Vasomotor reactivity comparison in multiple sclerosis patients with white matter lesions and nonmultiple sclerosis subjects with white matter lesions in brain magnetic resonance imaging.

BACKGROUND: It has been recognized a close relationship between multiple sclerosis (MS) lesions and the cerebral vasculature. In this study, we observed cerebrovascular vasomotor reactivity difference between the MS patients and the non-MS migraine individuals. MATERIALS AND METHODS: This prospective study was conducted on 40 patients with MS referring to Neurology Clinic of Isfahan Al-Zahra Hospital in 2012. The patients were compared with the same number of non-MS migraine individuals. Both groups had white matter lesions in brain magnetic resonance imaging. To evaluate the rate of cerebral artery vasomotor reactivity, transcranial Doppler device was used, and breath-holding index (BHI) was separately calculated for each middle cerebral artery. Main flow velocity (MFV) was determined by continuously recording of a period of 5 min of breathing the air in the room. The obtained data were analyzed using SPSS software version 18 and t-test, Chi-square and analysis of variance tests. RESULTS: The mean values of MFV at rest was not significantly different between cases and control groups (46.21 ± 4.20 vs. 44.69 ± 4.34, P = 0.115) but difference between cases and control groups in MFV apnea was significant (59.11 ± 5.10 vs. 55.35 ± 6.03, P = 0.004). BHI in the control group was 0.79 ± 0.26 and in the case group was 0.93 ± 0.20 and these differences was found to be significant (P < 0.05). CONCLUSION: The mean of BHI and cerebral vasomotor reactivity in MS patients was more than the non-MS migraine individuals, although the mechanism of this process still remains unknown.

Oral prednisolone in the treatment of cervical radiculopathy: A randomized placebo controlled trial.

BACKGROUND: Steroids are commonly used in the treatment of cervical radiculopathy (CR), but there is limited information in this regard. We evaluated the efficacy of oral prednisone in the treatment of CR. MATERIALS AND METHODS: This randomized, double-blinded, placebo-controlled trial was conducted on adult patients with neck/shoulder pain for at least 1 month with no alarm symptoms/sings of malignancy, infection, or severe myelopathy, and no contraindication for corticosteroid use. Patients were allocated to receive prednisolone 50 mg/day for 5 days that was tapered within the following 5 days, or placebo. All patients also received acetaminophen 325 mg three times a day and ranitidine 150 mg two times a day. Neck disability index (NDI) and the verbal rating scale (VRS) were used to evaluate the outcomes. RESULTS: A total of 59 patients (31 female, mean ± SD age = 46.2 ± 9.0 years) completed the study. A significant decrease was observed regarding the NDI and VAS scores from baseline to the end of study in both groups (P < 0.001). However, for both the NDI (35.7 ± 21.4 vs. 12.9 ± 10.2) and VRS (4.4 ± 2.7 vs. 1.6 ± 1.2), the amount of decrease was greater in the prednisone compared with the placebo group (P < 0.001). Based on the clinically important change in NDI, pain was improved in 75.8% (22/29) of the prednisolone and 30% (9/30) of the placebo group (P < 0.001). CONCLUSION: A short course of oral steroid therapy with prednisolone is highly effective in reducing pain in patients referring with uncomplicated CR. Further studies are warranted on dosing, duration, and long-term efficacy and safety of oral steroid therapy, compared with injection approach.

Seizure in Iranian patients with multiple sclerosis.

BACKGROUND: There is a broad variation in reported frequencies of seizure in multiple sclerosis (MS). In this study, the seizure and its characteristics analyzed among a large group of patients with MS. PATIENTS AND METHODS: We reviewed the medical records of all definite MS patients referred to the MS Clinic of Kashani hospital, Isfahan, Iran, between 2007 and 2011. RESULTS: Altogether, 34 cases with seizure activity identified among the 920 definite MS subjects (3.69%). Five excluded due to the other probable etiologies rather than MS. In the remained 29 patients (3.15%), the type of seizure was mostly generalized (79.3%); interictal electroencephalography showed an abnormal pattern in 84.6%, brain magnetic resonance imaging revealed subcortical white mater lesions in 84.6% of patients. The mean duration of MS onsets was 8.17 years and the mean interval between MS onset and the first seizure occurrence was 3.7 years. In general, response to antiepileptic treatment was excellent. CONCLUSION: Seizures can occur at any stage during the course of MS, but it is more common during the early stages.

Late-onset multiple sclerosis in Isfahan, Iran.

BACKGROUND: Multiple sclerosis (MS) typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS (LOMS).  METHODS: In this retrospective study, we extracted the records of 3522 MS patients (2716 females and 806 males) registered in the Isfahan MS Society (IMSS) from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database. RESULTS: We found 48 LOMS patients (28 females and 20 males), which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males (2.4%) was significantly greater than in females (1.0%, P = 0.002). The mean age at onset was 55.1 ± 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects (3.37:1, P = 0.003). The leading pattern of MS was relapsing-remitting (RR) in 62.5%, followed by primary progressive (PP) in 27.1%, and secondary progressive (SP) in 10.4%. Predominant presenting symptoms and signs were motor disturbances (35.4%), followed by brainstem (25%), optic neuritis (22.9%), and sensory related deficits (18.7%). The mean progression index (PI) in LOMS patients (0.88 ± 0.48) was significantly higher than in non-LOMS cases, 0.37 ± 0.17 (P < 0.0001). DISCUSSION: In comparing LOMS patients with the non-LOMS cohort, there was a higher frequency of the PP pattern and a higher PI in the LOMS group. In comparing other high-risk populations with the Isfahan cohort, LOMS formed a lower percentage of the total Isfahan MS population.

Validation of Persian Version of PedsQL™ 4.0™ Generic Core Scales in Toddlers and Children.

INTRODUCTION: To evaluate the reliability, validity and feasibility of the Persian version of the Pediatric Quality of Life inventory (PedsQL™ 4.0™ 4.0) Generic Core Scales in Iranian healthy students ages 7-15 and chronically ill children ages 2-18. METHODS: We followed the translation methodology proposed by developer to validate Persian version of PedsQL™ 4.0™ 4.0 Generic Core Scales for children. Six hundred and sixty children and adolescents and their parents were enrolled. Sample of 160 healthy students were chosen by random cluster method between 4 regions of Isfahan education offices and 60 chronically ill children were recruited from St. Alzahra hospital private clinics. The questionnaires were fulfilled by the participants. RESULTS: The Persian version of PedsQL™ 4.0™ 4.0 Generic Core Scales discriminated between healthy and chronically ill children (healthy students mean score was 12.3 better than chronically ill children, P<0.001). Cronbachs' alpha internal consistency values exceeded 0.7 for children self reports and proxy reports of children 5-7 years old and 13-18 years old. Reliability of proxy reports for 2-4 years old was much lower than 0.7. Although, proxy reports for chronically ill children 8-12 years old was more than 0.7, these reports for healthy children with same age group was slightly lower than 0.7. Constructive, criterion face and content validity were acceptable. In addition, the Persian version of PedsQL™ 4.0™ 4.0 Generic Core Scales was feasible and easy to complete. CONCLUSION: Results showed that Persian version of PedsQL™ 4.0™ 4.0 Generic Core Scales is valid and acceptable for pediatric health researches. It is necessary to alternate scoring for 2-4 years old questionnaire and to find a way to increase reliability for healthy children aged 8-12 years especially, according to Iranian culture.