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Background and Purpose: Simvastatin is an inhibitor of 3-hydroxy-3-methylglutaryl coenzyme, a reductase and widely used as cholesterol-lowering agent. It is a promising candidate for future treatment in multiple sclerosis (MS), as it has been shown to exhibit immunomodulatory and anti-inflammatory effects. This study examined the effect of simvastatin on the evolution of experimental autoimmune encephalomyelitis (EAE), as an animal model for MS.
Materials and Methods: EAE was induced by immunization of 8 week old C57BL/6 mice with MOG35-55 peptide with complete Freunds adjuvant. Therapy with simvastatin (1mg/kg/every day given as oral) was started on day 3 before the immunization until 25 day after immunization. Total antioxidant capacity (TAC) was assessed by ferric reducing-antioxidant power (FRAP) method. Nitric oxide (NO) production was also estimated by Griess reaction.
Results: The results show that simvastatin-treated mice had significantly less incidence and clinical score of EAE than non-treated (control) EAE induced mice (p=0.001 and p=0.0001, respectively). Moreover, treated mice displayed a significantly delayed disease onset compared with control mice. Simvastatin significantly increased TAC and level serum uric acid (p=0.001), but had no effect on serum nitrite production.
Conclusion: Our results suggest that simvastatin therapy may be effective in the prevention of symptomatic EAE. This resistance to encephalomyelitis may be associated with the inhibition of oxidative stress and the increase of antioxidant capacity.

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Background and purpose: Despite edidemiologic similarity of multiple sclerosis worldwide, prevalence shows considerable variability. According to Kurtzke, Iran is considered to have a low prevalence. In this study, we wanted to estimate the prevalence period and Indicate Epidemiologic aspect of MS in Mazandaran Province, North of Iran.
Materials and methods: A cross- sectional Registered case Study Conducted in 2007 on all definite MS Patients that live and reside within Mazandaran, as well az being a member of the Mazandaran MS Society. 582 difinite patients (161 men and 421 woman) were identified. The patients were Viu interview and questionaire to record demographic and Case related information. According to the national Sensius Reports, the population of Mazandaran was 2,893,087.
Results: The mean (SD) age of the participants was 34.3 (9.4) years. The MS period pervalence was 20.1 per 100,000{95% confidence interval(CI) 18.7-22.1}. The Female/male ration was 2.6 and MS rates were highest among 3rd decade. Visual and sensory distorbancec were thw most common initial persontations with prevalence of 40.1 %( 95% CI: 38.5-42.9 ) and 34.2% ( 95% CI: 32.8 – 36.1), respictively.
Conclusion: Mazandaran is in medium MS prevalence area. This is in clear contrast with background hypothesis, but other epidemiologic indices were almost pursuant with pervious information.

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Background and purpose: Multiple sclerosis (MS) is a disorder of the central nervous system and is rarely accompanied with seizure. The purpose of this study is to determine the frequency of different types of MS in patients with and without seizure. Materials and methods: A descriptive cross-sectional study was carried out on MS patients in Guilan from 2008-2010. The information regarding the demography of patients and the type of their MS were collected and then data were analyzed by χ 2, T- test and logistic regression using SPSS17. Results: From the total of 209 MS patients in this study (74.1% female and 25.9% male), 13 patients (69.2% female and 30.8% male) had seizure. The means of patients’ age, the age of disorder onset and EDSS in groups with & without seizure were 34.0 ± 8.6 and 33.2 ± 9.8 years, 26.18 ± 11.80 and 27.96 ± 8.05 years and 4.2 ± 2.5 and 4.6 ± 1.5 respectively. All these means between two groups were not significantly different. The prevalence of relapsing-remitting (RRMS), secondary (SPMS) and primary progressive MS (PPMS) in patients without seizure was 80.1%, 11.7% and 8.2% and in group with seizure was 38.5%, 53.8% and 7.7%, respectively and the difference was statistically significant. The seizure increases the probability of SPMS by 8.94-fold (95%CI: 2.51-31.77) and decreases the probability of RRMS by 10.16-fold (95% CI: 1.96-28.57). Also SPMS increases the chance of seizure by 10.16-fold (95% CI 2.65-38.88) compared with SPMS. Conclusion: SPMS is more prevalent in MS patients with seizure and seizure is a positive predictor for MS progression.

