Papers by Fereshteh Ashtari
Research Square (Research Square), Dec 21, 2022
Background. Cognitive dysfunction, including Information processing speed (IPS), is relatively co... more Background. Cognitive dysfunction, including Information processing speed (IPS), is relatively common in multiple sclerosis(MS). IPS de cits have profound effects on several aspects of patients' life. Previous studies showed that deep gray matter atrophy is highly correlated with overall cognitive impairment in MS. However, the effect of deep gray matter atrophy on IPS de cits is not well understood. In this study, we evaluated the effects of deep gray matter volume changes on IPS in early relapse-remitting MS (RRMS) patients compared to healthy control. Methods. In this case-control study, we enrolled 63 RRMS patients and 36 healthy controls. All patients were diagnosed within 6 years. IPS was evaluated using the Integrated Cognitive Assessment (ICA) test. We also performed a 1.5T MRI to evaluate deep gray matter structures. Results. RRMS patients had lower accuracy in the ICA test (p = .01). However, the reaction time did not signi cantly differ between RRMS and control groups (p = .6). Thalamus volume was signi cantly lower in the RRMS group with impaired IPS compared to the RRMS with normal IPS and control groups (p < 10-4). Other deep gray matter structures were not signi cantly different between the RRMS with impaired IPS group and the RRMS with normal IPS group. Conclusion. MS patients are impaired in IPS even in the early stages of the disease. Thalamic atrophy affected IPS in these patients, however atrophy in other deep gray matter structures, including caudate, putamen, globus pallidus, hippocampus, amygdala, accumbens, and cerebellum, were not signi cantly correlated with IPS impairment in early RRMS.
Multiple Sclerosis and Related Disorders, 2021
BACKGROUND Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD... more BACKGROUND Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children. METHODOLOGY We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between January 2015 and March 2021. Age, date, sex, diagnosis, MOG-IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed based on diagnosis between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. We compared the post-lockdown period (March 17th, 2020, to March 31st, 2021) to previous calendar years (2015 to 2019) alone and to previous calendar years and the pre-lockdown 2020 period (January 1st, 2020, to March 16th, 2020). A p-value of < 0.05 was considered significant. Post-hoc pairwise comparisons between the post-lockdown period and previous years were performed on significant results. A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. We hypothesized that the number of new MOGAD would be significantly lower in the post-lockdown period compared to previous years due to decreased regional pathogen transmission. RESULTS Among 491 referred cases, we identified 415 new cases of neuroinflammatory disorder between January 2015 and March 2021. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years, with no MOGAD patients presenting in 2020 after the spring lockdown (q=0.0009). In addition, there were significantly fewer parainfectious neuroinflammatory cases (q=0.04) and pathogen detected (q=0.04) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q=0.185 and 0.693 respectively). INTERPRETATION Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.
Journal of Research in Medical Sciences, 2022
Apparently, the purpose of this article is to increase public confidence in vaccination. Since th... more Apparently, the purpose of this article is to increase public confidence in vaccination. Since the epidemic has now stopped and general vaccination is no longer a priority, and on the other hand, various studies have been published in different parts of the world on acute complications of vaccination, this article, which is only a report of acute complications, is not novel. I believe that it is better to report late side effects of vaccination in this article as well. Many tables and figures can be presented in fewer numbers. Written language needs correction.
BMJ, Jun 21, 1969
Introduction Multiple Sclerosis (MS) is a common neurological disease in young adults with variab... more Introduction Multiple Sclerosis (MS) is a common neurological disease in young adults with variable clinical symptoms and signs. Many of MS patients experience headache. This study was done to evaluate the prevalence of headache in MS patients. Materials and Methods This descriptive cross-sectional study was carried out in MS clinics affiliated to Isfahan university of Medical Sciences in the first six months of 1380. For each patient a questionnaire was filled according to history and examination, and the data was analyzed by SPSS program. Results From 100 patients, 67 had headache and 86.6 of them were women .Tension headache in 47.7 and migraine headache in 34.3 was reported. Of 100 patients, 23 of them had migraine headache, 36 patients had history of headache before the onset of MS, whom in 52.8 severity of headache was increased. Of patients 10.4 had headache at the onset of MS and in 6.8 headache was the first symptom of MS. The neurological signs and symptoms were presented after headache. Conclusion According to this study different types of headaches are common in MS and the migraine type is more common than in general population.
