Neurology Research International The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Combined Supplementation of Choline and Docosahexaenoic Acid during Pregnancy Enhances Neurodevelopment of Fetal Hippocampus Sun, 22 Jan 2017 09:13:50 +0000 Choline is an essential nutrient for humans which plays an important role in structural integrity and signaling functions. Docosahexaenoic acid (DHA) is a polyunsaturated fatty acid, highly enriched in cell membranes of the brain. Dietary intake of choline or DHA alone by pregnant mothers directly affects fetal brain development and function. But no studies show the efficacy of combined supplementation of choline and DHA on fetal neurodevelopment. The aim of the present study was to analyze fetal neurodevelopment on combined supplementation of pregnant dams with choline and DHA. Pregnant dams were divided into five groups: normal control [NC], saline control [SC], choline [C], DHA, and C + DHA. Saline, choline, and DHA were given as supplements to appropriate groups of dams. NC dams were undisturbed during entire gestation. On postnatal day (PND) 40, brains were processed for Cresyl staining. Pups from choline or DHA supplemented group showed significant () increase in number of neurons in hippocampus when compared to the same in NC and SC groups. Moreover, pups from C + DHA supplemented group showed significantly higher number of neurons () in hippocampus when compared to the same in NC and SC groups. Thus combined supplementation of choline and DHA during normal pregnancy enhances fetal hippocampal neurodevelopment better than supplementation of choline or DHA alone. Huban Thomas Rajarethnem, Kumar Megur Ramakrishna Bhat, Malsawmzuali Jc, Siva Kumar Gopalkrishnan, Ramesh Babu Mugundhu Gopalram, and Kiranmai Sesappa Rai Copyright © 2017 Huban Thomas Rajarethnem et al. All rights reserved. Accumulation of α-Synuclein in Cerebellar Purkinje Cells of Diabetic Rats and Its Potential Relationship with Inflammation and Oxidative Stress Markers Wed, 04 Jan 2017 17:13:09 +0000 Objective. The present study was conducted to evaluate the relationship between plasma oxidative stress markers such as malondialdehyde (MDA) and glutathione (GSH), inflammatory marker pentraxin-3 (PTX3), and cerebellar accumulation of α-synuclein in streptozotocin- (STZ-) induced diabetes model in rats. Methods. Twelve rats were included in the study. Diabetes () was induced with a single intraperitoneal injection of streptozotocin (STZ, 60 mg/kg). Diabetes was verified after 48 h by measuring blood glucose levels. Six rats served as controls. Following 8 weeks, rats were sacrificed for biochemical and immunohistochemical evaluation. Results. Plasma MDA levels were significantly higher in diabetic rats when compared with the control rats (), while plasma GSH levels were lower in the diabetic group than in the control group (). Also, plasma pentraxin-3 levels were statistically higher in diabetic rats than in the control rats (). The analysis of cerebellar α-synuclein immunohistochemistry showed a significant increase in α-synuclein immunoexpression in the diabetic group compared to the control group (). Conclusion. Due to increased inflammation and oxidative stress in the chronic period of hyperglycemia linked to diabetes, there may be α-synuclein accumulation in the cerebellum and the plasma PTX3 levels may be assessed as an important biomarker of this situation. Volkan Solmaz, Hatice Köse Özlece, Hüseyin Avni Eroglu, Hüseyin Aktuğ, Oytun Erbaş, and Dilek Taşkıran Copyright © 2017 Volkan Solmaz et al. All rights reserved. Protective Effect of PPARγ Agonists on Cerebellar Tissues Oxidative Damage in Hypothyroid Rats Mon, 26 Dec 2016 14:00:22 +0000 The aim of the current study was to investigate the effects of peroxisome proliferator-activated receptor gamma (PPARγ) agonists on cerebellar tissues oxidative damage in hypothyroid rats. The animals included seven groups: group I (control), the animals received drinking water; group II, the animals received 0.05% propylthiouracil (PTU) in drinking water; besides PTU, the animals in groups III, IV, V, VI, and VII, were injected with 20 mg/kg vitamin E (Vit E), 10 or 20 mg/kg pioglitazone, and 2 or 4 mg/kg rosiglitazone, respectively. The animals were deeply anesthetized and the cerebellar tissues were removed for biochemical measurements. PTU administration reduced thiol content, superoxide dismutase (SOD), and catalase (CAT) activities in the cerebellar tissues while increasing malondialdehyde (MDA) and nitric oxide (NO) metabolites. Vit E, pioglitazone, and rosiglitazone increased thiol, SOD, and CAT in the cerebellar tissues while reducing MDA and NO metabolites. The results of present study showed that, similar to Vit E, both rosiglitazone and pioglitazone as PPARγ agonists exerted protective effects against cerebellar tissues oxidative damage in hypothyroid rats. Yousef Baghcheghi, Farimah Beheshti, Hossein Salmani, Mohammad Soukhtanloo, and Mahmoud Hosseini Copyright © 2016 Yousef Baghcheghi et al. All rights reserved. Remotely Assessing Symptoms of Parkinson’s Disease Using Videoconferencing: A Feasibility Study Mon, 26 Dec 2016 08:32:26 +0000 Purpose. To evaluate the feasibility of assessing a person’s symptoms of Parkinson’s disease (PD) in their home using the videoconferencing technology they already possess, without a home visit. Method. Eleven participants with PD completed the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) face-to-face and then via videoconferencing within a two-week period. Participants used free software and the computers and webcams available at their home to complete the videoconference assessment with a clinical rater scoring remotely. Clinical raters and participants provided feedback on the