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Background Though abnormal iron deposition has been reported in specific brain regions in multiple sclerosis (MS), no data exist about whether the overall quantity of iron in the brain is altered or not. We aimed to determine whether the noted aberrant iron deposition in MS brains was a problem of overall load or regional distribution in a cohort of MS patients. Methods An experienced neuroradiologist, a radiology software engineer, and four neurologists analysed data from quantitative susceptibility maps reconstructed from 3-T magnetic resonance brain images of 30 MS patients and 15 age- and sex-matched healthy controls. Global brain iron load was calculated, and the regional iron concentrations were assessed in 1,000 regions of interest placed in MS lesions in different locations, normal appearing white matter, thalami, and basal ganglia. Results Global brain iron load was comparable between patients and controls after adjustment for volume (p = 0.660), whereas the regional iron concentrations were significantly different in patients than in control (p ≤ 0.031). There was no significant correlation between global iron load and clinical parameters, whereas regional iron concentrations correlated with patients’ age, disease duration, and disability grade (p ≤ 0.039). Conclusions The aberrant iron deposition noted in MS seems to be a problem of regional distribution rather than an altered global brain iron load.

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Therapeutic drug monitoring (TDM) is increasingly recommended in antiepileptic drug (AED) therapy, yet a complex relationship exists between the unbound-drug serum concentration (C u.serum ) as a monitoring biomarker and clinical efficacy. The study was designed to investigate the validity of the intracellular unbounddrug concentration in Peripheral Blood Mononuclear Cells (C u.PBMC ) as a feasible TDM tool in relation to levetiracetam (LEV). Methods: Patients from epilepsy out-patient centre were included in a 4-month descriptive prospective study. Trough serum and PBMC LEV concentrations were monthly determined using HPLC and correlated with clinical features, demographic data, and P-glycoprotein (P-gp) expression. Results: Seventy-patients completed the study with a LEV dose range of 500−3000 mg/day. An absolute range for LEV C u.serum and C u.PBMC was 1.00-26.99 and 0.33-4.43 μg/mL, respectively. Unlike C u.serum , the average four-month LEV C u.PBMC displayed a significant positive correlation with clinical features and P-gp expression; where patients with higher LEV C u.PBMC experienced less number of seizure/month, better cognition and quality of life, and had a more reduction in P-gp expression, but no significant correlation with LEV daily dose was observed. A therapeutic response threshold of ≥ 0.82 μg/mL for LEV C u.PBMC was perceived by using a receiver operating characteristic curve that related the number of seizure/month to the LEV C u.PBMC . The validity of this therapeutic threshold was significant in contrast to LEV Cu.serum. Conclusion:Levetiracetam PBMC concentration is a more sensitive biomarker for LEV efficacy and correlates better with clinical events than C u.serum and could represent a novel tool for more precise LEV monitoring.

Objectives COVID-19 pandemic imposed a relevant number of stressful factors potentially impacting either daytime function or sleep quality. This study aimed to assess the sleep quality and anxiety among the general population living in Egypt. Material and Methods A cross-sectional survey was conducted among 1,000 individuals who have been recruited via a convenience sample. A predesigned questionnaire was distributed online to collect data on sleep quality using the validated Arabic version of the Pittsburgh sleep quality index, anxiety disorders by the generalized anxiety disorder (GAD-7) scale, demographic characteristics, and clinical history. Results Among the study participants (33.8% males, 46.2% healthcare workers, 25% had chronic diseases, 30.1% were physically active during lockdown, and 70.3% reported work termination due to COVID-19 infection, 68.4% complained of bad sleep and 70.3% showed clinically significant levels of anxiety). In multiple logistic regression analysis, bad sleep quality was significantly associated with moderate anxiety (OR: 1.88; [95% CI: 1.37-2.60]), severe anxiety (OR: 3.15; [95% CI: 2.18-4.55]), being physically active (OR: 0.53; [95% CI: 0.39-0.71]), received higher education as being postgraduate (OR: 0.56; [95% CI: 0.35-0.92]), or living with family (OR: 0.74; [95% CI :0.56-0.98]).The GAD-7 scale added 8% discrimination power for prediction of bad sleep quality compared to the model based on demographic and clinical data [with GAD: AUC=0.70, p<0.001; without GAD: AUC=0.62, p<0.001]. Conclusion COVID-19 had a significant impact on sleep quality and anxiety among Egyptians. Since both the conditions may overlap and potentiate each other leading to chronic dysfunctional outcomes, an accurate assessment and clinical approach may favor a better prognosis.