Background: To date, few results on well-being in individuals with neurological disease have been published, while several studies in other groups have indicated that well-being may not be the only ...absence of psychological distress, but also positive psychological function. The aim of the present study was to compare the psychological well-being (PWB) between the people with Multiple sclerosis (MS) and normal individuals and identify correlated demographic factors to PWB in people with MS disorder. Materials and Methods: A case-control study was performed in July 2012 on 55 people with MS who were referred to MS clinic (located at the Kashani Hospital), Isfahan Neurosciences Research Centre and 83 normal individuals with matched mean of age, level of education, and gender. The participants filled up the 18-item Ryff′s PWB and demographic profile. The data were analyzed by SPSS software based on the independent t-test, and ANOVA. Results: There is significant different in all PWB dimensions between people with MS and normal groups. There were no significant differences in PWB in people with MS in relation to gender and marital status, but individuals with higher level of education scored higher in total PWB, positive relationship with others and purpose in life. Conclusion: People with MS are at risk of lower level of PWB. Interventional programs for improving PWB are strongly recommended.
Background: The COVID-19 vaccination was one of the most important medical events of the century which resulted in the end of a horrible pandemic. Since NMOSD patients were high-risk for COVID-19 ...infection, they had priority in vaccination like patients with other autoimmune disorders. But the point is that immunological effects of vaccines may lead to disease activation and acute relapses. Objectives: In this study we aimed to report any acute relapses or neurological deficits, that occurred within three months after each episode of COVID-19 vaccination in Iranian NMOSD patients. The type and severity of symptoms were noticed. Methods: We asked 170 NMOSD patients who had been registered in our NMOSD clinic electronic database about experiencing acute relapses or neurological deficits during three months after each dose of COVID-19 vaccine. There was positive response in 7 patients out of 170. The duration between vaccine shot and neurological sign had been considered. Results: Acute relapses occurred in seven NMO patients (four seropositive) after vaccination shot. All of them were female with mean age of 39.28±7.02 years and disease duration about 7.14±2.41 years. The earliest relapse happened 2 weeks after vaccine shot and the latest one happened two months later but most of the relapses occurred about one month after vaccination. The type of neurological conflict included optic neuritis in two patients, myelitis in two patients, cranial nerves palsy, area postreoma syndrome and paresthesia. They received corticostroid pulse therapy. Optic neuritis in one patient was so severe that she received plasma exchange therapy. All of them were treated by rituximab as maintenance therapy. Conclusion: In our study 4.11% of patients experienced acute relapses after vaccination but we don’t know if it is a coincidence, or it is directly due to the immunological effect of vaccine. The other probability is the duration between receiving rituximab and vaccination, which is usually more than 4 months and in this time the drug effect is reduced and the immune system is more prone to be activated by vaccination.
Fingolimod was the first oral therapy approved for treating relapsing-remitting multiple sclerosis (RRMS) in 2010. This open-label study evaluated the safety and efficacy of fingolide
, 0.5 mg in ...Iranian MS patients during one-year follow-up.
A multicenter, open-label, longitudinal was designed to evaluate the safety and efficacy of fingolide
, 0.5 mg over a one-year follow-up period across 11 centers. The patients were visited by their neurologists every two months to evaluate possible adverse events and clinical disease activity considered by recording Kurtzke's Expanded Disability Status Scale (EDSS).
A total of 252 patients with the mean treatment duration of 343±45.70 days were. 20 patients experienced adverse events (AEs) and serious adverse events (SAEs) such as resistant urinary tract infection (UTI), premature atrial contraction (PAC), skin allergic reaction, macular edema, chicken pox, zona, panic attacks, and exacerbations associated with steroids treatment, all of which led to Fingolide
discontinuation. The mean EDSS decreased from (2.15±1.29, 95%CI: 1.99to2.32) at baseline to (1.85±1.22, 95%CI: 1.68to2.02) at 12th month (final visit) while a p-value revealed significant differences comparing baseline and final EDSS (p<0.001). Mean annualized relapse rate (ARR) of the patients in one year prior to the study was (0.006±0.016, 95%CI: 0.004to0.008) which changed to (0.005±0.016, 95%CI: 0.003to0.007) at the end of the study period. Patients with a 12-month period of fingolide
treatment experienced sustained ARR and disease progression (p<0.001).
