Background Autism spectrum disorder is a neurodevelopmental disorder that is characterized mainly by difficulties in social interaction and communication. Studies have suggested abnormal neural connectivity patterns in the brains of patients with autism. Objective The current work aimed to study the quantitative electroencephalography (EEG) findings in autistic children and compare it with those of normal controls. Methods The EEG recordings of 21 autistic children between 4 and 12 years of age were compared with those of 21 age-matched and sex-matched controls under an eyes-opened condition. Differences in cerebral functioning were examined using measurements of absolute and relative power and intrahemispheric and interhemispheric coherence. Results There were statistically significant differences in EEG power between the autistic and control groups, with greater absolute of delta and theta power especially at the frontal region in autistic children. There was also global reduction in relative alpha and beta power especially in the frontal, central, and posterior regions in autistic children. In addition, there was a pattern of underconnectivity and overconnectivity when measuring the intrahemispheric and interhemispheric coherence in the autistic compared with the control group. Conclusion These results suggested regional dysfunction of the brain in autistic children, along with a pattern of abnormal neural connectivity, which could explain the autistic symptomatology.

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Background A 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. Objective The aim of the present study was to examine the relationship between primary fatigue, cognitive dysfunction, and inflammatory biomarkers for patients with MS. Patients and methods A 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. Results A 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. Conclusion Primary fatigue contributes to cognitive dysfunction in patients with MS and is associated with elevated serum level of TNF-α and IFN-γ

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Background The prevalence of breakthrough seizures is estimated to occur in 39-75.3% of epileptic patients in developing countries. Patients and physicians should be aware of the possible precipitating factors of breakthrough seizures to prevent their occurrence. Objective The aim of this study was to determine the precipitating factors for breakthrough seizures in patients attending Cairo University Hospital. Methods This cross-sectional study included 90 epileptic patients with idiopathic epilepsy receiving antiepileptic drugs (AEDs). They were divided into two groups. Group I included 55 epileptic patients with a history of recent breakthrough seizures. Group II included 35 epileptic patients who had not experienced any recent breakthrough seizures. Patients with breakthrough seizures were subjected to a thorough questionnaire addressing precipitating factors. All participants were subjected to an electroencephalogram (EEG) and the Morisky Medication Adherence Scale. Results Missed doses (56.4%) represented the most frequent reported precipitating factor, followed by sleep deprivation (36.4%) and psychological stress (34.5%). The patients in group I were found to have lower durations of seizure control, adherence to AEDs, and were more frequently on AED polytherapy than the participants in group II. In terms of the EEG, group I showed a higher percentage of abnormal EEGs and more frequent focal epileptiform discharges. No significant difference was found in age or sex, age at onset of epilepsy, duration of disease, and type of seizures between both groups. Conclusion Patients and their caregivers should be educated about these possible precipitating factors to achieve better control of epilepsy.

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Background Testosterone and prolactin hormone abnormalities have been noticed in some epileptic patients and were attributed to either the direct effect of the disease or the effect of antiepileptic drug therapy. Objective The aim of this study was to evaluate the potential endocrinal dysfunction in nonmedicated male adolescents with idiopathic generalized epilepsy as well as those on valproate treatment. Patients and methods This study was performed on 40 epileptic patients, 20 newly diagnosed nonmedicated and 20 treated with valproate, who attended the epilepsy clinic in the Department of Neuropsychiatry, Tanta University Hospital. Twenty age-matched male healthy controls were also included. Patients were subjected to full history taking, neurological examination, evaluation of testosterone and prolactin blood levels, and electroencephalography. Results The serum levels of both free and total testosterone were higher in valproate-treated patients compared with nonmedicated patients and healthy controls. The levels were significantly lower in the nonmedicated group compared with the control group. The serum level of prolactin in both patient groups was significantly higher when compared with the healthy control group, with no statistically significant difference between the two patient groups. Conclusion The exact etiology of hormonal abnormalities in men with epilepsy appears to be multifactorial, including the disease and antiepileptic drug effects. Neuroendocrine regulation in men with epilepsy may be important not only for reproductive function but also for optimal management of seizure disorders.

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Background Gastrointestinal tract infection with Helicobacter pylori (HP) can inhibit levodopa (LD) in Parkinson's disease (PD) patients, leading to motor fluctuation. Objectives The aim of this study was to identify the incidence of HP in PD patients compared with healthy controls and its effect on motor fluctuation, response to treatment, and quality of life. Patients and methods Serum IgG Abs against HP urease were detected using enzyme-linked immunosorbent assay. We compared the incidence of HP infection in PD patients and controls. We compared PD patients with positive HP (PD positive) and PD patients with negative HP infection (PD negative) with regard to clinical features, the Unified PD Rating Scale (UPDRS) scores, Hoehn and Yahr (H and Y) stages, PD Questionnaire for the quality of life (PD-Q39), and PD Nonmotor Symptoms Questionnaire (PD NMSQ). Results Fifty Egyptians with PD were included. Forty-six percent of patients were HP positive compared with 20% in the control group; the difference was statistically significant (P = 0.043). In PD-positive patients, the total UPDRS and PD-Q39 scores were significantly higher in comparison with PD-negative patients (P < 0.005 and P < 0.001, respectively). The differences were not significant with regard to the total PD NMSQ score and H and Y stages between the two groups of patients. The LD onset period was significantly greater in PD-positive patients by nearly 14 min in comparison with PD-negative patients. There was a significantly prolonged on-duration time in PD-positive patients in comparison with PD-negative patients. Conclusion There is a high incidence of HP infection in PD. HP affects the response to LD and can deteriorate motor manifestations and the quality of life.

