Showing papers in "The Egyptian Journal of Neurology, Psychiatry and Neurosurgery in 2019"

Music therapy as a therapeutic tool in improving the social skills of autistic children

Abstract: The Cochrane Collection reviews of randomized clinical trials (RCT) showed a favorable result of music therapy (MT) on individuals with autism spectrum disorder (ASD) compared with a placebo treatment. This study focuses on accessing whether MT can improve the development of social skills of autistic children and to check if the effects of MT are long lasting. This study was designed as a pre-test/post-test and follow-up among the autistic children. Fifty-four children with mild to severe autism were selected and assigned into two groups: active and passive. The children received MT for 3 months and the groups were followed-up for 3 months. The data were analyzed with IBM-SPSS-21 software using t test and the groups were compared by analysis of covariance. The results of the MT intervention were mostly apparent in the following subscales—understanding/perspective-taking, initiating interactions, responding initiation, and maintaining interactions with others. The post-test covariance analysis results showed a significant increase in social skills’ scores (p < 0.05). Also, the t test results of the paired-sample revealed that the effectiveness of MT has been continual during the follow-up phase. The study illustrated that MT is an effective intervention in improving social skills of autistic children with steady effects. MT helped in developing a form of communication for these children which led to an improvement in their ability to understand, respond, and maintain their interaction with their peers.

The mean platelet volume and plateletcrit as predictors of short-term outcome of acute ischemic stroke

Abstract: Activation of the platelet plays an important role in the process of atherosclerosis. Mean platelet volume (MPV) is significantly associated with the poor outcome of acute ischemic stroke while the results of studies about the relationship between plateletcrit (PCT) and stroke outcome were inconsistent. The aim of this work is to determine whether an association exists between MPV and plateletcrit (PCT) and outcome of acute ischemic stroke. We examined 157 patients with ischemic stroke, admitted to the Sohag University Hospital. The diagnosis of stroke was performed clinically according to The World Health Organization and confirmed by brain CT and MRI when needed. Platelet indices including MPV and PCT were assessed immediately (within 2 h) after admission. After 3 months, the functional outcome was assessed using the modified Rankin Scale (mRS) with assessment of the relationship between platelet indices and stroke outcome. About 50% of the participants have favorable outcome. MPV was significantly higher in the unfavorable group (10.4 ± 2.3 fL) than in the favorable one (8.7 ± 1.3 fL) (P < 0. 001). MPV was an independent predictor of poor short-term outcome of acute stroke after controlling for confounders like diabetes mellitus. The mean PCT was significantly higher in the unfavorable group (0.28 ± 0.1%) than in the favorable one (0.25 ± 0.1%) (P = 0. 04) but not considered as an independent predictor of poor short-term outcome of acute stroke. MPV and PCT were significantly correlated with poor functional outcome, only MPV was an independent predictor of poor short-term outcome of acute stroke after controlling for confounders like DM, and these platelet indices can be used as a prognostic tool.

Role of single nucleotide polymorphisms (SNPs) in common migraine

Abstract: Single nucleotide polymorphisms (SNPs) may act as biological markers, as they can relate to the genes that are associated with various complex diseases such as heart diseases, diabetes, cancer, schizophrenia, blood pressure, migraine, and Alzheimer. These SNPs mostly locate within a gene or in a regulatory region near a gene and can affect the gene’s function to play a more direct role in disease. Hence, SNPs allow scientists to develop candidate drug therapy by evaluating an individual’s genetic makeup to develop a particular disease. Gene-gene interactions generally complicate migraine and its genetics and further gene-environmental interactions that often misguide the true defying causes of this disease. Due to its complex nature, it is difficult for scientists to reveal a complete list of SNPs or even all the genes that are related with the pathogenesis of this disease. Nowadays, much work has been done in this direction and new variants of migraine are being constantly identified. In this review article, the role of various SNPs reported to be disease-associated in published migraine GWAS has been discussed. To understand the molecular mechanisms of migraine attack by identifying new genetic variants of migraine can be a key to develop new therapeutic strategies in the future.

The NIHSS score can predict the outcome of patients with primary intracerebral hemorrhage

Abstract: Intracerebral hemorrhage (ICH) is characterized to be the most lethal form of stroke, with high rates of mortality, not only during the acute phase (39%), but also 3 months later (33.5%) with a significant long-term disability. The National Institutes of Health Stroke Scale (NIHSS) score is a purely clinical scale, is easily administrable, and does not require the use of any additional diagnostic procedure. To evaluate if the admission NIHSS score in acute primary ICH patients can be a predictive tool for their short-term outcome. We included 120 patients diagnosed with spontaneous ICH. All patients were subjected to full history taking, general, and neurological examination with assessment of neurological function on admission using the NIHSS. Laboratory assessment on admission including complete blood count, routine liver and kidney functions, and coagulation profile. Radiological investigations included computerized tomography (CT). The patients were followed, both clinically using the NIHSS score, radiologically with CT brain after 1 week and 4 weeks from the onset to assess the hematoma growth, its complications, and or resolution. Modified Rankin score (mRS) was done after 30 days of onset to assess patient’s disability. The 30-day mortality was about one third of the patients. The intracerebral hematoma volume on admission has a significant positive correlation with the NIHSS, and ICH score significantly correlates with the 30-day outcome. Admission NIHSS has an independent predictive value of the 30-day outcome in cases of primary ICH as regards mortality and disability.

