Dalfampridine in the treatment of primary fatigue in patients with multiple sclerosis: a randomized clinical trail.

INTRODUCTION: Fatigue is a highly prevalent debilitating symptom among patients with multiple sclerosis (PwMS), which markedly affects the quality of life. The present study aimed to evaluate the effect of extended-release fampridine on fatigue in PwMS. METHODS: This was a randomized, double-blind clinical trial on 77 PwMS with a complaint of fatigue, aged over 18 years old, randomized to extended-release fampridine (n = 44) or placebo (n = 35) for 12 weeks. Fatigue and motor function were assessed at baseline and end point. RESULTS: A total of 88 patients were recruited, of whom 77 were analyzed. 80.5% were female, with a median age of 38. 87% were diagnosed with relapsing-remitting MS (RRMS) with a median disease duration of 96 months. Fingolimod (37.7%) was considered the most frequently used DMT, followed by ani-CD20s (32.5%). The total median MFIS score was 43.5 and 37 in the fampridine and placebo groups which were not significantly different (p > 0.05). After 12 weeks, the total MFIS improved in both groups compared to the baseline, which was significant in the active group (p = 0.04). However, the final end point total MFIS was still comparable between the two groups (p = 0.11). CONCLUSION: The present study revealed a positive short-term effect of extended-release fampridine on MFIS in PwMS. However, this effect was not significantly superior to the placebo.

Therapeutic Plasma Exchange (TPE) Complications in Patients With Multiple Sclerosis (MS) and Clinically Isolated Syndrome (CIS): A Report From a Tertiary Center.

BACKGROUND: Therapeutic plasma exchange (TPE) is a conventional second-line treatment for patients with multiple sclerosis (MS) or clinically isolated syndrome with steroid-refractory relapses. METHODS: MS and clinically isolated syndrome patients with a steroid-refractory relapse, who fulfilled the indications for TPE were enrolled in this study. An expert nurse recorded the data comprising age, sex, type of MS, disease modifying therapy, disease duration, relapse rate, vital signs at the beginning, during and at the end of each plasma exchange session, plasma exchange volume, normal saline volume, and TPE complications. Ultimately, the statistical association was estimated amongst the variables. RESULTS: A total of 122 cases were assessed. Twelve cases (9.8%) received plasmapheresis for the second time. The mean age was 32.2±8.7 years and 107 (87.7%) were female. In total, 609 plasma exchange sessions were completed. Hypotension and skin reaction were the most clinical complications. Hemoglobin loss and hypokalemia were the most laboratory complications. Fifty-four cases (44.3%) had no complications, 40 (32.8%) had 1 complication, 21 (17.2%) 2 complications, 6 (4.9%) had 3 complications, and 1 (0.8%) disclosed 4 complications. The relapse rate in the past 12 months and the mean plasma volume exchange were significantly different between the groups. CONCLUSIONS: We revealed that TPE could be considered as a safe second-line therapy in MS relapses. Hypotension, skin reaction, hemoglobin loss, and hypokalemia were the most complications of TPE in our patients.

Evaluation of domperidone efficacy to prevent aspiration pneumonia in patients with acute ischemic stroke: a randomized clinical trial.

BACKGROUND AND AIM: Aspiration pneumonia is an essential complication of acute ischemic stroke (AIS), which is responsible for increased three-fold mortality within a month. There is an interest towards the effect of prokinetics on prevention of stroke-associated pneumonia. The present study aimed to investigate the effect of domperidone to prevent pneumonia in patients with AIS. METHODS: In this randomized clinical trial, 150 patients with AIS were assigned to receive either domperidone 10 mg daily or placebo during hospitalization. The clinical outcomes including of aspiration pneumonia occurrence, gastrointestinal discomfort, the need for intensive care unit admission, the length of hospitalization, final mRs, and mortality were then evaluated in both groups. RESULTS: 150 [Mean age 67.5 ± 13.5 years, 90 men and 60 women] were randomized in a 1:1 ratio. Both groups were similar in terms of baseline characteristics. The domperidone group experienced significantly less dysphagia, nausea and vomiting, and aspiration pneumonia (P < 0.005). Although domperidone did not considerably reduce the mortality (P = 0.978), it resulted in lower mean mRS and shorter length of hospitalization (P < 0.001). CONCLUSION: Domperidone is an effective and well tolerated agent which could be considered as a promising agent to prevent stroke-associated pneumonia leading to a better clinical recovery.

Association of COVID-19 Infection and Juvenile Stroke: a Case Series.

Ischemic stroke has been increasingly reported as a consequence of COVID-19 infection. However, the underlying etiology is not well determined. The objective of this study is to discuss association of juvenile stroke with COVID-19 infection. We analyzed 5 COVID-19 positive and stroke patients with a mean age of 41.2 years-old. Three patients developed large vessel occlusion, one small vessel occlusion and one PRES with superimposed lobar ICH, respectively. The mean initial NIHSS of our patients was 11.6. Except the one with massive cerebellar infarct, a desirable outcome occurred with a mean mRS 2.6 at discharge. The mean ESR and CRP level was elevated to 30.4 ml and 32 mg/dl. The severity of COVID-19 infection was considered mainly as mild. COVID-19 infection has the potential to induce hypercoagulability state contributing to stroke development even in the mild form of disease. Keywords: Cerebrovascular Accident, CVA, Stroke, COVID-19, Novel Coronavirus Acta.

Guillain-Barré Syndrome as a Neurological Complication of Novel COVID-19 Infection: A Case Report and Review of the Literature.

INTRODUCTION: The novel coronavirus (COVID-19) is a global pandemic. Although the main clinical manifestation of COVID-19 is respiratory involvement, there is evidence suggesting the neuroinvasive potential of COVID-19. There are limited reports of neurological complications of COVID-19 infection in the literature. Herein, we aim to describe 2 members of a family affected by COVID-19, presenting with ascending paresthesia with the final diagnosis of Guillain-Barré syndrome. CASE REPORT: A 38-year-old man presented with a history of ascending paresthesia and bilateral facial droop since 5 days before admission. The medical history was positive for flu-like symptoms affecting all the members of his family. The neurological examination was notable for bilateral peripheral facial paralysis, generalized areflexia, and derceased sensation in distal limbs. The cerebrospinal fluid analysis revealed an albuminocytologic dissociation. In addition, the electromyography-nerve conduction study findings were suggestive of acute axonal-demyelinating polyneuropathy. Meanwhile the patient was treated with a diagnosis of Guillain-Barré syndrome, his 14-year-old daughter presented with a history of progressive paresthesia and weakness. Similar to her father, the paraclinical evaluations were consistent with Guillain-Barré syndrome. Taking into account clinical findings and the outbreak of COVID-19, the suspicion of COVID-19 was proposed. Eventually, on the basis of throat swab samples stand on polymerase chain reaction, the patients were diagnosed with COVID-19. CONCLUSION: Our cases revealed the familial occurrence of Guillain-Barré syndrome after COVID-19 infection. The authors emphasize neurological complications of COVID-19.