Psychogenic non-epileptic seizures in Iran

AbstractPurposeWe investigated the demographic and clinical characteristics of psychogenic non-epileptic seizures (PNES) in patients in Iran.MethodsIn this prospective study, all patients with a clinical diagnosis of PNES (based on ictal recordings) were recruited at the outpatient epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2013. The epileptologist interviewed all the patients. We investigated the demographic and clinical characteristics of PNES.ResultsTwo hundred and forty-nine patients were diagnosed as having PNES. Two hundred and eleven patients had video-EEG recordings available and included in the study. One hundred and forty-one (66.8%) were female and 70 (33.2%) were male. There were no significant differences between our patients and previous reports regarding the clinical and semiological characteristics of PNES.ConclusionPsychogenic non-epileptic seizures are relatively common at epilepsy clinics. It appears that an Islamic lifestyle (in Iran) has little influence on the clinical characteristics and manifestations of PNES, as we observed similar results as in most previous studies from other cultures

Characterization of mechanical damage in granite

This paper aims to illustrate the use of infrared thermography as a non-destructive and non-contact technique to observe the phenomenological manifestation of damage in granite under unconfined compression. It allows records and observations in real time of heat patterns produced by the dissipation of energy generated by plasticity. The experimental results show that this technique, which couples mechanical and thermal energy, can be used for illustrating the onset of damage mechanism by stress concentration in weakness zones

Effects of Antiepileptic Drugs on Electroencephalographic Findings in Patients with Idiopathic Generalized Epilepsy

How to Cite this Article: Asadi-Pooya AA, Emami M. Effects of Antiepileptic Drugs on Electroencephalographic Findings inPatients with Idiopathic Generalized Epilepsy. Iranian Journal of Child Neurology 2011;5(4):33-36.ObjectiveSeveral antiepileptic drugs (AEDs) such as phenobarbital (Pb), carbamazepine (CBZ), and valproate (VPA) may suppress interictal epileptiform activity. We investigated the effects of AEDs on electroencephalography (EEG) data from patients with idiopathic generalized epilepsy (IGE).Materials & MethodsIn this cross-sectional study, all patients electroclinically diagnosed with IGE were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 through August 2010. A routine EEG was requested at the time of referral for all patients. Statistical analyses were performed using Chi square and Fisher’s exact test.ResultsThis study comprised of 336 patients. For about 20.8% (70 patients) of them, the initial EEG appeared normal. The first EEG was normal in 14.2% of the patients who had newly diagnosed IGE (19 patients). Normal EEG was also detected for 27.6% of the patients who received VPA monotherapy (16 patients), 31% of the patients who received CBZ monotherapy (9 patients), 29.4% of the patients who received Pb monotherapy (5 patients), and 11.1% of the patients who received lamotrigine (LTG) (1 patient).ConclusionThis study shows that compared to LTG, VPA suppresses generalized interictal epileptiform activity in patients with IGE more effectively. Theoretically, if a drug can frequently induce normalization of EEG, then it may be a better drug for treating IGEs.References1. Betting LE, Mory SB, Lopes Cendes I, Li LM, GuerreiroMM, Guerreiro CAM, et al. EEG features in idiopathic generalized epilepsy: clues to diagnosis. Epilepsia.2006;47(3):523-8.2. Libenson MH, Caravale B. Do antiepileptic drugs differin suppressing interictal epileptiform activity in children? Pediatr Neurol 2001;24(3):214-8.3. Pro S, Vicenzini E, Pulitano P, Li Voti P, Zarabla A, Randi F, et al. Effects of levetiracetam on generalized discharges monitored with ambulatory EEG in epileptic patients. Seizure 2009;18(2):133-8.4. Rocamora R, Wagner K, Schulze - Bonhage A. Levetiracetam reduces frequency and duration ofepileptic activity in patients with refractory primarygeneralized epilepsy. Seizure 2006;15(6):428-33.5. Szaflarski JP. Effects of zonisamide on  the electroencephalogram of a patient with juvenile myoclonic epilepsy. Epilepsy Behav 2004;5(6):1024 -6.6. Covanis A. Photo sensitivity in idiopathic generalized epilepsies. Epilepsia 2005;46(suppl 9):67-72.7. Asadi-Pooya AA, Sperling M. Antiepileptic Drugs: AClinician’s Manual. Oxford University Press, USA; 2009

Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies?

