Machine Learning-based Cerebral Venous Thrombosis Diagnosis with Clinical Data.

OBJECTIVES: Cerebral Venous Thrombosis (CVT) poses diagnostic challenges due to the variability in disease course and symptoms. The prognosis of CVT relies on early diagnosis. Our study focuses on developing a machine learning-based screening algorithm using clinical data from a large neurology referral center in southern Iran. METHODS: The Iran Cerebral Venous Thrombosis Registry (ICVTR code: 9001013381) provided data on 382 CVT cases from Namazi Hospital. The control group comprised of adult headache patients without CVT as confirmed by neuroimaging and was retrospectively selected from those admitted to the same hospital. We collected 60 clinical and demographic features for model development and validation. Our modeling pipeline involved imputing missing values and evaluating four machine learning algorithms: generalized linear model, random forest, support vector machine, and extreme gradient boosting. RESULTS: A total of 314 CVT cases and 575 controls were included. The highest AUROC was reached when imputation was used to estimate missing values for all the variables, combined with the support vector machine model (AUROC=0.910, Recall=0.73, Precision=0.88). The best recall was achieved also by the support vector machine model when only variables with less than 50% missing rate were included (AUROC=0.887, Recall=0.77, Precision=0.86). The random forest model yielded the best precision by using variables with less than 50% missing rate (AUROC=0.882, Recall=0.61, Precision=0.94). CONCLUSION: The application of machine learning techniques using clinical data showed promising results in accurately diagnosing CVT within our study population. This approach offers a valuable complementary assistive tool or an alternative to resource-intensive imaging methods.

Opinions about epilepsy surgery in adults with epilepsy.

OBJECTIVE: The goal of the current study was to investigate the opinions of adult patients with epilepsy (PWE) with regard to the application of epilepsy surgery for their condition. METHODS: We surveyed all the consecutive adult PWE with at least one year history of epilepsy who were referred to our neurology clinics (Shiraz University of Medical Sciences) from September 2022 until January 2023. Using a questionnaire, the degree of acceptance of epilepsy surgery was measured depending on the chance of seizure freedom and risk for surgery complications. RESULTS: In total, 393 adult PWE participated in the study; 180 patients (45.8%) expressed that they would be willing to have surgery if their epilepsy doctor told them that brain surgery was guaranteed to stop their seizures, without regard to the potential surgery complications. The most common reasons for the patients to be willing to have epilepsy surgery were as follows: to become seizure-free and to be able to discontinue their antiseizure medications. The most common reasons for the patients not to be willing to have epilepsy surgery were as follows: feeling of having the seizures under the control with antiseizure medications and fear of surgery complications. CONCLUSION: Many patients with epilepsy are willing to have epilepsy surgery if their physician presented epilepsy surgery to them as an established safe and effective treatment option. The important values and priorities of PWE must be considered when designing epilepsy surgery educational materials and programs for preoperative counseling for PWE with drug-resistant seizures.

COVID-19 vaccine-related frequently asked questions (FAQs) by people with epilepsy and carers in Iran; educational video is included.

OBJECTIVE: The aim of the current study was to inquire the questions and concerns of people with epilepsy (PWE) about COVID-19 vaccines in order to provide a more realistic list of their frequently asked questions (FAQs). METHODS: We surveyed all the consecutive PWE or their care-givers who were referred to our neurology clinics (Shiraz University of Medical Sciences) during January-February 2022. We collected their questions and concerns in relation to COVID vaccines based on a predesigned brief questionnaire. Informed consent to participate in the study was obtained from the participants. RESULTS: In total, 452 people participated in the study; 291 people (64.4%) did not have any questions or concerns with regard to the COVID-19 vaccination. Having any questions or concerns about COVID-19 vaccination was significantly associated with not being vaccinated. Questions and concerns about the adverse effects of COVID-19 vaccines [seizure worsening, general adverse effects, long-term effects (e.g., infertility, cognitive dysfunction)] were by far the most common questions by people with epilepsy and their carers. CONCLUSION: Our findings may be used by policy-makers to prepare appropriate educational materials to provide the best targeted and tailored information to people with epilepsy and their carers to convince them of the necessity and safety of COVID-19 vaccination. Such an educational material must include enough information on the associated adverse effects of COVID-19 vaccines and should also discuss some other important issues such as indications of these vaccines in special populations and drug-vaccine interactions.