experience. Results. Excluding rigidity and postural stability, between zero and seven items could not be completed in the assessment of each participant (median 2.0, IQR 1.0–4.0). Between face-to-face and videoconference assessments, the median difference in scores was 3.0 (IQR 1.5–9.0). Content analysis of feedback identified the clinical raters’ reasons why some scoring could not be completed and the participants’ hope for future clinical application. Conclusions. In using free everyday technology available in participants’ homes, MDS-UPDRS ratings could be obtained without an initial home visit; however some items were unable to be scored for some participants. Use of a protocol or technological advances are likely to reduce missing items. Tereza Stillerova, Jacki Liddle, Louise Gustafsson, Robyn Lamont, and Peter Silburn Copyright © 2016 Tereza Stillerova et al. All rights reserved. Description of Ictal HFO Mapping in Patients with Both Temporal and Extratemporal Seizure Focus Mon, 28 Nov 2016 12:49:55 +0000 Objective. Review presurgical use of ictal HFO mapping to detect ictal activation areas with dual seizure focus in both the temporal and extratemporal cortex. Methods. Review of consecutive patients admitted to the University of South Alabama Epilepsy Monitoring Unit (SouthCEP) between January 2014 and October 2015, with suspected temporal lobe epilepsy and intracranial electrode recording. Ictal HFO localization was displayed in 3D reconstructed brain images using the patient’s own coregistered magnetic resonance imaging (MRI) and computed tomography (CT) with the implanted electrodes. Results. Four of fifteen patients showed evidence of extratemporal involvement at the onset of the clinical seizures. Ictal HFO mapping involving both frontal and temporal lobe changed the surgical resection areas in three patients where the initial surgical plan included only the temporal lobe. Resection of the ictal HFO at the onset of the seizure and the initial propagation region was associated with seizure freedom in all patients; follow-up period ranged from 12 to 25 months. Significance. Extratemporal ictal involvement may not have clinical manifestations and may account for surgical failure in temporal lobe epilepsy. Ictal HFO mapping is useful to define the ictal cortical network and may help detect an extratemporal focus. Juan G. Ochoa and Walter G. Rusyniak Copyright © 2016 Juan G. Ochoa and Walter G. Rusyniak. All rights reserved. Increased Serum Levels of Tumor Necrosis Factor-Alpha, Resistin, and Visfatin in the Children with Autism Spectrum Disorders: A Case-Control Study Mon, 28 Nov 2016 11:33:27 +0000 Background. Autism spectrum disorders (ASDs) are complex disorders where the pathogenesis is not fully understood. Several proinflammatory and immunoinflammatory disturbances have been observed in the etiology of ASD. There is, however, limited knowledge on variations of adipokines in ASD. The present study aimed to analyze the serum levels of resistin, visfatin, and tumor necrosis factor-alpha (TNF-α) in children with ASD in relation to body weight, gender, and ASD severity level. Method. In total, 30 children with ASD (mean age:  y; range; 4–12 y) and 30 healthy children (mean age:  y; range: 4–12 y), including males and females, were matched for age, gender, and body mass index (BMI). Serum samples were collected, and visfatin, resistin, and TNF-α serum levels were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Result. Serum visfatin, resistin, and TNF-α levels in children with ASD were significantly higher than that in the healthy patients (). Two significant correlations were found: a correlation between resistin and visfatin with TNF-α in children with ASD (R = 0.8 and R = 0.62, resp.) and a correlation between resistin and visfatin in children with ASD (R = 0.66). Conclusion. Higher TNF-α, resistin, and visfatin levels were found in children with ASD in comparison with controls, suggesting that elevated levels of serum proinflammatory agents may be implicated in the pathophysiology of ASD. Mohammad Ali Ghaffari, Elham Mousavinejad, Forough Riahi, Masoumeh Mousavinejad, and Mohammad Reza Afsharmanesh Copyright © 2016 Mohammad Ali Ghaffari et al. All rights reserved. Cognitive Function in Parkinson’s Disease Patients with and without Anxiety Sun, 09 Oct 2016 09:56:29 +0000 Research on the implications of anxiety in Parkinson’s disease (PD) has been neglected despite its prevalence in nearly 50% of patients and its negative impact on quality of life. Previous reports have noted that neuropsychiatric symptoms impair cognitive performance in PD patients; however, to date, no study has directly compared PD patients with and without anxiety to examine the impact of anxiety on cognitive impairments in PD. This study compared cognitive performance across 50 PD participants with and without anxiety (17 PDA+; 33 PDA−), who underwent neurological and neuropsychological assessment. Group performance was compared across the following cognitive domains: simple attention/visuomotor processing speed, executive function (e.g., set-shifting), working memory, language, and memory/new verbal learning. Results showed that PDA+ performed significantly worse on the Digit Span forward and backward test and Part B of the Trail Making Task (TMT-B) compared to the PDA− group. There were no group differences in verbal fluency, logical memory, or TMT-A performance. In conclusion, anxiety in PD has a measurable impact on working memory and attentional set-shifting. K. A. Ehgoetz Martens, J. Y. Y. Szeto, A. J. Muller, J. M. Hall, M. Gilat, C. C. Walton, and S. J. G. Lewis Copyright © 2016 K. A. Ehgoetz Martens et al. All rights reserved. Assessment and Predicting Factors of Repeated Brain Computed Tomography in Traumatic Brain