Current Journal of Neurology
Volume:14 Issue: 3, Summer 2015

Dysphagia is common after stroke. The onset time of swallowing rehabilitation following stroke has an important role in the recovery of dysphagia and preventing of its complications, but it was either highly variable or was not stated in previous trials. The aim of this study was investigation effects of onset time of swallowing therapy on recovery from dysphagia following stroke. Sixty dysphagia patients due to stroke range of age 60-74 (67.1 ± 3.8), participated in this randomized clinical trial study. The patients allocated in Early, Medium and Late groups, on the base of initiation of swallowing therapy after the stroke. After basic clinical and video fluoroscopic swallowing study assessments, traditional swallowing therapy was initiated 3 times per week for 3 months. The outcome measures were North-Western dysphagia patient check sheet, functional oral intake scale, video fluoroscopy, and frequency of pneumonia. Statistical analysis was done by repeated measure ANOVA, Bonferroni and χ2 tests. Three groups of patients in terms of demographic and clinical characteristics were similar in the pre-treatment P > 0.050. Onset time of swallowing therapy after stroke was effective on swallowing recovery on the main outcome variables. So that in first group patients, recovery was rather than other groups P < 0.050. Furthermore, the frequency of pneumonia in the early group was less than other groups and in the early group no patients experienced pneumonia P = 0.002. Our data suggested that early interventions for dysphagia in stroke have an important role in recovery from dysphagia and prevention of complications like aspiration pneumonia.

Recent studies have shown a positive correlation between Helicobacter pylori infection and migraine headache. The aim of this study was to evaluate the role of H. pylori infection in migraine headache with (MA) and without aura (MO). This is a case-control study containing information on 84 patients (including MA, MO) and 49 healthy individuals. The enzyme-linked immunosorbent assay (ELISA) test was used to measure immunoglobulin G (IgG,) immunoglobulin M (IgM) titer in two groups. Headache severity was evaluated according to Headache Impact Test (HIT6) questionnaire. Mean ± SD of IgM antibody in Migrainous patients 26.3 (23.1) showed significantly difference with control group 17.5 (11.2) (P = 0.004). In addition, the mean ± SD HIT6 in Migrainous patients differed significantly between MA and MO groups 65.5 (4.7), 54.9 (5.3) respectively, P < 0.001). The only significant correlation was found for IgG antibody and HIT6 in MA patients (r = 0.407, P = 0.011) and MO group (r = 0.499, P = 0.002). The risk of migraine occurrence in patients did not significantly associate with the level of IgG and IgM antibodies. The results give a hope that definite treatment and eradication of this bacterium could be a cure or to reduce the severity and course of migraine headaches.

Epilepsy comprised the highest proportion of neurological problem of childhood stage, which observed mostly in the first decade of life. The dramatic effect of having a seizure in the classroom can be very traumatic for any child. The knowledge and attitude of teachers toward epilepsy have a direct impact on the life of students with epilepsy. A cross-sectional descriptive survey was conducted in Kermanshah (West of Iran). 305 teachers from 25 public schools were randomly participated in this study. The questionnaire included 39 items and three sections (demographic information, knowledge, and attitude about epilepsy). In this study, 97% participants had heard or read about epilepsy. Attitude and knowledge about epilepsy was positive in weighted sum of the item responses, but there were deficits in individual items and first-aid management of seizure attacks. There was no meaningful relationship between attitude scores and demographic items, but higher level of education, female gender, and marital status had a positive influence on teachers’ knowledge toward children with epilepsy. The main findings indicated a good knowledge and positive attitude about epilepsy among school’s teachers. Nevertheless, there is still a need to improve certain aspects of knowledge and attitude and first aid management of an epileptic attack among teachers.

