Current Journal of Neurology
Volume:12 Issue: 2, Spring 2013

Although the precise etiology of multiple sclerosis (MS) is unknown, it seems that both genetic and environmental factors are important. Recent studies suggest that low serum vitamin D levels are important environmental factor in MS. The aim of this study was to compare the serum levels of vitamin D between MS patients and healthy subjects, and to determine its association with disability in MS patients. In this cross-sectional study, a total of 52 patients with MS were randomly recruited and matched for age and sex with 52 healthy subjects. Demographic characteristics and serum vitamin D levels for both groups, as well as duration of disease Expanded Disability Status Scale (EDSS) for MS patients were evaluated. Statistical analysis was performed by independent samples t-test and multiple linear regression analysis. The mean serum vitamin D levels were 26.5 ± 16.3 ng/ml in MS patients vs. 37.1 ±19.7 in healthy subjects (P = 0.003). A linear regression analysis showed no significant association between vitamin D levels and EDSS score of patients with MS (P = 0.345), after adjusting for the covariates. Our findings did not suggest a protective association for serum vitamin D levels against disability in MS patients.

This study evaluated the efficacy of focal intramuscular injection of botulinum (BoNT) toxin type A in comparison with oral tizanidine (TZD) in treatment of post-stroke upper limb spasticity. This was a double-blinded randomized clinical trial that recruited 68 patients with post-stroke upper limb spasticity. Thirty-four patients received BoNT (Dysport®) injections in affected muscles of upper limb at the baseline and week 12. Thirty-four patients were treated with tizanidine (Sirdalude) by gradual increase in dosage of 2mg/week to reach maximum 24mg at week 12. Modified Ashworth Scale (MAS) and Action Research Arm Test (ARAT) were evaluated at the baseline, week 12 and week 24 for all the participants. The mean score of MAS reduced from 3.32 and 3.13 at baseline to 1.79 and 1.56 at week 24 on elbow and wrist joints, respectively (P < 0.01). However, there were only reductions from 2.79 and 2.77 to 2.32 and 2.31(P < 0.001) in TZD group. ARAT increased from 1.79 to 10.97 (P < 0.001) in BoNT group. ARAT increased from 11.08 to 11.35 in TZD group (P = 0.026). BoNT injection was safe and effective in reducing post-stroke upper extremity spasticity in comparison with TZD.

Headache is one of the most disturbing symptoms with common neurological signs. Variations in optic nerve perfusion quality or retinal microcirculation may end up in ganglion cell damage in patients with migraine. Sixty patients diagnosed with migraine and thirty normal individuals were evaluated in groups including migraine with aura, migraine without aura and controls. Retinal nerve fiber layer (RNFL) thickness was measured using stratus optical coherence tomography (OCT™) and then was compared in case and control groups. RNFL thickness was only significantly thinner in nasal quadrant in migraineurs compared to the control group. Other parameters showed no difference between the two groups and besides there was no statistically difference between the two migraine subgroups. Given the significant difference in nasal quadrant RNFL thickness between the migraineurs and normal individuals, we might be able to defend the retinal blood flow decrease theory in migraine; however, multicentre studies with larger samples seem mandatory.

Vitamin D is an important factor responsible for many physiologic functions. Vitamin D deficiency is associated with increased risk of neurodegenerative disease. The level of vitamin D in Iranian patients with Parkinson’s disease and its relationship with severity of symptoms and signs were evaluated in this study. Eighty-three patients with Parkinson’s disease (PD) were recruited using simple non-random sampling. 25-hydroxyvitamin D [25(OH)D3] was measured by Electrochemiluminescence immunoassay (ECLIA). Serum level of calcium and phosphorus was measured to exclude other endocrine disorders. The mean 25(OH)D3 concentration was lower in the PD population than in the normal group. Lower levels of 25(OH)D3 were associated with more severe postural instability and abnormal posture. There was no significant association between levels of 25(OH)D3 and severity of other symptoms of parkinsonism. This analysis showed that serum 25(OH)D levels are lower in PD patients in comparison with normal range. In addition, there was a significant association between the presences of chills, postural instability and abnormal postures with lower levels of 25(OH)D.

Hormones can play a significant role in the pathogenesis of multiple sclerosis (MS). The aim of this study was to compare levels of ghrelin, leptin, and testosterone hormones of MS patients with healthy subjects, and assess the relationship between levels of peptide hormone and sex hormones in MS patients. 35 MS patients with definite relapsing remitting multiple sclerosis (RRMS) (male = 9, female = 26) and 13 healthy subjects (male = 4, female = 9) were enrolled in the study. Levels of serum ghrelin, leptin, and testosterone hormones were measured in this study. ANOVA and Pearson correlation were used for data analysis (P < 0.05). The female and male participants of the patient group were compared with the healthy group. No significant differences were found in serum of leptin, ghrelin, testosterone, ghrelin/leptin, and testosterone/leptin (P < 0.05). Spearman correlation coefficient showed that leptin had a significant negative correlation with the variability of testosterone (r = -1.00) in the healthy male group. Moreover, leptin had a significant positive correlation with the variability of BMI (r = 0.68) and weight (r = 0.59), at the 0.01 level (2-tailed), in the female patient group. In addition, in the healthy male group, ghrelin had a significant negative correlation with the variability of weight (r = -1.00). According to the results, there was no significant difference between peptide and sex hormones of MS patients and healthy persons. Furthermore, there was no significant relationship between peptide and sex hormones of MS patients and healthy persons.

Various neurological complications occur in primary or secondary antiphospholipid syndrome (APS) consisting of cerebrovascular attacks, ocular events, dementia, seizure, chorea, and transverse myelopathy that are all related to the titer of antiphospholipid antibodies (aPL). We report a patient with chorea and retinal vessel occlusion as manifestations of systemic lupus erythematosus (SLE) and APS. A 27-year-old man presented with progressive visual field defect and decreases visual acuity of right eye (OD) as well as involuntary movements in both hands and slurred speech. Investigations led to the diagnosis of SLE and APS. Anticoagulant and immunosuppressant was started for him. As his condition improved, the prednisolone was gradually tapered. This is the first case report of concomitant retinal vessel occlusion and chorea in SLE and APS.

Superficial siderosis (SS) is a rare disease which affects people in all ages and both sexes, but three times more in men. Pathological etiology is deposition of hemosiderin (a product of the breakdown of blood) in leptomeninges, subpial layer, ependymal surface and other parts of central nervous system (CNS) and typically leads to neurological dysfunction and progressive irreversible signs and symptoms. We present a 33-year-old man with complete deafness in left ear, partial hearing loss in right ear, gait imbalance, bilateral frontotemporal throbbing headache and anosmia resulted from superficial siderosis.

Standard protocols should be established for treating eligible stroke patients with tissue plasminogen activator (TPA) (recommendation class I, level of evidence B). The Iranian standard protocol of intravenous thrombolysis with recombinant tissue plasminogen activator (IVTTPA) is the best possible and easy to use method for performing intravenous thrombolysis in Iran. This protocol overcomes problems and limitations of IVTTPA in Iran. The protocol achieves the best selection criteria and assessment method of IVTTPA for our residents and neurologists. This protocol was provided in Persian language and could be easily downloaded from Google site by writing Thrombolysis and Iran in Persian.