Injury Patients for Risk-Stratified Care Management: A 5-Year Retrospective Study Thu, 15 Sep 2016 07:31:49 +0000 Background and Objective. To determine the value of repeated brain CT in TBI cases for risk-stratified care management (RSCM) and to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Methods. A 5-year retrospective study from January 2009 to August 2013 was conducted. The primary outcome was the value of repeated brain CT in TBI cases. The secondary outcome is to identify predicting factors which will change the neurosurgical management after repeated brain CTs. Results. There were 145 consecutive patients with TBI and repeated brain CT after initial abnormal brain CT. Forty-two percent of all cases () revealed the progression of intracranial hemorrhage after repeated brain CT. In all 145 consecutive patients, 67.6% of cases () were categorized as mild TBI. For mild head injury, 8.2% of cases () had undergone neurosurgical management after repeated brain CT. Only 1 from 74 mild TBI patients with repeated brain CT had neurosurgical intervention. Clopidogrel and midline shift more than 2 mm on initial brain CT were significant predicting factors to indicate the neurosurgical management in mild TBI cases. Conclusion. Routine repeated brain CT for RSCM had no clinical benefit in mild TBI cases. Preeda Sumritpradit, Thitipong Setthalikhit, and Sorayouth Chumnanvej Copyright © 2016 Preeda Sumritpradit et al. All rights reserved. The Value of ABCD2F Scoring System (ABCD2 Combined with Atrial Fibrillation) to Predict 90-Day Recurrent Brain Stroke Tue, 23 Aug 2016 13:37:41 +0000 Background. The ABCD2 score is now identified as a useful clinical prediction rule to determine the risk for stroke in the days following brain ischemic attacks. Aim. The present study aimed to introduce a new scoring system named “ABCD2F” and compare its value with the previous ABCD2 system to predict recurrent ischemic stroke within 90 days of the initial cerebrovascular accident (CVA). Methods. 138 consecutive patients with the final diagnosis of ischemic CVA or TIAs who referred to emergency ward of Rasoul-e-Akram general hospital in Tehran from September 2012 to December 2013 were eligible. By adding a new score in the presence of atrial fibrillation to ABCD2 system, the new scoring system as ABCD2F was introduced and the risk stratification was done again on this new system. Results. The area under the curve for ABCD2 was 0.434 and for ABCD2F it was 0.452 indicating low value of both systems for assessing recurrence of stroke within 90 days of primary event. Multivariable logistic regression analysis showed that none of the baseline factors could predict 90-day recurrent stroke. Conclusion. ABCD2 and/or atrial fibrillation are not good scoring candidates for assessing the risk of recurrent stroke within first 90 days. Mostafa Almasi, Nader Hodjati Firoozabadi, Faeze Ghasemi, and Mojtaba Chardoli Copyright © 2016 Mostafa Almasi et al. All rights reserved. Electrophysiological Predictors of Clinical Outcome in Traumatic Neuropathies: A Multicenter Prospective Study Thu, 28 Jul 2016 12:35:09 +0000 Objectives. This prospective, observational, multicentre study aims to identify electrodiagnostic (EDX) markers of clinical recovery in patients with traumatic neuropathy (TN) receiving surgical (S) and nonsurgical (NS) treatments. Methods. Subjects referred to the Italian Traumatic Neuropathy Network between 2010 and 2011 (307 patients, for a total of 444 TN) were evaluated with serial clinical/EDX evaluations at 6, 12, 24, and 36 months of follow-up. Results. Primary surgery was performed in 21 subjects with open lesions and evidence of neurotmesis, while closed lesions were treated with either conservative medical approach (216 patients) or secondary surgery (70 patients), according to the clinical spontaneous recovery at 4–6 months. Clinical improvement correlated with the increase of the compound muscle action potential amplitude (OR 3.76; CI 1.61–8.76), particularly in the S group (OR 7.25; CI 1.2–43.87), and with sensory nerve action potential amplitude in the NS group (OR 4.35; CI 1.14–16.69). No correlations were found with needle electromyography qualitative evaluations, changes in maximal voluntary recruitment, age, and gender. Conclusions. Nerve conduction studies (NCS) represent the more accurate neurophysiological markers of clinical outcome in patients with TN. Significance. Serial NCS assessments predict the functional recovery in TN, increasing the accuracy of peripheral nerves surgical decision-making process. Palma Ciaramitaro, Mauro Mondelli, Eugenia Rota, Bruno Battiston, Arman Sard, Italo Pontini, Giuliano Faccani, Giuseppe Migliaretti, Aristide Merola, Dario Cocito, and Italian Network for Traumatic Neuropathies Copyright © 2016 Palma Ciaramitaro et al. All rights reserved. Focusing on Increasing Velocity during Heavy Resistance Knee Flexion Exercise Boosts Hamstring Muscle Activity in Chronic Stroke Patients Mon, 25 Jul 2016 16:07:38 +0000 Background. Muscle strength is markedly reduced in stroke patients, which has negative implications for functional capacity and work ability. Different types of feedback during strength training exercises may alter neuromuscular activity and functional gains. Objective. To compare levels of muscle activity during conditions of blindfolding and intended high contraction speed with a normal condition of high-intensity knee flexions. Methods. Eighteen patients performed unilateral machine knee flexions with a 10-repetition maximum load. Surface electromyography (EMG) was recorded from the quadrics and hamstring muscles and normalized to maximal EMG (nEMG) of the nonparetic limb. Results. For the paretic leg, the speed condition showed higher values of muscle activity