Current Journal of Neurology

Evaluation of obsessive-compulsive disorder prevalence in Iranian patients with multiple sclerosis and its relationship with demographic characteristics

Ali Keyhani — 2023-12-26

Background: The present study examined the prevalence of obsessive-compulsive disorder (OCD) among Iranian patients with multiple sclerosis (MS) and the relationship between OCD and the patient’s demographic characteristics.

Methods: The present study used a cluster sampling method to randomly select 297 patients with MS from the patients referred to the MS Clinic and Research Center of Sina University Hospital, Tehran, Iran, during 2018-2019. To gather the required data, a questionnaire consisting of demographic characteristics and disease information sections was used. Moreover, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive-Compulsive Inventory-Revised (OCI-R), and Hospital Anxiety and Depression Scale (HADS) were employed in the present study. between OCD-positive and negative groups was examined with chi-square test and independent samples t-test, respectively. Binary logistic regression was used as multivariate modeling to adjust the effects of potential confounders that could distort the relation of OCD with intended variables. Data were analyzed using SPSS software. The significance level was considered lower than 0.05.

Results: Of the total of 297 patients, 77.8% were women. Moreover, analysis of the data obtained from the HADS questionnaire revealed that 11.44% (n = 34) and 15.15% (n = 45) of patients had severe depression and severe anxiety, respectively. The results of Y-BOCS indicated that the prevalence of severe OCD among patients was 19.9%. The OCI-R questionnaire revealed that the prevalence of OCD was 47.8%, which was consistent with the total of moderate, severe, and extreme values of Y-BOCS (47.9%). Furthermore, the subscales of ordering-arranging with 69 patients (22.9%) and obsessing with 46 patients (15.5%) indicated the highest frequencies as compared to other subscales. Moreover, OCD had a significant relationship with depression, anxiety, and type of MS in this regard.

Conclusion: In this study, the prevalence rate of OCD among patients with MS was higher than its rate among the general population.

Evaluation of risk factors for recurrence of cutaneous adverse reactions due to anti-seizure medications in children: A retrospective study

Çağatay Günay — 2023-12-26

Background: Cutaneous adverse reactions (CARs) are one of the most important reasons for anti-seizure medication (ASM) discontinuation in epilepsy. However, such discontinuations can cause an increase in seizures. This study investigates the risk factors for ASM-related rash recurrence in children.

Methods: This retrospective case-control study consisted of the patient group with a single rash due to ASMs (group 1), the patient group with rash recurrence (group 2), and the control group. While the demographic and clinical features of group 1 and the control group were compared in terms of a single rash, group 1 and group 2 were compared for rash recurrence.

Results: Group 1, group 2, and control group consisted of 112, 33, and 166 patients, respectively. Female gender was a risk factor for a single rash (P < 0.001) but not for recurrence (P = 0.439). Presence of atopic disease [odds ratio (OR): 9.5, 95% confidence interval (CI): 3.8-23.1, P < 0.001], family history of drug allergy (OR: 26.3, 95% CI: 9.6-72.1, P < 0.001), and polytherapy (OR: 23.5, 95% CI: 8.7-62.9, P < 0.001) were risk factors for rash recurrence. Aromatic nature of both the ASMs associated with the first rash
(OR: 14.4, 95% CI: 3.2-63.2, P < 0.001) and rash recurrence (OR: 11.3, 95% CI: 4.6-27.5, P < 0.001) were determined as risk factors separately.

Conclusion: Careful use of aromatic drugs may prevent recurrence of ASM-related CAR in children, particularly in cases of personal history of allergic disease and family history of drug allergy.

Social support and anxiety correlation with resilience in patients with multiple sclerosis during COVID-19 pandemic

Vahid Shaygannejad — 2023-12-26

Background: Social support and anxiety are essential for patients with chronic diseases such as multiple sclerosis (MS). During coronavirus disease 2019 (COVID-19) pandemic, the psychological well-being of subjects with MS was an important issue, and we designed this study to assess anxiety, resilience, and social support in these patients during COVID-19 pandemic stage.

