International Clinical Neuroscience Journal

There have been a number of developments in screw design and implantation techniques over recent years, including proposal of an alternative trajectory entitled as cortical bone trajectory (CBT). Cortical bone trajectory has been investigated in recent medical treatments as an alternative for screw fixation aimed at increasing purchase of pedicle screws in higher density bone. CBT screw insertion follows a lateral path in the transverse plane and caudocephalad path in the sagittal plane. This technique has been advocated because it is reportedly less invasive, improves screw−bone purchase and reduces neurovascular injury. Furthermore CBT pedicle screw fixation provides stabilization to multilevel lumbar segment with low-grade spondylolisthesis comparable to the standard trajectory pedicle screw construct. However, these claims have not been supported by robust clinical evidence. Recent investigations focus on evaluations of CBT as a pioneer method.

Neurocysticercosis, is the infection caused by the larval form of the tapeworm Taenia solium. It is considered as the most common parasitic disease of the central nervous system and the most common cause of acquired epilepsy. This has primarily been a disease that remains endemic in countries with poor economy , but because of increased migration neurocysticercosis is being diagnosed more frequently worldwide. During the past decades improved diagnostics, imaging, and treatment have led to more accurate diagnosis and improved prognosis for patients. This article is a review about the current data about neurocysticercosis, including recent diagnostics and treatment developments.

Purpose: To study early treatment outcomes and complications of Gamma Knife Radiosurgery
(GKRS) in patients with functional and nonfunctional adenomas.
Methods: One hundred patients with a pituitary adenoma who were treated between 2011 and
2014 at Iran Gamma Knife Center were studied. The patients were followed up at least 2 years.
Radiosurgery was performed using the Leksell Gamma Unit. The median radiation dose was
18 Gy for non-functional and 24 Gy for functional adenoma. The MRI were compared pre and
post operation for any change in tumor size. Endocrine follow up was used to determine the
onset of new hormone deficiency when available or decrease in hormonal level.
Results: Our study group comprised 42 men (42%) and 58 women (58%). Ninety-three patients
were treated for recurrent or residual disease after Trans-sphenoidal surgery or craniotomy and 7
patients were treated as primary modality because of extensive involvement of cavernous sinus or
high risk for surgery. Forty-six patients (46%) had a diagnosis nonfunctional and 54 of patients
(54%) had hormone-secreting tumors including growth hormone secreting (23%), prolactinoma
(15%) and ACTH-secreting tumor (6%). No mortality was reported. Acute complication was
uncommon and of no clinical significance. Late complication was noted in two patients (2%)
and consisted of VI cranial nerve palsy with spontaneous resolution. None of the patients
developed visual loss. Before GKRS, 8 patients had cranial nerve palsy. After the treatment, the
palsy resolved in six (75%) of these patients. Only 9.5% of patients developed hypopituitarism
and required replacement therapy. Overall control was 92% (28% decreased in volume and
64% were unchanged), 8% experienced an increase in volume size. Normalization of GH and
IGF-1 for GH-secreting hormone was 48% with overall control of 73%. PRL normalization for
prolactinoma was 46% with overall control of 67%. ACTH normalization for ACTH-secreting
hormone was 35% with overall control of 70%.
Conclusion: It seems that GKRS to be safe and effective method for tumor control and optimal
hormonal function.

Background and Purpose: Multiple sclerosis (MS) is a disease determined by the interaction of genetic and environmental factors. Metals are suspected of being involved in MS. There is not any epidemiologic study about mines and MS. The purpose of this study was to determine MS prevalence according to mines in Kerman province.

Methods: This cross-sectional study was conducted on 932 patients in Kerman province in 2012. The details of the patients including age, sex, age at the onset of disorder and disease duration were collected from documents of MS centres of Kerman and Rafsanjan Universities of Medical Science. Diagnosis was confirmed according to the revised Mc-Donald criteria. To analyze the data, SPSS-17 software and descriptive statistics and t-test were used

Results: The male/ female ratio was 1:3. The prevalence of MS in Kerman province was 31.7 per 100000. Kerman, Sirjan, Zarand and Rafsanjan had the highest prevalence of MS, respectively. The mean prevalence of MS in mineral areas in Kerman province (Kahnoj, Sirjan, Zarand, Rafsanjan, Baft, Shahrbabak) was 23.01±10.78 and in non-mineral areas (Kerman, Bam, Jiroft) was 39.56±20.34 that show the higher prevalence of MS in non-mineral areas of Kerman province.

