Review Article

Neuroscience approach in Stem cell therapy among patients with Spinal Cord Injury

Afsaneh Zarghi

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 1-7

The first necessary step in researches to treat spinal cord injuries (SCI) is to understand complexities related to the neurophysiology and neurobiology changes of human SCI with stem cell therapy(SCT). The aim of this study is to identify these changes. The level of injuries is important in treatment and determination of this injury (whether it is complete, incomplete, or discomplete) is valuable too. Loss of all neurological functions affected by this injury and physiological or anatomical continuity of central nervous system tracts occur across this lesion. Obviously, a result that is achieved is that the maximum number of tracts can remain, be maintained, and increase in the acute phase of illness. Stimulating the axonal regeneration by neutralizing inhibitory factors, adding positive tropisms, and creating a permissive environment is suitable. Better results that had been obtained are achieved by filling gaps with peripheral nerve grafts or transplanting Schwann cells, and fibroblasts that genetic engineering has been done on them. Ability of poly potential cells to differentiate and create neural tissues is remarkable. The relatively good success in obtaining the proper repair for axons has been reported. However, this issue also should be considered that human spinal cord injuries have significant differences with spinal cord injuries in laboratory animals. In order to be successful in doing this research, the changes of human SCI must also be considered and the use of stem cells in treating human SCI must be performed due to these changes.

Original / Research Article

The Need for Stump-Socket Interface Pressure Measurment during Bidirectionally Perturbed Stance In Transtibial Amputees

S.Y. Shirazi, Z. Safaeepour, Amir Saied Seddighi, N. Fatouraee

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 8-11

Recent studies show significant reduction of postural stability in transtibial amputees (TTAs) especially when a perturbation is applied. However, no record has been seen on the consequences of such perturbation on the Stump-Socket Interface Pressure (SSIP). Our objective was to investigate whether such perturbation impose excessive pressures on the stump. We were also interested on the type of the response and direction in which TAs may face more difficulties. A 52-year-old TA participated in the study. The trial was performed using a custom bidirectional perturbing mechanism in the pitch and roll axes of ankle. Center of Pressure and were recorded by two force platforms and five resistive pressure sensors respectively. Right and anterior perturbations imposed the maximum SSIP while several CoP measures were considerably greater for the prosthetic leg just in left perturbations. This supports the necessity of measurement of SSIP as well as CoP to provide a better understanding about the new situations of TAs in postural stability

Surgical outcomes and correlation ODI and ASIA scores in patients with thoracolumbar and lumbar burst fractures

Parisa Azimi, Sohrab Shahzadi, Hassan Reza Mohammadi, Shirzad Azhari

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 12-15

Background and Purpose: Decision-making process in Thoracolumbar and Lumbar Burst Fracture (TLBF) patients with Thoracolumbar Injury Severity and Classification Score (TLICS) > 4 is remained controversial. On the other hand, the question is whether that the Oswestry Disability Index (ODI) can be use to assess to clinical outcomes in these patients. We aimed to study the correlation between the ODI and American Spinal Injury Association (ASIA) impairment scale in these patients and evaluation of surgical outcome.

Methods: This was a prospective study. The TLICS were determined and TLICS > 4 was included. The nerve injury was assessed according to sensory scores and motors scores of the using ASIA Scale at pre- and postoperative. It was also ODI calculated at last follow-up. In addition, correlation between ASIA and ODI was evaluated at last follow-up.

Results: Fifty eight patients (20.7% female) who underwent spinal surgery for TLBF with a minimum follow up of 2 years were studied. The mean age was 30.7 ± 8.7 (24 to 65) years. Automobile accident was the predominant mode of injury. Patients were followed for 25 months on average (24 – 43 months). ASIA sensory scores and motor scores were improved significantly at last follow-up (P < 0.001). No patient experienced neurological worsening during the follow-up period. The mean ODI were 29.7 (SD= 4.9) at last follow-up. Correlation test showed significant correlations among the ODI and the ASIA sensory scores (r = 0.74, P < 0.02) and motor scores (r = 0.78, P < 0.01) at last follow-up assessment.

Conclusion: The findings confirm that for TLICS > 4 surgical outcome is acceptable. It also shows that the ODI and the ASIA scores have a strong correlation in measuring disability in patients with TLBF after at least 2 year follow-up.

Analogy of brain function in men and women with NCCB

Afsaneh Zarghi

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 16-22

Purpose: The cognitive domains are assessed by cognitive tests and these assessments are different between man and woman in every test, this study assessed brain function by cognitive domains among men and women.

Methods: A cross-sectional study was done on a sample of 15 to 75 years old of 80 female and 80 male. All participants did Neuro-Cognitive Computer Battery (NCCB) after training and consent. Participants of both groups were physically and mentally examined and approved by specialist physicians.

Results: According to NCCB was no significant difference between two groups in attention domains (0.05< p).

Conclusion: Findings of current study show a similar attention in mentioned tests.