Vasospasm following aneurysmal subarachnoid hemorrhage: prediction, detection, and intervention.

Abstract: Vasospasm of the cerebral blood vessels is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) which results in delayed cerebral ischemia (DCI) and worsening of the outcome. This study was performed on 41 aSAH patients diagnosed by non-contrast brain CT, CT angiography, and digital subtraction angiography followed by interventional aneurysmal embolization. Patients were followed up for 20 days by clinical assessment, EEG monitoring, and transcranial duplex studies (TCD) for early detection of vasospasm and DCI. The most common ruptured aneurysmal sites were middle cerebral, anterior communicating, posterior communicating, terminal internal carotid, and anterior cerebral arteries respectively. The incidence of vasospasm was 36.8% of the included cases; 57% progressed to DCI while 43% passed a spontaneous regressive course. The most common arteries undergoing vasospasm were the MCA followed by the ACA, ICA, and lastly the basilar arteries. The mean time of vasospasm development as detected by EEG monitoring and/or TCD was 8.4 ± 2.8 days which was earlier than clinical signs by 12.5 ± 5.3 h in those progressed to DCI. Continuous EEG monitoring and TCD are valuable methods for early detection of vasospasm and they allow for early therapeutic intervention before irreversible ischemic neurological deficits take place.

Prevalence of Alzheimer dementia in Upper Egypt (desert areas)

Abstract: Alzheimer’s disease (AD) is the commonest type of Dementia worldwide. It rapidly increases with aging especially over 70 years. The aims of this study are to determine the prevalence of AD in Egyptian desert areas and to identify the risk factors and presenting symptoms. This study was carried out on desert areas Al Kharga district and Al Quseir city. All population aged 50 years and more (12,508) were included through door to door survey by seven Neuropsychiatrists. They were screened by standardized questionnaire prepared specifically. Positive cases were invited to attend Assiut Univ. Hospital where clinical evaluation, according to DSM-IV R. and necessary psychometric tests were applied. One hundred twenty-six patients with AD were diagnosed out of 12,508 people aged 50 years; yielding a prevalence of 1%. Prevalence increases with age, from 0.34% for those aged 60 ≤ 70 years to 2.9% for subjects aged 70 ≤ 80 years, and 9.74% for those aged 80 years and more. AD is more common among females than males in all ages. Eighty-five percent of diagnosed patients are of mild and moderate degrees. Hypertension (14.3%), smoking (10.3%), diabetes (8.73%), prior epilepsy (5.6%), and family history of AD (3.5%) are common risk factors. Impaired self-care (88.1%), memory loss (84.1%), impaired social judgment (77%), agnosia (58.7%), and behavioral changes (48.4%) are the most frequently encountered symptoms of AD. Prevalence of AD was 1% for population aged 50 years and more, reaching 9.7 for patients aged > 80 years. Early onset AD (< 65 years) was recorded in 7.9%.

Sex differences among epileptic patients: a comparison of epilepsy and its impacts on demographic features, clinical characteristics, and management patterns in a tertiary care hospital in Egypt

Abstract: Epilepsy is one of the most common neurological conditions. We aimed to identify sex differences in the demographic, clinical features, and treatment strategies in epileptic patients. To analyze and compare the differences in the impact of epilepsy on the socio-demographic characteristics of male and female patients along with gender differences in various types of epilepsies and treatment strategies. A record-based study for 1000 individuals attending the epilepsy outpatient clinic. The medical records were reviewed through a predesigned questionnaire to obtain all relevant data. Data was summarized using range, mean, standard deviation, and median interquartile range for quantitative variable or frequency and percentage for the qualitative ones. Comparison between groups was done using chi-square test. Females were more illiterate and unemployed compared to males. Tonic-clonic seizures were more frequent in males. Specific epileptic syndromes as juvenile myoclonic epilepsy (JME) were more frequent in females (p = 0.01). More males had an underlying secondary etiology (p = 0.001). The most common drug used was valproate (51.2%) which was more utilized by males. Significant differences between both sexes were observed in certain social impacts in addition to seizure syndromes, etiology, and drug utilization.

Use of low-power He-Ne laser therapy to accelerate regeneration processes of injured sciatic nerve in rabbit

Abstract: Photostimulation using low-power laser had been used for nervous repair with interesting results. This study aimed to evaluate the influence of 20 mW low-power He-Ne laser on the regeneration of a peripheral sciatic nerve after trauma using the Albino rabbit as an animal model for experimental treatment. Six adult male rabbits were randomly assigned into two equal groups (control- and laser-treated). General anesthesia was administered intramuscularly, and exploration of the sciatic nerve was done in the lateral aspect of the legs. Complete longitudinal and reverse sections of the nerve were performed, which was followed by crushing of the neural sheath. Treatment was carried out directly after the trauma. Irradiation doses of low-level laser therapy (LLLT-31.5 J/cm2) with once a day application for 10 consecutive days and observed for 30 days. The animals were followed up for an extra 2 weeks. Two important factors were examined histopathology and functionality of the nerve. Compared to the control group, significant variations in regeneration were observed, including thicker nerve fibers, and more regular myelin layers in the treated group. The results of the present study suggest that laser therapy may be a viable approach for nerve regeneration and repair.

