Iranian Journal of Neurology最新文献

{"title":"Bullous pemphigoid as an injection site reaction of glatiramer acetate","authors":"S. Baghbanian, M. Ghasemi, Somayeh Sheidaei, Z. Hajheydari","doi":"10.18502/ijnl.v18i4.2193","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2193","url":null,"abstract":"1 Department of Neurology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 2 Department of Pathology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 3 Immunogenetic Research Center, Mazandaran University of Medical Sciences, Sari, Iran 4 Department of Dermatology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran 5 Invasive Fungi Research Center, Bualicina Hospital, Mazandaran University of Medical Sciences, Sari, Iran","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41881388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fitness to drive in seizure and epilepsy: A protocol for Iranian clinicians","authors":"N. Tabrizi","doi":"10.18502/ijnl.v18i4.2187","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2187","url":null,"abstract":"Driving restriction is a well-known undesirable consequence of epilepsy and causes significant problems regarding independence and employment for epileptic patients. Many countries all over the world have provided comprehensive protocols in this regard with the aim of providing the possibility of less restricted, but safe driving for epileptic patients and also providing the opportunity for uniform decision-making for clinicians. However, the available fitness to drive protocol in Iran still lacks sufficient details and clinicians might encounter serious problems in terms of the driving issue in epileptic patients. In order to provide a uniform protocol containing adequate practical data, a systematic review of literature addressing guidelines about driving and epilepsy and driving laws of different countries for epileptic patients was performed and, after consideration of cultural issues, a practical protocol for Iranian neurologists was suggested.","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42407770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyotrophic onset in GCH1 dopa-responsive dystonia","authors":"S. Habibi, A. Albanese, A. Elia, Paria Arfa-fatollahkhani, N. Hashemi","doi":"10.18502/ijnl.v18i4.2191","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2191","url":null,"abstract":"Dopa-responsive dystonia (DRD) belongs to combined dystonia syndrome (dystonia-plus syndrome)1 which encompasses non-degenerative and neurometabolic disorders characterized by combination of dystonia as the prominent sign, with another movement manifestation. Parkinsonism and myoclonus are the main disturbances accompany dystonia in the combined dystonia syndrome. Dystonia with parkinsonism includes DRD [DYT5, tyrosine hydroxylase (TH), and sepiapterin reductase (SPR)], dopamine agonist-responsive dystonia, rapid-onset dystonia parkinsonism (DYT12), and early-onset dystonia with parkinsonism (DYT16). However, dystonia combined with myoclonus is just classified as myoclonus dystonia (DYT11).2 DRD can be inherited in either autosomal dominant or autosomal recessive patterns. The autosomal dominant inheritance results in the typical phenotype of DRD, known as DYT5 or Segawa disease, which is caused by heterozygous mutations of guanosine triphosphate (GTP) cyclohydrolase I gene (GCH1). Mutations of the TH and SPR genes are responsible for autosomal recessive types of DRD.3 \u0000DYT5 is represented as progressive lower limbs dystonia with childhood-onset at the common age of 2-5 years. It shows diurnal fluctuations, which are aggravated toward the evening and alleviated by sleeping. Excellent and sustained response to the low dose of levodopa is the marked feature of DYT5 disease. Additional parkinsonism and spasticity may present later in life.4 \u0000Moreover, hemiatrophy of the brain, body, or both has been reported in patients with DRD, associated with a biochemical lesion located in basal ganglia.5 However, focal atrophy and muscle weakness rarely accompanies DRD. Interestingly, we aimed to introduce weakness and focal muscle atrophy as the onset manifestations of DRD in an elderly man misdiagnosed for about 70 years.","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49462796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior reversible encephalopathy syndrome with spinal cord involvement as the first presentation of lupus nephritis","authors":"A. Okhovat, S. Abdi, F. Fatehi","doi":"10.18502/ijnl.v18i4.2190","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2190","url":null,"abstract":"A 23-year-old woman was admitted to the emergency department with the history of headache, serial seizures, and decreased the level of consciousness from a week before. At admission, blood pressure was 230/170 mmHg, and creatinine level was 7.6 mg/dl. Initial brain and cervical magnetic resonance imaging (MRI) revealed hyperintense