Publications by authors named "Noha Abo-Elfetoh"

16 Publications

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Surveillance Study of Acute Neurological Manifestations among 439 Egyptian Patients with COVID-19 in Assiut and Aswan University Hospitals.

Neuroepidemiology 2021 Feb 25:1-10. Epub 2021 Feb 25.

Department of Neuropsychiatry, Assiut University Hospital, Faculty of Medicine, Aswan, Egypt.

Background: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals.

Materials And Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated.

Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection.

Conclusion: In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.
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http://dx.doi.org/10.1159/000513647DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8018217PMC
February 2021

Electrophysiological differences in cortical excitability in different forms of dementia: A transcranial magnetic stimulation and laboratory biomarkers study.

Neurophysiol Clin 2020 Jul 23;50(3):185-193. Epub 2020 Jun 23.

Medical physiology department, faculty of medicine, Assiut university, Assiut, Egypt.

Background: The aim of the present study was to identify neurophysiologic markers to differentiate between Alzheimer dementia (AD), Vascular dementia (VaD), and Parkinson's disease dementia (PDD), and to examine their relationship to levels of transforming growth factor β1 (TGFβ1).

Methods: The study included 15 patients with each type of dementia (AD, VaD, PDD) and 25 control subjects. Dementia patients were diagnosed according to the DiagnosticandStatisticalManualofMentalDisorders4thedition-revised(DSM-IV-R). Modified Mini Mental State Examination (MMMSE), motor cortex excitability including resting and active motor thresholds (rMT, aMT), input-output (I/O) curve, contralateral and ipsilateral silent periods (cSP, iSP), short-interval intracortical inhibition (SICI) at 1,2 and 4ms, and serum levels of TGFβ1 were examined.

Results: There were no significant differences between groups with regards to age, sex, education or socioeconomic level. There was significant neuronal hyperexcitability in the form of reduced rMT and aMT and a shallower I/O curve in all three groups of dementia compared with the control group. The durations of cSP and iSP were longer in AD and PDD groups compared with the control group, whereas there were no significant differences in VaD. SICI was less effective in the three dementia groups than in the control group at intervals of 4ms. Serum levels of TGFβ1 were significantly elevated in all dementia groups in comparison with the control group. There was a significant negative correlation between serum level of TGFβ1 and cSP, iSP, and SICI across all patients and a significant negative correlation between serum level of TGFβ1 and iSP duration in AD.

Conclusion: Although motor thresholds were reduced in all patients, measures of SICI, cSP and iSP could distinguish between dementia groups. Serum level of TGFβ1 negatively correlated with iSP specifically in the AD group. This suggests that levels of TGFβ1 may relate to GABAergic dysfunction in dementia.
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http://dx.doi.org/10.1016/j.neucli.2020.05.001DOI Listing
July 2020

Therapeutic Role of Transcranial Direct Current Stimulation in Alzheimer Disease Patients: Double-Blind, Placebo-Controlled Clinical Trial.

Neurorehabil Neural Repair 2019 05 3;33(5):384-394. Epub 2019 Apr 3.

1 Assiut University Hospital, Egypt.

Objective: To explore the neuropsychological effects and levels of tau protein (TAU), amyloid β 1-42 (Aβ 1-42), and lipid peroxidase after 10 sessions of anodal transcranial direct current stimulation (tDCS) in patients with mild to moderate Alzheimer disease (AD).

Patients And Methods: A total of 46 consecutive patients with probable AD participated in this study. They were classified randomly into 2 equal groups: active versus sham. Each patient received 10 sessions of anodal tDCS over the left and right temporoparietal region for 20 minutes for each side with the cathode on the left arm. Patients were assessed using the Modified Mini Mental State Examination (MMMSE), clock drawing test, Montreal Cognitive Scale (MoCA), and the Cornell Scale for depression. Serum TAU, Aβ 1-42, and lipid peroxidase were measured before and after the 10th session.

