Mohamed El Tamawy

Background

Objective: Evaluating the long term efficacy and safety of rTMS sessions in management of ‘on-freezing’ and unpredicted offs in advanced Parkinson’s disease (PD).Background:Freezing of gait (FOG) is an independent feature of Parkinson’s disease that is related to both motor and cognitive deficits. Treatment of off-FOG is relatively straightforward, but ‘on-freezing’ is a difficult-to-treat scenario and it needs a multidisciplinary team approach.Design/Methods:A randomized, double-blind, placebo-controlled study included 43 patients with advanced PD who received 12 sessions of rTMS over 4 weeks (real or sham) every 3 months for a period of 9 months. rTMS (20 trains of 50 stimuli each, at 5 Hz) was delivered over the leg motor area contralaterally to the more affected side followed by a specific rehabilitation program (60 minutes). Treatments were synchronized with “on-time” to facilitate training sessions. All patients had their daily diary to record ‘on-times’, ‘offs’, ‘falls’, and ‘freezing episodes’. Primary efficacy variables were FOG Q (SF), unpredicted offs and UPDRS (motor section), secondary outcomes were on-time and gait variables (cadence, falls number, stride length and turn time). All patients signed a written consent.Results: Freezing episodes significantly decreased (p<0.05) and FOG Q (SF) significantly improved (p<0.001) in the active arm. Attacks of unpredicted offs also decreased significantly (p 0.03), whereas, the motor section of UPDRS improved, yet this was statistically non-significant. Number of falls reduced significantly (p<0.001) with improvement of turn time (p 0.04). Other gait variables were not affected. Long-term effects: the effects were maintained over the study period, the doses of dopaminergic drugs were individualized and modified according to the disease progression in both groups. No adverse events were recorded apart from mild transient headaches.Conclusions:rTMS has a positive effect in on-freezers with advanced PD with subsequent decrease of number of falls.Disclosure: Dr. Shehata has nothing to disclose. Dr. Shalaby has nothing to disclose. Dr. El-Tamawy has nothing to disclose. Dr. Jaafary has nothing to disclose.

The influence of the prenatal and postnatal maternal environment on stroke susceptibility was evaluated by reciprocally crossing the spontaneously hypertensive (SHR) and the Dahl salt-sensitive (SS/Jr) inbred rat strains to produce reciprocal F1 hybrids that were nurtured, respectively, during prenatal and postnatal life by SHR or SS/Jr mothers. Following placement on a high-salt diet containing 8% NaCl at 35 days of age, F1 rats reared by SHR mothers had shorter survival times and were more likely to die with cerebral hemorrhage than F1s reared by SS/Jrs. Across reciprocal F1 female groups, enhanced susceptibility to stroke was associated with greater elevations of systolic blood pressure, but this association was not seen across reciprocal F1 male groups. There was also an association between blood pressure and stroke within each F1/gender subgroup: Rats eventually suffering strokes developed higher blood pressure after placement on the high-salt diet than rats that did not suffer stroke. Lower day 35 body weights (before exposure to the high-salt diet) were associated with greater likelihood of stroke both across the reciprocal F1 groups, and within three of the four F1/gender subgroups. The differences in stroke susceptibility between the reciprocal F1 groupings may be due to systematic differences in the prenatal and/or postnatal environments of SHR and SS/Jr mothers and may be mediated by variations in the nutritive capacity of the two inbred mothers.

Fifty-one patients with CCT verified cerebral infarction were submitted to serum and CSF radioimmunoassay of FSH, LH, estradiol (E2), progesterone, testosterone, cortisol and T4. The results were compared to those of 82 matched controls. Our findings suggest that (1) high serum E2 is a risk factor of stroke in males; (2) low serum T4 is a risk factor in males; (3) serum testosterone is reduced in acute stroke in males confirming that it is stress sensitive; (4) serum LH was higher in hypertensive thrombotic males when compared to normotensive ones, and (5) FSH, LH, E2 and T4 are undetectable in CSF of patients and controls.