Concurrent multi-session anodal trans-cranial direct current stimulation enhances pelvic floor muscle training effectiveness for female patients with multiple sclerosis suffering from urinary incontinence and pelvic floor dysfunction: a randomized clinical trial study.

INTRODUCTION AND HYPOTHESIS: Urinary incontinence following a pelvic floor muscle (PFM) dysfunction is a common disorder in women with multiple sclerosis (MS). Concurrent anodal transcranial direct current stimulation (a-tDCS) of the primary motor cortex (M1) may prime the effects of PFM training (PFMT) in MS patients. This study was aimed at investigating the effects of M1 a-tDCS on the effectiveness of PFMT in the treatment of female MS patients with urinary incontinence and PFM dysfunctions. METHODS: In a randomized double-blinded, control trial study, 30 women with MS were divided into two groups (experimental group: concurrent active M1 a-tDCS and PFMT; control group: concurrent sham M1 a-tDCS and PFMT). Over the course of 8 weeks, these patients received 20-min interventions three times a week. As an indication of PFM function, the bladder base displacement was measured by ultrasonography before, during the 4th week, immediately, and 1 month after the intervention ended. Urinary incontinence was also measured by Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UISF) before, immediately, and 1 month after the intervention ended. RESULTS: A significant improvement in PFM function occurred in the 4th week of intervention and remained 1 month after the intervention in the experimental group when compared with the control group (p<0.05). Compared with baseline, both groups reported significant improvements in PFM function at 8 weeks (p<0.05). Also, both groups were found to have decreased ICIQ-UIS scores after the intervention and at 1-month follow-up (p<0.05). CONCLUSIONS: In MS patients, M1 a-tDCS can significantly enhance the effects of PFMT on the PFM function and urinary incontinence.

Plant based food bioactives: A boon or bane for neurological disorders.

Neurological disorders are the foremost occurring diseases across the globe resulting in progressive dysfunction, loss of neuronal structure ultimately cell death. Therefore, attention has been drawn toward the natural resources for the search of neuroprotective agents. Plant-based food bioactives have emerged as potential neuroprotective agents for the treatment of neurodegenerative disorders. This comprehensive review primarily focuses on various plant food bioactive, mechanisms, therapeutic targets, in vitro and in vivo studies in the treatment of neurological disorders to explore whether they are boon or bane for neurological disorders. In addition, the clinical perspective of plant food bioactives in neurological disorders are also highlighted. Scientific evidences point toward the enormous therapeutic efficacy of plant food bioactives in the prevention or treatment of neurological disorders. Nevertheless, identification of food bioactive components accountable for the neuroprotective effects, mechanism, clinical trials, and consolidation of information flow are warranted. Plant food bioactives primarily act by mediating through various pathways including oxidative stress, neuroinflammation, apoptosis, excitotoxicity, specific proteins, mitochondrial dysfunction, and reversing neurodegeneration and can be used for the prevention and therapy of neurodegenerative disorders. In conclusion, the plant based food bioactives are boon for neurological disorders.

Priming of postural training with cerebellar anodal transcranial direct current stimulation for its effects on postural balance and fear of falling in patients with multiple sclerosis: A randomized, double-blind, sham-controlled study.

Postural impairment is one of the most disorders in patients with multiple sclerosis (MS), while fear of falling can exacerbate it in these patients. One of the leading causes of postural impairment and fear of falling in patients with MS is the cerebellum region's abnormalities, which may be modulated by cerebellar anodal transcranial direct current stimulation (a-tDCS). The present study aimed to investigate the effects of cerebellar a-tDCS concurrent with postural training (cerebellar a-CSC-PT) on postureand fear of falling in patients with MS. Thirty-seven patients with MS were assessed to randomly assign into cerebellar a-tDCSC-PT, shamtDCSC-PT, and postural training alone groups. All groups received 10-session postural training, while 20-minute cerebellar a-tDCS was added in the tDCS groups. Before, immediately and one month after the intervention, posture, balance and fear of falling were assessed using Biodex Balance System, Berg Balance Scale (BBS), and Fall Efficacy Scale-International (FES-I), respectively. Postural stability indices, BBS, and FES-I scores improved immediately and one month after the intervention in the cerebellar a-tDCSC-PT group (p < 0.001). Postural stability indices were immediately improved after intervention in the control groups (P < 0.05), while the changes were not maintained one month after intervention (P > 0.05). However, FES-I was not changed after the intervention in the control groups (P > 0.05). Cerebellar a-tDCS induces the effects of postural training on posture and balance and controls the fear of falling. This knowledge helps the physicians/therapists plan tDCS interventions to improve the balance, posture, and fear of falling in MS patients.

