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1.
BMC Neurol ; 21(1): 53, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535985

RESUMEN

BACKGROUND: In Egypt, the characterization of Neuromyelitis Optica Spectrum Disorder (NMOSD) is lacking. OBJECTIVES: To determine the demographics, clinical features, aquaporin4 antibodies (AQP4-IgG) status, and neuroimaging of Egyptian NMOSD patients. METHODS: Retrospective analysis of 70 NMOSD patients' records from the MS clinic, Kasr Alainy hospital, between January 2013 and June 2018. RESULTS: Patients' mean age was 34.9 ± 9.2 years, and the mean at disease onset was 28.9 ± 10.5 years. Fifty-nine patients had an initial monosymptomatic presentation. AQP4-IgG was measured using either enzyme-linked immunosorbent assay (ELISA) (22 patients) or cell-based assay (CBA) (34 patients). Six and 29 patients had positive results, respectively (p < 0.001). 84% had typical NMOSD brain lesions. Longitudinally extensive myelitis was detected in 49 patients, and 9 had either short segments or normal cords. Treatment failure was higher in seropositive patients. Rituximab significantly reduced the annualized relapse rate (ARR) compared to Azathioprine with a percentage reduction of (76.47 ± 13.28) and (10.21 ± 96.07), respectively (p = 0.04). Age at disease onset was the only independent predictor for disability (p < 0.01). CONCLUSION: Treatment failure was higher in seropositive patients. However, there was no difference in clinical or radiological parameters between seropositive and seronegative patients. Patients, who are polysymptomatic or with older age of onset, are predicted to have higher future disability regardless of the AQP4-IgG status.

2.
Ther Clin Risk Manag ; 16: 759-767, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32884277

RESUMEN

The ongoing coronavirus (COVID-19) pandemic is a global health emergency of international concern and has affected management plans of many autoimmune disorders. Immunosuppressive and immunomodulatory therapies are pivotal in the management of neuromyelitis optica spectrum disorder (NMOSD), potentially placing patients at an increased risk of contracting infections such as COVID-19. The optimal management strategy of NMOSD during the COVID-19 era remains unclear. Here, however, we examined the evidence of NMOSD disease-modifying therapies (DMTs) use during the present period and highlighted different scenarios including treatment of relapses as well as initiation and maintenance of DMTs in order to optimize care of NMOSD patients in the COVID-19 era.

3.
Ther Clin Risk Manag ; 16: 651-662, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32801722

RESUMEN

The emergence of the novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge of global concern since December 2019, when the virus was recognized in Wuhan, the capital city of Hubei province in China and epicenter of the COVID-19 epidemic. Given the novelty of COVID-19 and the lack of specific anti-virus therapies, the current management is essentially supportive. There is an absence of consensus on guidelines or treatment strategies for complex disorders such as multiple sclerosis (MS), in which the risk of infections is higher than in the general population. This is due to the overall impairment of the immune system typical of autoimmune diseases, in addition to accumulation of disabilities, and the iatrogenic effect generated by corticosteroids and the recommended disease-modifying therapies (DMTs). DMTs have different modes of action, but all modulate and interfere with the patient's immune response, thereby raising concerns about adverse effects, such as an increased susceptibility to infections. In this review, we analyze the evidence for use of DMTs during the current critical period and ratify an algorithmic approach for management to optimize care between keeping DMTs, with their infection hazards, or coming off them, with the risk of disease activation. We also provide an algorithmic approach to the management of breakthrough activity during the COVID-19 pandemic.

4.
Int J Neurosci ; : 1-5, 2020 Aug 26.
Artículo en Inglés | MEDLINE | ID: mdl-32842834

RESUMEN

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.

