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Article
Psychiatric Squele of Sodium Valproate VersusCarbamazipine in Patients with Primary Generalized Epilepsy

Authors: Hassan Aziz حسان عزيز --- Abdul R Al Yasiri عبد الياسري --- Zaki N. Hasan زكي نوح حسن
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2009 Volume: 5 Issue: 1 Pages: 19-24
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: psychiatric and behavioral side effects are common in patients with epilepsy and it may represent an intrinsic feature of the disease itself or a side effect of the antiepileptic use. Our aim in the present study is to assess the psychiatric side effects of Sodium Valproate and Carbamazipine .as these drugs are the most commonly used antiepileptic drugs in Iraq.Methods: 80 patients with primary generalized epilepsy on Carbamazipine and 50 patients on Sodium Valproate were enrolled in the present study; all the patients were assessed for any psychological disturbances using semi-structural interview based on the tenth edition of the international classification of the diseases(ICD 10) adopted by WHO.Results: thirty percent of patients taking Sodium Valproate and (9%) of patients taking Carbamazipine were found to have depression while (16%) of patients taking Sodium Valproate and (20%) of patients taking Carbamazipine were found to have anxiety. There were no reported psychosis, suicidal attempts, cognitive deficit and mania in both groups of patients in the present study.Discussion: Carbamazipine is associated with lower rates of psychological side effects than Sodium Valproate; this result may be related to mood stabilization effects of Carbamazipine.Conclusion: Carbamazipine is preferred to Sodium Valproate when the efficacy of both drugs is comparable.


Article
PROVOCATIVE TEST'S VERSUS ELECTROPHYSIOLOGICAL STUDIES AS A MEASURE OF SEVERITY GRADES OF CARPAL TUNNEL SYNDROME

Authors: Zaki N. Hasan زكي نوح حسن --- Safaa H. Ali صفاء حسين علي
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2013 Volume: 11 Issue: 3 Pages: 275-279
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Carpal tunnel syndrome (CTS) is the most common nerve entrapment, electrodiagnostic studies are a valid and reliable means of confirming the diagnosis.Objectives:The study aims to find a correlation between the presence of Tinel's sign and Phalen's maneuver and the degree of severity of the CTS and to compare it with severity of nerve conduction study of median nerve.Methods:The study involves 133 patients (102 females and 31 males) with CTS, all were examined for Phalen's maneuver and Tinel's sign and median and ulnar nerves electro physiological study in Al-Yarmouk Teaching Hospital and the Neurosciences Hospital in Baghdad between January 2010 and January 2011. Their ages ranged between (19-87) years. The patients were grouped into mild, moderate and severe CTS according to modified Padua scale of CTS severity. Statistical correlation was done using one way Anova test.Results:Positive Tinel's sign was seen in 25% and positive Phalen's maneuver in 28%, coexistent Tinel's sign and Phalen's maneuver positive at the same time were seen in 47%. Total Tinel's sign was72% and total patients who had positive Phalen's sign was 75%. Mild, moderate and severe CTS were seen in 38%, 41% and 21% out of the total number of the studied patients.Conclusion:The study didn't find association between severity grading and provocative test, added to negative provocative tests in high percentage of patients. These results mandate the use of electrophysiological examination for the diagnosis of carpal tunnel syndrome and assessment of severity.Keywords:Carpal tunnel syndrome, Tinel's sign, Phalen's maneuver


Article
QUANTIFICATION OF PAIN THRESHOLD IN PARKINSON’S DISEASE

Authors: Aqeel K Hatim عقيل كريم حاتم --- Munther T Hamzah منذر طاهر حمزة --- Hasan A Hasan حسن عزيز حسن --- Zaki N Hasan زكي نوح حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 1 Pages: 83-86
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

