Mohamed El Tamawy

BackgroundAn accurate rehabilitation program of diabetic polyneuropathy (DPN) depends on a precise assessment of cognition and determination of its relation to gait using different objective and valid methods.ObjectiveOur aim was to assess cognitive function and analyze the influence of cognitive dysfunction on the spatiotemporal gait parameters under three different gait conditions (walking without a cognitive task, walking with verbal fluency, and walking with an arithmetic task) in DPN patients.Patients and methodsTwenty patients with type II diabetes mellitus with moderate polyneuropathy (PN) (group 1) and 20 matched patients with type II diabetes mellitus without PN (group 2) represented the sample of this study. Different cognitive domains of cognition were assessed using a computer-based RehaCom procedure. Spatiotemporal gait parameters were assessed using a 2D video-based motion analysis under the three different gait conditions.ResultsThe results showed a significant decrease in all cognitive domains in the DPN patients (group 1) (P<0.05). All spatiotemporal gait parameters were significantly affected in the DPN (group 1), especially during dual-task performance (P<0.05).ConclusionThere is an association between cognitive dysfunction and PN complications in diabetic patients. Spatiotemporal gait parameters are affected more in DPN patients, especially under dual-task conditions, than in diabetic patients without PN.

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.

BackgroundA rising concern about quality of life of multiple sclerosis (MS) patients has emerged. Cognitive dysfunction and primary fatigue have been largely related to each other.ObjectiveThe aim of the present study was to examine the relationship between primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS.Patients and methodsA total of 40 Egyptian MS patients (Expanded Disability Status Scale<5) were divided into two groups according to the Fatigue Severity Scale (FSS), into patients with fatigue (G1; FSS>36) and those without fatigue (G2; FSS<36). Patients with depression and sleep problems were excluded from the study. Cognitive functions were assessed for both groups using the computer-based 'RehaCom' software, using which the following tests were carried out: (a) attention/concentration tests and (b) reaction behavior tests. The serum levels of tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) were analyzed for all MS patients.ResultsA statistically significant decrease in cognitive functions was found in G1 compared with G2 (P < 0.001), as well as a statistically significant higher level of TNF-α and IFN-γ in G1 compared with G2. FSS was positively correlated with the attention/concentration test. Correlative study also indicated a strong relation between the level of cytokines and FSS but not cognitive dysfunction.ConclusionPrimary fatigue contributes to cognitive dysfunction in patients with MS and is associated with elevated serum level of TNF-α and IFN-γ

Background

Khat-(Catha edulis)related oromandibular dystonia is a difficult-to-treat subset of movement disorders that involve masticatory muscles with diverse and incapacitating manifestations. The aim of this study was to evaluate the efficacy of Botulinum toxin-type A therapy in khat chewer Yemeni patients with oromandibular dystonia. This prospective study included 18 khat-chewers Yemeni patients with refractory oromandibular dystonia, who were subjected to Botulinum toxin-A injection and followed up for 3 months thereafter. Primary efficacy outcome was the global impression scale, and secondary outcome measure was the Unified Dystonia Rating Scale. Patients showed improvement of both efficacy measures, maximum satisfactory responses were detected at the forth week after injection. No major adverse events were detected. Botulinum toxin-A is considered an effective and safe treatment option for refractory oromandibular dystonia in khat-chewers.

BACKGROUND: Stroke is a leading cause of functional impairments. High percentage of these patients will experience some degree of cognitive affection, ranging from mild cognitive impairment to dementia.

OBJECTIVE: Demonstrate the role of aerobic exercises enhancing cognitive functions and its effect on Brain Derived Neurotrophic factor (BDNF) in post-ischemic stroke patients in the territory of anterior circulation.

SUBJECTS AND METHODS: We included thirty Egyptian ischemic stroke patients in the territory of anterior circulation. They were divided into 2 groups; group 1 (G1) were subjected to physiotherapy program without aerobic exercises and group 2 (G2) were subjected to the same previous program followed by aerobic exercises. Both groups were subjected to pre- and post-treatment Addenbrookes's Cognitive Examination- Revised (ACER) and serum level of BDNF.

RESULTS: Our results showed a significant improvement in ACER score in G2 compared to G1 post-treatment (p = 0.017). BDNF serum level significantly increased in G2 post-treatment compared to pre-treatment (p = 0.001) and compared to G1 group (p = 0.0458). ACER improvement was positively correlated to increase in serum level of BDNF (r = 0.53, p = 0.044).