lesions on fluid-attenuated inversion recovery (FLAIR) in bilateral occipital lobes and a longitudinally extensive lesion in the spinal cord (Figure 1, A-C). In the laboratory investigations, the level of anti-double stranded DNA was 45 IU/ml (normal < 10 IU/ml) and anti-nuclear antibody titer was high (> 1/160). Moreover, in renal biopsy, lupus nephritis was reported. Two weeks later, after hypertension treatment, the hyperintense signals wholly disappeared (Figure 1, D-F). Figure 1. Axial fluid-attenuated inversion recovery (FLAIR) brain magnetic resonance imaging (MRI) indicating hypersignal lesions in parieto-occipital areas in favor of posterior reversible encephalopathy syndrome (PRES) at admission (A, B); sagittal T2 cervical MRI demonstrating a longitudinally extensive lesion in the spinal cord at admission (C); two weeks later, the hyperintense signals had completely disappeared on the brain and spinal cord MRIs (D-F).","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42804944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombolytic treatment in stroke mimic, inevitable but fortunately safe: An observational study from Iran.","authors":"Sara Esmaeili,&nbsp;Motahareh Afrakhteh,&nbsp;Maryam Bahadori,&nbsp;Seyedeh Fahimeh Shojaei,&nbsp;Rezan Ashayeri,&nbsp;Masoud Mehrpour","doi":"","DOIUrl":"","url":null,"abstract":"<p><p><b>Background:</b> A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center's SM (Firoozgar Hospital) among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes. <b>Methods:</b> We reviewed the medical records of all patients who received IVT between June 2015 and May 2018. The following variables were collected: demographic characteristics, past medical history, onset-to-needle (OTN) time, door-to-needle (DTN) time, National Institutes of Health Stroke Scale (NIHSS) score at admission, brain imaging, and all paraclinic findings. Functional outcome at discharge based on modified Rankin Scale (mRS) was also assessed. <b>Results:</b> 10 out of 165 (6.0%) patients including 8 men and 4 women were finally diagnosed with SM. The median age and NIHSS score at presentation were 60 years and 7, respectively. Final diagnoses were seizure (n = 6), hemiplegic migraine (n = 2), conversion (n = 1), and alcohol intoxication (n = 1). All patients were discharged with a mRS score of 0 and 1 without experiencing any thrombolytic adverse effects. <b>Conclusion:</b> None of the patients with SM experienced any adverse effect of tissue plasminogen activator (tPA) including hemorrhage and all of them reached good mRS score. This shows that tPA is generally safe and the risk of treating patients with SM is very low and making a vital treatment decision may outweigh the risk of neglected cases in a time-sensitive setting.</p>","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37693428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey from Turkey and Iran on comparison of risk factors and etiology in ischemic stroke.","authors":"Gulcin Benbir Senel,&nbsp;Ayse Deniz Elmali,&nbsp;Kaveh Mehrvar,&nbsp;Mehdi Farhoudi,&nbsp;Mohammad Aboutalebi,&nbsp;Mahsa Rezaei,&nbsp;Birsen Ince","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37693430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombolytic treatment in stroke mimic, inevitable but fortunately safe: An observational study from Iran","authors":"S. Esmaeili, M. Afrakhteh, M. Bahadori, Seyedeh Fahimeh Shojaei, R. Ashayeri, M. Mehrpour","doi":"10.18502/ijnl.v18i4.2188","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2188","url":null,"abstract":"Background: A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center’s SM (Firoozgar Hospital) among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes. Methods: We reviewed the medical records of all patients who received IVT between June 2015 and May 2018. The following variables were collected: demographic characteristics, past medical history, onset-to-needle (OTN) time, door-to-needle (DTN) time, National Institutes of Health Stroke Scale (NIHSS) score at admission, brain imaging, and all paraclinic findings. Functional outcome at discharge based on modified Rankin Scale (mRS) was also assessed. Results: 10 out of 165 (6.0%) patients including 8 men and 4 women were finally diagnosed with SM. The median age and NIHSS score at presentation were 60 years and 7, respectively. Final diagnoses were seizure (n = 6), hemiplegic migraine (n = 2), conversion (n = 1), and alcohol intoxication (n = 1). All patients were discharged with a mRS score of 0 and 1 without experiencing any thrombolytic adverse effects. Conclusion: None of the patients with SM experienced any adverse effect of tissue plasminogen activator (tPA) including hemorrhage and all of them reached good mRS score. This shows that tPA is generally safe and the risk of treating patients with SM is very low and making a vital treatment decision may outweigh the risk of neglected cases in a time-sensitive