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Objective: To spot the frontal theta/beta ratio alterations during Tests of Variance of Attention (TOVA) in Egyptian attention deficit hyperactivity disorder (ADHD) children. Methods: This is a cross sectional study performed in Clinical Neurophysiology Unit, Cairo University, Egypt. It included 2 groups, each of 52 children (one of them with ADHD and the other were normal control). EEG was recorded for every subject during normal relaxing circumstance with eyes opened as well as during TOVA. Results: Comparing both groups revealed statistically significant difference in the theta/beta ratio in both state (normal relaxing with eyes opened and during TOVA), also we found that the theta/beta ratio decreased in normal group (during concentration) while in the ADHD group it increased with a specific pattern. Conclusion: The theta/beta ratio can be of value in helping for differential diagnosis in patients presenting with mild ADHD.

Background Studies have compared electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) with regard to their clinical efficacy in the treatment of depression, but only a few studies have addressed their differential impact on cognition. The purpose of this study was to compare the neurocognitive side effects of both treatment modalities. Methods In this comparative study, 40 patients with major depressive disorder referred for ECT were randomly assigned either to a course of 25 sessions of rTMS to the left dorsolateral prefrontal cortex or to a course of ECT ranging from 4 to 8 sessions. The primary outcome measures were the results of a cognitive battery that assessed different aspects of cognitive functioning. The cognitive battery comprised the Digit Span Subtest from the Wechsler Adult Intelligence Scale, the Stroop Color-Word Test-Victoria version, the Color Trails Test Trials 1 and 2, and the Rey-Osterrieth Complex Figure Test. Results At the end of treatment, scores on the Digit Span Subtest, the Stroop Color-Word Test-Victoria version, and the Color Trails Test showed statistically significant better results in the rTMS group compared with the ECT group. Conclusions rTMS was well tolerated with less negative impact on cognitive functioning than ECT.

Introduction Diagnostic tests for vascular erectile dysfunction (ED) depend on cavernous smooth muscles (CSM) relaxation following an intracorporal injection (ICI). Enhanced sympathetic tone, which is not uncommon during performance of these tests, can bias its results. Also, CSM diseases can cause veno-occlusive diseases (VOD) ED. Corpus cavernosum electromyography (CC-EMG) potentials’ amplitudes represent the integrated sympathetic activity of healthy CSM. Stem-cells and gene-therapy are potential therapeutic options for impaired CSM. Objective To utilize CC-EMG, as a new diagnostic technique that can confirm the integrity of CSM, and to identify patients with impaired CSM activity, among those diagnosed as vascular ED per Color Duplex Doppler Ultrasonography (CDDU). Patient and methods Group 1 included 24 patients with ED and negative response to ICI. Group 2 included 10 men without ED. Patients included in group 1 had penile CDDU examination and all participants had spontaneous CC-EMG recordings. Results According to CDDU parameters, group 1 was sub-grouped as nine arterial, ten VOD and five mixed type. CC-EMG potentials’ amplitudes ranged 223–320, 179–237, 103–250 and 83–200 μV for group 2 and arterial, mixed and VOD subgroups respectively. The widest ranges of potentials’ amplitudes were recorded in the subgroups of patients with an element of VOD. Four patients with ED, within these subgroups, had CC-EMG potentials’ amplitudes ranged 200–250 μV that exceeded/approached the lowest value recorded from men in group 2. Conclusion CC-EMG recordings elicited marked differences of CSM activity among patients diagnosed with an element of VOD ED per CDDU. This finding highlighted the need to utilize CC-EMG to assess the integrity of CSM. Identifying patients with impaired CSM activity may modify the chosen methods for therapeutic interventions.

