Effectiveness of chitosan phonophoresis on ulnar nerve conduction velocity, pain relief, and functional outcomes for mild to moderate cubital tunnel syndrome: A double-blind randomized controlled trial.

BACKGROUND: Cubital tunnel syndrome (CBTS) impairs hand function, with limited conservative options often leading to surgery. Chitosan neuroregenerative effects delivered via phonophoresis provide a rationale for testing this emerging treatment approach. PURPOSE: The primary goal of this research was to assess the impact of chitosan phonophoresis on the conductivity of the ulnar nerve, as well as its effects on pain levels and functional outcomes in individuals diagnosed with mild to moderate CBTS. STUDY DESIGN: Double-blind randomized controlled trial. METHODS: This was a prospective, double-blinded, randomized controlled study. The participants consisted of 54 individuals aged between 20-35 years who were randomly assigned using block randomization. The control group (n = 27) received standard hand therapy alone, while the experimental group (n = 27) received both standard hand therapy and chitosan phonophoresis. Both groups underwent three treatment sessions per week, each lasting for 60-72 minutes, over a period of five weeks. Pre- and post-intervention evaluations included assessments of ulnar nerve conduction velocity (NCV), pain assessment using the numerical pain rating scale (NPRS), as well as hand function evaluated using the Quick Disabilities of Arm Shoulder Hand (QuickDASH) questionnaire. RESULTS: After the intervention, the experimental group significantly improved in all outcome measures compared to the control group. Accordingly, ulnar NCV (MD = 2.233 m/sec; CI = 1.63:2.83; p < 0.001; η2p = 0.516), NPRS (MD = -1.11; CI = -1.71: -0.50; p < 0.001; η2p = 0.208) and QuickDASH (MD = -2.72; CI = -4.54:0.87; p < 0.007; η2p = 0.133). CONCLUSIONS: The study findings suggest that chitosan phonophoresis may have the potential as a supplementary treatment to hand therapy for individuals with mild to moderate CBTS. This approach demonstrated significant improvements in nerve conduction, pain reduction, and enhancement of hand function.

Role of tumor necrosis factor-alpha in the pathophysiology of idiopathic intracranial hypertension.

BACKGROUND: Although the pathogenesis of idiopathic intracranial hypertension (IIH) is still poorly understood, the contribution of inflammatory mechanisms has been proposed in its pathophysiology. OBJECTIVE: This study aimed to measure serum tumor necrosis factor-α (TNF-α) levels in patients with IIH and to examine its relationship with clinical and ophthalmological parameters and cerebrospinal fluid (CSF) opening pressure. SUBJECTS AND METHODS: Thirty-six IIH patients and 30 healthy subjects were enrolled in the study. Patients were subjected to complete neurological, general, and ophthalmological assessments. Serum TNF-α levels were measured for patients and controls using the enzyme-linked immunosorbent assay. RESULTS: Serum TNF-α levels were significantly higher in IIH patients compared to healthy controls (p value <.001). Serum TNF-α level was significantly negatively correlated with grade of perimetry and CSF opening pressure (r = -.36, p value = .02), (r = -.37, p value = .02) respectively. However, serum TNF-α was not significantly correlated either with age at onset, disease duration, BMI, headache severity, relapse rate, visual acuity, or papilloedema grade. Serum TNF-α was found to be a significant predictor of the severity of the visual field affection in IIH patients, as one-grade increase of the perimetric grading was associated with a decrease in serum TNF-α by 13.96 ng/ml. CONCLUSION: Altered serum TNF-α levels may suggest the potential involvement of pro-inflammatory mechanisms in the pathogenesis of IIH. Serum TNF-α level may be an indicator of the severity of the visual field affection in IIH.

Effect of High Frequency Transcranial Magnetic Stimulation on Recovery of Chronic Post-Stroke Aphasia.