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Background and purpose: The present study is aimed at obtaining the experiences of Multiple Sclerosis patients regarding the impacts of the disease on their family and social relationships and also on medical interventions. The perception of nurses on these experiences is important in care plans. Materials and methods: This is a qualitative phenomenological research. Amongst the patients referred to Isfahan Multiple Sclerosis Society, 14 were chosen according to the purpose of study. The data was collected by in-depth interviews and Colaizzi method was used to interpret the data. Results: The results can be categorized in four groups: 1- cluttered family relationships, 2- changes in social relationships, 3- work interrupted, 4- inability to meet costs of living. Conclusion: Most participants stated that physical disorders resulting from the disease led to inability in doing their profession and consequently losing their job. Furthermore, inability to provide cost of living in some cases led to disturbance in the family and social relationships.

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Background and purpose: Oligodendrocytes are responsible for myelin synthesis in the central nervous system (CNS). Olig1 and Olig2 play an important role in regulating the development of oligodendrocyte precursor cells (OLPs). Myelin basic protein (MBP) is the main component of myelin sheath. Leukemia inhibitory factor (LIF) has an important role in myelination and pathology of multiple sclerosis (MS). This study investigates the effects of LIF on the expression of MBP, Olig1 and Olig2 in the cerebral cortex of cuprizone-induced MS mice. Materials and methods: In order to induce MS the mice were treated by Cuprizone for 5 weeks. The mice were then divided into three groups. The first group was injected LIF (25 µg/kg BW per day, i.p.) for 6 weeks. The second group (SHAM) received normal saline, i.p. for six weeks and the third group did not receive any injection. The mice were killed after six weeks and the cerebral cortex was harvested and MBP, Olig1 and Olig2 expression was studied by western blotting. Results: The results indicate that MBP, Olig1 and Olig2 expression in the cerebral cortical extracts was significantly increased in the LIF injected group compared with control and SHAM groups (P<0.001). Conclusion: This study reveals that LIF not only increases Olig1 and Olig2 expression in the oligodendrocytes and enhances oligodendrocytes activity and MBP expression, but also plays an important role in the pathophysiology of MS.

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Background and purpose: Multiple sclerosis (MS) is a chronic diseases of the nervous system in which the myelin nerve fiber in the brain and spinal cord is destroyed and the causes are still unclear. MS could result in progressive disabilities in young adults with different symptoms and incidence rate. This research aimed at comparing the big five personality factor in MS patients and healthy individuals. Materials and methods: This research was a case-control study which was conducted in east of Mazandaran. The research population included 191 patients with multiple sclerosis and 191 healthy individuals who were the patients’ companions with similar age, sex, marital status and education level with the first group. Personal questionnaire and NEO Personality Inventory-Revised were used and the data was analyzed by independent t-test. Results: The mean of neuroticism personality factor in patients and healthy subjects was 30.81 and 24.12, respectively (P= 0.001). Their means in conscientiousness were 30.9 and 35.93, respectively (P= 0.001). Conclusion: This study revealed that patients suffering from MS had a higher score in neuroticism personality factor and a lower score in conscientiousness compared with healthy subjects.

