The earlier the diagnosis of multiple sclerosis (MS), the sooner disease-modifying treatments can be initiated. However, significant delays still occur in developing countries. We aimed to identify factors leading to delayed diagnosis of MS in Upper Egypt. One hundred forty-two patients with remitting relapsing MS (RRMS) were recruited from 3 MS units in Upper Egypt. Detailed demographic and clinical data were collected. Neurological examination and assessment of the Disability Status Scale (EDSS) were performed. The mean age was 33.52 ± 8.96 years with 72.5% of patients were females. The mean time from symptom onset to diagnosis was 18.63 ± 27.87 months and the median was 3 months. Seventy-two patients (50.7%) achieved diagnosis within three months after the first presenting symptom (early diagnosis), while seventy patients (49.3%) had more than three months delay in diagnosis (delayed diagnosis). Patients with a delayed diagnosis frequently presented in the period before 2019 and had a significantly higher rate of initial non-motor presentation, initial non-neurological consultations, prior misdiagnoses, and a higher relapse rate. Another possible factor was delayed MRI acquisition following the initial presentation in sixty-six (46.5%) patients. Multivariable logistic regression analysis demonstrated that earlier presentation, initial non-neurological consultation, and prior misdiagnosis were independent predictors of diagnostic delay. Despite advances in MS management in Egypt, initial non-neurological consultation and previous misdiagnoses are significant factors responsible for delayed diagnosis in Upper Egypt.

Background: Many patients with obstructive sleep apnea (OSA) report no improvement in the excessive daytime sleepiness, despite compliant CPAP treatment. Associated periodic limb movements (PLMs)with OSA might be a cause of failure. Objectives: Our study aimed to assess the increased periodic limb movements index (PLMI) in patients with residual excessive sleepiness (RES) on CPAP and polysomnographic changes caused by the occurrence of PLMs in this group of patients, and predictors of PLMS's presence. Patients and methods: We searched the electronic medical records of the OSA patients who were followed up in the CPAP outpatient clinic between 2010-2015. Patients who had completed at least one year of treatment were assessed. We included only patients with OSA and RES due to only PLMs (45 patients) (group one) against patients with OSAS, RES and with no definite cause (11 patients) (group two). Results: There was significant difference between both groups(more in group one) in the age and waist circumference (p value 0.04 and 0.017, respectively). There was significantly longer sleep onset latency (28.01 vs. 9.29), lower total sleep time (5.5 vs. 6.6 hours) and lower sleep efficiency percentage (72.44% vs. 87.1 %) in group one than in group two (P-value of 0.042, 0.019 and 0.011, respectively). Also, there were significantly higher means of wake after sleep onset (WASO) and total arousal index in group one than in group two. Waist circumference was the only predictor for increased PLMs index in this population study, by logistic regression with OR (95%CI) 0.168 (0.011-0.324). Conclusion: Increased PLMI during sleep significantly impact the polysomnographic variables. The waist circumference might be the only predictor of increased PLMs index.

Background: Bell's paralysis is an acute paralysis onset due to idiopathic facial nerve inflammation It is the commonest cause of lower motor neuron facial paralysis with an annual rate of 15-30 per 100,000. Objectives: Our aim of the study to detect the difference of axonal regeneration response in chronic Bell's palsy to low intensity radial shock wave therapy and kabbat exercises Patients and methods: 60 chronic bell's palsy patients (six months post injury) with age 35-60 years old randomly allocated to one of two groups; group A [Shock Wave (SW)](n=30) treated with low intensity shock wave plus kabbat exercises and facial muscle exercise for six weeks. KE (kabbat exercise) group (n=30) treated with kabbat exercises plus sham treatment by a shock wave and facial muscle exercise for six weeks. patients were assessed by electrophysiological study (Amplitude and degeneration index of facial nerve). The assessment was done before and after treatment. Results: Degeneration index decrease significantly in the group A (p < 0.001), but not in the group B (p = 0.295). Amplitude of facial nerve was low at baseline, indicating sever axonal degeneration. After treatment, amplitude increased significantly in the two groups; however, the significance was higher in group A (SW) than group B (KE)(p < 0.001). Conclusion: low intensity shock wave therapy is safe and effective treatment of chronic bell's palsy after 6 months from the onset.

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Background Flow diversion with or without coiling has been established as the treatment of choice for large unruptured aneurysms. This study aims to assess possible predictors for radiological and clinical outcome such as location of the aneurysm (anterior or posterior circulation), complexity by a branching artery, bifurcation, and adjuvant coiling. Methods This study was conducted on 65 consecutive patients with 65 large, unruptured intracranial aneurysms (size ≥ 10 mm) treated with flow diverters. Follow-up angiography was done for 60 patients (92.3%) at 12 ± 8.6 months range from 3 to 36 months. Results Complete occlusion was achieved in 50 from 60 aneurysms (83.4%), while 8 aneurysms (13.3%) had neck remnant, and another two aneurysms (3.3%) remained with aneurysmal remnant. Periprocedural complications were encountered in 14 patients (21.5%) with morbidity in six patients (9.2%) and mortality in one patient (1.5%). In a multivariate logistic regression, anterior versus posterior location was less likely associated with worse outcome; adjusted OR (95% CI) of 0.16 (0.07–0.01), p = 0.006. Complete occlusion in complex aneurysms with branching artery was 60% versus 88% in simple aneurysms without branching artery (p-value = 0.04). Conclusions Flow diverter deployment of a large, unruptured aneurysm in the anterior circulation might have a better outcome than one in the posterior circulation. Flow diverter of aneurysms with branching artery or at bifurcation might be associated with aneurysm persistence and complications respectively.