El-Tamawy, M., M. Darwish, S. Ahmed, A. Abdelalim, and E. Moustafa, "Primary fatigue contributes to cognitive dysfunction in patients with multiple sclerosis", The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, vol. 53, issue 2: Wolters Kluwer Medknow Publications, pp. 74-78, April 1, 2016. AbstractWebsite

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

El-Tamawy, M., M. Darwish, H. El-Azizi, A. Abdelalim, and S. Taha, "The influence of physical therapy on oropharyngeal dysphagia in acute stroke patients", The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, vol. 52, issue 3: Wolters Kluwer Medknow Publications, pp. 201-205, July 1, 2015. AbstractWebsite


Abd-Allah, F., N. Kissani, A. William, M. I. Oraby, R. R. Moustafa, E. Shaker, M. S. El-Tamawy, and R. Shakir, "Neuroscience research in Africa: Current status", Neurological Disorders in Africa, vol. 3, issue Supplement C, pp. 7 - 10, 2016. AbstractWebsite
Shehata, H., N. Shalaby, M. El-Tamawy, and S. Jaafary, "rTMS for On-Freezers with Advanced PD. A Long Term Follow Up Study (S40.001)", Neurology, vol. 86, issue 16 Supplement, April 5, 2016. AbstractWebsite

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.

El-Tamawy, M., M. Darwish, S. Mohamed, M. Hegazy, and M. Basheer, "Influence of cognitive dysfunction on spatiotemporal gait parameters in patients with diabetic polyneuropathy", The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, vol. 53, issue 4: Wolters Kluwer Medknow Publications, pp. 253-257, October 1, 2016. AbstractWebsite

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.

Blizard, D. A., V. R. Challa, S. S. Iskandar, M. S. El-Tamawy, and N. Adams, "Modification of stroke susceptibility by genotype-dependent maternal influences.", Stroke; a journal of cerebral circulation, vol. 21, issue 11 Suppl, pp. III134-7, 1990 Nov. Abstract

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.

Elwan, O., S. Hashem, A. A. Helmy, M. el Tamawy, M. Abdel Naseer, F. Elwan, O. Madkour, A. Abdel Kader, and S. el Tatawy, "Cognitive deficits in ischemic strokes: psychometric, electrophysiological and cranial tomographic assessment.", Journal of the neurological sciences, vol. 125, issue 2, pp. 168-74, 1994 Sep. Abstract

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.

Elwan, O., M. Abdallah, I. Issa, Y. Taher, and M. El-Tamawy, "Hormonal changes in cerebral infarction in the young and elderly.", Journal of the neurological sciences, vol. 98, issue 2-3, pp. 235-43, 1990 Sep. Abstract

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.

Elwan, O., A. A. Helmy, M. E. Tamawy, M. A. Naseer, I. E. Banhawy, A. A. Kader, and F. Elwan, "Ergoloids and ischaemic strokes; efficacy and mechanism of action.", The Journal of international medical research, vol. 23, issue 3, pp. 154-66, 1995 May-Jun. Abstract

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.

El-Tamawy, M. S., A. S. Saeed, M. Farghaly, and H. A. Mohamed, "Magnetic Resonance Venography in Detection of Chronic Cerebrospinal Venous Insufficiency in Egyptian Patients with Multiple Sclerosis ", Egypt J Neurol Psychiat Neurosurg, vol. 50, issue 1, pp. 13-20, 2014.