Effect of 8 weeks selective training program with instructions focus of internal and external attention on statical balance of multiple sclerosis patients

Background and Objective: Multiple sclerosis [MS] is the most common progressive neurologic disorder among young adults. This disease leads to lesions regarded to as demylinating plaques which are scattered in the white matter of CNS hence create various neurological problems. This study was done to evaluate the effect of 8 weeks selective training program with instructions focus of internal and external attention on statical balance of MS patients$Methods: In this quasi-experimental study, 23 MS patients were non-randomly divided into, two interventional and one control groups. Training program for two interventional were carried out in 8 weeks, three sessions per week, and each session lasted about one hour. Pre and post test to evaluate the fall risk of subjects using Biodex system was performed in three groups

Results: Statical balance was significantly improved in the two interventional compared to control group [P<0.05]

Conclusion: The training program with instructions focus of internal and external attention significantly improves statical balance of MS patients

Creutzfeldt-jacob disease in an iranian patient confirmed by brain autopsy

Abstract Creutzfeldt-Jacob disease is the most common form of prion diseases, which have become public health problems in the last two decades because of the high number of reported cases of mad cow disease in Great Britain and other countries. Creutzfeldt-Jacob disease is a fatal situation with known cardinal clinical features including progressive memory loss and myoclonic seizure disorder. In this report, we present a case of Creutzfeldt-Jacob disease with characteristic clinical signs such as progressive memory loss, myoclonic jerks, and focal and generalized seizures. We also discuss the pathologic findings of the brain autopsy confirmed by Gottingen center [Germany] for spongiform encephalopathy

Seizure characteristics in patients with seizure attacks, visited in neurology emergency unit of Ghaem Hospital [2002-2003]

As a common symptom of brain diseases, seizure often indicates severe brain tissue involvement. The purpose of this study was to evaluate the different etiologies of seizure disorders. In this descriptive study, from Marches 2002 to February 2003 497 epileptic patients in Neurology Emergency Unit of Ghaem Hospital, Mashhad were studied. Routine laboratory tests, EEG, and brain CT-Scan was performed for all patients and brain MRI was done for some of them. Demographic data and results of laboratory tests, EEGs and brain CT-Scans were recorded in specific data collection sheets and were analyzed by SPSS software. In our patients [497 cases], 51.3% were male and the others [48.7%] were female. The mean age of our population was 37.6 years and most of patients were middle aged [35-60 years]. The prevalence of different seizures was as follows: Generalized seizures in 82.8%, Focal seizures in 7.5%, and focal seizures with secondary generalization in 9.7%. The prevalence of different etiologies of seizures was: idiopathic and cryptogenic in 48.5%, cerebral vascular diseases in 13.5%, brain tumors [primary or metastatic] in 6.8%, trauma in 6%, acquired metabolic diseases in 6%, drug intoxication or withdrawal in 4.8%, brain infections in 4.6%, developmental disorders in 2.6%, collagen vascular diseases in 2.2%, hypoxic-ischemic encephalopathy in 1.8%, phakomatosis in 0.8%, degenerative disorders in 0.8%, hypertensive encephalopathy in 0.6%, demyelinating diseases in 0.6%, and eclampsia in 0.2%. 65.85 of our patients had a previous history of at least one seizure attack, 25.25 had experienced their first seizure and 9.1% had been admitted because of status epilepticus. 15.3% of patients had positive family history for epilepsy. The most common cause of epilepsy in this study was idiopathic and cryptogenic and cerebral vascular diseases and tumors were the next common causes. Being so common as a cause of seizure and having significant morbidity and mortality, cerebral vascular diseases and brain tumors should be prevented or treated vigorously. Besides, recurrence of seizure attacks as the result of inappropriate drug intake or insufficient drug dose draws particular concern

[Etiology of first seizure, in patients refered to neurology emergency]

Seizures are frequent and important disorders in patients admitted in emergency wards, and arise from a variety of underlying conditions. This study was done to evaluate the etiology of first seizure in Neurology Emergency Department. In this descriptive study, 170 patients reffered to Neurology Department of Ghaem Hospital in the year 2003 were studied. Obtaning medical history and performing clinical examination, a questionnaire was filled and paraclinical studies [peripheral blood examination, EEC, bran CT scan and, in some cases, MRI] were done. Data was analyzed by descriptive statistics and frequency distribution tables. Out of 170 patients 97 were male and 73 female; mostly 33- 60 years of age. Most common etiologies of seizure in this study were: idiopathic, stroke, neoplastic, trauma, withdrawal syndrome, CNS infections, congenital and degenerative diseases. In this study the most common cause of first seizures was idiopathic epilepsy; but cerebrovascular diseases, head injuries, and opioid withdrawal syndrome were among the frequent causes of first seizures, wich can be controlled to reduce the number of seizures in our socity

[Evaluation of charactristics and outcome of treatment of reflex epilepsy]

