Consensus Guideline on the Management of Epilepsy in Egypt: A National Delphi Consensus Study.

OBJECTIVE: In epilepsy, early diagnosis, accurate determination of epilepsy type, proper selection of antiseizure medication, and monitoring are all essential. However, despite recent therapeutic advances and conceptual reconsiderations in the classification and management of epilepsy, serious gaps are still encountered in day-to-day practice in Egypt as well as several other resource-limited countries. Premature mortality, poor quality of life, socio-economic burden, cognitive problems, poor treatment outcomes, and comorbidities are major challenges that require urgent actions to be implemented at all levels. In recognition of this, a group of Egyptian epilepsy experts met through a series of consecutive meetings to specify the main concepts concerning the diagnosis and management of epilepsy, with the ultimate goal of establishing a nationwide Egyptian consensus. METHODS: The consensus was developed through a modified Delphi methodology. A thorough review of the most recent relevant literature and international guidelines was performed to evaluate their applicability to the Egyptian situation. Afterward, several remote and live rounds were scheduled to reach a final agreement for all listed statements. RESULTS: Of 278 statements reviewed in the first round, 256 achieved ≥80% agreement. Live discussion and refinement of the 22 statements that did not reach consensus during the first round took place, followed by final live voting then consensus was achieved for all remaining statements. SIGNIFICANCE: With the implementation of these unified recommendations, we believe this will bring about substantial improvements in both the quality of care and treatment outcomes for persons with epilepsy in Egypt. PLAIN LANGUAGE SUMMARY: This work represents the efforts of a group of medical experts to reach an agreement on the best medical practice related to people with epilepsy based on previously published recommendations while taking into consideration applicable options in resource-limited countries. The publication of this document is expected to minimize many malpractice issues and pave the way for better healthcare services on both individual and governmental levels.

Prediction of motor recovery after ischemic stroke: Clinical and diffusion tensor imaging study.

BACKGROUND: The severity of stroke-induced disruption to the corticospinal tract (CST) would be predictable to affect motor outcome. Diffusion tensor imaging (DTI) is a noninvasive technique that can be applied to assess the structural integrity of the CST. AIM OF THE WORK: To assess the value of DTI in patients early presenting with acute ischemic stroke as a prognostic modality to predict the clinical outcome PATIENTS AND METHODS: Thirty-four patients with acute ischemic stroke underwent clinical assessment using the National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Medical Research Council (MRC) score, Morticity Index (MI), and DTI to detect the degree of reduction of fractional anisotropy (FA), and pattern of CST at baseline and after 6 months follow up. Seventeen age, sex matched controls underwent DTI assessment. RESULTS: The stroke patients showed a significant reduction in the baseline FA values of the CSTs on the affected sides compared to the contralateral sides and controls. Moreover, they showed lower mean baseline FA lesion side and FA ratio(rFA) compared to follow up. The patients with high baseline FA, rFA showed good recovery response with cut off values of 0.483, 0.948 respectively. There was a significant negative correlation between baseline FA on the lesion side, rFA and follow up NIHSS, and MRS scores and they had a significant positive correlation with follow up MI scores. CONCLUSION: Patients with higher baseline FA, rFA values were correlated with better motor recovery, and could predict the motor recovery in ischemic stroke patients.

Prevalence of Stroke in Fayoum Governorate, Egypt: A Community-Based Study.

BACKGROUND: Stroke is a highly prevalent disease with consequent mortality and morbidity. Few community based studies have been conducted only in upper Egypt to estimate prevalence of stroke. OBJECTIVES: This study was designed to find out the prevalence of stroke in Fayoum Governorate & to study some associated risk factors. METHODS: through this community based cross-sectional study 4784 participants aged more than or equal to 18 years old were enrolled. A multi-stage random sample technique was followed to choose the study sample. A predesigned interviewer-administered structured questionnaire was used. Suspected stroke case by screening questionnaire was referred to the neurologist. RESULTS: The Crude prevalence of stroke was 16 out of 1000 with confidence interval of proportion (12.6%-19.7%). The age adjusted local (Fayoum 2017 census) prevalence rate was 7.97 out of 1000, age adjusted prevalence rate (Egypt population 2017) was 1.05 out of 1000. Age-adjusted World Health Organization standard world population prevalence rate was 1.69 out of 1000. The crude prevalence of ischemic stroke was significantly higher than hemorrhagic stroke 11.9 versus 3.9 out of 1000 population. The most prevalent risk factor was smoking among males, followed by obesity then hypertension. The prevalence of stroke was significantly higher among participants affected with hypertension, diabetes, heart diseases, obesity, and smoking. Logistic regression analysis showed that having hypertension, diabetes, heart diseases, atrial fibrillation, obesity, and smoking were reported risk factors of stroke. CONCLUSIONS: The prevalence of stroke in Fayoum governorate was 1.6%. Hypertension, diabetes, heart diseases, obesity, and smoking were reported risk factors of stroke.

Genetic resistance of eight native Egyptian chicken breeds having chicken B-cell marker 6 gene post-challenge with field strain of Marek's disease-induced tumor virus.

