Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides su... more Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides sufficient protein but insufficient carbohydrates for all the metabolic needs of the body. KD has been known as a therapeutic manner intractable epilepsy. In recent years, the effectiveness of KD drew attention to the treatment of some other disorders such as Parkinson’s disease (PD). This study has evaluated the efficacy of KD on motor function in Parkinsonian model of rat and compared it with pramipexole. Methods: A total of 56 male Wistar rats weighing 200-240 g between 12 and 14 weeks of age were randomized in seven 8-rat groups as follows: Control group; sham-operated group; KD group; Parkinsonian control group; KD-Parkinsonian group; pramipexole-Parkinsonian group; and KD-pramipexole-Parkinsonian group. The results of bar test, beam traversal task test, and cylinder task test were compared between the groups. Results: The mean number of ketone bodies had increased significantly in th...
Parkinson’s disease (PD) is the most common neurodegenerative disease with motor presentation and... more Parkinson’s disease (PD) is the most common neurodegenerative disease with motor presentation and the second most common neurodegenerative disorder, following Alzheimer’s disease. Nearly 200 years ago, James Parkinson described this process for the first time in his manuscript entitled An Essay on the Shaking Palsy [1]. He had focused mainly on the motor features of PD, overlooking non‐motor symptoms, but cognitive impairment was at that time completely disregarded. Nowadays, we know that the spectrum of non‐motor features in PD is broad [2, 3], but may often be missed in clinical practice. Nonetheless, whenever PD is suspected, the routine approach should include a set of questions for exploring their presence, since they may be helpful hints for the diagnosis, although they are non-specific. On the other hand, it is useful to quantify their severity and impact, as they carry an important additional burden on the patients, leading to significantly deteriorated quality of life (QOL)...
Churg-Strauss syndrome is a rare autoimmune disorder characterized by excess circulating, tissue ... more Churg-Strauss syndrome is a rare autoimmune disorder characterized by excess circulating, tissue eosinophils, and vasculitis, which affects the lung and skin. The syndrome occurs in patients with a history of asthma or allergy.1 Neuropathy develops in approximately 3/4 of the patients usually as mononeuritis multiplex. Centrally accentuated antineutrophil cytoplasmic antibody (CANCA) is generally found in more than half of the cases, while central nervous system (CNS) manifestations are relatively unusual and include headache, convulsion, hemiplegia, and brainstem signs.2 We report here a 42-year-old man with a history of severe asthma and rhinitis in the past 4 years prior to the first admission. The patient was presented with difficulty in walking and weakness of lower limbs. In addition, he had a history of flu vaccination about 1.5 months before his neurological symptoms. The patient also had a history of skin lesions of hemorrhagic bulla and palpable purpura few days after inje...
Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (... more Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (GBS) , this study was carried out to assess autonomic dysfunction signs and symptoms and also heart rate variation (HRV) with respiration in the acute phase of GBS and it's prognostic value. Materials and Methods: Forty-three patients with GBS who referred for electrodiagnostic study in the first week of their disease were studied. Autonomic system involvement detected with careful clinical examination and heart rate variation with deep breathing were studied in all patients and Prognostic value of test was evaluated with proper analytical tests. Results: HRV was abnormal in five patients (11.6%) and expiratory to inspiratory ratio (E/I) was abnormal in eight patients (18.6%). In 9 Patients (20/9%) each of the tests were abnormal. There was no significant correlation between HRV and E/I Ratio between axonal and demyelinating types. (P=0.88) but there were significant correlation betw...
Chorea is a complex, rapid, irregular and fluctuating hyperkinetic movements with several etiolog... more Chorea is a complex, rapid, irregular and fluctuating hyperkinetic movements with several etiologies. A rare type of generalized chorea is post-pomp chorea occurring after cardiac surgery especially in children, but it is rare in adults. Here, we report a 75-year old man with chorea and gait difficulties ten days after cardiac surgery. Neurological exams, excluding chorea, and paraclinical tests were normal. Magnetic resonance imaging of brain revealed old diffuse ischemic changes.�Among chorea medical treatments, pimozide resulted in mild improvement. We started clonazepam plus pimozide, thereafter choreic movements and gait gradually improved.
Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired muscle disease presenting with ... more Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired muscle disease presenting with subacute progression in adulthood. It can be accompanied by a monoclonal gammopathy of undetermined significance (MGUS). We describe clinical and histopathological findings of four SLONM patients with MGUS. In all patients, nemaline rod, inter-myofibrillary network disruption, atrophic changes, peripheral basophilic discoloration, vacuole without rim, and cytoplasmic body without inflammation were seen. Three out of four patients were treated with prednisolone in combination with IVIG monthly and had an appropriate response to the treatment. The optimal first-line treatment remains unclear in SLONM-MGUS, although corticosteroids plus IVIg is associated with favorable clinical response. These treatment modalities might be used as an optional treatment before autologous stem cell transplantation; however, further studies with a higher number of patients are required.
Introduction: Parkinson's Disease (PD) is one of the most common disorders among communities. PD ... more Introduction: Parkinson's Disease (PD) is one of the most common disorders among communities. PD is important due its several aspects like high burden of disorder, costs to health organizations and its progressive, and debilitating nature. In this study, we aimed to evaluate the reasons of admissions of patients with PD to ED in an 8-year range in Tabriz Imam Reza hospital. Materials and Methods: In this cross-sectional study, 51 patients with Parkinson disease whom were admitted to Tabriz Imam Reza hospital from March 2009 to March 2016 were included. Age, sex, cause of admission, hospitalization duration and outcome of patients were recorded and, then analyzed by SPSS software version 16.0. Results: The sexual distribution of hospitalized patients was almost equal (male = 47%, female=53%). The average age of patients was 66.47 ± 13.81 years. The main reasons of patients' admission were sepsis, aspiration pneumonia and motor symptoms exacerbation. Mortality rate was 21.6%; the most common cause was sepsis (54.5%) with aspiration pneumonia (45.5%) being the leading cause of death. The average hospitalization duration of discharged patients was 9.2 ± 8.39 days with a median of 7 days. Conclusion: Higher mortality rate of our patients with infectious diseases reported as main cause of hospitalization and death signify importance of clinical investigation of concomitant diseases and better training of the medical staff in management of Parkinson disease.
Journal of Experimental and Clinical Neurosciences
Parkinson's disease (PD) is a common, progressive, disabling, neurodegenerative disorder, that ap... more Parkinson's disease (PD) is a common, progressive, disabling, neurodegenerative disorder, that apart from well-known motor symptoms, reveals a wide spectrum of non-motor features, that are now widely accepted as part of the clinical aspect, and cognitive decline is a very important part of these non-motor presentations. The diagnosis of cognitive decline in PD can be extremely challenging, remaining largely based on clinical and cognitive assessments. Expert work groups have issued diagnostic criteria and methods for PD dementia and cognitive impairment. This manuscript has gathered relevant data in order to obtain an updated review regarding cognitive deficit in PD, from mild stages to dementia. This article has summarized clinical features, diagnostic methods, and therapeutic issues of cognitive decline in PD.
Advances in Bioscience and Clinical Medicine, 2015
Parkinson's disease is the second common neurological disease associated with elderly. Neuroinfla... more Parkinson's disease is the second common neurological disease associated with elderly. Neuroinflammation contributes in neuronal death in Parkinson's disease (PD). The ketogenic diet (KD) is low in carbohydrates, adequate in protein, and high in fat, has been used in intractable epilepsy and seems to be effective in neurologic disorders. The implication of Neuroinflammation in PD has been emphasized and there is evidence show that KD may provide advantages to reduce neuroinflammatory adverse effects. Based on this surmise, it seems that KD could reverse some neuronal injuries of PD.
Background: Parkinson’s disease (PD) is one of the widespread neurodegenerative diseases. Recentl... more Background: Parkinson’s disease (PD) is one of the widespread neurodegenerative diseases. Recently, a few studies have suggested that treatment with levodopa and vitamin B12 defciency may have some role in developing peripheral neuropathy (PN) among PD patients. Hence, the aim of this study was to evaluate PN in patients suffering from PD under long-term treatment with levodopa and also vitamin B12 defciency in these patients. Materials and Methods: Thirty PD patients who received levodopa for at least two years, 30 levodopa-naïve PD patients, and 30 age-matched controls individuals were included. The participants were subjected to electrodiagnostic tests and the level of vitamin B12 was measured. The prevalence of neuropathy was determined according to electrodiagnostic criteria and compared among the three groups. Results: Overall, 23.3% of cases in levodopa receivers, 3.3% in the levodopa-naïve group, and 3.3% in control group had PN (odds ratio=8.8, 95% confdence interval=1.7-45...