The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study.

OBJECTIVES: There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program). MATERIALS AND METHODS: In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period. RESULTS: 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients > 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P<0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. CONCLUSION: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended.

Attention-deficit hyperactivity disorder in adults with epilepsy.

PURPOSE: We investigated the prevalence of attention-deficit hyperactivity disorder (ADHD) in adult people with epilepsy (PWE). We hypothesized that ADHD is common among adult PWE and, some clinical factors may be associated with ADHD. METHODS: In this cross-sectional study, 200 adult PWE referred to our neurology clinic at Shiraz, Iran were recruited (consecutively sampled). Validated Persian versions of Adult ADHD Self-Report Scale (ASRS v1.1) and Addenbrooke's Cognitive Examination-Revised (ACE-R) tests were used. We performed univariate analyses and also a logistic regression analysis. RESULTS: Eighty-two patients (41%) were male, and 118 (59%) were female. Seventy patients (35%) had a positive screen for ADHD. There was a significant association between cognitive function and the prevalence of positive screening for ADHD in the whole group; 19 (18%) of the patients with a normal cognition, 23 (42%) of those with mild impairment, and 28 (70%) of those with severe cognitive impairment screened positive for ADHD (p = 0.0001). One hundred and five patients had normal cognition and were studied separately. Nineteen patients (18%) had screened positive for ADHD. Attention-deficit hyperactivity disorder was not associated with any of the tested variables in these patients. CONCLUSION: About one-fifth of adults with epilepsy and normal cognitive function may have a positive screen for ADHD. Routine screening of all PWE for early detection and appropriate management of ADHD would be a reasonable approach.

Effects of carbamazepine on male reproductive hormones.

BACKGROUND: Reproductive endocrine disorders and sexual dysfunction are common among men with epilepsy. We investigated sexual hormone serum levels among men with newly diagnosed epilepsy, before starting any antiepileptic drug (AED), and then after starting carbamazepine (CBZ), to determine the role and effects of epilepsy versus CBZ in creating reproductive endocrine disorders. METHODS: In this prospective study, male patients 20 to 40 years of age who due to new-onset seizure(s) were referred to the outpatient epilepsy clinic at Shiraz University of Medical Sciences from 2009 through 2012 were studied. A blood sample was obtained to evaluate the serum levels of follicle stimulating hormone, luteinizing hormone, prolactin, testosterone, free-testosterone, dehydroepiandrosterone sulfate and sex hormone binding globulin. CBZ was started after blood works. After at least three months of taking CBZ, another blood sample was obtained to determine the serum levels of those hormones again. RESULTS: Twenty patients were included. Their mean age (± standard deviation) was 28 years (± 5). The statistical analysis with paired sample tests did not show any significant changes in serum levels of sex hormones before and after CBZ therapy. CONCLUSION: Despite the fact that, sexual dysfunction and reproductive disorders are common among men with epilepsy, the exact pathophysiology of these problems is not clear yet. Further studies are required to determine the exact role of epilepsy itself, AEDs, and other possible determinants.

Management of epilepsy in resource-limited areas: establishing an epilepsy surgery program in Iran.