Efficacy of spinal extension exercise program versus muscle energy technique in treatment of chronic mechanical low back pain

Abstract: Mechanical low back pain (MLBP) is a major cause of illness and disability, especially in people of working age. People with chronic low back pain often experience anger, fear, anxiety, decrease in physical ability, and inadequacy of role fulfillment. This study aimed to compare the efficacy of extension exercise program versus muscle energy technique in treating patients with chronic mechanical low back pain. Forty patients complaining of chronic mechanical low back pain participated in the study. Patients were randomly allocated into two equal groups: group A which received spinal extension exercise program and group B which received muscle energy technique. Treatment sessions were given three times per week for four successive weeks. Patients were assessed before and after treatment using visual analogue scale (VAS), Oswestry Disability Index (ODI), and digital goniometer to assess pain intensity, functional disability, and range of motion (ROM) of lumbar spine respectively. There was significant decrease in the scores of pain and functional disability in both groups post-treatment especially in group B. There was significant increase in lumbar range of motion in both groups post-treatment, especially in group A. Extension exercise program had better effect on improving lumbar range of motion, whereas muscle energy technique was better in decreasing pain and functional disability in patients with chronic mechanical low back pain.

The potential value of capsaicin in modulating cognitive functions in a rat model of streptozotocin-induced Alzheimer’s disease

Abstract: Alzheimer’s disease (AD) is a progressive neurodegenerative disorder. This study aimed to examine the role of capsaicin dietary exposure in ameliorating cognitive functions in experimental rat model of streptozotocin-induced Alzheimer’s disease (STZ-induced AD). Thirty adult albino male rats were distributed randomly into three equal groups. Ten rats, served as negative controls, were treated once with intracerebroventricular (icv) injection and intragastric infusion of saline for 47 days. Twenty rats were treated with a single icv-STZ (3 mg/kg) injection for induction of AD. Behavioral tests were done after 2 weeks to evaluate the development of Alzheimer’s model. Rats with retention latency less than 300 s in the passive avoidance test were further subdivided into 2 groups; one group was treated with intragastric infusion of capsaicin (10 mg/kg) for 47 days and the other group was treated similarly with saline as positive controls. Then, behavioral tests were repeated at the end of the experiment. The expression level of β-amyloid 1-42 peptide (Aβ1-42) and tau proteins was measured using ELISA test. The behavioral impairments had been ameliorated by capsaicin treatment. Furthermore, there was improvement in the estimated biochemical parameters as revealed by the significant decline in the mean values of β-amyloid 1-42 peptide (Aβ1-42) and tau proteins in hippocampal homogenate in capsaicin-treated group as compared to the positive controls (p < 0.001 and p = 0.004, respectively). Chorioallantoic membrane (CAM) assay showed inhibition of angiogenesis in chick embryo by 5 μg capsaicin. Our study suggests that capsaicin is a promising agent for food additives and drugs which ameliorates AD through improvement of the behavioral and biochemical alterations detected in STZ-induced AD.

Do core stability exercises improve upper limb function in chronic stroke patients

Abstract: Upper limb paresis is a common problem in patients with stroke. To determine the effect of core stability exercises on upper limb function and trunk balance in hemiparetic patients. Thirty patients with hemiparesis, with age between 45 and 60 years, and with illness duration of more than 6 months. They were assigned into two equal groups, the control group, Group A: with 15 patients who received only conventional physical therapy program; the study group, Group B: with 15 patients who received conventional physical therapy program and additional core muscle training. Patients received 18 sessions for 6 weeks, three sessions/week. The upper limb function was assessed using Wolf motor function test with subscales (function ability scale, time, and grip strength), the range of motion of shoulder flexion and abduction was measured by using goniometer, trunk balance was assessed using the trunk impairment scale with subscales (static sitting balance, dynamic sitting balance, and coordination). All measurement outcomes were assessed before and after applying the treatment program. There was no statistical significant difference between two groups in pretreatment assessment using wolf motor function test, trunk impairment scale, and shoulder range of motion. In post treatment assessment, there was no statistical significant difference between group A and group B in all the outcome measures, except for trunk impairment subscale (dynamic sitting balance); the statistical significant difference was in favor of group B. Core muscle training is similar to conventional physical therapy program in improving upper limb function in hemiparetic patients, and has beneficial effect on improving trunk balance.