There are no clinical features or biomarkers that can reliably differentiate acute disseminated e... more There are no clinical features or biomarkers that can reliably differentiate acute disseminated encephalomyelitis from multiple sclerosis at the first demyelination attack. Consequently, a final diagnosis is sometimes delayed by months and years of follow-up. Early treatment for multiple sclerosis is recommended to reduce long-term disability. Therefore, we intend to explore neuroimaging biomarkers that can reliably distinguish between the two diagnoses. We reviewed prospectively collected clinical, standard MRI and diffusion tensor imaging data from 12 pediatric patients who presented with acute demyelination with and without encephalopathy. Patients were followed for an average of 6.5 years to determine the accuracy of final diagnosis. Final diagnosis was determined using 2013 International Pediatric MS Study Group criteria. Control subjects consisted of four age-matched healthy individuals for each patient. The study population consisted of six patients with central nervous system demyelination with encephalopathy with a presumed diagnosis of acute disseminated encephalomyelitis and six without encephalopathy with a presumed diagnosis of multiple sclerosis or clinically isolated syndrome at high risk for multiple sclerosis. During follow-up, two patients with initial diagnosis of acute disseminated encephalomyelitis were later diagnosed with multiple sclerosis. Diffusion tensor imaging region of interest analysis of baseline scans showed differences between final diagnosis of multiple sclerosis and acute disseminated encephalomyelitis patients, whereby low fractional anisotropy and high radial diffusivity occurred in multiple sclerosis patients compared with acute disseminated encephalomyelitis patients and the age-matched controls. Fractional anisotropy and radial diffusivity measures may have the potential to serve as biomarkers for distinguishing acute disseminated encephalomyelitis from multiple sclerosis at the onset.
Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (... more Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (GBS) , this study was carried out to assess autonomic dysfunction signs and symptoms and also heart rate variation (HRV) with respiration in the acute phase of GBS and it's ...
The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that p... more The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that presents with unilateral body Parkinsonism plus variable atrophy on the same side. Diagnosis of this syndrome needs a complete past medical history taking, as well as assessment of the familial history, clinical examination and complete paraclinical tests. The response to medical therapy has been variable in various researches. This case showed a good response to the addition of a dopamine agonist to levodopa therapy.
Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim o... more Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim of this study is to evaluate the frequency of common etiologies of late adult onset epilepsies. All patients referred to Razi and Imam Khomeini Hospitals in the year 2003 with at least two seizure attacks beginning after age of 50 were evaluated. In the majority of cases neuroimaging, electroencephalography and echocardiography were done and risk factors for atherosclerosis and cerebrovascular diseases were investigated. All medical records and previous medical histories were reviewed. A total of 97 patients were included. We found hemorrhagic stroke in 10 (10.3%), ischemic stroke in 43 (44.3%) and space-occupying lesion (all of them were tumors) in 19 patients (19.6%). In 24 (24.7%) cases we could not find a clear cause for seizure attacks. In conclusion, since seizures were associated with a central nervous system disease in about 75% of the patients, careful investigation is necessary. We also recommend better control of risk factors for cerebrovascular diseases in our country.
Italian naturalistic setting. Methods: The study started in Sept 2013 and plans to enroll 250 pat... more Italian naturalistic setting. Methods: The study started in Sept 2013 and plans to enroll 250 patients coming to observation of 21 Alzheimer's Evaluation Unit in Eastern Lombardy, Italy, until Dec-2014. 30 healthy elderly controls (HC) will also be enrolled. Patients will undergo a diagnostic work-up according to usual local practice. Physicians will formulate a clinical diagnosis and rate their diagnostic confidence (range between 15% and 85%). Patients will undergo 18F-Florbetapir PET. Diagnosis, diagnostic confidence and treatment plan will be revised based on 18F-Florbetapir scan results. Results: During the first 5 months, 73 patients and 9 HC were enrolled. Of these, 57 patients completed their diagnostic work-up. Clinical diagnosis were as follows n¼15 MCI due to AD; n¼ 23 AD; n¼3 FTD; n¼7 MCI not due to AD; n¼9 had other dementias (PDD, DBL, CBS). 56 patients and 8 HC underwent 18F-Florbetapir PET. Negative scans occurred in 18% of AD, 33% of MCI due to AD, 29% of MCI not due to AD, 33% of FTD, 33% of patients with other dementias. Two HC had a positive amyloid-PET scan. To date, the diagnosis was re-evaluated post-amyloid imaging in 40 patients, and 18F-florbetapir results led to a change in diagnosis in 42% of these patients. T he diagnostic confidence increased significantly after amyloid imaging for both confirmed and changed clinical diagnoses (15% and 17% increase in confidence respectively, p<0.0005). Amyloid PET positivity had a significant impact on the therapeutic plans of patients with an initial diagnosis of AD, MCI due to AD or DLB, with an increase of 29% in the prescription of AChE (p¼0.01). Conclusions: 18F-Florbetapir PET has a significant impact on diagnosis, diagnostic confidence and treatment plan of dementia experts.