Dysphagia, 2021
Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple scle... more Dysphagia and symptoms of depression, anxiety and stress are common in persons with multiple sclerosis (MS). We posited a relationship between dysphagia and increased frequency of psychological symptoms. Therefore, the aim of the present study was to examine associations between symptoms of psychological difficulties, use of emotional suppression and cognitive reappraisal strategies, and dysphagia status in persons with MS. One hundred persons with MS were prospectively assessed in multiple domains of functioning: cognitive, psychological, and dysphagia-related. Participants underwent cognitive screening with the Mini Mental State Examination and completed two psychological inventories: The depression, anxiety and stress scale (DASS)-21 and the Emotion Regulation Questionnaire. Further, they completed the dysphagia in Multiple Sclerosis questionnaire. A speech-language pathologist evaluated persons suspected of having dysphagia with the Mann Assessment of Swallowing Ability. Dysphagia was present in 29 persons with MS, and the sample was split accordingly. The two groups differed at baseline with respect to Expanded Disability Status Scale scores. There were significant between-group differences for mental health symptoms and for use of emotional regulation strategies. Accordingly, multivariate logistic regressions showed that increased symptoms of psychological stress, decreased use of cognitive reappraisal strategies, and increased indicators of emotional suppression independently predicted the presence of dysphagia. There was a clear pattern towards poorer psychological well-being in persons with dysphagia compared to those without. Psychological difficulties may contribute to the manifestation or worsening of dysphagia and should be addressed in treatment planning and future investigations. Therapeutic interventions that promote improvement in mental state alongside swallowing function may be highly beneficial.
Multiple sclerosis and related disorders, May 1, 2022
BACKGROUND The aim of this study was to evaluate the safety of Sinofarm vaccine (BBIBP-CorV) in p... more BACKGROUND The aim of this study was to evaluate the safety of Sinofarm vaccine (BBIBP-CorV) in patients with multiple sclerosis (pwMS). METHODS This study was conducted on pwMS patients in Isfahan, Iran. All participants received two doses of BBIBP-CorV (Sinopharm vaccine). Demographic information and data on vaccine side effects were collected after each dose using questionnaires. All patients that recorded worsening of MS symptoms were evaluated and those with true relapse were treated with IV methyl prednisolone. RESULTS Of the 1538 patients, 1151 (74.8%) were female and the mean age was 40.45 ± 9.74. The average disease duration was 10.38±6.81 years and 76.1% of participants had RRMS. 92.8% of the participants were using DMTs and mean EDSS was 2.06 ± 3.16. 54.2% (833 patient) reported at least one adverse event after the first dose of vaccine and 46.8% (720 patient) after the second dose; in both cases going away in a few days. Most prevalent adverse events after both doses were injection site pain, headache, myalgia, fever and fatigue. Adverse events were more prevalent in younger and less prevalent in mildly disabled patients. There were seven cases of Covid-19 infection between the first and second vaccination dose, and eight cases during one-month follow -up after the second dose, none of whom needed mechanical ventilation. Ten patients after first dose and thirteen patients after the second dose experienced acute relapse. A patient had two relapses, one after each vaccine dose that were clinically and radiologically confirmed. The first relapse occurred seven days after the first vaccination with hemiparesis and other relapse, 14 days after the second dose with diplopia, hemiparesis and ataxia. CONCLUSION Adverse events in pwMS following vaccination with Sinopharm vaccine was similar to the general population, which were more common in younger patients and less common in those with mild disability. As no increase in relapse rate after vaccination was detected, Sinopharm vaccine was safe in MS patients.
