,  Forouzan  Ahmadi , Khatamol Anbia hospital, Shafa Neurology building

Ictal SPECT is a safe and non-invasive procedure in determination of seizure focus and for evaluation of seizure focus extension in good selected patient. This method is usually done in pharmaco resistant patients before they become candidate for epilepsy surgery. This method is based on the phenomenon that blood perfusion to the seizure focus is rising during a seizure attack as double. Expert nurses inject Technetium 99 with proper dose through IV less than 30 seconds after starting Ictal EEG onset in selected patient during monitoring in LTM ward. Afterward, 10cc of Normal saline injects due to washing the vessel.

After this step, related physician should be informed for starting over of anticonvulsant drugs. The surface electrodes must be removed and the patient conduct to Gamma Scan ward for doing SPECT at the end of Ictal injection.

The second step of this procedure is Interictal SPECT. As its name shows, it will be done 24 hours after Ictal SPECT if no seizure occurred.

Although ictal SPECT shows hyper perfusion of seizure focus, Interictal SPECT shows hypo perfusion of this zone.

SPECT is a good radiologic method for cases that ictal onset zone of EEG is not completely clear or brain MRI with epilepsy protocol shows more than one lesion as epileptogenic zone.

Seyed Raheleh Ahmadian1*, Mona Hashemian1, Shahram Ghasemi2, Atefeh Akbari1, Leila zare3

1. Student Research Committee, Babol University of Medical Sciences, Babol, Iran
2. Nanochemistry Research Lab, Faculty of Chemistry, University of Mazandaran, Babolsar, Mazandaran, Iran
3. Neuroscience Research Center, Health Research Institute, Babol University, Iran

Introduction: Despite the numerous pharmacological activities of quercetin, it’s biomedical Application has been hampered, because of poor water solubility and low oral bioavailability.

In the present study, we fabricated a novel form of quercetin-conjugated Fe3O4–β cyclodextrin (βCD) nanoparticles (NPs), and the effect of these prepared NPs was evaluated in a chronic model of epilepsy.

Method and material: Quercetin-loaded NPs were prepared using an iron oxide core coated with βCD and pluronic F68 polymer. The chronic model of epilepsy was developed by intraperitoneal injection of pentylenetetrazole (PTZ) at dose of 36.5 mg/kg every second day. Quercetin or its nanoformulation at doses of 25 or 50 mg/kg were administered intraperitoneally 10 days before PTZ injections and their applications continued 1 hour before each PTZ injection.Immunostaining was performed to evaluate the neuronal density and astrocyte activation of hippocampi.

Result: Our data showed successful fabrication of quercetin onto Fe3O4– βCD NPs. In comparison to free quercetin, quercetin NPs markedly reduced seizure behavior, neuronal loss, and astrocyte activation in a PTZ-induced kindling model.

Conclusion: Overall, quercetin–Fe3O4–βCD NPs might be regarded as an ideal therapeutic approach in epilepsy disorder.

Keywords: quercetin, Fe3O4 nanoparticles, anticonvulsant, neuroprotection, astrocyte activation

Seyed Raheleh Ahmadian1*, Shahram Ghasemi2, Atefeh Akbari1 

• Student Research Committee, Babol University of Medical Sciences, Babol, Iran
• Nanochemistry Research Lab, Faculty of Chemistry, University of Mazandaran, Babolsar, Mazandaran, Iran

Introduction: Epilepsy is considered one of the most common neurological disorders, and is characterized by recurrent and unpredicted epileptic seizures. Although numerous antiepileptic drugs have been designed in recent years, available therapies are in efficient for control of seizure attacks in around 30% of patients. Therefore, several approaches have emerged to design novel drugs for treatment of epileptic patients. Most recently, in order to overcome the side effects of existing chemical drugs, natural products with anti-inflammatory agents such as curcumin has been regarded to reduce the epilepsy symptoms. But its medical application has been hampered due to low water solubility. To improve the aqueous solubility of curcumin, it has been loaded on chitosan -alginate nanoparticles (NPs). In this study, the effect of curcumin NPs on memory improvement and glial activation was investigated in pentylenetetrazol (PTZ)- induced kindling model.

