Motor cortex rTMS improves dexterity in relapsing-remitting and secondary progressive multiple sclerosis.

The motor cortex (MC) receives an excitatory input from the cerebellum which is reduced in patients with cerebellar lesions. High-frequency repetitive transcranial magnetic stimulation (rTMS) induces cortical facilitation which can counteract the reduced cerebellar drive to the MC. Our study included 24 relapsing-remitting multiple sclerosis (RRMS) and secondary progressive multiple sclerosis (SPMS) patients with dysmetria. The patients were divided into two groups: Group A received two sessions of real MC rTMS and Group B received one session of real rTMS and one session of sham rTMS. Ten healthy volunteers formed group C. Evaluation was carried out using the nine-hole pegboard task and the cerebellar functional system score (FSS) of the expanded disability status scale (EDSS). Group A patients showed a significant improvement in the time required to finish the pegboard task (P = 0.002) and in their cerebellar FSS (P = 0.000) directly after the second session and 1 month later. The RRMS patients showed more improvement than the SPMS patients. Group B patients did not show any improvement in the pegboard task or the cerebellar FSS. These results indicate that MC rTMS can be a promising option in treating both RRMS or SPMS patients with cerebellar impairment and that its effect can be long-lasting.

Detection of asymptomatic cranial neuropathies in patients with systemic lupus erythematosus and their relation to antiribosomal P antibody levels and disease activity.

The objectives of this study are to assess the risk of asymptomatic cranial neuropathy among patients with systemic lupus erythematosus (SLE) and find any association with disease activity and antiribosomal P antibodies. This study is a case-control study including 60 female patients and 30 healthy female controls. Disease activity was measured with the SLE disease activity index (SLEDAI). All patients were evaluated using evoked potentials, blink reflex, and levels of antiribosomal P antibodies. Patients with abnormal electrophysiological parameters had significantly higher levels of antiribosomal P antibodies (P = 0.034) and secondary antiphospholipid syndrome (P = 0.044). Antiribosomal P antibodies (odds ratio 5.4, 95 % confidence interval 1.002-1.03, P = 0.002) and presence of anti-DNA antibodies (odds ratio 1.01, 95 % confidence interval 1.2-24.8, P = 0.032) were independent risk factors for the presence of the abnormal electrophysiological parameters. Disease duration was positively correlated with wave 1 of the auditory brain reflex (P < 0.001) and a latency of the evoked blink reflex (component R1, P = 0.013). SLEDAI scores were positively correlated with latencies of the visually evoked potential (P100, P = 0.02), wave 1 of the auditory brain reflex (P < 0.001), and a latency of the evoked blink reflex (R2c, P = 0.005). Steroid dosage was negatively correlated with P100 latencies (P = 0.042) and components of the evoked blink reflex (R1, P = 0.042; R2i, P = 0.041; R2c, P < 0.001). Because abnormalities in the visually evoked potential and blink reflex were associated with antiribosomal P antibodies, they can be useful for detecting asymptomatic cranial neuropathy. Further studies on large number of patients should be done to determine any association.

Obstructive sleep apnea in epilepsy: a preliminary Egyptian study.

PURPOSE: The extent and clinical relevance of the association between epilepsy and sleep apnea are not previously studied in Egypt. What we wanted to know was the frequency of sleep apnea in Egyptian children with epilepsy and its influence on seizure frequency, other seizure characteristics, sleep complaint, and architecture. METHODS: All patients with epilepsy, aged up to 18 years, who underwent polysomnography were studied. Patients with any neurological disease apart from epilepsy, with psychiatric illness, had hypnotics, or sedatives or those with liver or kidney failure were excluded from the study. The patients were divided into two subgroups according to apnea/hypopnea index: group (1) patients without obstructive sleep apnea (OSA) and group (2) patients with OSA. For control group, we choose 12 healthy individuals, with age and sex matched to that of our patients. We studied the clinical characteristics of epilepsy, sleep history, and polysomnographic recording of the patients with epilepsy and the control. EEG digital and video monitoring was done for all patients. RESULTS: Eleven patients (42.3%) were found to have obstructive sleep apnea. Seizure frequency was significantly higher in the patients with OSA. Apart from apnea and hypopnea indices, all other sleep parameters did not differ between patients' subgroups. Hypopnea index in REM positively correlates with number of awaking. Apnea index in REM positively correlates with latency to deep sleep and to periodic leg movement. CONCLUSIONS AND RECOMMENDATIONS: Sleep apnea is frequent in patients with epilepsy. OSA may contribute to increase seizure frequency. We recommend investigating sleep apnea in all patients with epilepsy.