The Spine Vertebral Bodies 3D Modeling and its Biomechanical Advantages

Amirhossein Saveh, Alireza Zali, Farzad Ashrafi, Sohrab Shahzadi, Afsoun Seddighi, Sirous Momenzadeh, Behdad Behnam, Omid Dehpour, Mahmoud Chizari, Kazuyoshi Gammada

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 23-25

To perform an accurate approach to the spine specially for fracture stabilization a 3D model of spine surgical region may improve this mechanism and it can help the surgeon to have a deeper glance to this scenario. The pre-op planning facility is another advantage of the patient spine specific model to take a chance of making guides to direct pedicle screws safely and increase the pathomechanics of volumes of interest stability factor parallel with its mobility restoration. There are some algorithms for making 3D-reconstruction from CT or MR data-set but the main goal of in-vivo component 3D making is right component extraction from its peripheral segments to achieve the best judgment especially about the surgical approach. Here is a cervical vertebral bodies segmentation and 3D-reconstruction of two cervical adjacent levels combined with the registration process that is shown the intervertebral degree regarding to range of motion percent.

Agreement of electrodiagnosis, clinical findings and MRI in patients with low back pain

Mozaffar Hosseininezhad, Hamidreza Hatamian, Ahmad Alizadeh, Bahman Firozkohi, SHahrokh Yousefzadeh, Babak Bakhshayesh, Mohammadali Hajebrahimi

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 26-32

Background and Purpose: Disc herniation leading to radiculopathy is one of the important differential diagnosis of low back pain which needs specific medical care. Radiculopathies can be initially diagnosed by history taking and physical examination. However role of other diagnostic methods like Magnetic resonance imaging (MRI) and Electromyography (EMG) in narrowing differential diagnosis is warranted when clinical data are inconsistent or inadequate. In this study we evaluated level of agreements among three methods of radiculopathy diagnosis including EMG, MRI and physical exam.

Methods: This study is a comparative cross sectional study on 384 patients which was performed among patients who were referred to electrodiagnosis center for their back pain. Results from 3 questionnaires that filled by neurosurgeon for clinical results, radiologist for MRI findings and neurologist for electrodiagnosis findings were psychometrically analyzed using Kappa index for agreement among three methods.

Results: From the 384 cases studied, MRI were successful in 90.6% (348 cases) to identify radiculopathy and EMG and clinic with 76.6% (295 cases) and 70.5% (286 patients), respectively. EMG andMRI have agreed in 76.8% of cases in the diagnosis of radiculopathy. MRI and clinical data in 69.7% of cases (Pvalue<0.940) and EMG and clinical data in 62.7% of cases (Pvalue< 0.843) have agreed but they were not statistically significant.

Conclusion: Study results show that MRI is the best diagnostic tool for evaluating the presence of radiculopathy but EMG could also be used instead of MRI in radiculopathy diagnosis. Since EMG is more invasive than MRI, EMG is better to be considered as a second diagnostic tool.

Case Report

A case of Guillain-Barre syndrome presented with bilateral pseudo-internuclear ophthalmoplegia

Sadegh Izadi, Iman Sabzgolin

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 33-35

Guillain-Barre syndrome (GBS) or acute idiopathic polyradiculoneuritis is an acquired immune-mediated inflammatory and mainly demyelinating disorder of the peripheral nervous system. Cranial nerves are affected in over 50% of all cases, with the facial nerves being affected the most. It uncommonly presents as atypical forms such as brachial pharyngeal variant, miller fisher and other restricted forms. Herein, we reported a 44 year old male with GBS who presented with diplopia and bilateral pseudo- internuclear ophthalmoplegia. Initially, the patient was confused as a case of multiple sclerosis but finally diagnosis of GBS was made. Although internuclear ophthalmoplegia is a typical feature of multiple sclerosis, it may be seen as a rare manifestation of GBS as well.

Case Series

Intracranial aneurysm surgery: a case serie

Afsoun Seddighi, Amir Saied Seddighi, Hesam RahimiBaghdashti, Mehrnush Vahidi, Mahsa Ashrafi, Mohmmad Yousef Yaghubi

International Clinical Neuroscience Journal, Vol. 2 No. 1 (2015), 3 March 2015, Page 36-39

Background: Intracranial aneurysms are fatal but also curable diseases of nervous system which often present suddenly with Subarachnoid Hemorrhage (SAH). The aim of this study is to show the results of 7 years surgery performed on patients with intracranial aneurysm admitted in our center.

Methods: This study is a retrospective case series that is performed by "existing data" in patient’s documents. Different factors such as age, sex, sign and symptoms, anatomical location of deficit and before-after surgery complications have been analyzed.

Results: From February 2003 to June 2010, 54 cases (totally 62 aneurysms) were operated in our center. Male to female ratio was 1.28 and mean age was 50.47 years. The most common symptom was sudden severe headache. The most common sites were anterior communicating artery (40%), internal carotid artery bifurcation (35%) and middle cerebral artery (25%). Most of the patients were in grade 1 of Hunt & Hess scale. The most common mortality was due to cardiopulmonary arrest.

Conclusion: Considering that mortality rate in older patients with different risk factors is so high, it seems that operating these patients on an emergency basis and intensive care for vasospasm leads to favorable outcome.