To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to ass... more To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to assess the prevalence and characteristics of headache, especially migraine, in patients with polycystic ovary syndrome (PCO) compared with women without this disease. One hundred and thirty-three women with PCO and 107 controls were interviewed by 2 neurologists experienced in headache diagnosis. The headache disorders were classified according to the International Headache Society criteria. The statistical significance was determined using the chi(2) test, and a p value of &lt;0.05 was considered significant. Forty-five women (33.8%) of the 133 cases without PCO complained of headache. Of the PCO patients, 48 women (44.9%) suffered from headache. The prevalence of headache was not significantly higher among women with PCO (p = 0.85). The same results were found for migraine headache (p = 0.13). Migraine is not more frequent in women with PCO. It was concluded that male sex hormones and especially testosterone do not play an important role in the exacerbation of migraine headache.
Please cite this article as: Gordon, B.A., et al., The effects of white matter hyperintensities a... more Please cite this article as: Gordon, B.A., et al., The effects of white matter hyperintensities and amyloid deposition on Alzheimer dementia, NeuroImage: Clinical (2015), http://dx.
Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides su... more Background: The ketogenic diet (KD), high in fat and low in carbohydrate and protein, provides sufficient protein but insufficient carbohydrates for all the metabolic needs of the body. KD has been known as a therapeutic manner intractable epilepsy. In recent years, the effectiveness of KD drew attention to the treatment of some other disorders such as Parkinson’s disease (PD). This study has evaluated the efficacy of KD on motor function in Parkinsonian model of rat and compared it with pramipexole. Methods: A total of 56 male Wistar rats weighing 200-240 g between 12 and 14 weeks of age were randomized in seven 8-rat groups as follows: Control group; sham-operated group; KD group; Parkinsonian control group; KD-Parkinsonian group; pramipexole-Parkinsonian group; and KD-pramipexole-Parkinsonian group. The results of bar test, beam traversal task test, and cylinder task test were compared between the groups. Results: The mean number of ketone bodies had increased significantly in th...
Parkinson’s disease (PD) is the most common neurodegenerative disease with motor presentation and... more Parkinson’s disease (PD) is the most common neurodegenerative disease with motor presentation and the second most common neurodegenerative disorder, following Alzheimer’s disease. Nearly 200 years ago, James Parkinson described this process for the first time in his manuscript entitled An Essay on the Shaking Palsy [1]. He had focused mainly on the motor features of PD, overlooking non‐motor symptoms, but cognitive impairment was at that time completely disregarded. Nowadays, we know that the spectrum of non‐motor features in PD is broad [2, 3], but may often be missed in clinical practice. Nonetheless, whenever PD is suspected, the routine approach should include a set of questions for exploring their presence, since they may be helpful hints for the diagnosis, although they are non-specific. On the other hand, it is useful to quantify their severity and impact, as they carry an important additional burden on the patients, leading to significantly deteriorated quality of life (QOL)...
Churg-Strauss syndrome is a rare autoimmune disorder characterized by excess circulating, tissue ... more Churg-Strauss syndrome is a rare autoimmune disorder characterized by excess circulating, tissue eosinophils, and vasculitis, which affects the lung and skin. The syndrome occurs in patients with a history of asthma or allergy.1 Neuropathy develops in approximately 3/4 of the patients usually as mononeuritis multiplex. Centrally accentuated antineutrophil cytoplasmic antibody (CANCA) is generally found in more than half of the cases, while central nervous system (CNS) manifestations are relatively unusual and include headache, convulsion, hemiplegia, and brainstem signs.2 We report here a 42-year-old man with a history of severe asthma and rhinitis in the past 4 years prior to the first admission. The patient was presented with difficulty in walking and weakness of lower limbs. In addition, he had a history of flu vaccination about 1.5 months before his neurological symptoms. The patient also had a history of skin lesions of hemorrhagic bulla and palpable purpura few days after inje...
Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (... more Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (GBS) , this study was carried out to assess autonomic dysfunction signs and symptoms and also heart rate variation (HRV) with respiration in the acute phase of GBS and it's prognostic value. Materials and Methods: Forty-three patients with GBS who referred for electrodiagnostic study in the first week of their disease were studied. Autonomic system involvement detected with careful clinical examination and heart rate variation with deep breathing were studied in all patients and Prognostic value of test was evaluated with proper analytical tests. Results: HRV was abnormal in five patients (11.6%) and expiratory to inspiratory ratio (E/I) was abnormal in eight patients (18.6%). In 9 Patients (20/9%) each of the tests were abnormal. There was no significant correlation between HRV and E/I Ratio between axonal and demyelinating types. (P=0.88) but there were significant correlation betw...
Chorea is a complex, rapid, irregular and fluctuating hyperkinetic movements with several etiolog... more Chorea is a complex, rapid, irregular and fluctuating hyperkinetic movements with several etiologies. A rare type of generalized chorea is post-pomp chorea occurring after cardiac surgery especially in children, but it is rare in adults. Here, we report a 75-year old man with chorea and gait difficulties ten days after cardiac surgery. Neurological exams, excluding chorea, and paraclinical tests were normal. Magnetic resonance imaging of brain revealed old diffuse ischemic changes.�Among chorea medical treatments, pimozide resulted in mild improvement. We started clonazepam plus pimozide, thereafter choreic movements and gait gradually improved.
Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired muscle disease presenting with ... more Sporadic late-onset nemaline myopathy (SLONM) is a rare, acquired muscle disease presenting with subacute progression in adulthood. It can be accompanied by a monoclonal gammopathy of undetermined significance (MGUS). We describe clinical and histopathological findings of four SLONM patients with MGUS. In all patients, nemaline rod, inter-myofibrillary network disruption, atrophic changes, peripheral basophilic discoloration, vacuole without rim, and cytoplasmic body without inflammation were seen. Three out of four patients were treated with prednisolone in combination with IVIG monthly and had an appropriate response to the treatment. The optimal first-line treatment remains unclear in SLONM-MGUS, although corticosteroids plus IVIg is associated with favorable clinical response. These treatment modalities might be used as an optional treatment before autologous stem cell transplantation; however, further studies with a higher number of patients are required.
Introduction: Parkinson's Disease (PD) is one of the most common disorders among communities. PD ... more Introduction: Parkinson's Disease (PD) is one of the most common disorders among communities. PD is important due its several aspects like high burden of disorder, costs to health organizations and its progressive, and debilitating nature. In this study, we aimed to evaluate the reasons of admissions of patients with PD to ED in an 8-year range in Tabriz Imam Reza hospital. Materials and Methods: In this cross-sectional study, 51 patients with Parkinson disease whom were admitted to Tabriz Imam Reza hospital from March 2009 to March 2016 were included. Age, sex, cause of admission, hospitalization duration and outcome of patients were recorded and, then analyzed by SPSS software version 16.0. Results: The sexual distribution of hospitalized patients was almost equal (male = 47%, female=53%). The average age of patients was 66.47 ± 13.81 years. The main reasons of patients' admission were sepsis, aspiration pneumonia and motor symptoms exacerbation. Mortality rate was 21.6%; the most common cause was sepsis (54.5%) with aspiration pneumonia (45.5%) being the leading cause of death. The average hospitalization duration of discharged patients was 9.2 ± 8.39 days with a median of 7 days. Conclusion: Higher mortality rate of our patients with infectious diseases reported as main cause of hospitalization and death signify importance of clinical investigation of concomitant diseases and better training of the medical staff in management of Parkinson disease.