In this double-blind, randomized study the efficacy of the ergoloid compounds, co-dergocrine mesylate and nicergoline, in the rehabilitation of patients with ischaemic stroke was investigated. A group of 30 patients was treated daily with 60 mg nicergoline, orally, and a second group of 27 patients was given 1.8 – 6 mg co-dergocrine mesylate, orally or intramuscularly, daily (depending on the time since the initial ischaemic insult) for 6 months. Outcome measures included: motoricity index (limb function); Sandoz Clinical Assessment Geriatric (SCAG) scale; psychometric tests to assess functions such as attention, psychomotor performance, perception and sensory and short-term memory; conventional and computerized electroencephalography; and P300 and reaction time measures. The results showed improvements in some aspects such as limb function ( P < 0.05), SCAG score ( P < 0.01) and some electrophysiological parameters ( P < 0.01) after treatment with both drugs. Though statistically significant most of the changes were not large. The efficacy of both drugs was qualitatively similar. The quantitative difference in some aspects in favour of nicergoline could be attributed to differences in the mechanisms of action of the two drugs, although it is also possible that the difference may reflect the dosages used. Nootropic drugs may induce a condition that facilitates the effects of cognitive training.

To review the clinical, neuroimaging, cytogenetic, and biochemical studies obtained in 20 patients with different cerebellar structural abnormalities presenting at variable ages of onset with variable signs and symptoms.These patients visited the Clinical Genetics Department, National Research Center, Cairo, Egypt during the period from September 2002 to September 2003. All patients were subjected to complete personal and family history taking 3 generation family pedigree construction and full clinical examination, including complete eye evaluation. Metabolic screening, chromosomal examination and brain CT or MRI, or both, were also carried out.Patients with cerebellar structural abnormalities were broadly divided into those with cerebellar hypoplasia (15 patients; 75%), cerebellar atrophy (3 patients; 15%) and cerebellar white matter abnormalities (2 patients; 10%). Further, cerebellar hypoplasia was subdivided into cerebello-vermal hypoplasia (4 patients; 20%), vermal-cerebellar hypoplasia (3 patients; 15%) and associated with involvement of other features such as brain stem (4 patients; 20%), posterior fossa (1 patient; 5%); and intracranial calcification (3 patients; 15%).This study showed that the type of cerebellar structural abnormality is not the main determining factor of the clinical outcome, but rather the underlying etiology. A high incidence of mostly autosomal-recessive inheritance was diagnosed in 65% of the patients with cerebellar structural abnormalities. Nevertheless, the high rate of consanguinity (18 cases; 90%) with mean inbreeding coefficient of 0.05312 and the similarly affected sibs highlights the role of the autosomal recessive gene in our country.

Global and specific cognitive functions were assessed in 57 patients with ischemic strokes subjected to clinical neuropsychiatric, psychometric, electrophysiological and cranial tomographic evaluation. Patients did significantly worse than normal controls in the Blessed dementia scale, Sandoz clinical assessment geriatric scale but not the Folstein mini-mental state examination. Of the specific cognitive functions, attention and psychomotor performance were significantly impaired in stroke patients when compared to normal controls. The impairment in global cognitive functions, attention and psychomotor performance was more evident in chronic than acute cases. Increasing age correlated positively to the deterioration in psychomotor performance and perception. Cranial tomographic size of infarction was significantly related to global cognitive as well as intentional (sensory) memory impairment. The more marked the conventional electroencephalographic abnormalities, the more impaired were the global cognitive functions. High limit of the theta percent power correlated positively to deterioration in psychomotor performance. All P300 parameters except amplitude correlated significantly with impairment of global cognitive function and psychomotor performance in stroke patients.