Results: There was a significant improvement in the total score of each cognitive rating scale (MMMSE, clock drawing test, and MoCA) in the real group, whereas no such change was observed in the sham group. The Cornell depression score improved significantly in both groups. There was a significant increase in serum Aβ 1-42 ( P = .02) in the real but not in the sham group, with a significant Treatment condition × Time interaction ( P = .009). There was no significant effect on tau or lipid peroxidase in either group but a significant positive correlation between changes of Aβ1-42 and MMMSE ( P = .005) and MoCA ( P = .02).

Conclusion: The observed cognitive improvements were complemented by parallel changes in serum levels of Aβ 1-42.
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http://dx.doi.org/10.1177/1545968319840285DOI Listing
May 2019

Fatigue in Rheumatoid Arthritis Patients: Association With Sleep Quality, Mood Status, and Disease Activity.

Reumatol Clin 2020 Sep - Oct;16(5 Pt 1):339-344. Epub 2018 Aug 20.

Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt.

Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disease, characterized by polyarthritis and systemic manifestations. RA-fatigue is a significant problem and adds on disease burden. Sleep disturbance, depression, and disease activity are suggested contributing factors to RA-fatigue; however, their combined role did not examine before among Egyptian RA patients. The objective of the study was to investigate the presence of fatigue, sleep and mood disturbances in RA patients. Also, to evaluate the possible association of poor sleep, depression, and disease activity with RA-fatigue.

Methods: This cross-sectional study included 115 RA patients diagnosed according to the 2010 ACR-EULAR criteria and 46 age and sex matched controls. Fatigue using the Multidimensional Assessment of Fatigue-Global Fatigue Index, sleep using the Pittsburgh Sleep Quality Index and mood status using Beck Depression Inventory were assessed for all participants. RA disease activity was evaluated using disease activity score-28 joints.

Results: RA patients had higher mean fatigue, sleep disturbance, and depression scores (27.2±8.9, 6.4±3.6, and 12.8±7.3; respectively) than controls (22.7±7, 4.8±3, 7.8±5.9; respectively) (P<.05). Poor sleep, depression and higher disease activity were significantly correlated with fatigue (r=0.4, r=0.65, r=0.55; respectively) (P<.001). The three variables may explain up to 49.1% of the variation in fatigue on multiple regression analysis.

Conclusion: Fatigue, poor sleep, and depression are more common in Egyptian patients with RA. A remarkably higher fatigue was associated with poor sleep, depression, and high disease activity, thus monitoring these silent comorbidities in clinical practice is required.
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http://dx.doi.org/10.1016/j.reuma.2018.07.010DOI Listing
August 2018

Cortical excitability in tramadol dependent patients: A transcranial magnetic stimulation study.

Drug Alcohol Depend 2016 Dec 17;169:110-116. Epub 2016 Oct 17.

Pharmacology Department, Faculty of Medicine, Assiut University, Assiut, Egypt.

Background: Addiction to tramadol, a widely used analgesic, is becoming increasingly common. Tramadol can also induce seizures even after a single clinical dose. We tested whether the epileptogenicity of tramadol was associated with any changes in cortical excitability and inhibitory transmission using transcranial magnetic stimulation (TMS).

Methods: The study included 16 tramadol dependent patients and 15 age and sex matched healthy volunteers. Clinical evaluation was conducted using an addiction severity index. TMS assessment of excitability was conducted on the motor cortex since the response to each TMS pulse at that site is easily measured in terms of the amplitude of the twitches it evokes in contralateral muscles. Measures included resting and active motor threshold (RMT and AMT respectively), motor evoked potential (MEP) amplitude, cortical silent period (CSP) duration, transcallosal inhibition (TCI), and short interval intracortical inhibition and facilitation (SICI and ICF respectively). Urinary level of tramadol was measured immediately before assessing cortical excitability in each patient.

