Examining the validity and reliability of the Persian version of the MiND-B questionnaire in ALS patients.

BACKGROUND: In addition to affecting the nerves and muscles, amyotrophic lateral sclerosis (ALS) disease also affects the behavior and cognition of patients. In this study, we examine the validity and reliability of the Persian version of Motor Neuron Disease Behavioral instrument (MiND-B) questionnaire to investigate behavioral changes in Persian-speaking ALS patients. METHODS: Forty-six Persian-speaking patients with ALS filled out the MiND-B questionnaire. Then, the overall scores and each of the domains of this questionnaire were statistically analyzed. RESULTS: Cronbach's alpha coefficient was calculated .70 for the whole questionnaire. To check the validity of the questionnaire, the correlation of its scores with the Edinburgh Cognitive and Behavioral ALS screen (ECAS-A) questionnaire was taken, and this correlation was significant (p = .038). CONCLUSION: The findings of this study show that the Persian version of the MiND-B questionnaire has the necessary validity and reliability to investigate behavioral changes in Persian-speaking patients with ALS.

Clinical determinants of sleep quality in patients with amyotrophic lateral sclerosis.

OBJECTIVES: Poor sleep quality is more prevalent in patients with amyotrophic lateral sclerosis (ALS) than in healthy populations. The purpose of this study was to examine whether or not motor dysfunction at various distinct levels correlates with subjective sleep quality. METHODS: Patients with ALS and controls were assessed using the Pittsburgh Sleep Quality Index (PSQI), ALS Functional Rating Scale Revised (ALSFRS-R), Beck Depression Inventory-II (BDI-II), and the Epworth Sleepiness Scale (ESS). The ALSFRS-R was used to obtain information on 12 different aspects of motor function in patients with ALS. We compared these data between the groups with poor and good sleep quality. RESULTS: A total of 92 patients with ALS and 92 age- and sex-matched controls entered the study. The global PSQI score was significantly higher in patients with ALS than in healthy subjects (5.5 ± 4.2 vs. 4.0 ± 2.8) and 44% of the patients with ALS had poor sleep quality (PSQI score > 5). The sleep duration, sleep efficiency, and sleep disturbances components were significantly worse in patients with ALS. Sleep quality (PSQI) score correlated with ALSFRS-R score, BDI-II score, and ESS score. Of the 12 ALSFRS-R functions, swallowing significantly affected sleep quality. Orthopnea, speech, salivation, dyspnea, and walking had a medium effect. In addition, turning in bed, climbing stairs, and dressing and hygiene were found to have a small effect on sleep quality among patients with ALS. CONCLUSIONS: Nearly half of our patients had poor sleep quality related to disease severity, depression, and daytime sleepiness. Bulbar muscle dysfunction may be associated with sleep disturbances in individuals with ALS, particularly when swallowing is impaired. In addition, patients suffering from axial or lower limb muscle disruptions are likely to have trouble sleeping.

Memantine administration in patients with optic neuritis: a double blind randomized clinical trial.

INTRODUCTION: As an inflammatory phenomenon, optic neuritis (ON) that causes demyelination in the optic nerve damages the retinal cells, and leads to visual impairment. Herein, we aimed to investigate the potential therapeutic effects of memantine on ON. METHODS: In this double-blinded randomized clinical trial, participants with the first episode of acute ON meeting the inclusion criteria were enrolled and were randomly divided into memantine group (MG; N = 20) and placebo group (PG; N = 18). Patients of MG received memantine for 6 weeks. The thickness of the retinal nerve fiber layer (RNFL), visual evoked potential (VEP), and visual acuity (VA) was measured in both groups at baseline and 3-month follow-up. RESULTS: Thirty-eight patients with ON were enrolled. In the follow-up, mean RNFL thickness of both groups significantly decreased in all quadrants (P < 0.001). Also, RNFL thickness of all but temporal quadrants were significantly higher in the MG than placebo. The reduction in RNFL thickness difference was insignificant between two groups in all but the inferior quadrant which was significantly lower in MG (P = 0.024). In follow-up, mean-to-peak of P100 of the affected eye were significantly lowered (P < 0.001). The changes in VEP were insignificant. Originally, the mean VA was 0.15 ± 0.08 and 0.17 ± 0.09 in MG and PG, respectively, but was improved significantly to 0.92 ± 0.06 and 0.91 ± 0.06 in MG and PG, respectively, in follow-up. CONCLUSION: Memantine can reduce the RNFL thinning in three quadrants by blocking NMD receptors. However, visual acuity did not show a significant difference between the two groups.

Alterations of the serum and CSF ferritin levels and the diagnosis and prognosis of amyotrophic lateral sclerosis.

BACKGROUND: The ALS diagnostic challenges necessitate more robust diagnostic and prognostic methods. A potential biomarker in this regard is the alterations of ferritin levels in the serum and CSF of patients compared to controls. METHODS: The CSF and serum ferritin levels were measured in 50 ALS cases and 50 control patients with predefined exclusion criteria. The ELISA method was utilized for laboratory measurement and was statistically analyzed using the SPSS. RESULTS: Heightened serum ferritin levels in cases were not statistically significant. However, CSF ferritin levels were significantly higher in ALS patients (P < 0.001). Serum ferritin levels were significantly negatively correlated with the disease duration (P = 0.015) and were significantly positively correlated with the disease progression rate (DPR) (P = 0.012). CONCLUSION: Heightened CSF ferritin levels can be used for the diagnosis of ALS. The correlation between the serum ferritin levels with the DPR and its correlation with the disease duration suggests potential prognostic utilities.

Smart Acute Stroke Quality Registry Design-Data Elements Identification.

INTRODUCTION: Stroke is one of the most important health problems around the world. Care quality improvement in the acute phase is significantly influential on stroke prognosis. An acute stroke quality registry that is integrated with a guideline-based support tool is a powerful system for measuring and improving care quality. As the first step in registry system design, the goal of this study was to identify relative data elements. METHODS: A list of common data elements taken from the National Institute of Neurological Disorders and Stroke and a list of data elements for paper-based medical records were first evaluated, then compared with each other. In parallel, a literature review was conducted to explore the main data elements in acute stroke registries. Considering quality improvement as the main purpose, a second study was undertaken to identify the measures of acute stroke care quality. For guideline-based smart diagnosis of patients' eligibility for thrombolytic treatment (as a clinical support tool), clinical guidelines of the American Heart Association were assessed, and appropriate eligibility criteria were identified. Finally, a questionnaire was prepared based on the identified data elements. The questionnaire was distributed among 17 neurology physicians for identification of essential data elements (minimum data sets). RESULTS: Patient-centric data elements were identified and classified into 3 categories: (1) data elements identified based on acute stroke care quality measures; (2) data elements for diagnosis of patients' eligibility for tissue plasminogen activator treatment based on clinical guidelines; and (3) essential data elements based on paper medical records. After duplication removal, the 3 categories of data elements were integrated. Finally, essential data elements were identified using the neurology clinical experts' survey. CONCLUSION: Compared to traditional disease registries, quality improvement registries cover much more detailed data elements. Integration of medical record data elements with care quality measures, as well as guideline-based criteria, results in a powerful source of data for more exact studies and analysis by clinical support tools. Identifying essential data elements as a mandatory part of the system helps with more accurate data entry, and can also be considered a ready-to-use item for other relative systems.