AIM: The aim of this work was to detect chicken B-cell marker 6 (ChB6) gene in some native breeds in Egypt and find the relationship between founded genes in these different breeds to determine the resistance of native Egyptian breeds of chicken to Marek's disease (MD). MATERIALS AND METHODS: A total of 14 different chicken breeds (30 each) including ten native breeds in addition to SPF Lohmann, High Line, Bovans, and Roodiland were used. Blood samples were collected for the detection of (ChB6) by polymerase chain reaction (PCR) assay and sequenced to determine the presence or absence of ChB6 gene. Experimental infection was done using local field isolated MD virus (MDV) of 11 (1 day old) unvaccinated chick breeds having no maternal antibodies against MDV. Ten breeds of them carry ChB6 gene, eight breeds were native, and the rest two breeds were SPF Lohmann and High Line in addition to a group of ChB6 gene-lacking breed (Bovans) were infected. Spleen samples were collected from all infected breeds at 20th, 25th, 30th, 35th, and 40th weeks post-infection and tested by PCR assay for the detection of MDV. Furthermore, at 40th week post-infection, tumorized spleen sample of Bovans breed was collected and prepared for examination by transmission electron microscope (TEM) to confirm the presence of MDV. RESULTS: Our results revealed the positivity of 10 out of 14 breeds (Gimmizah, Sinai, Dandarawi, Fayoumi, Golden Montazah, Matrouh, Beheri, Dokki, SPF Lohmann, and High Line) to the presence of ChB6 gene and resistance to MDV infection, while the Bovans, Mandarah, Inshas and Roodiland breeds lack the ChB6 gene and are susceptible to MDV infection. The collected spleen samples revealed negative for the presence of challenged MDV by PCR in 10 breeds (Gimmizah, Sinai, Dandarawi, Fayoumi, Golden Montazah, Matrouh, Beheri, Dokki, SPF Lohmann, and High Line) and positive for Bovans breed. TEM is used to confirm MDV infection in Bovans group which demonstrated tumors. CONCLUSION: The study confirms the relationship between the presence of ChB6 gene in our native breeds and the absence of tumors.

The relationship between the severity of disability and serum IL-8 in acute ischemic stroke patients.

BACKGROUND: Stroke is the third leading cause of death and leading cause of adult disability worldwide. Long-term disability is a significant problem among survivors; post-stroke inflammation is well known to contribute to the expansion of the ischemic lesion resulting in significant morbidity and disability. To study the impact of serum level of IL-8 on severity of disability in patients with acute ischemic stroke in the first 48 h post stroke. METHODS: A cross-sectional case control study was conducted on 44 patients with acute ischemic stroke (in the first 48 h). The patients were subjected to full neurological examination, computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, and assessment of stroke disability using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Measurement of the serum levels of IL-8, erythrocyte sedimentation rate, and C-reactive protein (CRP) was done. Forty-four matched control subjects for their age and sex were included for comparison of serum level of IL-8. RESULTS: The level of IL-8 was significantly higher in the patients than in the control subjects (p < 0.001).There was a statistically significant positive correlation between serum level of IL-8 and disability assessed by NIHSS (r = 0.42, p = 0.004). The patients with moderate disability showed significant higher IL-8 levels than those with minor disability (p = 0.02). CONCLUSION: The severity of disability in early acute ischemic stroke is highly correlated to the serum level of IL-8.

Does vitamin D deficiency predict early conversion of clinically isolated syndrome? A preliminary Egyptian study.

BACKGROUND: It has been suggested that vitamin D influences the immunoregulation and subsequently affects the risk for conversion of clinically isolated syndrome (CIS) to clinically definite multiple sclerosis (MS). There is little information regarding the relationship between levels of vitamin D and CIS conversion to MS in Egyptian patients. OBJECTIVE: It is to study contribution of vitamin D deficiency to conversion of CIS to clinically definite multiple sclerosis (CDMS) and correlation of vitamin D level to cognitive and magnetic resonance imaging (MRI) results. PATIENTS AND METHODS: A longitudinal prospective case control study was conducted on 43 Egyptian patients diagnosed as CIS according to McDonald criteria (2010). Clinical presentation, brain MRI and 25-hydroxyvitamin D levels were evaluated at baseline and after one-year follow-up. RESULTS: The CIS patients that converted to MS showed significant lower vitamin D level (p < 0.001) than the non-convertors. Multivariate logistic regression analysis revealed that the CIS patients with lower 25-hydroxyvitamin D level (p < 0.001) are at higher risk for early conversion to MS. There was a significant positive correlation between the vitamin D level and PASAT (r = 0.36, p = 0.02). It was found that there was a significant negative correlation between vitamin D level and MRI T2 load (r = -0.38, p = 0.01). CONCLUSION: The low level of 25-hydroxyvitamin D may predict early conversion to clinically definite MS. Early vitamin D supplementation is recommended in patients with CIS.

Predictors of Outcome of Convulsive Status Epilepticus Among an Egyptian Pediatric Tertiary Hospital.

Convulsive status epilepticus is a common neurologic emergency in pediatrics. We aimed to study the etiology, clinical features, and prognostic factors among pediatric patients with convulsive status epilepticus. Seventy patients were included in this cohort study from pediatric emergency department of the specialized Children Hospital of Cairo University. The outcome was evaluated using the Glasgow Outcome Score. Acute symptomatic etiology was the most common cause of convulsive status epilepticus. Refractory convulsive status epilepticus was observed more significantly in cases caused by acute symptomatic etiologies. The outcome was mortality in 26 (37.1%) patients, severe disability in 15 (21.4%), moderate disability in 17 (24.3%), and good recovery in 12 (17.1%) patients. The significant predictor of mortality was lower modified Glasgow Coma Scale score on admission, whereas lower modified Glasgow Coma Scale score on admission and refractory convulsive status epilepticus were the significant predictors for disability and mortality.

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.