Caspian Journal of Neurological Sciences
Volume:11 Issue: 41, Apr 2025

Ribavirin is widely used in treating viral infections like Crimean-Congo hemorrhagic fever (CCHF), which is a severe disease with high morbidity and mortality. However, despite its antiviral effectiveness, there have been concerns about neurological adverse effects related to therapy with ribavirin.

This study aims to review the effects associated with ribavirin therapy in CCHF patients.

 We searched studies published up to June 2024 in databases PubMed, Scopus, Web of Science and Google Scholar. We screened articles reporting neurological side effects of ribavirin in CCHF infection patients. We extracted data on adverse neurological symptoms, dosing, and mode of administration of ribavirin, as well as the characteristics of patients.

Studies yielded neurological signs and symptoms such as headaches, dizziness, confusion, and advanced-state encephalopathy or seizures following treatment with ribavirin. These manifestations were found more often among patients with previous renal conditions and those receiving higher or more extended dosages of ribavirin. Although ribavirin can decrease mortality rates in some instances, this drug is potentially causing neurological damage in the most vulnerable of cases.

Ribavirin is considered one of the most important antiviral treatments for CCHF; however, it should be cautiously monitored. It is expected that future studies investigate the mechanism of neurotoxicity caused by ribavirin in greater detail and develop treatment modalities that carry less risk. Close monitoring of the patients receiving ribavirin therapy is crucial to avoid such risks.

The incidence of failed spinal anesthesia (FSA) for cesarean section (CS) varies widely among hospitals. Several risk factors have been proposed, but their predictive value remains unknown.

The main objective of this prospective study was to evaluate the incidence of FSA for cesarean deliveries in an academic obstetric hospital, and the secondary objective was to determine its predictive factors.

This analytic descriptive study was performed in a referral obstetric hospital affiliated with Guilan University of Medical Sciences from May 2024 to August 2024. The study enrolled women who underwent elective and emergency CS under spinal anesthesia, classification of The American Society of Anesthesiologists (ASA-I and ASA-II). A checklist containing women’s demographic data, surgery characteristics, and FSA rate was completed.

A total of 241 women with a Mean±SD age of 29.54±6.64 years and body mass index (BMI) of 27.98±3.16 kg/m2 participated. About 46 women (19.1%) underwent emergency CS and 195(80.9%) elective. Overall, the incidence of FSA was 7.9%. Of 19 FSA cases, 12(5%) received supplemental analgesia or sedation; in 5(2.1%) cases, the procedure was repeated, and only two cases underwent general anesthesia (GA). The most important predictive factors of FSA were BMI (P=0.003), emergency CS (P=0.0001), level of residency (P=0.037), bloody cerebrospinal fluid (P=0.0001), the number of attempts (P=0.0001), and ASA class (P=0.035).

In 7.9% of women, spinal anesthesia did not provide appropriate conditions for CS. Significant predictors included higher BMI, emergency surgeries, level of anesthesia residency, bloody CSF, the number of attempts, and ASA class.

Young people are at a higher risk of developing multiple sclerosis (MS), which can adversely affect their social and personal lives and, thus, psychological capital such as hope. 

This study was conducted to investigate the effect of core stability exercises on the levels of hope and its components in patients with MS.

This research employed a pre-test-post-test design with a control group. This study was conducted on MS patients referred to the Omid Clinic of Babol University of Medical Sciences Babol City, Iran, from April to June 2018. Using the available sampling method, 36 patients (two groups of 18 people) were selected with the diagnosis of a neurologist and under similar drug treatments who could perform core stability exercises. The experimental group performed a core stability training protocol for 8 weeks, three sessions a week, and one day between each session, and each session took about 30 minutes. Snyder’s adult hope scale was administered in the pre-test and post-test stages for both groups. 

This study involved 24 women and 12 men, most of whom were in their third decade. Findings indicate the effectiveness of core stability exercises on resilience, purposefulness, self-control and ability to solve problems, stubbornness, and optimism (P<0.05). However, it has not influenced the belief component (P>0.05).

Core stability exercises and medical and physical treatments in MS patients can improve their health because hope and its components increase with exercise.

One of the significant concerns of ischemic stroke patients is movement disabilities after stroke. Various drugs have been introduced to reduce these complications. However, the use of antidepressants is still under more studies.

This study explored the impact of fluoxetine and citalopram on improving motor function following ischemic stroke.

This study was a single-blind clinical trial conducted on patients hospitalized with ischemic stroke (from January 2021 to July 2022). According to the inclusion and exclusion criteria, patients were in one of three groups (fluoxetine, citalopram, placebo). Then, their movement disorder and performance level were evaluated using The National Institutes of Health Stroke Scale (NIHSS) in the first, 30, 60 and 90 days after stroke.

Based on our results, all three investigated groups showed significant decreases in the NIHSS scale during 90 days (P=0.018). However, fluoxetine caused the greatest reduction of the three groups. In addition, citalopram significantly lowers lower limb NIHSS in one month and two months compared to fluoxetine and placebo (P=0.003 and P=0.013, respectively). However, when the average NIHSS of the upper limb was examined during 90 days, the investigated drugs did not cause a significant decrease (P=0.253).