Does anodal trans-cranial direct current stimulation of the damaged primary motor cortex affects wrist flexor muscle spasticity and also activity of the wrist flexor and extensor muscles in patients with stroke?: a Randomized Clinical Trial.

Spasticity is a common symptom in stroke survivors. This study is double-blinded, sham-controlled randomized, clinical trial with three parallel arms. The aim of the study was to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the damaged primary motor cortex (M1) on spasticity of the wrist flexor and also the activity of wrist flexor and extensor muscles in sub-acute stroke patients. This study was performed on 32 stroke patients. The patients are assigned to three groups (intervention, sham, and control). All participants in the first two groups received 20-min concurrent M1 a-tDCS or sham tDCS and functional electrical stimulation (FES) for 10 sessions (5 sessions per week), while participants in control group were given only 20-min FES for 10 sessions. Modified Ashworth scale of wrist flexors and also electromyography (EMG) activity of flexor carpi radialis (FCR) and extensor carpi radialis (ECR) were recorded before, immediately, and 1 month after the interventions. A significant reduction was shown in the MAS and EMG activity of FCR muscle at passive rest position of the wrist, immediately and 1 month after the intervention in M1 a-tDCS compared to sham and control groups (p < 0.001). Also, the EMG activity of FCR and ECR muscles during active wrist flexion and extension increased immediately and 1 month after intervention in M1 a-tDCS compared to the other groups, respectively (p < 0.001). M1 a-tDCS can significantly decrease the spasticity of wrist flexor muscle and also increase the wrist flexor and extensor muscles activity in stroke patients during active flexion and extension.

Comparing the effects of multi-session anodal trans-cranial direct current stimulation of primary motor and dorsolateral prefrontal cortices on fatigue and quality of life in patients with multiple sclerosis: a double-blind, randomized, sham-controlled trial.

OBJECTIVE: To compare the effects of anodal trans-cranial direct current stimulation (a-tDCS) over primary motor and dorsolateral prefrontal cortices on Fatigue Severity Scale and its lasting effect on fatigue reduction and improvement in quality of life in patients with multiple sclerosis. DESIGN: A randomized, double-blinded, sham-controlled parallel clinical trial study. SETTING: Neurological physiotherapy clinics. SUBJECTS: Thirty-nine participants were randomly assigned to three groups: dorsolateral prefrontal cortex a-tDCS, primary motor a-tDCS (experimental groups) and sham a-tDCS. Finally, 36 participants completed the whole study (n = 12 in each group). INTERVENTIONS: Participants in the experimental groups received six-session a-tDCS (1.5 mA, 20 minutes) during two weeks (three sessions per week). The sham group received six sessions of 20-minute sham stimulation. MAIN MEASURES: The Fatigue Severity Scale and quality of life were assessed before, immediately and four weeks after the intervention. RESULTS: Findings indicated a significant reduction in the Fatigue Severity Scale and a significant increase in the quality of life in both experimental groups, immediately after the intervention (P < 0.001), while Fatigue Severity Scale and quality of life changes were not significant in the sham a-tDCS group (P > 0.05). In addition, improvement of the variables remained four weeks after the intervention in dorsolateral prefrontal cortex a-tDCS (mean differences (95% confidence interval): 0.03 (-0.63 to 0.68) as compared to primary motor (-0.62 (-0.11 to -1.14) and sham a-tDCS groups (-0.47 (-1.37 to 0.43)). CONCLUSION: Both primary motor and dorsolateral prefrontal cortex a-tDCS as compared to sham intervention can immediately improve fatigue and quality of life. However, the effects last up to four weeks only by the dorsolateral prefrontal cortex a-tDCS.

