Background: COVID-19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study, we estimate the frequency of such complications among hospital inpatients with COVID-19 in Assiut and Aswan university hospitals. Materials and Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory tests, CT/MRI of the chest and brain, and neurophysiology study were performed for each patient if indicated. Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these, 117 had acute neurological disease and the remainder had nonspecific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke and the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of multiple sclerosis (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31) and the others had Guillain-Barré syndrome (4), peripheral neuropathy (3), myasthenia gravis (MG, 2), or myositis (2). Fever, respiratory symptoms, and headache were the most common general symptoms. Hypertension, diabetes mellitus, and ischemic heart disease were the most common comorbidities in patients with CNS affection. Conclusion: In COVID-19, both the CNS and PNS are affected. Stroke was the most common complication for CNS, and anosmia and/or ageusia were common for PNS diseases. However, there were 6 cases of encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG, and 2 cases of myositis.

Background: COVID 19 can be accompanied by acute neurological complications of both central and peripheral nervous systems (CNS and PNS). In this study we estimate the frequency of such complications among hospital in-patients with COVID-19 in Assiut and Aswan University Hospitals. Material and Methods: We screened all patients with suspected COVID-19 admitted from 1 June to 10 August 2020 to the university hospitals of Assiut and Aswan in Upper Egypt. Clinical and laboratory data, CT/MRI of chest and brain, and neurophysiology were performed for each patient if indicated. Results: 439 patients had confirmed/probable COVID-19; neurological manifestations occurred in 222. Of these 117 had acute neurological disease; the remainder had non-specific neuropsychiatric symptoms such as headache, vertigo, and depression. The CNS was affected in 75 patients: 55 had stroke; the others had convulsions (5), encephalitis (6), hypoxic encephalopathy (4), cord myelopathy (2), relapse of RR-MS (2), and meningoencephalitis (1). The PNS was affected in 42 patients: the majority had anosmia and ageusia (31); the others had GBS (4), peripheral neuropathy (3), myasthenia gravis (2), or myositis (2). Fever, respiratory symptoms and headache, were the most common general symptoms. Hypertensions, Diabetes Mellitus, ischemic heart disease were the most common comorbidities in patients with CNS affection. Conclusion: In COVID‑19, both the CNS and PNS are affected. Stroke was the most common complication for CNS and anosmia and/or ageusia were common for PNS diseases. However there were 6 cases encephalitis, 2 cases of spinal cord myelopathy, 2 cases of MG and 2 cases of myositis.

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BACKGROUND: There is evidence that both high and low frequency rTMS may have therapeutic effects on motor performance of Parkinson's disease. OBJECTIVE: The aim of the study was to conduct the first direct comparison of the two approaches. METHODS: 52 PD patients were randomly classified into two groups. The first group received 20Hz and the 2 nd group received 1Hz rTMS with a total of 2000 pulses over M1of each hemisphere for ten days. Effects were assessed with the Unified Parkinson's Disease Rating Scale part III (UPDRS), Instrumental Activity of Daily Living (IADL), and a self-assessment score (SA) before, after the last session, and one month later. Cortical excitability was measured before and after the end of sessions. RESULTS: There was a significant improvement on all rating scales after either 1 Hz or 20 Hz rTMS, although but the effect was greaterpersisted for longer at after 20 Hz (treatment X time interaction for UPDRS and IADL (P = 0.075 and 0.04 respectively). Neither treatment affected motor thresholds, but 20 Hz rTMS increased MEP amplitude and the duration of transcallosal inhibition. In an exploratory analysis, Eeach group was subdivided into akinetic-rigid and tremor dominant subgroups and the effects of 1 Hz and 20 Hz treatment recalculated. There is was weak evidence that patients with an akinetic-rigid presentation may respond better than those with predominant tremor. CONCLUSION: Both 20 Hz and 1 Hz rTMS improve motor function in PD, but 20 Hz rTMS is more effective and patients with an akinetic-rigid respond better than predominant tremor.