Background Poor behavioural inhibition is the central impairment in attention deficit hyperactivity disorder (ADHD). At present, there is no reliable objective measure to detect ADHD. A proper pinpointing evaluation for ADHD depends mainly on the history from parents, family members as well as teachers and schoolmates, by means of questionnaires and conduct rating scales. Objective The aim of this study was to detect continuous performance task (CPT) (test of variants of attention) changes in children suffering from ADHD compared with normal children. Patients and methods CPT, Conners' parent rating scale and Wechsler intelligence scale were done for two groups of children each containing 39 children, a group of ADHD children and the other a normal control group. Results We found a significant difference between the mean total IQ score among the ADHD patients group compared with control group. Comparing both groups revealed statistically significant increase in omission, commission and reaction time among patients. A significant negative correlation was found between age on one side and IQ, hyperactivity and psychosomatic subscales, hyperactivity and total DSM-IV scores on the other hand and between commission and opposition, restlessness subscales and ADHD index and also between reaction time and restlessness and emotional index. There was a significant positive correlation between omission and hyperactivity and anxiety subscales, restlessness and emotional indices and DSM-IV hyperactive and total scores. In addition, there was a significant positive correlation between perfectionism and commission and also between reaction time and inattention and social problems subscales. Conclusion CPT can have a substantial role in objective identification of ADHD.

Background Nerve conduction (NC) studies and electromyography (EMG) are invaluable tools in the diagnosis of neuromuscular disorders. Databases with plenty of observations are useful in better assessment and safe and effective decision making. Objective The aim of this study was to analyze data provided by the EMG and NC records and to correlate referral diagnoses, especially carpal tunnel syndrome, with the final electrodiagnostic ones. This will offer strategic clues to minimize time, cost, and human errors. Methods The study was carried out in the Clinical Neurophysiology Unit, Faculty of Medicine, Cairo University. Tabulation of EMG/NC details for the cases examined during the study period (first half of the year 2014), followed by extensive analysis of the data provided, was carried out. Results Most of the referral clinical diagnoses were of carpal tunnel syndrome (44%) and the least were of ulnar entrapment (1.3%). Concordance between referrals and final diagnoses was found only in 59.2% of patients. The most concordant referral was facial palsy and the most nonconcordant referral diagnosis was anal dysfunction. Conclusion Because of the occurrence of the referral diagnoses and the percentage of concordance between provisional and electrodiagnostic diagnoses, the unit is launching a local project for standardized guidelines for every provisional diagnosis.

Background Assessment of cognitive function in normal aging has been considered as an important issue nowadays. There is a generalized proportional decline in mental processing speed among elderly adults that affects all elements of mentation equally. Objective The aim of this study was to assess cognitive functions in normal elderly individuals using psychometric cognitive assessment scales and electrophysiological studies including late cortical responses, P300 and contingent negative variation (CNV). Methods Thirty-five healthy elderly individuals of both sexes were included. Their ages ranged from 60 to 75 years. The participants were subjected to thorough clinical assessment, cognitive evaluation using psychometric scales and neurophysiological tests in the form of P300 and CNV. Results The results of P300 showed a significant positive correlation between reaction time and age. A significant negative correlation was found between reaction time and performance on the Wechsler Intelligence Scale (WIS) ( P = 0.03). The mean amplitude of P300 wave recorded from the parietal region was significantly greater in male participants than in female participants. As regards the results of CNV, a significant negative correlation was noted between N2 latency and the verbal scale of WIS. Comparison of the mean CNV parameters between male and female participants showed that the mean latency of P2 wave was significantly higher in the male population compared with the female population. No significant correlation was revealed between P300 and CNV parameters and scores of Wechsler Memory Scale subtests and parameters of Wisconsin Card Sorting Test. Conclusion Results suggest that the psychiatric scales do not provide a substitute for electrophysiological tests in evaluating the cognitive changes that occur with normal aging. However, there was a limitation for the study in detecting changes because of the narrow age range of the cases.

Background The electroencephalogram (EEG) has long been used to pick up and analyze the electrical activity of the outermost layer of the brain. Attention deficit hyperactivity disorder (ADHD) patients revealed increased power in the lower frequency bands (δ and θ power) and a raised θ/β ratio. Objective The aim of this study was to detect the quantitative EEG changes in children with ADHD compared with normal children. Patients and methods The sampled group consisted of 45 children suffering from ADHD and represented the patient group, and 45 normal children represented the control group. EEG was recorded under resting conditions for all participants. Data from frontal areas were digitally processed and analyzed to calculate the four frequency bands' power (β, α, θ, and δ) and then θ/β ratio was computed. For the patient group, the Wechsler Intelligence Scale for Children was applied and parents of these patients filled out the Arabic version of Conners' Parent Rating Scale-revised-long version. Results The patient group showed significantly higher θ/β ratio in frontal areas compared with the control group ( P P P Conclusion Quantitative EEG markers - namely, the θ/β ratio - could play a role in the understanding and identification of ADHD.

