Current Journal of Neurology

Neuropsychiatric tests and cognitive functions before and after epilepsy surgery in patients with drug-resistant epilepsy

Ghasem Farahmand — 2025-05-27

Background: Patients with refractory epilepsy may benefit from epilepsy surgery. However, cognitive decline following epilepsy surgery is a significant concern. In this study, we investigated the effect of epilepsy surgery on cognitive function.

Methods: In this pre-post study, we used a census method to include 15 patients diagnosed with intractable epilepsy based on International League Against Epilepsy (ILAE) criteria, aged 10-65 years, and eligible for epilepsy surgery. We used the Rey Auditory Verbal Learning Test (RAVLT) and Delis-Kaplan Executive Function System (D-KEFS) to evaluate patients’ cognitive function. The Wilcoxon test was used to compare cognitive function before and one month after surgery.

Results: Fifteen patients (mean age: 34.2 ± 11.1) were included. The Wechsler Symbol Digit Modalities Test and Wisconsin Card Sorting Test (WCST)/Condition 2-1 (3.26 ± 1.83 to 4.13 ± 2.03, +26.7%, P = 0.01) and WCST/Condition 2-2 (3.33 ± 2.05 to 3.86 ± 2.03, 15.0%, P = 0.021) were the only tests in the total population that showed significant improvement. RAVLT/Step 1-5 (31.00 ± 10.87 to 33.72 ± 13.12, +8.8%, P = 0.02), RAVLT/Step 6 (6.00 ± 3.06 to 7.36 ± 3.66, +22.7%, P = 0.04). Trail Making Tests (TMT)/Number Sequencing (93.40 ± 52.24 to 68.50 ± 50.54, -26.7%, P = 0.028), WCST/Condition 1-1 (3.63 ± 1.91 to 4.09 ± 2.25, +12.7%, P = 0.023), WCST/Condition 2-1 (2.90 ± 1.70 to 3.72 ± 2.10, +28.3%, P = 0.039), and WCST/Condition 2-2 (3.36 ± 1.91 to 3.90 ± 2.02, +16.1, P = 0.014) demonstrated significant improvements in patients who underwent right-sided surgery. The only significant improvement in the left-sided surgery group was the TMT/switching score (175.50 ± 70.00 to 128.50 ± 74.24, -26.8%, P < 0.05).

Conclusion: Surgery can benefit patients with refractory seizures. We observed that surgical treatment of epilepsy did not impair cognitive function. Postponing epilepsy surgery because of concerns about cognitive deterioration is unnecessary. However, it is important to note the limitations of our study, and future larger studies are needed to confirm and extend our findings.

Improving migraine headache characteristics with high dose of thiamine: A randomized double-blind controlled trial

Maryam Ghods — 2025-05-27

Background: Migraine, a prevalent neurological condition, is recognized as the sixth leading cause of global disability. The proposed mechanism involves a combination of diminished energy reserves and heightened sensory stimulation activating the trigeminovascular system. Thiamine, essential for energy generation in various tissues including the nervous system, is hypothesized to be involved. This study aims to examine the effects of administering a high dose of thiamine to women with episodic migraine.

Methods: A randomized, controlled clinical trial was conducted involving 40 women with episodic migraine. Participants were divided into two groups: one receiving 990 milligrams of thiamine three times daily, and the other receiving 990 milligrams of maltodextrin over 12 weeks. Headache frequency, duration, severity, and disability were evaluated through questionnaires. Initial and final measurements of serum calcitonin gene-related peptide (CGRP) were taken.

Results: Thiamine supplementation resulted in a significant reduction in Migraine Disability Assessment (MIDAS) scores, migraine frequency, duration, and intensity compared to the placebo group. However, both groups experienced a decline in serum CGRP levels, with no significant difference between them.

Conclusion: This study suggests that high-dose thiamine supplementation may offer a beneficial adjunctive treatment for episodic migraine. Further investigations with prolonged intervention periods are necessary to validate these findings.

Cytokine profile and case series of tract-specific myelitis following SARS-CoV-2 infection

Aleksandra Kozlova — 2025-05-27

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a potential trigger for central nervous system (CNS) autoimmune disorders. The most common type of spinal cord pathology following novel coronavirus infection is immune-mediated/autoimmune transverse myelitis (TM); however, there are also rare forms of spinal cord pathology ‒ tract-specific myelitis ‒ previously considered as non-autoimmune-originated.