Risk factors for post-stroke depression in Sohag University Hospital

Abstract: Depression is one of the important complications of stroke. Post-stroke depression is associated with more physical disability, especially in daily activities, poor functional outcome, and high mortality rate. Our study aimed to investigate the risk factors for development of post-stroke depression 3 months following stroke. This is a comparative study, comparing stroke patients with and without depression 3 months after the onset. Hamilton Depression Rating Scale (HDRS), Mini-Mental State Examination (MMSE), Scandinavian Stroke Scale (SSS), and modified Rankin scale (mRS) were used to evaluate patients 3 months post-stroke for depression, cognition, and physical disability. The patients were divided into two groups: patients’ group with depression and patients’ group without depression according to DSM-IV criteria. The clinical characteristics and scores on the HDRS, MMSE, SSS, and mRS were compared between depressive group and non-depressive group. Logistic regression analysis was performed to identify risk factors for depression 3 months after stroke. A total 102 stroke patients were recruited. Of these, 62 patients (60.78%) had depression. Multivariate logistic regression indicated that smoking, hypertension, increased physical disability, and impaired cognitive function were associated with post-stroke depression. Important risk factors found for PSD included smoking, hypertension, increased physical disability, and impaired cognitive function.

Chemotherapy-induced cognitive impairment in hematological malignancies

Abstract: Chemotherapy-induced cognitive impairment (CICI) is one of the most prominent side effects as it negatively impacts activities of daily life of the affected role. These problems can range from subtle to severe and last for months or years after discourse. As cognition is an important predictor of survival in patients with hematological malignancy, savvy factors that lead to CICI in hematological malignancies warrant attention. This is a cross-sectional discipline that was conducted at the Clinical Hematology Section in Ain Shams University Hospital during the period from March 2017 to September 2017. We studied the prevalence of cognitive deterioration among treated patients with chemotherapy for hematological malignancy, and we described its correlation to demographic data and risk agent. Test of cognitive function has been done by using Montreal Cognitive Assessment (MoCA). Out of 150 patients with different hematological malignancies who finished their chemotherapy at least 6 month ago, we found that 93 patient roles (62%) are cognitively impaired. The average score of Montreal test for all patient role was 23.913 ± 3.997. CICI is more among patient who received parenteral chemotherapies and closely related to premedication comorbidities, and all patients with myelodysplastic syndrome (MDS) were cognitively impaired. Also, there was a positive correlation between patient age and cognitive handicap as mean age of patients with abnormal cognitive function was 51.151 ± 9.933 (p value < 0.001) while period of hospital admission was showing significant correlation with impaired abstraction function (p value 0.003), and number of chemotherapy cycles showed significant correlation with naming and orientation cognitive impairment (p value 0.029 and 0.022, respectively). We found that female patients had significant shortcoming in naming ingredient more than male (p value 0.009). The type of chemotherapy regimen received did not significantly affected the overall cognitive impairment, but patients who had received Velcade-based chemotherapy had significantly lower executive and abstract function (p value 0.026). Patient roles which did not achieve remission at follow-up have markedly significant lower scores of most of the cognitive social function. CICI is a major problem in patient role with hematological malignance post-chemotherapy that can affect their quality of life, so fixture follow-up of the cognitive functions in those patients for early interference with proper management of risk factor is recommended.

Effect of valproate versus levetiracetam monotherapy on reproductive functions in newly diagnosed epileptic males

Abstract: Antiepileptic drugs are responsible for reproductive dysfunction in male epileptic patients. To evaluate the effect of valproate (VPA) versus levetiracetam (LEV) as a monotherapy on males’ sex hormones and sperm parameters in newly diagnosed epileptic patients. This comparative study included 50 newly diagnosed epileptic male patients. All patients were subjected to complete general and neurological examination, Doppler ultrasonography of the testis, pre- and post-treatment serum sex hormone assay, and semen analysis. Post-treatment re-evaluation checkpoint was determined if 8 weeks have passed after the last seizures. This study included two groups, group I (25 patients were treated by VPA) and group II (25 patients were treated by LEV). There was no statistical difference between groups regarding their baseline characteristics. In group I, at post-treatment checkpoint, we found significant decrease in luteinizing hormone and follicle-stimulating hormones and highly significant increase of prolactin serum level. In sperm parameters, there was significant decrease of all measured items. In group II, serum sex hormone was not significantly changed at post-treatment checkpoint but semen analysis parameters were significantly decreased regarding all items. In comparison between the two groups, there was significant decrease of sperm concentration among group II with highly significant decrease of normal morphology of sperm among group I. Both VPA and LEV had adverse effects on the semen of male epileptic patients while VPA had also an adverse effect on sex hormones.

Non-motor symptoms in newly diagnosed Parkinson’s disease patients

Abstract: The non-motor symptoms (NMSs) in Parkinson’s disease (PD) patients have greater effects on their quality of life compared to the motor symptoms; however, they are under-recognized. The study aims to evaluate the prevalence and severity of NMS in newly diagnosed PD patients in Tanta University hospitals. The study included 41 newly diagnosed PD patients. All patients were screened for NMS by the non-motor symptoms questionnaire (NMS-Quest). According to the NMS-Quest response, patients were further evaluated by Sialorrhea Clinical Scale for PD (SCS-PD), Scales for Outcomes in Parkinson’s disease for Autonomic symptoms (SCOPA-AUT), Rome III Questionnaire, Nocturnal voiding and Sleep-Interruptions Questionnaire, Brief Pain Inventory, Montreal Cognitive Assessment (MoCA), Scale for Evaluation of Neuropsychiatric Disorders in Parkinson’s Disease (SEND-PD), Pittsburgh Sleep Quality Index (PSQI), and questionnaires based upon the International Restless Legs Study Group criteria. The study included 22 female and 19 male patients; the duration of illness was 2.7 ± 2.08 years. Constipation was the most common symptoms as it was present in 73.1% in the studied patients; 61% suffered loss of sexual interest. 47.5% of patients had depressive symptoms. Sleep disturbance was present in 36.6% of the patients. Anxiety was reported by 30% of the patients. All newly diagnosed PD patients suffered one or more NMSs; constipation was the most frequent followed by sexual dysfunction, depressive symptoms, and sleep disturbance, while pain, sialorrhea, and restless leg were the least reported.

