Background

Ongoing research aims to correlate ultrasound (US) findings with nerve conduction studies (NCS) results for the diagnosis of Guillain–Barré syndrome (GBS). NCS is currently the gold standard for confirming GBS diagnosis. This study aimed to compare nerve cross-sectional area (CSA) between GBS patients and controls and among different GBS subtypes, determine the correlation between CSA and NCS parameters, and identify a potential CSA cut-off value for early GBS screening. This study included 41 patients with GBS and 35 matched controls. Participants underwent comprehensive history taking, physical examination, NCS, and US measurement of CSA of peripheral nerves in upper and lower limbs. Receiver operating characteristic (ROC) analysis was performed to assess the ability of US CSA measurements to discriminate between GBS cases and controls.

Results

GBS patients had larger US nerve CSA than controls. No significant variations in CSA existed among different GBS electrophysiological subtypes. ROC curve analysis showed that median nerve CSAs at mid-forearm, pronator quadratus, and pronator teres were highly accurate for diagnosing GBS, with an area under the curve (AUC) of 1. Ulnar and posterior tibial nerve CSA were less precise. No substantial correlation existed between CSA and NCS parameters in the same nerve, although some association with clinical rating scales was present.

Conclusions

This study suggests nerve US may complement NCS in early GBS diagnosis, proposing CSA cut-off values for median, ulnar, and posterior tibial nerves. Further larger studies with standardized US protocols are needed to validate the reproducibility and diagnostic utility of these cut-offs.

Background

Up to 96% of patients with Parkinson's disease (PD) experience sleep disturbances, which can emerge before motor symptoms. This study aims to determine the type of sleep disturbances in PD compared to controls using Parkinson's Disease Sleep Scale-2 (PDSS-2) and polysomnography (PSG). Twenty-four PD patients with sleep difficulties and 24 matched controls were included in this prospective case–control study. Sleep disturbances were diagnosed using screening questionnaires and PDSS-2. Patients were clinically assessed using Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS). All participants were evaluated using Beck Depression Inventory (BDI), Montreal Cognitive Assessment (MoCA), and full-night video PSG.

Results

The PD group had significantly higher BDI and lower MoCA scores than the controls. PD patients had significantly lower sleep efficiency (87.32% versus 95.48%) and longer sleep latency (29 versus 2.45 min), shorter REM latency (37.97 versus 78.94 min), higher N2 sleep percentage (65.32% versus 51.43%), and lower REM sleep percentage (15.89% versus 19.22%). PD patients also had a higher arousal index (11.35 ± 9.46/h versus 3.44 ± 2.93/h), more periodic leg movements (7 ± 6.64 versus 2.21 ± 2.39), and a higher apnea–hypopnea index (7.96 ± 4.91 versus 4.12 ± 3.71). Sleep latency showed a negative correlation with MoCA and a positive correlation with disease duration. REM sleep percentage was negatively correlated with BDI. Arousal index /hour was negatively correlated with age onset.

Conclusions

This study confirms significant sleep architecture differences between PD patients and controls, emphasising the importance of comprehensive sleep assessment and management in PD care.

Background: The apolipoprotein E (APOE) gene, encompassing three alleles (ε2, ε3, ε4), is a critical player in lipid metabolism and has been extensively studied for its role in neurodegenerative diseases. This study examines APOE genetic variability and its association with PD in an Egyptian cohort.

Methods: A total of 891 participants, including 422 PD patients and 469 healthy controls, were included in this study. APOE genotyping was performed using Kompetitive Allele Specific PCR (KASP) to detect the rs429358 and rs7412 SNPs, which define the APOE alleles. APOE alleles were categorized based on the genotypes into ε2, ε3, and ε4 groups. Clinical assessments of PD patients included age at onset, disease severity (MDS-UPDRS), and demographic factors. Statistical analyses compared APOE distributions between PD and control groups and examined associations with clinical variables.