5.
J Pain Res ; 13: 537-545, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32210609

RESUMEN

Background: Studies have shown that interferon-beta (IFN-ß) treatment is associated with headaches in patients with multiple sclerosis (MS). Headaches can affect quality of life and overall function of patients with MS. We examined the frequency, relationships, patterns, and characteristics of headaches in response to IFN-ß in patients with relapsing-remitting multiple sclerosis (RRMS). Patients and Methods: This study was a prospective, longitudinal analysis with 1-year follow-up. The study comprised 796 patients with RRMS treated with IFN-ß (mean age 30.84±8.98 years) at 5 tertiary referral center outpatient clinics in Egypt between January 2015 and December 2017. Headaches were diagnosed according to the International Classification of Headache Disorders ICHD-3 (beta version), and data were collected through an interviewer-administered Arabic-language-validated questionnaire with an addendum specifically designed to investigate the temporal relationship between commencement of interferon treatment, and headache onset and characteristics. Results: Two hundred seventy-six patients had pre-existing headaches, and 356 experienced de novo headaches. Of 122 patients who experienced headaches before IFN-ß treatment, 55 reported headaches that worsened following onset of IFN-ß treatment. In patients with post-IFN-ß headaches, 329 had headaches that persisted for >3 months, 51 had chronic headaches, and 278 had episodic headaches, and 216 of these patients required preventive therapies. Univariate analysis showed a >6- and an approximately 5-fold increased risk of headache among those treated with intramuscular (IM) INF-ß-1a (OR 6.51; 95% CI: 3.73-10.01; P-value <0.0001) and 44 µg of SC INF-ß-1a (OR 5.44; 95% CI: 3.15-9.37; P-value <0.0001), respectively, compared with that in patients who received 22 µg of SC INF-ß-1a. Conclusion: Interferon-ß therapy aggravated pre-existing headaches and caused primary headaches in patients with MS. Headache risk was greater following treatment with IM INF-ß-1a and 44 µg SC INF-ß-1a.

6.
J Adv Res ; 21: 141-150, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32071782

RESUMEN

Lately, long noncoding (lnc) RNAs are increasingly appreciated for their involvement in multiple sclerosis (MS). In inflammation and autoimmunity, a role of apoprotein A1 (ApoA1), mediated by sphingosine 1-phosphate receptors (S1PRs), was reported. However, the epigenetic mechanisms regulating these biomolecules and their role in MS remains elusive. This case control study investigated the role of ApoA1, sphingosine kinase 1 and 2 (SPHK1 & 2), S1PR1 & 5, interferon-γ (IFN-γ) and interleukin 17 (IL17) in MS, beside three lncRNA: APOA1-AS, IFNG-AS1, and RMRP. Expression of SPHKs, S1PRs, and lncRNAs were measured in 72 relapsing-remitting MS patients (37 during relapse and 35 in remission) and 28 controls. Plasma levels of ApoA1, IFN-γ and IL17 were determined. The impact of these parameters on MS activity, relapse rate and patient disability was assessed. APOA1-AS, IFNG-AS1, SPHK1 & 2, and S1PR5 were upregulated in RRMS patients. Differences in ApoA1, SPHK2, and IL17 were observed between relapse and remission. Importantly, ApoA1, SPHK2, and IL17 were related to activity, while S1PR1 and IFN-γ were linked to disability, though, only IFN-γ was associated with relapse rate. Finally, an excellent diagnostic power of IFN-γ, IL17, SPHK1 and APOA1-AS was demonstrated, whereas SPHK2 showed promising prognostic power in predicting relapses.

