Current Journal of Neurology最新文献

Background: Providing informal care can deeply influence, both physically and emotionally, the quality of life (QoL) of caregivers, especially when the disease becomes chronic. CarerQol-7D is one of the most common instruments for measuring informal care. We aimed to develop a Persian version of the CarerQol-7D in the context of Iranian caregivers of patients with multiple sclerosis (MS). To this end, we investigated the validity and reliability of the mentioned instrument. Methods: In this cross-sectional study using consecutive sampling method, the backward-forward translation method was used to achieve the Persian version of CarerQol-7D. Structural equation modeling (SEM) was used to perform confirmatory factor analysis (CFA). Cronbach's alpha was also reported for this instrument for the evaluation of internal consistency. Results: This tool was evaluated based on a sample of 452 caregivers of patients with MS from Sina Hospital, Tehran, Iran. Most of the participants were men (62.6%) and spouses of patients (56.6%). Based on the correlation of caregivers' characteristics, the clinical validity of this tool was observed to be relatively moderate. The Cronbach's alpha for this tool was estimated to be 65%. The normed fit index (NFI) (0.906), relative fit index (RFI) (0.812), incremental fit index (IFI) (0.948), Tucker-Lewis index (TLI) (0.892), comparative fit index (CFI) (0.946), and root mean square error of approximation (RMSEA) (0.049) were the model fit indices for the CarerQol-7D instrument. Conclusion: The findings showed good internal consistency and strong validity of the CarerQol-7D. Thus, we suggest researchers use this instrument to measure the QoL of caregivers for use in economic evaluations.

Background: A large percentage of patients with Parkinson's disease (PD) suffer from excessive daytime sleepiness (EDS). This study aims to compare the effectiveness of modafinil and methylphenidate on EDS and side effects. Methods: Fifty nine patients with PD and EDS [Epworth Sleepiness Scale (ESS) more than 9] were recruited in a double-blind placebo controlled trial. Twenty-two patients received modafinil 200 mg daily, twenty-six patients received methylphenidate 10 mg daily, and 11 patients received placebo for 6 weeks. Pittsburgh Sleep Quality Index (PSQI) and ESS were filled out at baseline and 6 weeks later. Results: There was no significant difference in demographics, PSQI, and ESS variables at baseline. The mean of ESS scores decreased significantly in modafinil (17.36 ± 5.05 vs. 10.55 ± 4.62, P < 0.001) and methylphenidate (16.27 ± 5.40 vs. 12.23 ± 6.28, P < 0.001) groups after 6-week trial, compared with control group (14.27 ± 4.49 vs. 14.09 ± 4.46, P = 0.710). The effectiveness of modafinil and methylphenidate on improving daytime sleepiness and night sleep of patients was not significantly different. Conclusion: Both modafinil and methylphenidate were effective drugs in improving EDS and quality of sleep without significant difference in efficiency and side effects.

Background: Isaacs' syndrome is a form of generalized peripheral nerve hyperexcitability (PNH) causing increased and continuous muscle activity characterized by muscle twitching, stiffness, cramps, myokymia, and pseudomyotonia. Herein, we aimed to review the clinical and paraclinical aspects of Isaacs' syndrome in a number of cases. Methods: We reported a series of 12 patients with Isaacs' syndrome, including their clinical features, electrophysiological findings, laboratory parameters, malignancy work-up, and therapeutic management. Results: In all cases, clinical and electrodiagnostic assessment was suggestive of Isaacs' syndrome. Of the 12 studied cases, 5 patients were positive for both leucine-rich glioma inactivated 1 (LGI1) and contactin-associated protein-like 2 (CASPR2) antibodies, 5 patients were CASPR2 positive and LGI1 negative, and 1 had borderline positive titers for CASPR2 with negative LGI1 antibody. The search for underlying malignancies was inconclusive in all subjects. After symptomatic treatment, mostly with carbamazepine or gabapentin, immunotherapies with double filtration plasmapheresis or Intravenous immunoglobulin (IVIG) provided favorable outcomes. Ultimately, all subjects fully recovered after 3-6 months of follow-up and all signs and symptoms resolved. Conclusion: Despite the rarity of the disease, our results provide valuable information for understanding the epidemiological, clinical, and paraclinical features of Isaacs' syndrome.

