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Background and purpose: Headache is one of the pain syndromes in multiple sclerosis (MS). Migraine is one of most frequent types of headache among patients with MS. The aim of this study was to investigate the association between MS and migraines.

Materials and methods: A cross-sectional study was conducted in 60 patients with definite MS. The brain MRI scans were obtained and the location of lesions and number of lesions and locations were recorded and compared.

Results: The study population included 51 females and 9 males. Among the patients 82% were diagnosed with remitting-relapsing MS and 18% had secondary progressive MS. Patients with headache were found with higher number of lesion locations compared with those without headache (P= 0.0001). Compared with MS patients without migraines, migraineurs with MS had larger sizes of lesions in midbrain, cerebellum, thalamus, frontal and temporal  lobes (P<0.05) while migraine patients with aura had more significant involvement of the frontal lobe and less significant involvement of the occipital lobe than migraine patients without aura (P= 0.035 and P= 0.011, respectively). Same results were found for number of lesions in MS patients with and without headache. The difference in number of lesions in subjects with and without aura were observed only in occipital lobe. (P= 0.031).

Conclusion: The presence of MS plaques in the infratentorial region mainly midbrain and cerebellum and supratentorial region especially the frontal and temporal lobes, and thalamus may contribute to the increase in occurrence of headache with migraine characteristics.

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Background and purpose: Anti-epileptic drugs (AEDs) can affect cognitive functions. The purpose of this study was to investigate the effects of lamotrigine (LT) on cognitive functions of patients with epilepsy.
Materials and methods: A study with retrospective cohort design was carried out in which we assessed cognitive functions of 20 IGE patients attending Sari Bu Ali Hospital, and 12 healthy subjects. The control group was matched for age, sex, and educational level. Standardized neuropsychological tests were used to evaluate cognitive functions. The study was analyzed applying one-way ANOVA and Tukey Test in SPSS.
Results: Compared with the control group, LT group showed poor performance in Stroop test and verbal fluency test-semantic test (P<0.05). The group on other drugs were also found to have poor performance in verbal fluency test (phonetic and semantic), forward digit span task, and Stroop test compared with those of the control group (P<0.05).
Conclusion: Compared with LT, other AEDs had more adverse effects on cognitive functions which could be due to their effect on channels and release changing stimulatory neurotransmitters.

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Background and purpose: Multiple Sclerosis (MS) is a common neurological disease in young adults. This study was performed to determine the prevalence of headache in these patients.
Materials and methods: This descriptive-analytic study was carried out using convenient sampling in patients attending neurology clinics affiliated to Mazandaran University of Medical Sciences, 2017. Data analysis was done in SPSS V24.
Results: There were 129 MS patients with history of headache, of whom 41.1% had migraine and 56.6% had tension headache. Severe types of headaches were reported by 47% of the patients and migraine was found to have the highest incidence. There were significant correlations between relapsing-remitting MS and tension and migraine headaches (P=0.001). About half of the patients did not mention a history of headache before MS, and there was no relationship between the new migraine headache and its aura (P>0.05).
Conclusion: In current study, tension headaches were found to be the most common types of headaches in MS patients. In relapsing-remitting MS, the most common type of headache was migraine. Given the adverse effects of headache on quality of life, awareness on the common types of headache could help in improving the quality of life of MS patients.

 

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Background and purpose: Sexual dysfunction (SD) is a common symptom of multiple sclerosis (MS). This study was conducted to determine the frequency of sexual dysfunction and its types in women with MS and identifying the related factors.
Materials and methods: A descriptive cross-sectional study was done in female patients
(n= 114) attending an outpatient MS clinic in Sari, Iran 2018. The participants included female married patients with no history of relapse and pulse therapy during the past three months, no history of hepatic problem, no history of pschyciateric diseases and pschyciateric medications. Information was collected using the Female Sexual Functioning Index (FSFI). Data analysis was done in SPSS V16 applying correlation test.
Results: All patients (100%) reported sexual dysfunction, including painful intercourse (93%), decreased lubrication (80.7%), lack of arousal (43.9%), lack of desire (38%), difficulty in reaching orgasm (36.8%), and lack of satisfaction (36.8%). In this study, 63.1% of the patients experienced mild depression. Significant associations were seen between depression (P=0.007), sphincter problems (P=0.02), and sexual dysfunction.
Conclusion: Awareness on the high frequency of sexual dysfunction in MS patients helps to eliminate the underlying causes and improving the quality of life in these patients.
 
