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Article
4.MOTOR EVOKED POTENTIAL IN PATIENTS WITH PARKINSON’S DISEASE: A TRANSCRANIAL MAGNETIC STIMULATION STUDY

Authors: Ali F. Al-Hashimi علي فؤاد الهاشمي --- Haneen R. Ahmed حنين رباح احمد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 1 Pages: 14-21
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Parkinson’s disease (PD) is a neurodegenerative condition of the central nervous system, which is accompanied by the impairment of the cortico-subcortical excitation and inhibition systems. It is characterized by motor and non-motor symptoms, having both hypokinetic and hyperkinetic features.Objective:To investigate the integrity of the central motor pathways by studying the motor evoked potential (MEP) latencies, amplitudes and central conduction time (CMCT) of the median nerve in patients with PD as compared to healthy controls.Methods:Twenty-five patients with documented PD were studied; with a mean age of (63.16±5.49 years) as compared to 25 age and sex matched apparently healthy controls. All subjects were instructed about the examination and informed consent was provided. Transcranial magnetic stimulation TMS-MEP study of the right median nerve was done. Cortical and cervical latencies and amplitudes of the MEP study were determined. The responses were recorded with both relaxed and slightly contracted target muscle. CMCT calculation was done by subtraction of the latency of peripheral segment of the motor pathway (spinal motor root to muscle) from that of the entire motor pathway (motor cortex to muscle) or by calculation of the CMCT with the F-wave method. Results:The means of the cortical latencies of PD patients during relaxation and facilitation states were lower than controls; and the differences were significant for both (P=0.03 and 0.02; respectively). In both relaxed and facilitation states, the means of CMCT in PD patients were lower than in control and the difference was significant during contraction (P=0.02), and near statistical significance during relaxation (P=0.08). CMCT calculations by the estimation of F wave and distal motor latency (DML) were equivocal between relaxation and facilitation states. Nevertheless, the differences were not statistically significant (P=0.45; P=0.62; respectively). The means of the MEP amplitude of PD patients were lower than controls (4.21±1.94 versus 4.28± 1.84 mV; respectively). Nevertheless, the differences were not significant (P=0.89).Conclusion:Single-pulse TMS is a valuable study to investigate central motor dysfunction in PD. CMCT measurement of the median nerve or any nerve in the upper limb is a potential marker for the evaluation of the severity of PD; especially in the facilitated state.Keywords:Parkinson’s disease, TMS, MEP, CL, CMCTCitation:Ahmed HR, Al-Hashimi AF. Motor evoked potential in patients with Parkinson’s Disease: a transcranial magnetic stimulation study. Iraqi JMS. 2018; Vol. 16(1): 14-21. doi: 10.22578/IJMS.16.1.4

Keywords

Parkinson’s disease --- TMS --- MEP --- CL --- CMCT


Article
Oxidant /Antioxidant Status in Newly Diagnosed Patients with Parkinsonism :Effects of Therapy

Authors: Imad A-J Thanoon عماد عبد الجبار --- Fadel A.Al-Hamamy --- Mohammed M.Al-Sheikh
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2013 Volume: 9 Issue: 15 Pages: 27-35
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

To assess effects of a fixed therapy on the oxidant (malondialdehyde ''MDA'' levels)/ antioxidant status (Total antioxidant status "TAS")in newly diagnosed patients with Parkinson disease in comparison to healthy controls.Thirty eight newly diagnosed patients with Parkinson disease were included in this study. they were referred cases from neurologist Clinic from October 2009 to February 2011. included also in the study 40 apparently healthy age and sex matched subjects as a control groups. A blood samples were taken initially from the patients before starting therapy and the controls and assay of serum MDA and TAS were done. Body mass index (BMI) were calculated according to a certain equation. Patients then were put on fixed therapy for 3 months after which another blood samples were taken and assay of the same parameters were done.There was a significantly elevated serum MDA and a significantly lowered serum TAS levels in newly diagnosed patients with Parkinson disease in comparison to healthy controls. After therapy patients still having a highly significant difference in the levels of serum MDA and TAS in comparison to controls.There was insignificant difference in the serum levels of MDA and TAS between patients in the pre-therapy and post-therapy stages.Newly diagnosed patients with Parkinson disease having signs of oxidation stress, and that the specific anti-parkinsonian therapy used in this study have no significant effect on the shifted oxidant/ antioxidant status.

