Epidemiology of headaches in Tehran urban area: a population-based cross-sectional study in district 8, year 2010.

Many population-based studies have been performed to determine the prevalence of different types of headaches; however, none of them was performed in Tehran urban area as a huge and crowded metropolitan with multiple serious problematic crises. This study was performed to evaluate the prevalence rates of different types of headache among adult population of Tehran urban area in the year 2010. In this cross-sectional survey, a "face-to-face, in-door" structured interview was developed and used in district 8 of Tehran urban area as one representative region in the year 2010. A form concerning the prevalence of different types of headaches which also comprised the characteristics of the headaches and sociodemographic data was designed. After enrollment, participation rate of 91% (3,655 out of 4,000) was achieved. Of 3,655 recruited individuals, 2,778 (76%) people have experienced headache within last year. Tension-type headache and migraine were the most common types with the prevalence of 48.6% (n = 1,777) and 18.2% (n = 665), while, chronic daily, medication overuse headache and cluster headaches were presented in 7.0% (n = 255), 4.9% (n = 180) and 0.1% (n = 3), respectively. The prevalence of primary headaches in a sample of Tehran adult population is considerable. This high prevalence of headaches necessitates further evaluation of possible risk factors derived from leaving in such a crowded metropolitan area.

Progesterone therapy induces an M1 to M2 switch in microglia phenotype and suppresses NLRP3 inflammasome in a cuprizone-induced demyelination mouse model.

Demyelination of the central nervous system (CNS) has been associated to reactive microglia in neurodegenerative disorders, such as multiple sclerosis (MS). The M1 microglia phenotype plays a pro-inflammatory role while M2 is involved in anti-inflammatory processes in the brain. In this study, CPZ-induced demyelination mouse model was used to investigate the effect of progesterone (PRO) therapy on microglia activation and neuro-inflammation. Results showed that progesterone therapy (CPZ+PRO) decreased neurological behavioral deficits, as demonstrated by significantly decreased escape latencies, in comparison to CPZ mice. In addition, CPZ+PRO caused a significant reduction in the mRNA expression levels of M1-markers (iNOS, CD86, MHC-II and TNF-α) in the corpus callosum region, whereas the expression of M2-markers (Trem-2, CD206, Arg-1 and TGF-ß) was significantly increased, in comparison to CPZ mice. Moreover, CPZ+PRO resulted in a significant decrease in the number of iNOS+ and Iba-1+/iNOS+ cells (M1), whereas TREM-2+ and Iba-1+/TREM-2+ cells (M2) significantly increased, in comparison to CPZ group. Furthermore, CPZ+PRO caused a significant decrease in mRNA and protein expression levels of NLRP3 and IL-18 (~2-fold), in comparison to the CPZ group. Finally, CPZ+PRO therapy was accompanied with reduced levels of demyelination, compared to CPZ, as confirmed by immunofluorescence to myelin basic protein (MBP) and Luxol Fast Blue (LFB) staining, as well as transmission electron microscopy (TEM) analysis. In summary, we reported for the first time that PRO therapy causes polarization of M2 microglia, attenuation of M1 phenotype, and suppression of NLRP3 inflammasome in a CPZ-induced demyelination model of MS.

Vitamin d3 concentration correlates with the severity of multiple sclerosis.

BACKGROUND: To investigate the possible association between serum 25(OH) vitamin D3 concentration and the severity of disease in Iranian patients with multiple sclerosis (MS) and to compare this concentration with a matched control group. METHODS: This was an analytical cross-sectional study performed at Jondishapour Neurology Clinic in Tehran, Iran. Patients with relapsing-remitting MS were categorized by disease severity: mild [0≤ Expanded Disability Status Scale (EDSS) ≤3], moderate (3.5≤EDSS≤5.5), and severe (6≤EDSS). Serum concentrations of 25(OH) vitamin D3, calcium, phosphorus, magnesium, and parathyroid hormone were measured in 98 MS patients and 17 healthy age- and sex-matched controls. Fisher's exact, Kruskal-Wallis, Mann-Whitney U test, and independent t and Spearman rank correlation tests were used. RESULTS: Serum 25(OH) vitamin D3 concentration was significantly lower in patients with MS, especially in the severe MS subgroup, compared with healthy controls (P=0.047). There was a statistically significant inverse correlation between 25(OH) vitamin D3 concentration and EDSS score (P=0.049, R=-0.168 by Spearman rank correlation test), which was observed in women only (P=0.044, R=-0.199). CONCLUSIONS: Our findings not only further disclose the lower level of vitamin D in MS patients in comparison with healthy controls, but also support the association between vitamin D and disease severity in MS.

