Study of some neurological disorders in peripheral arterial disease patients

Peripheral arterial disease [PAD] is most commonly a manifestation of systemic atherosclerosis. This study was designed to investigate some neurological aspects like silent stroke, cognitive function and peripheral neuropathy in PAD patients. twenty five PAD patients were selected from Benhna University Hospital All patients underwent complete clinical evaluation with computerized tomography of the brain, electrophysiological study [nerve conduction velocity of upper and lower limbs] and neuropsychological assessment by mini-mental state, digit span and trail making test. PAD patients had increase risk of silent stroke as [28%] of our patients have silent stroke on computerized tomography. Peripheral neuropathy was present in [48%] [12 out of 25 patients] and a total of 8 patients [32%] had pathological values with statistically significance difference between PAD patients and control group. Also PAD patients performed significantly more poorly than control in cognitive function tests. PAD patients had more common comorbid Neurological disorders like silent stroke, peripheral neuritis and cognitive decline and thus emphasizing the need for enhanced more preventive measures and early detection of this silent disorder

prevalence of metabolic syndrome among Egyptian stroke patients

The purpose of this study is to estimate the prevalence of the metabolic syndrome among Egyptian stroke patients as defined by National cholesterol Education program / Adult Treatment Panel 111[ATP111] criteria. A total of 100 stroke patients who were referred to neurology department in Benha University hospital were included in this study. Detailed medical history, physical examination, waist circumference of patients were recorded, fasting blood glucose levels and Lipid profiles of patients were evaluated. Those with at least 3 of the components regarded as having Metabolic syndrome. In all, 70% of stroke patients meets the criteria of metabolic syndrome [at least 3 of the abnormality]. 29 of 50 in men 58% and 41 of 50 in women 82% with statistically significant difference between both sexes. Abdominal obesity was markedly higher in female patients 86% and in 60% of male patients, and it was the most common component. 30% of male and 44% of female patients had low High density lipoprotein [HDL]. Elevated fasting blood glucose was identified in 58% of patients and high blood pressure in 68% of patients. Metabolic syndrome was prevalent in 70% among Egyptian stroke patients, in 58% of male and 82% of female patients and it is more prevalent among females and this high rate reveals the importance of the syndrome and the importance of the forth-coming preventive measures

Outcome of acute transversemyelitis and its predictors

Objective: Acute transverse myelitis [ATM] is an acute disease affecting a focal area of the spinal cord. Our study was done to study the out-come in our patients and study the possible prognostic factors which affect the outcome

Subjects and Methods: 25 patients included in ourstudy, 10 males and 15 females, with clinically proved transverse myeli-tis from Neurology Department, Benha University Hospital. Their meanage was 38+2.1 years. They were examined clinically and M.R.I. was done. Follow up of all patients was done to assess the outcome after two months

Results: We analysed the clinical findings and MR imaging of the patients including the age, onset, severity of neurological deficit which assessed by Barthel score, bladder dysfunction and the type of treatment. We compare these results with the outcome after two months. 32% of patients had cervical sensory level, 40% had upper dorsal and 28% had lower dorsal. The site of lesion was not related to the outcome. The over-all outcome of our patients was 60% had a good outcome with ability to walk without help or with only one aid Barthel >60. 40% had poor out-come [inability to walk or walking with two aids, Barthel <60]. The out-come was not associated with the age, sex of the patients, the site or the extent of the lesions. The patients with good outcome in comparison with bad outcome group had more acute onset [P <0.05], less likely to had severe neurological deficit at the onset [P < 0.001], also less likely to had bladder dysfunction [P < 0.05] and lastly are more likely take prednisol one pulse therapy in comparison with patients with poor out-come [P < 0.05]

Conclusion : Our study showed that 60% of ATM patients had goodoutcome, and the outcome depend mainly on the onset, severity of initialneurological deficit, bladder dysfunction and prednisolone pulse therapyand the most predictor factor was the severity of initial neurological defi-cit, although a few patients with a severe impairment at the onset mayhave a good outcome

Potential risk factors ofconvulsive status epilepticus inpatients with idiopathic epilepsy

Objectives:to determine risk factors for status epilepticus[SE] inadults with idiopathic convulsive epilepsy

Patients and Methods: Patients included 23 patients with convulsive SE All patients were attendingthe Emergency Unit of Benha University Hospital between June 2003and January 2005. Controls included 16 patients with primary convul-sive epilepsy [10males and 6 females with mean age 30 +/-10yr], nonehad SE. Medical records stored in computer files were reviewed for: thepatient's demographic data and medical history [acute/chronic, neurolog-ical/non-neurological] were documented. Data on aetiology, semiology,and clinical course were evaluated. In addition, paraclinical data from thefirst 24 hours after the onset of SE were analysed; serum sodium , serumcalcium and blood glucose levels,and rectal temperature. Other pointswere categorized as the following: intractability of epilepsy, seizures clus-tering by history,seizure types , electroencephlography for controls, neuro-imaging , antiepileptic drugs [number of drugs, types of drugs, withdraw-al of one or more drugs, serum Levels]

