Epidemiology of intractable epilepsy in Al-Kharga district; new valley; [Egypt]

Drug-resistant epilepsy, despite the advancement in epilepsy treatment, continues to be a major clinical problem with devastating consequences. Identification of the prevalence of intractable epilepsy, as well as causes of intractability. Total population of 62,583 persons were screened through door to door survey, including every door. All suspected cases of epilepsy were subjected to complete history taking, meticulous examination, conventional EEG, and Stanford-Binnet intelligence scale. Monitoring of serum level of AEDs was done for those with possible intractable seizures to ensure adequate dose compliance. Patients have an average seizure frequency of one or more per month during the last 6 months despite optimal and suitable use of AED were considered truly intractable Ohtsuka et al [2001]. They were subjected to video monitoring EEG, and brain MRI. In this study, 437 epileptic patients were identified with a life time prevalence rate of epilepsy 6.98/1000, out of whom, 11.4% [n = 50/134] of patients were intractable with a prevalence rate 0.8/1000. Possible aetiology of intractable epilepsy was determined among 46% of cases [Remote symptomatic], while 58% of cases had unknown causes [idiopathic and cryptogenic]. Symptomatic and cryptogenic causes had signicantly lower IQ than idiopathic group Perinatal complications should be better avoided and/or managed to avoid a large sector of intractable epilepsy

Rheumatic chorea; clinical, neurophysiological, and laboratory study

Rheumatic Chorea [Rh.C.] is the only extrapyramidal syndrome presents with hypotonia. However the pathogenesis of this hypotonia is not known. Still it is not known whether it is due to peripheral or central lesion. This work was designed to study the neurophysiologic and laboratory correlates of hypotonia in Rh. C. patients. The study included 20 patients with Rheumatic Chorea [15 females and 5 males] with mean age 77.7 +/- 5.5, they were subjected to : complete neuropsychiatric examination with evaluation of the duration and severity of chorea, electrophysiologic studies including; Distal Latency [DL], Motor Conduction Velocity [MCV], Compound Muscle Action Potential [cMAP], F.wave, H.Reflex latencies; and laboratory studies including; detection of ESR, ASOT, and serum immunoglobulin IgG. Neurophysiologic parameters were matched to that of 30 control subjects with mean age [13.1 + 5.4], and serum immunoglobulin G was compared to that of 12 normal control subjects with mean age 14.2. The study revealed that 70% were experiencing their 1[st] choreic acute attack, 15% had history of recurrence. [2[nd] attack] and 15% had chronic persistent Rh.C. Neurological examination revealed that 80% of our patients had hypotonia. Choreic movement were generalized in 95% of cases, but mostly asymmetrical [55%]. Neurophysiologic studies revealed generalized disruption of peripheral nerve function in comparison to controls, mainly of mixed type [50%.]. In the demyelinating type; proximal involvement was more common than distal involvement. ESR was elevated in 65% and 95% of cases at the 1[st] and 2[nd] hour respectively, while positive ASOT was recorded in 30% of cases only. There was significant positive correlation between serum level of IgG and various studied neurophysiologic parameters [F-wave and H-Reflex latencies, DL, and MCV]. But there was no significant relation between the distribution of hypotonia and the studied neurophysiologic parameters, which may suggest a possible role of other contributing factors, not yet studied

Neural maturation of breast and formula fed infants

Human milk provides infants with a full complement of all polyunsaturated fatty acids, including docosahexaenoic acid [DHA] and arachidonic acid [AA]. Formula milks contain only the precursors of DHA and AA, and linoleic acid and hence formula fed infants must synthesize their own DHA and AA. This work aimed at evaluating the hypothesis that the method of feeding; whether breast feeding or formula feeding in early infancy affects subsequent neurodevelopment and achievement of optimum brain function [Visual system, auditory and Sensory system]. The present study includes 53 infants [at the age of one year +/- I month], 30 infants were exclusively breast fed and 23 infants were exclusively formula fed. Each infant was subjected to a full neurological examination and neurophysiological studies including, flash Visual Evoked Potentials [FVEPs], Auditory Brainstem Evoked Potentials [ABEPs], and Somatosensory Evoked Potentials [SSEPs]. There was significant prolongation in the P100 wave latency of FVEP in formula fed infants [96.4 +/- 9.0] compared with breast-fed infants [90.2 +/- 8.5]. There was a significant prolongation of absolute latency of wave I with subsequent prolongation of wave Ill and wave V in formula-fed infants group compared with breast fed infants group. Meanwhile, there was no significant differences between the two groups as regards to interpeak latencies. There was significant prolongation in interpeak latencies between cortical and Erb's components in formula fed infants compared with breast fed infants. There was no significant correlation between sex, consanguinity, sibbling number, order of birth, parental educational level, age of supplementation of foods, social level, head circumference, anterior fontanel and different variables of evoked potentials. VEP, BAEP and SSEP are more mature in breast fed infants relative to formula fed infants at one year of age. Consequently we can speculate that breast milk helps earlier development and maturation of some aspects of the nervous system than milk formulas

Impact of stress on cognitive functions

This work was designed to study the effect of mental [exam] stress on the memory performance and on other cognitive functions. This was carried out through the evaluation of the cognitive aspects of 61 volunteer students [28 males and 33 females] during basal state by cognitive ability screening instrument [CASI] and Wechsler memory scale [WMS] together with an assessment of their anxiety levels by Hamilton anxiety scale and an estimation of the serum levels of catecholamines and cortisol. These estimates were reevaluated two months later immediately after exposure to mental [exam] stress. It was found that immediately after exposure to mental stress, there was a significant decline in all memory functions and total cognitive scales together with a significant increase in the perceived levels of anxiety symptoms and a significant rise in the serum levels of stress hormones. Stress hormones levels were found to have differential effects on memory and other cognitive functions with an end result of total impairment of these functions

Psychological stressful life events preceding cerebrovascular

The relationship of stressful life events [SLE] to cerebrovascular stroke through long term effect or short term effect was studied through evaluation of 120 stroke patients and 107 healthy controls of matched age and sex. A lot of laboratory investigations were carried out to verify the diagnosis and for detection of different risk factors. The study clarified the possible role of SLE as a risk factor through its long and short term effects. The mean scores of total SLE were significantly higher among stroke patients than controls whether along two years or one week prior to stroke. The proportion of stroke patients reporting at least one SLE was comparable to that of the controls along two years prior to stroke, but significantly exceeded the controls only during one week and one day immediately preceding stroke

Role of norharman, harman and ceruloplasmin in the aetiopathogenesis of Parkinson's disease

Determination of serum levels of Norharman, Harman and Ceruloplasmin of 39 patients with PD and 54 age and sex matched control subjects was done. The study aimed to identify the possible role of these biochemical indices in the etiopathogenesis of PD. The study clarified that most of the PD patients [59%] had moderate degree of illness. The most frequent presenting signs were in the following order: Resting tremors and bradykinesia in 97.4% of cases for each, loss of upper limb swinging during walking in 94.9%, mask facies in 92.3%, rigidity in 84.6%, postural abnormalities and speech disorders in 71.8% for each. Highly significant increase of serum levels of Harman and Norharman and highly significant decrease of Ceruloplasmin level were found among PD patients compared with the control group. The study added more support to the possible roles of the biochemical substances in the etiopathogenesis of Parkinson's disease through defects in the enzymes that regulate potential nigral neurotoxins [Norharman and Harman] or by the deficiency of one of the major plasma antioxidants [Ceruloplasmin]