Cognitive functions in Egyptian neuromyelitis optica spectrum disorder.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system, characterized by optic neuritis and longitudinally extensive transverse myelitis. Magnetic resonance imaging abnormalities may be observed in various brain regions of NMOSD patients. Only a few studies have addressed the cognitive functions in NMOSD, but none among Egyptian patients. OBJECTIVE: To investigate cognitive performance in a cohort of 20 Egyptian patients with NMOSD. DESIGN: Observational, prospective study. PATIENTS: We studied 20 Egyptian patients with NMOSD and compared them with 18 healthy Egyptian controls matched for age, sex, and educational level. MAIN OUTCOME MEASURE: We applied an Arabic translation of MOCA and BICAMS Tests for Multiple Sclerosis. RESULTS: Cognitive performance was significantly worse in the NMOSD group than in healthy controls for CVLT (P = 0.0099), SDMT (P = 0.0112), BVSMT (P = 0.019) and BICAMS in total (P = 0.0014). Patients with a later disease onset performed worse in MOCA and BVSMT. CONCLUSIONS: This study confirms the concept of cognitive involvement in NMOSD among Egyptian patients. Information processing speed was the function most commonly impaired.

Clinical and radiological characteristics of neuromyelitis optica spectrum disorder in the North Egyptian Nile Delta.

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disorder of the central nervous system that was previously thought to be a subtype of multiple sclerosis (MS). Epidemiology studies of NMOSD are rare in both Middle East and North African countries. To our knowledge, there are no such studies in Egypt. Herein, we describe a case series of NMOSD patients from North Egyptian Nile Delta region and compare them to NMOSD in other parts in the Middle East and the world. METHODS: This is a case series study of NMOSD patients who were seen at the neuroimmunology clinic, Elhadara Hospital, University of Alexandria, Egypt, from January 2017 to January 2018. We describe their clinical, serological and radiological features. RESULTS: Our study identified twenty Egyptian patients, all of who fulfilled the 2015 international NMOSD diagnostic criteria. Ten tested positive for AQP4 antibodies in the serum while the other ten were seronegative. The mean age at onset was 27.8 years with an average disease duration of 6.8 years. There was a strong female predominance with a ratio of 5.6:1. We identified clinical features of the cohort that differ from those reported in other worldwide studies. INTERPRETATION: This is the first NMOSD case series in Egypt. Despite some limitation in testing and access to care, there are features of our NMOSD cases that appear to be different from other worldwide cohorts reported in the literature.

WCST Performance in Schizophrenia and Severe Depression with Psychotic Features.

Background. Differentiating between schizophrenia and major depression with psychotic features often reveals diagnostic dilemma. Both share psychotic features and severe impairment in occupational functions. Severe psychomotor retardation, not uncommon in psychotic depression, may simulate negative symptoms of schizophrenia. Our work aims at utilizing Wisconsin Card Sorting Test (WCST) performance as a potential differentiating neurocognitive tool. Subjects and Methods. 60 patients were recruited randomly from the outpatient service at Alexandria University Hospital: 30 patients with schizophrenia and 30 patients with chronic psychotic depression. They were subjected to Clinical Global Impression for Severity (CGI-S) scale and Wisconsin Card Sorting Test (WCST) 128 card computerized version. Results. Both groups were balanced in terms of gender distribution, severity and duration of illness. The study compared all parameters of WCST. Only perseverative errors showed mild significant difference (P < 0.05) that disappeared when applying Bonferroni adaptation, setting significance level at 0.01 instead of 0.05. Conclusion. Performance on WCST is similar in schizophrenia and severe depression with psychotic features in most of the measured parameters and hence could not serve as a supplementary tool differentiating between both diagnoses in our study.