 

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Background and purpose: Migraine is a very debilitating disorder despite medication treatments. The aim of this study was to determine the effect of acupressure on severity of acute migraine headaches.
Materials and methods: This randomized controlled trial was performed in 84 migraine sufferers attending the Emergency Department in Sari Buali Hospital, Iran 2019. Patients were randomly divided into three groups (n=28) of acupressure, control, and sham using Random Allocation Software. In intervention group, acupressure was applied to eight points for 8 seconds in each acupoint followed by two-second rest periods and this sequence was repeated for 3 minutes. The control group received only medical treatments and in sham group, acupressure was applied to eight unrelated points. Pain intensity was measured by Visual Analog Scale (VAS) before and 24 minutes after acupressure. Data were analyzed using Kruskal-Wallis test and Mann-Whitney U test.
Results: Before the intervention, the median (Q3-Q1) pain intensity in intervention, sham, and control groups were 6, 5, and 5, respectively (P=0.175). After the intervention, the values were 1.5, 3, and 5 in intervention group, sham, and control groups, respectively (P<0.001). After the intervention, the mean score for pain intensity was significantly lower in intervention group than the sham (P<0.001) and control (P<0.001) groups. This rate was significantly lower in sham group than the control group (P<0.001).
Conclusion: Acupuncture alongside other treatments can be helpful in reducing the severity of pain caused by acute headaches.
 
(Clinical Trials Registry Number: IRCT20110906007494N30)
 

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Takayasu's arteritis is a chronic, idiopathic, inflammatory disease that mainly affects large blood vessels such as the aorta and its branches, and is mostly prevalent among women younger than 40 years old. Although involvement of the central nervous system and stroke may occur during the course of the disease, it is uncommon as the initial manifestation of the patient. Here, a 58-year-old patient is presented with stroke symptoms and occlusion of the left and right carotid and left vertebral arteries since 7 years ago. The patient was subjected to laboratory examination, imaging, and additional investigations, and with Takayasu's diagnosis, she underwent treatment with corticosteroids, cyclophosphamide (and then methotrexate), and antiplatelet therapy. In addition to the occurrence of stroke as the first manifestation of the disease, the development of symptoms at the age of 51 indicated that the inflammatory process had probably started more than a decade before the symptoms.
 

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Background and purpose: Ischemic strokes can be specified according to their vascular territory as anterior and posterior circulation ischemia. Although stroke has well-known risk factors, there is currently no clear information on the relationship of stroke subtypes with cerebrovascular risk factors and the etiology of stroke. The present study aimed to compare the risk factors and etiology of ischemic stroke in anterior and posterior circulation.
Materials and methods: This cross-sectional study was performed using 459 ischemic stroke patient data, which was recorded in the SITS registry from 2020 to 2022. Study variables, including vascular risk factors, etiology, severity of stroke, and vascular territory, were analyzed in SPSS software (version 20).
Results: Among 459 patients, 239 (52.51%) cases were female. Anterior circulation and posterior circulation involvement occurred in 309 (74.82%) and 93 (22.76%) patients, respectively. The mean age of patients (69.73±13.0 vs 70.28±13.9) was similar (P=0.40). Severe stroke was observed more frequently in anterior circulation (23.52% vs 23.52%; P=0.04). Stroke with cardioembolic etiology and diabetes were reported more frequently in the posterior circulation (P=0.08; P=0.10) but with no statistically significant difference.
Conclusion: These findings suggest that posterior and anterior circulation ischemia are more similar than different in their etiology and risk factors. Therefore, treatment and evaluations should not be based on the territory of infarction, and all risk factors and etiologies should be evaluated in both circulation ischemia.