Methods: We used convenience sampling for this study. Inclusion criteria were definite diagnosis of MS based
on McDonald criteria and age more than 18 years.
Two hundred patients with MS were enrolled. Subjects were asked to fill out valid and reliable Persian versions of Connor-Davidson Resilience Scale (CD-RISC), Beck Anxiety Inventory (BAI), and Perceived Social Support Scale. We also collected demographic data (age, sex, marital status, and occupation), disease duration, and disability level [Expanded Disability Status Scale (EDSS)]. Continuous variables were presented as mean ± standard deviation (SD) (except for EDSS, as its distribution was not normal), and categorical variables were presented as frequencies. Correlation coefficients were calculated. We did a subgroup analysis and compared patients with BAI less than 30 and more than 30 (severe anxiety). A P-value less than 0.05 was considered significant.

Results: Mean age and mean duration of the disease were 36.5 ± 9.3 and 6.2 ± 5.4 years, respectively. Mean BAI, social support, and resilience scores were
33.8 ± 11.4, 65.7 ± 16.7, and 62.5 ± 19.4, respectively. resilience and social support scales (r = 0.44, P < 0.001), and also a significant negative correlation between resilience and BAI (r = -0.31, P < 0.001). Patients with severe anxiety (BAI > 30) had lower social support scores and resilience (social support: 70.3 ± 13.1 vs. 61.5 ± 18.6, P < 0.001; resilience: 57.3 ± 17.0 vs. 68.2 ± 19.6, P < 0.001) compared to patients with BAI ≤ 30. By considering resilience score as the dependent variable and other variables as independent variables, we found that BAI and social support scores were independent predictors.

Conclusion: Social support and anxiety are independent predictors of resilience during COVID-19 pandemic in patients with MS.

Plasma neurofilament light chain associated with impaired regional cerebral blood flow in healthy individuals

Fardin Nabizadeh — 2023-12-26

Background: Recent findings suggest that the plasma axonal structural protein, neurofilament light (NFL) chain, may serve as a potential blood biomarker for early signs of neurodegenerative diseases, such as Alzheimer’s disease (AD). Given the need for early detection of neurodegenerative disorders, the current study investigated the associations between regional cerebral blood flow (rCBF) in brain regions associated with neurodegenerative disorders and memory function with plasma NFL in AD, mild cognitive impairment (MCI), and healthy controls (HCs).

Methods: We recruited 29 AD, 76 MCI, and 39 HCs from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database in the current cross-sectional study. We used Pearson’s correlation models adjusted for the effect of age, sex, and APOE genotype to investigate the association between plasma NFL and rCBF.

Results: We found non-significant differences in age (F_{(2, 141)} = 1.304; P = 0.275) and years of education (F_{(2, 141)} = 0.013; P = 0.987). Additionally, we found significant differences between groups in terms of MMSE scores (F_{(2, 141)} = 100.953; P < 0.001). Despite the observation of significantly reduced rCBF in AD and MCI groups versus HCs, we did not detect significant differences in plasma NFL between these groups. We found significant negative associations between plasma NFL and rCBF in various AD-related regions, these findings were only observed after analyses in all participants, and were observed in HCs alone and no significant associations were observed in the AD or MCI groups.

Conclusion: These outcomes add to our current understanding surrounding the use of rCBF and plasma NFL biomarkers as tools for early detection and diagnosis of neurodegenerative diseases. A conclusion might be that the association between NFL and impaired rCBF exists before the clinical symptoms appear. Further longitudinal studies with a large sample size should be performed to examine the correlation between plasma NFL and rCBF in order to understand these complex relationships.

On genotype-phenotype relationship of dystrophinopathies among Iranian population

Keivan Basiri — 2023-12-26

Background: Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD) are inherited
X-linked disorders resulting from alterations in the dystrophin gene. Genotype-phenotype matching studies have revealed a link between disease severity, the amount of muscle dystrophin, and the extent of mutation/deletion on the dystrophin gene. This study aimed to assess the relationship between genetic alterations in the dystrophin gene and the clinical status of patients with dystrophinopathies among the Iranian population.

