Toll-like receptors 2 and 4 expression on peripheral blood lymphocytes and neutrophils of Egyptian multiple sclerosis patients.

BACKGROUND: Studies have just started delineating the role of Toll-like receptors (TLRs) in the pathogenesis of multiple sclerosis (MS). OBJECTIVES: To investigate the expression of TLR-2 and TLR-4 on peripheral blood neutrophils and lymphocytes in Egyptian patients with MS, and to examine the role of TLR-2 and TLR-4 expression as a candidate biomarker for MS diagnosis. METHODS: A total of 84 patients with newly diagnosed MS and 68 healthy controls were included in this study. The expression levels of TLR-2 and TLR-4 were assessed by flow cytometry technique using appropriate monoclonal antibodies. RESULTS: TLR-2 demonstrated a significantly higher expression on the lymphocytes and neutrophils of patients, whereas that of TLR-4 was significantly higher only on lymphocytes than those in the control group. However, there was no significant difference between patients with relapsing remitting MS and those with secondary progressive MS in terms of TLR-2 and TLR-4 expression. The expression of TLR-2 and TLR-4 on the lymphocytes and neutrophils of patients showed no significant correlation with either the duration of the disease or disability. The sensitivity and specificity of TLR-2 expression on lymphocytes and neutrophils to diagnose MS were 73.81%, 70.59%, 69.05%, and 52.94%, respectively. The sensitivity and specificity of TLR-4 expression on lymphocytes and neutrophils were 88.10%, 79.41%, 78.57%, and 76.47%, respectively. CONCLUSION: The expression of TLR-2 and TLR-4 on peripheral blood neutrophils and lymphocytes has a potential role in the pathogenesis of MS. TLR-4 expression on lymphocytes and neutrophils could be used as a potential biomarker to diagnose MS.

Nutritional intake and its impact on patients with epilepsy: an analytical cross-sectional study.

BACKGROUND: Anecdotal reports have proposed that diet might influence the occurrence of seizures. OBJECTIVES: Our objectives were to assess nutritional status in a sample of patients with epilepsy and to investigate the impact of nutrition on epilepsy control. PATIENTS AND METHODS: One hundred and fifty patients with epilepsy participated in the study. To assess nutritional status, sociodemographic characteristics, anthropometric measurements, dietary food intake, and 24-hour food intake were evaluated. Patients answered questions using a food frequency questionnaire. RESULTS: In patients with epilepsy, there was insufficient intake of water, fiber, potassium, magnesium and some vitamins (C, E, B12, folate and niacin); suboptimal intake of calories, zinc, calcium, and some vitamins (A, B1 and B6); optimal intake of total fats; and over-intake of proteins, carbohydrates, phosphorus, iron, sodium, and vitamins D and B2. Moreover, there was a statistically significant difference between patients with controlled versus uncontrolled seizures regarding frequency of vegetable intake and percentage of caloric intake from the recommended dietary allowance. Stepwise logistic regression indicated that those with low intake of vegetables had a 2.3 times higher likelihood of uncontrolled seizure occurrence compared to those with a high intake of vegetables per week. Also, those with optimal caloric intake were 80% less likely to have uncontrolled seizures than those with too much caloric intake. CONCLUSION: Macro- and micronutrient intake were unbalanced in patients with epilepsy. Patients who consumed too many calories and too few vegetables were more likely to have improper seizure control.

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.

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.

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.

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.

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.