The obtained findings suggest that the administration of Fingolide
, 0.5 mg (Fingolimod, Osvahpharma, Tehran, Iran) is safe and efficient for Iranian MS patients.
Background: Methotrexate, a toxic antimetabolite that limits cellular reproduction by acting as an antagonist to folic acid, has been used to control autoimmune disease with different results. The ...aim of this study was to evaluate the effectiveness of low dose Methotrexate in the relapsing-remitting multiple sclerosis (RRMS). Methods: Eighty patients with definite RRMS aged 15 to 55 years were randomly allocated to receive a 12-month treatment course of either oral Methotrexate (7.5 mg/week) or intramuscular Interferon β-1α (30 μg/week). Response to treatment was assessed at 12 months after start of therapy. Results: The results of the study demonstrated significant reduction in relapse rate in both groups (p < 0.01). In 40 patients treated by Methotrexate, the mean value (SD) of relapse rate decreased from 1.75 (0.74) to 0.97 (0.83) (p < 0.01). Correspondingly, the mean value (SD) of relapse rate in patients treated by Interferon β-1α decreased from 1.52 (0.59) to 0.57 (0.78) (p < 0.01). Decrease of relapse rate in Interferon β-1α group was more than that in the other group (p = 0.06). Conclusions: This study suggests that although treatment with Methotrexate may significantly reduce relapse rate and slow progression of disease in patients with RRMS, its efficacy is less than Interferon β-1α and it may be better used as add-on therapy.
Background: Coronavirus 2019 created a pandemic with high mortality recently. People with underlying disease are prone to severe infection. The nature of NMOSD disease and its treatment by ...immunosuppressant predisposes patients to infection. Objectives: The aim of this study was to evaluate the effect of COVID-19 pandemic on the clinical course of NMOSD and also the characteristics of COVID-19 infection in NMOSD patient. Materials & Methods: This descriptive study was done in Isfahan, Iran from March 2020 to March 2021. We considered relapses during the year of epidemic and the year before, and also the presentation of COVID-19 infection in the patients of NMOSD Clinic of Isfahan Kashani hospital. Results: Study included 120 patients. Their mean age was 36.37±9.69 and mean duration of disease was 8.49±5.35 years. They experienced overall 36 relapses during the year before epidemic (ARR:0.3) and 29 relapses during COVID-19 epidemic (ARR is 0.24). The maintenance therapy of NMOSD was rituximab in 96 cases, azathioprine in 22 and methotrexate in 2 ones. 35 patients infected by COVID-19 (based on RT-PCR test). 6 of them admitted in hospital and two patients received ICU care. There was one death due to respiratory failure. Conclusion: In spite of suppression of the immune system, neither incidence nor the number of the serious complications of COVID-19 infection was high. Therefore, regarding the disabling nature of NMOSD as well as prolonged epidemic period, it may be reasonable to continue the routine treatment of these patients along with training patients to stick to health protection instructions.
To manage relapsing-remitting multiple sclerosis (MS) in the course of acute exacerbations, methylprednisolone (MP) (Medrol or Solu-Medrol), has the ability to lock the injured blood-brain barrier ...and decrease irritation in the central nervous system. The aim of this preliminary study was to investigate the frequency and time interval related to MP pulse therapy in patients with MS.
This Study is conducted in the MS clinic of the Isfahan Kashani hospital, that was carried out on patients (n = 901) from June 2011 to December 2012. Patients who visited MS clinic just for once disinterested from analysis. According to the incidence of MP pulse therapy in females and males, two groups were made. Group 1 included patients with 2-3 times and Group 2 included patients with more than 4 times pulse therapy. Demographical data, pharmacological variables including number and time interval related to pulse therapy for each individual were recorded in dBase. The statistical analyses of d-Base were performed using SPSS.