Diabetic peripheral neuropathy: the potential role of vitamin D deficiency

Abstract: Vitamin D is well known for its role in promoting calcium and phosphorus absorption and is recently associated with various neurological disorders. To study the possible relation between vitamin D deficiency and diabetic peripheral neuropathy in a sample of patients recruited from Beni-Suef governorate, north Upper Egypt A case-control study included 25 type 2 diabetic patients with diabetic peripheral neuropathy and 25 healthy controls. The patients included were subjected to clinical evaluation including Michigan Neuropathy Screening Instrument and nerve conduction study. And all patients and control were subjected to assessment of fasting and 2-h post prandial blood sugar, hemoglobin A1C, and serum vitamin D level. Serum vitamin D level was significantly lower in patients compared to control (P value = 0.008). For the patients group, females and patients with Michigan neuropathy screening instrument score more than 4 had statistically significant lower vitamin D level (P value = 0.003 and 0.006, respectively). No statistically significant difference in vitamin D level was found between patients below and above the age of 50 years, duration of diabetes less and more than 5 years, different types of diabetes medications, or patients with fair and poor control (P value = 0.525, 0.700, 0.881 and 0.252, respectively). No significant correlation was found between vitamin D level and the results of nerve conduction study. Vitamin D deficiency was highly prevalent in diabetic peripheral neuropathy patients. Females and patients with severe form of neuropathy are more liable for lower vitamin D levels.

Tumor necrosis factor alpha in peripheral neuropathy in type 2 diabetes mellitus

Abstract: To compare serum levels of tumor necrosis factor alpha (TNF-α) between type 2 diabetes mellitus patients with and without peripheral neuropathy (PN). Also, to study the relation between peripheral nerves conduction velocity and serum level of TNF-α in those patients. This study included three groups with 40 patients in each group. Diabetic PN patients (groups I and II) were compared with diabetic patients without PN (group III). Groups I and II differed in the duration of clinical neuropathy with less than 5 years in group I and more than 5 years in group II. All patients were subjected to general and neurological examination, neuropathy symptom score (NSS), neuropathy disability score (NDS), glycosylated hemoglobin (HbA1c), serum level of TNF-α and both sensory and motor nerve conduction study. This study showed raised serum levels of TNF-α in diabetic patients with PN, more with increased duration of neuropathy. TNF-α levels showed statistically significant negative correlation with nerve conduction velocity but positive correlations with each of neuropathy disability score, neuropathy symptom score, and glycosylated hemoglobin. TNF-α might be involved in the pathogenesis of diabetic PN, and its serum level might be used as a biomarker for the severity of diabetic PN.

Treatment satisfaction and adherence to medications among multiple sclerosis patients in Saudi Arabia

Abstract: Despite the apparent benefits of disease-modifying drug (DMD) use among multiple sclerosis (MS) patients, their rates of adherence are often variable and in some cases are quite low. To assess medication adherence and its relationship with treatment satisfaction of MS patients in Saudi Arabia Following a cross-sectional design, 598 adult MS patients were recruited from all tertiary care hospitals in all regions of Saudi Arabia. Patients’ medication adherence was assessed using the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8). Treatment satisfaction was assessed using the Treatment Satisfaction Questionnaire for Medication. Disease severity was assessed using the Patient-Determined Disease Steps (PDDS). The most used drug was interferon beta-1b (24.1%), while 18.7% were using interferon beta-1a and 17.4% were using fingolimod. Patients’ mean PDDS was 2.8 ± 1.9. Only 9.7% were “adherent” to medication. Patients’ adherence differed according to their educational level (p < 0.001), their currently received medications (p = 0.032), with those on Fingolimod having the highest adherence (17.3%). Treatment satisfaction was significantly higher among adherent patients (p < 0.023). The main reasons for changing prescribed drugs were the presence of attacks, i.e., response to treatment was substandard (41.8%) and the experienced side effects of used drugs (39.9%). PDDS differed significantly according to patients’ treatment adherence only among those receiving interferon beta-1b, with higher mean severity score among those who were adherent (p = 0.002). Medication adherence among MS patients in Saudi Arabia is low. Higher adherence is associated with patients’ higher education. The main underlying reasons for changing prescribed drugs are the presence of attacks, substandard response to treatment, or suffering the DMDs’ side effects. Medication adherence is associated with higher treatment satisfaction.

