Psychiatric comorbidities in patients with psychogenic nonepileptic seizures.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) are major challenges for diagnosis and management. The heterogeneity of psychogenic seizures is attributed to diverse psychopathological comorbidities, and the causal relationship between PNES and underlying psychopathologies is still enigmatic. OBJECTIVE: Our objective was to study psychiatric comorbidities and personality constructs in patients with PNES and compare them to a control group of patients with epilepsy. METHOD: We randomly recruited 33 patients with PNES and 33 patients with epilepsy. All patients completed the Mini-International Neuropsychiatric Interview (MINI) to screen for psychiatric comorbidities, the Structured Clinical Interview for psychiatric disorders in Axis II (SCID II) to screen for personality disorders, and Goldberg's International Personality Item Pool (IPIP) Big Five personality questionnaire to study the psychological constructs of extroversion-introversion, agreeableness, conscientiousness, emotional stability-neuroticism, and intellect. RESULT: Mood and anxiety disorders were highly prevalent in patients with PNES (72.7% and 54.5%, respectively); however, the prevalence of only cluster B personality disorder was higher in patients with PNES (69.7%) compared to 33.3% among patients with epilepsy (p < 0.05). Screening for personality disorders using SCID II showed that the prevalence of borderline and depressive personality disorders was significantly higher in patients with PNES (p < 0.001). Patients with psychogenic seizures were more likely to be receiving polydrug therapy (75.8%) compared to patients with epileptic seizures (45.5%); this difference was statistically significant (p < 0.05). CONCLUSION: Psychiatric comorbidities are highly prevalent among patients with PNES.

Deciding Thrombolysis in AIS Based on Automated versus on WhatsApp Interpreted ASPECTS, a Reliability and Cost-Effectiveness Analysis in Developing System of Care.

Background: Automated ASPECTS has the potential of reducing interobserver variability in the determination of early ischemic changes. We aimed to assess the performance of an automated ASPECTS vs. ASPECTS interpreted for sent CT images on WhatsApp and to correlate these results with the outcome. Materials and Methods: Patients with anterior circulation stroke who had baseline NCCT and underwent successful IV-thrombolysis were included. NCCT-ASPECTS was assessed by two neuroradiologists, and discrepancies were resolved by agreement. Two groups of patients were included; group 1, where treatment was decided after an automated ASPECTS interpretation that was provided by RAPID software, and group 2, where patients received IV-tPA after an assessment of CT images sent on WhatsApp. Results: A total of 122 patients were included: 36 in group 1 and 86 in group 2. In group 2, the interobserver agreement for NCCT ASPECTS was moderate (κ = 0.36), as was the dichotomized data (κ = 0.44). IOA, however, improved (to κ = 0.57 and κ = 0.64) when the same CT images were interpreted on a workstation. In group 1, Automated ASPECTS showed excellent agreement (κ = 0.80) with agreement reads for workstation images. There were significantly (P < 0.001) increased odds of functional independence and fewer hemorrhagic complications with thrombolyzed patients in group 1. Conclusions: Automated ASPECTS provided by the RAPID@IschemaView ASPECTS performs at a level equal to the agreement read of expert neuroradiologists, and this performance was severely degraded when WhatsApp captured CT images used for ASPECTS assessment. In our study, we found that automated ASPECTS might predict outcomes after IV thrombolysis.

Rapid eye movement (REM) sleep and seizure control in idiopathic generalized epilepsy.

BACKGROUND: Sleep and epilepsy are bedfellows, and they affect each other reciprocally. Despite the well-known relationship between sleep and epilepsy, data about the impact of sleep on seizure control and responsiveness to therapy are scarce. OBJECTIVE: The aim of this work was to study the impact of sleep architecture in drug-naïve patients with idiopathic generalized epilepsy (IGE) on seizure control and responsiveness to treatment. METHODS: This is a prospective cohort study conducted on thirty newly diagnosed patients with IGE attending the epilepsy clinic in Alexandria University Hospital in Egypt and thirty healthy controls. All recruited subjects had a baseline overnight polysomnographic study, then patients were given sodium valproate in therapeutic doses and followed up for six months for assessment of seizure control. After follow-up, they were classified into fully controlled and inadequately controlled patients, and a comparison between them was made. RESULTS: Of the recruited patients, 13 were fully controlled. Rapid eye movement (REM) sleep % was significantly lower among inadequately controlled patients (9.01 ±â€¯6.23) than fully controlled group (19.6 ±â€¯9.01) and controls (18.17 ±â€¯4.85) (p = 0.002), and the REM sleep latency was significantly longer among the inadequately controlled patients (115.7 ±â€¯72.8 min) than fully controlled patients (54.6 ±â€¯77.3 min) and controls (68.75 ±â€¯37.95 min) (p = 011). On univariate regression analysis, the Odd's ratio (OR) for REM sleep percentage was 3.04 (p = 0.001). CONCLUSION: Rapid eye movement sleep percentage and latency can contribute to seizure control in IGE.

Immunoglobulin G index as a biomarker of relapse response to corticosteroids during early stages of multiple sclerosis.

BACKGROUND: Despite the considerable advances in disease modifying therapy in multiple sclerosis (MS), management of acute MS relapses remains understudied. The response to relapse therapy is heterogenous among patients, and the exact reason behind such response remains elusive. Identification of a reliable biomarker for relapse responsiveness would contribute considerably to optimizing the relapse outcome. OBJECTIVES: to explore whether the immunoglobulin G (IgG) index during acute relapse contributes to relapse response to corticosteroid therapy or not. METHODS: A prospective study was conducted on 46 MS patients attending MS clinic in relapse with a baseline EDSS≤3 before the relapse. IgG index was measured in all patients before corticosteroids therapy, and their EDSS was re-assessed after 3 months. RESULTS: The mean age of the recruited patients was 26.89±4.19 years, with females constituting 71.7% of the sample. IgG index was significantly higher in patients who recovered fully after relapse (1.44) than those who were partially recovered (0.95)(P<0.001), and it was inversely correlated with EDSS increase after the relapse (r=-0.390, P = 0.007). On regression analysis, the OR of IgG index to relapse response was 0.05 (CI: 0.07-0.31, 95%)(P = 0.003). CONCLUSIONS: IgG index can be a promising biomarker of relapse response to steroids in early stages of MS.

Th17/Treg cells imbalance and their related cytokines (IL-17, IL-10 and TGF-ß) in children with autism spectrum disorder.

We aimed in this study to investigate a possible involvement of Th17/Treg cells imbalance in autism spectrum disorders (ASD). Using flowcytometry to determine circulating Th17 and Treg cells percentages, RT- PCR and ELISA for cytokine expression, we demonstrated that Th17/Treg balance in ASD children was significantly skewed toward a Th17 response compared to their control. Th17 cells and the ratio of Th17/Treg cells had a significantly positive correlation with disease severity whereas Treg cells had a negative correlation. The imbalance of Th17, Treg cells and their related cytokines may play a vital role in the progression of the disease.