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Background Nerve conduction (NC) studies and electromyography (EMG) are invaluable tools in the diagnosis of neuromuscular disorders. Databases with plenty of observations are useful in better assessment and safe and effective decision making. Objective The aim of this study was to analyze data provided by the EMG and NC records and to correlate referral diagnoses, especially carpal tunnel syndrome, with the final electrodiagnostic ones. This will offer strategic clues to minimize time, cost, and human errors. Methods The study was carried out in the Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University. Tabulation of EMG/NC details for the cases examined during the study period (first half of the year 2014), followed by extensive analysis of the data provided, was carried out. Results Most of the referral clinical diagnoses were of carpal tunnel syndrome (44%) and the least were of ulnar entrapment (1.3%). Concordance between referrals and final diagnoses was found only in 59.2% of patients. The most concordant referral was facial palsy and the most nonconcordant referral diagnosis was anal dysfunction. Conclusion Because of the occurrence of the referral diagnoses and the percentage of concordance between provisional and electrodiagnostic diagnoses, the unit is launching a local project for standardized guidelines for every provisional diagnosis.

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Background Spinal cord injury is associated with urinary and erectile dysfunction. Objective This study compared the efficacy of transcutaneous electrical nerve stimulation (TENS) with pelvic floor biofeedback (PFBFB) training in the treatment of bladder and erectile dysfunction for male patients with traumatic partial spinal cord injury. Methods The study included 30 male patients with bladder and erectile dysfunction (precipitancy overactive bladder) after traumatic partial spinal cord injury above the level of T12 within 6-18 months after injury. Patients were randomly divided into two equal groups: the study group was subjected to TENS and pelvic floor exercises and the control group was subjected to PFBFB training in addition the exercises. Patients were assessed before and after treatment by means of cystometric measurements, electromyography activity of pelvic-floor muscles, and International Index of Erectile Function (IIEF-5) Questionnaire. Results Before treatment, there was no significant difference in cystometric measurements, pelvic-floor muscle strength, and IIEF-5 score. In the TENS group, the treatment produced significant improvement in bladder volume at first desire to void (P = 0.001), maximum bladder capacity (P = 0.001) and maximum flow rate (P = 0.001), detrusor pressure at maximum flow (P = 0.002), strength of pelvic floor muscles (P = 0.001), and IIEF-5 score (P = 0.001). PFBFB training resulted in significant improvement only in the maximum flow rate (P = 0.042). Conclusion TENS of pelvic floor muscles is a promising, safe, effective, and inexpensive physical therapy technique to improve urinary and erectile dysfunction in patients with partial suprasacral spinal cord injuries.

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Background There is growing evidence regarding the role of inflammation in the pathogenesis of ischemic stroke, especially nonembolic types of ischemic stroke. Despite this, there is a need to investigate the direct impact of inflammatory markers on the early outcome in nonembolic ischemic stroke. Objective The aim of the present study was to determine whether positive inflammatory markers such as raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and leukocytosis could be used as biochemical predictors for poor early outcome in patients with acute noncardioembolic ischemic stroke. Patients and methods A total of 60 patients(40 men and 20 women; median age: 64.5 years) with first attack of noncardioembolic ischemic stroke were included in the study. Full clinical assessment and routine laboratory investigation were conducted for all patients. MRI of brain, ECG, and cardiac echo were carried out to confirm the diagnosis and exclude cases with embolic stroke. Blood samples for all patients within the first 24 h of onset of symptoms were taken for assessment of ESR, qualitative CRP, and leukocyte count on admission. National Institute of Health Stroke Scale was used for all patients after 7 days. On the basis of their scores patients were divided into two groups: 40 patients with favorable outcome were included in the first group and 20 patients with bad outcome in the second group. Results There was significant difference between the two groups regarding ESR value, and the leukocyte count was higher in the group with bad prognosis. In addition, positive CRP was associated more with the same group in statistically significant way. Conclusion Inflammatory markers play an important role in detecting the early outcome of noncardioembolic stroke.