Multiple sclerosis and related disorders, Feb 1, 2023
Multiple sclerosis and related disorders, Jun 1, 2023
Multiple sclerosis and related disorders, 2022
Background : Despite investigations on the effect of disease modifying therapies (DMTs) used in m... more Background : Despite investigations on the effect of disease modifying therapies (DMTs) used in multiple sclerosis (MS) on coronavirus disease 2019 (COVID-19); there are still controversies. Objective : We designed this study to evaluate the epidemiological features of covid-19 in a large sample of people with MS (pwMS) in Isfahan, Iran, as well as the association between DMTs, risk of COVID-19 infection and hospitalization. Methods : In an observational pwMS, we interviewed subjects on their MS and COVID-19 history. Results : 3050 subjects were included (74% female) with a mean age of 41.36. 423 (13.8%) had confirmed COVID-19 which shows that pwMS are at a higher risk of infection compared to the general population, No significant relationship was observed in COVID-19 infection when individual drugs. Dimethyl fumarate and rituximab had the lowest and the highest relative risks for hospitalization rate compared to other drugs, respectively. Conclusion : We found no evidence supporting a higher prevalence of COVID-19 in pwMS compared to the general population. However, our results show pwMS to be more prone to hospitalization compared to the general population, Therefore, it is advised to use safer treatment if possible until complete vaccination, and to postpone the use of rituximab.
Journal of the Neurological Sciences, Oct 1, 2019
50 years old lady with HIV and baseline CD4 count of 170, on antiretroviral therapy from 1.5 year... more 50 years old lady with HIV and baseline CD4 count of 170, on antiretroviral therapy from 1.5 years, presented with complaints of difficulty swallowing, change in voice and intermittent double vision since 10 months. There was a history of fluctuations. On examination she had bilateral mild lateral gaze palsy with mild asymmetric bifacial weakness. Her gag reflex was weak on both sides. Her CD4 count done 6 months back had increased to 477 and her MRI brain was normal. Myasthenia gravis was strongly suspected. Repetitive Nerve Stimulation showed a decremental response in bilateral median innervated muscles. Her MuSK antibody was positive and Ach receptor antibody was negative, which confirmed the diagnosis of MuSK myasthenia gravis. There was improvement with addition of pyridostigmine and she was later discharged on Pyridostigmine, Prednisolone and Azathioprine. On follow up, the patient is showing sustained improvement. Conclusions Autoimmune disorders are being increasingly reported with HIV infection since the advent of HAART. MuSK myasthenia gravis with HIV has been reported in very few case reports. The use of immunosuppressants in the treatment of these conditions should be carefully evaluated. I have obtained patient and/or Institutional Review Board approval, as necessary. An Institutional Review Board and /or Animal Use Committee have waived the requirement for their formal approval of the study.
Multiple Sclerosis Journal, 2021
Background and objective: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative diseas... more Background and objective: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative disease, which affects an estimated 2.5 million adults worldwide. MS poses multiple challenges for both physical and psychological well-being. People with MS experience unpleasant and unpredictable symptoms, difficult treatment regimes, drug side effects, and increasing levels of physical disability. They also face psychosocial consequences including disruptions to life goals, relationship with others, autonomy, personal growth, environment mastery and self-acceptance. Illness factors such as the extent of neurological disability, symptom severity, remission status, and length of illness can influence levels of psychological adjustment in MS. However, these factors are inconsistently associated with well-being, and are often only modest predictors. Research demonstrated that psychological factors are often better predictors of individual differences in well-being than illness factors. Psychological factors, unlike illness factors, are potentially modifiable through psychological interventions. One psychological factor related to psychological well-being is hardiness. Hardiness is a combination of attitudes that provides the necessary courage, motivation and capability to turn developmental and environmental stressors into opportunities for growth. Many positive outcomes have been found to relate to measures of hardiness, such as improved psychological and physical health in the face of work and