Results: The ε3 allele was the most prevalent in the cohort (77.3%), aligning with global and African trends. The ε2 allele was observed in 11.4%, and the ε4 allele in 11.3%, with both frequencies being lower than reported African estimates. The ε3/ε3 genotype was predominant in both PD patients (72.51%) and controls (72.07%). The ε4/ε4 genotype was absent in PD cases and rare among controls (0.64%). No significant association was found between APOE genotypes and PD risk, age at onset, or disease severity.

Conclusion: Our findings do not support a significant role for APOE in PD susceptibility or severity in Egyptians.

Background: Sleep problems impact over 65% of patients with multiple sclerosis (MS), a prevalence significantly greater than that observed in the general population. This study aimed to assess the frequency and risk-associated factors of sleep problems in a large MS cohort and evaluate their impact on quality of life (QoL).

Methods: The study included 103 participants with MS across different disease stages and 62 healthy controls. Assessment tools included the Expanded Disability Status Scale (EDSS), Pittsburgh Sleep Quality Index (PSQI), depression and fatigue scales, 9-Hole Peg Test, 25-foot walk test, cognitive function assessments, and QoL measures.

Results: Sleep problems were significantly more frequent in MS patients (68.9%) than in controls (30.6%). PSQI scores showed positive correlations with the number of MS relapses across the course of disease duration, walking impairment, fatigue and depression scores. Sleep problems were determined to adversely affect various domains of quality of life.

Conclusion: Our findings demonstrate that sleep problems are remarkably common among patients with MS. Patients experiencing poor sleep quality are typically associated with higher levels of fatigue, depression, greater difficulty with mobility, and more frequent disease relapses. These sleep problems significantly impaired the overall QoL in MS patients. A multidisciplinary approach is therefore essential for managing sleep disorders in MS.

Background

Data on mechanical thrombectomy (MT) to treat M2 occlusions of the middle cerebral artery (MCA) are sparse. We report the outcome and safety of MT versus intravenous recombinant tissue plasminogen activator (IV rTPA) versus conventional medical treatment (CMT) of acute ischemic stroke (AIS) due to occlusion of the M2 segment of the MCA. This prospective longitudinal intervention study compared the outcomes and safety of MT, rTPA, and CMT in M2 occlusion AIS patients. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and recanalization rate assessed outcomes.

Results

74 AIS patients were recruited (23 MT, 23 rTPA, 28CMT). MT group had significantly higher admission NIHSS (p = 0.018) and mRS (p = 0.023) than rTPA. At 24 h, NIHSS improved more with MT and rTPA than CMT (p < 0.0001). At 3 months, mRS were better with MT and rTPA versus CMT (p < 0.0001). Successful recanalization occurred in 73.9% of the MT group. 69% of the MT group required stent retrieval plus aspiration thrombectomy, and 60.9% required ≥ 3 trials, but outcomes did not differ by technique or number of trials. A good outcome (mRS 0–2) at 3 months was achieved in 69.6% MT versus 65.2% rTPA versus 7.1% CMT (p < 0.0001). Symptomatic intracranial hemorrhage (sICH) rates were slightly, but insignificantly, higher with CMT. Mortality did not significantly differ between groups.

Conclusions

For M2 occlusions, MT and rTPA achieved better early and 3-month outcomes than CMT; however, MT was not superior to rTPA. MT of M2 is feasible and effective, with a lower hemorrhage rate than rTPA and CMT.

Background

Acute ischemic stroke (AIS) is a major public health issue, and women have a disproportionate share of stroke-related disability and mortality, which is poorly understood. This study aimed to determine the effect of sex differences on AIS treated by thrombolysis using recombinant tissue plasminogen activator (rTPA). The study included 134 AIS patients eligible for rTPA. Risk factors, clinical presentation, thrombolysis response, complications, and outcomes were recorded. The outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) 3 months after stroke. The incidence of intracranial haemorrhage was also determined.

