Relationship of Opening CSF Pressure and Visual Field Defect in Idiopathic Intracranial Hypertension

Background: Idiopathic intracranial hypertension (IIH) is an increased intracranial pressure with normal cerebrospinal fluid (CSF) characteristic in the absence of identifiable causes. The most important complication of this disorder is visual impairment. So far, no comprehensive study has been done on the relationship between the opening CSF pressure and visual field defect in IIH.Methods: In this study, 35 patients with increased intracranial pressure who fulfilled modified Dandy’s criteria underwent ophthalmologic examination and lumbar puncture. The opening CSF pressure was categorized into mild (25-30), moderate (30-40) and severe (>40). The degree of visual field defect was reported both quantitatively and qualitatively. Eventually, the statistical relationship was established among these variables.Results: The mean opening CSF pressure was 33.71 CmH2o. Twelve patients had minor CSF pressure, whereas in 14 and 9 patients the CSF pressure was respectively moderate and severe. There was not statistically significant relationship between the visual field defect and CSF pressure. The most common patterns of visual field involvement were enlarged blind spot and peripheral restriction.Conclusion: The most important morbidity in IIH is visual impairment. According to the findings, the visual field impairment is not pertinent to CSF pressure. In other words, neither high CSF pressure predicts intense visual defect, nor low CSF pressure indicates minimal visual impairment

Measuring Serum Level of Ionized Magnesium in Patients with Migraine

How to Cite This Article: Assarzadegan F, Asadollahi M, Derakhshanfar H, Kashefizadeh A, Aryani O, Khorshidi M. Measuring Serum Level of Ionized Magnesium in Patients with Migraine. Iran J Child Neurol. Summer 2015;9(3):13-16.AbstractObjectiveMigraine is known as one of the most disabling types of headache. Among the variety of theories to explain mechanism of migraine, role of serum magnesium is of great importance. Serum magnesium, as a pathogenesis factor, was considerably lower in patients with migraine. We established this study to see if serum ionized magnesium, not its total serum level, was different in migraineurs from normal individuals.Materials & MethodsIn this case control study, all participants were recruited from Neurology Clinic of Imam Hossein Hospital, Tehran, Iran. Ninety-six people were entered in the study, 48 for each of case and control groups. The two groups were matched by age and sex. Migrainous patients were selected according to the criteria of International Headache Society. Various characteristics of headache were recorded based on patients’ report. Controls had no history of migraine or any significant chronic headaches. Serum ionized magnesium level was measured in both of the case and control groups and the results were compared to each other. P value of <0.05 was considered as significant.ResultsCase group consisted of 13 males, 35 females, and control group included 14 males, as well as 34 females. Mean age was 33.47± 10.32 yr for case and 30.45 ±7.12 yr for control group. Twenty-eight patients described the intensity of their headaches as moderate; 15 patients had severe and the 5 remainders had only mild headaches. Mean serum level of ionized Mg was 1.16± 0.08 in case group and 1.13± 0.11 in control group of no significant difference (P >0.05).ConclusionSerum ionized magnesium, which is the active form of this ion, was not significantly different in migraineurs and those without migraine. This may propose a revision regarding pathogenesis of migraine and question the role of magnesium in this type of headache

The buffering effect of family functioning on the psychological consequences of headache

The current study aimed to examine whether high family functioning mitigates the association between headache intensity and distress. The sample consisted of 124 patients with chronic or recurrent headache. Patients completed validated questionnaires about headache intensity, family functioning, and distress. Hierarchical regression analyses were performed to examine the interaction between headache intensity and family functioning on distress. Headache intensity was positively associated with distress (r = .28, p = .002). As hypothesized, family functioning moderated this association (B = −.01, p = .023). More specifically, the positive association between headache intensity and distress was significant only among patients with lower family functioning (B = .01, p < .001) and not among patients with higher levels of family functioning (B = .006, p = .075). Functional families appear to buffer the distress level in patients; they showed relatively low levels of distress regardless of the severity of their headache. In contrast, patients with dysfunctional families who experienced more pain reported more distress, presumably because they did not receive adequate help and support from these families. This study underlines the importance of a broader perspective on family dynamics in coping with pain

The Role of Antiepileptic Treatment in the Recurrence Rate of Seizures After First Attack: A Randomized Clinical Trial