Vitamin D status in acute ischemic stroke: relation to initial severity and short-term outcome

Abstract: A growing body of evidence indicated that vitamin D has a potential protective role against neurovascular injury. Low serum vitamin D has been associated with increased risk for incident stroke and stroke fatality. This study aimed to investigate vitamin D status among acute ischemic stroke patients and examine its relation to initial severity and short-term outcome. Forty-eight acute ischemic stroke patients and 48 matched healthy control subjects participated in the study. Subjects were divided according to vitamin D level into deficient, insufficient, and sufficient groups. National Institute of Health Stroke Scale (NIHSS) on admission and after 72 h and modified Rankin Scale (mRS) on discharge and after 3 months were performed for all patients. Stroke patients had significantly lower serum vitamin D levels compared to healthy subjects. Vitamin D deficiency and insufficiency were significantly prevalent among patients compared to healthy controls. Significant negative correlation was detected between serum vitamin D and NIHSS scores on admission and after 72 h. Significant negative correlation was also detected between serum vitamin D and mRS scores on discharge and after 3 months. An increased risk of stroke of 2.88 times was found in patients with insufficient vitamin D in comparison to sufficient subgroup, and this likelihood increases to be 13.78 times in the deficient compared to sufficient subgroups. Vitamin D deficiency increases the risk of acute ischemic stroke and is associated with increased initial stroke severity and worse short-term outcome.

Influence of pelvic inclination on sit to stand task in stroke patients

Abstract: Stroke results in an impaired sit to stand (STS) task. Pelvic movements are essential in daily living activities. Few studies investigated the effect of spine and pelvis separately on functional activities in stroke patients. The study aimed to assess the angles of pelvic inclination (anterior and posterior pelvic tilt angles) (APT and PPT) during sitting position and during STS movement. It aimed also to determine the influence of sagittal pelvic tilt angles on STS performance in stroke patients. Thirty male hemi-paretic stroke patients (GI) and 15 matched healthy volunteer subjects (GII) represented the sample of this study. Stroke patients were assigned into two equal groups (group Ia and Ib). Sagittal pelvic tilt angles were measured by using the palpation meter inclinometer during sitting position and during initiation and mid of STS by using two dimensional (2D) video-based motion analysis system. Time of five repetitions STS test was used to assess the ability to perform STS task. The results showed a significant increase of PPT angle during static sitting, a significant decrease in APT angle during initiation and mid of STS task and a significant increase in time taken for five repetitions STS test in both stroke groups (P < 0.05). Abnormal pelvic alignment and movements affect the functional performance of stroke patients during sitting and sit to stand task. NCT03053154. Registered January 22, 2017. Retrospectively registered.

Cardio embolic stroke and blood biomarkers: diagnosis and predictors of short-term outcome

Abstract: The brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), d-dimer, creatine–kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome. This study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, d-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS. The mean levels of BNP, d-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome. Elevated plasma levels of BNP, d-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.

Cognitive assessment of idiopathic intracranial hypertension patients

Abstract: Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology. Goals of treatment are to preserve vision and alleviate symptoms, including intractable headache, pulsatile tinnitus, and nausea. Cognition is not addressed routinely during clinical evaluation of IIH patients. The current study was designed to test whether there is cognitive impairment in IIH patients or not and to evaluate the nature and characteristics of cognitive functions in these patients. A case-control study conducted on 40 subjects; 20 with IIH and 20 healthy controls. Patients underwent full clinical and neurological examination as well as cognitive testing using eight psychometric tests. Patients with IIH performed significantly worse than controls in multiple cognitive domains (p value ≤ 0.05). Deficits were most pronounced in working memory, executive functions, visuospatial functions, attention, and processing speed. Patients with IIH have significant cognitive impairment, particularly in executive functions and memory. All domain measures showed a statistically significant difference from normal individuals, indicating that there is a form of multidomain cognitive impairment in IIH. The relationship between cognitive impairment and chronically elevated intracranial pressure and its role in contributing to patient morbidity should be considered.

Public knowledge of warning signs and risk factors of cerebro-vascular stroke in Ismailia Governorate, Egypt

Abstract: Knowledge and awareness of cerebro-vascular stroke (CVS) warning symptoms and risk factors is deficient in the general population in the developing countries. To evaluate the knowledge and attitude about warning symptoms and risk factors of cerebro-vascular stroke among a sample of people living in Ismailia Governorate, Egypt. This study was conducted at two selected areas of Ismailia Governorate, an urban area and a rural area. Seven hundred and twenty participants were included in the study (360 form the urban area and 360 from the rural area). Face-to-face questionnaire-based interviews were administered to the participants. The survey tool is a 9-item questionnaire translated in Arabic, designed to evaluate the knowledge and attitude about warning symptoms and risk factors of cerebro-vascular stroke. According to the participants, the main source of knowledge about CVS was from seeing someone with stroke, the main risk factor of CVS was hypertension, the most frequent warning symptom of CVS was paralysis of one side, and the most frequent action to be taken with the onset of CVS was direct transfer to the hospital. Hypertension was the mostly known risk factor. Only few participants were aware of diabetes mellitus as a risk factor for cerebro-vascular stroke. This information will be useful for planning CVS prevention campaigns.