Journal of Experimental and Clinical Neurosciences
Parkinson's disease (PD) is a common, progressive, disabling, neurodegenerative disorder, that ap... more Parkinson's disease (PD) is a common, progressive, disabling, neurodegenerative disorder, that apart from well-known motor symptoms, reveals a wide spectrum of non-motor features, that are now widely accepted as part of the clinical aspect, and cognitive decline is a very important part of these non-motor presentations. The diagnosis of cognitive decline in PD can be extremely challenging, remaining largely based on clinical and cognitive assessments. Expert work groups have issued diagnostic criteria and methods for PD dementia and cognitive impairment. This manuscript has gathered relevant data in order to obtain an updated review regarding cognitive deficit in PD, from mild stages to dementia. This article has summarized clinical features, diagnostic methods, and therapeutic issues of cognitive decline in PD.
Advances in Bioscience and Clinical Medicine, 2015
Parkinson's disease is the second common neurological disease associated with elderly. Neuroinfla... more Parkinson's disease is the second common neurological disease associated with elderly. Neuroinflammation contributes in neuronal death in Parkinson's disease (PD). The ketogenic diet (KD) is low in carbohydrates, adequate in protein, and high in fat, has been used in intractable epilepsy and seems to be effective in neurologic disorders. The implication of Neuroinflammation in PD has been emphasized and there is evidence show that KD may provide advantages to reduce neuroinflammatory adverse effects. Based on this surmise, it seems that KD could reverse some neuronal injuries of PD.
Background: Parkinson’s disease (PD) is one of the widespread neurodegenerative diseases. Recentl... more Background: Parkinson’s disease (PD) is one of the widespread neurodegenerative diseases. Recently, a few studies have suggested that treatment with levodopa and vitamin B12 defciency may have some role in developing peripheral neuropathy (PN) among PD patients. Hence, the aim of this study was to evaluate PN in patients suffering from PD under long-term treatment with levodopa and also vitamin B12 defciency in these patients. Materials and Methods: Thirty PD patients who received levodopa for at least two years, 30 levodopa-naïve PD patients, and 30 age-matched controls individuals were included. The participants were subjected to electrodiagnostic tests and the level of vitamin B12 was measured. The prevalence of neuropathy was determined according to electrodiagnostic criteria and compared among the three groups. Results: Overall, 23.3% of cases in levodopa receivers, 3.3% in the levodopa-naïve group, and 3.3% in control group had PN (odds ratio=8.8, 95% confdence interval=1.7-45...
There are no clinical features or biomarkers that can reliably differentiate acute disseminated e... more There are no clinical features or biomarkers that can reliably differentiate acute disseminated encephalomyelitis from multiple sclerosis at the first demyelination attack. Consequently, a final diagnosis is sometimes delayed by months and years of follow-up. Early treatment for multiple sclerosis is recommended to reduce long-term disability. Therefore, we intend to explore neuroimaging biomarkers that can reliably distinguish between the two diagnoses. We reviewed prospectively collected clinical, standard MRI and diffusion tensor imaging data from 12 pediatric patients who presented with acute demyelination with and without encephalopathy. Patients were followed for an average of 6.5 years to determine the accuracy of final diagnosis. Final diagnosis was determined using 2013 International Pediatric MS Study Group criteria. Control subjects consisted of four age-matched healthy individuals for each patient. The study population consisted of six patients with central nervous system demyelination with encephalopathy with a presumed diagnosis of acute disseminated encephalomyelitis and six without encephalopathy with a presumed diagnosis of multiple sclerosis or clinically isolated syndrome at high risk for multiple sclerosis. During follow-up, two patients with initial diagnosis of acute disseminated encephalomyelitis were later diagnosed with multiple sclerosis. Diffusion tensor imaging region of interest analysis of baseline scans showed differences between final diagnosis of multiple sclerosis and acute disseminated encephalomyelitis patients, whereby low fractional anisotropy and high radial diffusivity occurred in multiple sclerosis patients compared with acute disseminated encephalomyelitis patients and the age-matched controls. Fractional anisotropy and radial diffusivity measures may have the potential to serve as biomarkers for distinguishing acute disseminated encephalomyelitis from multiple sclerosis at the onset.
Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (... more Background: With respect to prevalence of cardiovascular involvement in Guillain-Barre syndrome (GBS) , this study was carried out to assess autonomic dysfunction signs and symptoms and also heart rate variation (HRV) with respiration in the acute phase of GBS and it's ...