compared with the normal and blindfolded conditions for both biceps femoris and semitendinosus. Likewise, the speed condition showed higher co-contraction values compared with the normal and blindfolded conditions for the vastus lateralis. No differences were observed between exercise conditions for the nonparetic leg. Conclusion. Chronic stroke patients are capable of performing heavy resistance training with intended high speed of contraction. Focusing on speed during the concentric phase elicited higher levels of muscle activity of the hamstrings compared to normal and blindfolded conditions, which may have implications for regaining fast muscle strength in stroke survivors. Jonas Vinstrup, Joaquin Calatayud, Markus D. Jakobsen, Emil Sundstrup, and Lars L. Andersen Copyright © 2016 Jonas Vinstrup et al. All rights reserved. Peripheral Nerve Ultrasonography in Chronic Inflammatory Demyelinating Polyradiculoneuropathy and Multifocal Motor Neuropathy: Correlations with Clinical and Neurophysiological Data Sun, 29 May 2016 14:13:13 +0000 Objective. This cross-sectional study analyzes the pattern of ultrasound peripheral nerve alterations in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN) at different stages of functional disability. Material and Methods. 22 CIDP and 10 MMN patients and a group of 70 healthy controls were evaluated with an ultrasound scan of the median, ulnar, peroneal, tibial, and sural nerves. Results were correlated with clinical disability scales and nerve conduction studies. Results. Patients with intermediate functional impairment showed relatively larger cross-sectional areas than subjects with either a milder () or more severe impairment (), both in CIDP and in MMN. In addition, MMN was associated with greater side-to-side intranerve variability (), while higher cross-sectional areas were observed in CIDP () and in nerve segments with predominantly demyelinating features (). Higher CSA values were observed in nerves with demyelinating features versus axonal damage ( for CIDP; for MMN). Discussion and Conclusions. Greater extent of quantitative and qualitative US alterations was observed in patients at intermediate versus higher functional disability and in nerves with demyelinating versus axonal damage. CIDP and MMN showed differential US aspects, with greater side-to-side intranerve variability in MMN and higher cross-sectional areas in CIDP. Aristide Merola, Michela Rosso, Alberto Romagnolo, Erdita Peci, and Dario Cocito Copyright © 2016 Aristide Merola et al. All rights reserved. The Potential of Curcumin in Treatment of Spinal Cord Injury Thu, 19 May 2016 07:52:23 +0000 Current treatment for spinal cord injury (SCI) is supportive at best; despite great efforts, the lack of better treatment solutions looms large on neurological science and medicine. Curcumin, the active ingredient in turmeric, a spice known for its medicinal and anti-inflammatory properties, has been validated to harbor immense effects for a multitude of inflammatory-based diseases. However, to date there has not been a review on curcumin’s effects on SCI. Herein, we systematically review all known data on this topic and juxtapose results of curcumin with standard therapies such as corticosteroids. Because all studies that compare the two show superior results for curcumin over corticosteroids, it could be true that curcumin better acts at the inflammatory source of SCI-mediated neurological injury, although this question remains unanswered in patients. Because curcumin has shown improvements from current standards of care in other diseases with few true treatment options (e.g., osteoarthritis), there is immense potential for this compound in treating SCI. We critically and systematically summarize available data, discuss clinical implications, and propose further testing of this well-tolerated compound in both the preclinical and the clinical realms. Analyzing preclinical data from a clinical perspective, we hope to create awareness of the incredible potential that curcumin shows for SCI in a patient population that direly needs improvements on current therapy. Raghavendra Sanivarapu, Vijayalakshmi Vallabhaneni, and Vivek Verma Copyright © 2016 Raghavendra Sanivarapu et al. All rights reserved. Utility of Plasmapheresis in Autoimmune-Mediated Encephalopathy in Children: Potentials and Challenges Thu, 28 Apr 2016 17:14:55 +0000 Autoimmune-mediated encephalopathy in children continues to constitute a diagnostic and therapeutic challenge in pediatric population. Utility and usefulness in this clinical setting of plasmapheresis have seldom been evaluated in current pediatric literature. Children with immune-mediated encephalopathies represent a uniquely different group among patients presenting to intensive care units or neurological services worldwide. Arriving at a final diagnosis is not an easy task for treating physicians. It is very crucial to consider early use of first-line immunotherapy modalities, save those children’s lives and improve outcomes. Plasmapheresis is an emerging, potentially beneficial first-line therapy in such patients. However, indications, value, logistics, and procedural difficulties are often faced. This study is mainly meant to review the current knowledge in regard to the clinical value of plasmapheresis in children with immune-mediated encephalopathy. Abdulhafeez M. Khair Copyright © 2016 Abdulhafeez M. Khair. All rights reserved. BMI, HOMA-IR, and Fasting Blood Glucose Are Significant Predictors of Peripheral Nerve Dysfunction in Adult Overweight and Obese Nondiabetic Nepalese Individuals: A Study from Central Nepal Wed, 20 Apr 2016 11:47:04 +0000 Objective. Nondiabetic obese individuals have subclinical involvement of peripheral nerves. We report the factors predicting