Background Spasticity is a common complication of many neurological diseases and despite contributing much disability; the available therapeutic options are limited. Peripheral magnetic stimulation is one promising option. In this study, we investigated whether peripheral intermittent theta burst stimulation (piTBS) will reduce spasticity when applied directly on spastic muscles. Methods In this sham-controlled study, eight successive sessions of piTBS were applied directly to spastic muscles with supra threshold intensity. Assessment was done by modified Ashworth scale (mAS) and estimated Botulinum toxin dose (eBTD) at baseline and after the 8th session in both active and sham groups. Results A total of 120 spastic muscles of 36 patients were included in the analysis. Significant reduction of mAS and eBTD was found in the active compared to sham group (p < 0.001). The difference in mAS was also significant when tested in upper limb and lower limb subgroups. The degree of reduction in mAS was positively correlated with the baseline scores in the active group. Conclusion piTBS could be a promising method to reduce spasticity and eBTD. It consumes less time than standard high frequency protocols without compromising treatment efficacy. Trial registration: Clinical trial registry number: PACTR202009622405087. Retrospectively Registered 14th September, 2020.

Background: Calcitonin-gene-related peptide (CGRP) and CGRP receptors are expressed in trigeminal nerve cells, and treatments targeting CGRP are effective in migraines. For headaches that do not respond to pharmacological treatment, minimally invasive techniques such as greater-occipital-nerve block (GONB) can help relieve the pain and reduce the frequency of headaches. Our study assessed the efficacy of ultrasound-guided greater-occipital-nerve block (USgGONB) in chronic migraines (CM) and its relationship to serum CGRP levels. Methods: Forty chronic migraineurs who underwent bilateral USgGONB using 40 mg triamcinolone and 1 mL lidocaine were recruited and interictal serum CGRP samples were collected immediately before and one month after GONB. The clinical response was evaluated using headache diaries before and one month after USgGONB. The patient response was determined after USgGONB according to the reduction in headache days as a good responder (>50% reduction), poor responder (<50%) or non-responder. Results: Monthly headache days after GONB showed a significant reduction (median, 10 days; range, 8–14.7) compared to before the block (median, 18 days; range, 17–22; p < 0.001). Across all patients, interictal serum CGRP levels after USgGONB were significantly lower than before the block (median, 40 pg/mL (range, 25–60) vs. 145 pg/mL (range, 60–380) (p = 0.001). The pre-treatment interictal CGRP levels showed a significant difference (p = 0.003), as their levels in non-responders (median, 310 pg/mL; interquartile range, 262–350) were significantly higher than those seen in responders, whether poor responders (median, 135 pg/mL; interquartile range, 100–200 pg/mL) or good responders (median, 140 pg/mL; interquartile range, 80–150 pg/mL). Conclusion: the study showed the beneficial effect of USgGONB in chronic migraines that was associated with lowering interictal CGRP levels, implying a potential role for CGRP in the mechanism of action of GONB in CM, and the interictal CGRP level may be used as a predictor for the response to GONB.

Introduction White matter hyperintensities (WMHs) are frequently found in migraineurs. However, their clinical significance and correlation to different migraine phenotypes and treatment responses are not well defined. The study aimed to examine the association of WMHs with migraine clinical patterns and treatment response. Aim of work We aimed to evaluate the association between WMHs and migraine phenotypes and explore the relationship of WMHs to treatment response. Methods Our cross-sectional study formed of 500 migraineurs who sought treatment in Kafr el-sheik university hospital and underwent (3 T) MRI to evaluate WMHs. Different migraine phenotypes were compared between patients with and without WMHs. According to reduced headache pain intensity and frequency, these patients were divided into treatment responder and non-responder groups. Results A total of 145 patients (29%) had WMHs. Patients with WMHs were significantly older, had a longer disease duration, and higher attack frequency. Patients who did not respond to acute and maintenance medications had a higher frequency of WMHs and high WMHs Scheltens score. Migraine with Aura and the presence of vomiting and dizziness were predictors for the development of WMHs. Conclusion WMHs are more common in migraine with aura. It is more frequent in migraine associated with vomiting and dizziness. WMHs increased with advancing age and more severe disease burden. Poorer response to acute and prophylactic medications was found in patients with WMHs.

Background A large proportion of painful diabetic neuropathy cases either do not respond or are intolerant to the currently available oral and physical therapies. There is encouraging evidence from a small number of studies that those patients can improve using botulinum toxin injection. The aim of the study was to evaluate the effect of intradermal injection of botulinum toxin type A on painful diabetic neuropathy. Eight adult patients with diabetic peripheral neuropathy (DPN), confirmed by nerve conduction studies, were refractory to a minimum of two neuropathic pain treatments for 6 months or more were recruited. All cases received intradermal injection of 48 units of botulinum toxins—type A in each foot in 6×4 distribution. Follow-up was done after 8 weeks using the Neuropathic Pain Scale (NPS), Pittsburgh Sleep Quality Index (PSQI), and Overall Disability Sum Scale (ODSS). Results After 8 weeks, there was a significant change in NPS from 55.8 (7.8) to 38.5 (8.1) (p value 0.007), also there was significant improvement in ODDS from 4 (IQR, 2.25-4.75) to 2.5 (IQR, 0.5-3) (p value 0.01). However, there was no significant change in PSQI. Conclusion Botulinum toxin type A injection is a promising treatment option in Egyptian DPN adults in this study.

Background: Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. Objective: We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. Methods: Thirty-two patients with cortical VFD secondary to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. Results: The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. Conclusions: Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies.