Reliability, validity, and responsiveness of the Arabic version of HIT-6 questionnaire in patients with migraine indicated for preventive therapy: A multi-center study.

BACKGROUND: The Headache Impact Test (HIT-6) is an important patient-reported outcome measure (PROM) in migraine prevention trials. OBJECTIVES: This study aimed to (i) assess the reliability and validity of the Arabic version of HIT-6 in Arabic-speaking patients experiencing migraine, and (ii) evaluate the responsiveness of HIT-6 following migraine preventive therapy. METHODS: In this prospective study, patients with migraine (n = 145) were requested to fill out a headache diary, the Arabic version of HIT-6, and Migraine Disability Assessment Scale (MIDAS) at two time points (baseline and 3 months after initiation of prophylactic treatment). Some respondents (n = 73) were requested to fill out HIT-6 again 1 week from the baseline for test-retest reliability. The intensity of migraine headache attacks was evaluated using the Visual Analogue Scale (VAS). An anchor-based method was used to establish the minimal important change (MIC) value and responsiveness of HIT-6. RESULTS: The total scores of HIT-6 were significantly correlated to a fair degree with MIDAS (r = 0.41), as well as VAS (r = 0.53), and monthly migraine days (r = 0.38) at the baseline while at the follow-up (after 3 months), the correlations were of moderate degree with MIDAS scores (r = 0.62) and monthly migraine days (r = 0.60; convergent validity). Reliability estimates of the Arabic HIT-6 were excellent (Cronbach's α = 0.91 at baseline and 0.89 at follow-up). The average measure interclass correlation coefficient (ICC) value for the test-retest reliability was 0.96 (95% confidence interval = 0.94-0.98, p < 0.001). The HIT-6 total score is sensitive to change, being significantly reduced after prophylactic treatment compared to before (effect size = 1.5, standardized response mean = 1.3). A reduction from baseline of 4.5 on HIT-6 showed the highest responsiveness to predict improvement with an area under the curve equal to 0.66, sensitivity of 80%, specificity of 45%, and significance at 0.021. Changes in the HIT-6 total score were positively correlated with changes in monthly migraine days (r = 0.40) and VAS scores (r = 0.69) but not with changes in the score of MIDAS (r = 0.07). CONCLUSION: The Arabic version of HIT-6 is valid, reliable, and sensitive to detect clinical changes following migraine prophylactic treatment with a MIC of 4.5 points.

Neurological Manifestations in a Cohort of Egyptian Patients with COVID-19: A Prospective, Multicenter, Observational Study.

BACKGROUND: The COVID-19 pandemic has reached over 276 million people globally with 5.3 million deaths as of 22nd December 2021. COVID-19-associated acute and long-term neurological manifestations are well recognized. The exact profile and the timing of neurological events in relation to the onset of infection are worth exploring. The aim of the current body of work was to determine the frequency, pattern, and temporal profile of neurological manifestations in a cohort of Egyptian patients with confirmed COVID-19 infection. METHODS: This was a prospective study conducted on 582 hospitalized COVID-19 patients within the first two weeks of the diagnosis of COVID-19 to detect any specific or non-specific neurological events. RESULTS: The patients' mean (SD) age was 46.74 (17.26) years, and 340 (58.42%) patients were females. The most commonly encountered COVID-19 symptoms were fever (90.72%), cough (82.99%), and fatigue (76.98%). Neurological events (NE) detected in 283 patients (48.63%) and were significantly associated with a severe COVID-19 at the onset (OR: 3.13; 95% CI: 2.18-4.51; p < 0.0001) and with a higher mortality (OR: 2.56; 95% CI: 1.48-5.46; p = 0.019). The most frequently reported NEs were headaches (n = 167) and myalgias (n = 126). Neurological syndromes included stroke (n = 14), encephalitis (n = 12), encephalopathy (n = 11), transverse myelitis (n = 6) and Guillain-Barré syndrome (n = 4). CONCLUSIONS: Neurological involvement is common (48.63%) in COVID-19 patients within the first two weeks of the illness. This includes neurological symptoms such as anosmia, headaches, as well as a constellation of neurological syndromes such as stroke, encephalitis, transverse myelitis, and Guillain-Barré syndrome. Severity of acute COVID-19 illness and older age are the main risk factors.

Impact of Ramadan fasting on disease activity in patients with multiple sclerosis: a multicenter study.

BACKGROUND: The safety of Ramadan fasting for Muslim patients suffering from multiple sclerosis (MS) is still a matter of debate. This work aimed to study the clinical course of MS during Ramadan fasting and to clarify the predictors of relapses and symptoms exacerbation. METHODS: This retrospective study included 153 Muslim patients with MS. Data related to the disease course before Ramadan were obtained from patients' files, whereas data related to the disease activity during Ramadan, were collected from patients over the two months following Ramadan. RESULTS: Patients with MS who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant longer disease duration compared to those who did not experience (P < 0.001, <0.001, 0.01 respectively). Also, patients who experienced relapses, exacerbation of symptoms and development of new symptoms during Ramadan had a statistically significant higher expanded disability status scale (EDSS) compared to those who did not experience (P <0.001, <0.001,0.01, respectively). The occurrence of relapses, exacerbation of symptoms and development of new symptoms during Ramadan, were significantly higher in patients who experienced relapses in the preceding year compared to those who did not (P= 0.002, 0.002, 0.01, respectively). Binary logistic regression revealed that each score elevation of EDSS increased the odds of relapse during Ramadan by 1.02 (P-value = 0.04). Also, each month's increase in disease duration increased the odds of relapse during Ramadan by 1.87 (P-value = 0.046). CONCLUSION: High EDSS and long disease duration are independent predictors of relapse during Ramadan.

Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era.

The ongoing coronavirus (COVID-19) pandemic is a global health emergency of international concern and has affected management plans of many autoimmune disorders. Immunosuppressive and immunomodulatory therapies are pivotal in the management of neuromyelitis optica spectrum disorder (NMOSD), potentially placing patients at an increased risk of contracting infections such as COVID-19. The optimal management strategy of NMOSD during the COVID-19 era remains unclear. Here, however, we examined the evidence of NMOSD disease-modifying therapies (DMTs) use during the present period and highlighted different scenarios including treatment of relapses as well as initiation and maintenance of DMTs in order to optimize care of NMOSD patients in the COVID-19 era.

Managing Disease-Modifying Therapies and Breakthrough Activity in Multiple Sclerosis Patients During the COVID-19 Pandemic: Toward an Optimized Approach.

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient's immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.

Timing to start anticoagulants after acute ischemic stroke with non-valvular atrial fibrillation.

OBJECTIVE: To identify timing for initiation of anticoagulation therapy in acute ischemic stroke (AIS) with non-valvular AF as regards safety and efficacy by detecting the rate of intracranial haemorrhage (ICH) and recurrent ischemic symptoms (RIS) during follow-up. METHODS: This is a prospective observational cohort study conducted at King Fahd Hospital of the University including 120 patients with AIS/TIAs from July 2016 till July 2018. We compared patients who received anticoagulants 1-6 days (Group I (45.83%), 7-14 days, Group II (35%), and > 14 days after the ischemic event (Group III (19.17%). Follow-up was at least 3 months and included identifying ICH or RIS. RESULT: ICH has occurred in 26.67% (n = 32) patients with a highly statistically significant association with time of treatment (P-value = .01) being higher in group I (n = 17) compared to only 1 case in group III. Subgroup analyses on the ICH patients (n = 32) has revealed statistical significant association with higher NIHSS score (P = .001). Also, the type of anticoagulants used between three groups pointed to an association existence (p = .02), however, the direction of this association cannot be determined. There was no statistical significant association between RIS (occurred in 4.16% (n = 5) with time of treatment (P = .754). Functional outcome at 3-6 months measured by mRS did not differ between 3 groups (worst mRS in group I). CONCLUSION: Early initiation of anticoagulation after stroke, especially in cases of large infarction, is associated with significant risk of ICH. This risk is highest with warfarin and lowest with DOAC.

Postepidural Spinal Intradural Arachnoid Cyst: A Rare Case Report.

Compression of the neural structures in spine by an intradural arachnoid cyst is a rare entity. At times such a cyst is an incidental finding. Spinal epidural injection is one of the few rare etiological factors for its development. Symptomatic cysts can present with variable neurological manifestations depending on the spinal level involved. This includes back pain, lower limb weakness, and sphincteric dysfunction. If asymptomatic, they can be followed radiologically. Surgical decompression along with a histological diagnosis is reserved for cysts that are enlarging, symptomatic or the ones for whom the diagnosis is uncertain. Incomplete excision of cyst wall or simple fenestration and decompression mandates close follow-up, clinically and radiologically for further recurrences.

Role of serum TRAIL level and TRAIL apoptosis gene expression in multiple sclerosis and relation to brain atrophy.

One of the presumed pathological mechanisms of multiple sclerosis (MS) is the failure of apoptosis of autoreactive T lymphocytes. This study aimed to determine the relationship of the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) mRNA gene expression ratio and serum TRAIL levels with MS and brain atrophy. This study was conducted on 53 relapsing-remitting Egyptian MS patients and 25 matched healthy volunteers. The expression of TRAIL in peripheral blood lymphocytes was analyzed by reverse transcription polymerase chain reaction, serum levels of soluble TRAIL (sTRAIL) were determined by enzyme-linked immunosorbent assay and brain MRI measured "black holes" and the bicaudate ratio as a measure of brain atrophy in all patients. The serum TRAIL level was lower in MS patients compared to controls but no difference was seen in the TRAIL mRNA gene expression ratio. No significant correlation was detected between the serum TRAIL level and the TRAIL mRNA expression ratio in either group. No statistically significant correlation was found between serum TRAIL levels or the TRAIL mRNA expression ratio with the number of black holes or the bicaudate ratio on MRI. Apoptosis of T lymphocytes is decreased in MS patients, which could be useful when designing treatments. There was no difference in the TRAIL mRNA gene expression ratio between MS patients and controls.

Sleep-related breathing disorders in cerebrovascular stroke and transient ischemic attacks: a comparative study.

Sleep-related breathing disorders are said to be common in patients with established cerebrovascular accidents. The aim of this study was to assess the frequency and characteristics of sleep-related breathing disorders in ischemic stroke and transient ischemic attacks. All patients were subjected to neurologic assessment, Berlin questionnaire (Arabic version), brain computed tomographic scan, and polysomnography along 6 to 8 hours overnight with special emphasis to apnea/hypopnea indices. All assessments were done for 30 patients who had stroke and transient ischemic attacks as well as 20 age- and sex-matched controls. Overall, 13.3% of patients had mild sleep apnea (apnea/hypopnea index, >5), 13.3% had moderate sleep apnea (apnea/hypopnea index, >15), and 34% had severe sleep apnea (apnea/hypopnea index, >30). The sensitivity and specificity of Berlin questionnaire for obstructive sleep apnea diagnosis were 55% and 100%, respectively, for mild sleep apnea, 56.3% and 85.7% for moderate sleep apnea, 66.7% and 83.3% for severe condition. Berlin questionnaire is a moderate sensitive but highly specific screening test for sleep apnea in cerebrovascular diseases. Those who scored high risk should consider polysomnography to specify the type and severity of apnea.

Role of interleukin 6 and alpha-globulins in differentiating Alzheimer and vascular dementias.

BACKGROUND: Inflammatory mechanisms and immune activation have been hypothesized to play a role in the pathogenesis of age-associated diseases, including Alzheimer's disease. PURPOSE: The evaluation of inflammatory markers in patients with dementia, and to determine whether these markers can be used to differentiate between vascular dementia (VD) and Alzheimer's dementia (AD). PATIENTS AND METHODS: Twenty demented patients (10 AD and 10 VD) and 20 non-demented controls were subjected to clinical evaluation, MRI brain scans and laboratory tests, including interleukin (IL) 6, C-reactive protein and serum protein electrophoresis. RESULTS: The results of this study revealed that serum levels of IL-6 and C-reactive protein were significantly elevated among patients with both types of dementia compared to normal elderly subjects. Although the mean IL-6 level was higher in patients with AD compared to patients with VD, this difference was not significant. The cutoff value at which the serum level of IL-6 gave maximum sensitivity and specificity was 14.25 pg/ml. Moreover, α1- and α2-globulins were able to discriminate between AD and VD (being significantly higher in AD). CONCLUSION: IL-6 levels could be used to differentiate dementia from normal aging. Moreover, α1- and α2-globulins could differentiate between AD and VD. It can be concluded that inflammation plays an important role in both types of dementia.

Guillain-Barré syndrome as a prominent cause of childhood acute flaccid paralysis in post polio eradication era in Egypt.

Guillain-Barré syndrome often follows an antecedent gastrointestinal or respiratory illness but, in rare cases, follows vaccination. This study was conducted to identify preceding events, demographic, clinical characteristics and prognostic factors of childhood Guillain-Barré syndrome after post-poliomyelitis eradication era in Egypt. This is a prospective study of all children with GBS (no = 50) admitted to pediatric Cairo University Hospital between January 2006 and June 2007 (70.42% of all acute flaccid paralysis patients during this period). Upper respiratory infection was the most common preceding event (24%) while only 4 patients (8%) reported antecedent oral polio vaccine. Motor deficit was frequent and severe (quadriparesis in 92% and paraparesis in 8%). Autonomic dysfunction was recorded in 32% of patients. Forty two percent of patients had poor outcome with 16% deaths. Presence of severe disability on admission and on nadir, cranial nerve affection or the need for mechanical ventilator were found to be significant predictors for poor outcome.