Health-related quality-of-life (HR-QoL) may be affected by various factors including injury-related characteristics among individuals with spinal cord injury (SCI). However, the impact of the influence of these variables has not yet been fully described in Iranian population. Here, we assessed the relationships between injury-related characteristics and HR-QoL among Iranian people with SCI. HR-QoL was assessed using short-form health survey (SF-36). Referred patients to Brain and Spinal Injury Research Center between 2010 and 2012 were invited to participate in this investigation. Injury-related characteristics including injury level and completeness, time since injury, plegia type, and American Spinal Injury Association (ASIA) Impairment Scale were evaluated. Total of 104 patients (85 men and 19 women) entered the study. The majority of patients had a complete injury (77.9%). The most frequent ASIA score was A (75%), and the most common level of injury was at thoracic sections (61.5%). Lower injury levels were associated with higher scores in physical component summary (P = 0.040), mental component summary (P = 0.010) and subsequently total score (P = 0.006). Mean age and time since injury were 52.58 ± 12.69 and 10.88 ± 16.68 years, respectively, and were not related with HR-QoL (P = 0.950 and 0.220, respectively). There was no difference in HR-QoL between patients with tetraplegia vs. paraplegia and participants with complete vs. incomplete injury. lower injury level is a significant predictor of better QoL among individuals with SCI whereas other injury-related characteristics including completeness, time since injury and plegia type may not influence HR-QoL.

This paper proposes a new emotional stress assessment system using multi-modal bio-signals. Electroencephalogram (EEG) is the reflection of brain activity and is widely used in clinical diagnosis and biomedical research. We design an efficient acquisition protocol to acquire the EEG signals in five channels (FP1, FP2, T3, T4 and Pz) and peripheral signals such as blood volume pulse, skin conductance (SC) and respiration, under images induction (calm-neutral and negatively excited) for the participants. The visual stimuli images are selected from the subset International Affective Picture System database. The qualitative and quantitative evaluation of peripheral signals are used to select suitable segments of EEG signals for improving the accuracy of signal labeling according to emotional stress states. After pre-processing, wavelet coefficients, fractal dimension, and Lempel-Ziv complexity are used to extract the features of the EEG signals. The vast number of features leads to the problem of dimensionality, which is solved using the genetic algorithm as a feature selection method. The results show that the average classification accuracy is 89.6% for two categories of emotional stress states using the support vector machine (SVM). This is a great improvement in results compared to other similar researches. We achieve a noticeable improvement of 11.3% in accuracy using SVM classifier, in compared to previous studies. Therefore, a new fusion between EEG and peripheral signals are more robust in comparison to the separate signals.

Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disorder in European populations. ALS can be sporadic ALS (SALS) or familial ALS (FALS). Among 20 known ALS genes, mutations in C9orf72 and superoxide dismutase 1 (SOD1) are the most common genetic causes of the disease. Whereas C9orf72 mutations are more common in Western populations, the contribution of SOD1 to ALS in Iran is more than C9orf72. At present, a clear genotype/phenotype correlation for ALS has not been identified. We aimed to perform mutation screening of SOD1 in a newly identified Iranian FALS patient and to assess whether a genotype/phenotype correlation for the identified mutation exists. The five exons of SOD1 and flanking intronic sequences of a FALS proband were screened for mutations by direct sequencing. The clinical features of the proband were assessed by a neuromuscular specialist (SN). The phenotypic presentations were compared to previously reported patients with the same mutation. Heterozygous c.260A > G mutation in SOD1 that causes Asn86Ser was identified in the proband. Age at onset was 34 years and site of the first presentation was in the lower extremities. Comparisons of clinical features of different ALS patients with the same mutation evidenced variable presentations. The c.260A > G mutation in SOD1 that causes Asn86Ser appears to cause ALS with variable clinical presentations.