Optical coherence tomography and cognitive dysfunction in Parkinson disease

Abstract: Parkinson’s disease (PD) is a progressive neurodegenerative disease of aging. Optical coherence tomography (OCT) is a simple noninvasive imaging technique to estimate the retinal nerve fiber layer (RNFL) thickness. The aim of this study is to measure the changes of the RNFL thickness in patients with Parkinson disease in comparison with the control group and to detect the relationship between these changes in RNFL with cognitive functions and physical disability in Parkinson patients. 20 PD patients (40 eyes) and 20 healthy persons (40 eyes) were enrolled according to the defined criteria. The diagnosis of the patient's Parkinsonism was done according to the brain bank clinical diagnostic criteria for idiopathic Parkinsonism and the severity of the disease was assessed using the Hoehn and Yahr scale. The Montreal Cognitive Assessment (MoCA) was used for cognitive evaluation in all participant subjects. Quality of life was evaluated by Parkinson's disease questionnaire-39 (PDQ-39). Optical coherence tomography (OCT) was done for all patients and control subjects. The mean RNFL thickness was significantly reduced in Parkinsonian patients with cognitive impairment (73.64±1.81 μm) when compared with those without cognitive impairment (77.25±4.53 μm) and control subjects (84.1±6.98 μm) (P < 0.001). The retinal thickness reduction was statistically significant in superior and inferior quadrants of the retina (P < 0.001, P =0.03 respectively).The thickness of the superior RNLF correlated significantly with both the Montreal Cognitive Assessment (MoCA) (r = 0.59; P < 0.001) and the mobility scores according to PDQ 39 scale (r= -0.39; P=0.012). Parkinson disease is associated with distinct retinal pathological changes. OCT seems to be a sensitive tool for detecting these retinal changes and correlated significantly with the progression and severity of Parkinson disease.

Psychiatric and sleep abnormalities in school-age children with migraine

Abstract: Migraine is a primary headache that commonly starts in childhood and adolescent’s periods with great negative impacts on the educational and psychosocial performances of its sufferers The objectives of this work were to study the existence and types of sleep and psychiatric abnormalities in school-age children with migraine (SCM) The study was conducted on 40 SCM and 20 age- and sex-matched healthy control subjects (HCS) submitted to history taking, neurological examination, Pediatric Migraine Disability Assessment (PedMIDAS) questionnaire, Child Behavior Checklist (CBCL), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), Pittsburgh Sleep Quality Index (PSQI) and one-night polysomnography (PSG) The study showed a high incidence of psychiatric and sleep abnormalities in SCM The most common psychiatric disorders were anxious depressed symptoms, withdrawal depressed symptoms, social problem, somatic complaints, and attention problems At the same time, SCM experienced decreased sleep quality, excessive daytime sleepiness (EDS), and PSG abnormalities in the form of decreased total sleep time (TST) and sleep efficiency (SE) in addition to increased sleep latency, wake after sleep onset (WASO), arousal index (AI), and REM sleep without atonia index Sleep and psychiatric abnormalities are common underdiagnosed pediatric migraine comorbidities greatly reducing headache control and school performance in this very important period of psychosocial development

The effects of kinesio taping of lower limbs on functional mobility, spasticity, and range of motion of children with spastic cerebral palsy

Abstract: Cerebral palsy (CP) is a non-progressive neurological disease in a growing brain. The aim of this study was to explore the effects of kinesio taping (KT) of the lower limbs on functional mobility, spasticity, and range of motion (ROM) of children with cerebral palsy. Thirty children with spastic cerebral palsy aged 3 to 10 years old were selected from pediatric rehabilitation clinics. Subjects were divided randomly into intervention and control groups. Each group contains 15 subjects. Both groups received kinesio taping along with occupational therapy for 2 weeks. In the intervention group, kinesio taping was applied in a treatment mode with suitable tension; however, taping was applied in the control group in a sham mode. Timed get up and go (TUG), Modified Modified Ashworth (MMA), and goniometer tests were used prior to the intervention and 2 days and 2 weeks after the intervention. Short-term application of kinesio taping in the intervention group did not lead to significant changes in ROM (P = 0.582), muscle tone (P = 0.317), and functional mobility (P = 0.320). However, long-term application of kinesio taping improved the range of motion, muscle tone, and functional mobility (P < 0.05). No significant change has been observed in the control group in different intervals. The findings indicated that kinesio taping can increase ROM of the knee and reduce spasticity. It also can improve the functional mobility. Therefore, it seems that kinesio taping is efficient for rehabilitation of spastic CP as a reliable treatment method. IRCT, IRCT2017082135822N1, Registered 19 September 2017, https://fa.irct.ir/IRCT2017082135822N1 .

Could vitamin D deficiency have an impact on motor and cognitive function in Parkinson’s disease?