Background Of about 40 million people with epilepsy, who live in developing countries, the majority do not receive appropriate treatment. Nonetheless, there are striking disparities among the so-called developing countries, however generally speaking, access to and availability of epilepsy management programs in developing countries are very limited and therefore, the issue of developing epilepsy centers in resource-limited settings in a large scale is very essential. The surgery for epilepsy, including temporal lobotomy, lesionectomy and corpus colostomy, for patients with medically-refractory seizures, defined as failure of adequate trials of two tolerated, appropriately chosen and using antiepileptic drug to achieve sustained freedom, from seizure has been proved to be feasible and cost-effective in developing countries. However, the success of epilepsy surgery depends upon the accurate identification of good surgical candidates based on the available resources and technologies without jeopardizing safety. In the current paper, we will share our experiences of establishing an epilepsy surgery program in Iran, despite all short-comings and limitations and try to provide some answers to those challenges, which helped us establish our program.

Corpus callosotomy is a valuable therapeutic option for patients with Lennox-Gastaut syndrome and medically refractory seizures.

PURPOSE: We present our experience with corpus callosotomy (CC) in a developing country with limited resources in patients with Lennox-Gastaut syndrome (LGS) and medically refractory seizures. METHODS: All patients with LGS who underwent CC for medically refractory epilepsy at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through March 2012 were reviewed in a retrospective study. Presurgical evaluation included clinical history, neurological examination, a 2-hour video-EEG recording, and 1.5-T MRI. Outcome was evaluated at 6, 12, and 24 months postoperatively. We considered the outcome as a success if the patients were either seizure-free or had more than 85% reduction in seizure frequency compared to their preoperative status. RESULTS: Eighteen patients (14 males and 4 females) had surgery. Overall, seizures in 11 patients (61.1%) responded favorably one year after surgery; this figure was 6 out of 9 patients (66.6%) two years after surgery. Seven patients (38.8%) were free of disabling seizures one year after CC; this figure was three out of nine patients (33.3%) two years after CC. Three patients (16.6%) were free of all seizure types one year after surgery. Ten patients (55.5%) had no postoperative complications of any kind. CONCLUSION: Corpus callosotomy is an effective palliative surgical procedure for patients with LGS with intractable seizures whose seizures are not amenable to focal resection. This is a feasible treatment option for patients, even for those in developing countries with limited resources.

Evaluation of Homocysteine Level as a Risk Factor among Patients with Ischemic Stroke and Its Subtypes.

BACKGROUND: Epidemiological research has shown that increased total homocysteine (tHcy) levels are associated with an increased risk of thromboembolic disease; however, controversy still exists over which subtype of stroke is allied to hyperhomocysteinemia. This study aimed to investigate whether elevated tHcy is an independent risk factor for ischemic stroke and to compare tHcy levels in patients with ischemic stroke subtypes. METHODS: We performed a case-control study, in which 171 ischemic stroke patients aged over 16 years and 86 age and sex-matched controls were eligible to participate and were enrolled from January 2009 to January 2010. The patients' demographic data, traditional stroke risk factors, and the results of fasting tHcy, vitamin B12, and folate of serum were collected in the first 5 days after ischemic stroke. Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. SPSS software (version 13) was used for the statistical analysis of the data, and a P value smaller than 0.05 was considered statistically significant. RESULTS: The mean fasting Hcy levels was significantly higher in the cases (16.2 µmol/L, 95% CI: 14.8 to 17.5) than in the controls (13.5 µmol/L, 95% CI: 12.4 to 14.6) (P=0.013). The mean Hcy levels was elevated significantly in those with cardioembolic strokes compared with the controls (17.7 µmol/L, 95% CI: 14.8 to 20.5; P=0.010). The plasma Hcy level was associated with an adjusted odds ratio of 2.17 (95% CI: 1.24 to 3.79; P=0.004) for Hcy above 15 µmol/L concentration for all types of stroke. CONCLUSION: Our data showed that elevated serum Hcy is an independent risk factor for ischemic stroke and it has a strong association with cardioembolic subtype.

The hospitalization rate and clinical characteristics of mucormycosis prior and during COVID-19 pandemic: A single-center study.