Background: An effective and reliable assessment tool is essential for evaluating the leisure activities of patients. The purpose of this study is to assess the validity and reliability of the Iranian-developed version of leisure questionnaire for people with multiple sclerosis (MS). Methods: Psychometric methods were used to assess face, content, differential, and convergent validity, as well as test-retest reliability. The study used SPSS software to enter data and assessed content validity using descriptive characteristics and the intraclass correlation coefficient (ICC) based on ratings by experts. Independent t-tests and analysis of variance (ANOVA) were used to analyse the differential validity, while the Pearson test was used to analyse the convergent validity by comparing it with the Nottingham Leisure Questionnaire (NLQ). The study calculated the reliability of the questionnaire using the paired t-test and ICC. Results: The subjects were 60 patients with MS. The content validity analysis showed a single measure validity coefficient of 0.158 and an average measure coefficient of 0.751, both of which were statistically significant. The results of the differential validity analysis for the entire questionnaire were also significant (t = -3.058, P = 0.003). Additionally, the convergent validity and reliability of the questionnaire were 0.92 and 0.82, respectively. Conclusion: The 50-item leisure questionnaire designed for patients with MS demonstrated good validity and reliability. Therefore, it can be used as an effective research tool for exploring the leisure activities of individuals with MS.

Background: Multiple sclerosis (MS) is the most common cause of non-traumatic disability in young individuals. There are limited reports of developing demyelinating events following the coronavirus disease 2019 (COVID-19) vaccination. Methods: We reported all individuals (n = 8) with new MS diagnoses with recent exposure (≤ 6 weeks) to the Sinopharm (BBIBP-CorV) vaccine between September 2021 and June 2022. We also reviewed the related literature published as of September 2023. Results: Of 338 newly diagnosed patients with MS who attended our tertiary referral MS center during the study period, 8 (2.36%) had their first demyelinating attack with a median interval of 2 [2.0, 4.0] weeks following the Sinopharm vaccine (sex ratio 1:1, median age: 20.5 [18.0, 27.0] years). No personal or family history of autoimmune/neurological disorders was documented, except for one patient's history of a previous potential demyelinating event and another's family history of immune thrombocytopenic purpura (ITP). All patients had demyelinating brain MRI lesions, and 4 had cervical spinal cord involvement. The brain areas most commonly affected were the periventricular and subcortical regions. Positive oligoclonal bands (OCBs) in all patients supported the MS diagnosis. All patients were diagnosed with relapsing-remitting MS and received intravenous methylprednisolone (IVMP) alone or in combination with plasma exchange (3/8). Rituximab was the most frequently used disease-modifying treatment (3/8). Conclusion: This study provides preliminary evidence of a potential association between the Sinopharm vaccine and the initial manifestations of MS. However, further larger-scale studies with control groups and long-term follow-ups are needed to confirm this association and determine the underlying mechanisms.

Background: The etiological factors leading to progressive supranuclear palsy (PSP) are poorly understood. This study aims to evaluate the role of various risk factors in patients with PSP. Methods: A case-control study was conducted over a period of two years from March 2016 to March 2018. The cases were recruited independently by two senior neurologists and a consensus was then reached after discussion for their inclusion. The controls were free of parkinsonian features or dementia and matched by age (± 3 years), sex, and race with the cases. The study population was then interviewed using a standard questionnaire for various possible risk factors. Variables with a significance (P ≤ 0.05) in univariate analysis were considered for bivariate analysis, multivariate analysis, and logistic-regression analysis. Results: A total of 51 cases with an equal number of controls were included in this study. Ten separate variables that included poor educational status, well water, smoking, tapioca, bakery/fast food, tea ≥ 5 cups/day, personality, exposure to pets, exposure to cattle, and family history of stroke were found to show statistical significance after univariate analysis. Among these, tapioca consumption, fast food and bakery items consumption, type A personality, and family history of stroke were found significant after adjusting for the confounding factors. Conclusion: The possible etiological factors that have a relevance in the causation of PSP as borne out in our study include dietary habits such as tapioca, fast food, and bakery items consumption, family history of stroke, and type A personality trait.