Abstract: Multiple epidemiological data showed a significant higher prevalence of hypovitaminosis D in patients with Parkinson’s disease (PD). To assess the serum vitamin D level in patients with Parkinson’s disease and to investigate the possible relationship between the serum vitamin D level and both motor and cognitive symptoms in Parkinson’s disease A case-control study was conducted on 25 patients who fulfilled the criteria for diagnosis of idiopathic Parkinson’s disease based on the British Brain Bank criteria, and 25 healthy volunteers. Selected PD patients were submitted for assessment of cognitive function using the PD - Cognitive Rating Scale (PD-CRS) and assessment of motor function using the Unified Parkinson’s Disease Rating Scale (UPDRS). Serum 25 hydroxy vitamin D level was measured for all the included patients and controls. PD patients were found to have a significantly lower level of serum vitamin D than controls (P value = 0.001). There was a statistically significant negative correlation between the serum vitamin D level and the scores of motor, mentation, activities of daily living, medication complication, other complications, and the total score of UPDRS (P value = 0.01, < 0.001, 0.012, 0.017, 0.039, and 0.002 respectively). There was a statistically significant positive correlation between the serum vitamin D level and the scores of attention, working memory, immediate recall, delayed recall, naming, visuoperceptual abilities, visuoconstructional abilities, alternating verbal fluency, action verbal fluency, and the total score of PD-CRS (P value < 0.001 in all parameters). Vitamin D deficiency is evident in PD patient, and such deficiency significantly affected both motor and cognitive symptoms.

Prevalence of migraine in Upper Egypt

Abstract: Migraine is a significant health problem due its frequency and accompanying morbidity. This study aims to estimate the prevalence of migraine headache among the population of Al-Quseir city (Upper Egypt) and its impact on the patients’ life. This study is part of a door-to-door survey of major neurological disorders in Al-Quseir city, Red Sea Governorate. All inhabitants (n = 33,285 persons) were screened through door to door by three specialists of neurology. Then, positive cases were subjected to clinical and neurological examination by three staff members of neurology each separately. Respondents were identified as suffering from migraine with aura, migraine without aura, and probable migraine as defined by the diagnostic criteria of the International Headache Society (IHS). Migraine Disability Assessment Scale (MIDAS) questionnaire was used to assess the impact of the disease on the patients’ daily life. We identified 911 patients suffering from migraine. The lifetime prevalence was 3.38/100 with male prevalence of 1.95/100 and female prevalence of 4.8/100. The highest prevalence figures were found during early adult life (18–40 years) among both genders reaching a total prevalence of 4.77/100 (2.89/100 for male and 6.53/100 for female). Among migraine patients, most of the attacks recorded were of moderate to severe intensity (97%) although virtually 66% of migraine patients reported that headache significantly interfered with their daily activities. Lifetime prevalence of migraine is 3.38/100. Migraine headache has a deleterious impact on the patient’s functional and wellbeing.

Radiofrequency thermocoagulation in cases of atypical trigeminal neuralgia: a retrospective study

Abstract: Trigeminal neuralgia (TN) is the most common cause of neuropathic facial pain. Atypical TN are usually refractory to conventional medical treatments and the standard microvascular decompression surgeries that lead to marked negative impact on the patient’s quality of life. The aim of this study is to examine the efficacy and safety of radiofrequency (RF) ablation in cases with atypical TN that did not respond to standard medical treatments. Our study included 19 consecutive patients with refractory atypical TN for more than 6 months. Neurological examination and MRI brain did not reveal any significant correlated signs. RF thermocoagulation was performed under fluoroscopy guidance. Collected data included preoperative conditions, pre- and post-procedure visual analog scale (VAS) score, and complications. Patients were followed up for a period of 1-year duration to evaluate the long-term efficiency of the procedure. A total of 19 patients were recruited into the study (56.32 ± 13.48 years, 21% males, 79% females). Females outnumbered males (15 female patients, 79%) versus (4 male patients, 21%). There was more than 50% improvement in VAS score (16 patients, 79% versus 3 patients, 21%) (p < 0.05). Age was the only statistically significant factor were more elderly patients showed better improvement regarding VAS score (p < 0.05). Radiofrequency thermocoagulation is an effective and relatively safe procedure for alleviating atypical facial pain.

Repetitive TMS in treatment of resistant diabetic neuropathic pain

Abstract: Diabetes mellitus is a clinical syndrome characterized by hyperglycemia caused by respective or absolute deficiency of insulin. Painful neuropathy in diabetic population is popular, impacting numerous chronic diabetic patients. Although antidepressants, anticonvulsants, and opioid agonists are useful in alleviating painful neuropathy, they produce a diversity of side effects and are occasionally ineffective. Hence, there is presently a need to pursue safe, non-invasive, and effective therapeutic opportunities. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive mechanism used in releasing neuropathic pain. TMS pulses—when applied repetitively—can modulate cortical plasticity, consequently causing excitability or inhibition according to the rate of stimulation. The aim of this study is to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving resistant chronic diabetic neuropathic pain. Twenty patients were recruited and divided equally into two groups: insulin-dependent (group A) and non-insulin-dependent (group B). A high-frequency (10 Hz) rTMS stimulation protocol was applied to both groups for five consecutive days over lower limbs motor cortex. VAS score and nerve conduction studies were compared before and after rTMS sessions. Highly significant improvements in VAS and nerve conduction studies (p > 0.01) were detected for both patient cohorts following the administration of the rTMS protocol. According to our study, rTMS significantly reduced painful diabetic neuropathy. rTMS may produce its analgesic effects, inducing motor cortex plasticity and activating descending inhibitory pain control systems.