7.
Epilepsy Behav ; 103(Pt A): 106840, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31864942

RESUMEN

PURPOSE: Antiepileptic drugs (AEDs) are commonly incriminated for vitamin D deficiency in children with epilepsy. The aim of this study was to examine 25(OH) vitamin D status among children and adolescents with genetic generalized epilepsy (GGE) who had never received AEDs and its relation to seizure frequency and epilepsy duration. METHODS: This case-control study was conducted on 42 recently diagnosed patients with GGE, aged ≤18 years and 40 age- and gender-matched controls. Serum 25(OH) vitamin D level was performed for all participants. RESULTS: Serum 25(OH) vitamin D level was significantly lower in patients (median = 22 ng/ml, interquartile range (IQR) = 16.6-28.6) compared with controls (median = 58.4 ng/ml, IQR = 53-68), (P-value < 0.001). Patients with ≥4 seizures per month had a significantly lower level of serum 25(OH) vitamin D (median = 17.7 ng/ml, IQR = 16-24) than patients with lower seizure frequency (median = 28.3 ng/ml, IQR = 24.2-40.2), (P-value = 0.004). Also, there was a statistically significant negative correlation between the duration of epilepsy and serum 25(OH) vitamin D level (r = -0.309, P-value = 0.046). The receiver operating characteristic curve analysis showed that serum 25(OH) vitamin D level with a cutoff value of 23.9 distinguished patients with low seizure frequency (five or less per year) from patients with higher seizure frequency with a sensitivity and specificity of 80% and 74%, respectively (area under the curve (AUC) = 0.798). CONCLUSION: Vitamin D deficiency is found in treatment-naive children with epilepsy and adolescents with GGE, and it is associated with higher seizure frequency, longer disease duration, and younger age at onset.


Asunto(s)
Epilepsia Generalizada/sangre , Epilepsia Generalizada/epidemiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Adolescente , Anticonvulsivantes/farmacología , Anticonvulsivantes/uso terapéutico , Estudios de Casos y Controles , Niño , Egipto/epidemiología , Electroencefalografía/efectos de los fármacos , Electroencefalografía/métodos , Epilepsia Generalizada/tratamiento farmacológico , Femenino , Humanos , Masculino , Vitamina D/farmacología , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/tratamiento farmacológico
8.
Lab Med ; 50(1): 34-41, 2019 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-30060033

RESUMEN

Single-nucleotide polymorphisms (SNPs) in microRNA-146a (miRNA-146a) can be associated with the development of immune-system dysfunctions.The aim of this work is to correlate SNPs of miRNA-146a and its target gene, IRAK1, with susceptibility, clinical manifestations, and diseases progression in patients with systemic lupus erythematous (SLE) and multiple sclerosis (MS). Genotyping for miRNA-146a (rs2910164) and its target gene IRAK1 (rs3027898) was performed using real-time polymerase chain reaction (RT-PCR) in 80 patients with SLE and 70 patients with MS, as well as 120 healthy control individuals. A statistically significant difference was found between the frequencies of the genotypes and alleles of miRNA-146a (rs2910164) and IRAK1 (rs3027898), compared with the control group. Also, whereas the mutant allele G of miRNA-146a may be a factor in the pathogenesis of lupus nephritis, the mutant allele C of IRAK1 may play a role in lupus arthritis. Both genes may contribute to the susceptibility of patients to SLE and MS.


Asunto(s)
Quinasas Asociadas a Receptores de Interleucina-1/genética , Lupus Eritematoso Sistémico/genética , MicroARNs/genética , Esclerosis Múltiple/genética , Polimorfismo de Nucleótido Simple , Adulto , Femenino , Humanos , Masculino
9.
Neuropsychiatr Dis Treat ; 14: 631-640, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29503547