INTRODUCTION: There have been some reports of the association between SARS-CoV-2 infection and mucormycosis. This study aims to compare the hospitalization rates and clinical characteristics of mucormycosis before and during the COVID-19 pandemic. METHODOLOGY: In this retrospective study, we compared the hospitalization rate of mucormycosis patients in Namazi hospital in Southern Iran for two periods of 40 months. We defined July 1st, 2018 to February 17th, 2020, as the pre-COVID-19 period and February 18th, 2020, to September 30th, 2021, as the COVID-19 period. In addition, a quadrupled group of hospitalized patients with age and sex-matched SARS-COV-2 infection without any sign of mucormycosis was selected as the control group for COVID-associated mucormycosis. RESULT: In the total of 72 mucormycosis patients in the COVID period, 54 patients had a clinical history and a positive RT-PCR, which confirms the diagnosis of SARS-COV2 infection. The hospitalization rate of mucormycosis showed an increase of + 306% (95% CI: + 259%, + 353%) from a monthly average value of 0.26 (95% confidence interval (CI): 0.14, 0.38) in the pre-COVID period to 1.06 in the COVID period. The use of corticosteroids prior to the initiation of hospitalization (p ≤ 0.01), diabetes (DM) (p = 0.04), brain involvement (p = 0.03), orbit involvement (p = 0.04), and sphenoid sinus invasion (p ≤ 0.01) were more common in patients with mucormycosis during the COVID period. CONCLUSIONS: In high-risk patients, especially diabetics, special care to avoid the development of mucormycosis must be taken into account in patients with SARS-COV-2 infection considered for treatment with corticosteroids.

Early and mid-term outcomes of carotid angioplasty and stent placement in 579 patients.

BACKGROUND AND PURPOSE: Carotid angioplasty and stenting (CAS) could be considered for preventing stroke in patients with carotid artery stenosis. This study aimed to determine the incidence and the risk factors of the early and mid-term complications associated with CAS. METHODS: This is a retrospective cohort study conducted at Shiraz University of Medical Sciences from March 2011 to March 2019. Patients at high risk and standard risk for carotid endarterectomy were included. The primary composite outcome was defined as stroke, myocardial infarction (MI), and death in the first 30 days after CAS. All-cause mortality, vascular mortality, and stroke were investigated during mid-term follow-up. RESULTS: A total of 579 patients (618 CAS) were recruited (mean age: 71.52 years). Overall, 394 (68.40%), 211 (36.63%), 179 (31.07%), and 96 (16.72%) patients had hypertension, dyslipidemia, diabetes mellitus, or were cigarette smokers, respectively. Primary composite outcomes were observed in 2.59% of patients (1.55% stroke, 0.69% MI, and 1.72% death). Atrial fibrillation was a predictor of primary composite outcome in multivariate logistic regression (p = .048). The presence of total occlusion in the contralateral carotid artery was significantly associated with the risk of stroke in univariate logistic regression (p = .041). The patients were followed for a period ranging from 1 to 83 months. The overall survival rate for all-cause mortality was 93.48% at 1 year, 77.24% at 5 years, and 52.92% at 8 years. All-cause mortality was significantly higher among patients with symptomatic carotid stenosis (p = .014). CONCLUSION: CAS provides acceptable short-term and mid-term outcomes in a unique population of high- and standard-surgical-risk, symptomatic and asymptomatic, octogenarian, and nonoctogenarian patients.

Cytokine secretion pattern in treatment of lymphocytes of multiple sclerosis patients with fumaric acid esters.

The present study was performed to investigate the effects of dimethylfumarate (DMF) and methylhydrogen fumarate (MHF) on the cytokine pattern of peripheral blood mononuclear cells (PBMCs) of multiple sclerosis (MS) patients. The PBMCs from patients and healthy controls were stimulated with myelin basic protein (MBP) or phytohemagglutinin (PHA) and cultured in the presence of DMF and MHF. The percentage of CD4+IL-4+ and CD4+IFN-γ+ cells was determined by means of intracellular cytokine staining. CD4+IL-4+ cells were significantly increased in the presence of DMF and MHF when PBMCs were stimulated by MBP (P < 0.003). The same significant result was obtained by PHA stimulation (P < 0.049). In terms of CD4+IFN-γ+ cells, the percentage of cells did not significantly differ between the cultures stimulated with MBP or PHA in the presence and absence of the drugs. Results of MBP stimulation in control group also showed a significant increase in CD4+IL-4+ cells in the presence of DMF and MHF. In comparison between patient and control groups, no statistically significant changes were observed. In conclusion, both DMF and MHF effectively increased IL-4 production, whereas they did not significantly change IFN-γ level, indicating the role of these drugs in increasing the production of beneficial cytokines such as IL-4.