BACKGROUND: Both hemispheres have role in post-stroke aphasia recovery but better recovery is expected with the restoration of function by the left hemisphere. Transcranial stimulation has been used to favor recruitment of left-hemispheric language networks and increase activity of the left hemisphere, thus helps aphasia recovery . OBJECTIVE: The aim of this study is to evaluate the effect of excitatory repetitive transcranial magnetic stimulation (rTMS) on recovery of post stroke aphasic patients . MATERIALS AND METHODS: Twenty patients with post stroke chronic aphasia were enrolled in the study. Aphasia severity was assessed using Aphasia Severity Rating Scale (ASRS). Linguistic deficits were assessed using Kasr Al-Aini Arabic Aphasia test (KAAT). Real rTMS was applied three for 10 sessions of 10-Hz stimulation, positioned over the left Broca's area of the affected hemisphere. All patients were evaluated before, after the end of treatment sessions and one month later . RESULTS: There was a significant improvement in the mean total score and mean scores of components of KAAT scale before, immediately after and after one month of rTMS (P< 0.05). Moreover, there was a significant improvement in mean scores of ASRS before, immediately after and after one month of rTMS (P= 0.000). There was a significant difference in mean scores of ASRS and KAAT before, immediately after the last session and after one month between small, medium and large brain infarcts. (P< 0.05). CONCLUSION: Excitatory rTMS is a beneficial adjuvant therapy that improves language skills in patients with chronic post-stroke non-fluent aphasia in short and long term. The protocol of this observational study was registered in clinical trial registration: www.ClinicalTrials.gov, identifier: NCT04708197.

Relation of serum levels of homocysteine, vitamin B12 and folate to cognitive functions in multiple sclerosis patients.

BACKGROUND: Hyperhomocysteinemia, vitamin B12 and folate deficiency have been linked to cognitive dysfunction in multiple sclerosis (MS) patients. OBJECTIVE: This study aimed to investigate the relation of serum homocysteine (Hcy), vitamin B12 and folate to cognitive functions in MS patients. SUBJECTS AND METHODS: Forty-five MS patients and twenty matched healthy controls were included. Subjects were submitted to cognitive assessment using a selected psychometric battery and measurement of serum levels of homocysteine, B12 and folic acid. RESULTS: MS patients showed significant worse performance in cognitive scales compared to controls (P  ≤ 0.05). Serum homocysteine, vitamin B12 and folate showed no significant difference between patients and controls (P  > 0.05). Serum homocysteine was negatively correlated with total score of Addenbrooke's Cognitive Examination (ACE), paced auditory serial addition test and controlled oral word association test scores. Serum vitamin B12 was positively correlated with ACE language, visuospatial and total scores and negatively correlated with trail making B score. Serum folate was significantly positively correlated with ACE language and total scores. Homocysteine was the only significant predictor for cognitive impairment in MS patients. CONCLUSION: Serum homocysteine may play a role in cognitive dysfunction in MS patients.

Corticobasal degeneration: clinical characteristics and multidisciplinary therapeutic approach in 26 patients.

Corticobasal syndrome (CBS) is a sporadic tauopathy that manifests by a various combination of motor and cognitive deficits, which makes its diagnosis challenging. Treatment of CBS is symptomatic and based on evidence from other similar disorders due to the lack of studies on CBS. The aim of the study was to investigate low-frequency repetitive transcranial magnetic stimulation (rTMS) as a therapeutic tool in CBS. Twenty-six patients with clinically evident CBS according to Cambridge criteria were followed for 12-18 months while receiving low-frequency rTMS combined with pharmacological, rehabilitation treatment and botulinum toxin injection. The majority of patients are manifested with akinetic-rigid syndrome and cognitive dysfunction. There was improvement of the UPDRS and quality of life after 3 months of therapeutic interventions (P < 0.001 and <0.05, respectively). No significant deterioration in cognitive functions was detected over the study period. There was a significant reduction of caregiver burden after 3 months of interventions (P < 0.01); this improvement was maintained up to 18 months. Cognitive dysfunction is a frequent manifestation of CBS. CBS patients can benefit from multidisciplinary therapeutic approach employing low-frequency rTMS.

Serum Apo Lipoprotein E, Apo Lipoprotein E Gene Polymorphisms, and Parkinson's Disease.