The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that p... more The syndrome of hemiparkinsonism-hemiatrophy is an uncommon form of secondary Parkinsonism that presents with unilateral body Parkinsonism plus variable atrophy on the same side. Diagnosis of this syndrome needs a complete past medical history taking, as well as assessment of the familial history, clinical examination and complete paraclinical tests. The response to medical therapy has been variable in various researches. This case showed a good response to the addition of a dopamine agonist to levodopa therapy.
Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim o... more Frequency of common etiologies of adult onset epilepsy is different in various studies. The aim of this study is to evaluate the frequency of common etiologies of late adult onset epilepsies. All patients referred to Razi and Imam Khomeini Hospitals in the year 2003 with at least two seizure attacks beginning after age of 50 were evaluated. In the majority of cases neuroimaging, electroencephalography and echocardiography were done and risk factors for atherosclerosis and cerebrovascular diseases were investigated. All medical records and previous medical histories were reviewed. A total of 97 patients were included. We found hemorrhagic stroke in 10 (10.3%), ischemic stroke in 43 (44.3%) and space-occupying lesion (all of them were tumors) in 19 patients (19.6%). In 24 (24.7%) cases we could not find a clear cause for seizure attacks. In conclusion, since seizures were associated with a central nervous system disease in about 75% of the patients, careful investigation is necessary. We also recommend better control of risk factors for cerebrovascular diseases in our country.
Italian naturalistic setting. Methods: The study started in Sept 2013 and plans to enroll 250 pat... more Italian naturalistic setting. Methods: The study started in Sept 2013 and plans to enroll 250 patients coming to observation of 21 Alzheimer's Evaluation Unit in Eastern Lombardy, Italy, until Dec-2014. 30 healthy elderly controls (HC) will also be enrolled. Patients will undergo a diagnostic work-up according to usual local practice. Physicians will formulate a clinical diagnosis and rate their diagnostic confidence (range between 15% and 85%). Patients will undergo 18F-Florbetapir PET. Diagnosis, diagnostic confidence and treatment plan will be revised based on 18F-Florbetapir scan results. Results: During the first 5 months, 73 patients and 9 HC were enrolled. Of these, 57 patients completed their diagnostic work-up. Clinical diagnosis were as follows n¼15 MCI due to AD; n¼ 23 AD; n¼3 FTD; n¼7 MCI not due to AD; n¼9 had other dementias (PDD, DBL, CBS). 56 patients and 8 HC underwent 18F-Florbetapir PET. Negative scans occurred in 18% of AD, 33% of MCI due to AD, 29% of MCI not due to AD, 33% of FTD, 33% of patients with other dementias. Two HC had a positive amyloid-PET scan. To date, the diagnosis was re-evaluated post-amyloid imaging in 40 patients, and 18F-florbetapir results led to a change in diagnosis in 42% of these patients. T he diagnostic confidence increased significantly after amyloid imaging for both confirmed and changed clinical diagnoses (15% and 17% increase in confidence respectively, p<0.0005). Amyloid PET positivity had a significant impact on the therapeutic plans of patients with an initial diagnosis of AD, MCI due to AD or DLB, with an increase of 29% in the prescription of AChE (p¼0.01). Conclusions: 18F-Florbetapir PET has a significant impact on diagnosis, diagnostic confidence and treatment plan of dementia experts.
To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to ass... more To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to assess the prevalence and characteristics of headache, especially migraine, in patients with polycystic ovary syndrome (PCO) compared with women without this disease. One hundred and thirty-three women with PCO and 107 controls were interviewed by 2 neurologists experienced in headache diagnosis. The headache disorders were classified according to the International Headache Society criteria. The statistical significance was determined using the chi(2) test, and a p value of &lt;0.05 was considered significant. Forty-five women (33.8%) of the 133 cases without PCO complained of headache. Of the PCO patients, 48 women (44.9%) suffered from headache. The prevalence of headache was not significantly higher among women with PCO (p = 0.85). The same results were found for migraine headache (p = 0.13). Migraine is not more frequent in women with PCO. It was concluded that male sex hormones and especially testosterone do not play an important role in the exacerbation of migraine headache.
Please cite this article as: Gordon, B.A., et al., The effects of white matter hyperintensities a... more Please cite this article as: Gordon, B.A., et al., The effects of white matter hyperintensities and amyloid deposition on Alzheimer dementia, NeuroImage: Clinical (2015), http://dx.
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