Cerebral venous-sinus thrombosis: a case series analysis.

BACKGROUND: Cerebral venous-sinus thrombosis is an uncommon form but important cause of stroke, especially in young-aged women. METHODS: We performed a retrospective descriptive-analytical study in which 124 patients with cerebral venous-sinus thrombosis, who referred to Nemazee Hospital, Shiraz University of Medical Sciences from January 2000 to March 2008, were included, and their demographic, etiologic, radiological and prognostic characteristics were evaluated. RESULTS: The patients' mean age was 34.01±10.25. Eighty seven (70.16%) were women and 37 (29.83%) were men. The most frequent clinical manifestations were headache, papilledema and seizures. Fifty seven (65.51%) women took oral contraceptive pills. Twenty of 57 women (35.08%) took the pill longer than one month to be able to fast in Ramadan or perform the Hajj ceremonies. In the mean time they developed cerebral venous-sinus thrombosis. Superior sagital sinus, with or without lateral sinuses, was the most involved area (70.96%). High mortality and morbidity rates (14.51% and 35.48%, respectively) were found in patients. Poor prognostic factors at the time of admission were stupor and coma (P=0.001) and evidence of hemorrhage in primary CT scan (P=0.005). CONCLUSION: Taking oral contraceptive pills was a main factor associated with cerebral venous-sinus thrombosis. Clinical manifestations, prognostic factors, common involved sinuses and image findings of this study were similar to those of other studies. Health care policy makers should design a plan to warn susceptible women of the risk of cerebral venous-sinus thrombosis, and to educate them the ways to prevent it.

Comparison of Pain-Related and Psychological Variables between Acute and Chronic Migraine Patients, and Factors Affecting Headache Chronicity.

BACKGROUND: Migraine headache is classified as acute or chronic. In recent years, efforts have been made to identify the factors that might predispose individuals to develop the chronic-type headache. The present study aimed to draw a comparison between patients with acute and chronic migraine in terms of demographic, pain-related, and psychological variables. In addition, we also investigated factors affecting headache chronicity in such patients. METHODS: The present cross-sectional study was conducted during 2017-2018. The target sample consisted of 250 patients with acute or chronic migraine who referred to various clinics affiliated to Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, recruited by convenience sampling. All the participants filled in the questionnaires related to demographic characteristics, pain intensity, disability, depression, emotional intelligence, and anger. The data were analyzed using SPSS software (version 22.0) with t test, Chi-square test, and logistic regression analysis. P<0.05 was considered statistically significant. RESULTS: Patients suffering from chronic migraine experienced higher levels of disability, depression, anger, and had lower levels of emotional intelligence compared to those with acute migraine. Based on the logistic regression analysis, variables that had a significant effect on headache chronicity were female gender (OR=5.81), married status (OR=3.77), patients with lower level of education (OR=0.26), headache duration (OR=1.53), disability (OR=0.28), depression (OR=3.66), and anger (OR=5.04). CONCLUSION: Variables such as disability, depression, and lack of anger control were among the key factors associated with headache chronicity in migraine patients.

Diagnostic value of contrast-enhanced fluid-attenuated inversion-recovery and delayed contrast-enhanced brain MRI in multiple sclerosis.