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Background and purpose: Multiple sclerosis (MS) is one of the diseases of nervous system that is accompanied with destruction of neuron ways corded sheath. The weakening nature of this disease affects all aspects of patient’s life and decreases their life expectancy. This consequence plays a considerable role in accelerating acute diseases such as MS. This study was done to assess the effectuality of cognitive behavioral therapy (CBT) on the life expectancy of patients suffering from MS. Materials and methods: this semi-experimental study included thirty MS patients attending Bou Ali Sina Hospital in Sari who were randomly divided into two groups. (control group=15 and intervention group= 15). The experimental group received CBT for three months during 12 sessions. The control group was placed in treatment waiting list. The data was collected using Hallajian Life Expectancy Questionnaire (2010). Results: The results showed that the mean scores for life expectancy increased significantly in the experimental group in post-treatment and follow up stages (P<0.001). Conclusion: According to his study interventions such as CBT could be of great benefit in in increasing life expectancy among patients with chronic diseases.

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Background and purpose: Multiple Sclerosis is a disease related to immune system with unknown factors which is considered one of the most important debilitating neurological diseases in adults particularly in youths in which myelin part of Central Nervous System (CNS) is damaged. This study mainly aims to compare styles of coping with stress in people with Multiple Sclerosisand healthy people in the East of Mazandaran. Materials and methods: in this study performed in case-control method comprised of the age range of 20-40 years, 191 patients with MS and 191 healthy people out of patient's accompaniers from the east of Mazandaran based on age, gender, marital status and education level matched with each other were selected. Endler and Parker's questionnaires of demographic characteristics and styles of coping with stress were used as a tool. Data were analyzed using independent t-test. Results: The mean of problem-focused coping style in patients was 16.86 and the one in healthy people was 15.60 (P>0.05). The mean of emotion-focused coping style in patients was 32.39 and the one in healthy people was 33.15 (P>0.05), and finally the mean of avoidant coping style in patients was 54.05 and the one in healthy people was 32.63 (P<0.01). Conclusion: Results of the study indicated that there was no significant difference between patients with MS in using problem-focused coping styles and emotion-focused compared with healthy people and they use more avoidant coping style.

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Background and purpose: Fatigue is one of the most common disabling complaints in patients with multiple sclerosis (MS). According to recently studies, between 60 to 90% of MS suffer of excessive fatigue. The nature of MS related fatigue is clearly distinct from normal fatigue. Complementary therapies probably effect on reduction of fatigue such as physiotherapy, yoga and exercise therapy. The purpose of this research was to evaluate the effect of aquatic exercise program on fatigue in women with Multiple sclerosis. Materials and methods: subjects of the research were 26 females with MS, who have age between 25-45 years and EDSS 1-4. And they were divided into two groups, experimental (12) and control (14). Aquatic Exercise program was 8 weeks (3 × weeks). Fatigue Severity Scale (FSS) used for measure fatigue in patients MS. Software SPSS (16) and T-student method used for statically analysis. Results: Results showed that there were a statically difference between pre and post test FSS scores in experimental group (P<0.05). Also, there were a statically difference between post-test FSS scores in experimental and control groups (P<0.05). And was observed that fatigue was significantly decrease after investigation Conclusion: Finally, we can state that aquatic exercise program decrease fatigue in people with MS.

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Background and purpose: Multiple sclerosis (MS) is a chronic and debilitating disease in which the central nervous system (brain and spinal cord) is destroyed. The most common complications of this disease are fatigue, cramps, tremor, diplopia, and unsteadiness of gait. This study investigated the effects of 12-week Pilates and aquatic training on fatigue in women suffering from MS. Materials and methods: This quasi-experimental study included 57 female patients attending Kashani MS clinic. The subjects (with MS 0 4/5 8±2 years disease 20-40 years old) were randomly assigned into Pilates, aquatic training and control group. Training program for Pilates and aquatic groups was carried out for 12 weeks (three sessions of one hour per week). Patients' level of fatigue was measured using a fatigue questionnaire, before and after the exercise. The data was analyzed using descriptive statistics and analysis of covariance and paired comparisons of adjusted averages in SPSS V.18. Results: The results showed significant differences in the adjusted mean of fatigue scores in the experimental groups (P<0.05). Pilates exercise interventions and aquatic training significantly decreased the level of fatigue in the experimental groups. Conclusion: Pilates and aquatic training reduced fatigue in patients with MS. Therefore, such exercises could be used as a complementary treatment alongside medications for MS patients.