Background: COVID-19 was associated with an increased number of patients with mucormycosis (MCR), followed by septic cavernous sinus thrombosis (SCST). We evaluated the association between anticoagulation (AC) and mortality/morbidity of COVID-19-associated MCR (CAM)-induced SCST. Methods: In this retrospective study, neurological sequelae, functional outcomes, and in-hospital mortality were compared between AC receivers and non-receivers. In addition, the association between AC and survivability was examined. Results: Twenty-nine patients (17 male; mean age: 51.27 years) with CAM-induced SCST were included in the study. The median intervals between COVID-19 and MCR, and COVID-19 and SCST were 19 and 27 days, respectively. Among AC recipients, the interval between SCST and AC initiation was 18 days, with an AC duration of 37 days. Baseline and management-related characteristics were comparable between AC recipients and non-recipients (P > 0.050). AC receivers (n = 15) and non-receivers (n = 14) did not significantly differ in terms of the proportion of sequelae (6/15 vs. 5/14; P = 1.000), complete recovery (2/15 vs. 4/14; P = 0.687), and in-hospital mortality (3/15 vs. 3/14; P > 0.999). Nevertheless, AC recipients had a longer hospital stay (72.0 vs. 35.5; P = 0.016). AC-related characteristics (AC receiving, type, early initiation, and duration) were not significantly different between survivors and non-survivors, or between recovered and disabled patients. Conclusion: In our study, CAM-induced SCST in-hospital mortality/morbidity did not differ between AC receivers and non-receivers. AC characteristics were not different between survivors and non-survivors, or recovered and disabled patients. However, the small sample size may have limited the ability to detect significant differences, leading to inconclusive results.

Background: Inflammation is the major contributor to the pathophysiology of ischemic stroke (IS). Long non-coding ribonucleic acids (lncRNAs) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) and tumor necrosis factor and heterogeneous nuclear ribonucleoprotein L-related immunoregulatory (THRIL) have been demonstrated to be up-regulated in inflammation and atherosclerosis. Therefore, we aimed to study the expression profile of these lncRNAs after IS. Methods: This observational case-control study was conducted in Namazi Hospital, Shiraz, Iran. The real-time polymerase chain reaction (RT-PCR) measured the sequential changes in circulating levels of MALAT1 and THRIL on days 1, 3, and 5 after IS. The receiver operating characteristic (ROC) curve analysis was used to estimate the diagnostic and prognostic potential of lncRNAs with the area under the curve (AUC). Results: In patients with IS, the relative MALAT1 and THRIL expressions were significantly higher than the controls (P < 0.001 and P < 0.01, respectively), on days 1, 3, and 5 after stroke. We showed a significantly increase in lncRNAs expression on day five compared to days 1 and 3 after stroke. Moreover, a positive correlation was detected between MALAT1 expression and time within the first 24 hours after stroke (r = 0.27, P = 0.03). Logistic regression analysis showed a significant positive association between MALAT1 and THRIL and the risk of stroke evolution. We found a potential diagnostic marker for MALAT1 with an AUC of 0.78. Conclusion: We demonstrated the significant sequential upregulation in MALAT1 and THRIL expression on days 1, 3, and 5 after IS with a significant positive association with the risk of stroke. MALAT1 also significantly correlated with time within the first 24 hours after stroke.