Tarek A. Rageh

Effect of Surgical Menopause on Cognitive Functions

To investigate the effect of estrogen deficiency on cognitive function in surgically menopausal women, a prospective study was conducted at the University Hospital in Assiut, Egypt, during the period of July 1997 to August 1999. The study included 35 women subjected to total abdominal hysterectomy and bilateral salpingo-oophorectomy for nonmalignant causes. They were subjected to cognitive assessment by Mini-Mental State Examination (MMSE), Wechsler Memory Scale (WMS) subtests, and measurement of auditory Event-Related Potentials (ERPs) and serial serum estradiol levels determination. Eighteen age- and education-, body-weight- and parity-matched control women were recruited for comparison. A significant decline in MMSE, WMS subtests (digit span, visual memory, logical memory and mental control) and prolongation of P300 of ERP latency was observed in the patient group at 3 and 6 months postoperatively. These changes were not observed in the control group. A significant correlation was found between serum estradiol level and mental control subtest score and P300 latency in patients preoperatively. Patients who had a drop of estrogen level >50% had more cognitive function decline. Rapid decline in estrogen level following surgical menopause was associated with a deleterious effect on cognitive function. Such observations may contribute to more understanding of the age-related cognitive decline in females.

Epidemiology of Major Neurological Disorders Project in Al Kharga District, New Valley, Egypt

Background/Methods: A door-to-door (‘every door’) study was carried out to assess the incidence and prevalence rates of epilepsy, stroke, Bell’s palsy and cerebral palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural populations of Al Kharga district, New Valley, Egypt. The study was carried out in 3 stages from June 1, 2005 to May 31, 2009. A door-to-door screening including every door was carried out using a standardized questionnaire, which was administered by 3 neurologists to all inhabitants (62,583) of Al Kharga district. The study was designed to assess the prevalence, incidence and risk factors of major neurological disorders in Al Kharga district and aimed to reduce the burden of these neurological disorders in the entire region. Results/Conclusions: This study clarified that dementia, primary nocturnal enuresis, epilepsy, stroke and cerebral palsy are the most common neurological disorders. On the other hand, Bell’s palsy, extrapyramidal syndromes, cerebellar ataxia, muscle dystrophies and myasthenia gravis are less common neurological disorders in Al Kharga district.

Door-to-door survey of major neurological disorders (project) in Al Quseir City, Red Sea Governorate, Egypt.

A door-to-door survey, including every household, was conducted for all inhabitants of Al Quseir City (33,283), Red Sea Governorate, Egypt by three specialists of neurology as well as nine senior staff members of neurology and 15 female social workers to assess the epidemiology of major neurological disorders. Over six phases, from July 1, 2009 to January 31, 2012, screening of all eligible people in the population was carried out, by which case ascertainment of all major neurological disorders included in the study was done according to the accepted definitions and diagnostic criteria of the World Health Organization. The order of frequency of prevalence of the studied neurological disorders was dementia (3.83% for those aged > 60 years), migraine (2.8% for those aged > 8 years), stroke (6.2/1000 for those aged > 20 years), epilepsy (5.5/1000), Parkinson’s disease (452.1/100,000 for those aged > 40 years), cerebral palsy (3.6/1000 among children < 18 years), spinal cord disorders (63/100,000) dystonia (39.11/100,000), cerebellar ataxia (30.01/100,000), trigeminal neuralgia (28/100,000 for those aged > 37 years), chorea (21.03/100,000), athetosis (15/100,000), and multiple sclerosis (13.74/100,000). The incidence rates of stroke, epilepsy, and Bell’s palsy were 181/100,000, 48/100,000, and 98.9/100,000 per year, respectively.

Door-to-door survey of major neurological disorders in Al Kharga District, New Valley, Egypt: methodological aspects.

