In PD, Non-Invasive Trans-Spinal Magnetic Stimulation Enhances the Effect of Transcranial Magnetic Stimulation on Axial Motor Symptoms: A Double-Blind Randomized Clinical Trial

Research Abstract
Background:
Axial symptoms in Parkinson’s disease (PD) often respond poorly to pharmacological treatment. We evaluated whether combining repetitive transcranial magnetic stimulation (rTMS) and repetitive spinal magnetic stimulation (rSMS) is more effective than rTMS alone in improving axial and other motor disabilities in PD.
Methods:
A total of 42 PD patients with axial symptoms were randomly allocated to 2 experimental intervention groups: Group I received active rTMS + active rSMS (2000 pulses; 20 Hz; 80% resting motor threshold for each motor area “M1” + 1500 pulses rSMS 10 Hz, at 50% of maximal stimulator output). Group II received active rTMS + sham rSMS with the same number of pulses. Both groups received 10 sessions (5 consecutive days/week for 2 weeks). Assessments using Freezing of Gait Questionnaire, walking speed, Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts II and III, and Parkinson’s Disease Questionaire-39 (PDQ-39) were performed at baseline (T0), end of sessions (T1), and 1 month later (T2).
Results:
At T0, Group II showed higher walking speed. At T1 and T2, Group I demonstrated significantly greater improvements in MDS-UPDRS parts II, III, and sub-items of part III. Group I showed stronger improvement in TUG-T and average fast velocity immediately post-intervention, but this effect diminished after 1 month. PDQ-39 scores for leisure activity and walking problems were significantly higher in group I.
Conclusions:
These findings indicate that combining rTMS and rSMS for 10 sessions is more effective than rTMS alone in managing PD’s motor and axial symptoms. The effect size of the outcome is large enough to be of significance in clinical practice.
Research Authors
Eman M Khedr, Nourelhoda A Haridy, Mohammad A Korayem, Ahmed Mamdouh Tawfik, Ahmed A Hamed
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
Neurorehabilitation and Neural Repair
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Pages
126-137
Research Publisher
SAGE Publications
Research Vol
Volume 39
Research Website
https://journals.sagepub.com/doi/abs/10.1177/15459683241300547
Research Year
2024

Outcomes and safety of mechanical thrombectomy, alteplase, and conventional medical care in the treatment of acute M2 segment middle cerebral artery occlusion: a comparative study

Research Abstract

Background

Data on mechanical thrombectomy (MT) to treat M2 occlusions of the middle cerebral artery (MCA) are sparse. We report the outcome and safety of MT versus intravenous recombinant tissue plasminogen activator (IV rTPA) versus conventional medical treatment (CMT) of acute ischemic stroke (AIS) due to occlusion of the M2 segment of the MCA. This prospective longitudinal intervention study compared the outcomes and safety of MT, rTPA, and CMT in M2 occlusion AIS patients. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and recanalization rate assessed outcomes.

Results

74 AIS patients were recruited (23 MT, 23 rTPA, 28CMT). MT group had significantly higher admission NIHSS (p = 0.018) and mRS (p = 0.023) than rTPA. At 24 h, NIHSS improved more with MT and rTPA than CMT (p < 0.0001). At 3 months, mRS were better with MT and rTPA versus CMT (p < 0.0001). Successful recanalization occurred in 73.9% of the MT group. 69% of the MT group required stent retrieval plus aspiration thrombectomy, and 60.9% required ≥ 3 trials, but outcomes did not differ by technique or number of trials. A good outcome (mRS 0–2) at 3 months was achieved in 69.6% MT versus 65.2% rTPA versus 7.1% CMT (p < 0.0001). Symptomatic intracranial hemorrhage (sICH) rates were slightly, but insignificantly, higher with CMT. Mortality did not significantly differ between groups.

Conclusions

For M2 occlusions, MT and rTPA achieved better early and 3-month outcomes than CMT; however, MT was not superior to rTPA. MT of M2 is feasible and effective, with a lower hemorrhage rate than rTPA and CMT.