How to Cite this Article: Asadi-pooya AA, Emami M. Is Interictal EEG Correlated with the Seizure Type in Idiopathic (Genetic) Generalized Epilepsies? Iran J Child Neurol 2012;6(2): 25-28. Objective We investigated the correlation between different interictal EEG abnormalities observed in patients with idiopathic (genetic) generalized epilepsies (IGEs) and their seizure types. Material & Methods In this cross-sectional study, all patients with the diagnosis of IGE, were recruited in the outpatient epilepsy clinic at Shiraz University of Medical Sciences, Iran, from 2008 through 2010. Demographic variables and relevant clinical and EEG variables were summarized descriptively. Statistical analyses were performed using independent samples T-test, Chi square and Fisher's Exact tests to determine potentially significant differences. Results Three-hundred thirty-six patients were diagnosed ashaving IGE. Interictal EEG findings in patients with generalized tonic-clonic seizure (GTCS) compared to patients without GTCS were not different. Abnormal EEG findings in patients with myoclonic seizures compared to patients without these were not different either. However, normal EEGs were more frequently observed in patients with history of myoclonic seizures (P = 0.0001). EEG findings in patients with absences compared to patients without absences were not different. Conclusion Interictal EEG cannot differentiate the seizure types and therefore different syndromes of IGEs. Polyspikes, 3-Hz generalized spike-wave (GSW) complexes and 3.5 - 6 Hz GSW complexes, alone or in combinations, could be observed in various seizure types and syndromes of IGE. The key element in making the correct diagnosis is a detailed clinical history. References Panayiotopoulos CP. Idiopathic generalized epilepsies. In: Panayiotopoulos CP, editor. The epilepsies: seizures, syndromes and management. Oxford: Bladon Medical Publishing 2005. p. 271-348. Lagerlund TD, Cascino GD, Cicora KM, Sharbrough FW. Long-term electroencephalographic monitoring for diagnosis and management of seizures. Mayo Clin Proc 1996 Oct;71(10):1000-6. Betting LE, Mory SB, Lopes-Cendes I, Li LM, Guerreiro MM, Guerreiro CA et al. EEG features in idiopathic generalized epilepsy: clues to diagnosis. Epilepsia 2006 Mar;47(3):523-8. Yenjun S, Harvey AS, Marini C, Newton MR, King MA, Berkovic SF. EEG in adult-onset idiopathic generalized epilepsy. Epilepsia 2003 Feb;44(2):252-6. Blume WT, Lüders HO, Mizrahi E, Tassinari C, van Emde Boas W, Engel J Jr. Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology. Epilepsia 2001;42(9):1212-8. Engel J Jr. A proposed diagnostic scheme for people with epileptic seizures and epilepsy: report of the ILAE task force on classification and terminology. Epilepsia 2001 Jun;42(6):796-803. Engel J. Jr. Report of the ILAE Classification Core Group. Epilepsia 2006 Sep;47(9):1558-68. Asadi-Pooya AA, Emami M. Effects of antiepileptic drugs on electroencephalographic findings in patients with idiopathic generalized epilepsies. Iran J Child Neurol 2011;5(4):33-6. Asadi-Pooya AA, Emami M, Nikseresht A. Early-onset versus typical childhood absence epilepsy; clinical and electrographic characteristics. Seizure 2012;21:273-5. Nordi DR. Idiopathic generalized epilepsies recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):48-56. Panayiotopoulos CP. Syndromes of idiopathic generalized epilepsies not recognized by the International League Against Epilepsy. Epilepsia 2005;46(Suppl. 9):57-66. Asadi-Pooya AA, Sperling MR. Choices of antiepileptic drugs based on specific epilepsy syndromes and seizure types. In: Asadi-Pooya AA, Sperling MR. Antiepileptic Drugs: A Clinician’s Manual. Oxford, UK: Oxford University Press; 2009. p. 95-102.  