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Background and purpose: Multiple Sclerosis (MS) is the most common neurological disorder in young adults that leads to their disability. This study aimed to evaluate the epidemiological characteristics of MS in Kermanshah, Iran in 2012. Materials and methods: In this descriptive study, total of 448 MS patients in Kermanshah were studied. Data for this study were derived from patients’ files, whom were members of MS Society in Kermanshah. SPSS software was used for this research. Results: The prevalence of MS in Kermanshah was 43.3 in 100,000 population, that the rate for women and men were 65.6 and 21.9 in 100,000 population, respectively. The onset for this disease was 30.8 years and the age-group of 30-34 years devoted the highest proportion of its morbidity to itself (20.1%). 1.2% of patients had familial history of MS in first-degree relatives. Sensory disturbances are the highest manifestations of MS onset (24.1%). 42.6% of patients have been diagnosed within 6 months after the onset of symptoms. Conclusion: According to the results of this study, there was a high prevalence of MS in Kermanshah and the incidence of this disease was more probable among youths (especially in women). Furthermore, more comprehensive studies are required on epidemiological data and risk factors of MS.

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Background and purpose: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system with the prevalence of about 2.5 million people worldwide about half of these patients have reported having trouble in sleeping. This study aimed to investigate the rate of sleep disorders in patients with multiple sclerosis. Materials and methods: This was a cross-sectional study on patients with multiple sclerosis in Kermanshah city, Iran, in 2011. Based on the list of MS society, 120 patients by convenient sampling were selected. Two-part questionnaire was used in this study the first part was researcher-made questionnaire including demographic characteristics and the second part was Global Sleep Assessment (GSA) questionnaire, which validity and reliability have been confirmed to evaluate sleep disorders. Results: The patients' mean age and mean disease duration was 34.68 ± 9.13 and 9.28 ± 5.57 years, respectively. From 120 samples, 32 (26.7%) were men and 88 (73.3%) were women. More than 87 percent of the subjects suffered from sleep problems and the most frequent problems were anxiety, sleep onset, and sleep continuity. Individuals' characteristics such as gender, marital status, educational level, employment status, and type of illness had a profound impact on certain types of sleep-related disorders. Conclusion: The results of this study indicate that the majority of people with with multiple sclerosis somehow involved with sleep-related problems. This problem can severely affect daily activities, social relationships and overall quality of life.

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Background and purpose: MDR1 is nowadays considered as a known transporter involved in drug resistance of different cancers. However, the importance of this protein in different systems of the body and its functional role in other diseases is less studied. This article aimed at investigating the role of MDR1 in the immune system and neurological disorders, and also exploring the possible therapeutic use of this protein. Material and Methods: In this review we studied 68 reputable articles published between 1998 and 2014 (both in Persian and English). The search engines included PubMed, Google Scholar, Science Direct and Elsevier databases. Results: The expression of MDR1 increases during the maturation of dendritic cells and their migration to lymph nodes to activate T lymphocytes. The function of this protein has been reported in naive B cells and it is expressed during the activation of CD4+ and CD8+ T lymphocytes. Compared with other leukocyte populations, MDR1 expression levels are the highest in NK cells. MDR1activity in brain capillary endothelial cells, involved in blood-brain barrier, prevents the entry of small drugs and inflammatory molecules into the CNS. The protein expression is reduced in a variety of immune destructive diseases. Conclusion: This article identifies the importance and function of MDR1in brain capillary endothelial cells and those involved in the immune system. Considering the confirmed role of MDR1 in immunological and degenerative disorders, this article may help in resolving the disorders caused by the lack of MDR1expression.