Eighty-eight normal Egyptian volunteers above the age of 40 years were studied for brain aging and subjected to neuropsychological (the Paced Auditory Serial Addition Test; the Trailmaking test A, B; the Digit Symbol Substitution Test; sensory and secondary memory tests), electrophysiological (computerized EEG, P300 and reaction time measures), and Computerized Cranial Tomography (CCT) assessment. A significant correlation was found between age and both perception (Digit Symbol Substitution Test (DDST) and psychomotor performance (Trailmaking B test (TMb)), reaction time (RT) and the size of the third ventricle. Whereas females were worse in attention (Paced Auditory Serial Addition Test (PASAT)), males had worse performance in secondary memory test. Elderly subjects with vascular risk factors did worse in psychomotor performance (TMa) than subjects with no risk factors. Non-educated subjects showed worse perception (DSST) than educated subjects. A significant decrease in upper and lower limit percent power of the alpha band was found in subjects above 60 years, males, and non-educated subjects. A significant increase in theta activity was found only in non-educated subjects. It is concluded that decline in specific cognitive functions occurs with advancing age. Vascular risk factors and lack of education early in life enhance these changes. Moreover, the EEG slowing in the elderly was linked to lack of education early in life.

Hanan M El Shakankiry,1 Ann A Abdel Kader21Department of Pediatrics, King Fahd University Hospital–Al Dammam University, Al Khobar, Kingdom of Saudi Arabia; 2Department of Clinical Neurophysiology, Kasr Aini Hospitals–Cairo University, Cairo, EgyptRationale: Pattern sensitivity can be diagnosed by presenting a series of visual patterns to the subject in the electroencephalography (EEG) laboratory; however, testing for pattern sensitivity is not routinely done during EEG recording. This work aimed to highlight the incidence of pattern sensitivity among patients referred for routine EEG recording during a 1-year period, identifying the cause of referral, diagnosis, and the characteristics of pattern-sensitive patients.Methods: All patients aged 4 years and older who were referred for routine EEG during a 12-month period and had no motor or visual impairment were enrolled in the study. Intermittent photic stimulation and pattern sensitivity were tested for each case. Pattern sensitivity was tested by scanning three different rhythmically moving patterns at reading distance with the patient seated in an illuminated room. A pattern evoking a paroxysmal response was reintroduced after exposure to a blank white card to confirm the findings.Results: Two hundred twenty-eight patients were studied; twelve patients (5.26%) had pattern sensitivity and their ages ranged from 5 to 12 years. Eight of these patients (66.7%) were referred for seizure disorders, two were referred with the diagnosis of migraine, one with headache and poor scholastic performance and one with recurrent attacks of dizziness for investigation. Seven of the twelve patients (58.3%) had a previous EEG done without testing for pattern sensitivity. Five patients (41.6%) had positive family history for epilepsy, three (25%) for migraine, and two (16.6%) for migraine and epilepsy. Two patients (16.6%) had pattern sensitivity without photosensitivity. Pattern stimulation provoked epileptiform discharges in eight patients (66.6%), focal discharges in one, and unilateral build-up of posterior discharge in three.Conclusion: Diagnosis of pattern sensitivity is often missed as it is not routinely tested for during EEG recording. The result of the study challenges the concept of a consistent association between photosensitivity and pattern sensitivity; it also raises questions about the incidence of pattern sensitivity among children who do not suffer from epilepsy and in particular those with migraine, headache and scholastic difficulties. Further studies are therefore needed to clarify the phenotypic spectrum of this EEG trait.Keywords: reflex epilepsy, pattern sensitivity, migraine, headache