RESUMEN

Introduction: Although the frequency of pediatric-onset multiple sclerosis (POMS) has increased in recent decades, it is still highly uncommon, which creates a need for the involvement of more registries from various clinical centers. Objective: To characterize the demographic, clinical, and paraclinical features of Egyptian patients with POMS. Patients and methods: A retrospective chart review study was undertaken on 237 Egyptian patients with demyelinating events which started before the age of 18 years who attended one of five tertiary referral centers in Cairo, Egypt. Results: Multiple sclerosis was diagnosed in 186 patients, 47 (25.27%) patients had disease onset before the age of 12 years; "early-onset pediatric multiple sclerosis (EOPMS)". The mean age of disease onset was (14.13±2.49 years), with a female:male ratio of 1.62:1, none of the enrolled patients had a primary progressive course (PPMS), whereas 10 patients (5.38%) had a secondary progressive form. Approximately two-thirds of the patients had monofocal disease onset, and less than 10% presented with encephalopathy; most of them had EOPMS. Motor weakness was the presenting symptom in half of the patients, whereas cerebellar presentation was detected in 34.95%, mainly in EOPMS. Seizures (not related to encephalopathy) were more frequent in those with EOPMS. Initial brain magnetic resonance images were positive in all patients, with detected atypical lesions in 29.03%, enhanced lesions in 35.48%, black holes in 13.98%, and infratentorial in 34.41%. Cervical cord involvement was found in 68.28%. More than two-thirds of the patients received either immunomodulatory or immunosuppressant (IS) treatment throughout their disease course, and about half of them received their treatment within the first year from symptoms onset, with a more favorable outcome, and patients with highly active disease received natalizumab, fingolimod, or other IS. Conclusion: The results from this registry - the largest for MS in the Arab region to date - are comparable to other registries. Immunomodulatory therapies in POMS are well tolerated and efficacious and they can improve the long-term outcome in children.

10.
Neuropsychiatr Dis Treat ; 13: 1895-1903, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28765711

RESUMEN

BACKGROUND: Multiple sclerosis (MS) is a complex autoimmune disease with a heterogeneous presentation and diverse disease course. Recent studies indicate a rising prevalence of MS in the Middle East. OBJECTIVE: To characterize the demographics and disease features of Egyptian patients attending four tertiary referral MS centers in Cairo. MATERIALS AND METHODS: This was a retrospective, observational study on 1,581 patients between 2001 and 2015. Medical records were reviewed and data were identified and extracted in a standardized electronic registry. RESULTS: The mean age of disease onset was 26.6±7.8 years, with the majority being female (2.11:1). Relapsing-remitting MS was the most common type (75.1%). The main presenting symptom was motor weakness (43.9%), which was also the most frequent symptom during the disease course. Family history of MS was found in 2.28%. Higher initial Expanded Disability Status Scale score, black holes, and infratentorial lesions on initial magnetic resonance imaging were independent factors for disease progression by univariate analysis (OR 3.87 [95% CI 1.84-6.51], 4.14 [95% CI 3.08-5.58], 4.07 [95% CI 3.21-4.99], respectively); however, in multivariate analysis, only infratentorial lesions were an independent risk for disease progression (OR 6, 95% CI 2.99-12.02; P=0.0005). CONCLUSION: The results from this registry - the largest for MS in the Arab region to date - are comparable to other registries with slight differences.

11.
Ther Clin Risk Manag ; 13: 779-785, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28721058

RESUMEN

INTRODUCTION: Refractory epilepsy is a common clinical manifestation in patients with tuberous sclerosis complex (TSC), which can be complicated by many life-threatening conditions, such as status epilepticus (SE). However, very few reports mention the patterns and semiology of SE in those patients. OBJECTIVE: To study the clinical characteristics and outcomes of SE in TSC patients. MATERIALS AND METHODS: This observational, prospective study was carried out on 36 Egyptian children with definite TSC. Clinical history, general and neurological examination and psychometric evaluation by standard questionnaires were used to explore characteristics of epileptic manifestations and clinical patterns of SE. All included patients were required to have long-term video electroencephalograms (EEGs) and brain MRI performed. RESULTS: A total of 32 attacks of SE were recorded in 21 patients (58.3%) in our cohort during a follow-up period of 2.8±1.1 years; of those patients, 15 had convulsive status, 7 had non-convulsive SE, 6 had refractory/super-refractory SE and 14 patients had a history of infantile spasms (epileptic spasms). The duration of status ranged from 40 to 150 min (mean ± standard deviation: 90±15). Fourteen patients with SE had severe mental retardation, 9 had autistic spectrum disorder and 22 had severe epileptogenic EEG findings. Patients with SE had higher tuber numbers (mean: 9.6), 5 patients had subependymal giant cell astrocytomas and 2 patients had their SE after receiving everolimus. CONCLUSIONS: The incidence of SE in our patient sample is high (>50%); severe mental retardation, autistic features, history of infantile spasm (epileptic spasms) and high tuber burden are risk factors for developing SE.

