Immune rebound: multiple sclerosis after treatment of Cushing's disease

High cortisol level in endogenous Cushing's syndrome suppresses the immune system and after treatment there may be an over activity of immune reaction leading to autoimmune diseases mostly thyroid and rheumatologic disorders. This is the second reported case of multiple sclerosis developing after treatment of Cushing's syndrome. A 42-year old man is reported who presented with bone fracture and osteoporosis and diagnosed with Cushing's disease. Six months after surgical treatment of his pituitary adenoma, he developed progressive multiple sclerosis. We conclude that after treatment of endogenous Cushing's syndrome, the patients should be watched for development of autoimmune disorders including those affecting the central nervous system

Effect of Motor Imagery on the F-Wave Parameters in Hemiparetic Stroke Survivors

OBJECTIVE: To assess the effect of motor imagery, as a rehabilitation method in stroke, on F-wave parameters that undergo changes during upper motor neuron involvement. METHODS: Twenty-one fully conscious hemiparetic stroke survivors with a completely plegic hand (power 0/5) and a minimum interval of 72 hours since stroke were recruited into this study. The mean F-wave latency, amplitude, and persistence in the median and ulnar nerves were measured in both the affected and non-affected sides at rest and in the paretic hand during a mental task. Comparison was made between data from the affected hand and the non-affected hand as well as between data from the affected hand at baseline and during motor imagery. RESULTS: Patients had significantly different F-wave persistence between the affected and non-affected sides (paired t-test, p<0.001). Motor imagery could improve F-wave persistence in both the investigated nerves (paired t-test, p=0.01 for ulnar nerve and p<0.001 for median nerve) and F-response amplitude in the median nerve (paired t-test, p=0.01) of the affected limb. CONCLUSION: The amplitude and persistence of F-wave were improved during motor imagery, representing F-wave facilitation. This result suggests that motor imagery can restore motor neuron excitability, which is depressed after stroke.

Educational intervention for reducing the fear of falling and improving balance in the elderly: a single blind randomized controlled trial

Falling is a major health threat for the elderly and has a significant impact on their well-being and quality of life. Yet, falls are preventable among the elderly. We sought to determine the effectiveness of an educational intervention in reducing the fear of falling and improving balance among the elderly visiting Jahandidegan center in Shiraz, Iran. A preliminary study was conducted to determine the validity and reliability of the Modified Fall Efficacy Scale [MFES] for the Iranian elderly. Then, 40 individuals, 17 males and 23 females, between 60 and 74 years old were selected for the survey. The inclusion criteria were "MFES" score of less than 8 and Berg Balance Scale [BBS] score of less than 45. After completing the demographic questionnaire, MFES, and BBS, the participants were randomly allocated to the training or control groups. In the training group, each participant took part in one fall prevention class per week for 8 consecutive weeks. On the other hand, the control group received no interventions. BBS and MFES were completed immediately after the intervention. Finally, the data were analyzed using independent sample t-test and Chi-square test. Besides, P<0.05 was considered as statistically significant. A statistically significant difference was found between the two groups regarding BBS and MFES mean scores [pre-post 8 weeks] [P<0.001]. The intervention reduced the fear of falling by 26.5% and improved balance by 4.3%. The study results indicated that attending the training classes was effective in decreasing the fear of falling and improving the balance.