Methods: This cross-sectional study examined 54 patients with muscle weakness caused by abnormalities in the dystrophin gene at a hospital affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in 2021. The participants’ demographic information, including age, family history of muscle dystrophies, and family history of other medical diseases as well as the type of muscular dystrophy were recorded. Furthermore, the number and region of deleted exons based on dystrophy types were also evaluated using multiplex ligation-dependent probe amplification (MLPA). The patients’ gaits were also assessed as using a wheelchair, the presence of waddling gaits, or toe gaits. The patients’ clinical status and the coexistence of pulmonary, bulbar, and mental conditions were also examined and compared between the two groups of dystrophinopathies.

Results: In this study, 54 patients with dystrophinopathy with the mean age of 16.63 ± 12.10 years were evaluated, of whom 22 (40.7%) and 30 (55.6%) patients were classified as BMD and DMD, respectively. The most affected regions with deleted exons were exons 45-47 (n = 5) and 45-48 (n = 4) in patients with BMD, while exons 45, 48-52, 51-55, and 53 (2 cases per exon) were the most common affected exons in patients with DMD. Further analyses revealed that deletions in exons 45-47 and 51-55 were significantly associated with older and younger ages at the onset of becoming wheelchair-bound in patients with dystrophy, respectively. The hotspot range in both BMD and DMD was within exons 45-55 (n = 15 for each group); 63% of the patients had alterations on the dystrophin gene within this range [30 patients (68.18%) in the BMD group, 15 patients (53.57%) in the DMD group].

Conclusion: Exon deletion was the most common genetic alteration in patients with dystrophinopathies. No significant difference was observed between DMD and BMD regarding the number of deleted exons. Deletions in exons 45-47 and 51-55 were linked to later and earlier onset of becoming wheelchair-bound, respectively.

Chronic pain among Lebanese individuals with spinal cord injury: Pain interference and impact on quality of life

Nour El-Hoda Saleh — 2023-12-26

Background: Chronic pain is one of the most disabling consequences of spinal cord injury (SCI). Although studies have identified a link between chronic pain and decreased quality of life (QOL) among this population, few studies have looked into the experience of chronic pain in Lebanese individuals with SCI and the impact of pain characteristics on QOL. Thus, the present study evaluated the chronic pain experience and its associated factors among Lebanese individuals with SCI in order to determine the impact of pain on QOL.

Methods: A cross-sectional study was conducted on
81 Lebanese individual with SCI between August 1^st and October 31, 2022. The collected information included sociodemographic characteristics, SCI-related information, pain-related variables, and the 12-item Short Form Health Survey (SF-12). Factors associated with pain interference were evaluated using a linear regression model. One-way ANOVA and independent sample t-test were used to evaluate the association of different baseline and pain characteristics with QOL.

Results: In the present study, 81.5% of participants reported chronic pain with the majority of them having neuropathic pain type. Employment status (P = 0.034), type of pain (P = 0.009), and pain severity (P = 0.028) were significantly associated with pain interference. Unemployed participants and those with severe chronic pain, particularly neuropathic pain, had lower QOL.

Conclusion: Chronic pain was found to be highly prevalent among Lebanese patients with SCI. Pain interference and QOL were significantly affected by employment status and pain type. Therefore, targeting chronic pain and its associated factors in rehabilitation practice is warranted.

Olfactory dysfunction in patients with Parkinson's disease: A systematic review and meta-analysis

Sara Bagherieh — 2023-12-26

Background: Parkinson’s disease (PD) is a progressive neuro-degenerative disease and olfactory dysfunction is considered as an important issue in these patients. The prevalence of olfactory dysfunction in patients with PD was reported variously in previous studies. Therefore, we designed this systematic review and meta-analysis to estimate the pooled prevalence of olfactory dysfunction in patients with PD.

Methods: Two expert researchers systematically searched PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the papers, and conference abstracts. The titles and abstracts of the potential studies were evaluated after deleting the duplicates. We extracted data regarding the total number of participants, first author, publication year, the country of origin, mean age, mean disease duration, female/male, number with olfactory dysfunction, and name of the test. We evaluated the risk of potential bias by the Newcastle-Ottawa Quality Assessment Scale (adapted for cross-sectional studies). All statistical analyses were done using Stata software. To determine heterogeneity between the findings of included studies, inconsistency (I²) was calculated. We applied random effect model when I² was more than 50%. P-value less than 0.05 was considered significant.

