had got the influenza vaccine last year felt more satisfied with the vaccine and accepted the COVID-19 vaccine easier than others.

This study revealed that there was an inverse correlation between fear of coronavirus and less trust in the vaccine in patients with MS. However, it should be mentioned that the patients felt more satisfied after COVID-19 vaccination.

Up to know, limited and contradictory results have been published about the role of prognostic values of lipid profile and proprotein convertase subtilisin/kexin type 9 (PCSK9) in Parkinson’s disease (PD). The aim of the present study is to investigate the role of lipid profile and PCSK9 in patients with PD and compare it with healthy individuals.

In this case-control study, 31 individuals diagnosed with PD were compared with 31 healthy individuals. The lipid profile and PCSK9 of research participants were measured and the resulting data were analyzed using SPSS software. The P-values smaller than 0.05 were considered significant.

The mean age of participants in the PD and control group was 56.9 ± 8.8 and 53.7 ± 10.1 years, respectively (P > 0.050). 27 individuals (87.1%) in the PD group and 13 individuals (41.9%) in the control group were men. Low-density lipoprotein (LDL) level (84.2 ± 24.9 ml/dl vs. 105.5 ± 16.8, P < 0.001), high-density lipoprotein (HDL) level (45.5 ± 8.7 ml/dl vs. 51.1 ± 9.5 ml/dl, P < 0.001), and total cholesterol (155.3 ± 31.2 ml/dl vs. 192.8 ± 32.5 ml/dl, P < 0.001) were lower and triglyceride (TG) level was higher in the PD group (133.3 ± 79.3 ml/dl vs. 131.2 ± 58.6 ml/dl, P = 0.900) compared with the control group. PCSK9 level was higher in the PD group, but no significant difference was found (141.6 ± 70.0 vs. 129.7 ± 51.0 ng/ml, P = 0.500) compared to healthy subjects. Moreover, there was no relation between PCSK9 and severity of PD. 

Our findings showed that individuals with PD had lower levels of HDL, LDL, and total cholesterol compared with the control group. However, higher concentrations of PCSK9 were observed in patients with PD compared with healthy volunteers.

Transient global amnesia (TGA) is a sudden-onset transient memory impairment along with intact neurologic examinations. Even though it is a benign neurologic condition with many differential diagnoses, the incidence rate of TGA is reported to have increased since the onset of the pandemic. Therefore, this systematic scoping review aims to investigate TGA in that context.

MEDLINE, Scopus, and Google Scholar databases were systematically searched for relevant articles with a string of specified keywords.

The primary search yielded 90 studies. After all the necessary screening rounds were carried out, we were left with six included studies. One study was also identified through a search in other relatively relevant databases. Finally, seven case reports were accepted including three TGA patients with positive and one with negative test for coronavirus disease-2019 (COVID-19), respectively. COVID-19 status was unclear in the others.

The reported COVID-19 positive cases had presentations similar to those with TGA before the pandemic. Therefore, we think that TGA might occur concomitantly with the COVID-19 infection or due to the psychological impact of the pandemic. In the confirmed cases of TGA and COVID-19, the abnormal findings may be due to COVID-19 infection. However, the reports were not as complete as desired. Therefore, providing the readers with more detailed reports in future cases is recommended.