Method and material: Male NMRI mice have received the daily injection of curcumin NPs at dose of 12.5 or 25 mg/kg. All interventions were injected intraperitoneally (i.p), 10 days before PTZ administration and the injections were continued until 1 h before each PTZ injection. Spatial learning and memory was evaluated using Morris water maze test after the 7th PTZ injection. Animals have received 10 injections of PTZ and then, brain tissues were removed and immunostaining method was performed against NeuN and GFAP/Iba1 for assessment of neuronal density and glial activation respectively

Result:Behavioral results showed that curcumin NPs exhibit anticonvulsant activity and prevent cognitive impairment in fully kindled animals. The level of neuronal cell death and glial activation reduced in animals which have received curcumin NPs compared to those received free curcumin.

Conclusion: To conclude, these findings suggest that curcumin NPs effectively ameliorate memory impairment and attenuate the level of activated glial cells in a mice model of chronic epilepsy.

Keywords:Curcumin nanoparticles; Memory improvement; Anticonvulsant; Glial activation; Pentylenetetrazol

Seyed Raheleh Ahmadian1*, Maryam Ghasemi2, Mitra Pourgholi1, Hanieh Yavarpour1

1. Student Research Committee, Babol University of Medical Sciences, Babol, Iran
2. Cellular and Molecular Biology Research Center, Health Research Center, Babol University of Medical Sciences, Babol, Iran

Introduction: Epilepsy is one of the most common chronic neurological disorders, which provoke progressive neuronal degeneration and memory impairment. In recent years, application of herbal compounds with anti- inflammatory properties, such as hesperetin has been introduced as useful agent in reducing of the epilepsy symptoms. Despite the numerous pharmacological activities of hesperetin, its biomedical application has been hampered, because of poor water solubility and low oral bioavailability. we fabricated a novel form of hesperetin solid lipid nanoparticles (SLNPs).

The effect of these prepared NPs was evaluated on inflammatory gene expression, neuronal density and astrocyte activation in pentylenetetrazol (PTZ)-induced kindling model.

Method and material: hesperetin-loaded NPs were prepared using a propylene glycol with stearic acid and pluronic F68 polymer. Male NMRI mice have received the daily injection of hesperetin and hesperetin- loaded NPs at dose of 10 and 20 mg/kg. All interventions were injected intraperitoneally (i.p.), 10 days before PTZ administration and the injections were continued until 1 h before each PTZ injection. Animals have received their last injections of PTZ and then, brain tissues were removed. Immunostaining against NeuN and GFAP respectively as mature neuronal and astrocyte markers were performed on brain sections. QRT-PCR was done for inflammatory gene expression in hippocampus.

Result: Our data showed successful fabrication of hesperetin-loaded NPs. In comparison to free hesperetin, hesperetin NPs markedly reduced seizure behavior, neuronal loss, and astrocyte activation in a PTZ-induced kindling model. Results showed that hesperetin administration attenuates inflammatory gene expression in fully kindled animals.

Conclusion: Overall, the results of this study suggest that hesperetin NPs administration effectively ameliorates inflammatory gene expression and alleviates the level of neuronal death and astrocyte activation in PTZ- induced kindling model.

Keywords: Epilepsy; hesperetin NPs; inflammatory gene expression; Neuronal loss; astrocyte activation

 Mohsen  Aghaee Hakak,MD Neurologist, Epilepsy Monitoring Unit, Razavi Hospital, Mashhad,Iran

Sleep and epilepsy are closely related. Hypersynchronization occurs during sleep and this phenomenon exacerbates epileptic seizures and epileptiform activities in some epileptic syndromes. Certain epilepsies are associated with sleep, especially in children. Epilepsy may aggravate by both sleep and sleep deprivation. Sleep disorders, on the other hand, are commonly seen in patients with epilepsy. Effective treatment of sleep disorders, especially sleep apnea, can improve the control of seizure attacks. In addition, the quality and quantity of sleep can be affected by seizures or antiepileptic drugs. Some sleep disorders, such as parasomnias, can mimic epileptic seizures and make it difficult to differentiate from epilepsy.