Does M1 anodal transcranial direct current stimulation affects online and offline motor learning in patients with multiple sclerosis?

OBJECTIVE: Multiple Sclerosis (MS) is one of the most common neurological diseases in the world. Due to structural and functional changes in central nerves system, the patients with MS may affected by sensory-motor learning deficits. The aims of the current study was to assess the effect of primary motor cortex (M1) anodal transcranial direct current stimulation (a-tDCS) on online and offline motor learning in patients with MS. MATERIALS AND METHODS: Thirty-nine patients with MS were randomly assigned in three groups: concurrent M1 a-tDCS and serial response time test (SRTT) (n=13), concurrent sham a-tDCS and SRTT (n=13) and SRTT-only control (n=13). The participants in all groups were asked to concurrently perform 20 minutes of SRTT. M1 a-tDCS group received 20-minute M1 a-tDCS (2 mA) concurrent with SRTT, while the a-tDCS was turned off after 30 seconds in the sham a-tDCS group. Response time (RT) and error rate (ER) during SRTT were assessed prior, during and 48 hours after the intervention. RESULTS: Online learning happened in all groups (P < 0.05), with more significant learning in M1 a-tDCS group as compared to the other groups (P < 0.05). However, offline learning was occurred only in M1 a-tDCS group (P < 0.05). CONCLUSIONS: The findings indicate offline motor learning impairment in patients with MS. M1 a-tDCS may be used for enhancement of motor learning especially offline learning in patients with MS.

Assessment of cognitive functions and related risk factors in Iranian patients with generalized epilepsy as compared to patients with non-epileptic neurological disorders.

Background: The cognitive impairment in patients with generalized epilepsy may affect their social efficiency and quality of life (QOL). The aim of this study is to determine the cognitive dysfunction and related risk factors in patients with generalized epilepsy as compared to patients with non-epileptic neurological disorders. Methods: In the present descriptive cross-sectional study, the cognitive function was assessed by Montreal Cognitive Assessment (MoCA) test in 62 patients with generalized epilepsy and also 62 patients with non-epileptic neurological diseases who referred to the Neurology Clinic, Semnan University of Medical Sciences, Semnan, Iran. The relationship between cognitive impairment and related risk factors was also investigated. The data were analyzed by SPSS software. Results: The mean score of MoCA in the patients with generalized epilepsy and the control group was 22.80 ± 4.14 and 26.48 ± 2.85, respectively (P < 0.050). The results indicated significantly lower MoCA scores in the epileptic group rather than the non-epileptic one (P < 0.001). Moreover, there was a significant relationship between MoCA score and age, education level, living place, the dose and rate of medicines, and the number of seizures in patients with epilepsy (P < 0.001). Gender and the duration of disease had no significant effects on the cognitive impairment of patients with epilepsy (P > 0.05). Conclusion: Patients with epilepsy had a significant cognitive impairment as compared to the patients with non-epileptic neurological disorders. Age, education level, living place, the dose and rate of medicines, and the number of seizures were the risk factors of cognitive impairment in the patients with epilepsy, while duration of disease and gender had no effects on the intensity of cognitive deficits.

Mitochondrial DNA G15927A and G15928A variations in patients with multiple sclerosis.