peripheral nerve function in overweight and obese nondiabetic Nepalese individuals. Methodology. In this cross-sectional study, we included 50 adult overweight and obese nondiabetic volunteers without features of peripheral neuropathy and 50 healthy volunteers to determine the normative nerve conduction data. In cases of abnormal function, the study population was classified on the basis of the number of nerves involved, namely, “<2” or “≥2.” Multivariable logistic regression analysis was carried out to predict outcomes. Results. Fasting blood glucose (FBG) was the significant predictor of motor nerve dysfunction (, 95% confidence interval (CI) = 1.003–1.127). Homeostatic model assessment of insulin resistance (HOMA-IR) was the significant predictor (, 96% CI = 1.420–49.322) of sensory nerve dysfunction. Body mass index (BMI) was the significant predictor (, 95% CI = 1.018–1.577) in case of ≥2 mixed nerves’ involvement. Conclusion. FBG, HOMA-IR, and BMI were significant predictors of peripheral nerve dysfunction in overweight and obese Nepalese individuals. Lekhjung Thapa and P. V. S. Rana Copyright © 2016 Lekhjung Thapa and P. V. S. Rana. All rights reserved. Febrile Seizures and Febrile Seizure Syndromes: An Updated Overview of Old and Current Knowledge Mon, 30 Nov 2015 17:09:17 +0000 Febrile seizures are the most common paroxysmal episode during childhood, affecting up to one in 10 children. They are a major cause of emergency facility visits and a source of family distress and anxiety. Their etiology and pathophysiological pathways are being understood better over time; however, there is still more to learn. Genetic predisposition is thought to be a major contributor. Febrile seizures have been historically classified as benign; however, many emerging febrile seizure syndromes behave differently. The way in which human knowledge has evolved over the years in regard to febrile seizures has not been dealt with in depth in the current literature, up to our current knowledge. This review serves as a documentary of how scientists have explored febrile seizures, elaborating on the journey of knowledge as far as etiology, clinical features, approach, and treatment strategies are concerned. Although this review cannot cover all clinical aspects related to febrile seizures at the textbook level, we believe it can function as a quick summary of the past and current sources of knowledge for all varieties of febrile seizure types and syndromes. Abdulhafeez M. Khair and Dalal Elmagrabi Copyright © 2015 Abdulhafeez M. Khair and Dalal Elmagrabi. All rights reserved. The Role of the Craniocervical Junction in Craniospinal Hydrodynamics and Neurodegenerative Conditions Mon, 30 Nov 2015 14:30:22 +0000 The craniocervical junction (CCJ) is a potential choke point for craniospinal hydrodynamics and may play a causative or contributory role in the pathogenesis and progression of neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, MS, and ALS, as well as many other neurological conditions including hydrocephalus, idiopathic intracranial hypertension, migraines, seizures, silent-strokes, affective disorders, schizophrenia, and psychosis. The purpose of this paper is to provide an overview of the critical role of the CCJ in craniospinal hydrodynamics and to stimulate further research that may lead to new approaches for the prevention and treatment of the above neurodegenerative and neurological conditions. Michael F. Flanagan Copyright © 2015 Michael F. Flanagan. All rights reserved. Recurrence Quantification Analysis of F-Waves and the Evaluation of Neuropathies Tue, 24 Nov 2015 09:25:30 +0000 Electrodiagnostic (EDX) patterns of neuropathic dysfunction have been based on axonal/demyelinating criteria requiring prior assumptions. This has not produced classifications of desired sensitivity or specificity. Furthermore, standard nerve conduction studies have limited reproducibility. New methodologies in EDX seem important. Recurrent Quantification Analysis (RQA) is a nonlinear method for examining patterns of recurrence. RQA might provide a unique method for the EDX evaluation of neuropathies. RQA was used to analyze F-wave recordings from the abductor hallucis muscle in 61 patients with neuropathies. Twenty-nine of these patients had diabetes as the sole cause of their neuropathies. In the other 32 patients, the etiologies of the neuropathies were diverse. Commonly used EDX variables were also recorded. RQA data could separate the 29 patients with diabetic neuropathies from the other 32 patients (). Statistically significant differences in two EDX variables were also present: compound muscle action potential amplitudes () and F-wave persistence (). RQA analysis of F-waves seemed able to distinguish diabetic neuropathies from the other neuropathies studied, and this separation was associated with specific physiological abnormalities. This study would therefore support the idea that RQA of F-waves can distinguish between types of neuropathic dysfunction based on EDX data alone without prior assumptions. Morris A. Fisher, Vijaya K. Patil, and Charles L. Webber Jr. Copyright © 2015 Morris A. Fisher et al. All rights reserved. Prevalence of Provocative Seizures in Persons with Epilepsy: A Longitudinal Study at Khon Kaen University Hospital, Thailand Thu, 12 Nov 2015 13:24:42 +0000 Background and Objective. Provocative factors are one causative factor of seizure attacks in persons with epilepsy (PWE). There are limited data of prevalence and major provocative factors in Asian populations. Methods. This study was performed at the Epilepsy Clinic, Khon Kaen University Hospital. The patients who aged 15 years or over, who had been treated at least 3 months with at least one antiepileptic drug, and who were followed up for