Given the above, screening, diagnosis and treatment of sleep disorders are an important part of the treatment and care of epileptic patients.

Keywords: sleep, epilepsy, parasomnia

 Sara Abedi1, Narges Zeinalzadeh2, Leila Mehdizadeh3, Yousef Panahi4   1, 2, 3- Department of Animal Sciences, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran.

4- Department of Basic Sciences, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran.

Background: This study aimed to compare the number of spikes induced by acute and chronic intraperitoneal injection of pentylenetetrazol in adult male rats.

Methods: In this study, 22 adults male Wistar rats (200-250 g) were used in the control (n=6), acute (n=6) and chronic group (n=10). After anesthesia with the combination of ketamine (80 mg/kg) – xylazine (eight mg/kg), the animal’s head was held fixed using a stereotaxic device and after longitudinal incision in the scalp and wiping the tissue and determining the Bregman point, the intracranial recording electrode was inserted into the CA1 hippocampal striatum layer and seizure activity was induced by intraperitoneal injection of pentylenetetrazol (80 mg/kg). After digestion, the recording electrode was inserted into the CA1 hippocampal striatum layer and seizure activity was induced by intraperitoneal injection of pentylenetetrazole (80mg/kg). Animals were anesthetized with the combination of ketamine (80 mg/kg) – xylazine (eight mg/kg) and after fixation using a stereotaxic apparatus, followed by longitudinal incisions in the scalp and wiping the tissues on the skull, intracranial recording electrodes were placed in the CA1 hippocampal striatum layer, and seizure activity were induced by intraperitoneal injection of pentylenetetrazol (80 mg/kg). In the control group, after recording the activity in basal condition, normal saline and in the acute, group were injected intraperitoneally with pentylenetetrazole and the number of spikes was evaluated by eTrace software. However, whereas in the chronic group for eight weeks on Saturday, Monday and Wednesday, 30 mg/kg pentylenetetrazole were injected intraperitoneally and after the end of this epileptic activity period, similar to the grave group. Diazepam 10 mg/kg was used to suppress epileptic activity induced by pentylenetetrazol.

Results: The results of the present study showed that no spike activity was recorded in the control group and the number of spikes in the acute group compared to the chronic group did not show a significant difference, although the number of spikes in the chronic group in compared with the acute group had been decreased. Data were analyzed by SPSS software version 22 using one-way ANOVA Tukey post hoc test. P <0.05 were considered significant.

Conclusion: The decrease in the number of spikes in animals that are chronically affected by epilepsy is likely to reflect the role of specific biological pathways in the pathophysiology of epilepsy, which requires further study to identify these pathways.

Keywords: Acute, Chronic, Rat, Epilepsy, and Pentylenetetrazol

MA Arami, Neurologist
Milad General Hospital, aliarami40@gmail.com

Abstract: Corticography during surgery is a relatively new method, which can be used to improve surgical outcomes if selected and appropriately performed.
Besides recording and identifying seizure focuses, corticography is also required in the brain mapping process. This issue is also important during awakening craniotomy and can prevent false interpretations in mapping of eloquent areas including languag corteex and subcortex areas.
However, there is no consensus on its effectiveness and usefulness. Depending on the underlying pathology, its usefulness may vary. Sometimes technical problems also interfere with standard corticography.
This article describes how to conduct corticography during surgery and its problems and how they are managed, as well as their indications and existing discrepancies.