Results: RMT and AMT were significantly lower, the duration of the CSP was shorter and SICI was reduced in patients compared with the control group. These findings are suggestive of increased neural excitability and reduced GABAergic inhibition following exposure to tramadol. Also there were negative correlations between the severity of tramadol dependence and a number of cortical excitability parameters (AMT, RMT, and CSP with P=0.002, 0.005, and 0.04 respectively).

Conclusions: The results provide evidence for hyperexcitability of the motor cortex coupled with inhibitory deficits in tramadol dependent patients.
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http://dx.doi.org/10.1016/j.drugalcdep.2016.09.027DOI Listing
December 2016

Acquired equivalence associative learning in GTC epileptic patients: experimental and computational study.

Front Cell Neurosci 2015 27;9:418. Epub 2015 Oct 27.

Department of Neurology, Faculty of Medicine, Assiut University Assiut, Egypt.

Previous cognitive behavioral studies based on Acquired Equivalence Associative learning Task (AEALT) showed a strong relation between hippocampus and basal ganglia in associative learning. However, experimental behavioral studies of patients with Generalized Tonic Clonic (GTC) epilepsy remained sparse. The aim of the present study is to integrate a classical behavioral cognitive analysis with a computational model approach to investigate cognitive associative learning impairments in patients with GTC epilepsy. We measured the accuracy of associative learning response performance in five GTC epileptic patients and five control subjects by using AEALT, all subjects were matched in age and gender. We ran the task using E-Prime, a neuropsychological software program, and SPSS for data statistical analysis. We tested whether GTC epileptic patients would have different learning performance than normal subjects, based on the degree and the location of impairment either in basal ganglia and/or hippocampus. With the number of patients that was available, our behavioral analysis showed no remarkable differences in learning performance of GTC patients as compared to their control subjects, both in the transfer and acquisition phases. In parallel, our simulation results confirmed strong connection and interaction between hippocampus and basal ganglia in our GTC and their control subjects. Nevertheless, the differences in neural firing rate of the connectionist model and weight update of basal ganglia were not significantly different between GTC and control subjects. Therefore, the behavioral analysis and the simulation data provided the same result, thus indicating that the computational model is likely to predict cognitive outcomes.
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http://dx.doi.org/10.3389/fncel.2015.00418DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4621864PMC
November 2015

A double-blind randomized clinical trial on the efficacy of magnetic sacral root stimulation for the treatment of Monosymptomatic Nocturnal Enuresis.

Restor Neurol Neurosci 2015 ;33(4):435-45

Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.

Purpose: Purpose of this study was to evaluate the long term efficacy of repetitive sacral root magnetic stimulation (rSMS) in patients with monosymptomatic nocturnal enuresis (MNE).

Methods: Forty four patients were randomized to receive either sham or real repetitive sacral root magnetic stimulation (rSMS; 15 Hz with a total of 1500 pulses/session) for 10 sessions. Evaluation was performed before starting treatment, immediately after the 5th and 10th treatment session, and 1 month later, using frequency of enuresis/week, visual analogue scale (VAS) and quality of life as outcome measures. Resting and active motor thresholds of gastrocnemius muscles were measured before and after the end of sessions.

Results: Both treatment and control groups were comparable for baseline measures of frequency of enuresis, and VAS. The mean number of wet nights/week was significantly reduced in patients who received real rSMS. This improvement was maintained 1 month after the end of treatment. Patients receiving real-rSMS also reported an improvement in VAS ratings and quality of life. A significant reduction of resting motor threshold was recorded after rSMS in the real group while no such changes were observed in the sham group.

Conclusion: These findings suggest that rSMS has potential as an adjuvant treatment for MNE and deserves further study.
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http://dx.doi.org/10.3233/RNN-150507DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4923722PMC
June 2016

Anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex improves anorexia nervosa: A pilot study.

Restor Neurol Neurosci 2014 ;32(6):789-97

Department of Neuropsychiatry, Assiut University Hospital, Assiut, Egypt.