Methods: The current study includes case series of 5 patients with a rare type of myelitis with predominant involvement of the dorsal and lateral columns following coronavirus disease 2019 (COVID-19). We aimed to analyze cytokines parameters in cerebrospinal fluid (CSF) of affected patients. In order to support the autoimmune origin of the disease, CSF cytokine profiles were compared to patients with TM following COVID-19 (n = 12). Scale variables were compared between two independent groups using
t-test or Wilcoxon-Mann-Whitney test depending
on the distribution.

Results: In contrast to patients with TM, patients with tract-specific myelitis demonstrated higher levels of a proliferation-inducing ligand (APRIL), B cell activating factor (BAFF), interleukin (IL)-11, and thymic stromal lymphopoietin (TSLP). The BAFF/APRIL system is renowned for its involvement in the genesis and advancement of autoimmune disorders, and its pronounced increase in this case supports the autoimmune origin of the disease.

Conclusion: The heightened activation of BAFF and APRIL cytokines, which promote B-cell maturation, suggests an autoimmune origin of tract-specific myelitis, thereby informing prognosis and treatment strategies for affected patients.

Transcranial magnetic stimulation/electromyography biomarker for differential diagnosis of adult patients with psychogenic nonepileptic seizure from patients with epileptic seizure and healthy subjects: An experimental study

Alireza Hoomankia — 2025-05-27

Background: Epilepsy is a prevalent disease worldwide which affects 1% of the global population, making it the fourth most common disease. The primary category of epilepsy, psychogenic nonepileptic seizures (PNES), can lead to significant time and financial burdens if not promptly diagnosed. Diagnosing epileptic seizures (ES) can be complex, with video electroencephalography (VEEG) monitoring, history taking, and interviews being the most effective methods. However, VEEG is costly and not always accessible. approach using transcranial magnetic stimulation (TMS)-derived indicators. The motor threshold (MT), a key brain and spinal cord excitability indicator, differentiated ES from PNES.

Methods: The study compared 24 patients with ES, 24 patients with PNES, and 24 healthy individuals in the control group, all aged between 31-57 years.

Results: The mean MT for individuals with ES and those with PNES was the same (73.5%), and there was no significant difference in the mean MT between the two groups of patients and individuals without any medical conditions (P > 0.05). The findings indicated that VEEG remained the preferred method for diagnosing various forms of epilepsy, particularly PNES.

Conclusion: The MT derived from TMS and the general assessment of motor cortex excitability may not be a suitable diagnostic criterion for distinguishing ES from PNES.

Migraine and its relation with eating attitudes: A cross-sectional study

Selcen Duran — 2025-05-27

Background: Data on the eating attitudes in patients with migraine are limited. We aimed to investigate the eating attitude, anxiety, depression, fatigue, and sleep quality in patients with migraine, and assess their relationships with attack frequency, attack severity, and migraine-related disability.

Methods: 71 patients with migraine and 57 controls were included in this cross-sectional prospective study. Migraineurs were evaluated according to attack frequency (number of attacks per month), attack severity [average visual analog scale (VAS)], and migraine-related disability [Migraine Disability Assessment Scale (MIDAS)]. All patients and controls were given the Eating Attitude Test (EAT-40), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Fatigue Severity Scale (FSS), and Pittsburgh Sleep Quality Index (PSQI).

Results: EAT-40, BAI, BDI, and PSQI scores were significantly higher in patients with migraine than in control group (P < 0.05), whereas FSS scores were similar between the groups (P > 0.05). In patients with migraine, male migraineurs had significantly higher attack frequency when compared to women (P = 0.012). However, MIDAS scores were higher in female migraineurs than in men (P = 0.046). VAS scores were similar according to gender (P = 0.382). In the correlation analysis, VAS was positively correlated with EAT-40 (r = 0.240, P = 0.044) and BAI (r = 0.250,
P = 0.036). In the multivariate analysis, BAI score was found to affect the EAT-40 score in the whole population [odds ratio (OR) = 1.08, 95% confidence interval (CI) = 1.03-1.13, P = 0.001].

Conclusion: Psychiatric comorbidities and poor sleep are common in migraine sufferers, which also contribute to the development of disordered eating attitude in these patients. The close link between anxiety, headache, and eating attitude warrants further research.

Nano-selenium and the SRC family kinases pathway: Redefining gene expression dynamics in major depressive disorder based on a randomized controlled trial

Morvarid Noormohammadi — 2025-05-27

Background: Major depressive disorder (MDD) is a prevalent psychiatric condition. Dysregulation of signaling pathways interacting with SRC family kinases has been implicated in the pathophysiology of MDD through inflammation. Nano-selenium, a nanoscale form of selenium with enhanced bioavailability, has the potential to modulate oxidative stress and inflammation, which are implicated in MDD. To the best of our knowledge, in this study, for the first time we aimed to examine whether nano-selenium supplementation would decrease c-SRC gene expression.

