Noha T. Abokrysha

Possible induction of acute disseminated encephalomyelitis (ADEM)-like demyelinating illness by intrathecal mesenchymal stem cell injection

We report a 27-year-old woman with an episode of encephalitis and optic neuritis, followed by autologous bone marrow mesenchymal stem cell transplants and possible induction of acute disseminated encephalomyelitis-like demyelinating illness.

Ibn Sina (Avicenna) on Pathogenesis of Migraine Compared With the Recent Theories

From its dramatic rise in the seventh century, Islamic civilization has covered a large part of the globe, incorporating many subcultures and languages into its orbit (http:// www.nlm.nih.gov/hmd/arabic/med_islam.html). Islamic medicine typifies that experience, being built on the theoretical and practical knowledge first developed in Greece and Rome. For Islamic scholars, Galen (d. ca. 210 AD) and Hippocrates (fifth century BC) were pre-eminent authorities, followed by Hellenic scholars in Alexandria. Islamic scholars translated their voluminous writings from Greek into Arabic and then produced new medical knowledge based on those texts. In order to make the Greek tradition more accessible, understandable, and teachable, Islamic scholars ordered and made more systematic the vast GrecoRoman medical knowledge by writing encyclopedias and summaries (http://www.nlm.nih.gov/hmd/arabic/med_ islam.html). Drawing upon Hellenic medical tradition, Islamic medicine developed its own traditions. In turn, medieval and early modern scholars in Europe drew upon Islamic traditions and translations as the foundation for their medical enterprise. It was through Arabic translations that the West learned of Hellenic medicine, including the works of Galen and Hippocrates (http://www.nlm.nih.gov/hmd/ arabic/med_islam.html). Of equal, if not of greater influence, in Western Europe were systematic and comprehensive works such as Avicenna’s Canon of Medicine, which were translated into Latin and then disseminated in manuscript and printed form throughout Europe. During the 15th and 16th centuries alone, the Canon of Medicine was published more than 35 times (http://www.nlm.nih.gov/hmd/arabic/med_ islam.html). Avicenna’s work represented one of the first scientific encyclopedia covering logic, natural sciences, psychology, geometry, astronomy, arithmetic, and music. In the Canon of Medicine, Avicenna (980-1037 ad) surveyed the entire medical knowledge available from ancient and Muslim sources, supplementing this information with his own original contributions. The Canon became a standard of medical scienc, on a par with the works of Hippocrates (460-377 bc) and Galen (129-199 ad). The work could be found in all the important European university libraries. The Canon of Medicine consists of 5 books containing approximately 1 million Arabic words on 1000 pages, written in a completely systematic manner. 1 Avicenna begins his Canon with the following words: “It is my heart’s desire, to start off with speaking about the general and common principles of both parts of medicine, that is, theory and practice.” The Canon gained widespread popularity in the West only after the introduction of typography in the 15th and 16th centuries, but its impact throughout Europe remained steady until the end of the 18th century. Only a few modern European libraries now retain a complete Canon of Medicine (a 1482 edition in Paris, France; 1658 editions in Padua and Milan, Italy and a copy in Berlin). There is only 1 edition in a modern language (Russian), limiting an actual interpretation of this work. Recent articles considering history of theories of pathogenesis of migraine have ignored Avicenna. Villalón et al summarized in their history of theories of pathogenesis of migraine, declaring that around 400 bc Hippocrates released migraine from the realms of the supernatural by attributing it to vapours rising from the stomach to the head. They pointed out that the Hippocratic/Galenic concept of migraine survived into the 17th century, when Thomas Willis published, in 1664, his hypothesis that “megrim” was due to dilatation of blood vessels within the head (the first enunciation of a vascular theory). In 1873, Edward Liveing proposed that migraine was due to “nerve storms evolved out of the optic thalamus.” Toward the end of the 19th century, attempts were made to reconcile both theories. Thus, Moebius stated in 1898 that “parenchyma is the master, circulation the servant,” and that both brain and blood vessels dysfunctions were

Association between total plasma homocysteine level and cognitive functions in elderly Egyptian subjects

BACKGROUND High plasma total homocysteine has emerged as a new risk for cognitive decline with age. OBJECTIVES The aim of the present study was to examine the association of plasma homocysteine with cognitive performance in normal aged Egyptians. SUBJECT AND METHODS Forty five aged Egyptians subjects were included in the study. Their cognitive performance was assessed using Mini-Mental State Examination MMSE, Addenbrookes Cognitive Examination (ACE) and Clinical Dementia Rating (CDR) scale. Total plasma homocysteine level in fasting blood samples was also measured. RESULTS A statistically significant negative association was detected between plasma homocysteine level and age. A statistically highly significant inverse association was found between plasma tHcy and scores of cognitive assessment in aged subjects after adjustment for age, gender, education years and cardiovascular risk factors. No significant association was detected between total plasma homocysteine level and sex, blood sugar or lipid profile (p≥0.05). CONCLUSION Elevated tHcy level is an independent risk factor for the decline of cognitive performance in normal elderly subjects.