BACKGROUND: A central role for apolipoprotein E (APOE) has been suggested in modulating processes of neurodegeneration. OBJECTIVE: To study the association between serum APOE levels, APOE gene polymorphisms, and Parkinson's disease (PD). MATERIAL AND METHODS: Fifty-five patients with PD and 30 healthy subjects were enrolled. PD patients were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS), Modified Hoehn and Yahr scale, and Schwab-England Activities of Daily Living scale. Serum APOE level and genotyping for APOE polymorphisms were done for PD patients and controls using enzyme-linked immunosorbent assay and polymerase chain reaction, respectively. RESULTS: Mean serum APOE level was significantly higher in PD patients compared with healthy controls. APOE ε2/4 genotype was present in a significantly higher proportion of patients compared with controls. APOE ε4 allele was significantly associated with a higher score on the "mentation, behavior, and mood section" of UPDRS compared with ε2 allele. APOE ε2 allele was significantly associated with a shorter disease duration compared with ε3 and ε4 alleles. Mean serum APOE level was significantly higher in patients presenting predominantly by rigidity and bradykinesia compared with those presenting predominantly by tremors. Serum APOE level was positively correlated with mean scores of "mentation, behavior, and mood section" of UPDRS and disease duration. Serum APOE level was a significant predictor for the scores of "mentation, behavior, and mood section" of UPDRS. CONCLUSION: APOE ε2/4 genotype might be a susceptibility variant for PD. There may be a possible role for APOE in modulating the process of neurodegeneration in PD.

Association between serum apolipoprotein E and cognitive functions in Egyptian patients with temporal lobe epilepsy.

Memory, cognition and visuospatial aspects of temporal lobe epilepsy (TLE) have not been fully analyzed yet. From among the huge growing population of circulating apoproteins analyzed in TLE, apolipoprotein E (APOE) was discovered; however, its role in TLE has not been fully elucidated yet. This study was designed to investigate the relation between the serum level of APOE and cognition in TLE patients. Sixty-five subjects (35 TLE patients and 30 healthy matched controls) were included. Evaluation of cognitive functions was done using Addenbrooke's Cognitive Examination Revised (ACE-R) scale. Serum APOE level was measured by ELISA. The mean total score, memory and visuospatial scores of ACE-R were significantly lower in TLE patients compared to healthy subjects. The mean total score and memory score of ACE-R were significantly lower in seizures originating from mesial temporal lobe (MTL) and left temporal lobe seizures. Serum APOE levels were significantly higher in TLE patients compared to healthy subjects. Serum APOE levels significantly negatively correlated with total score, memory, and visuospatial ability scores of ACE-R. Serum APOE was significantly higher in MTL seizures compared to lateral lobe seizures and in left temporal lobe seizures compared to right temporal seizures. Memory and visuospatial aspects were significantly affected in TLE patients. So, the serum APOE level can possibly contribute to cognitive dysfunction in such patients.

Interleukin-18 promoter polymorphisms and idiopathic Parkinson disease: an Egyptian study.

Etiology of sporadic Parkinson's disease (PD) is largely unknown. The contribution of genetic factors to the pathogenesis of PD is supported by the demonstration of high concordance in twins, increased risk among relatives of PD patients and existence of familial cases. This study aimed to examine the relation between interleukin 18 (IL-18) gene promoter polymorphisms and idiopathic PD, and its impact on clinical presentation and disease severity. 30 idiopathic PD patients and 15 age- and sex-matched healthy subjects were included. Disease severity was assessed using Unified Parkinson's Disease Rating Scale (UPDRS). Genetic testing for IL-18 gene promoter -607C/A single nucleotide polymorphisms (SNP) was done using real-time polymerase chain reaction (PCR) technique. A raised risk of PD development was found in patients with A/C and C/C genotypes of the site -607C/A (odds ratios = 1.83 and 1.98, respectively). The distribution of the genotypes showed no significant relation to gender or predominant clinical presentation. The age at onset of disease was significantly lower in C/C and A/A genotypes compared to A/C genotype (p = 0.001 and 0.04, respectively). Patients with A/A genotype showed significantly higher mentation score of UPDRS compared to patients with A/C and C/C genotypes (p = 0.003 and p = 0.002, respectively). Polymorphisms of IL-18 gene promoter increase the risk of developing idiopathic PD. The polymorphisms may affect phenotypic expression rather than being a direct cause of idiopathic PD.