at least one year were included. Data of seizure control and triggers were collected retrospectively from medical records. Data analysis was performed to identify independent provocative factors. Results. A total of 382 PWE met the study criteria. The mean age was years. Approximately 44% of the patients had at least one provocative factor. By multivariate analysis, the independent provocative factors with the first three highest adjusted odds ratios were sleep deprivation (adjusted , 95% CI 3.73–19.99), alcohol consumption (adjusted , 95% CI 1.44–31.78), and feeling stressful (adjusted , 95% CI 1.29–6.86). Conclusion. Almost half of seizure attacks may be caused by provocative factors in Thai PWEs and some factors may be preventable. Avoidance of these factors should be emphasized to epilepsy patients for improving clinical outcomes and quality of life. Nutthaya Vongkasamchai, Sunee Lertsinudom, Acharawan Topark-Ngarm, Udomlack Peansukwech, Kittisak Sawanyawisuth, Somsak Tiamkao, and Integrated Epilepsy Research Group Copyright © 2015 Nutthaya Vongkasamchai et al. All rights reserved. Differential Expression of Tyrosine Hydroxylase Protein and Apoptosis-Related Genes in Differentiated and Undifferentiated SH-SY5Y Neuroblastoma Cells Treated with MPP+ Sun, 08 Nov 2015 11:56:42 +0000 The human neuroblastoma SH-SY5Y cell line has been used as a dopaminergic cell model for Parkinson’s disease research. Whether undifferentiated or differentiated SH-SY5Y cells are more suitable remains controversial. This study aims to evaluate the expression of apoptosis-related mRNAs activated by MPP+ and evaluate the differential expression of tyrosine hydroxylase (TH) in undifferentiated and retinoic acid- (RA-) induced differentiated cells. The western blot results showed a gradual decrease in TH in undifferentiated cells and a gradual increase in TH in differentiated cells from days 4 to 10 after cell plating. Immunostaining revealed a gradual increase in TH along with neuritic outgrowth in differentiated cells on days 4 and 7 of RA treatment. For the study on cell susceptibility to MPP+ and the expression of apoptosis-related genes, MTT assay showed a decrease in cell viability to approximately 50% requiring 500 and 1000 μM of MPP+ for undifferentiated and RA-differentiated cells, respectively. Using real-time RT-PCR, treatment with 500 μM MPP+ led to significant increases in the Bax/Bcl-2 ratio, p53, and caspase-3 in undifferentiated cells but was without significance in differentiated cells. In conclusion, differentiated cells may be more suitable, and the shorter duration of RA differentiation may make the SH-SY5Y cell model more accessible. Kawinthra Khwanraj, Chareerut Phruksaniyom, Suriyat Madlah, and Permphan Dharmasaroja Copyright © 2015 Kawinthra Khwanraj et al. All rights reserved. Visual Interhemispheric and Striate-Extrastriate Cortical Connections in the Rabbit: A Multiple Tracer Study Tue, 08 Sep 2015 06:38:51 +0000 Previous studies in rabbits identified an array of extrastriate cortical areas anatomically connected with V1 but did not describe their internal topography. To address this issue, we injected multiple anatomical tracers into different regions in V1 of the same animal and analyzed the topography of resulting extrastriate labeled fields with reference to the patterns of callosal connections and myeloarchitecture revealed in tangential sections of the flattened cortex. Our results extend previous studies and provide further evidence that rabbit extrastriate areas resemble the visual areas in rats and mice not only in their general location with respect to V1 but also in their internal topography. Moreover, extrastriate areas in the rabbit maintain a constant relationship with myeloarchitectonic borders and features of the callosal pattern. These findings highlight the rabbit as an alternative model to rats and mice for advancing our understanding of cortical visual processing in mammals, especially for projects benefiting from a larger brain. Adrian K. Andelin, David J. Bruning, Daniel J. Felleman, and Jaime F. Olavarria Copyright © 2015 Adrian K. Andelin et al. All rights reserved. Prevalence and Correlates of HIV-Associated Neurocognitive Disorders (HAND) in Northwestern Nigeria Sun, 09 Aug 2015 14:26:08 +0000 HIV-associated Neurocognitive Disorders (HAND) are common among HIV-positive individuals. This study explored the prevalence and correlates of HAND in Nigeria. 80 HIV-positive and 40 HIV-negative adults selected from Aminu Kano Teaching Hospital (AKTH) received comprehensive evaluations. A multidomain neuropsychological test (MDNPT) battery assessing 7 domains was administered to the participants and their performance was combined with measures of functional status to classify impairments into various grades of HAND. Univariate and multivariate analyses were performed to identify correlates of symptomatic HAND. Among the HIV-positive individuals, 50% were highly active antiretroviral therapy-experienced (HAART+) and 50% were highly active antiretroviral therapy naive (HAART−). Symptomatic HAND was found among 40% of the HAART− individuals and 30% of the HAART+ individuals. Respective prevalence of HIV-associated dementia (HAD) was 23% and 5%, respectively (). In a binary logistic regression model, only fewer years of education independently predicted symptomatic HAND [Odds Ratio (OR) = 1.2, 95% confidence interval (CI) = 1.04–1.44, ]. The prevalence of HAND in Nigeria is high with HAD being commoner among HAART− patients. Provision of HAART and strict monitoring of patients at risk of HAND are needed to scale down the burden of the disease. Ahmad M. Yakasai, Mustafa I. Gudaji, Hamza Muhammad, Aliyu Ibrahim, Lukman F. Owolabi, Daiyabu A. Ibrahim, Musa Babashani, Muhammad S. Mijinyawa, Musa