Comparison of Accuracy Between Pulp/Tooth Ratio and Tooth Coronal Index Methods for Dental Age Estimation Using Digital Panoramic Radiographs

Objective: To evaluate the reliability and the accuracy of Tooth Coronal Index (TCI) and Pulp/Tooth Ratio (PTR) methods in dental age estimation using digital panoramic radiography. Material and Methods: In this cross-sectional study, 237 dental panoramic images were collected. The two methods (TCI and PTR) were applied to all left mandibular first and second molars based on inclusion and exclusion criteria. In order to analyze the acquired data, statistical methods were used. The estimated ages derived by exclusive formula were compared to the chronological age, and the error ranges for each indicator were measured to determine their accuracy. Results: There were negative correlations between PTR in the first molar (r=-0.89) and in the second molar (r=-0.788), as well as TCI in the first molar (r=-0.587) and in the second molar (r=-0.242). In this study, we found that the Pulp/Tooth Ratio (PTR) accuracy rate for mandibular first and second molar teeth was 79.21% and 62.09 %, respectively, although the Tooth Coronal Index (TCI) value for these teeth was 34.45% and 5.85%. Conclusion: Pulp/Tooth Ratio and Tooth Coronal Index are potential age estimation indices. Although PTR was the more accurate one in our study. The results also demonstrated that indices related to the first molar tooth could be used to estimate age with greater accuracy and validity

Comparison of temporal lobe epilepsy with hippocampal sclerosis and temporal lobe epilepsies due to other etiologies.

BACKGROUND: This study compares the clinical characteristics of patients with mesial temporal lobe epilepsy with hippocampal sclerosis (mTLE-HS) with those who have temporal lobe epilepsy (TLE) due to other etiologies. METHODS: In this retrospective study all patients with a clinical diagnosis of TLE were recruited in a referral outpatient epilepsy clinic at Shiraz University of Medical Sciences from September 2008 to May 2013. We classified the patients with TLE as having mesial temporal sclerosis if they had clear signs of mesial temporal sclerosis and/or atrophy in their MRI and others who had any other MRI abnormality. RESULTS: A total of 174 patients were studied (including 105 patients with mTLE-HS and 69 patients with TLE due to other etiologies). Frequency of seizure types was not significantly different between these two groups. Earlier age at epilepsy onset (p= 0.005), a past history of febrile seizures (p= 0.010) and presence of affective auras (p= 0.008) were commonly seen in patients with mTLEHS, while auditory auras (p= 0.020) were more frequent in those with TLE due to other etiologies. CONCLUSION: The mainstay for making a correct diagnosis, when evaluating a patient with seizure, is having a standardized approach, particularly with regard to taking a detailed clinical history. One may find important clues in the clinical history (e.g., age at disease onset, detailed seizure description and past history) to make a correct diagnosis

Epidemioclinical Feature of Early-Onset Colorectal Cancer at-Risk for Lynch Syndrome in Central Iran.