RATIONALE AND OBJECTIVES: In brain MRI of multiple sclerosis (MS) patients, enhancement of the lesions is usually evaluated in early contrast-enhanced T1-weighted images (CE-T1WI). The objective of this study is to determine the sensitivity of contrast-enhanced fluid-attenuated-inversion-recovery (CE-FLAIR) and delayed contrast-enhanced MRI in evaluation of MS brain lesions. MATERIALS AND METHODS: Brain MRI examination including early and delayed CE-T1WI and early and delayed CE-FLAIR images was performed for 46 patients with clinically definite MS disease. Number, size, location, degree, and pattern of enhancement of the enhanced lesions in each sequence were recorded separately. RESULTS: A total number of 87 enhanced lesions was detected in 30 patients. Early CE-T1WI could detect only 63 lesions (72.4% of total) in 24 patients, while delayed CE-T1WI and early and delayed CE-FLAIR images showed 85 (97.7%), 84 (96.6%), and 81 (93.1%) lesions in 28, 28, and 26 patients, respectively. A greater degree of enhancement and larger lesion size were observed in the additional sequences compared with the early CE-T1WI. CONCLUSIONS: The sensitivity of early CE-T1WI for the detection of enhanced MS lesions is significantly lower than that for other additional sequences. Delayed CE-FLAIR images could not add significant information to other sequences. Therefore, early CE-FLAIR and delayed CE-T1WI brain MRI can be considered as part of the evaluation of MS patients, especially if, despite clinically suspected active disease, no enhanced lesion is found in the routine CE-T1WI.

Cerebral venous sinus thrombosis--clinical features, predisposing and prognostic factors.

PURPOSE: Cerebral venous sinus thrombosis (CVST) is a disease with potentially serious consequences and usually affecting young to middle aged people. This study was designed to investigate the clinical features, and predisposing and prognostic factors of CVST in a prospective series of 61 patients. METHODS: This prospective study comprised 61 consecutive patients with confirmed diagnosis of CVST who were hospitalized in Namazi Hospital in Shiraz, south of Iran, between January 2000 and August 2003. The diagnosis was confirmed using conventional MRI or cerebral angiography. RESULTS: The male to female ratio was 1/3.1. The mean age of patients was 35.6 +/- 12.1 years. Headache was seen in 91.8% of the patients. The most frequent risk factor was oral contraceptive consumption (62.2%). Elevation of ESR and CRP titer were seen in 37.7%, and 36.1% of patients, respectively. Involvement of superior sagittal sinus and lateral sinus was 80.3% and 41%, respectively. The final diagnosis was neurobechet in 5 ppatients (8.2%). The fatality rate was 14.7% and an altered consciousness was associated with poor prognosis. DISCUSSION: CVST presents with a wide spectrum of symptoms and signs. Headache was the most frequent symptom. Women who used OCP were especially at risk. Because of moderate to high mortality rate, patients at increased risk of death, specially comatose patients, should be closely monitored.

Effects of cognitive-behavioral group therapy on recurrent headaches in Iranian culture.

This study investigated effects of applying cognitive-behavioral group therapy on recurrent headaches. Among Shiraz University female students complaining of headaches, 20 patients, each reporting either migraine or tension-type headaches and who met the 1988 International Headache Society diagnosis criteria for migraine and tension-type headaches, formed two groups. Analysis showed cognitive-behavioral group therapy decreased headache index significantly. Therapeutic response patterns on dependent variables were similar for patients with migraines and those with tension-type headaches.

Curcumin ameliorates scopolamine-induced mice memory retrieval deficit and restores hippocampal p-Akt and p-GSK-3ß.