901 patients in 1592 occasions were studied. The mean age of patients was 34.6 years old (ranged: 8-87 years old). 586 patients included 465 females and 121 males visited MS clinic just for once. 245 females in 797 occasions and 70 males in 209 occasions received pulse therapy with a mean of 4 times (ranged: 2-11 times). 51.1% and 48.9% of patients received MP pulse therapy for two and more than two up to 11 times respectively. In the 70% of the patients' time interval between pulse therapy was with a mean of 137 days (ranged: 28-480 days).
For pulse therapy, it seems that the female subjects refer to clinic are approximately 3.7 times higher than male subjects. To reduce the demand of patients to pulse therapy, disease management could be rationalized on the basis of illness expansion and its correlation to inter and intra individual variability. Finally, to understand the effectiveness of pharmacotherapy, in MS population (Isfahan/Iran), clinical neuropharmacology in relation to better understand of the individualized pharmacokinetics could be useful.
The relation between Vitamin D deficiency with depressive and fatigue symptoms in both Multiple sclerosis (MS) patients and healthy population have been reported. To represent our regional ...achievement in this field we investigated the relation between Vitamin D status with fatigue and depressive symptoms in MS patients.
In two hundred MS patients, depressive symptoms and fatigue were measured using Beck PC (BDI-PC) and FFS scale, respectively. Venous blood sample was obtained from all participants and serum 25-hydroxy Vitamin D was measured by radioimmunoassay (RIA) method. Mean score of FSS, BDI-PC and EDSS were compared in patients with normal and low level of Vitamin D. The relation between FSS, BDI-PC score, EDSS and low Vitamin D status was determined.
There was a moderate significant correlation between MS disability evaluated by EDSS and fatigue (r = 0.37, P < 0.001) and depression (r = 0.26, P < 0.001). The prevalence of low Vitamin D status was 48.5%. Low Vitamin D status was inversely associated with depressive symptoms of patients with MS (P = 0.02 rs = -0.16), but there was not significant correlation between Vitamin D and fatigue symptoms (P = 0.2).
More interventional studies for determining the role of Vitamin D supplements in this regard is recommended.
According to the international reports, brain stroke is the main reason of death and disability. In ischemic stroke, early and precise classification of patients who may profit from conflicting ...finest therapeutic interference is necessary if enhanced effects in terms of survival are to be talented. Due to uncomplicated, easy performance, and inexpensive method the aim of this preliminary study was to investigate changes related to biochemical and hematological variables in patients with stroke.
A cross-sectional study located at the neurology ward of the Ayatolah Kashani and Alzahra Hospitals' (conducted to Isfahan Neurosciences Research Center) was carried out on fifty patients (females; n = 20 and males; n = 30) between April 1, 2012 and September 31, 2012. The data from subjects' records were taken for analyzing variables. The statistical analysis of d-base was performed using (SPSS) for windows.
Analysis of available data showed that with a mean of 182.4 mg/dl, blood sugar (BS) ranged from 75 to 300 mg/dl (n = 15/50). The changes in hemoglobin (Hgb) (mean 4.6 g/dl, n = 27/50), platelet (mean 210, 653/mm(3), n = 26/50) and lymphocyte (Lymph) (mean 37, n = 26/50) seems to be significant. The mean age of females was 76 years (ranged 46-93 years). The mean age of males was 70 years (ranged 31-90 years). Information related to previous drug history was available only in 24 patients. In 5 out of 22 cases ischemic heart disease (IHD) were positive. In 8 out of 29 cases, diabetes mellitus was positive. In 5 out of 28 cases, hypertension (HTN) was positive. In the four patients both IHD and HTN were positive.
Any considerable alter in patients' biochemical and hematological figures (BS, Hgb, Plt and Lymph) may necessitate further attention related to inter- and intra-individual variability in clinical supervision and drug's assortment. Therefore, success in treatment could be achieved by the close management of clinical, biochemical, hematological, and pharmacological manifestation. To reduce disability, mortality, and morbidity in Iranian stroke population further clinical studies are needed to correlate drugs and laboratory markers to associated clinical events in order.
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