Background: Existing treatments for adults with anorexia nervosa (AN) have limited proven efficacy. New treatments that have been suggested involve targeted, brain-directed interventions such as transcranial direct current stimulation (tDCS). We describe findings from seven individuals with treatment-resistant AN who received 10 sessions of anodal tDCS, over the left dorsolateral prefrontal cortex (DLPFC).

Material And Method: In this open-label, single-arm study, seven patients received anodal tDCS (2mA) for 25 minutes over the left dorsolateral prefrontal cortex daily for ten days. Assessments pre-tDCS, post-tDCS and one month later included the Eating Attitude Test (EAT), Eating Disorder Inventory (EDI) and Beck Depression Inventory (BDI).

Results: Three patients improved in all three rating scales immediately after the treatment sessions and one month later. Two patients showed improvement at the end of treatment but returned to the baseline after one month. One subject improved only on the BDI scale but not eating scales. The scores in the three rating scales were unaffected by treatment in the remaining patient. There was a significant effect of time (pre, post and 1 month later) on the three rating scores; BDI (P = 0.016), EDI (P = 0.018) and EAT (P = 0.016) and a significant correlation between the percent improvement of BDI and EAT (p = 0.01), and between BDI and EDI (P = 0.006).

Conclusions: These findings suggest that tDCS has potential as an adjuvant treatment for AN and deserves further study.
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http://dx.doi.org/10.3233/RNN-140392DOI Listing
July 2015

Epidemiological study and risk factors of stroke in Assiut Governorate, Egypt: community-based study.

Neuroepidemiology 2013 13;40(4):288-94. Epub 2013 Mar 13.

Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.

Background: Because there have been no epidemiological studies of stroke in Egypt, a community-based survey was conducted in the Assiut Governorate to estimate the prevalence and risk factors of stroke in our community.

Methods: A three-phase door-to-door study was performed in which 6,498 participants were chosen by random sampling from 7 districts in Assiut (first phase). Out of this sample, 578 dropped out leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 (61.8%) urban residents and 2,260 (38.2%) from the rural community. In the second phase participants were screened using the questionnaire for stroke, while the third phase involved medical evaluation of all suspected cases, with diagnosis of stroke confirmed by evaluation of CT scans. The Mini Mental State Examination and Hamilton Depression Scale were evaluated for each patient.

Results: 65 participants were identified as positive on the survey questionnaire, but only 57 patients were found to have stroke, giving a crude prevalence rate of 963/100,000 inhabitants with an age-adjusted local prevalence rate of 699.2/100,000 and an age-adjusted prevalence relative to the standard world population of 980.9/100,000. The prevalence among males was higher than females (1174/100,000 vs. 736/100,000) with a ratio 1.7:1. There was a significantly higher prevalence of ischemic (895/100,000) than hemorrhagic (68/100,000) stroke. Stroke prevalence was the same in rural and urban areas and in males and females. There was, however, a significantly higher prevalence in illiterate (2413/100,000) than literate participants (357/100,000). Forty-two patients (73.7%) had one or more risk factors for stroke, hypertension being the commonest (66%) and diabetes mellitus second (38.6%). Nine cases had poststroke dementia (15.8%) and 14 cases (24.6%) had mild depression.

Conclusions: The overall prevalence rate of stroke is high, especially in older adults, men and illiterate individuals. A higher prevalence of ischemic than hemorrhagic stroke was recorded, with hypertension and diabetes mellitus being the commonest risk factors in our community.
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http://dx.doi.org/10.1159/000346270DOI Listing
December 2013

A community based epidemiological study of epilepsy in Assiut Governorate/Egypt.

Epilepsy Res 2013 Feb 1;103(2-3):294-302. Epub 2012 Sep 1.

Department of Neurology, Assiut University Hospital, Assiut, Egypt.

Background: The aim of the study was to estimate the prevalence of different types of epilepsy and their possible risk factors in the region of the Assiut Governorate/Egypt.

