Effectiveness of the Concurrent Intravenous Injection of Dexamethasone and Metoclopramide for Pain Management in Patients with Primary Headaches Presenting to Emergency Department

Introduction: Headache is a common reason for visiting emergency departments, and pain control is a major therapeutic goal in patients with headaches. Objective: The present study was conducted to examine the effectiveness of the concurrent intravenous administration of dexamethasone and metoclopramide in pain control in patients presenting to emergency departments with complaints of primary headache. Methods: This quasi-experimental study examined patients with moderate to severe headache attacks presenting to emergency departments. An 8-mg dose of dexamethasone and a 10-mg dose of metoclopramide were intravenously administered to the patients. The degree of headache was measured and recorded using the Numeric Rating Scale (NRS) upon admission and one hour and two hours after the injection. Results: A total of 51 patients with a mean age of 38.3±10.5 years participated in the study. The patients’ mean pain score was 8.4±1.3 upon admission and reduced to 6.2±2.3 one hour after the administration of the medication and to 3.1±2.9 two hours after the administration, suggesting significant reductions on both occasions (P<0.05). The therapeutic success was 39.2% one hour after the administration of the medication and 84.3% two hours after the administration. Conclusion: Based on these findings, the concurrent administration of dexamethasone and metoclopramide appears to affect the control of headache intensity in patients with primary headaches presenting to emergency departments

Ketorolac versus Magnesium Sulfate in Migraine Headache Pain Management; a Preliminary Study

Introduction: Migraine is a common cause of emergency department (ED) visits. To date, there is no recommended drug of choice for pain management of these patients. In the present study, we aimed to evaluate the effectiveness of ketorolac and magnesium sulfate in this regard. Methods: This is a cross-sectional study performed on all 18 - 60 year-old patients, visiting two different EDs with complaint of moderate to severe migraine headache. Patients were treated with 30 mg ketorolac in one hospital and 1 gram magnesium sulfate in the other. Pain scores were assessed on arrival, 1 and 2 hours after drugs administration and quality of pain management was compared between two groups using SPSS 22. Results: 70 patients with the mean age of 36.4 ± 11.4 years were enrolled (51.4% male). The two groups were similar regarding baseline characteristics (p > 0.05). The improvement in pain score in magnesium sulfate group was greater than Ketorolac group after both one hour (6 vs 3; p < 0.001) and two hours (7 vs 5; p < 0.001). Conclusion: It seems that both ketorolac and magnesium sulfate are significantly effective in pain control of patients with migraine headache presenting to the emergency department. Magnesium sulfate was superior to ketorolac both one and two hours after drug administration

The Effectiveness of Attribution Retraining on Health Enhancement of Epileptic Children