Stroke is the main cause of physical disability and the second leading cause of death worldwide. Two-thirds of all strokes occur in the developing countries. Despite being preventable, stroke is increasingly becoming a major health issue in these countries. The aim of this study was to evaluate the epidemiology of stroke in Shiraz, Iran, one of the main referral centers in the southwestern part of Iran. A cross-sectional study was conducted on all stroke patients admitted to the Namazee Hospital, affiliated to Shiraz University of Medical Sciences, between August 2010 and January 2011. Patients’ demographic data, atherosclerosis risk factors, type of stroke, drug history, outcomes, and neurological signs were recorded. Chi-square test, Kolmogorov–Smirnov test, t-test, and Mann–Whitney U-test were used to analyze the data. A total of 305 patients with stroke, aged 27-97 years (mean ± SD = 68.33 ± 12.99), 269 patients (88.2%) had ischemic stroke (IS) and 36 (11.8%) had hemorrhagic stroke (HS). 133 patients (43.6%) were men and 172 (56.4%) were women. 11.4% of the patients with IS and 40.6% with HS died during hospitalization, causing 12.1% death in all stroke patients [Odds ratio (Or) = 5.34, 95% Confidence intervals (CI) = 2.35-12.11]. Hypertension, ischemic heart disease, diabetes, and recurrent stroke were the most common risk factors. This study provides evidence that the epidemiology of stroke in the southwestern part of Iran may be similar to other places. However, it seems necessary and helpful to design a registration system for patients with stroke in Shiraz Namazee Hospital.

Besides the well-known adverse effects of valproate (VPA), disorders related to male reproductive functions have been reported. Furthermore, only a limited number of previous studies have reported the relationship between VPA dose and impairment of the hormonal axis and semen quality. A patient with reversible changes that occurred in the sperm parameters after a dose increment of VPA. A 34-year-old male patient who was diagnosed with juvenile myoclonic epilepsy almost 15 years ago was admitted to our clinic. His seizures responded well to high doses of VPA treatment. As the VPA dose was increased, consecutive semen analyses were performed and averaged for each dose; the results showed a remarkable decline in the sperm count and a manifest loss of sperm motility. VPA treatment was gradually diminished and stopped; meanwhile, treatment with another antiepileptic (lamotrigin) was initiated to control the patient’s seizures. Nine months later, the patient’s semen analysis was within normal ranges. After modification of the patient’s treatment regimen, he and his wife had a healthy baby. We suggest that VPA-dependent impairments in the hormone and semen analysis parameters were reversible after the termination of medical treatment, and that the VPA treatment did not cause permanent hormonal deregulation and, these side effects are dose dependent.

We investigated the effects of carbamazepine (CBZ) on semen parameters in men with newly diagnosed epilepsy, by performing semen analysis before starting any antiepileptic drugs, and then after starting CBZ, to determine the role and effects of CBZ in creating abnormalities in sperm analysis in these patients. In this prospective study, eight male patients 20-40 years of age who were referred to the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2009 to 2012, due to new-onset seizure(s) were studied. A semen analysis was performed. CBZ was started and after at least 3 months of taking CBZ, another semen analysis was requested to determine the changes in semen quality. Statistical analyses were performed using non-parametric Wilcoxon test. Mean age of the patients was 28.5 ± 3.5 years. 7 (87.5%) patients had temporal lobe epilepsy and 1 (12.5%) had parietal lobe epilepsy. The mean follow-up period was 5.5 ± 0.9 months. We observed that semen quality (concentration, progressive motility, morphology) has significantly changed in patients with newly-diagnosed epilepsy after being treated with CBZ (P = 0.012 for all indices). This study shows the direct effects of CBZ in causing changes in semen quality in men with epilepsy. Abnormalities in sperm concentration, morphology and motility, which were observed in the current study, might play a significant role in causing reduced fertility in men with epilepsy.

Cinema is a multidimensional art capable of affecting our neurophysiologic structure in different ways. Studies show that different parts of the brain are activated while watching a structured film and consequently, the movie imitates consciousness structure. This imitation of the consciousness structure enables cinema to deeply influence the brain. The effect and its manner are the main themes of the newly-emerged science of neurocinema.