Evaluation of bone health among epileptic patients using biochemical markers and DEXA scan: an Egyptian study.

BACKGROUND: An association between antiepileptic drugs, low bone mineral density (BMD), fractures, and abnormalities in bone metabolism has been suggested for a longer period, although conclusive evidence has not been reported. METHODS: Thirty epileptic patients and 30 matched healthy subjects participated in the study. Measurements of serum levels of calcium, phosphorus, vitamin D, parathormone, and alkaline phosphatase were done for included subjects. Dual-energy X-ray absorptiometry (DEXA) scan was also performed. RESULTS: Serum calcium, phosphorus, and vitamin D were significantly lower, whereas serum parathormone and alkaline phosphatase were significantly higher in epileptic patients compared to control subjects. Bone mineral density (BMD) abnormalities were detected in 22 patients (73.4%). A statistically significant difference in DEXA scan measurements at different regions was detected between epileptic patients and control subjects. Epileptic patients receiving enzyme inducer antiepileptic drugs (AEDs) had significantly lower serum (calcium, phosphorous, and vitamin D) and lower BMD values compared to those receiving enzyme inhibitors. Results of BMD were positively correlated with serum calcium, phosphorous, and vitamin D, while negatively correlated with serum alkaline phosphatase and duration of therapy. CONCLUSIONS: Abnormal bone health is common in epileptic patients. These abnormalities may be attributed to prolonged intake of AEDs especially enzyme inducers.

Effect of transcranial direct current stimulation on cognitive function in stroke patients.

BACKGROUND: Cognitive impairment after stroke is common and can cause disability with major impacts on quality of life and independence. Transcranial direct current stimulation may represent a promising tool for reconstitution of cognitive functions in stroke patients. OBJECTIVES: This study aimed to investigate the effect of transcranial direct current stimulation on cognitive functions in stroke patients. PATIENTS AND METHODS: Forty male stroke patients were included. Patients were divided randomly into two equal groups (A and B). Group A received transcranial direct current stimulation (tDCS) in combination with selected cognitive training program by RehaCom. Group B received sham transcranial direct current stimulation in combination with the same cognitive training program.Cognitive evaluation and functional independence measure (FIM) were done for all patients before and after treatment. RESULTS: There was a significant improvement in the scores of attention and concentration, figural memory, logical reasoning, reaction behavior, and FIM post treatment in both groups; the improvement was significantly higher in group A compared to group B. CONCLUSION: tDCS is a safe and effective neuro-rehabilitation modality that improves post stroke cognitive dysfunctions. Moreover, tDCS has a positive impact on performance of daily activities.

Association between total plasma homocysteine level and cognitive functions in elderly Egyptian subjects.

BACKGROUND: High plasma total homocysteine has emerged as a new risk for cognitive decline with age. OBJECTIVES: The aim of the present study was to examine the association of plasma homocysteine with cognitive performance in normal aged Egyptians. SUBJECT AND METHODS: Forty five aged Egyptians subjects were included in the study. Their cognitive performance was assessed using Mini-Mental State Examination MMSE, Addenbrooke's Cognitive Examination (ACE) and Clinical Dementia Rating (CDR) scale. Total plasma homocysteine level in fasting blood samples was also measured. RESULTS: A statistically significant negative association was detected between plasma homocysteine level and age. A statistically highly significant inverse association was found between plasma tHcy and scores of cognitive assessment in aged subjects after adjustment for age, gender, education years and cardiovascular risk factors. No significant association was detected between total plasma homocysteine level and sex, blood sugar or lipid profile (p≥0.05). CONCLUSION: Elevated tHcy level is an independent risk factor for the decline of cognitive performance in normal elderly subjects.