Results: Patients with SE were significantly older [42.4 +/-14.6 versus 30.4 +/-10.5] and had a significant lower blood glucose level [69 +/-24 versus 94 +/-16 mg/dl] than controls.Also, patients had nearly significant lower serum sodium [136 +/-5 versus139 +/-3mmol/l ; p=0.06] levels than controls.in addition, Patients with SE had a significant lower serum levels of Phenytoin [11.4 +/-1.5 versus 15.8+/-2.3; ?g/ml p=0.01], Carbamazebine [4.1 +/-0.5 versus 6.7 +/-0.3 microg/dl;p=0.01],and Valproate [53.2 +/-5.9 versus 76.9 +/-6.5?g/ml; p=0.002]. There was a significant association between the incidence of status epilepticus and history of intractable seizures [RR=36%; 95% CI=0.82-2.24p<0.05], history of seizure clusters [RR=32% ; 95% CI=0.92-2.45 p<0.05],fever [RR=51%; 5% CI=1.03-2.51; p<0.05], if the type of epilepsy was partial seizures and 2ry generalization [RR=45%; 95% CI=1.56-3.58;P<0.05], use of three AEDs [RR=33%; 95% CI=01.36-3.52; p<0.05],and ifthe patients had non therapeutic serum AEDs levels [RR=29%; 95%CI=1.42-3.61; p=0.04].In logistic regression analysis ,four factors emerged as significant, Independent predictors of SE: increase age of the patients [OR =2.254; 95% CI=1.112-4.572; P=0.04], if the type of epilepsy was partial seizure with secondary generalization [OR = 2.254; 95% CI =1.023-3.028; P = 0.04], withdrawal of one or more AEDs [OR =3.294; 95%CI=1.112-5.572; P=0.002] and low serum AEDs levels [OR = 3.254; 95%CI = 1.250-4.365; P = <0.001]

Conclusion: Four risk factors emerged assignificant, Independent predictors of SE in patients with idiopathic convulsive epilepsy: increase age of the patients,if the type of epilepsy waspartial seizures with secondary generalization,withdrawal of one or moreAEDs and low serum AEDs levels. There was a significant association be-tween the incidence of SE and history of intractable seizures and historyof seizure clusters. The etiology of SE may help to predict both the initialresponse to drug therapy and the short-term outcome

Guiliain-Barre' syndrome in aged patients clinical, electrophysiological, and therapeutic outcome

Objectives: The aim of this study is to describe the clinical and electrophysiological and therapeutic outcome of those patients with Geriatric guillain-Barre' syndrome

Patients and Methods: Guillain-Barre' syndrome in patients older than 60 years of age were collected and HUGES disability score was used to quantify neurological deficit and outcome after therapeutic trials

Results: 18 patients were included at this study with a mean age of 64, 8 years. 80% of them was found to have sensory - motor deficit. Evidence of demylination was found in 8 subjects and axonal deficit was found in another 6 subjects there were only one with Miller-Fisher syndrome and 3 unclassfied. Plasmapharesis was carried out to 12 patients and [IVIg] in 2 patients. No significant difference between the two groups as regarding disability score before treatment .no significant difference in outcome in both groups after treatment

Conclusion: Axonal GBS are more frequent in elderly and this may have a prognostic clue. plasmapharesis and IVIg treatments have no significant difference in outcome but with more complications at plasmaphresis than IVIg

Plasma trace elements: selenium, zinc and magnesium in patients with refractory epilepsy

Objective: To study the effect of long term use of antiepleptic drugs [AEDs] on the serum levels of selenium, zinc, and magnesium and the role of these trace elements in evolution of refractory seizures

Subjects and Methods: Thirty patients were chosen to have idiopathic tonic clonic seizures [15 Cases] and idiopathic partial epilepsy [15 Cases]. They were 18 males and 12 females with age range 16-44 years. [mean 31.85+/- 4. 68 yr].Preliminary studies were done[thorough general and neurological evaluation, brain imaging studies [CT and MRI], Serum electrolytes and blood gases, random blood sugar, total calcium assay, electroencephlography] to exclude cases with suspected etiology for recurrence of seizures and cases of low serum drug levels. Patients selected for the study were additionally subjected to: determination of serum levels of antie-pileptic drugs [phenytoin, carbamazepine valporoate, and clonazepam] by using commercially available kits from Behring diagnostic Inc., and assessment of plasma trace elements levels [selenium, zinc and magnesium] by using the atomic absorption spectrophotometry method. Fifteen healthy subjects of matched age and sex were tested for plasma selenium, zinc and magnesium as a control group

Results: No significant differences between the two patients' groups as regards age, sex, frequency of fits ,duration of illness and Plasma trace element levels . One way ANOVA showed significant lower levels of zinc and magnesium in all of the patients compared to controls [P<0.001 and P<0.05 respectively]. Serum selenium levels were nearly significantly lower in epileptic patients [p=0.08] than in control. Correlation studies revealed a significant negative correlation between selenium levels and duration of AED therapy [r=-0.65 and P<0.05], PHY serum level [r=-0.42 and P<0.05], and VPA serum level [r=-0.62 and P<0.05]. Also a significant negative correlation between plasma zinc levels and age of the patients [r=-0.52 and P<0.05], duration of AEDs therapy [r=-0.73 and P=0.04], phenytoin serum level[r=-0.64 and P=0.04], and valporoate serum level [r=-0.65 and P=0.04], In addition, there was a significant negative correlation between plasma magnesum levels and age of the patients [r=- 0.52 and P<0.05] duration of AEDs therapy [r=-0.65 and P<0.05], PHY serum level [r=-0.69 and P<0.05]

Conclusion: The long term use of antiepileptics may lead to trace element deficiencies, especially selenium, zinc and magnesium with subsequent neuronal damage and evolution of resistant states. In future, wide scale studies to investigate the effect of anti- epileptic drugs on other trace elements and suppelmentation of these elements in every case of epilepsy who developed intractable seizures during the course of antiepileptics and before the addition of more drugs