BACKGROUND: Modern genetics has offered a fresh perspective on the pathology of Multiple Sclerosis (MS). As mitochondrial DNA (mtDNA) variations are held to be potential contributors to the complex pathobiology of MS, the present study tests the claim that mtDNA G15927A or G15928A variations, or both, are associated with MS in an Iranian population. MATERIALS AND METHODS: Following DNA extraction from blood samples of 100 subjects with relapsing-remitting MS, and 100 healthy unrelated control subjects, PCR-RFLP analyses was carried out by HpaII restriction enzyme reaction. Electrophoresis was then performed with 3% Agarose gel. As the restriction enzyme did not differentiate between two neighboring nucleotide positions (G15927A and G15928A), all PCR products with a variant allele were sequenced to determine the exact position of the variation. RESULTS: The MtDNA G15927A or G15928A variations were observed in 11 of all 100 cases of MS (11%) and in 7 of 100 healthy control subjects (7%) (P = 0.3, OR = 1.6, 95% CI = 0.5-5.2). Having sequenced all the PCR products with the variant allele (11 cases and 7 controls), the mtDNA G15927A variation was found in one of the 100 cases (1%) and 3 of 100 controls (3%) (P = 0.3, OR = 0.3, 95% CI = 0.0-4.1). Therefore, the mtDNA G15928A variation was present in 10 of the 100 cases (10%) and in 4 of 100 controls (4%) (P = 0.09, OR = 2.6, 95% CI = 0.7-12.0). CONCLUSION: Neither mtDNA variation, G15927A or G15928A, was associated with MS in the studied Iranian population. There was a non-significant association of the G15927A and the G15928A variations separately with MS.

No evidence of association between optic neuritis and secondary LHON mtDNA mutations in patients with multiple sclerosis.

Leber's Hereditary Optic Neuropathy (LHON) shares features with Multiple Sclerosis (MS). Both diseases develop optic lesions. Frequent secondary LHON mutations in MS patients may explain the optic damage. Here, we tested the hypothesis that secondary LHON mutations are associated with optic neuritis (ON) in MS patients. We recruited 56 MS subjects with ON and 47 MS subjects without ON. DNA was extracted by salting out, after sampling of peripheral blood from each participant. We completed Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) analysis with appropriate primers and restriction endonucleases for seven secondary LHON mutations. Products were visualized using 3% agarose gel electrophoresis with the aid of DNA safe stain in a UV transilluminator. Accuracy of the genotyping procedure was confirmed by sequencing. Data was analyzed using chi square and Fisher exact tests and logistic regression analysis. There was no significant difference between the numbers of MS subjects with ON and without ON that carried secondary LHON mutations (T4216C [P=0.1], A4917G [P=0.2], G13708A [P=0.6], G15257A [P=1], G15812A [P=0.8], G15927A [P=1], G15928A [P=0.4]). The evidence from the present study are not consistent with the hypothesis that secondary LHON mutations are associated with ON in MS subjects.

Serum 25(OH) Vitamin D levels is not associated with disability in multiple sclerosis patients: A case-control study.

BACKGROUND: It seems that serum vitamin D levels are one of the potential environmental factors affecting the severity of multiple sclerosis (MS). In this study, we aim to evaluate vitamin D levels in MS patients and healthy subjects and assess the relationship between vitamin D level and disability. METHODS: In this case-control study, 168 rapid relapsing MS patients and 168 matched healthy controls were randomly included in this study. Demographic characteristics and serum vitamin D levels for patients and controls, as well as expanded disability status scale (EDSS), duration of disease and diagnostic lag for patients were evaluated. We followed up patients for 6 months and relapses were recorded. RESULTS: The mean serum vitamin D levels were 19.16 ± 17.37 inpatients and 25.39 ± 19.67 in controls (P = 0.560). The mean serum vitamin D levels were 12.65 ± 13.3 in patients with relapses and 22.08 ± 18.22 in patients without any relapses (P < 0.001). There was no significant correlation between EDSS score and serum vitamin D levels (r = -0.08, P = 0.280). There was a significant positive correlation between EDSS score and disease duration (r = 0.52, P < 0.001). CONCLUSION: In conclusion, vitamin D level in patients with MS was significantly lower than the healthy subjects, but no significant relationship was found between vitamin D levels and disability. Our findings did not suggest a protective role for serum vitamin D levels against disability.