M. Borodo, Abayomi S. Ogun, and Abdulrazaq G. Habib Copyright © 2015 Ahmad M. Yakasai et al. All rights reserved. Evaluation of the Effects of Charged Amino Acids on Uncontrolled Seizures Thu, 09 Jul 2015 11:27:25 +0000 Introduction. Epilepsy is one of the most common diseases of the central nervous system. The prevalence of epilepsy throughout the world is 0.5 to 1%, and the same rate is 7.8 per 1000 in Kerman. Almost 20 to 30% of epileptic patients do not respond properly to common medications. The present study investigated patients who did not respond to common and, even in some cases, adjuvant therapies, with two seizures or more per week, regardless of the type of the inflicted epilepsy. Methodology. The participants of the present double-blind study were randomly selected into three 10-member groups of uncontrolled epileptic patients (arginine, glutamic acid, and lysine). The patients used amino acid powder dissolved in water (three times the daily need) every day for two weeks before breakfast. The number of seizures was recorded one week prior to commencing amino acid use, as well as the first and the second weeks subsequent to use. Results. A total of 32 patients were studied in three groups. The decline rates of seizures were 53%, 41%, and 13%, and the P value was 0.013, 0.027, and 0.720, respectively. Conclusion. Administration of the charged amino acids, arginine, and glutamic acid can decrease the seizures of patients suffering from uncontrolled epilepsy. Hossein Ali Ebrahimi and Saeed Ebrahimi Copyright © 2015 Hossein Ali Ebrahimi and Saeed Ebrahimi. All rights reserved. Hypobaric Hypoxia Imbalances Mitochondrial Dynamics in Rat Brain Hippocampus Sun, 05 Jul 2015 08:55:55 +0000 Brain is predominantly susceptible to oxidative stress and mitochondrial dysfunction during hypobaric hypoxia, and therefore undergoes neurodegeneration due to energy crisis. Evidences illustrate a high degree of association for mitochondrial fusion/fission imbalance and mitochondrial dysfunction. Mitochondrial fusion/fission is a recently reported dynamic mechanism which frequently occurs among cellular mitochondrial network. Hence, the study investigated the temporal alteration and involvement of abnormal mitochondrial dynamics (fusion/fission) along with disturbed mitochondrial functionality during chronic exposure to hypobaric hypoxia (HH). The Sprague-Dawley rats were exposed to simulated high altitude equivalent to 25000 ft for 3, 7, 14, 21, and 28 days. Mitochondrial morphology, distribution within neurons, enzyme activity of respiratory complexes, , ADP: ATP, and expression of fission/fusion key proteins were determined. Results demonstrated HH induced alteration in mitochondrial morphology by damaged, small mitochondria observed in neurons with disturbance of mitochondrial functionality and reduced mitochondrial density in neuronal processes manifested by excessive mitochondrial fragmentation (fission) and decreased mitochondrial fusion as compared to unexposed rat brain hippocampus. The study suggested that imbalance in mitochondrial dynamics is one of the noteworthy mechanisms occurring in hippocampal neurons during HH insult. Khushbu Jain, Dipti Prasad, Shashi Bala Singh, and Ekta Kohli Copyright © 2015 Khushbu Jain et al. All rights reserved. Inventory of a Neurological Intensive Care Unit: Who Is Treated and How Long? Wed, 24 Jun 2015 08:10:19 +0000 Purpose. To characterize indications, treatment, and length of stay in a stand-alone neurological intensive care unit with focus on comparison between ventilated and nonventilated patient. Methods. We performed a single-center retrospective cohort study of all treated patients in our neurological intensive care unit between October 2006 and December 2008. Results. Overall, 512 patients were treated in the surveyed period, of which 493 could be included in the analysis. Of these, 40.8% had invasive mechanical ventilation and 59.2% had not. Indications in both groups were predominantly cerebrovascular diseases. Length of stay was 16.5 days in mean for ventilated and 3.6 days for nonventilated patient. Conclusion. Most patients, ventilated or not, suffer from vascular diseases with further impairment of other organ systems or systemic complications. Data reflects close relationship and overlap of treatment on nICU with a standardized stroke unit treatment and suggests, regarding increasing therapeutic options, the high impact of acute high-level treatment to reduce consequential complications. Roland Backhaus, Franz Aigner, Felix Schlachetzki, Dagmar Steffling, Wolfgang Jakob, Andreas Steinbrecher, Bernhard Kaiser, Peter Hau, Sandra Boy, Kornelius Fuchs, Ulrich Bogdahn, and Markus Ritzka Copyright © 2015 Roland Backhaus et al. All rights reserved. Children with Autism Spectrum Disorder and Patterns of Participation in Daily Physical and Play Activities Mon, 15 Jun 2015 12:06:51 +0000 Autism spectrum disorder (ASD) indicates several neurodevelopmental impairments which may end in impairments in motor or physical activities. Daily physical activity involvement was investigated in a total of 83 children (52 boys and 31 girls) with ASD aged 6–15 years. Results indicated that only 10 (12%) of children with ASD were physically active. Children were predominantly engaged in solitary play rather than social play activities. Gender, family income, and household structure were found to be associated with activity scores. Financial burden and lack of opportunities were noted as the leading barriers to physical activities. In conclusion, findings indicated a low rate of physical activity participation in children with ASD that is closely associated with sociodemographic variables. Amir Hossein Memari, Nekoo Panahi, Elaheh Ranjbar, Pouria Moshayedi, Masih