Abstract Background Epilepsy is a multifaceted chronic neurological disease characterized by recurrent spontaneous seizures. It affects almost 70 million patients around the globe, making it one of the most common chronic causes of neurological morbidities. Aim of the Work detect an association between some inflammatory markers {C-reactive protein (CRP), Neutrophil-lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR)}and epilepsy in order to detect a pathogenic relation that in turn can influence the course and management of epilepsy. Patients and Methods the current body of evidence recognizes the association between inflammation and epilepsy. Several inflammatory markers have been investigated in relation to different types of epilepsy. This study chose CRP as a convenient and widely used inflammatory marker, together with NLR and PLR, the two novel, readily available indices of inflammation that are yet to be fully investigated in relation to epilepsy. We included 50 patients with uncontrolled generalized motor tonic–clonic seizures. Ages ranged from 18 – 45 years and both genders were represented. Patients were compared with 50 controls of same age and gender. Strict inclusion and exclusion criteria were applied to all volunteers. Results In this study, levels of CRP, NLR and PLR in 50 patients with epilepsy were significantly higher than controls. These results add to the pool of evidence that support the association between epilepsy and inflammatory processes. This study managed to investigate the correlation between inflammatory markers and specific independent variables such as frequency of seizures, time interval between last seizure and presentation, number of status epilepticus per year, number of anti-epileptic medications, duration of postictal confusion, age of onset of seizures, duration of illness, and EEG findings, in addition to age and gender differences. This study found increased levels of CRP, NLR, and PLR in patients with high frequency seizures compared to those with intermittent seizures. Similar results were obtained with increased number of episodes of status epilepticus, number of anti-epileptic medications and shorter time interval between last reported seizure and sample withdrawal. Longer duration of postictal confusion was associated with high values of NLR and PLR. Conclusion systemic inflammatory response has been detected in patients with uncontrolled generalized motor tonic–clonic seizures, which confirms the association between inflammation and epilepsy. This association is specifically correlated to higher seizure frequency, shorter duration between last seizure and blood sample withdrawal, higher number of status epilepticus in the last 12 months, higher number of anti-epileptic medications, longer duration of post-ictal confusion and female gender.

Tonic (physiology)

10.1093/qjmed/hcae070.346

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Corrected QT interval and QT dispersion in temporal lobe epilepsy

The Egyptian Journal of Neurology Psychiatry and Neurosurgery (2021)

Maram Samy Nasef Ahmed Gaber Yousry Aboelnaga Abdelhamid Islam Bastawy Salem Abdelhady

Abstract Background Cardiac arrhythmias are expected among patients with epilepsy due to the effect of anti-epileptic drugs. Temporal lobe epilepsy also causes autonomic seizures that may affect heart rhythm. Prolongation of the corrected QT interval and QT dispersion is a risk factor for cardiac arrhythmia. Objectives We aimed to assess corrected QT interval and QT dispersion in patients with epilepsy and if there is a difference between patients with temporal epilepsy versus non-temporal epilepsy. Methods This study was conducted on 100 patients (50 patients with temporal epilepsy and 50 patients with non-temporal epilepsy) and 50 age- and sex-matched healthy controls. They underwent a prolonged (6 to 24 h) 22 channel computerized electroencephalogram monitor with a 10–20 system. QT dispersion, QT interval, and corrected QT interval (using Bazett’s formula) were calculated. Results This study showed significantly higher QT dispersion and corrected QT interval in patients with epilepsy when compared to the age- and sex-matched control group ( P < 0.001, P < 0.001). Also, the corrected QT interval and QT dispersion were significantly higher in temporal epilepsy patients when compared to the non-temporal group ( P < 0.001, P < 0.001). Conclusion Corrected QT interval and QT dispersion are higher in epileptic patients and more among temporal epilepsy patients in comparison to non-temporal epilepsy patients.

10.1186/s41983-020-00257-1

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OROPHARYNGEAL PROLONGED DYSPHAGIA AFTER ACUTE STROKE: DIAGNOSIS AND CLINICAL PREDICTORS

Al-Azhar Medical Journal (2015)

Yousry Aboelnaga Abdelhamid Ahmed A.I. Elbassiouni Taha K.T. Aloush

Background: Dysphagia following acute stroke can be a serious threat to one's health because of the risk of aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. There is an evidence that early enteral feeding via percutaneous endoscopic gastrostomy (PEG) is both beneficial and safe. Objectives: To predict risk factors ofprolonged dysphagia following acute stroke and proper management of similar cases. Subjects and Methods: This study was a prospective cohort study conducted on 113 patients with acute stroke admitted within 24 hours. Clinical findings and imaging results were prospectively collected, and subsequent progress was recorded. Subjects were divided into 3 groups for analysis: no dysphagia; transient dysphagia (≥14 days); or prolonged dysphagia (>14 days). Particular attention was paid to bulbar function. Stroke severity was assessed using the National Institutes of Health Stroke Scale on admission and on discharge. The water swallow test was performed to all patients who were able to attend sufficiently to follow the instructions. Modified Barium Swallow or Video-fluoroscopy test was done for some patients to detect the oropharyngeal dysphagia. Results: Significant associations for prolonged dysphagia were seen with large stroke, increased stroke severity, dysphasia and lesions of the frontal and insular cortex and presence of old vascular insult on brain imaging. Conclusion: These results indicated that it is potentially possible to identify those patients who have prolonged significant dysphagia following acute stroke at an early time point. This would allow the judicious use of early PEG to avoid aspiration pneumonia and for better nutrition.

Stroke

Acute stroke

Oropharyngeal Dysphagia

10.12816/0023137

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CLINICAL FEATURES AND RISK FACTORS OF ACUTE STROKE IN WOMEN

Al-Azhar Medical Journal (2015)

Yousry Aboelnaga Abdelhamid Taha K.T. Aloush Yasmin M. Hanafy

Background: There is growing recognition of the clinical and public health importance of stroke in women. Moreover, stroke-related outcomes, including disability and quality of life are consistently poorer in women than in men. Yet the reasons for this are not well understood. Objectives: The aim of this study was to identify risk factors, clinical severity, type, site and size of stroke among sample of Egyptian women patients with acute stroke. Subjects and Methods: The study evaluated 103 female patients with acute stroke admitted within 48 hours of stroke onset. All patients were subjected to full history and neurological examination. The stroke severity was assessed on presentation using National Institutes of Health Stroke Scale (NIHSS). Also, computer topography and magnetic resonance imaging brain, bilateral carotid duplex study and trans-thoracic echocardiography study were done to all patients. Results:The mean age of the patients was 62.16 ± 13.5 years. Hypertension was the highest family (48.5%) and past history (78.6%) among the study patients. The mean of NIHSS score of our study patients on admission was 6.5 ± 3.76. The past history of previous cerebral stroke insult, high erythrocyte sedimentation rate and abnormal glycosylated hemoglobin were significantly associated with more severe stroke. Large artery atherosclerosis was the most common ischemic etiology in our sample (38.3%). Parietal lesions was the most common stroke site affected in our study patients (26 patients = 25.2%) followed by frontal lesions (18 patients =17.5%). Conclusion: Understanding acute stroke among females will help neurologist to develop sex-specific interventions that improve post-stroke recovery for women and reduce their excess burden of disability.

Stroke

Etiology

10.12816/0023136

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