Methods: This triple-blind, randomized, placebo-controlled clinical trial was conducted at Imam Khomeini Hospital Complex, Tehran, Iran.

Using block randomization, fifty participants diagnosed with MDD per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria were randomly assigned to receive nano-selenium (55 µg/day, n = 25) or placebo (n = 25) for
12 weeks alongside sertraline (50 mg/day). c-SRC gene expression was assessed using real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR) from peripheral blood samples collected at baseline and after 12 weeks.

Results: Twenty-one participants in each group completed the study, with an 84% retention rate in both groups. No serious adverse events were reported. There was no significant difference between groups at baseline. Post-intervention, c-SRC gene expression levels decreased in both the nano-selenium and placebo groups [median change (Q1, Q3): -0.0031,
(-0.0065, -0.0005) vs. -0.0021 (-0.0085, 0), respectively; P < 0.05]; however, no significant differences were observed between the two groups (P = 0.606).

Conclusion: Nano-selenium supplementation did not significantly modulate c-SRC gene expression. Limitations included a short duration. Future studies should explore alternative molecular pathways, higher supplementation doses, and treatment-naïve populations to better understand nano-selenium’s therapeutic potential in MDD.

A novel approach for migraine detection using localized component filtering and electroencephalographic spectral asymmetry index

Samaneh Alsadat Saeedinia — 2025-05-27

Background: This study aims to improve the accuracy and reliability of migraine detection by combining the localized component filtering (LCF) method with the electroencephalographic (EEG) spectral asymmetry index (SASI) method. The integration of LCF and SASI in the frequency domain under 3 Hz photic stimulation offers a novel approach for robust classification.

Methods: EEG recordings from 13 control subjects and 15 migraineurs were used in this study. The SASI values, obtained from LCF pre-processed signals, served as features for classification. The K-means clustering algorithm was applied, and the accuracy was evaluated using the silhouette values method.

Results: The combination of the LCF method with the SASI technique resulted in a 17% improvement in clustering accuracy, achieving an overall accuracy of around 87%. This new approach outperformed the histogram K-means clustering method and the SASI technique used alone. The accuracy attained by this combined approach was as high as multi-layer perceptron (MLP) and superior to K-means clustering, which are two well-known approaches of artificial and machine learning (ML) clustering methods, respectively.

Conclusion: This study presents a novel and effective approach by combining LCF and SASI for migraine detection, which enhances classification accuracy
and provides valuable insights into migraine-related brain activity. Accurate and reliable detection of migraine can lead to more effective treatment and management of the condition, ultimately improving the quality of life for migraine sufferers.

Latent microbial infections leading to myelin and axonal damage in multiple sclerosis: A narrative review

Fatemeh Nezam Zadeh — 2025-05-27

Background: Multiple sclerosis (MS) is a complex autoimmune disease characterized by chronic inflammation, demyelination, and axonal damage in the central nervous system (CNS). This review specifically aims to investigate the role of latent microbial infections-such as those caused by Epstein-Barr virus (EBV), Chlamydia pneumoniae, and others-in contributing to myelin and axon damage in MS.

Methods: We evaluated recent studies from PubMed, Google Scholar, and Scopus databases that focus on the relationship between latent microbial infections and MS pathogenesis.

Results: In MS, emerging evidence suggests that latent microbial infections play a significant role in triggering and perpetuating the inflammatory processes associated with the disease. The potential mechanisms by which these infections contribute to the pathogenesis of MS, highlighting the interplay between the immune system, microbial agents, and the CNS are evaluated. These include molecular mimicry, where similarities in sequence or structure between viral, bacterial, or self-peptides can activate autoreactive T or B cells through cross activation by pathogen-derived peptides, chronic inflammation triggered by persistent infection, leading to immune-mediated damage, and disruption of the blood-brain barrier, allowing microbial agents or immune cells to infiltrate the CNS.

Conclusion: This review underscores the critical role of latent microbial infections in MS pathogenesis. By elucidating these mechanisms, we provide new insights that could inform the development of innovative therapeutic interventions and preventive strategies for MS.

A 58-year-old patient with acute lymphocytic leukemia with methotrexate-induced leukoencephalopathy

Marcos R. Flores — 2025-05-27

The Article Abstract is not available.

Intrathecal iodinated contrast mimicking subarachnoid hemorrhage in a patient with neurological symptoms

Abel Gonzalez-Huete — 2025-05-27

The Article Abstract is not available.