How to Cite This Article: Najafi Fard T, Pourmohamadreza-Tajrishi M, Sajedi F, Rezasoltani P, Delavar Kasmaei H. The Effectiveness of Attribution Retraining on Health Enhancement of Epileptic Children. Iran J Child Neurol. Spring 2016; 10(2):53-59.AbstractObjectiveEpilepsy is a chronic neurological disease. Evidence has indicated that epilepsy has an impact on mental and physical health of children. The present study aimed to determine the effectiveness of attribution retraining on health enhancement of epileptic children.Materials & MethodsThis was an experimental study with a pre-test and a post-test design with a control group. Thirty students with epilepsy (11 female and 19 male students) were selected in convenience from Iranian Epilepsy Association. They were assigned to experimental and control groups and their mothers completed Child Health Questionnaire (CHQ-PF.28) before and after the intervention.The experimental group attended to eleven sessions (each session 45 minutes; twice a week). Subjects were trained by attribution retraining program, but control group was not. Multivariate analysis of covariance (MANCOVA) was used for analyzing the data.ResultsHealth (both psychosocial and physical) of experimental group enhanced significantly after the intervention sessions compared to control group.ConclusionAttribution retraining is an effective intervention to enhance the psychosocial and physical health of epileptic children. References 1. Sadock B, Sadock V, Ruiz P. Comprehensive textbook of psychiatry. Philadelphia: Williams and wilkins. 2009.2. Walter G, Bradley R. Neurology in clinical practice. B & H Elsevier. 2008; 66:63-74.3. Baker GA, Hargis E, Hsih MMS, Mounfield H, Arzimanoglou A, Glauser T, et al. Perceived impact of epilepsy in teenagers and young adults: an international survey. Epilepsy Behav 2008; 12(3):395-401.4. Konda K, Ablah E, Kond K, Liow K. Health behavior and conditions of persons with epilepsy: A bivariate analysis of 2002 Buffs data 2009; 16:120-127.5. Mushi D, Hunter E, Mtuya C, Mshana G, Aris E, Walker R. Social–cultural aspects of epilepsy in Kilimanjaro Region, Tanzania: knowledge and experience among patients and carers. Epilepsy Behav 2011; 20(2):338-43.6. Loughin J. College and epilepsy. J Clin Psychiat 2011; 38(3):295-300.7. Rodenburg R, Wagner JL, Austin JK, Kerr M, Dunn DW. Psychosocial issues for children with epilepsy. Epilepsy Behav 2011; 22(1):47-54.8. Quintas R, Raggi A, Giovannetti AM, Pagani M, Sabariego C, Cieza A, et al. Psychosocial difficulties in people with epilepsy: a systematic review of literature from 2005 until 2010. Epilepsy Behav 2012; 25(1):60-7.9. Vázquez C, Jiménez F, Saura F, Avia MD. The importance of “importance”: A longitudinal confirmation of the attributional-stress model of depression measuring the importance of the attributions and the impact of the stressor. Personal Individual Diff 2001; 31(2):205-14.10. Sepahvand T, Gilani B, Zamani R. Relationship between Attributional Styles with Stressful Life Events and General Health. Psychol Res 2007; 9(3,4): 33-46.11. Endermann M. Predictors of health-related and global quality of life among young adults with difficult-to-treat epilepsy and mild intellectual disability. Epilepsy Behav 2013; 26(2):188-95.12. Jackson B, Sellers R, Peterson C. Pessimistic explanatory style moderate the effect of stress on physical illness. Personal Individual Diff 2002; 32:567-73. 13. Seligman ME, Walker EF, Rosenhan DL, Norton W. Abnormal psychology. 4, editor. New York: Norton London; 2001.14. Schultz D, Schultz S. Theories of personality. Tehran: Virayesh Publication; 2010.15. Seligman ME. The optimistic child: A proven program to safeguard children against depression and build lifelong resilience. Tehran: Roshd Publication; 2004.16. Saif A. Modern educational psychology (psychology of learning and instruction). Tehran: Dowran Publishing Company; 2008.17. Salehi M, Haghighat S. Attribution retraining on student achievement an successful girl. Psychol Res 2008; 1(1):27-39.18. Rosendal M, Fink P, Bro F, Olesen F. Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care. Scandinavian J Primary Health Care 2005; 23(1):3-10.19. Larisch A, Schweickhardt A, Wirsching M, Fritzsche K. Psychosocial interventions for somatizing patients by the general practitioner: a randomized controlled trial. J Psychosom Res 2004; 57(6):507-514.20. Vazehie Ashtiani A. Effect of training documents on attributional style, self-esteem, performance and persistence in mathematics students. J Psychiatr Clin Psychol 2003; 35-87.21. Qaympnah Z, Azadfallah P, & Tabatabai K. [Psychometric standards and standardization of the Persian version of the Child Health Questionnaire. (Persian)]. Journal of Kermanshah University of Medical Sciences 2013;17(7), 431-441 (In Persian).22. Ashouri M, Pourmohamadreza-Tajrishi M, Jalil-Abkenar S, & Ashouri J.[The effectiveness of learning strategies and attribution retraining instruction methods on mathematics problem solving in intellectually disabled students (Persian).] Developmental Psychology: Iran Psychol J 2011;8(31), 247-255.23. Holder EE, Levi DJ. Mental health and locus of control: SCL-90-R and Levenson’s IPC scales. J Clin Psychol 1988; 44(5):753-5.24. Wang D, Wang Y, Zhang Y. The relationship between locus of control, depression, shame, and self esteem. J Mental Health 1992; 6(5):207-21.25. Iravani M, Izadi M. Relationship between attribution and mental health in student of Azad University Khorasegan Branch. Knowledge Res Appl Psychol 2000; (1):7-20. 26. Peterson C, Seligman ME. Explanatory style and illness. J Personal 1987; 55(2):237-65.27. Pourmohamadreza-Tajrishi M, Abbasi S, Najafi Fard T, Yousefi S, Malek Abadi AM, Delavar Kasmaei H. Efficacy of attribution retraining on mental health of epileptic children. Iran Red Cresc Med J 2015; 17(10):1-7