Conclusion: Our findings showed that prevalence of MS is lower in mineral areas and probably, living in these areas isn’t a predisposing factor for MS.

Background and purpose: Cognitive impairment (CI) is one of the causes of disabilities in multiple sclerosis patients (MS). Therefore, early detection and evaluation of cognitive performance is very important in patients with MS. The aim of the present study is to compare Montreal Cognitive Assessment (MoCA) test and Mini Mental Status Exam (MMSE) in Relapsing Remitting (RR) MS patients.

Methods: Fifty RRMS patients who met inclusion and exclusion criteria were recruited in this study. MMSE and MoCA were administrated to all subjects. Also demographic data, disease duration and EDSS were recorded. The results of both tests were compared.

 Results: The mean score of MoCA and MMSE was 22.86±3.85 and 27.64±2, with a significant difference (p<0.0005). With using MoCA 60% of subject had CI, whereas with MMSE only 34% were impaired (p<0.0005). There was an inverse significant association between education and CI detected by both MMSE and MoCA (for MMSE r=0.535 and p<0.0005, for MoCA r=0.544 and p<0.0005). A significant association was also found between disease duration and CI on both tests (for MMSE r=0.394 and p<0.0005, for MoCA r=0.538 and p<0.0005).

Conclusion: This study suggests that the MoCA has superiority to the MMSE for evaluating cognitive function in RRMS patients.

Background and purpose: Progressive degeneration of dopaminergic neurons in the midbrain is the main mechanism of Parkinson’s disease (PD). Although potassium channels affect neural activity and death in this area, little research has investigated the effect of potassium channel blockers, such as 4-aminopyridine in the pretreatment of PD.

Methods: Fifty-six healthy male Wistar rats were selected for this study. They were divided into seven groups according to receiving saline or 4-aminopyridine, receiving a low or high dose of 4-aminopyridine and receiving 4-aminopyridine for short or long periods. Apomorphine-induced rotational test, elevated body swing test and rotarod test were done to examine behavioral performances.

Results: 4-aminopyridine could not completely block behavioral disturbances induced by MPTP, however, it decreased them in all behavioral tests. Long administration of 4-aminopyridine was more effective than short administration in lowering behavioral disturbances. Although high dose of 4-aminopyridine was more effective than low dose in initial trials of each behavioral test, there was no difference between them in the last trial.

Conclusion: Long administration of low dose of 4-aminopyridine is the best way to lessen behavioral disturbances induce by MPTP and also avoiding side effects of high dose of 4-aminopyridine. 

Kennedy disease is a rare X-linked neurodegenerative disorder that affects patients in 30-50 years of age. It is caused by CAG-repeat in androgen receptor gen. There is no known effective treatment for Kennedy disease. We report a 60-year-old man who had fasciculations and proximal and distal muscle weakness. Physical examination showed involvement of the bulbar musculature accompanied by tongue atrophy and perioral muscle weakness. Furthermore, he had bilateral gynecomastia. Laboratory and imaging findings were normal, except electromyography that showed chronic proximal and distal denervation. Finally, the patient diagnosed with Kennedy disease according to clinical presentation and EMG abnormality that confirmed with genetic study.

A young known case of multiple sclerosis was evaluated with chief complaint of gradually progressed left lower limb weakness over 3 weeks. Pathologic examination of a mass in brain magnetic resonance imaging confirmed the diagnosis of glioblastoma multiforme (GBM). Given the importance of the definite diagnosis of malignant glioma and its effect on patient’s management, GBM should be considered as a differential diagnosis in cases with coexisting mass like lesion and demyelinating plaques.