No abstract

Guillain–Barré syndrome (GBS) is a potentially fatal, immune-mediated disease of the peripheral nervous system that is usually triggered by infection. Only a small number of cases of GBS associated with COVID-19 infection have been published. We report here five patients with GBS admitted to the Neurology, Psychiatry, and Neurosurgery Hospital, Assiut University/Egypt from July 1 to November 20, 2020. Three of the five patients were positive for SARS-CoV-2 following polymerase chain reaction (PCR) of nasopharyngeal swabs on day of admission and another one had a high level of IgM and IgG; all had bilateral ground-glass opacities with consolidation on CT chest scan (GGO) and lymphopenia. All patients presented with two or more of the following: fever, cough, malaise, vomiting, and diarrhea with variable duration. However, there were some peculiarities in the clinical presentation. First, there were only 3 to 14 days between the onset of COVID-19 symptoms and the first symptoms of GBS, which developed into flaccid areflexic quadriplegia with glove and stocking hypoesthesia. The second peculiarity was that three of the cases had cranial nerve involvement, suggesting that there may be a high incidence of cranial involvement in SARS-CoV-2-associated GBS. Other peculiarities occurred. Case 2 presented with a cerebellar hemorrhage before symptoms of COVID-19 and had a cardiac attack with elevated cardiac enzymes following onset of GBS symptoms. Case 5 was also unusual in that the onset began with bilateral facial palsy, which preceded the sensory and motor manifestations of GBS (descending course). Neurophysiological studies showed evidence of sensorimotor demyelinating polyradiculoneuropathy, suggesting acute inflammatory polyneuropathy (AIDP) in all patients. Three patients received plasmapheresis. All of them had either full recovery or partial recovery. Possible pathophysiological links between GBS and COVID-19 are discussed.

Background: essential tremor (ET) is thought to emerge from activity in a distributed cerebello-thalamo-cortical network. It has been proposed that the network goes into oscillation because of some disorder of GABAergic inhibitory transmission. Objective: To test this idea by probing GABAergic circuitry in motor cortex using transcranial magnetic stimulation (TMS). Methods: Motor cortex excitability was examined using TMS in 21 patients with essential tremor and in 20 control subjects. Resting and active motor threshold (RMT, AMT) and input-output curves examined corticospinal excitability. Contralateral silent period (cSP) at a different range of stimulation intensities, and the ipsilateral silent period (iSP) using a stimulus intensity of 150% RMT were used as measures of GABAergic function. Results: RMT and AMT were significantly lower in patients than controls and patients had a steeper I/O curve. However, there were no significant differences in either cSP at different intensities nor in iSP. Conclusion: We found no evidence in favour of the GABA hypothesis in ET.

Background. Repetitive transcranial magnetic stimulation (rTMS) has become widely used as a therapeutic tool in parkinson's disease. Late-onset (tardive syndromes) movement disorders typically manifest three months or later (this varies) after the exposure to antipsychotic drugs, and unfortunately have no satisfactory medical treatment. The aim of this study was to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) on drug induced tardive syndromes. Material and Methods: Twenty patients with Tardive syndromes were allocated to receive real or sham rTMS. Each patient received 2000 rTMS pulses (20 Hz at 100% rMT) over the hand motor area area for 10 consecutive days. The Abnormal involuntary movement scale (AIMS), and cortical excitability of all patients were measured before, and immediately after the 10 sessions,. Results. At baseline, there was no significant difference between the groups in age, sex distribution, duration of illness, and treatment. The offending antipsychotic drugs that induced TS and the current treatment were similar in both groups, and no significant differences in clinical rating scale and their subitems nor in cortical excitability between groups. However, there was a significant improvement in the AIMS score (pre versus post sessions with p= 00001) in the real rTMS group compared with the sham group (P = 0.03). A repeated-measures ANOVA that showed a significant Time (pre, post session) × Group (real vs sham) interaction (P = .0001). The same trends were observed in the clinical subscales with significant improvement in real group and no effect the sham group. There were no significant changes in cortical excitability in either group. Conclusion. This is the first clinical trial study of bilateral hemispheric rTMS in patients with tardive syndromes. Bilateral hemispheric high frequency rTMS might be a feasible treatment for tardive syndromes resistant to medical treatment; further multicenter studies are needed to confirm this result.-American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision (DSM-IV-TR). Washington, DC., American Psychiatric Association, 2000.