Research Authors
Eman M Khedr, Ahmed Elbassiouny, Mahmoud Nageeb, Ahmed Aly, Khalid O Mohamed, Nourelhoda A Haridy
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Publisher
Springer Berlin Heidelberg
Research Vol
Volume 61
Research Website
https://link.springer.com/article/10.1186/s41983-025-00935-y
Research Year
2025

Effects of transcranial magnetic stimulation on sleep quality in fibromyalgia: A double-blind randomized clinical trial

Research Abstract

Objectives

The aim of the current study was to assess the therapeutic impact of repeated low frequency repetitive transcranial magnetic stimulation (rTMS) over the right dorsolateral prefrontal cortex (rDLPFC) on sleep problems in patients with fibromyalgia.

Methods

Forty two patients with fibromyalgia who had sleep difficulties were randomly assigned to receive either real or sham rTMS treatment. Patients received 20 treatment sessions (5 sessions per week) in which 1200 rTMS pulses were applied over the rDLPFC using a frequency of 1 Hz and an intensity of 120 % of the resting motor threshold. All participants were evaluated at baseline, and then 1 month and 3 months after treatment using the Fibromyalgia Impact Questionnaire (FIQ), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Sleep Scale (MOS-SS) and polysomnography (PSG).

Results

There were significant time (pre, 1month, and 3 months)X group (real versus sham group) interactions in all 3 clinical rating scales; FIQ (Df = 1.425, F = 237.645, P = 0.001), PSQI (Df = 2, F = 64.005, P = 0.001), MOS-SS (Df = 2, F = 28.938, P = 0.001) due to the fact that the real group improved significantly more over time than the sham group. Similarly, the real group improved more on the PSG parameters than the sham group. The effect sizes were large both in the rating scales and PSG, indicating a substantial clinical improvement. Correlation as an exploratory analysis between the changes (pre - post 3 months) in MOS-SS and PLMs index (/h) showed significant negative correlation (r = −0.643, P = 0.002).

Conclusions

20 sessions of LF-rTMS over rDLPFC can improve sleep quality in both subjective (PSQI and MOSS) as well as objective (PSG) rating scales.
Research Authors
Marwa Y Badr, Reham A Amer, Hend M Aref, Rehab M Salem, Heba A Elmokadem, Nourelhoda A Haridy, Eman M Khedr
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
Sleep Medicine
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Pages
354-361
Research Publisher
Elsevier
Research Vol
Volume 124
Research Website
https://www.sciencedirect.com/science/article/abs/pii/S1389945724004647
Research Year
2024

The impact of sex differences on stroke risk factors and 3-month outcomes in patients receiving thrombolytic therapy for acute ischemic stroke

Research Abstract

Background

Acute ischemic stroke (AIS) is a major public health issue, and women have a disproportionate share of stroke-related disability and mortality, which is poorly understood. This study aimed to determine the effect of sex differences on AIS treated by thrombolysis using recombinant tissue plasminogen activator (rTPA). The study included 134 AIS patients eligible for rTPA. Risk factors, clinical presentation, thrombolysis response, complications, and outcomes were recorded. The outcomes were measured using the National Institute of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS) 3 months after stroke. The incidence of intracranial haemorrhage was also determined.

Results

Among 134 AIS patients treated with rTPA (59% male, 41% female), females had higher rates of hypertension (67.3% versus 49.4%, p = 0.040) and atrial fibrillation (AF) (12.7% versus 2.5%, p = 0.020), while smoking was more prevalent in males (31.6% versus 0%, p < 0.0001). Cardioembolism was more frequent in females than in males (23.6% versus 6.3%, p = 0.004). Females also had shorter onset-to-door (110.7 ± 63 versus 131.1 ± 50.2 min, p = 0.035) and onset-to-needle times (151.6 ± 66.5 versus 173.7 ± 50.6 min, p = 0.046). Both sexes showed significant improvements in NIHSS (males: 11.58 ± 3.7 to 6.05 ± 5.6; females: 11.64 ± 4.7 to 6.9 ± 5.9; p < 0.0001) and mRS scores (males: 3.34 ± 1.05 to 2.03 ± 2; females: 3.53 ± 1 to 2.02 ± 2; p < 0.0001) over 3 months, with no significant differences between sexes. Predictors of poor outcome (mRS 3–6) differed: diabetes mellitus (DM) (OR 7.79, p = 0.002) and longer door-to-needle time (OR 1.04, p = 0.008) for males, and hemorrhage (OR 9.41, p = 0.048) for females. Hemorrhage predicted mortality in males (OR 27.08, p < 0.0001), while AF was associated with increased mortality in females (OR 8.06, p = 0.024).