Association of serum 25(OH) vitamin D3 concentration with severity of multiple sclerosis.

BACKGROUND: There is a known inverse association between solar radiation and the prevalence of multiple sclerosis (MS). Some studies have investigated the link between vitamin D and MS. The aim of this study was to investigate the possible association between serum 25(OH) vitamin D3 concentration and the severity of disease in Iranian patients with MS. METHODS: Patients with relapsing-remitting MS underwent neurological examination, including measurement of Expanded Disability Status Scale (EDSS) score, and were categorized by disease severity into mild (0 ≤ EDSS ≤3), moderate (3.5 ≤ EDSS ≤5.5) and severe (6 ≤ EDSS). Serum concentrations of 25(OH) vitamin D3, calcium, phosphorus, magnesium and parathyroid hormone were also measured. RESULTS: A total of 78 (73.1% female) patients with MS were evaluated. The mean (± standard deviation) of age was 33.9 ± 9.2 years. The mean (± standard error) serum concentrations of 25(OH) vitamin D3 were 36.6 ± 5.1 mg/dL, 50.1 ± 12.6 mg/dL and 19.8 ± 6.5 mg/dL in patients with mild, moderate and severe disease, respectively. There was a statistically significant inverse correlation between 25(OH) vitamin D3 concentration and EDSS score (P = 0.016, r= -0.273 by Spearman rank correlation test), which was observed in women only (P = 0.021, r = -0.305). Receiver operating characteristic curve analysis suggested that a serum 25(OH) vitamin D3 concentration cutoff of 16.5 mg/dL could differentiate patients with mild/moderate MS from severe disease with 74.6% accuracy. CONCLUSION: Our findings further support the association between vitamin D and disease severity in MS.

Venous thrombosis in multiple sclerosis patients after high-dose intravenous methylprednisolone: the preventive effect of enoxaparin.

Aim. This study was designed to examine the possible role of high-dose intravenous methylprednisolone (IVMP) in the development of venous thrombosis (VT). The cerebral one anecdotally had been reported in patients with relapsing remitting multiple sclerosis (RRMS) in acute attacks and the possible preventive role of enoxaparin. Material and Methods. From a pool of 520 patients, 388 patients with definite RRMS who fulfilled entry characteristics were selected and randomly received either a 5-day course of daily 1 gr IVMP or the aforementioned plus 5 days of daily subcutaneous 40 units of enoxaparin according to a predefined protocol. Results. Mean age, gender ratio, mean relapse rate, and EDSS were similar in both groups of patients (P > 0.05). Finally, 366 patients remained in the study. Of 188 patients treated with IVMP with 855 relapses, 5 developed VT (0.37% per patient per year and 0.58% per each course of IVMP) within 3 to 15 days of starting therapy. None of the 178 patients who experienced 809 relapses who received IVMP plus enoxaparin developed such complications. Conclusion. The study implies that high-dose IVMP in MS exacerbation may increase the risk of VT and prophylactic anticoagulant treatment in this setting is warranted.

Cytokines genes polymorphisms and risk of multiple sclerosis.

Association studies of proinflammatory and anti-inflammatory cytokines single nucleotide polymorphisms with multiple sclerosis (MS) in population with different ethnic background have shown inconsistent results. To study the possible role of tumor necrosis factor-alpha G-308A, interleukin-6 G-174C, interleukin-10 C-592A, C-819T, G-1082A, transforming growth factor (TGF)-beta (codons 10 and 25), and interferon-gamma T+874A polymorphisms in susceptibility to MS in Iranian population, DNA samples from 98 patients and 97 healthy controls were genotyped using polymerase chain reaction-sequence-specific primers. Analysis of the genotypes revealed a significant lower frequencies of tumor necrosis factor-alpha GA and TGF beta C/C G/G genotypes and higher frequency of TGF beta T/C G/C genotype in patients (P < 0.05). Our data suggest that these polymorphisms play a role in susceptibility to MS, which is possibly mediated by dysregulated production of these cytokines.