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Background and purpose: Multiple sclerosis (MS) is a chronic disease of the central nervous system which is accompanied by cognitive dysfunction. The aim of this study is to compare the sustained attention and reaction time in patients with MS and healthy normal individuals considering their level of depression, anxiety, and stress. Material and methods: This causal-comparative study recruited 108 participants. The patients were 54 with relapsing-remitting and 54 healthy people were included in control group. To collect the data DASS-2 questionnaire was used and computerized continuous performance test was administered. Results: Results showed significant difference in sustained attention and reaction time between the two groups. We also observed significant differences in cognitive function considering the levels of depression, anxiety and stress. Conclusion: MS could result in impairment in sustained attention and reaction time. Also, depression, anxiety, and stress intensify these cognitive impairments.

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Background and purpose: This research aimed at studying the efficacy of cognitive-existential group therapy on levels of depression, anxiety, and stress in patients with Multiple Sclerosis (MS). Materials and methods: This study was performed using semi-experimental and the extended pretest-posttest design. The study population included all patients with MS who were members of the Mazandaran MS Society, in 2013. The subjects were 20 females selected through accessible sampling, and they were randomly allocated into two groups (intervention and control, n=10 per group). All participants completed the Depression, Anxiety and Stress (DAS) measurement test in both pre-test and post-test stages. For the intervention group cognitive-existential group therapy was performed in 8 sessions, but the control group did not receive any intervention. Descriptive statistics and covariance analysis were applied to analyze the data. Results: The covariance analysis showed that the cognitive-existential group therapy led to a significant decrease in levels of depression (P <0.0001) and stress (P <0.0001) in the intervention group. Also, the cognitive-existential group therapy had a positive effect in lowering the anxiety level in this group, but this effect was not significant. Conclusion: According to this research, the cognitive-existential approach is an effective way that could be of great benefit in solving the emotional problems of patients with MS.

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Multiple Sclerosis (MS) is a complex autoimmune demyelinating disease of the central nervous system. Although the main cause of MS is still unknown, several risk factors may contribute in MS development. In the search for the etiology of MS, infectious agents, genetic factors, and/or their combination were believed to participate in MS occurrence. The association between MS and infectious diseases was proposed by Pierre Marie in 1884. It was later accepted following epidemiological studies, analysis on twins, immigrants and animal model. This study aimed at investigating the possible relationship between infectious agents and MS. Our findings showed that viral agents such as EBV, borna virus, measles, mumps, and fungi are possible agents in MS development, while parasites may induce immunomodulatory effects. Identifying the relationship between MS and infectious agents and determining a special pathogenic agent for MS could lead to novel treatment strategies. Furthermore, it may result in developing preventive programs. Therefore, further studies are needed to understand and identify the infectious agents that might affect the pathogenesis of MS and their mechanism of actions.

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Background and purpose: Multiple sclerosis (MS) is one the main diseases of the central nervous system. While the significance of cognitive decline in MS patients is well recognized, mild to moderate forms of cognitive dysfunction has received little attention. This study aimed at comparing memory and emotion in patients with multiple sclerosis and healthy individuals. Materials and methods: In a retrospective research 176 MS patients were randomly selected from all patients attending MS clinic in Alzahra Hospital in Isfehan and 68 healthy individuals who were chosen from patients’ caregivers. MS Neuropsychological Screening Questionnaire (MSNQ), Face Symbol Test (FST) in 90 and 300 seconds and Paced Auditory Serial Addition Test (PASAT) were administered. The data was analyzed in SPSS applying descriptive statistics, pearson’s correlation coefficient, covariate and multivariate analyses. Results: Covariate and multivariate analyses showed significant difference between the two groups in Face Symbol Test in 90 and 300 seconds and Paced Auditory Serial Addition Test (P<0.0001). In Face Symbol Test in 90 and 300 seconds, the patients had higher scores while healthy individuals obtained higher scores in Paced Auditory Serial Addition Test. No significant difference was observed in the results of Neuropsychological Screening Questionnaire in both groups (P=0.76). Conclusion: Dysfunction of memory and emotion in patients with multiple sclerosis is simply assessed by the tests performed in our study. They are useful and simple to use, thereby, more convenient for clinicians and neurologists.