Behavioral Problems in Iranian Epileptic Children; A Case Control Study

Background Epilepsy is among the most common neurological disorders in childhood, prevalence of which is increasing. Unpredictable and chronic nature of the disease affects physical, social and mental functions of the children and their family. This study was aimed to compare behavioral problems in epileptic children group versus healthy control group. Materials and Methods This study is a case-control one conducted from January 2013 to June 2016 in Tehran, Iran. The epileptic children in age of 7-10 years old that were diagnosed by neurologist referred to the researcher for further process. Their parents were provided with Child Behavior Checklist (CBCL) to be completed. For matching by age and gender, the healthy group was sampled after the epilepsy group. Multivariate Analysis of Variance was used for statistical analysis. Results In this study 94 children with epilepsy and 83 healthy children in age of 7-10 years old were studied. The results indicated that there were significantly higher behavioral problems in the children with epilepsy than in control group in nine categories of seclusiveness, physical complaints, anxiety and depression, social problems, thought problems, attention problems, delinquent behaviors, aggressive behaviors, and other problems. Comparison of two generalized and partial epilepsy groups indicated that there was a significant difference only in attention problems (p = 0.024). Conclusion The present study indicates that the children with epilepsy have more behavioral problems as compared to control group. Therefore, educational and psychological interventions are necessary for supporting desirable psychosocial growth and development of such children

Efficacy and Safety of MLC601 in the Treatment of Mild Cognitive Impairment: A Pilot, Randomized, Double-Blind, Placebo-Controlled Study

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients

Effectiveness and Safety of MLC601 in the Treatment of Mild to Moderate Alzheimer's Disease: A Multicenter, Randomized Controlled Trial

Background: MLC601 is a possible modulator of amyloid precursor protein processing, and in a clinical trial study MLC601 showed some effectiveness in cognitive function in Alzheimer's disease (AD) patients. We aimed to evaluate the effectiveness and safety of MLC601 in the treatment of mild to moderate AD as compared to 3 approved cholinesterase inhibitors (ChEIs) including donepezil, rivastigmine and galantamine. Methods: In a multicenter, nonblinded, randomized controlled trial, 264 volunteers with AD were randomly divided into 4 groups of 66; groups 1, 2, 3 and 4 received donepezil, rivastigmine, MLC601 and galantamine, respectively. Subjects underwent a clinical diagnostic interview and a cognitive/functional battery including the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Patients were visited every 4 months, and the score of cognition was recorded by the neurologists. Results: There were no significant differences in age, sex, marital status and baseline score of cognition among the 4 groups. In total, 39 patients (14.7%) left the study. Trend of cognition changes based on the modifications over the time for MMSE and ADAS-cog scores did not differ significantly among groups (p = 0.92 for MMSE and p = 0.87 for ADAS-Cog). Conclusion: MLC601 showed a promising safety profile and also efficacy compared to 3 FDA-approved ChEIs