Conclusions

This study revealed sex-specific differences in AIS risk factors, aetiology, and rTPA treatment timelines, although post-treatment improvements were comparable between sexes. Notably, outcome predictors and mortality factors differed by sex. These findings emphasize the need for sex-specific considerations in AIS management and risk assessment.

Research Authors
Eman M Khedr, Noha Abo-Elfetoh, Asmaa M Hasan, Ahmed Nasreldein, Nourelhoda A Haridy
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Publisher
Springer Berlin Heidelberg
Research Vol
Volume 60
Research Website
https://link.springer.com/article/10.1186/s41983-024-00900-1
Research Year
2024

Impact of COVID-19 pandemic on the care of people with epilepsy and predictors of epilepsy worsening: Aswan/upper Egypt hospital-based study

Research Abstract

Background

During the Coronavirus disease pandemic “COVID-19”, epilepsy was one of many chronic neurological diseases in which treatment was neglected. This study aimed to evaluate the impact of the pandemic on people with epilepsy and identify potential predictors of seizure worsening through a face-to-face hospital survey. During the study period, 245 participants were recruited: 124 people with epilepsy (PwE) and 121 people without epilepsy (PwoE) age and sex-matched. Both groups were compared using sociodemographic COVID-19-related questionnaires and Hamilton Anxiety and Depression scales. PwE also completed epilepsy-specific questionnaires. Subsequently, we subdivided the PwE group into people with worsening epilepsy (WPwE) and those without (NWPwE).

Results

Compared with PwoE, PwE had significantly higher rates of COVID-19 infection (59.7% versus 41.3%, p = 0.004), and 69.4% of them (86/124) reported WPwE. WPwE had significantly higher rates of COVID-19 infection (75.6% versus. 23.7%, p < 0.0001), emergency room visits (69.8% versus 42.1%, p = 0.004), delayed neurology appointments (69.8% versus 42.1%, p = 0.004), and difficulties accessing medication (69.8% versus 47.4%, p = 0.02) and being less likely to be vaccinated (39.5% versus 68.4%, p = 0.003) than NWPwE. Depression and anxiety rates increased significantly during the pandemic compared with prior pandemics in both PwE and PwoE (p < 0.0001 for each). Moreover, the WPwE showed a significant increase in depression rates (33.7–60.5%, p < 0.0001) and higher mean anxiety scores compared to the NWPwE (p = 0.029). A multivariate binary logistic regression analysis showed that having a COVID-19 infection (AOR: 12.086, p < 0.0001), being laid off (AOR: 0.024, p = 0.001), or having more seizures before the pandemic (AOR: 3.366, p = 0.009) were all strong predictors of seizures getting worse.

Conclusions

Nearly 69% of PwE experienced pandemic-related seizures worsening, along with deterioration of mental health. Factors such as personal COVID-19 infection, unemployment, work interruption, and higher pre-COVID seizure frequency were identified as key predictors of seizure worsening. Mitigating these predictors could strengthen resilience among PwE during future widespread crises.

Research Authors
Eman M. Khedr, Nourelhoda A. Haridy, Gellan K. Ahmed, Mohamed Nemr Othman, Abdelrahman S. Elsoghier & Bastawy M. Al Fawal
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Publisher
Springer Berlin Heidelberg
Research Vol
Volume 60
Research Website
https://link.springer.com/article/10.1186/s41983-024-00874-0
Research Year
2024

90. The Clinical and Neurochemical Effect of Transcranial Magnetic Stimulation on the Unusual Symptoms of Multiple Sclerosis

Research Abstract
Background/Objective(s)
A plethora of debilitating symptoms can be caused by multiple sclerosis (MS) such as sensory and motor dysfunction, cognitive impairment, mood disorder, and fatigue. Such complaints can drastically impact a patient's quality of life, are mostly assessed in a clinical manner or with the help of scales, questionnaires, or test batteries, and cannot be completely or partially relieved using pharmaco the rapeutics. Moreover, their underlying mechanisms are not fully elucidated. Therefore, probing corticospinal excitability as a surrogate of the neuronal network function by using transcranial magnetic stimulation (TMS) could help in further understanding the underlying mechanisms of MS.
Applying TMS could help in identifying biomarkers of the disease itself. In addition, an inflammation-mediated synaptopathy seems to underlie a hyperexcitability state which could appear, using TMS, as an …
Research Authors
Amal Tohamy, Ghaydaa Shehata, Mahmoud Yosry
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
Multiple Sclerosis and Related Disorders
Research Member
Ghaydaa Ahmed Shehata Abo Zeid
Amal Mohamed Aly Tohamy
Research Pages
106051
Research Publisher
Elsevier
Research Vol
92
Research Website
https://www.sciencedirect.com/science/article/pii/S2211034824006278
Research Year
2024

