Tramadol-associated seizures in Egypt: Epidemiological, clinical, and radiological study.

BACKGROUND: Tramadol intake related seizures have emerged as a common cause of seizures in Egypt affecting mainly young men. OBJECTIVE: This study aimed to determine the percentage of tramadol induced seizures, and to compare the clinical, neurophysiological, and radiological features of tramadol induced seizures group with idiopathic epilepsy group. METHODS: Two phases study; at first phase, data analysis for all Kasr-Alainy epilepsy clinic patients in Cairo during the period from January 2012 through June 2014, then at second phase a group of tramadol induced seizures' patients were compared with a matching group of idiopathic epilepsy patients. Detailed history and examination, laboratory tests, electroencephalogram (EEG), Magnetic Resonance Imaging (MRI) of the brain, and Hamilton depression rating scale (HAM-D) were performed for both groups. RESULTS: Tramadol induced seizures represented 7% of all patients (103 out of 1480) and 12% of male patients. All cases were males. Occupational driving was the most common job. Seizures were generalized tonic clonic (GTCs) in 86%. Seventy-seven percent of tramadol induced seizures developed with toxic tramadol dose (>400 mg/day). Inter-ictal EEG was normal in most patients (87.5%). Depression and EEG abnormalities were significantly less than idiopathic epilepsy patients. MRI brain for both groups was normal. CONCLUSION: Tramadol induced seizures represented 7% of cases. This deviates the attention to the problem of tramadol addiction in Egypt and raises our awareness of tramadol induced seizures.

Screening of Asymptomatic Intracranial Arterial Stenosis among High Risk Subjects: A Pilot Study from Egypt.

BACKGROUND: Stroke ranks as the second leading cause of death and the leading cause of morbidity worldwide. Large intracranial arterial stenosis (ICAS) is a major cause of stroke. METHODS: This study investigated the prevalence and associated vascular risk factors of ICAS in a high-risk population in Qalyeubia Governorate, Egypt. A cross-sectional pilot survey using transcranial Doppler (TCD) was conducted at Toukh Central Hospital and Aghore El-qubra primary healthcare units in the Qalyeubia Governorate from 1 January 2016 until the end of June 2016. RESULTS: A total of 153 participants were included in this study. The prevalence of asymptomatic ICAS was 13.1%. Among the modifiable risk factors, cardiac diseases, hypertension, diabetes, obesity, dyslipidemia, physical inactivity, and smoking were the strongest independent predictors of ICAS. CONCLUSION: This pilot study concluded that the prevalence of asymptomatic ICAS is relatively high in Egypt, and modifiable risk factors were the strongest predisposing factors of ICAS. TCD is an efficient non-invasive modality for the diagnostic evaluation of ICAS.

Public stroke knowledge, awareness, and response to acute stroke: Multi-center study from 4 Egyptian governorates.

BACKGROUND AND PURPOSE: Acute stroke treatment has significantly improved over the years in Egypt. However, there is often notable delay in pre-hospital and in-hospital management of acute stroke patients. The delay may be largely attributed to poor stroke knowledge and awareness of the general public and this study was aimed at the evaluation of the abovementioned factors. METHODS: Descriptive cross-sectional study involving 1154 participants from 4 governorates using a questionnaire in Arabic, collecting sociodemographic data, participants' risk factors, and knowledge and stroke awareness (risk factors, symptoms, prevention, treatment and prognosis, action in response to acute stroke). Data were collected during the World stroke day October 29, 2015. RESULTS: Study participants were found to have a low level of awareness of stroke with median percent score of 35.7% and interquartile range (IQR) of 17.86. Higher income, level of education, having risk factors and knowing someone with stroke were significant predictors of a higher level of stroke awareness. CONCLUSION: In general, low public stroke awareness has been detected among Egyptians, and this is a call for healthcare authorities to invest in public education programmes among the Egyptian population.

Effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients.

BACKGROUND: Large number of patients with first-ever stroke developed spasticity. Spasticity can reduce the range of motion, hinder voluntary movements, provoke pain, and result in impairment of functional activities of daily living. OBJECTIVE: Demonstrate the effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients. METHODS: We included forty ischemic stroke patients divided into 2 groups; group I were subjected to the selected physical therapy program and shock wave therapy whereas group II received the selected physical therapy program as well as placebo shock wave for six weeks. Both groups were subjected to pre- and post-treatment assessment by H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking. RESULTS: Baseline characteristics showed no significant difference between the two groups regarding the grades of spasticity. Whereas After treatment, there were a highly significant difference between both groups regarding the grades of spasticity according to the 3 parameters, H/M ratio, dorsiflexion active range of motion, and time of ten-meters walking test (P values; <0.001, 0.006, and 0.009 respectively). CONCLUSIONS: Shock wave therapy is effective in controlling spasticity, increase dorsiflexion active range of motion of ankle and improving ten- meters walking test in stroke patients.

Arabic cross cultural adaptation and validation of the National Institutes of Health Stroke Scale.

INTRODUCTION: The National Institutes of Health Stroke Scale (NIHSS), the most commonly used tool to quantify neurological deficit in acute stroke, was initially developed in English. We present our experience in developing and validating an Arabic version of the NIHSS (arNIHSS). RESULTS: In 6months, 137 patients were recruited (mean age±standard deviation 62±12years; 48 women). For interrater agreement, weighted kappa value ranged from 0.36 to 0.66 and intraclass correlation coefficient (ICC) for the whole scale was excellent at 0.95 (95% confidence interval [CI] 0.94-0.97). For intrarater agreement, weighted kappa ranged from 0.52 to 1.0 and the ICC was 0.94 (95% CI 0.87-0.98). The construct validity of the arNIHSS is demonstrated by its correlation with the DWI-ASPECT and the 3months mRS score (Spearman correlation -0.46 and 0.58 respectively; P<0.001 for both). CONCLUSION: We developed and validated a culturally adapted Arabic version of the NIHSS. Further validation in other Arab countries is recommended.