Interferon-beta-1b induced autoimmune hemolytic anemia in a patient with MS: a case report

A 26-year-old lady with the diagnosis of multiple sclerosis who had received interferon beta1-b for eleven months was visited in MS clinic of our hospital because of icter and fatigue. Laboratory tests showed anemia, indirect hyperbillirubinemia, increased LDH, positive direct and indirect coomb's tests, and increased reticulocyte count and percentage. Other causes of autoimmune hemolytic anemia [AHA] and pre-existing AHA in the patient were ruled out. After INF discontinuation, symptoms disappeared, hemoglobin increased, and indirect coomb's test became negative. We concluded that autoimmune hemolytic anemia should be considered in all MS patients who receive interferon beta 1-b and present with symptoms and signs of anemia

[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