A New Technique Employing Direct Tactile Pressure on the common Carotid Artery to Relieve Acute Episode Attack of Migraine Headache: A Single-Arm Interventional Study

Introduction: Migraine, is a common neurological disorder, and its pathology and acute treatment has not been determined so far. In the contemporary literature, there is no remedy that can abort an acute episode of migraine. Objective: We aimed to evaluate the effect of transient presser on the middle part of common carotid artery for terminating an acute attack of migraine headache. Methods: It is an interventional study without a control limb, performed on patients within age range of 18-45 years. Patients with established migraine headache based on International Classification of Headache Disorders (ICHD) guidelines, who had no atheromatous plaque in their common carotid arteries were included. Pain intensity was evaluated by Universal Pain Assessment Tools (UPAT). In safe position, applying vital signs monitoring and ipsilateral of headache, a gentle pressure was applied on the common carotid artery, lateral to the cricothyroid membrane and medial border of the Sterno-Cleido-Mastoid (SCM) muscle, by using both index and middle fingers, till the headache was relieved, following which the pressure was maintained for a period of 15 seconds. Then the middle finger was maintained at its position and the index finger slid caudally with the same pressure as far a distance of four centimeters and the pressure withdrawn slowly. After 2 minutes, patients were asked to report any change in headache which was recorded. Results: Totally, 215 patients entered this study. The mean of pain score before and after using the technique regarding to UPAT, was 6.28±1.34 and 0.4±0.64, respectively; Also, the pain decreases equal 5.88 score was significant, special by according sex (p<0.001). No side effect was seen. Conclusions: It seems that pressure on the common carotid artery and extending the pressure caudally, helped a rapid, safe and significant reduction in pain score for patients with acute attack of migraine headache

Nutritional Aspects of Treatment in Epileptic Patients

How to Cite This Article: Soltani D, Ghaffar pour M, Tafakhori A, Sarraf P, Bitarafan S. Nutritional Aspects of Treatment in Epileptic Patients. Iran J Child Neurol. Summer 2016; 10(3): 1-12. Abstract Epilepsy is a neurological disorder characterized by interruption of normal neuronal functions that is manifested by behavioral disorders, changing of awareness level, and presence of some sensory, autonomic and motor symptoms or signs. It is resulted from many different causes. Many antiepileptic drugs (AEDs) are considered to manage epileptic attacks. Some of them  hange metabolism and absorption of many nutrients. Therefore, epileptic patients may be in higher risk of nutrient deficiency and its unwelcome effects. In the present paper, we intend to review the relationship between nutrition and epilepsy in two aspects. In one aspect we discuss the nutritional status in epileptic patients, the causes of nutritional deficiencies and the way of compensation of the nutrient deficiencies. It will guide these patients to have a healthy life. In another aspect we explain the role of some nutrients and specific diets in management of epileptic attacks. It can help to better control of epileptic attacks in these patients. References1. Gragnani A, Müller BR, Oliveira AF, Ferreira LM. Burns and epilepsy–review and case report. Burns 2014;41:e15–e18.2. Carlson C, Dugan P, Kirsch HE, Friedman D, Investigators E. Sex differences in seizure types and symptoms.EpilepsyBehav 2014; 41:103-8.3. Speed D, O’Brien TJ, Palotie A, Shkura K, Marson AG, Balding DJ, et al. Describing the genetic architecture of epilepsy through heritability analysis. Brain 2014; 137:2680-9.4. Poduri A, Sheidley BR, Shostak S, Ottman R. Genetic testing in the epilepsies developments and dilemmas. Nat Rev Neurol 2014; 10:293-9.5. Malkan A, Beran RG. An appraisal of the new operational definition of epilepsy-Then and now. Epilepsy Behav 2014; 41:217-20.6. Wong VC, Fung C, Kwong AK. 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Hashimoto Encephalopathy in Case of Progressive Cognitive Impairment; a Case Report

Hashimoto's encephalopathy (HE) is a rare condition characterized by atypical psychiatric and heterogeneous neurological manifestations such as acute cerebral ischemia, seizure, tremors, myoclonus, psychosis, depression, cognitive disorders, and fluctuating loss of consciousness. Here, a case of 28 year-old man was reported who referred to the emergency department (ED) with different acute neurologic disorders and final diagnose of HE

Application of Ultrasonography and Radiography in Detection of Hemothorax: a Systematic Review and Meta-Analysis

Introduction: Hemothorax is one of the most prevalent injuries caused by thoracic traumas. Early detection and treatment of this injury is of utmost importance in prognosis of the patient, but there are still controversial debates on the diagnostic value of imaging techniques in detection of hemothorax. Therefore, the present study aimed to evaluate the diagnostic value of chest ultrasonography and radiography in detection of hemothorax through a systematic review and meta-analysis. Methods: Two independent reviewers performed an extended systematic search in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. Data were extract and quality of the relevant studies were assessed. The number of true positive, false positive, true negative and false negative cases were extracted and screening performance characteristics of two imaging techniques were calculated using a mixed-effects binary regression model. Results: Data from 12 studies were extracted and included in the meta-analysis (7361 patients, 77.1% male). Pooled sensitivity and specificity of ultrasonography in detection of hemothorax were 0.67 (95% CI: 0.41-0.86; I2= 68.38, p<0.001) and 0.99 (95% CI: 0.95-1.0; I2= 88.16, p<0.001), respectively. These measures for radiography were 0.54 (95% CI: 0.33-0.75; I2= 92.85, p<0.001) and 0.99 (95% CI: 0.94-1.0; I2= 99.22, p<0.001), respectively. Subgroup analysis found operator of the ultrasonography device, frequency of the transducer and sample size to be important sources of heterogeneity of included studies. Conclusion: The results of this study showed that although the sensitivity of ultrasonography in detection of hemothorax is relatively higher than radiography, but it is still at a moderate level (0.67%). The specificity of both imaging modalities were found to be at an excellent level in this regard. The screening characteristics of ultrasonography was found to be influenced of the operator and frequency of transducer