Results

Among 134 AIS patients treated with rTPA (59% male, 41% female), females had higher rates of hypertension (67.3% versus 49.4%, p = 0.040) and atrial fibrillation (AF) (12.7% versus 2.5%, p = 0.020), while smoking was more prevalent in males (31.6% versus 0%, p < 0.0001). Cardioembolism was more frequent in females than in males (23.6% versus 6.3%, p = 0.004). Females also had shorter onset-to-door (110.7 ± 63 versus 131.1 ± 50.2 min, p = 0.035) and onset-to-needle times (151.6 ± 66.5 versus 173.7 ± 50.6 min, p = 0.046). Both sexes showed significant improvements in NIHSS (males: 11.58 ± 3.7 to 6.05 ± 5.6; females: 11.64 ± 4.7 to 6.9 ± 5.9; p < 0.0001) and mRS scores (males: 3.34 ± 1.05 to 2.03 ± 2; females: 3.53 ± 1 to 2.02 ± 2; p < 0.0001) over 3 months, with no significant differences between sexes. Predictors of poor outcome (mRS 3–6) differed: diabetes mellitus (DM) (OR 7.79, p = 0.002) and longer door-to-needle time (OR 1.04, p = 0.008) for males, and hemorrhage (OR 9.41, p = 0.048) for females. Hemorrhage predicted mortality in males (OR 27.08, p < 0.0001), while AF was associated with increased mortality in females (OR 8.06, p = 0.024).

Conclusions

This study revealed sex-specific differences in AIS risk factors, aetiology, and rTPA treatment timelines, although post-treatment improvements were comparable between sexes. Notably, outcome predictors and mortality factors differed by sex. These findings emphasize the need for sex-specific considerations in AIS management and risk assessment.

Background

During the Coronavirus disease pandemic “COVID-19”, epilepsy was one of many chronic neurological diseases in which treatment was neglected. This study aimed to evaluate the impact of the pandemic on people with epilepsy and identify potential predictors of seizure worsening through a face-to-face hospital survey. During the study period, 245 participants were recruited: 124 people with epilepsy (PwE) and 121 people without epilepsy (PwoE) age and sex-matched. Both groups were compared using sociodemographic COVID-19-related questionnaires and Hamilton Anxiety and Depression scales. PwE also completed epilepsy-specific questionnaires. Subsequently, we subdivided the PwE group into people with worsening epilepsy (WPwE) and those without (NWPwE).

Results

Compared with PwoE, PwE had significantly higher rates of COVID-19 infection (59.7% versus 41.3%, p = 0.004), and 69.4% of them (86/124) reported WPwE. WPwE had significantly higher rates of COVID-19 infection (75.6% versus. 23.7%, p < 0.0001), emergency room visits (69.8% versus 42.1%, p = 0.004), delayed neurology appointments (69.8% versus 42.1%, p = 0.004), and difficulties accessing medication (69.8% versus 47.4%, p = 0.02) and being less likely to be vaccinated (39.5% versus 68.4%, p = 0.003) than NWPwE. Depression and anxiety rates increased significantly during the pandemic compared with prior pandemics in both PwE and PwoE (p < 0.0001 for each). Moreover, the WPwE showed a significant increase in depression rates (33.7–60.5%, p < 0.0001) and higher mean anxiety scores compared to the NWPwE (p = 0.029). A multivariate binary logistic regression analysis showed that having a COVID-19 infection (AOR: 12.086, p < 0.0001), being laid off (AOR: 0.024, p = 0.001), or having more seizures before the pandemic (AOR: 3.366, p = 0.009) were all strong predictors of seizures getting worse.

Conclusions

Nearly 69% of PwE experienced pandemic-related seizures worsening, along with deterioration of mental health. Factors such as personal COVID-19 infection, unemployment, work interruption, and higher pre-COVID seizure frequency were identified as key predictors of seizure worsening. Mitigating these predictors could strengthen resilience among PwE during future widespread crises.