Stem Cell in Neurological Disorders

1.2 Adult stem cells Adult stem cells (ASCs) play a critical role in tissue maintenance and repair (Stem Cell Basics, 2010). Research on adult stem cells began in the 1950s with the discovery of multipotent hematopoietic and mesenchymal stem cells in bone marrow, which can generate a number of tissues (Stem Cell Basics, 2010). Bone Marrow-Derived Mesenchymal Stem Cells can be expanded and differentiated in vitro using various media formulations and culture surface conditions to direct them to different cell lineages (Ho et al., 2006). BMSCs have the ability to migrate to areas of injury, even crossing the blood-brain barrier (Akiyama et al., 2002; Tang et al., 2007). Although the reproducibility of BMSC therapies needs to be thoroughly examined, these early experiments suggest that BMSCs can be administered intravenously to CNS targets. (Rice & Scolding, 2008)

Pediatric-onset multiple sclerosis in Egypt: a multi-center registry of 186 patients

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.

Ultrasound evaluation of internal jugular valve incompetence (IJVI) in Egyptian patients with idiopathic intracranial hypertension (IIH)

BACKGROUND Idiopathic intracranial hypertension (IIH) is a clinical syndrome with no identified causative factor. Internal jugular valve incompetence (IJVI) has been linked to many neurological disorders such as idiopathic intracranial hypertension (IIH), transient global amnesia and cough-induced headache. Intact valves prevent efficiently retrograde flow into the internal jugular vein. AIM The aim of this study is to evaluate the competence of the jugular vein valves and its relationship to age, BMI, opening CSF pressure and MRV findings in IIH patients. SUBJECTS AND METHODS Twenty-five Egyptian female patients diagnosed with IIH according to the modified Dandy criteria, and 24 female controls, matched for age and BMI, were included and examined using color-coded duplex for IJVI during the Valsalva maneuver. The patients underwent lumbar puncture to measure the opening pressure, MRV, ophthalmic examination and laboratory work-up. RESULTS There was no statistically significant difference in the proportion of IJVI among the patients and controls (P=0.7). There was a statistically significant increase in the opening pressure and proportion of MRV abnormalities in the patients with IJVI compared to the patients without IJVI (P=0.03 and 0.007, respectively), but there were no statistically significant difference with regard to age, BMI, grade of papilledema and perimetry findings. CONCLUSION This study showed that there is no relationship between IJVI and IIH; thus, IJVI would be a rather normal finding. Further studies are recommended to confirm or rule out a possible relationship.

Diagnostic value of aquaporin 4 antibody in assessing idiopathic inflammatory demyelinating central nervous system diseases in Egyptian patients

Neuromyelitis optica immunoglobulin G (NMO-IgG) binds selectively to aquaporin 4 (AQP4). We aimed to evaluate the frequency of AQP4 antibody in Egyptian patients. We retrospectively evaluated 39 consecutive Egyptian patients with suspected idiopathic inflammatory demyelinating central nervous system disease (IIDCD) who visited the multiple sclerosis clinic at Kaser Al-Aini Hospital. The patients were diagnosed with NMO, other NMO spectrum disorders, or multiple sclerosis using the respective current diagnostic criteria. For the anti-AQP4 antibody assays, serum samples from all patients and 16 healthy matched controls were evaluated. The coded sera were tested for AQP4 antibody using an enzyme-linked immunosorbent assay kit. The relations between the clinical diagnosis and the AQP4 antibody serologic status were studied. Among the 39 patients, 21 (53.85%) were AQP4 antibody-positive. NMO spectrum disorders patients had a significantly higher level of AQP4 antibody compared with MS patients and controls (p<0.001). Only eight patients (36.36%) met the Wingerchuk 2006 criteria for NMO diagnosis excluding AQP4 antibody-seropositive status. AQP4 antibody was highly prevalent (almost 54%) in Egyptian IIDCD patients. Our research revealed that we must maintain a high index of suspicion for NMO spectrum disorders.