life stress. Kobasa (1982) proposed commitment, control, and challenge as three components of hardiness, which buffer the disease process. Commitment involves one's feelings towards work, family, social encounters, and self. Control refers to a sense of power. Challenge is the ability to view all situations as potentially positive with successful outcomes. Hardy people have a strong commitment to self, work, family, and other values and are often role models for their children and their community, are able to take an active role in and possess a sense of responsibility for their lives, believe that they have the power to influence the course of events in their life, even unpleasant events, and he/she accepts personal responsibility for both the failures and successes in his/her life, see change in their lives as a challenge, not a threat. They enjoy facing challenges in their work and lives. In view of the fact that MS is one of the stressors that severely affect the lives of individuals, the purpose of this study was to investigate relationship between hardiness and psychological well-being in people with Multiple Sclerosis (MS) and normal group. Methods: This case-control study was done on 55 people with MS, who referred to Kashani hospital in Isfahan and 83 healthy people that were selected through convenience sampling. The research instruments were Ahvaz Hardiness Inventory and short form of Ryff Psychological Well-Being Scale. Pearson correlation coefficient, independent sample t test, and regression analysis were used to analyze the data through spss-21. Results: The results indicated people with MS showed a lower level of psychological well-being (p<0.001), Nonetheless, the difference was not statistically significant. The relation between hardiness and psychological well-being was stronger in MS group (p<0.001). There was not any statistically significant difference in hardiness with regard to gender, marital status. A statistically significant relationship was found between hardiness and education. That is, MS patients with higher education level reported higher hardiness (p=0.035). Conclusions: This study indicates that there is strong relation between hardiness and psychological well-being. Interventional programs for educating hardiness for promoting psychological well-being in MS patients strongly recommended.
Research Square (Research Square), Apr 21, 2022
Multiple sclerosis (MS) is one of the most prevalent chronic inflammatory diseases caused by demy... more Multiple sclerosis (MS) is one of the most prevalent chronic inflammatory diseases caused by demyelination and axonal damage in the central nervous system. Structural retinal imaging via optical coherence tomography (OCT) shows promise as a biomarker for monitoring of MS. There are successful reports regarding application of Artificial Intelligence (AI) in analysis of crosssectional OCTs in ophthalmologic diseases. However, the alteration of sub-retinal thicknesses in MS are noticeably subtle compared to other ophthalmologic diseases. Therefore, raw crosssectional OCTs are replaced with multilayer segmented OCTs for discrimination of MS and heathy controls (HCs). To conform to the principles of trustworthy AI, interpretability is provided by visualizing regional layer contribution to classification performance with proposed occlusion sensitivity approach. The robustness of the classification is also guaranteed by showing the effectiveness of the algorithm while being tested on the new independent (but similar) dataset. The most discriminative features from different topologies of the multilayer segmented OCTs are selected by dimension reduction methods. Support vector machine (SVM), random forest (RF), and artificial neural network (ANN) are used for classification. Patient-wise cross-validation (CV) is utilized to evaluate the performance of the algorithm, where the training and test folds contain records from different subjects. The most discriminative topology is determined to be squares with side of 40 pixels and the most influential sub-retinal layers are ganglion cell and inner plexiform layer (GCIPL) and inner nuclear layer (INL). Linear SVM resulted in 88% Accuracy, 78% precision and 63% recall in discrimination of MS and HCs using macular multilayer segmented OCTs.
PubMed, Jun 1, 2017
Background: This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on... more Background: This study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients. Methods: Twenty-eight eligible patients with ankle plantar flexor spasticity were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed. Results: After one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups. Conclusion: ESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.