BackgroundParkinson's disease (PD) is the second most common degenerative neurologic disorder after Alzheimer’s disease. Pain is one of the major clinical symptoms of Parkinson's disease, occurring in 50-83% of patients. Pathways mediating pain are complex and include basal ganglia and thalamocortical-basalganglia circuits.ObjectiveTo quantitatively assess pain perception in Parkinson disease patients, by determining pain threshold in patients with and without pain through using electrical stimulation.MethodsA cross sectional observational study recruiting 18 patients with a clinical diagnosis of Parkinson disease and healthy controls from the neurologic unit in Al-Kadhimiya Teaching Hospital in Baghdad; between May 2010 to Jan 2011. There were 13 men and 5 women with a mean age of (66.5 ± 10.2 years). The control group includes 18 healthy subjects, [12 males/ 8 females] with a mean age of 56.6±6.74 years. Quantitative sensory testing was carried at the neurophysiology laboratory in Al-Kadhimiya hospital; using bipolar stimulating electrodes on the forearm, index finger, mid leg, and big toe.ResultsFourteen Out of 18 patients (77.7%) reported pain, while 4 (22.3%) had no pain. There was a highly significant statistical difference in electrical perception between the affected and unaffected side, and between Parkinson disease patients and the controls. There was no statistically significant difference between males and females [p =0.8248], and between patients with and those without pain [p =0.3279]. And between upper and lower limbs on the affected side [p =0.1412], and body side involvement whether right or left in both the patients and controls.ConclusionChronic pain is present in 77.7% of Parkinson disease. Patients with Parkinson disease had lower pain threshold compared to controls. The affected side had lower pain threshold. The left or right body side and gender had no effect on pain threshold.Key worldsParkinson disease, Pain

Keywords

Parkinson disease --- Pain


Article
CLINICAL ASSOCIATION OF DEPRESSION IN A GROUP OF IRAQI PATIENTS WITH PARKINSON'S DISEASE

Authors: Farah I Al-Saffar فرح عصام الصفار --- Hasan A Al-Hamadani حسن عزيز حسن الحمداني --- Zaki N Hasan زكي نوح حسن
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2012 Volume: 10 Issue: 4 Pages: 356-361
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

To evaluate the depressive features that accompanies Parkinson’s disease and its relation to different parameter of this disease. This cross sectional study examined 30 patients with idiopathic Parkinson’s disease neurologically and psychiatrically, searching for depression and its association with different features of idiopathic Parkinson’s disease. The American diagnostic and statistical manual (DSM-IV) and the international classification of the disease (ICD10) were used for diagnosis of depression.53% of Parkinson’s disease patients were found to be depressed and their depression significantly correlated with autonomic system infliction, dysphagia and insomnia. This finding was not correlated with duration or severity of the Parkinson’s disease or the late complications of the disease.We found depression to be very common among Parkinson’s disease patients; however, no specific type of depression could be identified in those patients. There is significant association between depression and autonomic involvement, insomnia and dysphagia in Parkinson’s disease. Depression in Parkinson’s disease was not found to be related to the age of onset or to the duration of the disease.

Keywords

Parkinson --- Depression


Article
CLINICAL AND PARACLINICAL PREDICTORS OF MECHANICAL VENTILATION IN GUILLAIN BARRÉ SYNDROME

Authors: Zaki N. Hasan زكي نوح حسن --- Sajid I. Kadhim ساجد ابراهيم كاظم --- Ghufran K. Shamick --- Aqeel K. Hatim عقيل كريم حاتم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2014 Volume: 12 Issue: 3 Pages: 216-221
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Guillain Barré syndrome (GBS) is an acute post infective autoimmune polyradiculo-neuropathy; it is the commonest polyneuropathy causing respiratory failure. A lot of studies suggested certain GBS clinical and preclinical features anticipate and predicate the neuromuscular respiratory failure and can accurately assess the progression to mechanical ventilation; bulbar muscles involvement, severity of weakness of upper and lower limbs, bilateral facial muscles involvement and autonomic nervous system involvement were the main features associated with progression to mechanical ventilation.Objectives:To assess demographic, clinical and para clinical features and their relation with the progression of GBS to respiratory failure.Methods:Clinical and paraclinical predictors of impending respiratory involvement and requirement for mechanical ventilation were studied in 40 GBS patients aged 12-57 years (28 males and 12 females).Results:Ten (6 female/4 male) patients (25%) were admitted to the intensive care unit and received mechanical ventilation. Younger age, female gender and rapid disease progression in first 3 days were associated with respiratory involvement and subsequent ventilation. Bulbar weakness, bilateral facial palsy, poor digit counting (<10/1 breath) were the strongest indicators of impending respiratory failure. In combination they were found in 90% of ventilated patients. Dense weakness (power grade ≤2), weak neck flexion and axonal electromyography also showed significant risk for mechanical ventilation. Other parameters (autonomic dysfunction, antecedent gastrointestinal and respiratory illness, earlier upper limbs weakness and pain) showed no statistical significance in our studyConclusion:Respiratory failure in the course of GBS can to some extent, predicted depending on clinical information. Respiratory failure was associated with younger age, female gender, rapid progressive weakness, bulbar weakness. Facial weakness. Dense weakness, weak neck flexion, poor digit count and axonal neuropathy.Keywords:Guillain Barre syndrome, respiratory failure, bulbar weakness, mechanical ventilation.


