role of melatonin in the pathogenesis of multiple sclerosis: a case-control study

The association between the prevalence of multiple sclerosis [MS] and latitude gradient indicates the importance of environmental factors in MS susceptibility. Sunlight's ultraviolet radiation, its ability to influence melatonin, and an imbalance of melatonin in the central nervous system [CNS] may be involved in this process. This case-control study was conducted in Isfahan MS Society [IMSS], Isfahan, Iran. Enrollment was limited to patients with MS referring to the MS clinic of Alzahra and Kashani hospital during January and February 2012. Thirty-five patients with MS and 35 healthy individuals were included in our study. The melatonin levels were analyzed using enzyme-linked immunosorbent assay [ELISA] kits. There was no significant difference between saliva melatonin level of two groups [patients and healthy individuals] [P = 0.417]; however, after controlling the effect of age, a significant difference [P= 0.022] was found. In the present study, it is proposed that environmental conditions in Isfahan city might have increased the susceptibility to MS, but more studies in different parts of the world are needed to evaluate this claim

Comparison of botulinum toxin type-A and divalproex sodium for prevention of chronic and episodic migraine

Background & Objective: There is a need for a more effective and better tolerated prophylactic treatment of migraine. This study aims to compare the effi cacy of botulinum toxin type-A (Dysport) and divalproex sodium (divalproex) as prophylactic treatment in patients with episodic or chronic migraine. Methods: This was a randomized, cross-over, single-center clinical trial. Participants were randomly divided into two treatment groups. Two phases of intervention were arranged (each for three months). In the fi rst phase, patients received either Dysport (125 units) or divalproex (200 mg bid for three months). The patients were left for a three months washout period, and then the treatment agents were swapped in the second stage. The response to each treatment was assessed at the end of each phase. Results: With divalproex, the frequency, intensity and duration of headache, as well as analgesic consumption were signifi cantly reduced (p<0.05) in both episodic and chronic patients. However, Dysport demonstrated signifi cant effi cacy only in patients with episodic migraine. In chronic migraine, Dysport only showed a non signifi cant trend to benefi t in these parameters, with exception of headache intensity,where it resulted in signifi cant improvement from baseline. Divalproex was signifi cantly superior to Dysport, in terms of headache frequency and intensity in patients with episodic migraine. Conclusions: Both Dysport and divalproex are effective prophylactic therapies for patients with episodic migraine. Divalproex but not Dysport was signifi cantly effective for chronic migraine.

Evaluation of the effect of donepezil on cerebral blood flow velocity in Alzheimer's disease

To evaluate the effect of Donepezil on cerebral blood flow velocity using non-invasive transcranial Doppler [TCD] sonography. This clinical trial was carried out in the Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran from March 2008 to July 2009, on Alzheimer's disease [AD] patients in 2 groups of case and control, each consisting of 11 patients. The case group who received Donepezil medication was examined by TCD before [baseline], after 4 weeks of oral treatment with 5mg per day Donepezil, and a further 4 weeks of 10mg per day Donepezil, orally. The control group comprised AD patients who did not receive any medications, and were examined by TCD only once. Peak systolic [PSV], end-diastolic [EDV], and mean flow [MFV] velocities of the posterior cerebral artery [PCA] and the middle cerebral artery [MCA] was assessed by TCD. Also, mini-mental state examination [MMSE] was carried out. There were no significant differences between the case and control groups, in terms of age and gender. In the case group, the mean MMSE score reached 20.2 +/- 2.8 from a baseline value of 15.8 +/- 3.3 after 4 weeks of oral treatment with 5mg/d Donepezil, and reached 20.6 +/- 3.9 after 4 more weeks at 10mg/d Donepezil. In the MCA, the difference in PSV and MFV values after 4 weeks of treatment with 10mg/d Donepezil was statistically significant compared with the baseline values. In PCA, the values of MFV and EDV after 4 weeks of treatment with 10mg/d Donepezil were statistically significant in comparison with the baseline value. Donepezil [10mg/d] increased cerebral blood flow velocity and MMSE score in our AD patients, but more extensive trials are recommended

Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors

To estimate the prevalence and risk factors of peripheral neuropathy [PN] in people with type 2 diabetes mellitus. 810 patients with type 2 diabetes [289 male and 521 female] from Isfahan Endocrinology and Metabolism Research Centre outpatient clinics, Iran, were examined. Part of the examination included an assessment of neurological function including neuropathic symptoms and physical signs, and nerve conduction velocity. The prevalence of PN was 75.1% [95% confidence interval [CI] 72.1, 78.0]. Peripheral neuropathy was associated with age, proteinuria, and duration of diabetes, insulin-treatment, and presence of retinopathy and ischaemic heart disease [IHD]. The age-adjusted prevalence rate of PN was 78% higher among patients with IHD, 64% higher among patients with any retinopathy, 66% higher among insulin-treated type 2 diabetes, and greater with duration of diabetes. Using a stepwise binary logistic regression model, age, duration of diabetes and proteinuria were significant independent predictors of PN. PN is a common complication in this population of Iranian type 2 diabetic patients. It increases with age, duration of diabetes and proteinuria