Material And Methods: A community based study with random sampling of 7 districts, involving 6498 inhabitants. Out of this sample, 578 dropped out leaving 3066 males (51.8%) and 2854 females (48.2%). There were 3660 (61.8%) urban residents and 2260 (38.2%) from the rural community. Patients were evaluated using a screening questionnaire for epilepsy, and then referred to the hospital to be re-evaluated by a qualified neurologist and with electroencephalography (EEG) and computed tomography of the brain (CT).

Results: Seventy-five cases were diagnosed with epilepsy giving an overall the crude lifetime prevalence rate (CPR) for epilepsy of 12.67/1000 (95% CI: 9.8-15.54). The active prevalence rate was 9.3/1000 and the incidence rate was 1.5/1000 (95% confidence interval: 0.53-2.51). Fifty-six cases (75%) had idiopathic epilepsy (CPR 9.5/1000). Symptomatic epilepsy was recorded in 19 (25%) cases (CPR 3.2/1000). Generalized seizures were more common (CPR 6.75/1000) than partial seizures (CPR 2.5/1000). The prevalence rate of partial seizures evolving to secondary generalization was 0.84/1000 while simple partial and complex partial seizures had CPR 1.4/1000 and 0.34/1000, respectively. The CPR of mixed seizures was 0.17/1000. Epilepsy was slightly but not significantly more common among males than females (CPR of 14.4 and 10.9 per 1000 population, respectively). The CPR was higher in rural than urban populations (17.7/1000, with 95% CI 12.2-23.18 and 9.56/1000, with 95% CI: 6.39-12.7, respectively) and in the illiterate group than the literate population (12.02/1000 and 9.94/1000, respectively). The highest prevalence rate was recorded in the early and late childhood period (69.78/100,000 and 43.78/100,000, respectively). Prenatal insults and infection represented major causes of symptomatic epilepsy.

Conclusions: We found a high prevalence rate of epilepsy (comparable with that in other Arabic and European countries) in our community particularly among children and teenagers. Overall the prevalence was higher in the rural than in the urban population. A family history of epilepsy, prenatal insults, and infection represented major risk factors of symptomatic epilepsy.
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http://dx.doi.org/10.1016/j.eplepsyres.2012.08.006DOI Listing
February 2013

Epidemiological study and clinical profile of Parkinson's disease in the Assiut Governorate, Egypt: a community-based study.

Neuroepidemiology 2012 29;38(3):154-63. Epub 2012 Mar 29.

Department of Neurology, Assiut University Hospital, Assiut, Egypt.

Background: Few comprehensive epidemiological studies of the prevalence of Parkinson's disease (PD) have been undertaken in Arab countries, and none has been carried out in Egypt. A community-based survey was conducted in the Assiut Governorate to estimate the prevalence and clinical profile of PD.

Methods: A community-based study was carried out, with random sampling of 7 districts, involving 6,498 inhabitants. Out of this sample, 578 subjects dropped out, leaving 3,066 males (51.8%) and 2,854 females (48.2%). There were 3,660 urban residents (61.8%) and 2,260 (38.2%) from the rural community. Patients were evaluated using a screening questionnaire, the Unified Parkinson Disease Rating Scale and the Non-Motor Symptoms Scale for PD.

Results: Thirty-nine subjects were found to have parkinsonism, giving a crude prevalence rate of 659/100,000 inhabitants. Of these subjects, 33 were diagnosed with PD (21 males), with a mean age of 66.9 ± 8.4 years, a crude prevalence rate of 557/100,000 and an age-specific prevalence rate (≥50 years old) of 2,748/100,000. There were more males than females (3,395 vs. 1,989/100,000), but the difference was not significant. The highest age-specific prevalence rate was recorded among subjects 70-79 years old (7,263/100,000). There was a significantly higher prevalence among rural than urban inhabitants (973 vs. 301/100,000) and among illiterate than literate persons (1,103 vs. 280/100,000). The clinical profile of our patients was similar to that of other populations but was characterized by a high prevalence of mood/cognition dysfunction and gastrointestinal symptoms; there were few reported perceptual problems.

