Peripheral nerve affection in patients with hyperlipidemia: a clinical and electrophysiological study

Familial hypercholesterolemia is a common genetic disorder, in its heterozygous form occur in 1:500 of the general population. Peripheral neuropathy has been reported with this disorder, some related it to the use of lipid-lowering agents [statins], others related it to the disease itself. This study was conducted on 3 groups of patients: 1[st] group; 15 patients with familial hypercholesterolemia receiving statins for variable durations, 2[nd] group: 15 newly diagnosed patients with familial hypercholesterolemia not receiving statins, and a 3[rd] group: 15 healthy matching controls. None of the subjects in the 3 groups had any disease causing peripheral neuropathy e.g. diabetes mellitus, renal failure, alcohol abuse... etc. All patients and controls were subjected to nerve conduction studies in both lower limbs; sensory and motor. None of the patients or controls had symptoms or signs of peripheral neuropathy. Electrophysiohgical studies didn't show any abnormalities in 2[nd] group and controls. In patients taking statins, 3 patients had neurophysiological evidence of sensory axonal neuropathy. The results of the present study support the previous reports that statins could be a cause of sensory polyneuropathy. Further investigations are recommended to determine which patient should discontinue statin treatment and identify other treatment options

Hormonal changes in epileptic children with primary generalized tonic-clonic seizures

We studied the hormonal changes in 24 epileptic children with primary generalized tonic-clonic seizures. Their ages ranged between 3 and 16 years with a mean of 9.08 +/- 4.05 years, 13 were males and 11 were females. Electroencephalographic studies showed high voltage slow waves pattern in 17 patients while computed tomography of brain was normal in all cases. As regards the acute changes following an attack, we found significant elevation of both prolactin and ACTH levels after 20 minutes, 1, 2, and 3 hours of seizure compared with baseline level [after 24 hours]. The increase in plasma ACTH level was accompanied with significant elevation in plasma cortisol level after 1, 2 and 3 hours of the seizure onset. Plasma TSH level after 1 and 2 hours were significantly higher than the baseline value. Early postictal significant elevation of growth hormone levels was observed after 20 minutes and 1 hour. Concerning chronic hormonal changes, we found that the baseline levels of prolactin, ACTH and cortisol in epileptic children with generalized tonic-clonic seizures were significantly higher than the levels recorded in healthy children while no significant differences could be detected as regards TSH and growth hormone. We suggest conducting other studies in pediatric age to assess the role of neurotransmitters in producing the variable hormonal changes following the onset of seizures

Transcranial doppler ultrasound versus neurologic examination in detection of cerebral infarction in children with sickle cell disease

Cerebral infarctions are a major source of disability in children with sickle cell disease [SCD], leading to serious impairment in cognitive and motor functions. The aim of the present work is to assess the value of transcranial Doppler ultrasonography [TCD] of the middle cerebral artery [MCA] and neurologic examination in detection of cerebral infarction in children with SCD. The present work included 28 children [10 boys, and 18 girls] aged 5 to 13 years, underwent full neurologic examination, non-contrast CT of the brain, and TCD. TCD was evaluated for maximum flow velocity in the right and left MCAs. The sensitivity and specificity of neurologic examination for identification of patients with infarction were 55.6% and 89.5% respectively. Depending on the alteration in the maximum flow velocity of the MCA either <100 cm/sec or > 200 cm/sec, the TCD allowed detection of 7 out of 9 patients with documented CT evidence of cerebral infarction with only one false positive result [77.9% sensitivity and 94.4% specificity]. The combination of neurologic examination and TCD produced 88.9% sensitivity and specificity, for detection of cerebral infarction. We conclude that TCD of the MCA can be used as a screening method for identifying children with SCD at risk for developing strokes. Single vessel examination namely MCA makes the examination more easy, of shorter duration, and more suitable for children with no need for special preparation or sedation. The combination of neurologic examination and TCD is promising as a sensitive screening test in this patient population