The loss of cholinergic neurons has been a major issue in researches on Alzheimer's disease (AD) for about 40 years. Therefore, the scopolamine model of amnesia has been widely used in AD researches. Recently, it was reported that the early stage amnesia of AD is related to memory retrieval deficit. Curcumin, as the main ingredient of turmeric, has been suggested to decrease the prevalence of AD in human population. This study was conducted to assess if curcumin prevents retrieval deficit induced by scopolamine in passive avoidance task. Moreover, according to the proposed link between cholinergic system and Akt/GSK-3ß (Glycogen synthase kinase 3 beta) signaling, the hippocampal contents of these proteins were determined. Male NMRI mice (20-25 g body weight) were treated with 50 or 100 mg/kg/po curcumin or its vehicle for 10 days. On day 10, the animals were trained in passive avoidance apparatus. The retention trial was performed 24 h later. Scopolamine (1 mg/kg/i.p.) or its vehicle was administered 30 min before retention test. At the completion of behavioral studies, the hippocampi were removed and western blot analysis was performed to determine hippocampal phosphorylated and total Akt and GSK-3ß and beta actin contents. The results showed that curcumin treatment at 50 and 100 mg/kg doses prevented scopolamine-induced memory retrieval deficit and restored Akt and GSK dephosphorylation caused by scopolamine. Overall, these findings showed that pre-test scopolamine administration disrupts memory retrieval along with the diminished Akt and GSK-3ß phosphorylation in hippocampus while curcumin administration prevented those changes.

Outcome after temporal lobectomy in patients with medically-refractory mesial temporal epilepsy in Iran.

BACKGROUND: Epilepsy surgery has been proved to be feasible and cost-effective in developing countries. In the current paper, we discussed the outcome of patients with mesial temporal lobe epilepsy (MTLE) and medically-refractory seizures who had surgery at our center in Shiraz, Iran. METHODS: Patients aged 18 years and older with refractory MTLE and mesial temporal sclerosis operated at Namazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran from May 2009 through December 2011 were enrolled. Presurgical evaluation included clinical history, neurological examination, 2-hour video-EEG recording, and 1.5-T MRI. All patients were submitted to standard temporal lobectomy at the side determined by MRI and video-EEG. RESULTS: Twenty-two patients (12 women and 10 men) underwent surgery between May 2009 and December 2011. All patients were followed postoperatively for at least 12 months (mean=24.8±7.7 months; minimum=12 months; maximum=36 months). At the last follow-up visit, 18 patients (81.8%) had a good outcome (15 patients [68.2%] had Engel class 1 and three others had Engel class 2). The total cost of presurgical evaluation and epilepsy surgery at our center was less than $500. CONCLUSIONS: Resources are limited for the vast majority of medically-refractory patients with epilepsy who live in the developing countries. However, it is feasible to select good surgical candidates for anterior temporal lobectomy relying on the clinical history and examination, MRI and interictal EEG. Broader application of epilepsy surgery should be encouraged in countries with limited financial resources.

Neurological manifestations of Behçet's disease.

OBJECTIVE: To determine the prevalence, clinical manifestations, and laboratory features of Neuro-Behçet's disease. METHODS: This prospective study was carried out in the Behçet's Research Clinic in Shiraz (south-west Iran) and included the patients referred from 1990-1999. The patients' clinical records, images, CSF analyses, and electrodiagnostic studies were reviewed. RESULTS: Eighteen (15 males and 3 females) out of 690 Behcet s patients (2.6%, 95% CI = 1.4-3.8%) were found to have neurological involvement. The mean +/- standard deviation age of these patients was 34.7 +/- 8.6 years. All fulfilled the criteria of the International Study Group of Behcet s Disease. Central nervous system involvement was more common than peripheral nervous system manifestations. Headache, weakness, tingling, and numbness were the most common symptoms. Hyperreflexia, upward plantar reflex, and somatosensory findings were the most frequent signs. Hemispheral and brainstem stroke-like syndromes and cerebral venous thrombosis were the major neurologic presentations. There were also cases of myelitic, pure meningoencephalitic, amyotrophic lateral sclerosis-like, multiple sclerosis-like, and Guillain Barre syndromes. CONCLUSION: Neuro-Behçet's disease must be considered in the differential diagnosis of stroke in young adults, chronic meningitis, intracranial hypertension, multiple sclerosis, myelopathies, and peripheral neuropathies.