This study aimed to evaluate the efficacy of rTMS in treating sleep disorders in PD. It included 24 patients with PD who had sleep disorders. Group allocations (active or sham with a ratio of 2:1) were placed in serially numbered closed envelopes. Each patient was evaluated with the following: MDS-UPDRS, Parkinson’s Disease Sleep Scale (PDSS), Beck Depression Inventory (BDI), and polysomnography (PSG) before and 10 days after the treatment sessions. Each session consisted of 10 trains, 20 Hz, 10 sec for each, over the parietal cortex (bilaterally). Scores of UPDRS, BDI, and PDSS improved significantly in the active group but not in the sham group. The PSG data showed that sleep onset and rapid eye movement (REM) latencies (min), REM duration, and time spent awake (both as %TST) were improved after rTMS in the active group compared with the sham group. The number of awakenings, the wake-after-sleep onset index, the arousal index, and periodic leg movements (PLMs) were all significantly reduced in the active group but not in the sham group. Ten sessions of 20 Hz rTMS over parietal cortexes improved sleep quality and PLMs in patients with PD. The improvement in PSG and PDSS were correlated with improvements in UPDRS and BDI scores.

Evaluation of neuronavigation in glioma surgery

Background

Gut microbiota plays a pivotal role in the gut-brain axis and can influence neurodevelopment and mental health outcomes. This review summarizes the current evidence on the associations between gut microbiota alterations and various psychiatric illnesses.

Main body

The composition of the gut microbiome evolves from birth through old age, and disruptions during critical periods may increase disease risk. Factors like diet, medications, stress, and infections can disturb the gut microenvironment and lead to dysbiosis. Dysbiosis has been linked to conditions like depression, anxiety, autism, ADHD, and schizophrenia. Proposed mechanisms involve microbial regulation of neurotransmitters, inflammation, oxidative stress, blood-brain barrier permeability, and the immune system. Therapeutic strategies like probiotics, prebiotics, and faecal transplantation may modulate the gut-brain axis and microbial ecosystem. However, more research is needed to elucidate the causal microbiota-psychiatry relationship. Understanding gut-brain interactions may uncover new possibilities for preventing and managing psychiatric disorders.

Conclusion

A growing body of research points to a close relationship between gut microbiota and mental health. While the field is still emerging, dysbiosis of gut microbial ecosystem has been associated with various neuropsychiatric conditions. The underlying mechanisms likely involve the microbiota-gut-brain axis signalling pathways. Additional research with larger samples is required to establish causal links between specific microbial changes and psychiatric outcomes.

Background

Multiple sclerosis (MS) is an inflammatory demyelinating central nervous system disease with diverse clinical manifestations. The present study aimed to compare the psychiatric outcomes of MS patients with full ambulatory versus impaired ambulatory function and identify the potential risk factors for disability in MS. Seventy MS patients were classified into two groups based on their Expanded Disability Status Scale (EDSS) scores, Group A: full ambulatory (EDSS ≤ 4.5) (N = 48), Group B: impaired ambulatory (EDSS ≥ 5) (N = 22). All participants were evaluated by the Socioeconomic Scale, Hamilton Anxiety Scale, Hamilton Depression Scale, Brief Psychiatric Rating Scale, and The Pittsburgh Sleep Quality Index.

Results

In the total cohort (N = 70), females represented (77.1%). The mean age was 31.16 ± 6.46, the mean age of onset was 26 ± 6.083, and the mean disease duration was 5.33 ± 3.653 years which was less in Group A than in Group B. Relapsing–remitting multiple sclerosis (RRMS) was the most common presentation (80%), representing 93.6% of Group A. Group A reported more severe depression and anxiety, while Group B had more poor sleep quality. Correlation analysis showed increased relapses, progressive-relapsing multiple sclerosis (PRMS), cervical or dorsal plaques, sensory or motor manifestations, and precipitancy increased disability, while RRMS type decreased disability.

Conclusions

Full ambulatory MS patients had high anxiety and depression, while impaired ambulatory MS patients had poor sleep quality. Associated factors for disability were frequent relapses, plaque location, MS subtype, sphincter, and sensory symptoms.

Background

Myasthenia gravis is an autoimmune neuromuscular junction disorder characterized by fatigable muscle weakness and autoantibodies. Frequent associations exist between myasthenia gravis and thymic abnormalities, including hyperplasia and thymoma. Several autoimmune illnesses have been identified to be associated with thymoma; however, a few case reports have linked thymoma and achalasia, and the underlying mechanism is unknown.

Case report

A 43-year-old man with thymoma-associated myasthenia gravis presented with dysphagia that was refractory to conventional treatment of myasthenia gravis. This dysphagia was challenging to diagnose even after multiple gastroenterology consults and upper endoscopy. The diagnosis of achalasia type II was established after a comprehensive evaluation, including upper endoscopy, barium swallow, and high-resolution esophageal manometry. The patient underwent elective pneumatic balloon dilatation, which successfully alleviated his dysphagia.

Conclusion

This case confirmed the association between myasthenia gravis secondary to thymoma and achalasia and showed how the diagnosis of achalasia was challenging. Awareness of this association is crucial for early diagnosis and treatment, improving affected patients’ quality of life.

Background: Epilepsy is a prevalent neurological illness, impacting about 70 million individuals around the world. Although a large number of patients are controlled with anti-seizure drugs (ASDs), 30%–40% of patients fail to be controlled and develop drugresistant epilepsy (DRE). Objectives: This study aimed to identify miRNa-223 expression and serum level of high mobility group box 1 (HMGB1) as biomarkers for detecting DRE. Methodology: This case-control study comprised 96 subjects categorized to three groups: group I: 46 patients with genetically presumed epilepsy who having DRE; group II: 25 patients with medically controlled genetically presumed epilepsy and group III: 25 healthy individuals. MiRNA-223 expression level was measured by real-time PCR and serum HMGB1 was estimated by ELISA technique. Results: MiRNA-223 expression serum HMGB1 and hs-CRP levels in epilepsy patients were considerably greater than in patients with controlled epilepsy and in healthy controls (p<0.001 for all). The predictive ability of miRNA, HMGB1 and hs-CRP for the detection of epilepsy and DRE using the ROC curve analysis revealed good sensitivities and specificities. Conclusion: MiRNA-223 expression and serum HMGB1 and hs-CRP levels are important biomarkers for diagnosis of epilepsy in suspicious cases. They are also significant for predicting DRE which may pave the way to the development of new antiepileptogenic drugs.