Background: Trigeminal neuralgia (TN), or Tic Douloureux, is one of the most common neuropathic pains. Gamma knife stereotactic radiosurgery (GNSRS) has been considered one of the procedures for treating primary TN. Objective: This study evaluates the effectiveness of GNSRS in treating primary TN in patients who are unresponsive to medical treatment in a single-center experience. Subjects and Methods: This study was conducted on 180 patients from January 2018 to October 2021. The study utilized the Barrow Neurological Institute (BNI) pain intensity score to assess pain before and after GNSRS treatment. Results: A total of 180 patients with primary TN were included in this study, 108 female with a 1.5:1 female: male ratio. Results showed significant pain score reduction post-GNSRS, indicating GNSRS as an effective second-line treatment for primary TN. The study suggests GNSRS's potential in decreasing medication dosage with minimal short-term complications, recommending further research to assess long-term benefits and side effects. A notable decrease in medication usage was reported, with minimal short-term complications. These results support the consideration of GNSRS as a viable alternative for TN patients who have exhausted traditional treatment options. Further research is recommended to explore long-term outcomes and potential side effects associated with GNSRS. Conclusion: The study's findings demonstrate that GNSRS is an effective and safe second-line treatment for patients with primary TN unresponsive to medical therapy. Significant reductions in pain intensity, as measured by the BNI pain scale, were observed following GNSRS treatment.

Background: Multiple sclerosis (MS) is often diagnosed in women of childbearing age (WCBA), with a mean age of onset of 30 years. Women with MS have long been cautioned to carefully plan their pregnancies and, traditionally, disease-modifying therapies (DMTs) have not been recommended for use in patients engaged in family planning. In 2020, the United States Food and Drug Administration (FDA) approved a label update for interferon beta (IFN ß) by adding new safety data on pregnancy and breastfeeding. Because current management guidelines do not yet reflect the recent label update, a panel of neurology experts from Iraq decided to discuss the potential need for changes in treatment strategies in Iraq. Methods: A panel of experts consisting of 8 neurologists from Iraq and one international neurology expert from Germany convened to develop an expert opinion that would provide practical guidance for the pharmacological management of WCBA with MS in Iraq. They considered the latest label update and relevant published literature, along with local clinical practice and available resources. Results: Interferon and Glatiramer acetate have no evidence of harm during pregnancy. IFN β can be continued safely through pregnancy. Switching treatment during pregnancy is generally not recommended. Short-term intravenous methylprednisolone can be used to treat disabling relapses. Conclusion: Given the complexity of managing MS in pregnant women, it is the opinion of the expert panel that family planning should be discussed early in the disease course, planned pregnancy should be encouraged, and open communication with patient for her treatment decisions is paramount. Patients who are engaged in family planning are no longer discouraged from treatment with some of the currently available DMTs.

Background: Surgical treatment for advanced Parkinson disease (PD) is considered when medical therapyfails to control the symptoms.Objective: Assessment of effectiveness of deep brain stimulation (DBS) in controlling motor manifestationsof advanced PD.Patients and Method: Twenty patients (14 male and 6 female) whom fulfill the requirements for DBSsurgery, were included in this study. All patients were on Levodopa (L-dopa), procyclidine, pramipexol, andamantadine medications. The study conducted between March 2017 and March 2018 in the neurosurgicalteaching hospital and neuroscience hospitalin Baghdad/Iraq. Unified Parkinson’s Disease RatingScale(UPDRS) was used before and after surgery.Results: There was a statistically significant improvement in the tremor, rigidity, and bradykinesia.Conclusion: Most disabling axial symptoms of gait and postural instability, that failed to respond to medicaltherapy, will show effective response to the bilateral STN stimulation in advanced PD cases.

Background:Stroke is one of the major causes of morbidity and mortality throughout the world, and carries greater economic costs. [MLC 601] originates from Traditional Chinese Medicine approved in 7 countries as drug that can aids post-stroke recovery. Objective:To assess [MLC 601] efficacy in improving outcomes of Iraqi patients’ stroke. Methods:Two hundreds ischemic stroke patients and 17 intracerebral hemorrhage patients were participated in this study; they took [MLC601] at the onset of their disease for 3 months and were assessed monthly for the motor power using modified Rankin scale mRs scale, speech, and visual field assessments. Results: mRs grade [4-5] were changed from (zero out of 159) at onset to (89 out of 55) at first month and to 98 out of 134 ischemic stroke patients after 3 months; also mRs grade [4-5] were changed from (1 out of 17) at onset to (12 out of 17) at first month and to 12 out of 17 intracerebral hemorrhage patients after 3 months. In 44% of the enrolled patients with aphasia were improved. Visual field assessments showed improvement in 43% of the patients with homonymous heminopia after 3 months [MLC 601] treatment. Conclusion:[MLC 601] is associated with improvement in all post stroke disabilities and placebo controlled trial is crucial to assess the benefit of it. Key worlds:Stroke, intracerebral hemorrhage, MLC 601, NeuroAid