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Background On the night before surgery, poor sleep quality due to anxiety is a frequently encountered problem. Objective This study aimed at determining the effect of preoperative sleep quality on intraoperative isoflurane requirements in patients undergoing elective surgeries and also offers an electroencephalography (EEG)-based classification of sleep quality. Patients and methods Twenty-seven adult male patients scheduled for elective open cholecystectomy with ages ranging from 20 to 40 years were included in this study. The night before the operation, the patients were subjected to an at least 8 h sleep EEG, which was scored for the following: total sleep time, percentage of slow wave sleep, and percentage of rapid eye movement sleep. Intraoperative isoflurane requirements were determined by recording the amount of inspired isoflurane concentration (every 2 min) needed to achieve an intraoperative bispectral index value between 40 and 60. Patients were classified according to sleep EEG into good sleepers and bad sleepers. Isoflurane requirements were first correlated with the EEG and then compared between the two groups. Results The inspired concentration of isoflurane in good sleepers was 1.15% (1.01-1.22%), whereas in bad sleepers it was significantly lower, at 0.99% (0.87-1.18%) (P = 0.003). There was a positive correlation between isoflurane requirements and both slow wave sleep percentage (r = 0.693; P = 0.003) and rapid eye movement sleep percentage (r = 0.687; P = 0.005). Conclusion Patients suffering from poor sleep quality on the night before surgery need less intraoperatively inspired isoflurane concentration. This finding may have clinical importance in adjusting the isoflurane dose to meet patients' requirements, avoiding intraoperative complications. In addition, an EEG-based classification of sleep is offered.

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Background Nocturnal enuresis (NE) is one of the most common pediatric sleep-related problems. Data on sleep patterns in children with NE are conflicting. Objective We aimed at studying the sleep architecture, associated breathing problems, and its relation to antidiuretic hormone (ADH) in children with primary NE. Patients and methods This study included 31 children aged 6-18 years with primary monosymptomatic NE and 16 healthy matched controls. They were subjected to a single overnight polysomnography and assessment of ADH levels at 9-11 a.m. and 9-11 p.m. Results Enuretic children had significantly prolonged sleep latency and higher stage N1 percentage, less total sleep time, lower sleep efficiency, and lower rapid eye movement sleep percentage compared with the control group. Ten (32.2%) NE children had nocturnal arrhythmia, whereas six (19.35%) had a respiratory distress index more than 5. Reversed ADH secretion pattern was present in 82% of the NE children. Children with reversed ADH secretion had lower stage N1 and respiratory distress index, and higher sleep efficiency, compared with NE children with normal ADH rhythm. Conclusion Primary NE is associated with disturbed sleep architecture. NE could be a presenting symptom for hidden sleep disordered breathing. The association of NE with cardiac arrhythmia is an interesting finding that requires further research. Most NE children have a reversed pattern of ADH secretion.

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Background Thrombolytic therapy is currently the only FDA-approved treatment for acute ischemic stroke. Hence, early diagnosis and risk stratification is of great importance in management. Objective The aim of this work was to study serum level of matrix metalloproteinase-9 (MMP-9) within 24 h of acute ischemic stroke onset and its relation with clinical severity. Patients and methods Thirty patients with acute ischemic stroke were subjected to measurement of serum MMP-9 within 24 h of stroke onset and clinical assessment of stroke severity. Thirty healthy volunteers of matched age and sex were included as controls. Results Fifteen male and 15 female patients with a mean age of 61 ± 7.11 years were studied. The mean National Institutes of Health Stroke Scale (NIHSS) score on admission was 11.17 ± 4.76. The mean serum level of MMP-9 in patients was 998.8 ± 154.72 ng/ml, which was significantly higher compared with the serum level of MMP-9 in controls (P = 0.003). The mean NIHSS of patients with normal serum level of MMP-9 was less than the mean NIHSS in patients with high MMP-9 serum levels (P = 0.003). There was a significant positive correlation between serum level of MMP-9 and NIHSS score (r = 0.5; P = 0.005) even after adjustment of other variables )age, sex, diabetes, hypertension, fasting blood sugar, uric acid, serum triglycerides, serum cholesterol, and right and left carotid intima media thickness( (r = 0.48; P = 0.032). Conclusion Serum MMP-9 level was found to be high in acute ischemic stroke patients and correlated with clinical stroke severity.

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Background Environmental factors such as vitamin D deficiency have been linked to the etiology of multiple sclerosis (MS) through interaction with genetic factors. Researches must be carried out to answer the question whether the relationship between vitamin D and MS is consistent and reproducible. Objective The aim of the present study was to assess the level of vitamin D in Egyptian MS patients. Subjects and methods In total, 111 patients with MS and 33 normal subjects were included in this study. Vitamin D level was estimated for each participant using the enzyme linked immunosorbent assay technique. Results Vitamin D levels were significantly lower among MS patients (ranging from 5 to 75 ng/ml with a mean ± SD of 26.4 ± 18.5) when compared with controls [ranging from 25 to 80 ng/ml with a mean of 51.2 ± 19.6 (P < 0.001)]. High expanded disability status scale scores were found to be related to low vitamin D levels. Conclusion Patients with MS tended to have lower vitamin D levels, and those with higher (expanded disability status scale) scores were more likely to have lower levels of vitamin D.

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