Signal intensity of basal ganglions in T2 magnetic resonance imaging in multiple sclerosis

Background and Objective: Although multiple sclerosis is a disease affecting white matter of brain and spinal cord, but involvement of basal ganglions in some studies demonstrated a decrease in T2 sequence signals. This study was done to assess signal intensity of basal ganglions in T2 magnetic resonance imaging (MRI) in multiple sclerosis Materials and Methods: This case – control study was done on 30 multiple sclerosis patients and 30 controls in Imam Reza hospital, Kermanshah, Iran, during 2010. MRI images of multiple sclerosis of patients and control group were matched according to age and sex. The basal ganglia signals were identified based on involvement areas, number of plaques, and brain atrophy in T2 and flair sequences. Data were analyzed using SPSS-16, Chi-Square, Fisher exact test and independent t-tests. Results: Among the case group, 10 patients (33.3%) demonstrated low signals in right thalamus and 14 patients (46.7%) in left thalamus, which was statistically significant compared with control group (P<0.001). The presence of plaques in right and left globus pallidus was observed in 4 (13.3%) and 7 patients (23.3%) respectively. The presence of plaques in right and left thalamus was observed in 10 patients (33.3%) and 14 patients (46.7%) respectively, which was significant compared with control group (P<0.001). The presence of brain atrophy was observed in 18 patients (60%) in case groups and in one patient (3.3%) in control group (P<0.001). Conclusion: This study indicated that reduction of T2 signals in thalamus is a valuable finding in multiple sclerosis patients and it may facilitate the diagnosis of multiple sclerosis

Multiple sclerosis national registry system in Iran: Validity and reliability of a minimum data set

Background: As the prevalence and incidence of Multiple Sclerosis (MS) are increasing remarkably in Iran, gathering standardized information regarding the individual's diagnosis, care, and outcomes through a uniform registry system would enable policy-makers to systematically plan for care quality improvements. Objective: To design a valid and reliable Persian version of a minimum data set to be utilized and integrated into the national MS registry system of Iran. Method: The minimum data set consisted of six domains including patient identification, family history of MS, diagnosis, disease course, disability status, and medications. The content validity was assessed based on 27 experts’ opinions. Item-Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI) were used to assess the questions and their validities. Reliability was evaluated using the intra-class correlation coefficient (ICC) of the test-retest results. Results: For validity appraisal, 27 experts reviewed the developed minimum data set. All the items had I-CVI values higher than the critical value of 0.78 in terms of relevance, clarity, and simplicity, except for “medication start date” and “medication end date” in relevance (I-CVI = 0.75 and 0.73, respectively) and “MS type” in simplicity (I-CVI = 0.76). The total S-CVI scores for relevance, clarity, and simplicity were higher than 0.9. In reliability assessment, 27 patients (out of 74 interviewed patients) were re-interviewed to assess the test-retest reliability. All ICCs were higher than the critical value of 0.7 (in 14 items out of 16), except for “progression to secondary-progressive MS” with the ICC = 0.68 and “the reason for medication discontinuance” with the ICC = 0.64. Conclusion: The use of standardized validated minimum data set has the potential to enable the researchers and policy-makers to systematically compare and analyze patient information. The Persian version of the minimum data set found to be valid and reliable in Ira

Trends of quality of life changes in amyotrophic lateral sclerosis patients

Background Amyotrophic lateral sclerosis (ALS) is an incurable progressive neurodegenerative disease and thus the assessment of quality of life (QOL) changes and factors that may influence its course is valuable in the meantime. Objectives The present study aimed to assess the deterioration rate of QOL and influencing factors in different subgroups of Iranian ALS patients. Methods 132 patients were evaluated in this prospective multicenter observational study. QOL was measured using ALS Assessment Questionnaire (ALSAQ-40) during 1 year follow up and its progression rate was assessed in different subgroups of patients according to age, sex, stage of disease, riluzole consumption, onset type. Also physical disability and functional disability were measured using MMT and ALSFRS-R scores respectively and their progression rates were compared with ALSAQ-40 changes. Results Significant deterioration of the scores of ALSAQ-40 during study was consistent in all of its domains (p = 0.000). There was a significant negative correlation between ALSFRS-R and MMT changes and ALSAQ-40 change (p = 0.000) and this was consistently observed in all domains of ALSAQ-40 (p = 0.00). ALSAQ-40 deterioration rate was shown to be significantly lower in severe/terminal stages compared to mild/moderate stages (p = 0.00). Significantly higher deterioration rate was observed in bulbar onset versus limb onset patients F (1,130) = 4.52, p = 0.04 but no significant difference was observed among other subgroups according to age, sex and riluzole consumption. Conclusion All domains of QOL significantly deteriorate during ALS course and there is a significant correlation between their changes and progression of physical and functional disabilities. Rate of degradation of QOL may be different at different stages of the disease. QOL worsens independent of factors such as sex, age and consumption of riluzole; but onset type (bulbar versus limb) is an imperative factor in quality of life changes during the disease course. © 2016 Elsevier B.V