Mohamed S. El-Tamawy

Aerobic exercises enhance cognitive functions and brain derived neurotrophic factor in ischemic stroke patients

BACKGROUND Stroke is a leading cause of functional impairments. High percentage of these patients will experience some degree of cognitive affection, ranging from mild cognitive impairment to dementia. OBJECTIVE Demonstrate the role of aerobic exercises enhancing cognitive functions and its effect on Brain Derived Neurotrophic factor (BDNF) in post-ischemic stroke patients in the territory of anterior circulation. SUBJECTS AND METHODS We included thirty Egyptian ischemic stroke patients in the territory of anterior circulation. They were divided into 2 groups; group 1 (G1) were subjected to physiotherapy program without aerobic exercises and group 2 (G2) were subjected to the same previous program followed by aerobic exercises. Both groups were subjected to pre- and post-treatment Addenbrookess Cognitive Examination- Revised (ACER) and serum level of BDNF. RESULTS Our results showed a significant improvement in ACER score in G2 compared to G1 post-treatment (p = 0.017). BDNF serum level significantly increased in G2 post-treatment compared to pre-treatment (p = 0.001) and compared to G1 group (p = 0.0458). ACER improvement was positively correlated to increase in serum level of BDNF (r = 0.53, p = 0.044). CONCLUSION Aerobic exercises improve cognitive functions of ischemic stroke patients. This improvement is related to the increase in serum level of BDNF.

Botulinum toxin-type A: could it be an effective treatment option in intractable trigeminal neuralgia?

BackgroundBotulinum toxin type A (BTX-A) has been reported to have analgesic effects independent of its action on muscle tone, mostly by acting on neurogenic inflammatory mediators and controlling the neurotransmitter release of sensory and autonomic nerve terminals that are involved in many chronic painful conditions as chronic intractable trigeminal neuralgia (TN).The aim of our work was evaluating the efficacy, safety, and tolerability of BTX-A for the treatment of intractable idiopathic TN.MethodsThis was a randomized, single-blinded, placebo-control study carried out on 20 Egyptian patients with intractable TN. Patients received a one-time subcutaneous administration of BTX-A using “follow the pain” method. The primary efficacy measure was reduction in pain severity on the 10-cm VAS score as well as in paroxysms frequency from the baseline to week 12 (endpoint last observation carried forward [LOCF]). Secondary efficacy measures included QoL assessment and number of acute medications received from baseline to the endpoint.ResultsPain reduction at the 12-week endpoint was significant in BTX-A group (p<0.0001); VAS scores at endpoint LOCF relative to baseline for BTX-A group showed a decrease of 6.5 compared with a decrease of 0.3 for placebo, also there was a significant decrease in the number of acute medications and an increase in QoL functioning scale.ConclusionThese results indicate that BTX-A has a direct analgesic effect in patients with TN and can represent a therapeutic option for intractable cases.

Effects of augmented proprioceptive cues on the parameters of gait of individuals with Parkinson's disease

Context: Impairment of initiating sequential movements and processing of proprioception contribute to characteristic Parkinsons disease (PD) gait abnormalities. Many studies have used a single external cue or 2 different cues to correct PD gait. Aim: An aim of this study was to determine the influence of paired proprioceptive cues on gait parameters of individuals with PD. Setting and Design: Double-blind randomized controlled trial. Materials and Methods: Subjects were 30 PD patients who had mild to moderate impairment according to the United Parkinsons Disease Rating Scale (UPDRS). They were randomly assigned to either a routine physiotherapy program or treadmill training with vibratory stimuli applied to the feet plantar surfaces and proprioceptive neuromuscular facilitation (PNF) as well as the same physiotherapy program. All Participants received a 45-minutes session of low intensity physiotherapy program, 3 times a week, for 8 weeks. The duration of treadmill training was 5 minutes at baseline and 25 minutes at the end of treatment. Walking speed and distance were recorded from the treadmill control panel for both groups before and immediately after the end of treatment. The Qualysis ProReflex motion analysis system was used to measure cadence, stride length, hip, knee, and ankle joints’ angular excursion. Results: The cadence, stride length, and lower limb joints’ angular excursion showed a significant improvement in both groups (P ≤ 0.05). These improvements in spatio-temporal parameters and angular excursion were higher in the study group than in the control group (P ≤ 0.05). Conclusion: Potentiated proprioceptive feedback improves parkinsonian gait kinematics, the hip, knee, and ankle joints’ angular excursion.

Hormonal changes in cerebral infarction in the young and elderly.