Epidemiology of neurological disorders is still lacking in Egypt. The door-to-door method is the most suitable one to screen neurological disorders in our country. Over a 4-year period (June 1, 2005 to May 31, 2009), screening and examination had been carried out to ascertain the incidence and prevalence rate of epilepsy, stroke, cerebral palsy and Bell’s palsy, as well as the prevalence of dementia, extrapyramidal syndromes, muscle and neuromuscular disorders, cerebellar ataxia and primary nocturnal enuresis among the urban and rural population of Al Kharga District, New Valley, Egypt. A total of 62,583 people were screened by 3 neurologists in a door-to-door manner, including every door, using a standardized Arabic questionnaire to detect any patient with a neurological disorder. This was a project study of neurological disorders including 3 stages: first stage (June 1, 2005 to May 31, 2006) for data collection, designing a standardized questionnaire and screening; second stage (June 1, 2006 to May 31, 2008) for case ascertainment, classification of neurological disorders and investigations, and third stage (June 1, 2007 to May 31, 2009) for data entry and statistical analysis. The results of this study revealed that the total prevalence rate of neurological disorders in Al Kharga District, New Valley was 2.4/100 with no significant difference among both sexes. The highest prevalence rate was recorded among elderly people (60+ years; 9.25%) and among children (≤18 years; 2.9%).

Neuropsychological effects of antiepileptic drugs (carbamazepine versus valproate) in adult males with epilepsy

Purpose: To evaluate the effect of antiepileptic drugs (AEDs) on cognition and behavior in adult epileptic males controlled on treatment with conventional antiepileptic medications. Methods: Cognitive, mood, behavior and personality traits were assessed in 45 epileptic patients treated with carbamazepine and/or valproate and free of seizures for ≥1 year. Thirty-four newly diagnosed or untreated patients with epilepsy and 58 matched healthy subjects were also included for comparison. A battery of psychometric tests was utilized including Stanford-Binet (4th edition), Beck Inventory for Depression, Aggressive Scale and Eysenck Personality Questionnaire. Results: Compared to matched control subjects, treated and untreated epileptic patients had poor performance in different cognitive and behavioral functions testing. Treated patients had worse scores in memory for digits forward and backward, total short-term memory, extroversion and psychosis. The duration of AEDs intake was correlated with memory of objects (r = −0.323; P = 0.030), bead memory (r = −0.314; P = 0.036) and total nonverbal short-term memory (r = −0.346; P = 0.020). Treated and untreated epileptic patients had poor performance of similar extent in behavioral functions testing (depression, aggression and neurosis). The dose of AEDs was correlated with testing scores for neurosis (r = 0.307; P = 0.040), verbal aggression (r = 0.483; P = 0.001) and nonverbal aggression (r = 0.526; P = 0.000), and duration of drug intake was correlated with scores for depression (r = 0.384; P = 0.009), psychosis (r = 0.586; P = 0.0001) and nonverbal aggression (r = 0.300; P = 0.045). Conclusions: This study provides support for the notion that AEDs can impair performance in cognition, mood and behavior. Duration of drug intake and the number of the utilized AEDs are the main confounding variables. This study did not provide clues on how to exclude the effect of epilepsy itself and psychosocial variables as additional important confounding variables.

Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors

Cerebral palsy (CP) is the most frequent cause of motor handicap. The present door-to-door survey was conducted in Al-Quseir City, Egypt, to investigate the epidemiology of CP. All inhabitants were screened by three neurologists. Medical and neurological examinations were performed for all residents and suspected cases of CP were confirmed by meticulous neurological assessment, brain magnetic resonance imaging, electroencephalography, and testing with the Stanford-Binet Intelligence Scale. Forty-six of 12,788 children aged ≤18 years were found to have CP, yielding a childhood prevalence of 3.6 (95% confidence interval 1.48–2.59) per 1,000 live births. Five adults (aged 19–40 years) among 13,056 inhabitants had CP, giving an adult prevalence of 0.4 (95% confidence interval 0.04–0.72) per 1,000. The risk factors for CP identified in this study were premature birth, low birth weight, neonatal jaundice, neonatal seizures, and recurrent abortion in mothers of children with CP.

Epidemiology of uncontrolled epilepsy in the Al-Kharga District, New Valley, Egypt.

BACKGROUND Despite advances in treating epilepsy, uncontrolled epilepsy continues to be a major clinical problem. Therefore, this work aimed to study the epidemiology of uncontrolled epilepsy in Al-Kharga District, New Valley. METHODS This study was carried out in 3 stages via door-to-door screening of the total population (62,583 persons). All suspected cases of epilepsy were subjected to case ascertainment, conventional ElectroEncephaloGraphy (EEG), and the Stanford-Binet Intelligence Scale. Patients who had been receiving suitable anti-epileptic drugs (AEDs) over the previous 6 months and were having active seizures were considered uncontrolled, according to Ohtsuka et al.(23) The patients underwent serum AED level estimation, video EEG monitoring, and brain MRIs. Fifty age- and gender-matched patients with controlled epilepsy were chosen for statistical analysis and compared with true intractable patients. RESULTS A total of 437 patients with epilepsy were identified, 30.7% of whom (n=134/437) were uncontrolled, with a prevalence of 2.1/1000. A total of 52.2% of uncontrolled patients (n=70/134) were inappropriately treated, while 47.8% (n=64/134) were compliant with appropriate treatments. Video monitoring EEG of compliant uncontrolled patients demonstrated that 78.1% patients (n=50/64) had definite epilepsy, while 21.9% (n=14/64) had psychogenic non-epileptic seizures (PNES). A logistic regression analysis revealed that status epilepticus, focal seizures, and mixed seizure types were risk factors for intractability.