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

Patients presented with spinal metastases from unknown primary tumours are rare. In this research we evaluated all patients with metastatic spinal tumour of unknown primary tumour, all patients were evaluated pre-operatively and comparison was done to those patients who had known primary tumour the study aimed to compare the group with known primary and the group with the unknown primary regarding the: mean age, gender, duration of symptoms, complication rate, region of the spine affected by metastasis, presence or absence of other skeletal or visceral metastasis, histological cell type and neurological outcome. Method: A retrospective study was performed on 40 patients presented to Neuroscience hospital in Baghdad from January 2010 till January 2014; all patients with metastatic spinal tumour were included in our study. We reviewed all patients’ records including age, sex, primary tumour, duration of their symptoms, neurological out come and complications. Results: Out of the 40 patient who presented with spinal tumours that underwent surgery duo to metastatic spinal tumour, five patients presented with spinal compression duo to metastatic tumour of unknown primary tumour (12.5%). The mean age was 64 years, 4 male and one female. For those with a known primary tumour mean age was 61 year, 22 male 13 female. Duration of symptoms prior to surgery was the same 180 days for those with unknown primary and 190 day for those with known primary tumours. They also had similar neurological outcome (80%) remain the same or improved post operatively for those with unknown primary and (85.7%) for those with a known primary tumour, and a similar complication rate for unknown primary was 25% versus 28% for known. The primary site of metastatic spinal tumour of unknown primary was confirmed after histopathology all shown adenocarcinoma four from the lung (80%) and one from colorectal. While the most common known carcinoma site were the lung 18 patient (51.4%), colorectal 8 (22.8%), breast 7 (20%), and renal 2 (5.71%). All patient who complain from secondary spinal metastasis with unknown primary tumour didn’t show any other skeletal or visceral metastasis, while those with a known primary tumour 6 patient out of 35 (17.1%) shown involvement of other site, the indication of surgery was to remove cord compression and restore neurological deficit. The most common site for metastasis was the dorsal spine for those of an unknown primary tumour 4 out of 5 patients (80%), and for those of a known primary tumour it was the lumbar area 28 out of 35 patient (80%). In conclusion metastatic spinal tumour of unknown primary was a common condition; it has similar demographic features, complications, and neurologic sequel with the spinal metastasis of known primary. Adenocarcinoma of the lung is the most common primary tumour proved after histopathology for spinal metastasis of unknown primary.

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 (

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.

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

Aim of study: This study was carried out to describe characteristics of 22 primary dystonic patients and their response to therapy. Patients and method: Twenty-two patients were entered into the study from Baghdad teaching hospital, Al-Kadhymia teaching hospital in Baghdad, privet nursery home teaching hospital in Baghdad, and Alzehraa teaching hospital in Kut south to Baghdad from January 2005 to January 2008. All cases were primary dystonia, secondary dystonia has been excluded from our study. Neuroimiging and slit Lampe examination have been done for all cases, L-Dopa in dose of 10/mg/kg/day for 2 weeks was giving for all patients. Type of study is a retrospective cohort study. All patients were followed in the outpatient clinics of the hospitals mentioned previously with frequent neurological examinations. Results: Out of 22 patients, 15 (68%) patients were females, 7 (32%) were males. According to descriptive classifications of dystonia by age of onset, fourteen patients (64%) were of early onset and eight (36%) being late onset (26 years and older). Three patients had generalized dystonia, 19 patients had focal dystonia {11 (58%) cases were cervical (TORTICOLIS) type, 5 (26%) blepharospasm type and segmental (LIMBES) dystonia 3 (16%)}. All cases were given L-DOPA in dose 10/mg/kg for 2 weeks, only two cases shown clinical response for the drug inform of absence of abnormal movements and improve quality of life. Conclusion: Dystonia is rare; however, early onset dystonia are more common than late onset. Dystonia are more common in females than in males and focal dystonia is more common than generalized dystonia.

