Objective: To assess the cerebral vasomotor response to ipsilesional repetitive transcranial magnetic stimulation (rTMS) on transcranial Doppler (TCD) in patients with recent ischemic stroke without carotid occlusive disease, and to compare this response in patients with cortical and subcortical infarcts. Methods: Consecutive patients with first-ever anterior circulation acute ischemic stroke (<3 days) and no extra- or intracranial arterial stenosis were prospectively recruited. Patients were divided into 2 groups: cortical infarct (CI, n = 15) and subcortical infarct (SI, n = 16). TCD cerebral blood flow velocity (CBFV) and pulsatility index were measured before and after 10-Hz suprathreshold rTMS over the dorsolateral prefrontal cortex. Results: ANOVA showed a greater percentage increase in middle cerebral artery (MCA) CBFV in the SI group than in the CI group following rTMS (p = 0.01). The percentage change in CBFV was significantly correlated between both MCAs in SI patients but not in CI patients (r = 0.8, p < 0.001 vs. r = 0.05, p = 0.9, respectively). Conclusions: 10-Hz rTMS induces significant bilateral hemodynamic changes in patients with acute ischemic stroke, which appear to be less prominent and less synchronous in patients with cortical infarcts. These findings may allow optimization of the use of TMS in acute stroke.

Background: Sleep disorders and epilepsy commonly exist and affect each other. Patients with epilepsy often complain of poor sleep and on the other hand, poor sleep makes epilepsy control difficult. Objectives: We aimed at comparing the sleep disturbances in a group of patients with medically controlled epilepsy versus another group with medically refractory epilepsy, from the electrophysiological standpoint. Subjects and methods: Sixty epilepsy patients were included; half of them with controlled epilepsy were assigned as group I, and the other half with refractory epilepsy was assigned as group II. All patients had an overnight polysomnogram and sleep EEG done. We excluded any patient with abnormal general or neurological clinical examination. Results: Patients in group II, had significantly delayed sleep onset latency and REM latency. However, higher arousal index, insomnia, and periodic limb movement index were found to be significantly higher in group I. Respiratory events; as light sleep durations, were observed to be higher in Group II, in addition to apnea-hypopnea index that was significantly higher in this group. Conclusion: Epilepsy affects sleep architecture and sleep-related events. Patients with refractory epilepsy suffer from more disturbance in sleep patterns. Moreover, antiepileptic drugs can have a diverse effect on sleep architecture and quality in epileptic patients.

Background: A high prevalence of obstructive sleep apnea (OSA) has been reported in medically refractory epilepsy patients, and there is increasing evidence that treatment of OSA in refractory epilepsy patients would reduce seizure frequency. Objective: Studying the frequency of occurrence of OSA in a group of refractory epilepsy patients, compared to a matched group with medically controlled epilepsy. Methods: Sixty patients with epilepsy, 30 patients with controlled epilepsy (group I), and 30 patients with refractory epilepsy (group II) were included. All patients underwent overnight polysomnogram and sleep EEG and completed Sleep Apnea Sleep Disorders Questionnaire (SASDQ). All patients had normal general and neurological examination. Results: The frequency of OSA was found to be 10% in patients with controlled epilepsy, while its frequency in patients with refractory epilepsy was found to be 16.7%, yet this was statistically insignificant. In addition, O 2 desaturation nadir was higher in group II, compared to group I with no statistical significance. In the controlled epilepsy group, we found that older patients tend to have higher Apnea-Hypopnea Index (AHI). Moreover, it was found that older subjects, with early onset of epilepsy, and longer duration of the illness tend to have higher AHI in group II. Conclusion: There is an association between refractory epilepsy and OSA, especially regarding O 2 desaturation during sleep. In addition, older age, early onset of epilepsy, and longer duration of illness are independent risk factors for the OSA in patients with refractory epilepsy.

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Background Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system. Autonomic dysfunction is present in a wide range of patients (15–80%) that might present with abnormalities in the regulation of the cardiovascular system, sleep disturbance, urinary symptoms, sexual problems, and temperature regulation problem. Although the predominant view is that of an autoimmune inflammatory condition, changes in brain vasculature can occur and contribute to pathophysiology. Objectives The aim of this study was to evaluate cerebral hemodynamics and assess autonomic dysfunction in patients with MS and explore its relationship with disease status. Methods Eighty patients diagnosed with MS according to McDonald criteria 2017 were recruited to this comparative cross-sectional study. All participants underwent assessment of cerebral hemodynamics through transcranial Doppler ultrasonography. Cerebral vasomotor reactivity (CVR) to hypercapnia was measured by the breath-holding index (BHI). They were also assessed for autonomic dysfunction by autonomic questionnaire and blood pressure measurements in both erect and supine positions. Results BHI values showed decreased CVR and were significantly lower in SPMS than in RRMS patients. Autonomic functions were more affected in SPMS than RRMS with total score 2.58 ± 1.13 for the RRMS group and 4.05 ± 1.04 for the SPMS group. Conclusions Cerebrovascular hemodynamic insufficiency in MS may be secondary to the downstream effects of neuro-inflammatory cascades.