BACKGROUND Colorectal cancer (CRC) is becoming one of the most complicated challenges of human health, particularly in developing countries like Iran. In this paper, we try to characterize CRC cases diagnosed < age 50 at-risk for Lynch syndrome within central Iran. MATERIALS AND METHODS We designed a descriptive retrospective study to screen all registered CRC patients within 2000-2013 in Poursina Hakim Research Center (PHRC), a referral gastroenterology clinic in central Iran, based on being early-onset (age at diagnosis ≤50 years) and Amsterdam II criteria. We calculated frequencies and percentages by SPSS 19 software to describe clinical and family history characteristics of patients with early-onset CRC. RESULTS Overall 1,659 CRC patients were included in our study of which 413 (24.9%) were ≤50 years at diagnosis. Of 219/413 successful calls 67 persons (30.6%) were reported deceased. Family history was positive for 72/219 probands (32.9%) and 53 families (24.2%) were identified as familial colorectal cancer (FCC), with a history of at-least three affected members with any type of cancer in the family, of which 85% fulfilled the Amsterdam II Criteria as hereditary non-polyposis colorectal cancer (HNPCC) families (45/219 or 20.5%). Finally, 14 families were excluded due to proband tumor tissues being unavailable or unwillingness for incorporation. The most common HNPCC-associated extracolonic- cancer among both males and females of the families was stomach, at respectively 31.8 and 32.7 percent. The most common tumor locations among the 31 probands were rectum (32.3%), sigmoid (29.0%), and ascending colon (12.9%). CONCLUSIONS Given the high prevalence of FCC (~1/4 of early-onset Iranian CRC patients), it is necessary to establish a comprehensive cancer genetic counseling and systematic screening program for early detection and to improve cancer prognosis among high risk families

Comparison of Accuracy Between Pulp/Tooth Ratio and Tooth Coronal Index Methods for Dental Age Estimation Using Digital Panoramic Radiographs

Objective: To evaluate the reliability and the accuracy of Tooth Coronal Index (TCI) and Pulp/Tooth Ratio (PTR) methods in dental age estimation using digital panoramic radiography. Material and Methods: In this cross-sectional study, 237 dental panoramic images were collected. The two methods (TCI and PTR) were applied to all left mandibular first and second molars based on inclusion and exclusion criteria. In order to analyze the acquired data, statistical methods were used. The estimated ages derived by exclusive formula were compared to the chronological age, and the error ranges for each indicator were measured to determine their accuracy. Results: There were negative correlations between PTR in the first molar (r=-0.89) and in the second molar (r=-0.788), as well as TCI in the first molar (r=-0.587) and in the second molar (r=-0.242). In this study, we found that the Pulp/Tooth Ratio (PTR) accuracy rate for mandibular first and second molar teeth was 79.21% and 62.09 %, respectively, although the Tooth Coronal Index (TCI) value for these teeth was 34.45% and 5.85%. Conclusion: Pulp/Tooth Ratio and Tooth Coronal Index are potential age estimation indices. Although PTR was the more accurate one in our study. The results also demonstrated that indices related to the first molar tooth could be used to estimate age with greater accuracy and validity

Large-vessel stenosis in the patients with ischemic stroke in Iran: Prevalence, pattern, and risk factors

Background—Large artery disease (LAD) is a common cause of stroke, but a little is known regarding its role in Iranian stroke patients. The current study investigates the prevalence and risk factors for cervicocephalic arterial stenosis in the patients with ischemic stroke using digital subtraction angiography (DSA). Methods—This was a prospective cross-sectional study performed in hospitals affiliated to Shiraz University of Medical Sciences from March 2011 to March 2013. Patients with ischemic stroke underwent noninvasive vascular and cardiac investigations to find the etiology of the stroke. Patients suspected of having large artery stenosis underwent DSA. The severity of the stenosis was calculated according to the North American Symptomatic Carotid Endarterectomy (NASCET) and Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial criteria. The presence of cigarette smoking, hyperlipidemia, hypertension, and diabetes mellitus were documented for all subjects. Results—A total of 3703 stroke patients were identified. Of them, 342 patients (62.3%, male) underwent DSA for LAD. The mean age at the time of angiography was 66.7±10.3 years. Extracranial and intracranial arteries were involved in 305 (89.2%) and 162 (47.4%), respectively. And 301 patients (88%) had anterior circulation and 128 patients (37.4%) had posterior circulation involvement. Diabetes mellitus but not age, sex, hypertension, hyperlipidemia, or smoking was significantly associated with intracranial involvement. (P = 0.002) Conclusion—It can be concluded that the distribution of the large arterial atherosclerotic disease in Iran is similar to that seen in North America and Europe. Intracranial stenosis was more prevalent in diabetic patient