Epidemiology of epilepsy in New Valley Governorate, Al Kharga District, Egypt

UNLABELLED Epilepsy is one of the serious neurological disorders which results in profound morbidity and mortality. Although epilepsy has no geographical boundaries, understanding cultural, social, and economic backgrounds is a very important step for interpretation of its epidemiological characteristics. This work aims to study the epidemiological profile of epilepsy in New Valley Governorate and to estimate its magnitude of treatment gap. It was conducted in a door to door survey, including all inhabitants (62,583 subjects), by 3 neurologists to detect any suspected case of focal or generalized epilepsy. All suspected cases were subjected to detailed history, clinical examination, EEG, neuroimaging studies, and estimation of serum drug level if needed. The study revealed that life time prevalence of epilepsy in Al Kharga district is 6.76/1000, with highest peak during early child hood, while that of active epilepsy is 4.99/1000 population. The annual incidence rate is 43.14/100,000, and age specific incidence rate has a U-shaped pattern with two peaks of incidence at early infancy and elderly. Localization-related epilepsy is the most frequently encountered type (53.7%). However the treatment gap of epilepsy in New Valley is similar to that in developing countries (61.5%). CONCLUSION Prevalence and Incidence Rate of epilepsy in New Valley are similar to that in industrialized countries.

Epidemiology of cerebral palsy in El-Kharga District-New Valley (Egypt)

Cerebral palsy (CP) is the most frequent cause of motor handicap among children. The present door to door (every door) study was conducted in El-Kharga District-New Valley to estimate the epidemiology of CP among children. Each child was subjected to complete medical and neurological examination to detect cases with CP. These diseased children were subjected to meticulous neurological and medical assessment, brain MRI, EEG and Stanford Binet (4th edition). It was found that 52 out of 25,540 children had CP yielding prevalence rate of 2.04/1000 (95% CI: 1.48-2.59) of living births. Mean age of children with CP, was 7.17±4.38years. The order of frequency of different subtypes of CP was as follows, 65.4% had spastic type, 26.9% mixed type and 3.8% for each ataxic and dyskinetic types of CP. The frequency of risk factors of CP in our study is prenatal complications (cyanosis, preterm, jaundice, birth weight and obstructed labor of mothers), first baby, similar condition and recurrent abortions.

Prevalence of Parkinson’s disease and other types of Parkinsonism in Al Kharga district, Egypt

Parkinson’s disease (PD) is a common neurodegenerative disorder in older people. The prevalence of PD varies among ethnic and geographic groups around the world. In this study, we aimed to estimate the prevalence of PD and other types of Parkinsonism in persons aged ≥40 years in the Al Kharga district of Egypt. The study was conducted on the total population of Al Kharga district (62,583 persons) between 2005 and 2009 and involved three neurology specialists and 15 female social workers undertaking a door-to-door survey. Suspected cases of Parkinsonism were subjected to meticulous clinical and neurological examination by three neurology staff members from Assiut University hospital who carried out their examinations separately. Of the total population surveyed, 15,482 persons were aged ≥40 years and 49 of these were identified as having Parkinsonism (prevalence: 316.50 per 100,000 people [95% confidence interval {CI} 240.21–404.98]). Of the 49, 33 fulfilled the diagnostic criteria for PD, giving a prevalence rate of 213.15/100,000 (95% CI 150.51–285.80) while 14 fulfilled those for vascular Parkinsonism, with a prevalence rate of 90.43/100,000 (95% CI 49.60–137.78). Postencephalitic and unspecified Parkinsonism each had a prevalence rate of 6.46/100,000. The prevalence of Parkinsonism was found to increase steadily with age, and the prevalence of all types of Parkinsonism was statistically higher in rural compared with urban communities, with no significant difference between men and women.