There is strong evidence that diabetes mellitus increases the risk of cognitive impairment and dementia. Insulin signaling dysregulation and small vessel disease in the base of diabetes may be important contributing factors in Alzheimer's disease and vascular dementia pathogenesis, respectively. Optimal glycemic control in type 1 diabetes and identification of diabetic risk factors and prophylactic approach in type 2 diabetes are very important in the prevention of cognitive complications. In addition, hypoglycemic attacks in children and elderly should be avoided. Anti-diabetic medications especially Insulin may have a role in the management of cognitive dysfunction and dementia but further investigation is needed to validate these findings.

BACKGROUNDLittle is known about the incidence of Guillain-Barré syndrome (GBS) in Iran. We determined the incidence and evaluated prognostic factors for GBS in a prospective, population-based study.PATIENTS AND METHODSWe evaluated and followed all patients with a diagnosis of GBS admitted to three referral neurology centers in East Azerbaijan province over a 1-year period (2003). Clinical and electrophysiological characteristics of cases were reviewed and analyzed.RESULTSA total of 76 patients were found, corresponding to a crude annual incidence rate of 2.11/100 000 population. Six patients (7.9%) died acutely within 21 days from the onset of the disease. Acute mortality was due to respiratory involvement, sepsis and acute autonomic system dysfunction. The persistence of disability after the acute phase was related to axonal involvement (OR=3.19, 95%CI, 1.65 to 6.16). There was a significant correlation between a history of diarrhea and a further need for mechanical ventilation (P<0.05). Mechanically ventilated patients had a low GBS disability score on discharge compared with patients not mechanically ventilated (P=0.05).CONCLUSIONSThe incidence rates of GBS in our province is similar to that in other countries. Acute mortality in GBS was mostly due to poor respiratory care of patients and infective complications, but disability and probably late mortality were due to axonal nerve injury.

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Drug-resistant epilepsy seems like a different disease compared with easy to control epilepsy, and new strategies are needed to help these patients. Vagus nerve stimulation (VNS) therapy is the most frequently used neurostimulation modality for patients with drug-resistant epilepsy who are not eligible for seizure surgery. In this study, we aimed to evaluate the efficacy and adverse effects of VNS in patients with drug-resistant epilepsy in an open-label, prospective, long-term study in Iran. We selected 48 patients with partial-onset drug-resistant epilepsy. Implantations were performed in the neurosurgery department of Loghman Hospital, Tehran, Iran. Follow-up visits were done on monthly bases for 5 years. Forty-four patients completed the study. Mean age of patients was 24.4 years. Mean years of epilepsy history was 14 years. The mean number of anti-epileptic drugs did not significantly change over five years (p = 0.15). There was no exacerbation of epilepsy; however, one patient discontinued his therapy due to unsatisfactory results. Five patient had more than 50 %, and 26 patients (59 %) had 25-49 % reduction in the frequency of monthly seizures persistently. Overall mean frequency of monthly seizures decreased by 57.8, 59.6, 65, 65.9, and 67 %, in 1st, 2nd, 3rd, 4th, and 5th years of follow-up, respectively. Most common side effects were as follows: hoarseness (25 %) and throat discomfort (10 %). We found VNS as a safe and effective therapy for drug-resistant epilepsy, with an approximate long-term decrease in mean seizure frequency of 57.8-67 %. Thus, VNS is recommended for suitable patients in developing countries.

Background: To evaluate the role of some sex hormones in migraine headaches, the aim of this study was to assess the prevalence and characteristics of headache, especially migraine, in patients with polycystic ovary syndrome (PCO) compared with women without this disease. Methods: One hundred and thirty-three women with PCO and 107 controls were interviewed by 2 neurologists experienced in headache diagnosis. The headache disorders were classified according to the International Headache Society criteria. The statistical significance was determined using the χ² test, and a p value of <0.05 was considered significant. Results: Forty-five women (33.8%) of the 133 cases without PCO complained of headache. Of the PCO patients, 48 women (44.9%) suffered from headache. The prevalence of headache was not significantly higher among women with PCO (p = 0.85). The same results were found for migraine headache (p = 0.13). Conclusion: Migraine is not more frequent in women with PCO. It was concluded that male sex hormones and especially testosterone do not play an important role in the exacerbation of migraine headache.