Results: The literature search revealed 1546 studies; after deleting duplicates, 894 remained. Finally, twelve studies remained for meta-analysis. Studies were published between years of 2009 to 2021, the sample size of studies ranged between 30 and 2097, and the mean age ranged between 61 and 70 years. The pooled prevalence of olfactory dysfunction in patients with PD was estimated as 64% [95% confidence interval (CI): 44-84, I²= 99.7%, P < 0.001]. The pooled prevalence of olfactory dysfunction using Sniffin's test was 67% (95% CI: 51-83) and using other tests was
60% (95% CI: 28-92).

Conclusion: The results of this systematic review and meta-analysis showed that the pooled prevalence of olfactory dysfunction in patients with PD was 64% which should be considered by physicians.

Neuro-mucormycosis: Lessons from COVID-19-associated cases

Nahad Sedaghat — 2023-12-26

Background: Scarce data are available on the neurological presentations of coronavirus disease
2019 (COVID-19)-associated mucormycosis (CAM)
and COVID-19-unrelated rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to compare the neurological presentations and their associated outcomes in patients with CAM and COVID-19-unrelated ROCM.

Methods: In December 2021, a case-control analysis was conducted on the CAM (case group) and
COVID-19-unrelated ROCM (control group) referrals of one center in Isfahan, Iran. Confirmed CAM patients from January 2020 to December 2021 constituted the case group, and patients with COVID-19-unrelated ROCM from 2016-2019 constituted the control group. Their data were then analyzed using proper (non) parametric tests and generalized linear models (GLM), therein P-value below 0.05 was considered as the criterion of statistical significance, and the SPSS software was used.

Results: After retrieving data on 177 patients with mucormycosis, 78 patients with CAM were included as the case group and 72 patients with COVID-19-unrelated ROCM were included as the control group. Neurological presentations suggestive of second, third, and eighth cranial nerve involvement were more prevalent in the CAM group (all with P < 0.05). The mortality rate in the CAM group was 1.9 times that of the controls (P = 0.01), being explained by higher extent of corticosteroid administration among them. Higher age and presentation with gait ataxia, ptosis, and mydriasis were considered to be predictive of poor prognosis in patients with CAM (all with P < 0.05).

Conclusion: The neurological manifestations of CAM differ from COVID-19-unrelated ROCM based on the presented results, some of which are associated with poor prognosis. Further replication is warranted to confirm our retrospective analyses.

Injudicious use of cranio-spinal imaging in Guillain-Barré syndrome in a low resource country

Muhammad Hassan — 2023-12-26

Guillain-Barré syndrome (GBS) undergo unnecessary neuroimaging. The objective of this study was to determine the proportion of patients with GBS undergoing neuroimaging investigation, and to investigate any association with different GBS variants using the Brighton criteria.

Methods: This cross-sectional observational study was conducted in the leading tertiary care hospital in Pakistan; 148 patients being investigated for, and subsequently diagnosed with GBS between January 2017 and March 2020 were enrolled. Participants were asked if they had undergone neuroimaging of the craniospinal axis before or during hospital admission, and the purpose of any computed tomography (CT) scan was investigated. We enquired whether fundoscopy had been performed before lumbar puncture (LP) and determined the level of certainty based on the Brighton criteria.

Results: The majority of participants were men
(n = 107, 73%), with a mean age of 42.85 ± 18.40 years. The mean waiting time to their first interaction with a neurologist was 5.20 ± 4.01 days, and the demyelinating variant of GBS was more common than the axonal variant (1.6:1). Most patients were diagnosed with level I certainty using the Brighton criteria (n = 113, 76%). Brain and spine magnetic resonance imaging (MRI) were performed ahead of admission in 48 (32%) and 59 (39%) patients, respectively. Brain CT scan was performed in 121 (82%) patients before LP, while 27 (18%) only underwent fundoscopic examination before LP.

Conclusion: Clinical examination is fundamental in the diagnosis of GBS. Neuroimaging may be inappropriate and unnecessary, and may detract attention from crucial peripheral neuropathy measures while misusing limited resources.

A case of type II fucosidosis-diagnosed with neuroradiological and dysmorphological findings

Sanjay M. Khaladkar — 2023-12-26

The Article Abstract is not available.