Reflex epilepsy: a review

Interesting phenomena of reflex epileptic syndromes are characterized by epileptic seizures each one induced by specific stimulus with a variety of types. Simple triggers, which lead to seizures within seconds, are of sensory type [most commonly visual, most rarely tactile or proprioceptive stimuli]. Complex triggers, which are mostly of cognitive type such as praxis, reading, talking, and music, usually induce the epileptic event within minutes. It should differ from what most epileptic patients report as provocative precipitants for seizures [such as emotional stress, fatigue, fever, sleep deprivation, alcohol, and menstrual cycle]. The identification of a specific trigger is not only important for patients or their parents to avoid seizures, but also it might help neurologists to choose the most effective antiepileptic drug for each case. In addition, research in this area may possibly reveal some underlying pathophysiology of epileptic phenomena in the brain. In this review, we briefly introduce reported reflex epileptic seizures, their clinical features and management

Clinical trial of subcutaneous steroid injection in patients with migraine disorder

Background: Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients

Methods: Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area [exactly at retromastoid cervicocranial junction] and the other two injections in the lower medial frontal area [exactly at medial right and left eyebrows]. A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis

Results: 504 patients [378 females, 126 males] with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection

Conclusion: Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache

Recognition of special form of amphetamine acquaintance in iran and presentation of 4 cases with neurovascular complication

Ecstasy and crystal are recently new most widely abused illegal drugs in Iran. Ecstasy/MDMA abuse may cause acute complications that have fatal consequences. Pt 1: A 26 year old who referred to emergency room due to acute paraplegia and finally died with cardiac arrest. Pt 2: A 45 year old woman who came with seizure disorder and unconsciousness. Finally she died due to cardiac arrest. Pt 3: A 32 year old man was admitted due to acute flaccid paraplegia. He had diffused skin rash due to vasculitis. The patient died despite of supportive cares. Pt 4: A 23 year old man who referred to neurological ward because of generalized tonic-clonic seizures following Crystal and Ecstasy abuse. The patient was discharged after 4 days with good general conditions. Unfortunately recently, the rate of Ecstasy and Crystal drugs abusers in Iran have increased. This paper notify about the neurological side effects of these drugs

Brain venous thrombosis

The First Cerebral vein thrombosis was reported in 1825. Early diagnosis is very important, because early treatment can prevent mortality in most cases. Also, cerebral vein thrombosis is preventable by finding the underlying etiology. True incidence of cerebral vein thrombosis is not predicative. This descriptive study was performed from 2005 through 2006 on patients referred to Qaem Hospital neurological emergency ward. All of the patients with clinical feature of ICP rising were evaluated and underwent CT scan and MRI of brain. In cases suspicious to cerebral vein thrombosis, the disease was actually diagnosed with MR venography of brain, after discharge Patients were followed up every week for 3 weeks in neurological clinic of Qaem Hospital. From 20 evaluated patients, 70% were female and 30% were male, in which the ratio of F/M was 3/2. Patients mean age was 30 year. The most clinical feature was headache. Underlying etiologies in above patients were: OCP consumption, post partum period, mediaotitis, nephrotic syndrome and Crystal abuse. In MRI and MRV assays of studied patients, 20% had superior sagital sinus, 10% lateral sinus, 5% sigmoid sinus and 65% had superior sagital and lateral sinus involvement simultaneously. In patients who refer having headache and papilla edema, cerebral vein thrombosis should be considered. Early diagnosis is achieved by precise diagnostic methods like MRI and MRV, and the prevention of severe irreversible and fatal side effects of disease with the early treatment

investigation into the CSFabsorption in cats

Cerebrospinal fluid [CSF], its secretion, circulation and absorption have been the subject of recent researches. There is a general agreement that the main site of CSF secretion is in the choroids plexus. However, the main absorption site is controversial. Some believe that arachnoid granulations are the principle sites of CSF absorption. In this study, different locations of CSF absorption in cats are investigated. 2 ml [100 mg], of ferrous dextran was injected into the subarachnoid compartment of seven cats. After 15 days the animals were euthanized, and the central nervous system [CNS] and its relative tissues were analyzed for any iron amlumulation. Several tissue samples were taken and stained with Prussian blue and Hernatoxylin-eosin. The light microscopic study of different tissues showed amlumulation of the tracer in olfactory and optic nerves, dorsal root ganglia as well as spinal nerve roots. The main locations of CSF absorption were the spinal nerve roots and their surrounding lymphatic tissue. There is reason to believe that some endothelial fenestrate within these roots were involved in this process