12.
J Pain Res ; 10: 1289-1295, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28603429

RESUMEN

BACKGROUND: The reported prevalence of headache disorders in Arab regions varies considerably between countries. This may be due to a lack of standardized survey instruments that capture the prevalence. PURPOSE OF THE STUDY: Our goal was to construct and validate a structured headache questionnaire for Arabic-speaking headache patients to be used as an epidemiological survey instrument. METHODS: We developed a culturally adapted interviewer-administered questionnaire in Arabic language comprising two sets of questions. The first set included personal and sociodemographic data together with a screening question regarding the presence of headaches over the last year. The second set was designed to define the type and pattern of headaches according to the International Classification of Headache Disorders criteria (for subjects with "yes" answers on the screening question). Validation process took place in two phases through probability random sampling selected from 1,221 headache subjects collected in an epidemiological survey 3 (n=70) and 6 months (n=232) later. A detailed assessment of patients' headaches was performed by neurologists (blinded from the questionnaire diagnosis) who clinically assessed the patients' headache. RESULTS: The validity of the questionnaire was tested in 232 subjects with a mean age of 41.2±10.9 years, 72.8% of whom were females. The mean time to complete the questionnaire was 8.4±1.7 minutes. The intraclass correlation coefficient was 0.903 (95% confidence interval: 0.875-0.925), the Cronbach κ coefficient was 0.775 (95% confidence interval: 0.682-0.837), and the percentage of agreement was 84.5%. CONCLUSION: Our results support the use of this comprehensive questionnaire as a valid tool for headache assessment among Arabic-speaking patients.

13.
J Pain Res ; 9: 771-777, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27785091

RESUMEN

BACKGROUND: Chronic migraine is a prevalent disabling disease, with major health-related burden and poor quality of life. Long-term use of preventive medications carries risk of side effects. OBJECTIVES: The aim of this study was to compare repetitive transcranial magnetic stimulation (rTMS) to botulinum toxin-A (BTX-A) injection as preventive therapies for chronic migraine. METHODS: A pilot, randomized study was conducted on a small-scale sample of 29 Egyptian patients with chronic migraine, recruited from Kasr Al-Aini teaching hospital outpatient clinic and diagnosed according to ICHD-III (beta version). Patients were randomly assigned into two groups; 15 patients received BTX-A injection following the Phase III Research Evaluating Migraine Prophylaxis Therapy injection paradigm and 14 patients were subjected to 12 rTMS sessions delivered at high frequency (10 Hz) over the left motor cortex (MC, M1). All the patients were requested to have their 1-month headache calendar, and they were subjected to a baseline 25-item (beta version) Henry Ford Hospital Headache Disability Inventory (HDI), Headache Impact Test (HIT-6), and visual analogue scale assessment of headache intensity. The primary efficacy measures were headache frequency and severity; secondary measures were 25-item HDI, HIT-6, and number of acute medications. Follow-up visits were scheduled at weeks 4, 6, 8, 10, and 12 after baseline visit. RESULTS: A reduction in all outcome measures was achieved in both the groups. However, this improvement was more sustained in the BTX-A group, and both the therapies were well tolerated. CONCLUSION: BTX-A injection and rTMS have favorable efficacy and safety profiles in chronic migraineurs. rTMS is of comparable efficacy to BTX-A injection in chronic migraine therapy, but with less sustained effect.

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