The A1 allele of the DRD2 TaqA1/A2 polymorphism as risk factor for PTSD

Background and Objectives: Dopaminergic neurotransmission is implicated in stress responses. The dopamine D2 receptor gene (DRD2) has been studied by the authors to assess its possible role as a predictor of those who are at a higher risk to develop PTSD after major psychological trauma. Methods: Over one year period 75 children and adolescents 6-18 yrs of age who had been exposed to moderate to severe burns were recruited from the burn unit at the Alexandria University Hospital for the study. Patients and their family were interviewed within the first 10 days of exposure. After signing a written consent form a 2 ml blood sample was obtained for genetic studies of the TaqA1/A2 polymorphism site of the DRD2 gene. Patients were reevaluated three and six months later for assessment of PTSD. Results: Among the 75 children recruited in the study, 26 died due to their burn injury, 19 dropped out as parents refused follow up and 30 continued the study follow up visits. Fourteen carried the A1A2 genotype. Of these 11 (78.6%) developed PTSD. Sixteen carried the A2A2 genotype. Of these only one child (6.3%) developed PTSD. The results were significant at p < 0.001 with a relative risk 12.5. Conclusions: Following exposure to severe stress, the presence of the Taq A1 allele of the DRD2 gene results in a significant increase in the risk of developing PTSD (AU)

Psychogenetics of post-traumatic stress disorder: a short review.

Post-traumatic stress disorder is a commonly overlooked psychiatric disorder due to the heterogeneity of symptoms that may simulate many other psychiatric disorders. Such heterogeneity of manifestations may be explained by the multifaceted nature of the different neurotransmitters, endocrinologic axis, and their genetic basis, that are implicated in the etiology. Although this disorder has been studied from many different perspectives, its etiology is still enigmatic. This minireview demonstrates, in brief, that different susceptibility genes are associated with post traumatic stress disorder.

Sleep and aging: 2. Management of sleep disorders in older people.

The treatment of sleep-related illness in older patients must be undertaken with an appreciation of the physiologic changes associated with aging. Insomnia is common among older people. When it occurs secondary to another medical condition, treatment of the underlying disorder is imperative. Benzodiazepines, although potentially effective, must be used with care and in conservative doses. Daytime sedation, a common side effect, may limit use of benzodiazepines. Newer non-benzodiazepine drugs appear to be promising. Rapid eye movement (REM) sleep behaviour disorder can be treated with clonazepam, levodopa-carbidopa or newer dopaminergic agents such as pramipexole. Sleep hygiene is important to patients with narcolepsy. Excessive daytime sleepiness can be treated with central stimulants; cataplexy may be improved with an antidepressant. Restless legs syndrome and periodic leg-movement disorder are treated with benzodiazepines or dopaminergic agents such as levodopa-carbidopa and, more recently, newer dopamine agonists. Treatment of obstructive sleep apnea includes weight reduction and proper sleep positioning (on one's side), but may frequently necessitate the use of a continuous positive air-pressure (CPAP) device. When used regularly, CPAP machines are very effective in reducing daytime fatigue and the sequelae of untreated obstructive sleep apnea.

Sleep and aging: 1. Sleep disorders commonly found in older people.

Aging is associated with several well-described changes in patterns of sleep. Typically, there is a phase advance in the normal circadian sleep cycle: older people tend to go to sleep earlier in the evening but also to wake earlier. They may also wake more frequently during the night and experience fragmented sleep. The prevalence of many sleep disorders increases with age. Insomnia, whether primary or secondary to coexistant illness or medication use, is very common among elderly people. Rapid eye movement (REM) sleep behaviour disorder and narcolepsy, although less common, are frequently not considered for this population. Periodic leg-movement disorder, a frequent cause of interrupted sleep, can be easily diagnosed with electromyography during nocturnal polysomnography. Restless legs syndrome, however, is diagnosed clinically. Snoring is a common sleep-related respiratory disorder; so is obstructive sleep apnea, which is increasingly seen among older people and is significantly associated with cardio-and cerebrovascular disease as well as cognitive impairment.