Article
SUB THALAMIC NUCLEUS DEEP BRAIN STIMULATION: IRAQI CASE SERIES

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Abstract

Background: Sub thalamic nucleus (STN) Deep brain stimulation (DBS) electrodes are implanted into STN and programmed by external pulse generator. DBS alleviates the cardinal Parkinson disease symptoms and reduce the need for levodopa and related drugs and eventually reduces levodopa-related motor complications in advanced Parkinson's disease.Objective: To evaluate the STN DBS implantation in Parkinson disease patients.Methods: A retrospective evaluation of data base of the patients operated on for STN DBS between Jan. 2010 and Jan. 2011. The study involved 11 patients (10 males and 1 female) with an age range between 39 and 65. Surgical implantation was done in the Neurosciences Hospital in Baghdad. Unified Parkinson's disease Rating Scale was reported before surgery and 3 monthly after implantation. Paired t test was used to test the significance of difference between 2 means.Results: Highly significant differences (P < 0.0001) in the activities of daily living, Tremor, Rigidity, Bradykinesia and Gait parameter. There was no difference in Postural stability before and after. There was 65% of the patients reduced their levodopa medication dosage after STN DBS. One patient out of 11 (9%) developed intracerebral hemorrhage. Conclusions: STN DBS is very successful in managing motor clinical manifestations in advanced Parkinson disease and reducing levodopa medication. Key worlds: Parkinson, Deep brain stimulation, subthalamic


Article
EFFICACY OF VAGAL NERVE STIMULATION IN IRAQI PATIENTS WITH REFRACTORY EPILEPSY: TWO-YEAR EXPERIENCE

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Abstract

Background:Refractory epilepsy patients who fail to respond to two antiepileptic drugs used appropriately are likely to have medically refractory seizure disorder and should be investigated for alternative forms of treatments like experimental drug trial, surgical treatment, electrical stimulation and combination of these. Vagal nerve stimulation is an adjunctive treatment for certain types of epilepsy.Objectives:To evaluate the efficacy of vagal nerve stimulation in refractory epilepsy, as an adjunctive therapy to antiepileptic drugs in Iraqi patients.Methods:A retrospective study recruiting 34 patients at Neurosciences Hospital in Iraq between Feb. 2008 and Jan. 2011. Diagnosed as refractory epilepsy according to International League Against Epilepsy criteria; the epilepsy state, number of the anti-epileptic drugs, frequency and severity of the attacks (using Chalfont scale) was assessed before and after the vagal nerve stimulation implantation. Programming was done every two weeks depending on clinical assessment.Results:Severity of the attacks was reduced totally 100% in 26.5% of the patients and 50-99% in 26.5% of patients. The number of attacks per month was decreased by 100% in 26.5% of patients and showed more than 50% improvement in 38% of patients. The number of the drugs used after the implantation decreased by 17.6% (P = 0.007). The most common side effects were hoarseness of voice 55.8% and dysphagia 41% only during the on time of the device.Conclusion:Vagal nerve stimulation is effective safe and well tolerated in Iraqi patients.Key words:Vagus nerve stimulation, Refractory epilepsy, Anti-epileptic drugs, Iraqis.

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