Advanced Biomedical Research, 2015
Multiple Sclerosis (MS) is a chronic neurological disease in which demyelination and axonal loss ... more Multiple Sclerosis (MS) is a chronic neurological disease in which demyelination and axonal loss leads to disruption in the communication between the neurons of the central nervous system (CNS). Cognitive impairment occurs in a significant proportion of the patients with multiple sclerosis (MS). [1,2] The prevalence of cognitive impairment in persons with MS is high; The estimates range from 43 to 65%. [3]
Multiple sclerosis and related disorders, Mar 1, 2023
Background. Cognitive dysfunction, including Information processing speed (IPS), is relatively co... more Background. Cognitive dysfunction, including Information processing speed (IPS), is relatively common in multiple sclerosis(MS). IPS de cits have profound effects on several aspects of patients' life. Previous studies showed that deep gray matter atrophy is highly correlated with overall cognitive impairment in MS. However, the effect of deep gray matter atrophy on IPS de cits is not well understood. In this study, we evaluated the effects of deep gray matter volume changes on IPS in early relapse-remitting MS (RRMS) patients compared to healthy control. Methods. In this case-control study, we enrolled 63 RRMS patients and 36 healthy controls. All patients were diagnosed within 6 years. IPS was evaluated using the Integrated Cognitive Assessment (ICA) test. We also performed a 1.5T MRI to evaluate deep gray matter structures. Results. RRMS patients had lower accuracy in the ICA test (p = .01). However, the reaction time did not signi cantly differ between RRMS and control groups (p = .6). Thalamus volume was signi cantly lower in the RRMS group with impaired IPS compared to the RRMS with normal IPS and control groups (p < 10-4). Other deep gray matter structures were not signi cantly different between the RRMS with impaired IPS group and the RRMS with normal IPS group. Conclusion. MS patients are impaired in IPS even in the early stages of the disease. Thalamic atrophy affected IPS in these patients, however atrophy in other deep gray matter structures, including caudate, putamen, globus pallidus, hippocampus, amygdala, accumbens, and cerebellum, were not signi cantly correlated with IPS impairment in early RRMS.
This study attempts to assess the healthcare management and psychological well-being of both the ... more This study attempts to assess the healthcare management and psychological well-being of both the patients and their primary caregivers. Study is a descriptive in nature, conducted on 200 Multiple Sclerosis (MS) patients and 200 primary caregiver's in 2013. For data collection, the Reef questionnaire was used to determine psychological well-being of these individuals. Data were analysed using SPSS, according to the obtained results the mean duration of MS was estimated 6.37 years. There was significant difference between final score of Psychological well-being in people with MS and in their caregivers (P<0.05). Subscales of psychological wellbeing in people with MS and their primary caregivers were more than average, comparison of mean score in psychological well-being subscales in people with MS and their primary caregivers had significant difference. Autonomy subscale in people with MS was less than average. There was no significant difference in "positive relationship" and "personal growth" between people involved with MS and their primary caregivers; as a matter of fact the primary caregivers had higher score in other psychological well-being subscales, than MS involved people.
Multiple sclerosis and related disorders, May 1, 2021
Background There are reports that stress-related disorders are increasing during coronavirus dise... more Background There are reports that stress-related disorders are increasing during coronavirus disease 2019 (COVID-19) pandemic. Patients with Multiple Sclerosis (MS) are at higher risk of developing psychiatric disorders, which result in worsening of their disability. There are concerns about the mental health of MS patients during this pandemic. Objective We aimed to evaluate the prevalence of anxiety, depression, and levels of fear about Corona in MS patients during the COVID-19 pandemic. Materials and methods This was a cross-sectional study on MS patients who were admitted to the MS clinics affiliated with Isfahan University of medical sciences from May to June 2020. Anxiety and depression were evaluated according to the Hospital Anxiety and Depression Scale (HADS). The Corona Fear Questionnaire developed by Ahorsu et al. was applied to evaluate the state of fear about COVID-19. Chi-square tests were used to compare depression and anxiety between different groups, Kruskal-Wallis was used for fear scores, Spearman correlation coefficient was also reported for correlations. Results 410 MS patients with a mean age of 38.6 years (±10.35) were enrolled in the study. Among those patients who answered the HADS questionnaire completely (n=399, n=388, for anxiety and depression subscales respectively) the prevalence of anxiety and depression were 31.2% (n=128) and 39.3% (n=161), respectively. There was no significant relationship between anxiety and depression with any of the following variables: sex, marital status, history of drug abuse, smoking, duration of taking psychiatric medication, being tested for COVID-19, being quarantined. Regarding fear about COVID-19, patients with depression or anxiety showed higher scores on the fear questionnaire (p-value=0.03, p-value=0.008 respectively). Conclusions The prevalence of anxiety and depression in MS patients was higher than previously reported. Fear about COVID-19 was correlated with anxiety and depression. Multicenter studies are required to develop specific recommendations for screening mental health problems in MS patients during COVID pandemic.
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Papers by Fereshteh Ashtari