لتقييم تأثيرات العلاج الثابت على حالة الاكسده(مستوى المالونديليهايد)/ مضادات الاكسده (مضادات الاكسده الكليه) في مرضى باركنسون المشخصين حديثا"بالمقارنه مع مجموعة ضبط من الاصحاء.ادخل لهذه الدراسه 38 من مرضى باركنسون المشخصين حديثا.احليت هذه الحالات من عياده للامراض العصبيه من تشرين الاول 2009 ولغاية شباط 2011.ادخل للدراسة ايضا اربعون من الاشخاص الاصحاء من اعمار واجناس مقاربه لمجموعة المرضى كمجموعة ضبط. في البدايه سحبت عينات من الدم من مجموعة المرضى قبل بدء العلاج ومجموعة الضبط وتم قياس مستوى المالونديليهايد ومضادات الاكسده الكليه في مصل الدم كما وتم حساب دلالة كتلةالجسم باستخدام معادله خاصه. بعدها وضع المرضى على علاج ثابت وبجرعه موحده لمدة ثلاثة اشهر بعدها تم سحب عينةدم ثانيه من مجموعة المرضى وقياس نفس المفردات المذكوره اعلاه.كان هنالك ارتفاع معنوي في مستوى المالونديليهايد وانخفاض معنوي في مستوى مضادات الاكسده الكليه في مصل الدم في مرضى باركنسون بالمقارنه مع مجموعة الضبط. بعد فترة العلاج بقي الارتفاع المعنوي في مستوى المالونديليهايد والانخفاض المعنوي في مستوى مضادات الاكسده الكليه في مصل الدم بالمقارنه مع مجموعة الضبط.لم يكن هنالك اختلاف معنوي في مستوى المالونديليهايد ومضادات الاكسده الكليه في مرضى باركنسون في مرحلة ماقبل وبعد العلاج.هنالك علامات فرط الاكسده عند مرضى باركنسون المشخصين حديثا وان العلاج بمضادات باركنسون المحدده في هذه الدراسه كان ذا تأثير لايذكر على التحول في حالة الاكسده/مضادات الاكسده.


Article
SURGICAL TREATMENT OF PARKINSON'S DISEASE: A CLINICAL PROSPECTIVE STUDY WITH SIX YEARS FOLLOW UP

Author: Moneer K. Faraj منير خماس فرج
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2015 Volume: 13 Issue: 1 Pages: 45-50
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Deep Brain stimulation is well accepted now as amethod for treating refractory parkinsons disease.Objective:To describe deep brain stimulation in Iraq, emphasize the technically demanding procedure and to discuss the results on the patients after six years of follow up.Methods:A clinical prospective study of 8 patients with Parkinson’s disease underwent deep brain stimulation surgery in the Neurosciences Hospital. We performed 18 multiple stages operations from October 2007 to June 2008. The procedure begins with proper selection of patients, pre operative radiological studies, planning for targeting the subthalamic nucleus, the operation stage and the programming stage, which usually starts one-week post operatively.Results:One patient developed subarachnoid hemorrhage, another one have miss targeting and required retargeting surgery. A part from these complications all the patients had satisfactory outcome in controlling their symptoms during the six years follow up period.Conclusion:Deep brain stimulation is indicated for the treatment of refractory Parkinson disease. However it needs a well skilled personnel working as a team. The future of deep brain stimulation is remarkable as the list of indications is continually increasing to include other disease modalities.Key words:Parkinson's disease, deep brain stimulation, functional neurosurgery.


Article
The role of Herpes simplex virus type 1 and 2 in patients with neurodegenerative diseases

Authors: Mohamad I. Hassan --- Rana S. Aboud --- Saife D. Al-Ahmer
Journal: Iraqi Journal of Science المجلة العراقية للعلوم ISSN: 00672904/23121637 Year: 2018 Volume: 59 Issue: 4C Pages: 2179-2183
Publisher: Baghdad University جامعة بغداد

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Abstract

With the growing number of patient’s being diagnosed with Parkinson’s disease and Multiple Sclerosis each year it is becoming ever more important to find the cause for these neurological disorders. The present study attempts to shed light on one of the factors that may play a role as a causative agent in these neurological diseases by finding a correlation between the Herpes simplex virus type 1 and 2 in patients with Parkinson’s disease and multiple sclerosis by detecting the virus in these patients using immunological techniques. Sixty patients with neurological diseases (40 patients with Multiple sclerosis and 20 patients with Parkinson’s disease) who’s ages ranged from (17-76) years have been investigated. Samples were collected during the time period between November 2017 and April 2018 and compared to twenty five apparently healthy individuals as a control group. All the studied groups were measured for herpes simplex virus type-1 IgM and herpes simplex virus type-2 IgM by using the enzyme linked immuno sorbent assay. The results of the present study showed that there was a highly significant difference (p<0.01) in the concentration of IgM HSV-1 and HSV-2 in the sera of patients with MS and PD compared to the control group, While there was a none-significant difference (p>0.05) in the concentration of IgM HSV-1 and HSV-2 according to the gender. Thus, there is a likely possibility the HSV could be a contributing factor in the activation of some neurological diseases by the means of initiating an autoimmune reaction against the host’s nerve cells. The nerve cells have proteins that resemble portions of the virus from a structural and genetic stand point.