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Multiple sclerosis,is the most prevalent disabling neurologic disorder, that manifest itself with limb weakness, visual and sensory symptoms, depression, and cognitive impairment. Psychotic symptoms particularly in the onset of disease are rare. We report a young patient with gradual onset of psychotic symptoms including hallucination, delusion and disorganized behavior. In further investigations the patient was diagnosed with multiple sclerosis.

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Background and purpose: Fatigue is a common symptom in multiple sclerosis (MS). Available fatigue measurement tools evaluate severity or impact of fatigue and none of them can be used to guide therapists on planning fatigue management interventions. Comprehensive Fatigue Assessment Battery for Multiple Sclerosis (CFAB-MS), in addition to assessment of the fatigue, evaluates factors related to fatigue, including sleep, pain, mobility, stress, anxiety, mood and fatigue management skills. The aim of this study was to translate the tool into Persian, adapt it culturally and establish validity of this measure in people with MS in Iran.

Materials and methods: After a forward-backward translation using the International Quality of Life Assessment process, the Persian-CFAB-MS was administered to 60 people with MS. The content validity and face validity of the tool was assessed by 10 therapists. Construct validity was assessed by measuring the associations between score of the Persian-CFAB-MS and  Modified fatigue impact scale (MFIS), the hospital anxiety and depression scale (HADS), Pittsburg sleep quality index (PSQI), Short-Form McGill Pain Questionnaire (SF-MPQ), and WALK-12. Data was then analyzed using SPSS (version 20).

Results: From the view of 10 therapists who were experts in MS, all items of the Persian-CFAB-MS were understandable and culturally acceptable to Iranians. As hypothesized the scores were significantly correlated with MFIS, HADS, PSQI, SF-MPQ and WALK-12 (ranging from 0.470 to 0.863, P<0.001), and showed satisfactory to excellent validity.

Conclusion: The results illustrated evidence to support validity of the Persian-CFAB-MS in studying the reasons for fatigue in patients with MS.

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Background and purpose: Multiple sclerosis (MS) is one the most prevalent diseases associated with neurological and non-traumatic disability in adults. This autoimmune disease affects the central nervous system (CNS) and manifests different signs and symptoms. The prevalence of disease and age of onset varies considerably across the world. This study aimed at investigating demographic, clinical characteristics, and different risk factors in patients with MS.

Materials and methods: The study was performed on 152 MS patients from May 2013-July 2014. McDonald diagnostic criteria were used for disease diagnosis. Data was recorded and analyzed in SPSS V.17.

Results: The mean age of patients was 31.6 ± 7.3 and females were three times more likely to be afflicted with MS. Most of the female patients were married. The majority of patients had benign disease (86.4%), and positive family history of MS was found in 21.2%. Plaque lesions in MRI were seen in 94% of the patients. Sensory loss, visual impairment and depression were observed in 45.7%, 43.8%, and 9.2%, respectively. Visual impairment was the first sign of the disease that was observed in most of the patients (41.3%). Fatigue and sexual dysfunction were significantly different between relapse-remitting, primary progressive, and secondary progressive form of MS (P= 0.05 and P= 0.02, respectively). Fatigue was associated with disease progression but other symptoms were not significantly different between three forms of the disease.

Conclusion: Demographic and clinical characteristics of MS in Mazandaran province were similar to those reported from other countries. MS registry is recommended to record all MS cases in order to increase knowledge on demographic and clinical characteristics, treatment options, and patient’s response to medications. Furthermore, high familial prevalence of multiple sclerosis in Mazandaran province compared with other regions in Iran calls for further genetic analyses.