Shafiei, Ramin Kordi, and Vahid Ziaee Copyright © 2015 Amir Hossein Memari et al. All rights reserved. Pioglitazone Ameliorates Neuron Loss in the Cortex after Aluminum-Treatment in Rats Mon, 08 Jun 2015 14:00:03 +0000 The objective was evaluation of the effects of pioglitazone on medial prefrontal cortex (mPFC) of the rats exposed to aluminum (Al). Al induces structural changes in several brain regions, including mPFC. Pioglitazone is an agonist of peroxisomal proliferator activated receptor gamma. Male rats were randomly assigned to control, Al-treated (10 mg/kg/day), and Al + PIO-treated groups (Al+ 40 mg/kg/day). After 56 days, the right mPFCs were removed. Then, the volume of mPFC and its subdivisions, volume of vessels, and total number of neurons and glia were estimated using stereological methods. The results showed 13–38% decrease in the volume of the mPFC and its subdivisions, mainly in the infralimbic region (). Besides, the volume of the vessels reduced by 47% after Al-treatment (). The total number of the neurons and glial cells was also reduced (40% and 25%, resp.) in the Al-exposed rats in comparison to the control ones (). Treatment of the animals with Al + PIO ameliorated the neuron loss and no improvement was seen in other parameters (). It can be concluded that treatment of the rats with PIO could ameliorate the neuron loss in the mPFC of the Al-treated animals. Ali Rafati, Hajar Yazdani, and Ali Noorafshan Copyright © 2015 Ali Rafati et al. All rights reserved. Atrial Fibrillation in the Young: A Neurologist’s Nightmare Thu, 02 Apr 2015 18:17:24 +0000 Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia seen in clinical practice with prevalence in excess of 33 million worldwide. Although often asymptomatic and until recently considered a “benign” arrhythmia, it is now appreciated that thromboembolism resulting from AF results in significant morbidity and mortality predominantly due to stroke. Although an arrhythmia more commonly affecting the elderly, AF can also occur in the young. This review focuses on the impact of AF in the younger population and discusses the dilemmas of managing younger patients with AF. Nikhil Aggarwal, Subothini Selvendran, Claire E. Raphael, and Vassilios Vassiliou Copyright © 2015 Nikhil Aggarwal et al. All rights reserved. Clinical Manifestations of Herpes Zoster, Its Comorbidities, and Its Complications in North of Iran from 2007 to 2013 Sun, 29 Mar 2015 13:20:44 +0000 Background. Herpes zoster infection is a painful worldwide disease. Inappropriate and delayed treatment causes prolongation of the disease with debilitating symptoms and postherpetic neuralgia. Method. A cross-sectional study evaluated shingles cases admitted in a teaching hospital with one-year followup in north of Iran from 2007 to 2013. Results. From 132 patients, 60.4% were male. Head and neck involvement occurred in 78 people (59.1%), thoracoabdominal region in 37 cases (28%), and extremities in 16 cases (12.1%), and one case (0.8%) got multisites involvement. 54 cases (40.9%) had predisposing factors including diabetes mellitus in 26 cases (19.7%), malignancy in 15 (11.4%), immunosuppressive medication in 7 (5.03%), HIV infection in 3 (2.3%), radiotherapy in 2 (1.5%), and tuberculosis in one patient (0.8%). The most common symptoms were pain (95.5%), weakness (56%), fever (31.1%), headache (30.3%), ocular complaints (27.3%), itching (24.2%), and dizziness (5.3%). 21 cases (15.9%) had bacterial superinfection on blistering areas and overall 18 cases (13.6%) had opium addiction. 4 cases (3.03%) died during admission because of comorbidities. Postherpetic neuralgia was reported in 56 patients (42.5%) after three months and seven cases (5%) in one-year followup. Conclusion. Shortening interval between skin lesion manifestation and starting medication can accelerate lesion improvement and decrease disease course, extension, and complication. Farhang Babamahmoodi, Ahmad Alikhani, Fatemeh Ahangarkani, Leila Delavarian, Hamidreza Barani, and Abdolreza Babamahmoodi Copyright © 2015 Farhang Babamahmoodi et al. All rights reserved. Optic Nerve Sonography in the Diagnostic Evaluation of Pseudopapilledema and Raised Intracranial Pressure: A Cross-Sectional Study Sun, 22 Mar 2015 11:43:26 +0000 Introduction. Differentiating pseudopapilledema from papilledema which is optic disk edema and a result of increased ICP (intracranial pressure) is important and can be done with noninvasive methods like orbital ultrasound examination. Method. This was a cross-sectional study in which patients with optic nerve head swelling were referred for LP exam after optic nerve head swelling diagnosis confirmation and having normal brain imaging (CT scan). Before LP (lumbar puncture) exam the patients were referred for optic nerve ultrasound test of both eyes. Results. Considering 5.7 mm as the upper limit for normal ONSD (optic nerve sheath diameter), sensitivity and negative predictive value of optic sonography in diagnosis of pseudopapilledema are 100% for both eyes. Calculated accuracy validity of ONSD measurement in detecting pseudopapilledema is 90% for the right eye and 87% for the left eye. Conclusion. Our study demonstrated a close correlation between optic nerve sheath dilation on ocular ultrasound and evidence of elevated ICP with optic disk swelling. With the aid of noninvasive diagnostic tests we can avoid unnecessary concerns along with expensive and invasive neurological investigations while targeting the correct diagnosis in bilateral optic disk swelling. Our study showed optic nerve sonography as a reliable diagnostic method for further usage. Masoud Mehrpour, Fatemeh Oliaee Torshizi, Shooka Esmaeeli, Salameh Taghipour, and Sahar Abdollahi Copyright © 2015 Masoud Mehrpour et al. All rights reserved.