Impact of Parkinsonism comorbid depression on cognitive functions

Research Abstract
Background
Parkinson's disease (PD) is a chronic progressive neurodegenerative disabling disease and involves about 1–3% of the worldwide population over the age of 60. A significant prevalence of psychopathological symptoms has been recorded as most patients with PD developed over their disease course neuropsychiatric symptoms such as depression, anxiety, sleep disorders, psychosis, and cognitive and behavioral abnormalities. These non-motor symptoms, which could appear decades before motor ones, become disturbing symptoms during the later phases of the disease. Hence, the current research aims to study depressive symptoms in Parkinson's disease patients. Thirty-six patients with Parkinson’s disease aged from 40 to 65 years (20 males and 16 females) and 36 age and sex-matched controls (19 males and 17 females) were included in the study. Unified Parkinson’s Disease Rating Scale …
Research Authors
Ghaydaa A Shehata, Hassan M Farweez, Anwar M Ali, Huda S Hassan, Amal M Tohamy, Mohamed Mostafa, Mostafa A Ibrahim, Khaled Tarek, Asmaa Ahmed Elrashedy, Ramy Abdelnaby, Mohamed Elsayed, Dina Elsayed Gaber
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Research Member
Ghaydaa Ahmed Shehata Abo Zeid
Hasan Mohamed Mohamed Mohamed Ferwez
Anwar Mohamed Ali Kobeisy
Amal Mohamed Aly Tohamy
Mohamed Mustafa Ahmed Mohamed
Research Pages
Pages 37
Research Publisher
Springer Berlin Heidelberg
Research Vol
Volume 60 Issue 1
Research Website
https://scholar.google.com.eg/scholar?oi=bibs&cluster=7996670340842538608&btnI=1&hl=en
Research Year
2024

Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study

Research Abstract

Background

Post-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. This nested case–control study included 2,624 acute stroke patients from a university hospital between May 2017 and April 2022. Patients who developed PSP within 6 months post-stroke were identified as cases (n = 108), and 119 patients without PSP were randomly selected as controls. Comprehensive assessments included clinical, laboratory, and imaging evaluations at baseline. After 6 months, follow-up evaluations were conducted, including neurological examinations, psychiatric assessments, and stroke severity assessments using the Barthel index (BI). The psychiatric assessments included the Hamilton Depression Rating Scale for depression and the Mini-Mental State Examination for cognitive status.

Results

The prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (≤ 5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. Non-specified psychosis and delusional disorder were the most common psychosis subtypes. There was a significantly higher percentage of excellent patients in the non-PSP group compared to those who had PSP regarding the observed improvement in the patient's condition. Also, there is a higher percentage of deteriorated patients in the PSP group (46.6%) compared to another group (18.9%) regarding BI.

Conclusion

PSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.

Research Authors
Bastawy M Al Fawal, Gellan K Ahmed, Ahmed K Ibrahim, Mohamed A Abdelhamed, Nourelhoda A Haridy
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Publisher
Springer Berlin Heidelberg
Research Vol
Volume 60
Research Website
https://link.springer.com/article/10.1186/s41983-024-00852-6
Research Year
2024

Case Report: Avoidant/restrictive food intake disorder after tonsillectomy

Research Abstract
Background
Avoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery.
Case presentation
A female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis.
Conclusions
To our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.
Research Authors
Gellan Ahmed, Ahmed A Karim, Eman M Khedr, Khaled Elbeh, Amira Moheb, Marwa Abokresha, Nourelhoda Haridy
Research Date
Research Department
Department of Neurology and Psychiatry
Research Journal
Frontiers in Psychiatry
Research Member
Nourelhoda Ahmed Ahmed Haridy
Research Pages
1351056
Research Publisher
Frontiers
Research Vol
Volume 15
Research Website
https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2024.1351056/full
Research Year
2024
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