Conclusion: The overall prevalence of PD was high, especially in older adults.
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http://dx.doi.org/10.1159/000335701DOI Listing
September 2012

Prevalence of dementia in Al Kharga District, New Valley Governorate, Egypt.

Neuroepidemiology 2012 15;38(3):130-7. Epub 2012 Mar 15.

Department of Neurology, Faculty of Medicine, Assiut University, Assiut, Egypt.

Background: With aging, there is a parallel increase in the prevalence of dementia worldwide. The aim of this work is to determine the prevalence of dementia among the population of Al Kharga District, New Valley, Egypt.

Methods: Screening of all subjects aged ≥50 years (n = 8,173 out of 62,583 inhabitants) was done through a door-to-door survey by 3 neurologists, using a short standardized Arabic screening test and a modified Mini-Mental State Examination. Suspected cases were subjected to full clinical examination, psychometric assessment using the Cognitive Abilities Screening Instrument, Instrumental Activities of Daily Living Scale, Geriatric Depression Scale, Hachinski Ischemic Score, DSM-IV-TR diagnostic criteria, neuroimaging, and laboratory investigations, when indicated.

Results: The prevalence rate of dementia was 2.26% for the population aged ≥50 years. It increased steeply with age to a maximum of 18.48% for those aged ≥80 years. Alzheimer's disease (51.2%) was the most common subtype, followed by vascular dementia (28.7%), dementia due to general medical conditions (12.8%), and lastly dementia due to multiple etiologies (7.3%). Mild dementia was the commonest (53.7%).

Conclusion: Dementia is prevalent in Egypt as elsewhere. Detection through a door-to-door survey is the best method in developing countries for early detection of mild cases.
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http://dx.doi.org/10.1159/000335655DOI Listing
September 2012

Population-based study of acquired cerebellar ataxia in Al-Kharga district, New Valley, Egypt.

Neuropsychiatr Dis Treat 2011 5;7:183-7. Epub 2011 Apr 5.

Department of Neurology and Psychiatry, Assiut University, Assiut, Egypt;

Background: The aim of this research was to determine the prevalence and etiology of acquired ataxia in Al-Kharga district, New Valley, Egypt.

Methods: A population-based study of acquired ataxia was conducted in a defined geographical region with a total population of 62,583. A door-to-door survey was used to identify cases of acquired cerebellar ataxia. Patients with acquired cerebellar ataxia at any age and of both genders were included. Cases of known inherited cerebellar ataxia, acquired neurological disorders with ataxia as a minor feature, or pure acquired sensory ataxia, were excluded.

Results: We identified 17 cases of acquired ataxia, of which eight were vascular, six were an ataxic cerebral palsy subtype, and three involved postencephalitic ataxia. The crude prevalence rate for acquired ataxia was 27.16/100,000 (95% confidence interval [CI]: 14.3-40.1). The mean age of the patients at interview was 31.8 (range 4-72) years, with a male to female ratio of 2.1:1. The most frequent presenting complaint was disturbance of gait (90.7%). The majority (92%) were ambulatory, but only 9.3% were independently self-caring.

Conclusion: This population-based study provides an insight into acquired cerebellar ataxia within a defined region, and may inform decisions about the rational use of health care resources for patients with acquired cerebellar ataxia. The most common causes of acquired cerebellar ataxia in this region were cerebrovascular injury and cerebral palsy.
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http://dx.doi.org/10.2147/NDT.S14497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3083991PMC
July 2011

Epidemiology of cerebral palsy in El-Kharga District-New Valley (Egypt).

Brain Dev 2011 May 24;33(5):406-11. Epub 2010 Aug 24.

Department of Neurology, Assiut University, Egypt.