Reflex epilepsy is a disorder, in which seizure attacks are induced by an external stimulus or, rarely, by a mental activity. The attacks in this disorder are usually provoked just in response to a specific stimulus and patients with this disorder have no unprovoked ictal event in most instances. This research was designed to study different reflex epilepsies and their appropriate managements. This descriptive study was done by evaluating the medical files of 9676 patients with the diagnosis of epilepsy, visited in a 10-year period [1996-2006] in Dr. Nikkhah Clinic. 33 of them with the final diagnosis of reflex epilepsy were selected. The data [such as, types of seizure, type of stimulus, electroencephalographic findings, and therapeutic strategy] was recorded for each patient in questionnaire and analyzed by appropriate descriptive statistics and frequency distribution tables. In the study population, 15 females and 18 males with reflex epilepsy, seizure attacks had been provoked by the following stimuli: visual stimuli in 21[63.6%] patients, chewing in 4[12%] patients, mathematical calculating processes in 3 [9%] patients, micturation in 3 [9%] patients, playing chess in one[3%] patient, and warm bathing in another one [3%] patient. Brain CT scan was normal in all of our patients. Seizure attacks were eliminated in 6 patients with visual-evoked reflex epilepsy after cessation of visual stimuli. Being unable to eliminate the stimulant factor, we started antiepileptic drugs for other patients. 90% of these patients have been seizure- free just with sodium valproate. In a suspected patient whose attacks are related to a specific stimulus, the practitioner should consider the nature and properties of stimulant precisely. The treatment consists of prevention from and elimination of stimulant, and pharmacological managements

[Isolated nuclear oculmotor nerve syndrome due to mesencephalic hemorrhage Report of case]

Nilateral third nerve plasy with bilateral superior rectus paresis and bilateral ptosis is a typical condition for nuclear oculomotor nerve syndrome. In these patients, other neurological examination is normal. We report a rare case nuclear oculomotor nerve syndrome due to midbrain hemorrhage. As a rare cause of intracranial hemorrhage A 59-year-old man presented with an abrupt onset of ptosis and difficulty opening his eyes. He had uncontrolled hypertension in his history. Neurological examination revealed left oculomotor palsy with impairment of bilateral upward gaze and bilateral ptosis. CT scan showed mesencephalic hematoma in superior and left area. It is emphasized that isolated mesencephalic hemorrhage may be the cause of the nuclear oculomotor nerve syndrome without of other associated neurological signs

[ etiologic study of acute non traumatic myelopathy in patients who admitted in neurology emergency of Ghaem hospital [2002-2005]]

Acute myelopathy is defined as an acute spinal cord dysfunction initiated during less than 2 weeks. Many of these spinal cord dysfunctions are reversible if quickly recognized and treated, on the contrary. If recognized late, irreversible damages are expected. In this prospective, descriptive, cross - sectional study which done in patients who admitted in neurology emergency of Ghaem hospital [2002 - 2005], we supposed acute myelopathy base on history and Clinical findings for patients with paraparesia or tetraparesia and we completed questionnaire for all them. Based on laboratory findings, X-ray, MRI, Cerebrospinal fluid [CSF] and pathology, etiology of acute myelopathy was definited or was strong probability. From 42 cases with acute myelophathy, 19 cases [45%] had myelitis, 16 cases [37%] was secondary to tumor, 5 cases [12.5%] vascular, 1 case [2.5%] structural [stenosis of spinal cord canal due to klipple fiels], 1 case [2.5%] central herniation. Results from this study [like other studies] indicate that non - infectious myelitis is the most common etiology of acute myelopathy but in this study post - infectious myelitis was observed more than MS as the etiologic agent of acute myelopathy; but in other studies , MS was most common agent

[Cerebral venus thrombosis in association with HSV1 encephalitis report of 1 case]

Encephalitis due to herpes simplex virus [HSV] is the most important cause of fatal Sporadic encephalitis that prompt diagnosis is necessary because there is effective antiviral treatment for this disorder. In the fatal cases, severe meningoencephalitis is associated with diffuse destructive changes in the brain tissue and is following the reactivation of latent virus.Recent studies demonstrate increased hypercoagulopathy state due to HSV infection in the endothelium and footprints of virus has been found in the vascular thrombosis. In this issue, one of the very rare manifestations of HSV encephalitis, which has so far been reported in a neonate, is presented. The patient presented with the signs of encephalitis including stupor state and agitation, headache, seizure and neck stiffness. The diagnosis of HSV encephalitis is confirmed by the PCR test of CSF fluid .MRI and MR venography of the patient's brain demonstrated the thrombosis of sagital, rectus and lateral venous sinus. The patient survived with the specific treatments. Herpes simplex virus type 1 can be a cause for the development of cerebral Venus thrombosis. This case report is a conformation for the studies demonstrating hypercoagulopathy state in the setting of HSV infection