Background: Genetic backgrounds play an important role in susceptibility to and protection against Guillain Barre Syndrome. Certain human leukocyte antigens have been found to be associated with Guillain Barre Syndrome. Aim of Study: This study aimed to study the relationship between the susceptibility of HLA Class II "DRBI" allele's frequencies in a sample of Iraqi's patients with Guillain Barre Syndrome compared with a healthy control group using PCR-SSOP method. Patients and Methods: Thirty consecutive Iraqi Arab Muslim patients with Guillain-Barre syndrome admitted in the Neurological Department in neurosciences Hospital between September-2012 to June-2013 were assessed for HLA genotyping for HLADRB1. A control group consisted from thirty healthy volunteers among the staff of Al-Kindy College of Medicine that did not have any neurological disorders whether recent or previously and had negative family history for this diseases or other neurological disorders. HLA genotyping for HLADRB1 was performed for each patient and for the control persons using the PCR with sequence-specific oligoneucleotide primers. Allele frequencies were compared across groups. Results: There was a significant higher rate of DRB1*03:01 frequencies in patients with GBS compared with healthy controls (p=0.007, Odds ratio=5.687, 95% CI: 1.59-20.33)

Objective: To find an association between human leukocyte antigen (HLA) class II DRB1, DRB3, DRB4, and DRB5 alleles frequencies in a sample of Iraqi patients with Guillain-Barre syndrome (GBS) and compare with a healthy control group.Methods: We performed a cross-sectional study consisting of 30 Iraqi Arab patients with GBS attending the Neurological Department in the Neuroscience Hospital, Baghdad, Iraq between September 2012 and June 2013. The control group comprised 42 apparently healthy volunteers. Human leukocyte antigen genotyping for HLA DRB1, DRB3, DRB4, and DRB5 was performed using the polymerase chain reaction-sequence-specific primers method. The allele frequencies were compared across both groups. Major histocompatibility complex (MHC)-class II HLA-DR genotyping and serotyping were performed by software analysis.Results: We found increased frequencies of HLA genotype DRB1*03:01 (p=0.0009), DRB1*07:01 (p=0.0015), and DRB4*01:01 (p<0.0001) in patients with GBS compared with healthy controls. The HLA DR6 was increased in the control group (p<0.0001).Conclusions: Our results suggest an association between HLA-DRB1*03:01, DRB1*07: 01, DRB4*01:01, and HLA DR3, DR7 and a susceptibility to GBS.

The epidemiology of multiple sclerosis (MS) is rapidly changing in many parts of the world. In a geographic area that was previously associated with low prevalence, recent studies showing high prevalence and fast rising incidence of MS in the Levant countries led us neurologists of this region to meet in a consensus panel, in order to share our latest findings in terms of MS epidemiology and consent on MS management in the Levant. Twelve neurologists and MS experts representing various countries of the Levant (Lebanon, Syria, Jordan and Iraq) have met in Beirut on the 17th of February 2013, shared their latest epidemiological findings, discussed recent MS aspects in the region, and drafted a consensus on MS management relevant to this geographic area.

Background: Intracerebral hemorrhages (ICHs) comprise approximately 10% of all strokes with a thirty-day case fatality rate of 30% to 50%. Objectives: To determine potential early predictors of outcome within first week of primary intracerebral hemorrhage and to evaluate the influence of those various factors on the mortality and morbidity of patients with intracerebral hemorrhage (ICH). Methods: 70 patients (48 men and 22 women) were admitted to Baghdad teaching hospital, between May 2009 and January 2011. They were diagnosed with supratentorial hemorrhage by brain CT. Total Serum cholesterol, the vital signs and the size of hematoma were arranged for each patient at the time of admission, then a modified Rankin scale (mRS) was calculated at the onset of this catastrophe. Result: Of the 70 patients (48 men and 22 women) consecutively admitted with ICH, 24 (38%) were died in the hospital: 31.5% on the first and second days and 82.5% by the fourth, fifth and sixth day of the event. The mRS outcome results were as follow: 8 (12.9%) good outcome mRS=2, 38 (62.9%) were dependent mRS=(3-5), 24 (34.3%) were died mRS=(6). Conclusion: High mortality and morbidity (high mRS scores value) were observed in patient with large hematoma size, low serum cholesterol, and high vital signs readings.