Cerebral palsy (CP) is the most frequent cause of motor handicap among children. The present door to door (every door) study was conducted in El-Kharga District-New Valley to estimate the epidemiology of CP among children. Each child was subjected to complete medical and neurological examination to detect cases with CP. These diseased children were subjected to meticulous neurological and medical assessment, brain MRI, EEG and Stanford Binet (4th edition). It was found that 52 out of 25,540 children had CP yielding prevalence rate of 2.04/1000 (95% CI: 1.48-2.59) of living births. Mean age of children with CP, was 7.17±4.38years. The order of frequency of different subtypes of CP was as follows, 65.4% had spastic type, 26.9% mixed type and 3.8% for each ataxic and dyskinetic types of CP. The frequency of risk factors of CP in our study is prenatal complications (cyanosis, preterm, jaundice, birth weight and obstructed labor of mothers), first baby, similar condition and recurrent abortions.
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http://dx.doi.org/10.1016/j.braindev.2010.07.011DOI Listing
May 2011

Door-to-door survey of major neurological disorders in Al Kharga District, New Valley, Egypt: methodological aspects.

Neuroepidemiology 2010 24;35(3):185-90. Epub 2010 Jul 24.

Neurology Department of Assiut University, Assiut, Egypt.

Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the most suitable one to screen neurological disorders in our country. Over a 4-year period (June 1, 2005 to May 31, 2009), screening and examination had been carried out to ascertain the incidence and prevalence rate of epilepsy, stroke, cerebral palsy and Bell's palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural population of Al Kharga District, New Valley, Egypt. A total of 62,583 people were screened by 3 neurologists in a door-to-door manner, including every door, using a standardized Arabic questionnaire to detect any patient with a neurological disorder. This was a project study of neurological disorders including 3 stages: first stage (June 1, 2005 to May 31, 2006) for data collection, designing a standardized questionnaire and screening; second stage (June 1, 2006 to May 31, 2008) for case ascertainment, classification of neurological disorders and investigations, and third stage (June 1, 2007 to May 31, 2009) for data entry and statistical analysis. The results of this study revealed that the total prevalence rate of neurological disorders in Al Kharga District, New Valley was 2.4/100 with no significant difference among both sexes. The highest prevalence rate was recorded among elderly people (60+ years; 9.25%) and among children (≤18 years; 2.9%).
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http://dx.doi.org/10.1159/000314345DOI Listing
February 2011

Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brainstem infarction.

J Neurol Neurosurg Psychiatry 2010 May 14;81(5):495-9. Epub 2009 Oct 14.

Department of Neurology, Assiut University Hospital, Assiut, Egypt.

Background: There is some evidence for a therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on dysphagia in hemispheric stroke.

Aim: To compare the effect of active or sham rTMS applied to the motor area of both hemispheres in patients with acute lateral medullary infarction (LMI) or other brainstem infarctions.

Material And Method: The study included 22 patients with acute ischaemic stroke who had severe bulbar manifestation. 11 patients had LMI, and 11 had another brainstem infarction. They were randomly allocated to receive active (n=11) or sham (n=11) rTMS of the oesophageal motor cortex. Each patient received 300 rTMS pulses at 3 Hz and an intensity of 130% resting motor threshold to each hemisphere for five consecutive days. Clinical ratings of dysphagia and motor disability were assessed before and immediately after the last session, and then again after 1 and 2 months.

Results: There were no significant differences in baseline clinical assessment of swallowing between active and sham groups. Active rTMS improved dysphagia compared with sham rTMS in both groups of patients, (p=0.001 for both); the LMI group also improved the scores in the Barthel Index. All improvements were maintained over 2 months of follow-up (p=0.001).

Conclusion: These findings suggest that rTMS could be a useful adjuvant strategy in neurorehabilitation of dysphagia due to LMI or other brainstem infarction, although further assessment is necessary in multicentre clinical trials.
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http://dx.doi.org/10.1136/jnnp.2009.188482DOI Listing
May 2010