Diagnostic Accuracy of Ultrasonography and Radiography in Detection of Pulmonary Contusion; a Systematic Review and Meta-Analysis

Introduction: Ultrasonography is currently being used as one of the diagnostic modalities in various medical emergencies for screening of trauma patients. The diagnostic value of this modality in detection of traumatic chest injuries has been evaluated by several studies but its diagnostic accuracy in diagnosis of pulmonary contusion is a matter of discussion. Therefore, the present study aimed to determine the diagnostic accuracy of ultrasonography and radiography in detection of pulmonary contusion through a systematic review and meta-analysis. Methods: An extended systematic search was performed by two reviewers in databases of Medline, EMBASE, ISI Web of Knowledge, Scopus, Cochrane Library, and ProQuest. They extracted the data and assessed the quality of the studies. After summarization of data into true positive, false positive, true negative, and false negative meta-analysis was carried out via a mixed-effects binary regression model. Further subgroup analysis was performed due to a significant heterogeneity between the studies. Results: 12 studies were included in this meta-analysis (1681 chest trauma patients, 76% male). Pooled sensitivity of ultrasonography in detection of pulmonary contusion was 0.92 (95% CI: 0.81-0.96; I2= 95.81, p<0.001) and its pooled specificity was calculated to be 0.89 (95% CI: 0.85-0.93; I2 = 67.29, p<0.001) while these figures for chest radiography were 0.44 (95% CI: 0.32-0.58; I2= 87.52, p<0.001) and 0.98 (95% CI: 0.88-1.0; I2= 95.22, p<0.001), respectively. Subgroup analysis showed that the sources of heterogeneity between the studies were sampling method, operator, frequency of the transducer, and sample size. Conclusion: Ultrasonography was found to be a better screening tool in detection of pulmonary contusion. Moreover, an ultrasonography performed by a radiologist / intensivist with 1-5MHz probe has a higher diagnostic value in identifying pulmonary contusions

Comparison of myocardial perfusion between the users of two antiepileptic medications: valproate vs. carbamazepine

Objective(s): The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use , may contribute to higher CAD risk.In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate.Method: Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal.Results: Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12).  In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014).Conclusion: MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD

Early versus Late Decompression for Traumatic Spinal Cord Injuries; a Systematic Review and Meta-analysis

Introduction: Despite the vast number of surveys, no consensus has been reached on the optimum timing of spinal decompression surgery. This systematic review and meta-analysis aimed to compare the effects of early and late spinal decompression surgery on neurologic improvement and post-surgical complications in patients with traumatic spinal cord injuries.Methods: Two independent reviewers carried out an extended search in electronic databases. Data of neurological outcome and post-surgery complication were extracted. Finally, pooled relative risk (RR) with a 95% confidence interval (CI) was reported for comparing of efficacy of early and late surgical decompression.Results: Eventually 22 studies were included. The pooled RR was 0.77 (95% CI: 0.68-0.89) for at least one grade neurological improvement, and 0.84 (95% CI: 0.77-0.92) for at least two grade improvement. Pooled RR for surgical decompression performed within 12 hours after the injury was 0.26 (95% CI: 0.13-0.52; p<0.001), while it was 0.75 (95% CI: 0.63-0.90; p=0.002) when the procedure was performed within 24 hours, and 0.93 (95% CI: 0.76-1.14; p=0.48) when it was carried out in the first 72 hours after the injury. Surgical decompression performed within 24 hours after injury was found to be associated with significantly lower rates of post-surgical complications (RR=0.77; 95% CI: 0.68-0.86; p<0.001).Conclusion: The findings of this study indicate that early spinal decompression surgery can improve neurologic recovery and is associated with less post-surgical complications. The optimum efficacy is observed when the procedure is performed within 12 hours of the injury

Clinical Functional Seizure Score (CFSS): a simple algorithm for clinicians to suspect functional seizures

PurposeDistinguishing functional seizures (FS) from epileptic seizures (ES) poses a challenge due to similar clinical manifestations. The creation of a clinical scoring system that assists in accurately diagnosing patients with FS would be a valuable contribution to medical practice. This score has the potential to enhance clinical decision-making and facilitate prompt diagnosis of patients with FS.MethodsParticipants who met the inclusion criteria were randomly divided into three distinct groups: training, validation, and test cohorts. Demographic and semiological variables were analyzed in the training cohort by univariate analyses. Variables that showed a significant difference between FS and ES were then further scrutinized in two multivariate logistic regression models. The CFSS was developed based on the odds ratio of the discriminating variables. Using the validation group, the optimal cutoff value was determined based on the AUC, and then the CFSS was evaluated in the test cohort to assess its performance.ResultsThe developed score yielded an AUC of 0.78 in the validation cohort, and a cutoff point of 6 was established with a focus on maximizing sensitivity without significantly compromising specificity. The score was then applied in the test cohort, where it achieved a sensitivity of 86.96% and a specificity of 73.81%.ConclusionWe have developed a new tool that shows promising results in identifying patients suspicious of FS. With further analysis through prospective studies, this innovative, simple tool can be integrated into the diagnostic process of FS