Article
Cardiovascular Autonomic Impairment in Parkinson Disease

Authors: Asma'a Khalaf Hamod --- Ali Musa Ja'afer --- Abdul Kareem Kadim AL- Khazraji --- Isra'a Fayiq Ja'afer --- et al.
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2015 Volume: 8 Issue: 1 Pages: 1-7
Publisher: Diyala University جامعة ديالى

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Abstract

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor dysfunction and several non-motor features. Dysautonomia is a significant non-motor feature as well as a neuropsychiatric symptom.Objective: To assess cardiovascular autonomic function in Parkinson patients.Patients and Methods: Samples were collected from Al Kadhimiya teaching hospital and Baquba teaching hospital in a period lasts from 1st January to 1st November 2013. Cardiovascular autonomic function had been tested in 44 Parkinson patients with autonomic dysfunction, 23 Parkinson patients without autonomic dysfunction and 25 healthy matched controls; using Valsalva maneuver, 30:15 ratio, and effect of posture on blood pressure.Results: The most frequent dysautonomic symptoms in parkinson disease were fainting and dizziness (postural hypotension) with a frequency of 26.8% with a P-value 0.015. The comparison between valsalva levels in three groups of study population was significant (P- value 0.04). The comparison between 30:15 ratio in three groups of study population was not significant statistically (P-value 0.344).Conclusion: Cardiovascular autonomic dysfunction is a common non-motor symptom associated with Parkinson's disease. It may precede the development of the cardinal motor symptoms in PD, making cardiovascular dysfunction an attractive target for early detection and potential neuroprotective strategies for PD. Valsalva maneuver and effect of changes in posture on blood pressure are affecting tests in cardiovascular autonomic study.


Article
Oxidative Stress Association with Autonomic Dysfunction in Parkinson Patients
ارتباط الإجهاد التأكسدي مع خلل الوظائف التلقائية في مرضى باركنسون

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Abstract

Background: Parkinson’s disease may be caused by oxidative stress within cells due to defective nucleoli. Dopamine producing neurons are particularly sensitive to oxidative stress. The researcher's present evidence showing defective nucleoli within dopamine producing neurons lead to oxidative stress and damageObjective: To assess antioxidant activity in Parkinson patients with autonomic dysfunction.Materials and Methods: samples were collected in Al Kadhimiya Teaching hospital and Baquba teaching hospital in a period lasts from 1st January to 1st November 2013. Antioxidant activity had been tested in 44 Parkinson patients with autonomic dysfunction, 23 Parkinson patients without autonomic dysfunction and 25 healthy matched controls; using (Antioxidant Capacity, Total BioAssay™ Kit ;US Biological company, Catalog No. A2298-43).Results: antioxidant activity showed a reduction in its level in Parkinson patients without autonomic dysfunction (0.75) with further reduction in Parkinson patient with autonomic dysfunction (0.37) compared with the control groups (1.2).Conclusion: Oxidative stress and antioxidants have a role in pathogenesis of Parkinson disease. Both increase oxidative stress (direct) and a reduction in activity of the antioxidants (indirectly) cause loss of neuron and reinforcing damage mechanisms that play a role in autonomic dysfunction in Parkinson Disease.

خلفية الدراسة: قد يكون سبب مرض باركنسون هو الإجهاد التأكسدي في الخلايا بسبب نويات المعيبة. ينتج الدوبامين من الخلايا العصبية الحساسة بشكل خاص للإجهاد التأكسدي. عدد من الباحث بين ان النويات المعيبة خلال فترة انتاج الدوبامين من الخلايا العصبية يؤدي إلى الإجهاد التأكسدي والتلفالهدف من الدراسة: تقييم نشاط مضادات الأكسدة في مرضى الشلل الرعاشي (باركنسون) مع خلل الوظائف التلقائية.المواد والطرق: جمعت العينات من مستشفى الكاظمية التعليمي ومستشفى بعقوبة التعليمي خلال الفترة من 1 كانون الثاني لغاية 1 تشرين الثاني . النشاط المضادة للأكسدة تم اختباره في 44 مريضا باركنسون مع خلل الوظائف التلقائية، 23 مريضا باركنسون دون خلل الوظائف التلقائية و 25 شخص لا تظهر عليهم اعراض المرض بأستخدام عدة القدرة المضادة للأكسدة، حسب الشركة البيولوجية الاحيائية - اميركيا.النتائج: أظهر النشاط المضادة للأكسدة انخفاض مستواه في مرضى الشلل الرعاشي دون خلل الوظائف التلقائية (0.75) مع مزيد من الانخفاض لمرضى الشلل الرعاشي المصحوب بخلل الوظائف التلقائية (0.37) مقارنة مع الاشخاص الذين لا تظهر عليهم اعراض المرض (1.2)الاستنتاجات: تشير البيانات الحالية أن الاكسدة ومضادات الأكسدة قد تلعب دورا هاما في التسبب بمرض الشلل الرعاشي (باركنسون.( قد يسبب ارتفاع الاكسدة الى فقدان الخلايا العصبية اما انخفاض نشاط مضادات الأكسدة مسؤولة بشكل غير مباشر عن فقدان الخلايا العصبية وتعزيز آليات الضرر الذي لعب دورا في خلل الوظائف التلقائية في مرض الشلل الرعاشي (باركنسون).

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