دکتر محمدعلی آرامی,  نورولوژیست
بیمارستان میلاد تهران

aliarami40@gmail.com

خلاصه
کورتیکوگرافی حین عمل جراحی روشی نسبتا جدید است که در صورت انتخاب موارد مناسب و اجرای صحیح آن میتواند برای بهبود نتایج جراحی بکار گرفته شود.
علاوه بر ثبت و شناسایی فوکوس های تشنجی, کورتیکوگرافی در فرایند نقشه برداری مغزی نیز ضروری است. این موضوع هنگام کرانیوتومی در حالت بیداری هم اهمیت بسزایی دارد و میتواند از تفسیرهای نادرست جلوگیری کند. موضوعی که در تعیین مناطق تکلم اهمیت ویژه دارد.
با این حال در مورد اثربخشی و مفید بودن چشمگیر آن اتفاق نظر کامل وجود ندارد. بسته به پاتولوژی زمینه ای ممکن است سودمندی آن متفاوت باشد. همچنین گاهی مشکلات تکنیکی نیز برای انجام یک کورتیکوگرافی استاندارد مزاحمت ایجاد میکنند.
در این مقاله در خصوص نحوه انجام کورتیکوگرافی حین عمل و مشکلات موجود و نحوه مدیریت آنها و همچنین اندیکاسیون های انجام آن و اختلاف نظرهای موجود توضیحاتی داده خواهد شد.

Siamak Afshinmajd: Department of neurology. Neurophysiology research center. Shahed university

Massoud Moghadamnia. Department of psychiatry .Shahed university

Objectives: Epilepsy is a common disorder in all societies, especially in psychiatric patient communities. This study is designed to compare the rate of seizure attacks in depressed patients treated by tricyclic antidepressants (TCA) with patients treated with serotonin reuptake inhibitors (SSRI).

Methods: Two-hundred and forty three depressed patients selected according to DSM4 criteria in two years duration in mostafa Khomeini hospital. The only problem of these patients were depression and they were treated with only single drugm which were TCA or SSRI’S. Patients with other kind of psychiatric or neurologic disorders (especially previous  seizure attacks) except depression is not permitted. All patients were above eighteen and below sixty –five years old and examined by a psychiatrist and neurologist for detection of depression. All patients were followed for appearance of seizure for at least three years.

Results: There were one hundred and fifty- two females (63%) and eighty –eight(37%) males’ patients.  Thirty – three(14%) patients had seizure attacks in two years duration. Twenty- five(76%) attacks were in patients taking TCA and eight(24%) patients were in those who received SSRI’S.   

Conclusion: Seizure  attacks is more prevalent in patients who receive TCA in comparison to patients who receive SSRI’S. It is rationale to use paramedical items or at least   SSRI’S in patients with history of  seizure attacks instead of TCA’S.

Mohsen Aghaee Hakak, MD

Department of neurology, Epilepsy Center, Razavi Hospital, Mashhad, Iran

Email: Mohsen.hakak@gmail.com

Seizures that occur in close proximity to an event should be considered as situational or acute symptomatic or provoked seizures. By definition, provoked seizures are classified as resulting from transient derangements that involve metabolic, toxic, or medication side-effects, whereas acute symptomatic seizures are caused by an acute event such as stroke, traumatic brain injury (TBI), or CNS infection.  40% of all first Seizures (50% to 70% of Status Epilepticus) are acute symptomatic seizures. These seizures are different from unprovoked seizures both in prognosis and management. In this review we will discuss about therapeutic approach and risk of recurrence of acute symptomatic seizures.

In acute phase of brain insult, patients who experience provoked seizures have higher rate of morbidity and mortality. In certain conditions due to higher risk of seizure recurrence, short-term (a few weeks) antiepileptic medications are recommended in acute period (such as penetrating traumatic brain injuries, subdural hematoma, venous sinus thrombosis, viral encephalitis and cortical strokes). In patients with persistent epileptic activity on EEG and structural lesions on imaging longer treatment is recommended (a few months). In patients who have an unprovoked seizure subsequently (> week after an event), long-term medication with antiepileptic drugs should be considered.

Multiple studies have confirmed that anti-seizure medications may reduce risk of seizure recurrence in the short-term but it does not appear to alter rate of developing epilepsy in long-term (In other words, anti-seizure medication is not anti-epileptogenic).

Keywords: Acute symptomatic seizures, Provoked seizures, Antiepileptic drugs