CONCLUSION: Aerobic exercises improve cognitive functions of ischemic stroke patients. This improvement is related to the increase in serum level of BDNF.

BACKGROUND: Botulinum toxin type A (BTX-A) has been reported to have analgesic effects independent of its action on muscle tone, mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN).The aim of our work was evaluating the efficacy, safety, and tolerability of BTX-A for the treatment of intractable idiopathic TN.

METHODS: This was a randomized, single-blinded, placebo-control study carried out on 20 Egyptian patients with intractable TN. Patients received a one-time subcutaneous administration of BTX-A using "follow the pain" method. The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 (endpoint last observation carried forward [LOCF]). Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint.

RESULTS: Pain reduction at the 12-week endpoint was significant in BTX-A group (p<0.0001); VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo, also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale.

CONCLUSION: These results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases.

CONTEXT: Impairment of initiating sequential movements and processing of proprioception contribute to characteristic Parkinson's disease (PD) gait abnormalities. Many studies have used a single external cue or 2 different cues to correct PD gait.

AIM: An aim of this study was to determine the influence of paired proprioceptive cues on gait parameters of individuals with PD.

SETTING AND DESIGN: Double-blind randomized controlled trial.

MATERIALS AND METHODS: Subjects were 30 PD patients who had mild to moderate impairment according to the United Parkinson's Disease Rating Scale (UPDRS). They were randomly assigned to either a routine physiotherapy program or treadmill training with vibratory stimuli applied to the feet plantar surfaces and proprioceptive neuromuscular facilitation (PNF) as well as the same physiotherapy program. All Participants received a 45-minutes session of low intensity physiotherapy program, 3 times a week, for 8 weeks. The duration of treadmill training was 5 minutes at baseline and 25 minutes at the end of treatment. Walking speed and distance were recorded from the treadmill control panel for both groups before and immediately after the end of treatment. The Qualysis ProReflex motion analysis system was used to measure cadence, stride length, hip, knee, and ankle joints' angular excursion.

RESULTS: The cadence, stride length, and lower limb joints' angular excursion showed a significant improvement in both groups (P ≤ 0.05). These improvements in spatio-temporal parameters and angular excursion were higher in the study group than in the control group (P ≤ 0.05).

CONCLUSION: Potentiated proprioceptive feedback improves parkinsonian gait kinematics, the hip, knee, and ankle joints' angular excursion.

In this double-blind, randomized study the efficacy of the ergoloid compounds, co-dergocrine mesylate and nicergoline, in the rehabilitation of patients with ischaemic stroke was investigated. A group of 30 patients was treated daily with 60 mg nicergoline, orally, and a second group of 27 patients was given 1.8-6 mg co-dergocrine mesylate, orally or intramuscularly, daily (depending on the time since the initial ischaemic insult) for 6 months. Outcome measures included: motoricity index (limb function); Sandoz Clinical Assessment Geriatric (SCAG) scale; psychometric tests to assess functions such as attention, psychomotor performance, perception and sensory and short-term memory; conventional and computerized electroencephalography; and P300 and reaction time measures. The results showed improvements in some aspects such as limb function (P < 0.05), SCAG score (P < 0.01) and some electrophysiological parameters (P < 0.01) after treatment with both drugs. Though statistically significant most of the changes were not large. The efficacy of both drugs was qualitatively similar. The quantitative difference in some aspects in favour of nicergoline could be attributed to differences in the mechanisms of action of the two drugs, although it is also possible that the difference may reflect the dosages used. Nootropic drugs may induce a condition that facilitates the effects of cognitive training.

Global and specific cognitive functions were assessed in 57 patients with ischemic strokes subjected to clinical neuropsychiatric, psychometric, electrophysiological and cranial tomographic evaluation. Patients did significantly worse than normal controls in the Blessed dementia scale, Sandoz clinical assessment geriatric scale but not the Folstein mini-mental state examination. Of the specific cognitive functions, attention and psychomotor performance were significantly impaired in stroke patients when compared to normal controls. The impairment in global cognitive functions, attention and psychomotor performance was more evident in chronic than acute cases. Increasing age correlated positively to the deterioration in psychomotor performance and perception. Cranial tomographic size of infarction was significantly related to global cognitive as well as intentional (sensory) memory impairment. The more marked the conventional electroencephalographic abnormalities, the more impaired were the global cognitive functions. High limit of the theta percent power correlated positively to deterioration in psychomotor performance. All P300 parameters except amplitude correlated significantly with impairment of global cognitive function and psychomotor performance in stroke patients.