Fifty-one patients with CCT verified cerebral infarction were submitted to serum and CSF radioimmunoassay of FSH, LH, estradiol (E2), progesterone, testosterone, cortisol and T4. The results were compared to those of 82 matched controls. Our findings suggest that (1) high serum E2 is a risk factor of stroke in males; (2) low serum T4 is a risk factor in males; (3) serum testosterone is reduced in acute stroke in males confirming that it is stress sensitive; (4) serum LH was higher in hypertensive thrombotic males when compared to normotensive ones, and (5) FSH, LH, E2 and T4 are undetectable in CSF of patients and controls.

Neuroscience research in Africa: Current status

There are limited data on the contribution of the African continent to neuroscience research and publications. This review aims to provide a clear view on the state of neuroscience research among African countries, and to compare neuroscience research within the 52 African countries. A literature review search was conducted for all published articles by African authors in both local and international journals using Medline and other primary databases. Neuroscience represents 9.1% of the total medical publications. The highest percentage of neuroscience publications comes from South Africa. There is a positive correlation between the Gross Domestic Product and the total number of neuroscience publications among African countries. There is therefore an urgent need to develop strategies to improve neuroscience research in African countries.

Oromandibular dystonia in Yemeni patients with khat chewing: a response to botulinum toxin treatment

Khat-(Catha edulis)related oromandibular dystonia is a difficult-to-treat subset of movement disorders that involve masticatory muscles with diverse and incapacitating manifestations. The aim of this study was to evaluate the efficacy of Botulinum toxin-type A therapy in khat chewer Yemeni patients with oromandibular dystonia. This prospective study included 18 khat-chewers Yemeni patients with refractory oromandibular dystonia, who were subjected to Botulinum toxin-A injection and followed up for 3 months thereafter. Primary efficacy outcome was the global impression scale, and secondary outcome measure was the Unified Dystonia Rating Scale. Patients showed improvement of both efficacy measures, maximum satisfactory responses were detected at the forth week after injection. No major adverse events were detected. Botulinum toxin-A is considered an effective and safe treatment option for refractory oromandibular dystonia in khat-chewers

S186 Effect of reciprocal pedaling exercise on cortical reorganization and gait in stroke patients

Objectives Functional impairment of the lower limb is a major complication in stroke patients. The involvement of the cortex in pedaling has critical clinical implications to control of cyclical motor functions in patients with damaged cortical structures or cortical pathways.The study aimed at determining the effect of reciprocal pedaling exercise (RPE) on the gait and cortical reorganization in the stroke patients. Methods Forty patients suffering from stroke with hemiparesis will be included in this study. They were divided to Group I treated by training for lower limb muscles of the affected side. While Group II were treated by the same program as group I in addition to RPE. Quantitative EEG (QEEG) was carried for all patients before and after the treatment programs. The midline frontal, central and parietal regions (Fz, Cz and Pz) were studied for evidence of plasticity induced by RPE. Results Neuroplasticity was noticed among patients of group II in the midline frontal region (Fz) and to a lesser extent the midline central region (Cz). Discussion The rhythmic and reciprocal nature of cycling motion permits patients to generate timely symmetrical and reciprocal powers from both limbs required for locomotion. Conclusions Leg cycling exercise, and thus RPE, is a rehabilitation program that improves the function of ambulation in stroke patients. Significance Post stroke physical therapy can utilize RPE for better rehabilitation.

The influence of physical therapy on oropharyngeal dysphagia in acute stroke patients

Background Dysphagia occurs in 65% of acute stroke patients, resulting in airway obstruction, malnutrition, and chest infection. Objective The aim of this study was to evaluate the effect of a designed physical therapy program that consists of therapeutic physical exercises in addition to neuromuscular electrical stimulation on severe swallowing disorders (oropharyngeal dysphagia) in acute ischemic cerebrovascular stroke patients. Methods Thirty stroke patients suffering from severe dysphagia were assigned randomly to two equal groups: the study group (G1) and the control group (G2). The patients in the study group (G1) received medical treatment in addition to a designed physical therapy program mainly directed at strengthening and stimulating the elevator muscles of the larynx above and below the hyoid bone, whereas the patients in the control group (G2) were under medical treatment only. Digital fluoroscopy was used to assess the following variables: oral transit time, laryngeal elevation, hyoid elevation, esophageal sphincter opening, and aspiration or penetration. Assessment was carried out before and at the end of treatment after 6 weeks. Results Before treatment, there were no significant differences in different variables between G1 and G2. After treatment there was significant improvement in all variables in G1 compared with G2, as measured by digital fluoroscopy. Conclusion The suggested physical therapy program could be an effective and safe method for improving and restoring the normal swallowing mechanism in ischemic stroke patients suffering from severe dysphagia.