Considering motor dysfunction after ischemic stroke, fluoxetine and citalopram treatments can be a suitable treatment suggestion to improve the motor status of patients and thus improve their health.

One of the most significant public health concerns in our local communities is the high prevalence of methamphetamine use among teenagers. 

This study aimed to explore the neuroprotective role of silymarin on methamphetamine-induced changes in adolescent Wistar rats, focusing on both behavioral and cellular markers.

For this study, 40 juvenile Wistar rats were used. The animals were divided into four groups of ten animals each. Control group A (control) received the vehicle, group B received methamphetamine, group C received silymarin, and group D received methamphetamine and silymarin. Methamphetamine and silymarin were given orally at 5 mg/kg and 385 mg/kg for 14 days. Neurobehavioral tests were done on the last four days of the treatment, postnatal day 39–42. The animals were sacrificed 24 hours after the last treatment, and the histological evaluation of the amygdala and the hippocampus was performed.

Malondialdehyde (MDA) tissue levels increased significantly (P=0.002) in the methamphetamine group but decreased in the combined methamphetamine and silymarin group. Differences in risk assessment, cognitions, and depressive-like behaviors between the methamphetamine plus silymarin group and the control group were statistically significant in the methamphetamine group (P=0.001, 0.004, 0.001, respectively). Microglia activation, neuronal edema and shrinkage, neurofibrillary tangles, and senile plaques increased in the group that received only methamphetamine but reversed in methamphetamine plus silymarin-treated animals. Oligodendrocyte transcription factor 2 (OLIG2) and myelin basic protein (MBP) decreased in the methamphetamine group but increased in the methamphetamine plus silymarin group.

According to this research, silymarin inhibits lipid peroxidation (measured using the level of MDA). Also, methamphetamine induces significant levels of animal behavioral deficits (measured with elevated plus maze (EPM) test, tail suspension test, and Morris water maze test). These behavioral deficits were reversed to a nonsignificant level in the group treated with both methamphetamine and silymarin when compared to the control group. This finding indicates that silymarin could reverse behavioral deficits and molecular alterations associated with methamphetamine exposure.

 One of the most prevalent issues older people face is the decline in postural control. Addressing postural control is crucial for maintaining independence in older adults. 

This study aimed to compare the effect of strength and balance training on kinetic variables and postural control of healthy older people.

The current research includes two experimental groups (strength and balance training groups) and one control group. The statistical sample of this research included 36 people (12 people in each group) with an age range of 60 to 75 years. The force plate was used to evaluate the kinetic variables and postural control of older people.

Balance and strength training significantly affect the center of pressure in older people’s anterior-posterior (P=0.001) and medial-lateral directions (P=0.001). The results of the research also showed no significant difference between balance and strength training regarding the center of pressure in the anterior-posterior (P>0.05) and medial-lateral directions (P>0.05) of the older people.

Both balance and strength training significantly impact the postural control of older people. Additionally, the results indicate no significant difference between balance and strength training in terms of their effects on the postural control of older adults. Therefore, balance and strength training can be used as an alternative to improve the postural control of older people and thus reduce their risk of falls.

A cerebrovascular accident results in behavioral deficits as a result of damage to the brain’s systems. The motor system is one of the most commonly affected nervous systems. Lower limb motor function is important to a person’s functional independence. Therefore, restoring lower limb motor function can be an important goal in rehabilitating patients after stroke. Scientists have shown the effects of non-invasive brain stimulation, such as tDCS, in improving the performance of stroke patients. Recently, researchers have proposed that unihemispheric dual-site anodal transcranial direct current stimulation (UHCDS a-tDCS) targeting the primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) could improve the effectiveness of a-tDCS in stroke rehabilitation.

This study aimed to examine the effect of simultaneous stimulation of two points on the function of the lower limbs of stroke patients.

 This was a double-blind, randomized clinical trial. The study included 18 patients who had experienced their first chronic stroke. Participants were assigned to either experimental group 1 or group 2, with both undergoing 5 consecutive sessions of a-tDCS. In experimental group 1, patients received active a-tDCS targeting both the M1 and DLPFC, while in experimental group 2, patients received a-tDCS to the M1 and sham stimulation to the DLPFC. Lower limb motor function was assessed using the Fugl-Meyer and time up-and-go test. Assessments were made before and after 5 sessions.

The results indicate that following 5 sessions of a-tDCSM1-DLPFC, mobility and functional strength are better than a-tDCSM1 (P=0.04 and P=0.07).

Dual site stimulation a-tDCSM1-DLPFC can further improve balance in patients with chronic stroke.

Aspergillosis is a fungus-related health problem that may include allergic reactions like allergic bronchopulmonary aspergillosis, which presents as upper and lower airway disease or chronic and invasive forms of fungal infection. 

Here, we report a young woman with a history of poorly controlled asthma. She was primarily diagnosed with a skull base tumor due to the left eye proptosis and soft tissue mass involving the orbit and skull base, with intracranial extension. The diagnosis of aspergillosis was confirmed after tissue sampling, and the patient was successfully managed with an oral anti-fungal agent. 

Aspergillosis could be a differential diagnosis in the patients presenting with skull base tumor and a positive history of allergic asthma.