setting.","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45874542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and side effects of dimethyl fumarate in multiple sclerosis after 12 months of follow up: An Iranian clinical trial.","authors":"Mohsen Foroughipour,&nbsp;Sahar Gazeran","doi":"","DOIUrl":"","url":null,"abstract":"<p><p><b>Background:</b> Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent studies, but the efficacy of this drug in patients with MS is still being studied in different parts of the world. In the present study, we evaluated the effectiveness of DMF therapy on reducing relapses, lesions, and disability in Iranian patients with MS. <b>Methods:</b> The present single-arm before-after study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran [Iranian Registry of Clinical Trial (IRCT) code: IRCT20190121042439N1]. Every patient who was diagnosed with relapsing MS was considered eligible to enroll in the present clinical trial. Before receiving DMF therapy, the baseline liver function tests and complete blood count were obtained from all individuals. Also, a baseline brain magnetic resonance imaging (MRI) was obtained and Expanded Disability Status Scale (EDSS) was documented from all patients. After receiving 240 mg DMF twice daily for 12 months, the laboratory and imaging measurements as well as EDSS were repeated. Furthermore, the total number of relapses within the study period was recorded. Satisfaction with DMF treatment was determined by answering a yes-no question. <b>Results:</b> A total number of 50 patients enrolled in the study and most of them were female (80%). There was a significant decrease in EDSS score and gadolinium (GD)-enhancing lesions after the study period (P < 0.001 for each). Moreover, the attacks significantly dropped after the study period (P < 0.001) and 86% of patients were satisfied with their treatment. <b>Conclusion:</b> The findings of this study showed that 240 mg DMF administered twice daily can effectively reduce disability and provide satisfaction within the first year of therapy in patients with MS.</p>","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37692958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amyotrophic onset in GCH1 dopa-responsive dystonia.","authors":"Seyed Amir Hasan Habibi,&nbsp;Alberto Albanese,&nbsp;Antonio E Elia,&nbsp;Paria Arfa-Fatollahkhani,&nbsp;Neda Hashemi","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37693432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey from Turkey and Iran on comparison of risk factors and etiology in ischemic stroke","authors":"G. Şenel, A. Elmalı, K. Mehrvar, M. Farhoudi, M. Aboutalebi, M. Rezaei, B. Ince","doi":"10.18502/ijnl.v18i4.2189","DOIUrl":"https://doi.org/10.18502/ijnl.v18i4.2189","url":null,"abstract":"Background: Multiple sclerosis (MS) is a neurologic disorder with a considerable global burden. During the last decades, some pharmaceutical treatments have been approved for patients with MS. Dimethyl fumarate (DMF) is one of these drugs which has been reported to have early promising results in recent studies, but the efficacy of this drug in patients with MS is still being studied in different parts of the world. In the present study, we evaluated the effectiveness of DMF therapy on reducing relapses, lesions, and disability in Iranian patients with MS.Methods: The present single-arm before-after study was approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran [Iranian Registry of Clinical Trial (IRCT) code: IRCT20190121042439N1]. Every patient who was diagnosed with relapsing MS was considered eligible to enroll in the present clinical trial. Before receiving DMF therapy, the baseline liver function tests and complete blood count were obtained from all individuals. Also, a baseline brain magnetic resonance imaging (MRI) was obtained and Expanded Disability Status Scale (EDSS) was documented from all patients. After receiving 240 mg DMF twice daily for 12 months, the laboratory and imaging measurements as well as EDSS were repeated. Furthermore, the total number of relapses within the study period was recorded. Satisfaction with DMF treatment was determined by answering a yes-no question.Results: A total number of 50 patients enrolled in the study and most of them were female (80%). There was a significant decrease in EDSS score and gadolinium (GD)-enhancing lesions after the study period (P < 0.001 for each). Moreover, the attacks significantly dropped after the study period (P < 0.001) and 86% of patients were satisfied with their treatment.Conclusion: The findings of this study showed that 240 mg DMF administered twice daily can effectively reduce disability and provide satisfaction within the first year of therapy in patients with MS.","PeriodicalId":45759,"journal":{"name":"Iranian Journal of Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45457165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}