How to Cite This Article: Assarzadegan F, Tabesh H, Hesami O, Derakhshanfar H, Beladi Moghadam N, Shoghli A, Beale A.D, Hosseini-Zijoud S.M. The Role of Antiepileptic Treatment in the Recurrence Rate of Seizures After First Attack: A Randomized Clinical Trial. Iran JChild Neurol. Spring 2015; 9(2):46-52.AbstractObjectiveEpilepsy is a serious, potentially life-shortening brain disorder that occurs in patients of all ages and races. A total of 2–4% of people have experienced seizures at least once in their lifetime. Although treatment usually begins after a seizure, it is an important question whether the first cases of seizure do need to be treated by antiepileptic drugs. In this manner, we compare the recurrence rates of epilepsy in first seizure patients treated with sodium valproic acid as an antiepileptic drug versus a placebo.Material &amp; MethodsIn a randomized clinical trial study, 101 first seizure patients were randomly divided into two groups: one group was treated with antiepileptic drugs (sodium valproate 200mg, three times a day) and the other group was given a placebo.The recurrence rate of seizures was evaluated and compared between the groups after 6 months of follow up.ResultsEight recurrence cases were detected. All recurrence cases came from the placebo group, with four patients suffering an additional seizure after four months and between 4-6 month follow up. A comparison of recurrence rate detected a statistically significant difference between the drug group and placebo group.ConclusionOur data shows that the recurrences occurred only in the placebo group with the difference between the recurrence rates in the placebo versus drug-treated was significant. Our results suggest that drug therapy for people after their first seizure attack might reduce the probability of seizure recurrence

Prayer and pain catastrophizing coping strategies on headache intensity prediction in patients with headache

Introduction: Headaches are the most common cause of absence from work and school and one of the most common reasons of referring to neurologist. The present study aimed to investigate the role of prayer and pain catastrophizing as coping strategies in prediction of headache intensity. Methods: In this research we selected 124 patients (89 female and 35 male) with headache as comparison group via available sampling method and 53 individual (30 female and 23 male) as control group. The patients were chosen after the diagnosis of headache by a neurologist in a neurology clinic. The patients completed demographic questionnaire, visual analogues scale (VAS), prayer subscale of coping strategies questionnaire (CSQ) and pain catastrophizing scale (PCS). Results: The analysis of regression showed that rumination as one of the subscale of pain catastrophizing and prayer could account for 9% of variation for headache intensity. Conclusion: The results show that prayer and rumination, which is one of catastrophic components, are effective in prediction of pain. In other words, prayer can predict low intensity of headache, and rumination can predict high intensity of headache and this result which prayer predicted low intensity of pain, can explain the role of spirituality in mental health, especially in our country with religious background. Declaration of Interest: None

International Normalized Ratio Response Subsequent to Modest Increase in Vitamin K Intake in Patients Treated with Warfarin

Background: Warfarin is an effective oral anticoagulant which exert its effect by blocking the utilization of vitamin K. Warfarin therapy requires ongoing monitoring using the international normalized ratio (INR). In this study, effect of modest increase in vitamin K intake from vegetables on INR values was evaluated in warfarin treated patients. Methods: A single-center study involving 24 outpatients (mean age, 62 years) with two last INR in therapeutic range in which INR variations was less than 0.5. Patients were selected based on their VKORC1 1639G→A polymorphism so that 8 patients from each of GG, AA or GA genotypes were recruited. Patients were asked to consume a vegetable mix (including lettuce, peeled cucumber and tomato) containing approximately 100 µg vitamin K (divided in two meals, lunch and dinner) daily for one week when INR response was measured. Results: Daily consumption of vegetable mix decreased patient’s INR from 2.43±0.51 to 2.08± 0.46 (P<0.001). INR value had a significant decrease in each VKORC1 genotypes (from 2.55± 0.55 to 2.21± 0.54 in GG, 2.35± 0.33 to 2.00± 0.25 in AA, and  2.39± 0.65 to 2.00± 0.25 in GA) but the values did not differ between genotypes. Conclusions: Daily increase in vegetable salad containing approximately 100 µg, decreased INR of patients. Therefore, avoiding variation in consumption of foods with even moderate content of vitamin K could help to prevent INR fluctuations in warfarin treated patients

Frequency of dyslipidemia in migraineurs in comparison to control group

Background: Migraine is a common disease with neurovascular nature, which is commonly prevalent in the general population. Due to the significant prevalence of migraine and its long-term complications, it is necessary to pay attention to its exacerbating factors. Therefore, the aim of this study was to evaluate the frequency distribution of dyslipidemia in patients with migraine compared with control group. Materials and Methods: This is a case–control study, in which 50 patients with migraine (with aura and without aura) were confirmed by the criteria of International Headache Society. Migraineurs and control group (n = 50) were selected from among patients who referred to the Neurology Clinic of Imam Hossein Hospital. The levels of total cholesterol, triglyceride, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) cholesterol were measured in both the groups. SPSS software (version 21) was used to analyze the data. Results: The findings showed that among migraineurs, 21 patients (42%) revealed high levels of cholesterol and 22 revealed high levels of LDL (44%); whereas among subjects without migraine, 12 subjects (24%) exhibited high levels of cholesterol and 12 (24%) high levels of LDL, where a significant correlation between the two groups was achieved. Conclusion: The present results showed that migraine is associated with higher level of cholesterol and LDL when compared with the control group, where a significant relationship was found

CLIPPERS: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive To Steroids

A novel type of brainstem-predominant encephalomyelitis was first described as chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) in 2010 by Pittocket al and then few additional patients were reported. Here we report a 50-year-old Iranian male who presented with a number of clinical features described as typical for CLIPPERS. The association of typical clinical presentation and typical MR imaging could be sufficient for a reliable diagnosis of CLIPPERS